22

By all reports 22 American veterans will end their own lives today.

That’ll be another 22 tomorrow.

And another 22 the day after that, and the day after that.

Start in January this year, and by New Year 2015 it will 8,000-plus.

Unless we tackle this problem, by the end of the decade it will be more than 80,000.

I ask you, what country tolerates this horrific loss of life by those who served and defended it?

Where is the public outcry?

More importantly, where is the action?

Imagine that a commercial airplane fell out of the sky every five days with 100 Americans on board? What would we do?  Wring our hands?  I don’t think so.

Our National Alliance for Suicide Prevention  http://actionallianceforsuicideprevention.org/ has a plan and is working hard, but if you don’t belong, don’t support, don’t share and don’t push this agenda in your community, nothing much will happen.

If 22 soldiers a day were dying in firefights with an enemy somewhere, we would start a war to stop the dying. Planes, ships, tanks, drones, battalions, the works.  No holds barred, full bipartisan support.  We’d send the following warning: “Get low, get out, or get blown up” because here we come!

Americans soldiers don’t die cheap. Our enemies pay. Unless we kill ourselves. Then we’re just national a rounding error.

I say “we” because I am a veteran (US Army Security Agency, 1960-‘63, South Asia). My brothers, uncles and father were or are vets, and I know lots and lots of vets. I have a dog in this fight and he is pissed.

Our recent wars may have ended for civilians, but for veterans they never end. Soldiering changes you, and the changes are permanent. Some of them are good changes, some not so good. One of the “not so good things” is that after serving we are elevated risk for suicide. And that includes our women vets.

I know the Pentagon and the VA talk boldly about preventing suicide, and recently Congress passed a bill to provide more VA staff and better medical access for vets to the tune of 50 billion bucks.  This is significant, and it will count.  I only wish the bill had included a requirement that all those health care professionals vets will see outside of the VA (which has a strong focus on suicide prevention) will have had some training in suicide risk assessment, treatment and management, because without it, our vets won’t get the best service possible.

I know preventing suicide is hard, not easy. If it were easy, government would have done it by now.  We’d have a cure. But suicide is pernicious, like a virus on the soul.  Thoughts of suicide burrow into the psyche and eat away at hope.  At once corrosive and contagious, it takes strong medicine to counter it.  Our current death toll begs a massive public health funding research approach on par with the Manhattan Project. Given the burden of suffering, why do we putts around?

Every veteran life lost to suicide is a special affront to me.  It’s one thing to die in combat for your country; it is quite another thing to take your own life because your country doesn’t back you when the shooting stops.

Mind you, there are lots of good people out there helping vets, training others in how to identify those at risk, and carrying goodwill and the medicine of hope to this new psychological battle front. But every day I still hear things like, “troubled vets need to ask for help.”  Give it up folks, those vets most at risk for suicide are never going to ask for help. (See my note at the bottom to learn more about what I think we should be doing and why.)

Last week I gave a talk at a public meeting celebrating Flag Day. There was music, singing, a few of the last of the Pearl Harbor survivors in attendance, presentations about services for vets, and some paintings of veterans by my artist friend, John Thamm (http://jfthammstudios.com/).  I spoke briefly about my younger brother, Jim, who served in Vietnam during the 1968 Tet Offensive and saw a full year of combat, and then tried to explain what it was like for him to come home.

I tried to explain that as much times as it takes to turn a civilian into a soldier, it takes that much time and more to turn a soldier back into a civilian.

Jim was six days out of his last firefight in the jungles of Vietnam when he turned up on my doorstep in Washington State. I told him I would take him fishing in the morning. He said, “Don’t bang on the door to wake me up, I’ve been sleeping in the bush with a .45 for pillow and I’m still a little jumpy.”

Jim was “still a little jumpy” for about 20 years.

Toward the end of my remarks I ruined everything by bringing up the 22 veterans.  I said they would be dead today by sundown, and that unless I was much mistaken, no one but their families would know or care. I’d like to be wrong.

As an aside, I much admired Robert Gates, our Secretary of Defense, when he started writing personal letters to the families of those who died in combat, instead of sending form letters.  Who would write letters to the families of our vets who kill themselves? Our Commander in Chief?

A table had been set aside for me to talk with folks who might like to chat. Out of a fairly large crowd – maybe 150 – one chap came over and said he’d lost his son-in-law to suicide a week ago. Then he quickly hustled away. I waited 15 minutes, but the crowd never came my way.  I don’t think it was my deodorant.

I left the building concluding that suicide remains the unspeakable subject, and it occurred to me that until we can have an intelligent conversation about the 22, they will just keep dying.

People are trying, God bless them, and the ground is starting move, but until we reach a tipping point in public sentiment that cries “ENOUGH!” there will be no cascade of political leadership.  Politician only watch parades of public sentiment until they see which way the procession is headed, then they scamper around to the head of the line and shout, “Follow me!” 

Bring up suicide and people say, “Can’t we talk about something more pleasant?” Or they just smile and change the subject. Or, as one healthcare system CEO said in a community meeting about our county’s top health priorities – and where suicide had emerged at the top of the list from one small group of advocates – “Let’s fix something we know about…. like, say, diabetes.”  The majority followed his lead and stigma once again won the day.

Yes, I know, the majority of veterans are psychologically and physically doing just fine. But that doesn’t change the number 22. It is still 22.

A scientific article study published by my colleague Marc Kaplan and his colleagues in the Journal of Epidemiology and Community Health in June 2007 found that, “Veterans in the general U.S. population, whether or not they are affiliated with the VA, are at an elevated risk of suicide.”

When 22 vets a day die from preventable suicidal self-directed violence it boils up in me a great anger…, an anger directed at our collective failure to place the resources we know can save lives right into the hands of our veterans and their families. I mean manpower, mobile outreach, re-entry training – boot camp in reverse to become a civilian again – jobs, jobs, and more jobs, education, continuity of care, and especially family support and training in how to look after the safety of their loved ones.

It means requiring health care professionals to aim at zero suicides in those they serve, and to get over their causal attitudes about suicide prevention, and buckle down and show us they know what they are doing.  If sued successfully for suicide malpractice, and if the clinician could not show evidence of best-practice training in this area of clinical care, and if the deceased patient is a vet, juries should award triple damages to the survivors.

I know Michelle Obama and Jill Biden are supporting measures to help families, but so much more needs to be done. Waiting lists at VA hospitals? Need I say more?

And keep in mind, again, that the vast majority of suicidal veterans will never go to a VA hospital for care, nor to any outreach center. Most will go it alone, even over the rough patches ahead of them. Death in combat is not always avoidable, but suicide should be.  And even if we cannot entirely prove this to be true, we must believe it to be true, otherwise all is lost and tomorrow it will be another 22.

Lastly, I leave you with a poem written by Jim’s battle buddy from Viet Nam who, like Jim, made it through the war. There is a warning in this poem; one none can afford to ignore.

SO WE SHOT

We liked to shoot things. Boys being boys. We shot flying and

crawling things and swimming and walking things. We shot

birds and parrots and gulls and beautiful things we didn’t

know the names for. We shot monkeys and gibbons and

lemurs and deer and pigs and dogs and turtles. We shot oxen

and water buffalo in the rice paddies and bet how many M-16

rounds it would take to buckle one to its knees because it was

big and stupid. We shot tigers and elephants. Because we

rarely saw them, we rarely shot the enemy. We shot

Vietnamese women and children in their yellows and blacks

and a goodly number of old men. And if any of that were not

enough, we shot each other. Then we went home and shot

ourselves.

Edward Micus, From his book, “The Infirmary”

Dr. Paul

P.S. For my part, I have posted an online lecture describing our institute’s approach to preventing veteran suicide. It’s one. Using the QPR model, and understanding warrior psychology, and applying social network theory to suicide prevention, you might find it worth the 44 minutes to watch. See and share at: http://www.qprinstitute.com/vets.html.

9 thoughts on “22”

  1. Paul, That’s the most moving and powerful message I have ever read. Thank you. I was recently told about two suicides in a very exclusive private school. Two teen aged girls, one a junior, and another I think a senior took their lives weeks apart. I just read a tribute to one of the girls in the school’s spring magazine. Not one mention of the fact that she took her own life. The only thing remotely related to it was a tiny footnote at the bottom of the page stating that mental illness affects everyone…but no reference to the relationship of that message to the sad death of the girl. When I mentioned that to the parent of another child attending the school, she replied “Obviously, it’s sensitive. Everyone in the community knows it was suicide. I think they wanted to honor her memory without focusing on suicide….” The line in your piece “I left the building concluding that suicide remains the unspeakable subject, and it occurred to me that until we can have an intelligent conversation about the 22, they will just keep dying.” reminded me of the deaths of these two teen girls and the fact that no one connected with this school seems to want to talk about it either. Your pal,Atilla the Hun

    Date: Wed, 2 Jul 2014 14:46:37 +0000 To: nbraveman@hotmail.com

    1. Norm,

      There are good reasons to not “advertise” the method by which people end their own lives, or to glorify their deaths in anyway, but in my experience it is impossible to solve a problem you can’t even talk about. It took Happy Rockefeller to tell her story of breast cancer to LIFE MAGAZINE many years ago to get Americans to even use the “C word” with some comfort. And look what has happened since then. We now have “attempt survivors” and those with “lived experience” with suicide telling their stories — and, again in my view and experience, this will change the world for the better.

      Paul

  2. I am a veteran. I have made an attempt. I think about it all the time. Setimes I feel this is the day. I struggle pretty much alone. I have ce clean with my VA providers. They seem afraid of me. I just moved and started at a new VA. I was right up front with them as I feel my endurance to keep myself safe is shaky at times. They said they are stRting a group in a few weeks for women. I wonder if we will be able to talk about suicide or if they will tell us we cannot be specific. I need to talk and share what I go through mentally and how hard I struggle to stay alive.

    1. I’m glad you are getting help — Not sure what your line “I have ce clean with my VA providers” – means… what is “ce”? — Yes, you need to be able to talk with people who get it and are comfortable with this whole area of human experience. There is always the vet crisis line via our 1-800-273-TALK line and the press 1 if a vet option for backup and support. Great people.

      If you do not get what you need when being honest, get a second opinion, or a third. Since you are signing off as “Night Owl” I’m guessing you may have a sleep disturbance… a problem at the root of so many of our modern ills. I found this article absolutely compelling and you might find it worth reading as well…
      http://moreintelligentlife.com/content/features/rosie-blau/light-and-health?page=full

      Take care and be safe.

      Paul

  3. .
    Just a couple of points:
    ~ Prevention SHOULD have started at the recruiter’s office. A huge number of Axis II were enlisted and continue to create problems at tremendous cost.
    ~ Here in Alaska, Active Duty personnel and Vets are not being referred to qualified therapists, AND there was another death last weekend at Ft Wainwright.
    ~ We need to change the way we think and talk about suicide. We think about it because we can. When our lives are out of control, thinking about it gives us a sense of control. We need to normalize SI, then create ways of creating a stronger sense of self in our children. History shows us that a few rights of passage would help. Being conscious of the part culture plays in the process is important! I work with kids who havne’t a clue of who they are or where they fit in, kids without power, kids who live immersed in fear without hope of anyone throwing them a life-ring. Many join the military in search of belonging in the Band of Brothers Many become frustrated in that search and end up pursuing a slow death by poison or at the sound of a gun-shot.
    ~ Most of what we do in the name of prevention is intervention. Pre-vention must take place much earlier.
    Thanks for what you have done, Paul, for what you do now, and what I know you will continue.
    PHBeals, LPCS
    Fairbanks, Alaska
    I Corps, RVN, ’67, 8 & 9.

  4. A PS –
    If anyone wants an idea of what the suicidal mind sounds like, read Psalm 88.
    Thanks again.

  5. Paul, is it OK if I use a portion of this in the Florida Suicide Prevention Coalition – of course giving you credit?

  6. Paul. Just getting caught up on many months of emails. Kept your message in the “in box” – glad I did. Compelling. I agree – “It means requiring health care professionals aim at zero suicides in (the population) they serve, (like the Henry Ford Health System in Detroit did), …to get over… causal attitudes about suicide prevention.” WE DO know what we are doing…some of us, and we want so desperately for others to care enough to learn how to do it, too. But to learn, we must first admit we don’t know. That’s not a crime, yet many of my colleagues in medicine act as though they can’t be honest about this and come forward for help. But we are guilty of abandonment and gross discrimination with our mental health system as it is, and that should be a crime. Yet, no one is sued for (preventable) suicide malpractice. You have started the ball rolling with best-practice training in Washington State. Part of our challenge is to educate survivors to stop allowing themselves to be victimized, to seek damages when appropriate. Unfortunately, it seems only the pocketbook speaks to the business culture of the United States to effect change. Ethics doesn’t seem to matter, sadly, when the topic in mental health illness or suicide, even though many will agree it’s wrong, but only behind closed doors. But we will keep on keeping on…because we must. Thanks again for your blog. Right on!

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