I leave the Naval Medical Center Portsmouth Virginia tomorrow and toward the end of October report as the Command Chaplain for Naval Hospital Camp LeJeune North Carolina. My last time at Camp LeJeune was as part of the Portsmouth SPRINT (Special Psychiatric Rapid Intervention Team) mission to care for Emergency Department personnel at the Naval Hospital and Base Fire/EMS responders to a particularly gruesome suicide of a young Marine who had recently served in Iraq and was preparing for another tour.
As a Chaplain and in my previous life as a Medical Service Corps officer commanding a Medical Company in Germany and Brigade Adjutant in Texas I have dealt with a lot of suicides, attempted suicides and the lives left shattered by suicide. Likewise I have seen the results of suicide attempts as a trauma, emergency and critical care chaplain in major medical centers. I have attended the DOD Suicide Prevention Conference on a number of occasions and gotten to know many of the experts working in the field.
As I said I began my career as an officer in the Army Medical Service Corps. We had a close connection to the movie and television series M*A*S*H and the theme music to that movie is emblematic of the feelings of many combat vets who continue to deploy even after making many combat deployments. http://www.metacafe.com/watch/3444418/suicide_is_painless_johnny_mandel/
Through early morning fog I see
visions of the things to be
the pains that are withheld for me
I realize and I can see…
That suicide is painless
It brings on many changes
and I can take or leave it if I please.
I try to find a way to make
all our little joys relate
without that ever-present hate
but now I know that it’s too late, and…
The game of life is hard to play
I’m gonna lose it anyway
The losing card I’ll someday lay
so this is all I have to say.
The only way to win is cheat
And lay it down before I’m beat
and to another give my seat
for that’s the only painless feat.
The sword of time will pierce our skins
It doesn’t hurt when it begins
But as it works its way on in
The pain grows stronger…watch it grin, but…
A brave man once requested me
to answer questions that are key
‘is it to be or not to be’
and I replied ‘oh why ask me?’
‘Cause suicide is painless
it brings on many changes
and I can take or leave it if I please.
…and you can do the same thing if you choose.
Last week four soldiers, one a highly decorated senior NCO and all combat veterans are believed to have committed suicide at Fort Hood Texas. The base which has already seen more than its fair share of tragedy with 14 confirmed suicides this year is stunned that these occurred in one weekend.
Defense Secretary Robert Gates commented about the stress on the all-volunteer force: “No major war in our history has been fought with a smaller percentage of this country’s citizens in uniform full-time — roughly 2.4 million active and reserve service members out of a country of over 300 million, less than 1 percent,” as a result the wars have been fought by a small proportion of the country, for many they are “a distant and unpleasant series of news items that does not affect them personally.” While the distance grows between those that serve and the general population military families are under even more stress, with anxiety and disruption inflicted on children, increased domestic strife and a growing number of suicides. Divorce rates in the Army have doubled since the wars in Afghanistan and Iraq began.
In the years prior to about 2004-2005 the military suicide rate was almost always below civilian rates in all demographics. This is something that we took legitimate pride in. That began to change as the war in Iraq shifted from a “Shock and Awe” campaign to a rather nasty and intractable insurgency this began to change as the deployment tempo increased and the Army increased its “boots on ground” time from a year to 15 months with a one year dwell time between deployments. Even as Iraq calmed down and the US role shifted many troops remain and Afghanistan has become a much more difficult war than it was even a few years ago. The Marines retained a 6-7 month deployment schedule but as the war went on and personnel requirements increased many Marine units were doing 6 months in country and 6 months home. The difficult of what was described as “dwell time” for the Army and Marines was that for all intents and purposes it wasn’t. The units would get a few weeks leave and stand down time on their return home and then begin preparing for their next deployment. These preparations out of necessity entailed much time in the field training including trips to the Fort Irwin National Training Center (NTC) or the Marine Corps Air Ground Combat Training Center at 29 Palms. Speaking from experience before 9-11 I can say that a Marine battalion going to 29 Palms in reality makes a short but intense deployment which is taxing on the organization even as it sharpens combat skills. The same can be said for Army units going to NTC. Thus the time that is nominally considered time at home to recuperate is not that and instead serves to keep the pressure on already stressed units, leaders and soldiers/Marines. In the intervening time those that present to mental health providers or chaplains are provided with care to get them back in shape for the next deployment but never really get to deal with the deeper psychological and spiritual wounds. These include “moral injury” which often involves unresolved grief for the loss of comrades and real or imagined guilt for their own actions in war. Such wounds ultimately create despair, loss of faith and eventually cause some service members to make attempts on their life with varying degrees of “success” in “completing” the suicide.
The result is that those who have experienced the moral injuries that come as a result of combat, seeing comrades killed and wounded, participating in actions where they are directly or indirectly involved in killing the enemy, see the “collateral damage” of civilians, including children killed and maimed go right back into to fight. Since this war has now gone on longer than any war in US history and we are fighting it with an all volunteer force of limited numbers with many making multiple deployments, some as many as 5 or more these wounds are pushed aside. The effect of this is a cumulative grinding down of those that serve in harm’s way. Many suffer from some form of psychological, neurological or even spiritual injury that in combination with other life stressors make them particularly vulnerable to taking their lives. In regard to moral injury “Many of the troops kill themselves because they feel that those kinds of experiences have made them unforgivable,” said Dr. William Nash, a top PTSD researcher. “It’s a lot harder for most people to forgive themselves than to forgive others.”
Unfortunately there is a stigma attached to seeking treatment or admitting that one is suffering from depression, anxiety or any other condition associated with either seeking help on their own or being “command referred” for psychological/psychiatric help. Since that stigma is real many war fighters don’t seek help and take “refuge” in destructive behaviors such as alcohol abuse, drug abuse (to include prescription drugs) and risky behaviors. One wonders how many of the single vehicle accident fatalities that occur late at night to combat vets are not accidental at all but are suicides by another more “socially acceptable” means. If a forensic psychological profile was done on every service member that dies in such events I would guess that the finding would be a lot more suicides not an accidental deaths as we would like to believe. Yes all of these deaths are tragic but it is far easier to rationalize death in an auto accident than death by gunshot, knife wounds, overdose or hanging.
I am not proposing any solutions for this problem. I do believe that somehow the deployment tempo needs to be slowed down to allow troops to actually recover and get help. This is one of the suggestions of the DOD Suicide Prevention Task Force. Their report is linked here: http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20report%2008-21-10_V4_RLN.pdf
When I go to LeJeune I know that as a Chaplain at the Naval Hospital I will be collaborating with our mental health professionals to provide care to Marines, Sailors and their families that are living this daily. The Marine situation is poignantly show in this article: http://www.nctimes.com/news/local/military/article_3dc03ec3-6a37-5608-8563-aca88f635271.html
I have served with the Marines almost 6 years and from what I see the Corps has changed. It is battle hardened but less resilient than it used to be. The Marine Corps’ suicide rate has reached 24 per 100,000, a rate that surpasses all the other services. The rate was 13 per 100,000 in 2006 when I finished my tour at Marine Security Forces. The latest available figures put the civilian suicide rate at 20 per 100,000. The problem extends past active duty as Veterans Affairs Secretary Eric Shinseki, the former Army chief of staff, said the suicide rate for men aged 18-29 who have been discharged had gone up by 26% from 2005-07. Likewise, “of the more than 30,000 suicides in this country each year, fully 20% of them are acts by veterans.” This means as Shinseki said “on average 18 veterans commit suicide each day. Five of those veterans are under our care at VA. So losing five veterans who are in treatment every month, and then not having a shot at the other 13 who for some reason haven’t come under our care, means that we have a lot of work to do.”
There is also an effect on military health care providers of all kinds and chaplains. These individuals not only have to deal with their trauma but the trauma and hopelessness that they see in many of their patients or parishioners. These caregivers have no respite between deployments because their reason for being is to care for the Soldiers, Marines, Airmen and Sailors that present to them be they deployed or back in a military hospital or clinic.
The work will be hard and long after the last Marine, Sailor, Soldier or Airman leaves Iraq and Afghanistan we will be dealing with this for years to come.