U.S. News and World Report
by Marianne Szegedy-Maszak | Oct 13 '03
The anecdotes from Iraq are chilling. One soldier simply pulled the pin on a hand grenade, stood his ground, and blew himself up. Another's last words to his wife were: "There is nothing I can do from here." When their phone call ended, the soldier put his service revolver in his mouth and pulled the trigger. Then there is the story about the distraught family still wondering whose weapon was responsible for the "nonhostile gunshot wound" that, according to official records, killed their son.
According to the most recent Pentagon figures, Operation Iraqi Freedom as of September 25 had claimed the lives of 309 U.S. troops. Of those, 196 were killed in action or as a result of wounds suffered in action. The rest died from what's called the "fog of war"--often mundane things like traffic accidents, injuries, and illnesses. Also included in the fog, but not often mentioned, are 10 service members--nine Army, one a marine--who have committed suicide or, in military parlance, whose cause of death was "self-inflicted." Fifteen other deaths are still being investigated as possible suicides.
Cluster? Whether it's 10 or 25, it's a high rate of suicide--high enough that the Army last month deployed a special mental health advisory team to Iraq to look into the troops' emotional problems and coping strategies. The team members--a behavioral health consultant, a combat stress control officer, a psychologist, an epidemiologist, and a chaplain--are, according to a U.S. Army Medical Command spokesman, "assessing all aspects of mental health issues in Operation Iraqi Freedom"--including, of course, efforts to prevent suicide.
Suicide is as unhappy a fact of life in the military as it is in the civilian world. But different questions arise when young servicemen kill themselves. (The military has not released any demographic data on suicide victims in Iraq, though at least one outside monitor says most are young men.) Obviously, being in the line of fire is always stressful, but is there something about the U.S. occupation of Iraq that has created particular stresses for these troops, perhaps contributing to these suicides? Was there some failure in screening the emotional vulnerabilities of these young people when they volunteered for service in the first place? Are there times when a soldier may be especially at risk? And which of these issues have been examined thoughtfully? Says Carl Bell, a psychiatrist and suicide specialist at the University of Illinois-Chicago: "The issue here is whether or not the military was asleep."
To be fair, the military has hardly ignored the issue of suicide. Indeed, military physicians are keenly aware of soldiers' increased risk. In the year 2000, suicide was the second-leading cause of death in the military, and it's always in the top three. By contrast, suicide does not even appear in the 10 leading causes of death in the general population. But that overall statistic masks facts more telling from the military's point of view. For example, for men it is the eighth-leading cause of death. And it's the third-leading cause of death among males who are 15 to 24 years old--double the rate of the general population. So, in part, suicide may be a major medical problem for the military simply because the services are made up mostly of a high-risk population of young men.
But experts believe there is more to it than that. A recent study comparing college students and members of the Air Force--all seeking mental-health care-- found that generally the two groups struggled with the same issues: failed relationships, low self-esteem, depression. But those in the military had one important difference when compared with the typical young adult: Most, in addition to experiencing the predictable stresses of young adulthood, were very troubled by what they perceived as restrictions on their personal freedom. "People find themselves stuck and are not pleased about it," says Catholic University of America psychologist David Jobes, a past president of the American Association of Suicidology. Even though most military volunteers are well aware that some loss of freedom comes with the deal when they sign up, the reality often turns out to be much more distressing than anticipated.
Faking it? Military leaders have been concerned about this issue for some time. More specifically, they've been concerned about disillusioned soldiers' using suicide attempts as a way to get out of service they regret signing up for. Although there are no reliable figures for attempted suicide in the military, a recent article in Military Medicine concludes: "Suicide attempts in the military frequently represent manipulative behavior to avoid combat or simply to go home."
Military psychiatrists are well aware of the stress--especially marital stress-- associated with lengthy deployments in places such as Iraq. But ironically, they say, in the actual heat of combat, the camaraderie, the sense of mission, and unity of purpose can be a tonic for soldiers' mental health. Indeed, much more stressful for many soldiers is the end of combat--and the return home. Just last year, two soldiers who had been serving in Afghanistan returned to Fort Bragg, N.C., and killed their wives and then themselves.
The military is working hard to prevent incidents like the ones at Fort Bragg. Or like the one in Warsash, England, where a British Navy officer killed himself in June after returning from Iraq. According to his wife, he simply could not cope with the horrors he had seen there. Walter Reed Army Medical Center in Washington, D.C., has worked with over 700 wounded soldiers returning from Iraq, to assure a supportive transition back to their normal stateside routine. And the Army's Well-Being program includes physical and mental health screening for nearly all the 55,000 soldiers returning from Iraq.
When someone dies of a noncombat injury, each branch of the service has its own procedures for investigating. If it appears that suicide is a possibility, mental health professionals are generally called in to perform a "psychological autopsy." The goal is to understand as much as possible about the soldier who died: state of mind, religious beliefs, family history, relationships with peers and superiors, and as much detail about the last days of life as is discernible. The hope of such exhaustive analyses--and it's still just a hope--is to determine why this soldier, among all the others, gave up hope.
The Air Force's suicide prevention program is widely considered a model, not just within the armed services but within the general field of suicide prevention. It was established in late 1995, after growing concern over the unusually high number of suicides in this branch of the service. The underlying philosophy, according to Lt. Col. Rick Campise, who runs the Air Force's suicide prevention effort, is that "suicide is not a medical problem. It's a community problem. You don't reduce suicide by reducing suicide. You reduce it by improving the quality of life in the military."
In that way, the military is probably not much different from the rest of the population. The question of why some people, in uniform or not, kill themselves, and others do not, is and will probably remain one of the essential mysteries of life.
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