RUMINATIONS OF A PSYCHIATRIST
When I saw the statistic, the number of American veterans who suicide daily, I was shocked. (It’s approximately 20 each day.) When I read about ongoing efforts to assess, prevent, and treat potential suicides I was impressed. But when I looked at the ostensible causes I was disappointed. All the causes listed were essentially stressors, symptoms of medical disorders, potential predictors of suicide like moral injury, psychic bruising, and guilt. None gave me what I was looking for, that final trigger, that last straw that made them do it. I had hoped someone might have identified one. I wasn’t surprised, then, when I encountered this caveat: “Knowing the reason behind a suicide is difficult or impossible, even for family members who knew the victim best.” Clearly I’d have to pursue this alone.
What follows—my understanding and conclusions about at least one last straw for at least some veteran suicides—has been drawn from published war accounts and memoirs and my own clinical experience.1 It is not based on academic research.
That said . . . .
Sense of one’s self: So fragile, so crucial (a prisoner’s story)
It’s evening. An agitated street criminal behind bars is explaining to the on-call psychiatrist why he needs to be transferred to a psychiatric hospital for his safety. He’s suicidal. He describes how, earlier, on the way to chow, several prisoners had taunted him with cruel insults and he was unable to respond. His taunters were out of reach. When he returned to his cell he was beside himself with rage at that humiliation and the frustration of not being able to get-back, get-even. It was in this mental state that he began thinking of killing himself and then couldn’t stop. Why kill himself? “I had to kill someone.” he explained. His story was deemed threshold-credible, his reasoning bizarre, but his desperation genuine. His transfer to the psychiatric hospital was approved.
There are steps missing here but these can be deduced. Taunted without recourse can leave us feeling diminished, vulnerable, not our usual selves. Self is, it seems, at the heart of both wound and recovery. Self-respect, self-image, and self-confidence are in momentary abeyance as we prepare to get-even and correct that imbalance. If that means violence, a “Dis’ me you die!” mindset, so to speak, then that wound must have been near fatal or the sense of self seriously fragile and vulnerable at baseline.
That call to get-even: An instinctive path to redemption? (a story from five military doctors)
Six military doctors, all fresh recruits and strangers to one another, are into their 3rd day at Camp Bullis in Texas on bivouac. The year is 1965. This is part of their basic training and officer orientation. Late that night, in his tent, the doctor who’d been assigned to be their temporary company commander for these training sessions, someone who was widely known to be obnoxious and provocative in his behavior and universally disliked, is assaulted and beaten up by his tent-mates. Several of his ribs are broken, and he needs a medical evacuation in the morning by chopper to Brooke Army Medical Center.
Because this restorative urge to get-even is so universal, normative, and class-neutral, it’s arguably an instinctive reflex.
1. Gwin, L Baptism New York, Random House, 1999 Hastings M - Vietnam New York, Harper Collins, 2018 Herr, M - Dispatches New York, Vintage, 1991 O’Brian, T The Things They Carried New York, Houghton Mifflin, 1991 - Sheehan, N A Bright Shining Lie New York, Random House, 1998.
2. Appy, Christian G. “American Reckoning: The Vietnam War and Our National Identity” Penguin Books (2015) p. 175.