Category Archives: suicide

The Uncounted Cost of War: Veteran Suicides

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Friends of Padre Steve’s World,

Marine Corps Major General Smedley Butler probably discussed the true cost of war better than anyone. Butler, a two time Medal of Honor winner wrote in his book War is a Racket:

“What is the cost of war? what is the bill? “This bill renders a horrible accounting. Newly placed gravestones. Mangled bodies. Shattered minds. Broken hearts and homes. Economic instability. Depression and all of its attendant miseries. Back -breaking taxation for generations and generations. For a great many years as a soldier I had a suspicion that war was a racket; not only until I retired to civilian life did I fully realize it….”

Mangled bodies, shattered minds. The bodies get counted, the minds do not, and when a Marine, Sailor, Soldier, Airman or former serviceman or women ends their life due to suicide their name is not included on the casualty reports.

In January 2014 the Veterans Administration released a disturbing report that male veterans under 30 years old saw a 44% increase in the rate of suicide. The rate for women veterans increased by 11%. About 22 veterans a day committed suicide in 2013. That did not count those still on active duty numbers which are still high but have dropped somewhat since 2012 and previous years.

The VA National Mental Health Director for Suicide Prevention, Jan Kemp said “Their rates are astronomically high and climbing…” Kemp postulated that reasons for the spike might include “the pressures of leaving military careers, readjusting to civilian life and combat injuries like post-traumatic stress disorder…”

I believe that the stigma that many felt about getting psychological help while they were in the military continues on when they enter civilian life. Unlike the military where there is still some sense of camaraderie and a chance that the chain of command might force a service member to get help, no corresponding structure or community exists in the civilian world. Young veterans are often isolated and face new stresses while they are already on edge. Many find that the military occupation specialties that they trained for have no direct civilian counterpart, leaving them struggling in the civilian job market. Combat injuries as well as injuries sustained in training often continue on, limiting what they can do and the unseen injuries of PTSD, Traumatic Brain Injury and Moral Injury, often undiagnosed and untreated lurk in the background.

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This is a national tragedy and crisis. Many of these young men and women are among the best and brightest. They volunteered to serve in time of war and now as the military, especially the Army and Marine Corps begin to shed large numbers of troops, many more will be thrust into a world that they may be ill equipped to survive.

They will attempt to go to work or attend school, quite often alone. There they will be surrounded by people who have no idea of the issues that they face or understanding of the military world that they left, or the places that they served. I think this social isolation will be a killer for many.

My recommendation is that people who work or go to school with these young veterans, or for that matter any veteran get to know them. Help them adjust to the world and keep an eye on them. Ask them how they are doing and just show that you care. You do not have to be a veteran to do that. Likewise get to know about the resources that are available for veterans and help direct them to them. Have the courage to care.

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Resources include the Veterans Crisis Hotline which is staffed 24 hours a day, 7 days a week. They can be reached at (800)-273-8255, press 1, or here to chat online. They also allow veterans to send a text message to 838255 to receive confidential support 24 hours a day.

Another resource is the Real Warriors Live Chat. The a trained health resource consultant is ready to talk, listen and provide guidance and resources. They can be reached by calling 866-966-1020 or going to their live chat service here http://www.realwarriors.net/livechat.

Afterdeployment.org http://afterdeployment.t2.health.mil offers wellness resources for the Military Community. Service members in transition to civilian life can contact inTransition by calling 800-424-7877 or at their website http://www.health.mil/InTransition/default.aspx

To me this is personal. I still suffer from the effects of PTSD, TBI, Moral Injury and have been to the brink of suicide. I am doing a lot better, and I love life, and I can’t imagine living it without me.

However, I have known far too many veterans who have taken their own lives, or struggle with mental health issues, physical injuries and illness, or social isolation. Last January, about the time the VA report came out a brilliant and heroic senior officer I knew, Captain Tom Sitsch who helped me when I was collapsing due to the effects of PTSD took his own life. This is something that all of us have a stake in. Please help look out for our veterans.

Peace

Padre Steve+

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Filed under leadership, mental health, Military, PTSD, suicide

A Good Day to Speak Truth to Power and to be Listened to

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I have been writing about my recent experiences in trying to get help for my own issues dealing with PTSD as well as my frustration with a military mental health system that is, at least in my view, floundering.

That effort over the past month or so has been quite painful, at times humiliating and dehumanizing, and frankly driven me into a depressed and nearly suicidal fog, from which I am slowly emerging.

Today was a good day. Not just for me but maybe for all of those seeking help at our local Naval Medical Center. Instead of being blown off and shunted aside by providers as well as mid and high level administrators I was able to have a long, nearly forty-five minute phone conversation with the Admiral who commands that facility as well as every Naval Medical facility on the East Coast and Europe, with the exception of the Bethesda-Walter Reed complex in Washington DC. Bottom line up front; it was a very good and positive experience for me that I believe will help others get better care.

I have to say up front that I was terrified about asking to talk to him. One of the people on his staff told me that “it would not be a good thing for me to talk to him.” When I heard that comment my heart sank. I didn’t know what to do, I was perplexed because most commanders of Medical facilities in the Navy that I have worked for actually did want to hear about negative experiences of the people that are their customers, most because they care, but if nothing else because they want to make sure that they pass the Joint Commission accreditation that their facilities get every few years. So I wondered if the Admiral actually knew what was going on, at least in regard to the Mental Health Department and the experiences of people like me.

My last Command Master Chief, who read some of my very angry posts on a social media site suggested that I call my former Commanding Officer, a man who helped me a lot, cared about me and who is soon to become an admiral. I finally worked up the courage to call him, not out of fear, but because I felt like I might be bothering him, and would not be worth his time. I left his command a year ago and frankly I thought why should someone moving up in an organization be bothered by the problems of a former subordinate.

However, he was both concerned and helpful. He did not just listen but he took action by contacting the Admiral here. He told him that he knew me and that he knew that it was my desire to make sure that people get the help and care that they need, that I wasn’t just complaining or seeking special treatment.

Yesterday the admiral called me, of course my phone went directly to voice mail so I missed the call, but his message, and the tone of his voice conveyed a sense of care and concern. I called back and got his voice mail. So this morning I called again and was able to share my heart, in a very respectful way with him. He listened and seemed to be attempting to formulate some kind of positive response that would actually help people. He wants to get answers and he told me that he wanted those that come to that facility to be treated as he would want his grandparents treated.

As I said we talked for forty-five minutes and he listened. I have no doubt, within the very real fiscal constraints faced with current budget cuts and the still looming threat of sequester that he will do his best to improve and change the system that is within his control. He also did something that I have never experienced before from a superior officer, he called me “sir” a number of times. I am not used to that and I don’t think that I have ever in all of my reading of military history recall an Admiral or General calling a subordinate “sir.” I was blown away.

That system appears to be undermanned, under-budgeted and overwhelmed. It is struggling and as it struggles, as it reacts to criticism from the media, politicians and advocacy groups, it resorts to protecting itself as any bureaucracy does in such a situation. The Admiral realized this and he encouraged me to call him again on his office number if I see things that he can help. That was very encouraging. I don’t think that I will have to ask him to intervene on my part, but I have an open door to use this relationship to help others.

All that being said, most people do not have the connections that I have in the system, nor are they willing to take the risks to rock the boat. The stigma is great and personal risk can be or at least seem too great to make the effort, so most people just give up. After all the bureaucracy can be unbending and even vindictive in the way that it rebuffs those that try to raise issues. They resist change and try to keep bad news from enquiring superiors. Bureaucracies and those who faithfully serve them do just that. It is part of who and what they are; be they military, other government, business or ecclesiastical organizations. Admiral Alfred Thayer Mahan wrote:

“It [the bureaucracy] tends to overvalue the orderly routine and observance of the system by which it receives information, transmits orders, checks expenditures, files returns, keeps the Service the touch of paper; in short, the organization has been created for facilitating its own labors.”

However, when I first collapsed after Iraq, I decided that I could not be silent and have “sky-lined” myself which probably will not help me get promoted, not that care anymore. I am sure that being so public about my struggles with PTSD, Moral Injury and even my crisis of faith, which left me an agnostic for a couple of years, while serving as a Chaplain in adult and pediatric Intensive Care Units has marginalized me in the Chaplain Corps. I don’t know that for a fact and would hope that it is not the case, but it is the feeling that I get when I deal with most Chaplains.

All of that said, the past few weeks have been some of the most difficult since my return from Iraq. I personally find no pleasure in being anxious, depressed or feeling suicidal and getting even less sleep than my chronic insomnia normally allows.

At least I was listened to, and I really did get the sense that the Admiral that I was able to have such an honest conversation with today, does really care and wants to help improve the system and change the culture.

But that is the thing. This is a systemic and cultural problem, not just in the military or the Veterans Administration, but in society as a whole. In our desire for efficiency, supposed effectiveness  measured by profits and the bottom line; we have forgotten to care about people. Sadly that is statistically verified in poll after poll by people from all parts of the political spectrum. People don’t trust the government, they don’t trust big business, they don’t trust health care systems, they don’t trust the police, they don’t trust the banking and insurance industries and they certainly don’t trust the church or religion in general. Can I get an amen?

Thank you…

But our culture has to change, we have become so materialistic and embrace the most crass forms of predatory Capitalism and Social Darwinism, even in church, that people don’t matter, especially the poor and those with no voice or power, especially those who volunteer to serve the nation and come back broken in body, mind and spirit.

Joshua Chamberlain the hero of Little Round Top at Gettysburg spoke years after the Civil War something that should be a warning to us about how we treat people. Of course Chamberlain was talking about the horror of war, but it can apply to anyone, anywhere:

“But we had with us, to keep and care for, more than five hundred bruised bodies of men–men made in the image of God, marred by the hand of man, and must we say in the name of God? And where is the reckoning for such things? And who is answerable? One might almost shrink from the sound of his own voice, which had launched into the palpitating air words of order–do we call it?–fraught with such ruin. Was it God’s command that we heard, or His forgiveness that we must forever implore?”

His question is as operable today as it was then. There has to be a reckoning somewhere for destroying peoples lives, and further traumatizing them when they seek help, otherwise there is no justice nor anything that resembles a loving God.

We have to start valuing people, regardless of their social status, their race, religion, sexual preference, disability or even their alma mater. If we don’t start caring for people as human beings, then why bother with anything else? It is either about humanity or its not. Those who are comfortable cannot turn a  blind eye thinking that these issues don’t affect them, because they will.

So in spite of being unpopular in some circles I take the personal risk to speak the truth the best and most honest way I can to anyone that will listen. I have to do it, for those that feel that they have no voice, as well as those who I have known who have lost their lives after giving up on the system. I owe it to them. It is now my mission in life and I do that I can both inside the system and outside of it to speak out for those who need it.  I guess I have become something of a liberal social activist, not that there is anything wrong with that.

I can be as persistent and irritating as Mustard Gas; I am doggedly determined to speak out for those that do not feel that they matter or have a voice; and I will stay in the fight until I can’t fight anymore. As Paul Tillich said “It is my mission to comfort the afflicted and to afflict the comfortable.”

I admit that sometimes it is like tilting at windmills, but this week, two men who have the position to influence the system took the time to listen and just maybe at least at some level things will begin to change. I am grateful tonight, maybe I will sleep well…

Peace

Padre Steve+

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Filed under faith, healthcare, mental health, Military, PTSD, suicide, US Navy

Moral Injury: Betrayal, Isolation, Suicidality, & Meaninglessness; the War after the War

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“Great Odysseus woke from sleep on native ground at last- he’d been away for years- but failed to know the land.” Homer, The Odyssey 

War changes the men and women that fight them. This is a truth that dates to antiquity. It does not matter the age or era, where the war was fought or what weapons were used, the pathology is similar, the scars of war, physical, The trauma of war, as Jonathan Shay notes in his book Odysseus in America, “shows ugly deformities of character that trauma can cause, but these deformities are fully human such as might happen to ourselves….” The fact is that the does happen is normal, but how we deal with it is not.

One of the most difficult things that many returning combat veterans face is being re traumatized upon returning home. As the Odyssey shows, for many returning combat veterans it is as if they are returning to an alien planet, which looks familiar, but feels like an alternate universe. It looks the same, but it is profoundly different. Erich Maria Remarque in his classic All Quite on the Western Front wrote:

“I imagined leave would be different from this. Indeed, it was different a year ago. It is I of course that have changed in the interval. There lies a gulf between that time and today. At that time I still knew nothing about the war, we had been only in quiet sectors. But now I see that I have been crushed without knowing it. I find I do not belong here any more, it is a foreign world.”

Shortly before his death in a motorcycle crash T.E. Lawrence, the great Lawrence of Arabia wrote a friend. Lawrence certainly suffered from PTSD and other afflictions that lingered long after the war. The words are haunting and they so describe how many veterans feel, even long after they left the combat zone. For Lawrence and so many others the war after the war never ended.

Lawrence wrote:

“You wonder what I am doing? Well, so do I, in truth. Days seem to dawn, suns to shine, evenings to follow, and then I sleep. What I have done, what I am doing, what I am going to do, puzzle and bewilder me. Have you ever been a leaf and fallen from your tree in autumn and been really puzzled about it? That’s the feeling.”

This has been a facet of life for American military personnel ever since the Vietnam War. Much of the trauma comes from the unnatural and ahistorical manner of how we send men and women to war and bring them home. Now generally we prepare people for war fairly well. However, we send many to war as individual augments, away from their units and people they know, place them in units or organizations where they are relatively isolated and sometimes face great danger, then we bring them back alone, with barely any time to decompress, tell their story and face the consequences of war with those that they know.

Guy Sager, writer of the classic The Forgotten Soldier wrote of his return from war:

“In the train, rolling through the sunny French countryside, my head knocked against the wooden back of the seat. Other people, who seemed to belong to a different world, were laughing. I couldn’t laugh and couldn’t forget.”

The result is that most don’t get the help that they need to make the adjustment. The fact is that the best help is usually found among our comrades who have shared our experience. Before trans-ocean air travel, soldiers came home on troopships, with those that they served and the voyage home lasted anywhere from two weeks to a month. That gave these soldiers the opportunity to process what they had been through, and while they might not have had much in the way of “professional” mental health care, they did have each other. Likewise, they returned to a country where many if not most of the citizenry had shared at least some of the sacrifice of war, and many of whom had family members who had served at war, or who had lost people they knew.

A survivor of World War I’s “Lost Battalion” wrote after the war:

“We just do not have the control we should have. I went through without a visible wound, but have spent many months in hospitals and dollars for medical treatment as a result of those terrible experiences.”

Today soldiers are sent from the United States or United States military bases in Europe or Asia into harms way, and when their tour of duty is done, are sent home in a process that seldom takes more than a week, usually less. Apart from a few airport greeters and their family, if they have a family, their return goes almost unnoticed. They return to a world where there has been no shared experience and people go about their business untouched by war. The return is often overwhelming, and many times disorienting and frightening to the combat veteran who no longer feels connected to the country or people that sent him or her to war. The normal issues faced by redeploying soldiers, especially with their families are often even more pronounced, they and their families struggle.

The general feeling of social isolation is often made worse when they return to their home bases, stations or units and discover that instead of being welcomed home, that they are treated as if they made the life of those who did not deploy harder. “Welcome back, now you can get back to real work, now you can be back on the duty roster.” Within weeks they are submerged in routine, often mind numbing tasks among people who have not shared their experience. Alone they try to cope, quite often not very successfully. For those suffering from combat trauma, especially the unseen injuries of PTSD and Traumatic Brain Injury the experience is magnified. There is a sense of isolation and meaninglessness as they attempt to put their lives back together. For those that seek help, on the active duty side of the house there is a stigma to getting mental health care, which is so pronounced that many either avoid treatment or stop shortly after starting, instead self-medicating with alcohol or drugs. The same is often true for those who seek help in the Veterans Administration system, except they, having finished their active service do not have to endure the shame of being called or considered “broken” by their superiors or their peers. For those that have not served, to be labeled as “broken” is one of the worst things that can happen to you in the military, it is to say that you have no intrinsic value, no matter what you have accomplished to that point or what you have suffered in the line of duty.

Those that do decide to take the risk in going to get mental health care are often then traumatized by the very system that supposedly is there to help them. While there are many gifted, caring and skillful psychiatrists, psychologists and therapists working for the military and the VA, the process of getting care can be brutal and dehumanizing. The intake process is often impersonal and quite often the ordeal dissolutions those going through it. As a personal note, when I transferred back to the area that I previously had been treated it was like I had never been in the system. It was starting from scratch, and while I had gone back to the system seeking basic follow up care, the process broke me and made me worse. Due to the intervention of so very caring people including a former commanding officer who is being promoted to Admiral, I am getting some help and may even be able to contribute to a solution. But it should not be so hard, the system in overwhelmed, undermanned, underfunded and broken, despite the best efforts of some in leadership. The result is that combat veterans are further traumatized and marginalized.

The combination of new trauma, that of no longer feeling a part of society, that of being disconnected from friends and family; that of being isolated at work and treated as a number by those in the medical and mental health system. All of those things add further injury and contributes to the sense of betrayal, the sense of betrayal that goes to the heart of Moral Injury.

Moral Injury involves the breaking of trust, confidence and core beliefs. That can encompass everything from what a person believes about God, the idealism about one’s country, the military that one serves and even the society and family. Moral Injury is an abiding sense of loss of faith and confidence in the things, the beliefs and ideals that one held dear. It is a layer of trauma that adds to what one has experienced in combat, it is another layer of trauma on top of PTSD, TBI and other Combat Stress related issues. It increases the severity of other psychological conditions including depression, anxiety and the risk of suicidal, or other risk taking behaviors.

But it doesn’t seem to me that anyone gets this, and those that do are not in a position to influence policy. Neither are they in a position to ensure that mental health providers are trained to recognize, care for and not increase the chance of further traumatizing those in their care. Instead those coming home from war seem to be condemned to a sort of hell where they do not feel they matter, are treated as numbers or even worse, feel that they no longer can contribute, because they are “broken.”

My experience is that it takes far too much effort to get the basic care that one requires, and most people after being beaten down simply give up. A person should not be reduced to tears and seriously consider suicide to get attention. A person should not have to know a doctor who is going to be an Admiral to get someone to listen to them. Honestly most people will neither endure the ignominy or pain of seeking help in such an environment, much less skyline themselves but writing and speaking about I like I do. For most any of that is far too dangerous or risky.

Some, including people that I know and love and respect have lost their families, careers and lives simply because they did not want to have the stigma of being considered “broken” or deal with the impersonal and machine like bureaucracy that is our mental health system. The sad thing is that this encompasses not only the military and VA systems, but the civilian system as well. I have known far too many people who have ended their lives after being further traumatized by the system. These people include senior officers and even chaplains, most who risked their lives in combat multiple times only to return home broken. I know too many of them, men who were real heroes, who died at their own hand, or others who lost their families and careers.

I know PTSD, I live with that reality daily, the depression, anxiety, hyper vigilance, paranoia, nightmares, night terrors, insomnia and fear of of crowds, traffic, and normal relationships. That is life and I do my best to deal with it, sometimes more successfully than others. My marriage has suffered because of my madness, and I have experienced the rejection of many of my peers in the Chaplain Corps. Likewise my former church and bishop, after two knowing that for two years I was for all practical purposes an agnostic and knowing my life was a wreck, kicked me out when my faith, though very fragile and mixed with doubt, returned. I asked hard questions, and when I asked them publicly I was tossed for being “too liberal.” That rejection, the rejection of a faith community also contributes to Moral Injury. Sadly I know too many others who have returned from war to be rejected by faith communities that advertise how the “love, pray for and support the troops.”

In spite of that I continued to seek help, and at Camp LeJeune my commanders and others ensured that I got what I needed. It helped and when I returned to Hampton Roads a year ago I really thought that I was doing better. That changed last month. I went back, seeking follow-up care, which I assumed was just to download my issues with once in a while and manage my medication. Instead that attempt to re-enter the military mental health care system did me considerable harm, hell I considered suicide just last week after this. I no longer think that what I need is simple occasional follow up care, instead my experience shattered me. I had no idea just how fragile that I was, it was as if the floor had been kicked out from under me.

That my friends is what Moral Injury does to someone. Those are the kind of experiences that break a person’s faith and trust in the things, ideals, institutions and people that they grew up trusting and believing in. That loss of faith and trust, combined with the other layers of Combat Stress Injury can be devastating, and it doesn’t seem to matter because most people are neither aware, nor do they care. Not because they are bad people, but because there is such a gulf between the military and society at large that such issues are distant and incomprehensible to most people not in the military.

Yes, my trust in the system and my country is broken and I don’t know if I will ever regain the faith that I have lost. I honestly want to, I want to believe. God I want to believe. Now it does look like I will be getting help, and maybe even a chance to help being a part of the solution, and that will be a good thing.  Today I got a call from the Admiral at the Medical Center, unfortunately it went directly to voice mail, but he did sound like he cared and wanted to listen. For that I am grateful.

Pray for me as I get a chance to speak with leaders who have some influence to make things better, not just for me, but for all of us.

Peace

Padre Steve+

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Depression Kills: RIP Robin Williams

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Robin Williams during his 2007 USO Tour to Iraq and Afghanistan 

Tonight I found out about the unexpected death of the great Robin Williams. It was shocking and upsetting to hear that it was believed that Williams had recently suffered from severe depression and that he was believed to had committed suicide.

I guess I can say that I almost met Williams when I was in Iraq, in between missions at Ta’Qaddum airbase west of Fallujah in 2007. Williams was with a number of celebrities and the former chairman of the Joint Chiefs of Staff, Admiral Mike Mullen touring Iraq and Afghanistan. I had just come in from a mission and could not see his show, but the following morning I walked by Williams as he was walking back from the dinning facility. I recognized him, but I am loathe to interrupt a person’s time alone. I simp gave him a “good morning” which he returned and both of us went on our ways. I could have stooped him and detained him, but in good conscience could not do it. My friend Fr Jose Bautista, a Navy Chaplain had Williams and Lance Armstrong sign a baseball cap for me. I treasure it.

Robin Williams was brilliant, talented and brought much you to many people. Unfortunately. like so many brilliant and caring people he was afflicted with his own personal “demons.” He struggled with depression ands substance abuse.

I understand. Since returning from Iraq in 2008 I have dealt with the effects of PTSD, including depression, anxiety, hyper-vigilance, insomnia, nightmares and night terrors. I know why people commit suicide, and at times considered it myself. Most recently less than two weeks ago when dealing with the inhuman machine that is the Navy mental health system, something that is common to the rest of the military and VA systems.

The fact is that depression is a killer and it disproportionally afflicts the most talented, brilliant, artistic and insightful people.  Van Gogh, Hemingway, Williams and so many others, including men and women that distinguished themselves in combat, some of whom I knew, have taken their lives.

The death of Robin Williams has shaken me. I pray for his wife and children and all those who loved him, or who were touched by him.

Please, if you are suffering from anything that makes you think that suicide is the only option, please seek help. If you have no one else, contact me. I may not be able to do much but I will listen. You are not alone.

Rest in Peace Robin Williams. You brought much joy to my life and to so many others.

Peace

Padre Steve+

 

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