The Center for a New American Security recently published an in-depth study of suicide within the United States armed forces.  Losing the Battle: The Challenge of Military Suicide”, by Dr. Margaret C. Harrell and Nancy Berglass, presents an overview, statistics, analysis, and recommendations to help address a growing tragedy – our nation’s combat personnel and veterans are taking their own lives at significantly accelerating rates.  Harrell and Berglass challenge all branches of the military (from top commanders to unit leaders), Congress, and other government agencies to make key and important changes to preserve young American lives.

Last week I presented some statistics and observations from the study; today I will review the authors’ findings and recommendations.  I will also add some observations of my own.

“Losing the Battle” identifies the following as obstacles to reducing military suicides:

1. Military personnel transfers complicate efforts to help individuals struggling with mental health issues

2. Army personnel transfers occur too soon after deployment

3. Commanders are not always aware when subordinates are the subject of an investigation

4. The mental health screening process following deployment is flawed

5. A cultural stigma attached to mental health care persists in the armed services

6. Military hazing persists

7. The number of care providers is insufficient

8. Legal restrictions prevent military leaders from discussing privately owned weapons

9. There is excess prescription medication in the military community

10. Unit commanders have limited visibility into service members’ medical problems

11. Infrequent interaction among drilling Guardsmen and Reservists limits unit leaders’ ability to recognize and help subordinates struggling with mental health issues

12. The National Guard has too many suicide prevention programs

13. The true number of veterans who die by suicide is unknown

14. Understanding and addressing the challenge of suicide requires cooperation beyond the traditional jurisdictional boundaries for many organizations, including the Department of Defense, Veterans Affairs, Health and Human Services, and Congress

All these points are important and I have comments I could make on each one.  That would make for an extremely lengthy post, however, so I will limit myself to pointing out what I feel are the crucial issues.  I encourage you to read the entire report for yourself.

Harrell and Berglass’ findings recommend structural, procedural, informational, and cultural changes.  Everything from national government policy, to the intimate conversations between a small unit leader and his troops can be improved.  But I see what I call a “red thread” – a key problem or idea – running through all their observations.

That “red thread”, which has become overwhelmingly evident to me through over forty years of experience in the trauma treatment profession, is the essential understanding that suicide is a symptom of trauma, and that it feeds on secrets and isolation.

Look at the findings.  Each recommendation addresses one of three things.  First, the report addresses the issue of isolation by underscoring the risks of losing connection with struggling service members and veterans through transfers, quick troop dissolution after deployment, and numerous barriers to communication between leaders and individual troops.  Next, the report highlights the destructive nature of secrets, through a culture of shaming personnel for the “weakness” of mental health repercussions from combat service, and through a “don’t-go-there” atmosphere around discussing drugs, personal firearms, and hazing.

Lastly, the report exposes the current limitations of the DoD or VA to address deficiencies in care for emotionally wounded and potentially suicidal personnel, including an insufficient number care providers, inaccurate data-gathering, flawed screening processes, inconsistent prevention programs, and lack of coordination across services and agencies.

Units break up and vital relationships of trust and shared experience are lost.  Admitting to having trouble dealing with emotions and memories will lead to ridicule or negative consequences for military careers.  It’s alarmingly clear that there are too many subjects – besides sexual orientation – for which the message has been “don’t ask, don’t tell”.

Double binds exist.  Commanders and unit leaders want to be able to help their troops, and are prevented from doing so by confidentiality regulations and by cultural taboo.  Revealing the unspoken problems – the secrets service members and veterans won’t tell, so that they can get the help they need with their suicidal thoughts – can create problems for them both in the present and future.

Here’s my message to all our combat troops, past and present: What you can’t, or won’t, talk about – because you’re not supposed to, or no one’s there to listen – can be deadly.  I’ve seen this over and over in my practice.  There is no shame in being affected by horrific events and experiences beyond your ability to handle on your own.  The truth really can set you free.  If you can’t yet tell it within the system, find someone outside the system and break the silence.