The keen sense of being broken beyond repair, yet knowing they look no different outwardly, threatens to strangle their spirits. They are caught in a downward spiral of hopelessness.
Those Battle Buddies who sustained them through the unimaginable ravages of war have dispersed, each returning to his or her version of homeland hell.
The Armed Forces have attempted to reduce the stigma of the invisible wounds of war, but repeat the same unsuccessful pattern. Despite numerous suicide prevention programs (i.e.: ASSIST, the Army’s “ACE: Ask, Care, Escort”, the Navy’s “ACT: Ask, Care, Treat.”), military personnel – active duty, National Guard and veterans – comprise 20 to 22 percent of suicides in the United States.
It has been determined that there is no direct link between combat and suicide. It can then be surmised that the painful, isolating reintegration into civilian life must contribute to the aforementioned abyss that awaits.
Author Platoni’s grandfather, a World War I veteran and former paymaster for a Russian tsar, took his life in 1959 by throwing himself in front of a New York City subway train. Platoni was told he was pushed onto the tracks by a thief, but when she returned from Afghanistan, a cousin revealed the truth. From her grandfather’s suicide note, it was evident that silent suffering can be sustained only so long.
The Air Force Suicide Prevention Program, the only military program that reports some reduction in suicides, has a community-based approach, including strong social support, development of social skills and improvement of help-seeking behaviors.
This program, with 11 different well-researched initiatives, is more deeply involved than the simplified versions adopted by other military branches.
There is an erroneous assumption that all persons struggling with suicidality must be depressed, displaying clear warning signs listed on suicide prevention websites. A 2018 Center for Disease Control press release, however, revealed that in 27 states, more than half of all deaths were individuals who had no known or diagnosed mental health condition(s) when they died by suicide.
Major Jennifer Neuhauser, an Army JAG officer (attorney), noted in a Creighton Law Review article that Army leaders acknowledge that much of the military training and culture fosters a stigma that prevents individuals from seeking care for fear of being viewed as weak or unreliable, thus limiting or even ending their military careers. Fewer than 40 percent of military members affected by suicidality or other wounds of war seek mental health treatment.
Many military personnel had considered suicide years before entering the military. Their military trauma amplifies original subliminal feelings of worthlessness, bringing previously hidden suicidality to the surface.
Because of its nuaissance in childhood or adolescence, this chronic suicidality is much different and must be treated uniquely from situational suicidality or suicidality strictly and directly as result of wounds of war (i.e.: Traumatic Brain Injury, Military Sexual Trauma, PTSD).
Common strategy is to refer an individual struggling with suicidality to emergency care. An evaluation takes place, possible hospitalization and medication may be prescribed, followed by referral to counseling.
Then what? Most involved friends and family realize that this is not the total solution. Long-lasting recovery is desperately elusive. Concerned others ask what they can do, only to get limited information, if any, about meaningful support. Hospital personnel hesitant to offer further disclosure for fear of HIPAA violations.
Social support provides a valuable element in suicide intervention and prevention. In fact, psychotherapeutic experience provides the most powerful evidence for the main purpose of social support – that of listening. It is active listening and consequent proactive contributions by an educated social support team that provides the compassionate understanding needed to combat persistent hopelessness and helplessness.
For military patients, it is not difficult to introduce expanded social support by involving Battle Buddies. Indeed, Battle Buddy relationships formed through military camaraderie are known to be closer than any blood kin can forge. Three things can be instituted that build on their experience of deep camaraderie that goes beyond just common peer support.
First, it is essential to school the support team in active listening skills and the origin and dynamic of chronic suicidality. Active listening is more than just hearing. It involves reflecting emotions back to the speaker that demonstrate an understanding beyond mere superficial factual knowledge.
Second, research shows that individuals will not ask for help if they cannot reciprocate. Making support reciprocal elevates and invigorates the peer effort. No longer does it feel like a “pity party” and the person struggling with suicidality no longer feels the spotlight of the “Identified Patient.”
Lastly, team members realize their job is to insert themselves on a daily basis – not as a “9-1-1” emergency squad. To decrease isolation, the team proactively checks in and provides interaction for increased emotionally uplifting sober opportunities.
Truly successful and meaningful support is not a natural process. If it were, we would not have the horrendous suicide rates, not only in this country but in our world.
Luckily the process can be learned. When taught appropriately, it coalesces into mutual support and establishes the needed continuous intercession outside the clinical office. How to form educated support teams for individuals struggling with suicidality can be found at www.jsp3.org.
The military and the civilian community have missed the mark on suicide intervention and prevention. The truly intervening and healing elements are not treatment programs, not piles of pills, not being encouraged time and again to reach out…but community itself, in the context of compassionate, educated, reciprocal, PROACTIVE social support.
References available from authors
Randi Jensen, is a licensed mental health counselor, chemical dependency professional, former director of The Soldiers Project Washington and founder/director of Jensen Suicide Prevention Inc. She is in private practice in Shoreline, Wash., and is the author of Just Because You’re Suicidal Doesn’t Mean You’re Crazy: The Psychobiology of Suicide, (2012.) Her email address is: firstname.lastname@example.org. Kathy Platoni, Psy.D., has been a clinical psychologist for more than 36 years, with a private practice in Centerville, Ohio. As an Army Reserve clinical psychologist, she deployed four times in war zones: Operation Desert Storm, Operation Enduring Freedom (Joint Task Force-Guantanamo Bay, Cuba and Afghanistan) and Operation Iraqi Freedom. She retired from the Army with the rank of colonel in 2013 and currently serves as the brigade psychologist for the Ohio Military Reserve, State Defense Forces. Her email address is: email@example.com.