Reblogged:Have We Failed Our Veterans?

[Michael J. Hurd Ph.D.]

The suicide rate for the 1,200 Marines who deployed together — most now out of the military — is nearly four times as high as for young male veterans as a whole and 14 times as high as that for all Americans. After a New York Times report in September about the suicides underscored shortcomings in the government’s ability to monitor and treat mental health problems among veterans, members of Congress called for the military and the Department of Veterans Affairs to address the issue. But those efforts have remained halting and incomplete, critics say.

If the Veterans Administration is unwilling and unable to provide adequate medical care for obvious physical problems, how can we expect this single-payer system of socialized medicine to “address” the more elusive problem of suicide? A big part of the problem is that the veterans of the unit, like hundreds of thousands of other young veterans, fall between the cracks of the two enormous institutions. The military’s authority stops when troops leave active duty. The V.A.’s responsibility starts only if veterans come in for benefits or medical care — and many do not seek that care.

“Falling between the cracks” is not an accident. It’s what happens in any system of medical care which is unaccountable for its actions. While not every medical practitioner in the VA medical system is bad, the system as a whole is bad primarily because it does not reward accountability. It is single-payer, cannot go out of business, and ultimately answers to nobody other than politicians whose concern is more with appearances than with reality.

This is true the extent to which the VA operates as a totally single-payer system. Any contracting the government does with private, potentially more accountable health providers and hospitals provide relief to the inherent socialism of such a system.

The story provides one sad example of a Marine suicide: Tyler Schlagel slipped out of his parents’ house while they were asleep three weeks ago and drove through the wintry darkness to his favorite fishing lake high in the Rockies.

Mr. Schlagel, a 29-year-old former Marine corporal who was stocking shelves at a sporting goods store, carried with him the eight journals he had filled during tours in Iraq and Afghanistan. He also carried a .40-caliber pistol. Under the bright mountain stars, he kindled a small campfire. When the flames grew high, he threw the journals into the fire, then shot himself in the head.

Mr. Schlagel’s death on Dec. 9 [2015] was reportedly the 14th suicide in his military unit — the Second Battalion, Seventh Marine Regiment — since the group returned from a bloody tour in Afghanistan in 2008. Many other members have attempted suicide, one just three days after Mr. Schlagel’s death.

Such events are referred to as “suicide clusters.” Madelyn Gould, an epidemiologist at Columbia University who helped create national guidelines on responding to suicide clusters, said that clusters can form in tightknit groups, such as schools or military units, where one death can spur others until suicide becomes what she called “a cultural norm.” She said healthcare providers could intervene to discuss the problem and teach effective ways to respond and cope. But that requires identifying those groups and reaching out to them.

What’s in the mind of a person who successfully completes a suicide? We’ll never know. Former soldiers who use decisive methods to kill themselves, such as guns, mean to end their lives and (having been trained warriors) know how to do so. Because they are no longer alive, we’re unable to study their perspectives and motivations for taking this step.

A lot is made of veterans with Post Traumatic Stress Disorder (PTSD). The most common symptoms as they pertain to veterans include: re-experiencing the trauma symptoms; intrusive memories that interrupt everyday life; flashbacks in which the person acts or feels like they’re in the middle of the event again; re-occurring nightmares about the trauma; intense distress or irritability when reminded of the event; physical reactions such as rapid breathing, sweating, or nausea, when remembering or being reminded of the trauma; increased distress as the anniversary of the event approaches; avoidance symptoms; feeling emotionally detached from others; experiencing hopelessness about the future (“No one will ever love me” or “I know I’m going to die young”); inability to remember important aspects of the traumatic event; arousal or anxiety symptoms; bouts of moodiness or anger; insomnia or difficulty staying asleep; a sense of being “on alert” or “on guard” (also called hypervigilance); developing a destructive addiction to alcohol, drugs or even gambling; suicidal thoughts or actions are another potential symptom of PTSD.

If someone you love has thoughts of committing suicide, the general advice is to take him or her seriously and seek help immediately. Support groups, even more than individual psychotherapy, can be a means of addressing the problems associated with post-war PTSD. There are pros and cons to support groups. On the “pro” side, they provide a welcome relief to express one’s problems with understanding others. For veterans in particular, it’s important to interact with people who have actually been there. Not only is it valuable to reconnect with people who have been in the same types of situations; it’s also helpful to learn how many of these people are having the same problems you’re having.

On the “con” side, support groups—for any problem, not just veterans—can encourage a “woe is me” attitude. I base this not just on my own particular opinion, but also on the reports of therapy clients over the years. For many, there appears to be a value of diminishing returns when it comes to support groups. At first there’s an overwhelming sense of relief from the realization that, “I’m not alone.” Over time, however, participants in support groups start to feel like their victimization is the most important part of their identity. They start to feel that they’re primarily or exclusively “war survivors” or “sexual abuse survivors,” or whatever the nature of the trauma was.

At some point, people appear to want to learn how to be more than just survivors. If you tie the word or concept “survivor” too much to your identity, the past trauma starts to dominate your emotions, personality, and even your values. As a result, on top of the original trauma, you now have a new problem.

Mental health professionals, significant others of veterans as well as veterans themselves must be careful not to fall into the trap of thinking of themselves as victims. I wonder about this factor with the veterans who do successfully complete a suicide. It’s the same as for the victim of any other trauma—sexual abuse, physical abuse, etc. The trauma is not your fault, and it’s not the core of your identity. It’s normal and natural to have to make adjustments from one mode of living—a war situation—to another mode of living—life as most of us know it.

Undoubtedly, veterans sometimes feel their work, efforts and painful losses are unappreciated. To some extent, this is inevitable. The whole purpose of a war for soldiers in a historically prosperous, free country such as the United States is to preserve what exists. If the soldiers’ efforts are successful, then their work was not in vain, whether people show appreciation for their efforts, or not. This is not to minimize the lack of respect or poor treatment soldiers may receive upon their return. Such ingratitude or insensitivity should certainly be countered with positive efforts. But veterans, just like anyone else suffering from trauma or emotional pain, must ultimately learn how to cope with their loss and suffering even if they do not enjoy the approval or sensitivity from others they are arguably entitled to expect. It’s for their own sake they must do so. One way to do so is to remind oneself of an objective, undeniable fact: that civilization is still standing, and—whatever the veteran him- or herself may think of the actual war or conflict which took place—the very act of participating in a nation’s defense forces actively enables that society and civilization to go on.

To understand what a veteran goes through once home, it can be useful to examine what a veteran goes through while overseas. Daniel Duffy, who served as a Marine in Afghanistan, describes some of his experiences as follows:

Helmand province could be the scene of a biblical tale. The barren naked landscape is only interrupted briefly by the consolidation of a few decrepit mud huts. Ask a child to draw Fred Flintstone’s house, and she’ll draw you Helmand province. There are dabbles of modernism in an otherwise B.C. world: Soviet era Kalashnikovs, rocket propelled grenades, recoilless rifles, and roads fertile with toxic explosives are among the unforgiving aspects of daily life in a world where war has become a sport. Our squad faces these underlying threats every time we leave the wire. October 23rd would be the first time we would face them directly.

Sheriffe, our interpreter, would always listen intently in our HUMVEE’s backseat to the incoherence over the airwaves. The Taliban knows we have interpreters and radios, but it’s their only means of communication. There’s more than just incomprehensible gibberish tonight, however. Even a foreigner understands the unmistakable tension in the airwaves. The Taliban are following us and planning an ambush. Like a rollercoaster deliberately climbs its initial first hill, the knot in my stomach grows tighter as my body prepares itself for the adrenaline that’s a moment away.

The sharp whistling of a rocket -propelled grenade overhead initiates our contest. Like a cue ball in pool, it travels indiscriminately through space, and makes no judgment of its target. The professionals that they are, Marines act with decisive and cunning action. Months of built-up anxiety are channeled through their devastating weaponry. My medium is a .50 caliber machine gun. The elongated black barrel and pulsating sound waves hitting my face spells Armageddon. The .50 caliber was designed in WWI to combat scores of charging enemy personnel. Tonight I learn why it remains largely unchanged because of the unparalleled efficacy of its task. The highly developed level of interdependence forged by countless rehearsals keeps our gun firing without hiccup when Baker, our junior Marine, readies an ammo can after hearing my command that I’m low. To watch an infantry squad mesh is to see through the fuselage of a jet; one can’t help but marvel at the intricate weavings that produce an unstoppable force.

The lightshow of tracers and explosions might be mistaken for a Fourth of July celebration, if one weren’t wiser. To someone flying in a plane overheard, it would appear to be the only spark of life in otherwise infinite darkness. No doubt he would be naïve to the awe-inspiring and unforgivable struggle of men and ideologies below. In my brain, endorphins are released as pain-numbing chemicals to preempt a 7.62mm round that might explode through flesh at any moment. Adrenaline flows through my muscles, giving me the strength to rack the heavy .50 caliber over and over…15 minutes straight…20 minutes …30 minutes of intense fighting. A disciplined adherence to intense workout regimen builds the prowess every infantry Marine must possess. The cocktail of adrenaline and endorphins is as powerful as any drug a doctor might prescribe. Never have I experienced such effusive emotion. Marines often seek to duplicate this prodigious set of emotions when they return to the civilian world, only to be disappointed that skydiving and crotch rockets [powerful motorcycles] don’t equate to this ultimate human experience.

This last part strikes me as very important to understanding the psychological experience of many veterans, not only while in combat, but how they are once they return home. Duffy makes a highly astute and relevant point when he states that Marines often duplicate the “cocktail” of endorphins and emotions once they go home. Awareness of this perfectly reasonable and understandable need, if it exists, ought to inform a veteran’s assumptions about what to expect both of himself and life upon returning home. I would expect that a lot of people in the veteran’s life will think and say, “You must be relieved to be home. No more of that awful experience.” But Duffy’s comments point out how not all of the experience was awful.

Bear in mind that America has an all-volunteer military, entirely proper for a free country. It stands to reason that the volunteers—particularly in the highly demanding branch of the Marines—will, as individuals, find fulfillment, excitement and purpose in a line of work that most of us would avoid or dread if faced with it. It’s an error, therefore, for a counselor, loved one or any other party to suggest that a veteran should necessarily want nothing to do with his or her previous way of life. While this certainly could be true, it’s not absolutely true in every respect. People who would never wish to serve in the military need to understand that those who do wish to be military professionals, while not warmongers, do crave a level of endorphins and purposeful, exciting activity without which it might be hard to cope upon returning home. Duffy continues:

Because we operated in such a hostile area, air support was almost always on call. One of our radio operators called in Cobra attack helicopters when the fighting began. Just as quickly as our firefight initiated, it ended just as abruptly, and tranquility was restored. When the firing ceased, the ecstasy one feels when he’s accomplished something great by way of months of training takes hold. 600 .50 caliber rounds and 35 minutes later, we took no casualties and the enemy retreated. The radio chatter is silent except for only a brief interruption; the Taliban are looking for a place to dig their comrades’ graves.

There must be an amazing satisfaction that comes from such work. Leaving this productive, energizing form of work will, for many soldiers, be a challenge and sometimes a trauma itself. The loss of meaningful, productive work might be just as much the cause of the PTSD symptoms as what the rest of us readily assume can only be the painful memories.

Like most things, veterans’ issues are not always obvious and easy to understand; it’s better to listen and learn, before drawing premature or erroneous conclusions.

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