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.
Wartime: So many assaults to self, so many ways to get even (a traumatized combat soldier’s story)
Not all the participants in the My Lai massacre became thugs. Some were, themselves, traumatized. Private Paul Meadlo refused Lt Calley’s order to murder the 60 or so Vietnamese men he’d gathered together under Calley’s order and who were now squatting together in a group. Calley, who ordered this mission in unmistakable frustration over his inability to stop Viet Cong attacks that had successfully and repeatedly killed his men before disappearing among the civilians in the area, insisted and became angry when Meadlo demurred. This was to be Calley’s retaliation, killing an entire village of men, women, and children. He gave Meadlo a direct order to shoot those villagers. Private Meadlo reluctantly attempted to obey but quickly broke down. In tears he handed his weapon to another trooper who continued the shooting.
Returning home most townspeople supported Meadlo’s participation in that crime. “Things like that happen in war,” one World War II and Korean War veteran assured him. “They always have and they always will.” “One has to obey one’s officer,” others said. His mother, however, understood. He was a good boy, she recalled with anger. “He fought for his country and look what they done (sic) to him. Made him a murderer!”2
All soldiers go through basic training during which one’s conscience, one’s better nature with its foundational ethics and values, becomes superseded by orders and a chain of command. Problem is, inevitably there come times when orders from above clash with principles from within and rules of engagement don’t help and you have to make your own decision. Which will you honor, order or principle? Which, by default, will you dishonor?
The story of that massacre at My Lai was only the tip of an iceberg.
The parts of that iceberg below-the-surface, the parts not talked about albeit impossible to forget and impacting many, involve not just fear but guilt. If those parts could speak you’d hear, “I shouldn’t have done that. I could have refused.” “I could have tried harder.” “I should have stayed.” “I could have prevented that.” Such words of regret and remorse are clear indications of guilt.
Seeds of guilt are everywhere in the military during wartime. It doesn’t matter whether they were sown in the interest of showing off, bonding with buddies, or managing anxiety. Crimes are crimes, and guilt has its own agenda, the restoration of a balance-that-has-no-name. The upside? In the military, relief and reassurance are always at hand. You’re never alone. There’s no shortage of someone who has your back. Downside? There’s no shortage of memories that will pull you down once you get home.
Re-entry: The returning veteran’s predicament
While veterans are mustered out of the military none are mustered back into civilian life. The latter has traditionally been a patchwork of as-needed processes. The Navaho Nation is the one exception I’m aware of, although I suspect all the Indian Nations are exceptions. The DinÃ© (Navaho) spiritual leaders have traditionally stood ready to provide cleansing, blessing, and soul healing ceremonies to men and women returning from war. They have always understood that a balance must be restored to the returning warrior.
How do the rest of us address that imbalance-that-has-no-name, those wounds to our self-respect, self-worth, and self-confidence? How do we explain our scars of guilt, especially those that don’t become evident right away? Or explain why returning to the battlefield and our comrades there is a good idea? No wonder so many vets coming home find it impossible to return to what and who they were, or the way they were. Their better nature has been in lock-down for so long its surfacing now is not only inconvenient and a burden, it’s a threat. It can remind and scold mercilessly, only this time with no company of heroes to have your back.
Self under siege: Is death before madness a veteran suicide’s story?
You’re feeling isolated and desperate, even in the bosom of a loving family. You can’t go on like this. Despite drugs, alcohol, distractions, and medications, the torment and dread have become unbearable. You feel a heartbeat from unravelling and going mad. At such times suicide appears, not as a punishment but as your last hope for ending the horror. At last and ironically you can provide yourself a moment of self-affirmation, redemption, and finally peace. “I deserve to die,” you’ll write in your note, your final statement, to make clear that you know what you’re doing and have yourself under control. You have at last restored a balance. Your Self is-at last-getting even.
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.