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Health, Science, Environment

After surviving war, many vets come home to battle suicide

This article first appeared in the St. Louis Beacon, Sept. 17, 2012 - Since 2009, more American troops have died from suicide than combat.

An active duty soldier commits suicide every 36 hours. That rate jumps for veterans – one act of suicide every 80 minutes, according to the Centers for Disease Control

Each day, 31 veterans attempt suicide and 18 die, according to the Department of Veterans Affairs. That means that one out of every five suicides in the United States is a veteran.

Just last month, the Defense Department announced another increase in suicides among Army active duty, reservists and guardsmen, now set to surpass last year’s total of 283. The first seven months of this year already have seen 187 suicides. That means the rate of suicides has risen to 26.7 suicides a month from last year’s 23.6. In July alone, 38 soldiers committed suicide.

Nancy Sherman, a professor of philosophy at Georgetown University and the U.S. Naval Academy’s first distinguished chair in ethics, says the United States is falling short of its duty to assess the moral costs of 10 years of war.

The alarming rate of suicide among troops and veterans is one of those costs, she says.

“We’re at the end of a long decade of war taking place,” she says. “The burden has fallen on a very few – about half a percent of the American population has served in the volunteer forces.”

About 300,000 troops have deployed to Afghanistan and Iraq during the past decade. 

Many of the troops injured in battle survived because of armor and advancements in medical care, Sherman says, but there has been a remarkable spike in suicides. Now these veterans are coming home and they require help from the nation that sent them to war, she says.

“They need jobs, they need health care, they need family healing, they need their marriages,” Sherman says. “But they also need to be heard.”

She says a subset of psychological injuries known as moral injuries has contributed to the growing number of suicides among veterans.

Moral injuries occur when soldiers feel accountable for actions over which they had no control, Sherman says, or when they feel they have betrayed others or have been betrayed themselves.

“Even when they fight honorably, justly, according to the best standards of just warfare, they still may feel they’ve done wrong in some way,” she says.

Jane Tomory, suicide prevention coordinator for St. Louis Veterans hospital at Jefferson Barracks, says the suicide rate for younger veterans is alarming.

“The fact is the younger veterans don’t have life experience to deal with their problems, and they tend to be more impulsive,” she says.

Tomory says statistics show veterans are at twice the risk for suicide as their civilian counterparts and more veterans commit suicide by guns than any other method because they are familiar with and often have access to weapons.

“Guns make it easier,” she says. “One of the first questions we ask is ‘Do you have a gun at home?’”

Veterans were 58 percent more likely to use guns to kill themselves than people in the general population, according to a report by Mark Kaplan in the July 2007 Journal of Epidemiology and Community Health.

Larry Stout, a licensed clinical social worker at the Marion, Ill. VA Medical Center, says untreated psychological injuries, such as post-traumatic stress disorder, can lead to suicide.

“Our staff expects that a lot of the vets coming in are reluctant to discuss trauma or PTSD,” Stout says. “We try to break through and make them feel comfortable about going to behavioral medicine. We don’t want to pressure new vets to discuss anything that’s uncomfortable.”

He says victims of post-traumatic stress disorder tend to minimize the disease and avoid talking about their problems.

They rationalize their symptoms by telling themselves it’s not that bad, Stout says, or don’t think about their problems at all because it interferes with their daily lives.

Rosemary Simmons, the director of the Southern Illinois University Carbondale’s student counseling center, says proximity to the battlefield can cause more severe post-traumatic stress disorder and a higher risk for suicide.

“If you directly see the consequences of what you did, it’s more traumatic,” Simmons says. “It’s hard to take another person’s life. And you have to have a clear reason for doing it.”

If the purpose for taking another’s life is not clear, she says, it creates a delicate psychological condition.

“Therapy and medication really are useful and people really can recover,” Simmons says, “but a lot of times, people are in a lot of pain before they give themselves permission.”

Dr. Jonathan Shay, a retired VA psychiatrist and recognized national expert on psychological injuries, says veterans often avoid seeking help for post-traumatic stress disorder because they fear being stigmatized.

Shay says he’d like to change the label from “post-traumatic stress disorder” to “post-traumatic stress injury” because of the way a soldier perceives a “disorder.”

To a soldier, he says, the term disorder falls into the same category as illness, and while it’s not dishonorable to be ill, it can be perceived as weak.

An injury, Shay says, has a starting point, where something external happened, so it is less stigmatizing for a soldier returning from war to suffer from an injury.

Shay says veterans treated for post-traumatic stress disorder are frequently stigmatized when they are job-hunting, and chronic unemployment is a factor in some veteran suicides.

“Having a ‘diagnosis’ is a stigma that can prevent somebody from getting a whole range of civilian jobs, especially in the uniformed civilian services – fire, police, EMT, corrections. This needs to be solved,” he says.

The 2005 suicide of an Iraq veteran who was afraid to seek help for post-traumatic stress disorder has led to better tracking of suicides among veterans. Joshua Omvig, a 22-year-old Iraq war veteran, committed suicide in December 2005 while visiting his parents’ home in Wyoming.  Shortly before he shot himself, he told his parents he thought he was suffering from post-traumatic stress disorder but was afraid to seek help because it would damage his career.

Since the passage of the Joshua Omvig Act in 2007, the VA has placed more emphasis on tracking suicide attempts, completions, causes and better methods of prevention.

The data still are incomplete. There is no national standardized reporting system to track veteran suicides. The CDC is the source of most data on veteran suicides, but only 18 states report suicides committed by veterans as a separate category. The VA only reports on suicides in the 6 million of the nation’s 22 million veterans enrolled in VA health services. Eric Shinseki, the Veterans’ Affairs secretary, is finalizing standardized reporting on veteran suicides this year.

In addition, in 2007 the VA established the veteran’s suicide hotline, which was renamed the veteran’s crisis hotline in 2011 because the VA wanted to promote the hotline as a place to get information before reaching the point of considering suicide as an option.

In 2009 the VA set up a chat line that’s monitored by mental health professionals, she says.

Tomory says her office reaches out to veterans by going to community outreach events several times each month. 

“To help the veterans, we need their families and communities involved,” Tomory says.

Sharon Wittke is a student in the School of Journalism at Southern Illinois University at Carbondale. She served 25 years in the United States Air Force before retiring last year as a lieutenant colonel. These stories are part of a project of Midwest journalism schools, the Investigative Journalism Education Consortium. For other stories in this series, see IJEC.org.

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