Feature Article
Battle Wounds - Countering suicide in soldiers and vets
- Sleeping with a loaded weapon.
- Being surrounded by unpredictable rocket, mortar and sniper attacks.
- Not knowing who the enemy is.
- Gathering body parts after a fellow soldier steps on a land mine.
These are some among the many horrific experiences of war, of day-to-day life in a combat zone. They can leave their mark on soldiers, not only in physical but also mental scars that may last a lifetime. Those scars combined with other factors can create a potential for suicide.
Recent news reports about the rising incidence of suicide in the U.S. military – among both active-duty enlisted and reservists as well as recently discharged personnel – highlight the precarious mental condition of some soldiers returning from battle.
More than 130,000 U.S. troops began coming home from Iraq and Afghanistan in January 2004. Nearly that many more will rotate into those countries to replace departing troops in what has become the largest mobilization of American military personnel in more than a decade.
Not since Vietnam has exposure to combat violence been as great for U.S. troops as what they may be encountering in Iraq and Afghanistan. Returning troops bring with them both physical and emotional battle wounds.
So chances are good that crisis interventionists along with civilian psychologists, social workers, physicians, law enforcement, clergy and others will begin to encounter returning soldiers and newly “minted” veterans in coming months.
Some of them may be suicidal, like Lt. Brandon Ratliff, a six-times decorated Army reservist. He took his life in March after unsuccessfully fighting Columbus city officials for an expected promotion when he returned from service in Afghanistan. Ratliff was executive officer of a reserve surgical team on the front lines; his duties included retrieving wounded soldiers from the battlefield. “I didn’t think that I’d have to fight over there and come back and fight these guys,” Ratliff is quoted as saying in a March 19 story by the Associated Press. A coworker and friend attributes Ratliff’s anger about his work to depression he suffered after his return. “He had seen children die,” she said as reported by AP.
Another suicidal veteran, Green Beret William Howell, shot himself March 14 outside his home in Monument, Colo., after city police officers ordered him to drop his weapon. Howell, 36, had been following his wife around the front yard with a handgun. He left three children.
Jeremy Shannon Seely, survived three years in the Army – including one year in Iraq – but lived just days after returning home. Seely was found dead Jan. 17 of an apparent suicide at a motel in Clarksville, Tenn., near the 101st Airborne Division’s base at Fort Campbell, Ky. By his bed were jugs of soda pop, antifreeze and drain cleaner.
Stressors can overwhelm
After the terrorist events of Sept. 11, 2001, Americans can perhaps better grasp the lingering mental effects of feeling under siege, of having personal safety threatened by fear-provoking terrorism.
But unless someone has served in a military combat zone, they may not fully appreciate what war can do to the psyche – particularly of those who are already vulnerable because of underlying emotional disorders.
“In some ways, stress is stress – especially for those who have experienced assault, rape, snipings, air accidents,” says Lawrence Lehmann, M.D., chief consultant for mental health with the Department of Veterans Affairs. “But there are frightening and terrible things that happen in war.
It’s different in combat. You yourself may actually have to shoot back.”
Lehmann cites a similarity among military combat veterans and those serving on police and fire forces.
“Your buddy is killed or injured even though you’re there to try to help them,” he notes. “Your mandate is to help, to protect and serve people. There’s a commonality.”
At-risk troops can be vulnerable to violent outbursts – including self-directed violence – in the early stages of “reintegration” to home life as a civilian or as an enlisted soldier back in the States.
Reintegration is a time of change, when shifting responsibilities and different stressors can weigh heavy on a soldier’s mind. Sometimes their stress is based in unrealistic expectations for homecoming, according to military reintegration counselors.
Simple pleasures like rest, showers, money, sex, leave, shopping, food and alcohol are baseline expectations of returning troops. Yet some of these may go unfulfilled. The result can be frustration, stress, anxiety and depression.
And while military reintegration training programs are in place for all those those coming home, that training can’t actually solve problems but can only spur personnel to seek appropriate help when problems do arise.
Not all vets tap VA services
Those working in suicide prevention in the civilian sector shouldn’t assume that the mental health needs of soldiers and veterans are being fully met by the Department of Defense or the Department of Veterans Affairs (VA).
While the military and VA have placed renewed emphasis on mental health and suicide prevention in recent years, veterans are free to choose services outside of those provided by VA. Many do.
Additionally, the Department of Veterans Affairs is undergoing a restructuring to realign services through its CARES plan, or Capital Asset Realignment for Enhanced Services. CARES sets forth a vision for the next 20 years to help VA evolve from a hospital-based system to a user-friendly network focusing more on outpatient services and partnerships with the military and private sectors. That evolution brings changes in services to veterans.
Particularly vulnerable to mental health issues may be reservists and those serving in the National Guard – “weekend warriors” as they’ve come to be known. Sending these soldiers back into their families and communities without a support system in place could have distressing effects. In a recent analysis by the Boston Globe, Army reservists serving in Iraq are suffering from significantly more mental breakdowns, illnesses and accidents than enlisted soldiers. About 12 percent of 2,600 nonhostile injuries incurred by reservists in conflict zones were psychiatric in nature, the Globe found. And some mental health issues may not become apparent for months or even years after service.
Women are also vulnerable, as their numbers serving in Iraq and Afghanistan represent the largest pool of women ever to serve simultaneously in a combat zone. While deployed they endured capture by enemy forces such as the highly publicized story of Pvt. Jessica Lynch. Women also are sustaining severe wounds similar to those of their male counterparts, including loss of limbs from suicide bombings and mortar attacks. Stressors unique to their sex can include unplanned pregnancies and sexual trauma resulting from assault.
Also vulnerable to mental health issues are soldiers who return home with physical reminders of war – a prosthetic leg, a wheelchair, a missing hand.
“Of the people at Walter Reed (Army Medical Center), 40 percent of those (physically) injured have PTSD (post-traumatic stress disorder),” says Lehmann. “They may have physical injuries of other kinds, but they also have mental health issues.”
Call to action
What can crisis interventionists and other civilians involved in suicide prevention do to better understand and assist veterans and their families?
First, they can ask if military service occurred, and under what circumstances including combat exposure.
Second, they should acquire a better understanding of and appreciation for the soldier’s experience.
“And listening to the vet. Listening to what the issues are, the real human issues,” Lehman says.
Those human issues may be as commonplace as marital or financial difficulties, child-rearing challenges and loneliness. Or they could be as critical as undiagnosed post-traumatic stress disorder, survivor guilt and flashbacks to the battlefield – complete with overpowering sights, sounds and smells of war. Additionally, the veteran may be numbing mental anguish with alcohol, illegal drugs or misuse of prescribed medications.
“Substance abuse is a universal lubricant for all kinds of bad things,” adds Lehmann.
Barring a suicidal crisis, Lehmann suggests civilians working in suicide prevention encourage veterans and their families to tap into VA to obtain mental health services.
VA now has enhanced medical benefits, including offering two years of free health care to military personnel who recently served in a combat zone. In the past, veterans had to prove that a medical problem was connected to their military service.
VA physicians and psychologists also have in-depth knowledge of post-traumatic stress disorder and other conditions that can predispose veterans to thoughts of suicide.
“Encourage them to contact mental health services at their local VA medical center – during regular business hours,” says Lehmann. “We don’t technically have ER, but we have acute triage that’s 24/7.”
Marty Melstrom, a psychologist with the Carl T. Hayden VA Medical Center in Phoenix, notes that tapping into VA has been recently streamlined for those returning from Iraq.
“Every eligibility department at VA now has an Iraqi Freedom coordinator whose job it is to fast track newly returning veterans into services they want or need,” says Melstrom, adding that this is part of mandatory training for VA staff under the VA’s “Our Turn to Serve” initiative to help Iraq veterans. “The motto is, treat first and worry about benefits and eligibility second.”
Finally, Lehmann encourages crisis interventionists and others to partner with local affiliate offices of the Department of Veterans Affairs to exchange information and support one another’s services related to suicide prevention. VA has facilities in all 50 states (see the Learning More article listed below).
“This is the direction we’re heading in – linking up to existing community resources, and doing this as sort of an ongoing public health activity,” Lehmann notes. “The question becomes how to best hook up more with community environments – how to get more VA elements into non-VA organizations.”
“As for the Guard and Reserves, we’re trying to do outreach to them. There are limitations, but if we get ourselves invited, then we’ll certainly come.”
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