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G.I. Suicide and Cultural Suicide

Is there really an 'epidemic' of suicides among the US military, as a CBS report recently stated? Jules Crittenden, who has been in war zones, looks at what the numbers actually mean and reflects on the personal impact of close combat.

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Jules Crittenden

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November 16, 2007 - 1:00 am

Since the dawn of time, human beings have been combat animals, engaged in defense of their own kind, engaged in war over resources, fighting day by day for survival. Living short, brutal lives in frequent, violent struggle.

To be a battle-tested warrior has been considered a necessary right of passage for men. To accomplish something in battle, to exert leadership and demonstrate courage, was to stand as an example. Songs would be sung about such a man.

There are still some vestiges of that. But the inspirational tales of great warriors are replaced by cautionary tales of victimhood.

Our war dead are called a waste by those who would lead us. Our returning soldiers are viewed as damaged goods, their accomplishments ignored. The holidays we dedicate to them have long been excuses for trips to the beach and the mall, ignored by the vast majority of our population. The dire threats to world peace our soldiers have combated, from communists to Muslim terrorists and would-be nuclear despots, are fabricated excuses to seize oil supplies, drive up corporate profits and undermine constitutional freedoms. War, even when it might be justified, produces unacceptable tragedy and debases us. Patriotic display is disconcerting. Our children are not encouraged to develop the strength and courage of warriors, are discouraged from playing at war, and efforts are made to keep recruiters away from them.

Here’s the latest thread in the pervasive new storyline:

War makes you suicidal.

CBS, for whom Edward R. Murrow once broadcast from the rooftops of London, inspiring Americans who would soon find themselves called to war, posits a GI suicide epidemic. This is not CBS reporting on a scholarly study. It is CBS conducting its own study. Not surprisingly, while it makes a great gotcha, it is somewhat limited in its scope, and questionable in its findings:

CBS News went to the Department of Veterans Affairs, where Dr. Ira Katz is head of mental health.

“There is no epidemic in suicide in the VA, but suicide is a major problem,” he said.

Why hasn’t the VA done a national study seeking national data on how many veterans have committed suicide in this country?

“That research is ongoing,” he said.

So CBS News did an investigation – asking all 50 states for their suicide data, based on death records, for veterans and non-veterans, dating back to 1995. Forty-five states sent what turned out to be a mountain of information.

And what it revealed was stunning.

In 2005, for example, in just those 45 states, there were at least 6,256 suicides among those who served in the armed forces. That’s 120 each and every week, in just one year.

Dr. Steve Rathbun is the acting head of the Epidemiology and Biostatistics Department at the University of Georgia. CBS News asked him to run a detailed analysis of the raw numbers that we obtained from state authorities for 2004 and 2005.

It found that veterans were more than twice as likely to commit suicide in 2005 than non-vets. (Veterans committed suicide at the rate of between 18.7 to 20.8 per 100,000, compared to other Americans, who did so at the rate of 8.9 per 100,000.)

Some observers thought those numbers a little suspect. Here’s Michael Goldfarb at the Weekly Standard:

When I first saw this story, I went and checked the ever reliable Wikipedia for suicide rates-and as I expected, suicide rates for American men are only slightly less than the numbers CBS gave for veterans. Which I suspect could have a lot to do with the fact that veterans have a familiarity with violence and firearms that is slightly higher than average. But leave it to Bill Sweetman, who is more reliable, and on such matters more knowledgeable, than Wikipedia, to break it down: “In the US, male veterans outnumber female veterans 13:1. Since four times as many males as women commit suicide in the general population, you’d expect the rate among veterans to be close to the rate among males – 17.6/100,000 per year in 2002 – and indeed it is, if the CBS raw numbers are correct.”

At first blush, it looked like CBS had goofed. CBS’s methodology statement indicates that gender differences were taken into account.

There are some things the CBS methodology doesn’t address.

For men in their mid-50s on up, military service was mandatory. How does that play out in overall numbers, and what might it say about the different populations that are being compared? The series tells us that numbers for younger veterans, 20-24 years old, are even higher than veterans overall, suggesting the “epidemic” is worsening in the current war on terror.

There is nothing about how any of these numbers have changed over time, from peacetime to wartime. In fact, despite collecting data for a 10-year period, CBS draws its conclusions from just two, 2004 and 2005. I wouldn’t mind a look at the last 65 years or so, to see how the number shifts, and whether there might be any correlation with the perceived worth of any given conflict, based on polling or media coverage. Is this an epidemic or a chronic condition?

Nor does CBS tell us how many of those veteran suicides are actual combat veterans. The second part CBS series also tells us that while veterans make up 11 percent of the population, they make up 25 percent of the nation’s homeless. In that case, lack of age, race, education, job history and other factors mean a lack of context to understand the disturbing statistic. It may not simply be their status as veterans.

CBS was offered but wasn’t particularly interested in active duty suicides, numbers that were readily available but showed a counter-epidemic. If adjusted for gender, active duty suicide may actually stand well below civilian suicide rates. Numbers for the last 20 years show that from a high of 15 per 100,000 in 1995, they’ve trended downward, to about 9 per 100,000 in 2006. Despite this wretched war, the trauma and multiple extended deployments.

The overall number of veterans’ suicides, even at double, remains small as a percentage of the population, however frightening the word “epidemic” is and however disturbing and tragic each individual case may be. But these are interesting results. Hopefully some actual scientists are looking into the matter. The VA, as quoted by CBS, suggests that they have been.

CBS, relying on critics, creates the impression that the VA is responding inadequately to the mental health of needs of veterans. That could be. It is unclear to me whether some additional number of suicides as a result of extreme war experiences might be unpreventable, or whether some people might be unreachable. CBS doesn’t go into detail on screening and treatment offerings. I heard some veterans’ complain that those are inadequate. I’ve heard others say they got good treatment. This gets added in the second part part of the CBS series:

The VA recently responded to such criticism by opening a suicide prevention hotline, hiring thousands of new workers, including suicide-prevention coordinators at all its medical centers.

I hope the VA is in fact addressing these issues, and if it’s needed, then I hope the CBS effort leads to more support for the VA in Congress and in the White House.

Because war is stressful. And yes, war can make you crazy and suicidal.

CBS is not the only news organization in this time of war to be more interested in the damage war does, than the lives it may be saving and the good that might come as a result, however. Having accepted and promoted political claims that our wars are unnecessary, and that they are excessive and inhumanely executed, CBS is not unlike most of our major news organizations. They have devoted large amounts of time and space to PTSD and the difficulties returning soldiers face, reporting on those issues and others — physical war wounds, death and family stress — with a great deal more enthusiasm than they have shown for the liberation of 50 million people, the willingness of hundreds of thousands of young Americans to fight battles for the freedom of others and our national security, and their successes in combat operations.

The predominant storyline of war in our time has not been one of volunteers struggling and triumphing over adversity. It has been about victimhood, quagmires and failure. Whether the facts fit the description or not.

If you have been to war, then you know that you are undeniably changed and damaged by it. Images, obsessions and adrenaline rushes at odd times become a part of one’s life, along with barely controllable upwellings of emotion, shortness of temper, a tendency to speak one’s mind in ways that may be disturbing to others. For some people, it fades with time, for others it doesn’t.

As one friend who had seen heavy combat and struggled with it said, “We are the detritus of war.” That man, a veteran of heavy combat in Vietnam, credits the PTSD treatment he received at the VA with saving his life. Men walking around with wounds others can’t see. It’s not always so extreme, even for veterans of heavy combat. As another friend said, “There was life before, and life after. Not good, not bad, just different.”

Myself, after mild exposure to fire in a couple of warzones and moderate combat in Iraq that included death close at hand and a number of close calls, I came home with what I have considered a mild case. I’m lucky enough to have seen the intensity of death images and adrenaline rushes subside, though my wife tells me I’m a different person than I was before. It’s as though she’s had two marriages, she said, to two different people. I am grateful not to be damaged such that it might be unendurable. I consider it in fact normal, what I experienced in the last four years, a normal reaction to extreme events, exacerbated by the deep political divisions that developed and the disparagement of the war. PTSD experts will tell you the latter can be a significant factor.

Lost in these discussions of war and PTSD is the fact that trauma is the stuff of life. Millions upon millions of human beings have experienced it, adjusted to it and moved on. War, accidents, disease, crime, childbirth … the latter a terrifying and excruciatingly painful ordeal that up until recently carried a significant risk of death. That’s made me wonder about the resiliency of humans, and whether, just as I found to my surprise that I enjoyed combat and later missed it, the reaction after the fact is a normal process, part of something hardwired into us.

Absent until recently in this equation was the culture of victimhood, the glorification of traumatization, or any system of benefits that might make its indulgence desirable.

That’s what makes a new round of studies particularly interesting.

Some researchers are looking into the military records of Vietnam-era PTSD patients and finding some startling discrepancies. Many of those seeking treatment were not in heavy combat, or in some cases had not been in combat at all.

This April 2006 article announces that studies are being conducted to look at the issue, because of a recent dramatic leap in PTSD claims … not among Iraq and Afghanistan vets but among Vietnam vets 40 years after the fact.

How widespread is PTSD among Vietnam War veterans? Only 3.5 percent of soldiers reported combat stress reactions during the war, yet the National Vietnam Veterans Readjustment Survey in the mid-1980s found a lifetime incidence of 30.9 percent among men who had served in the war zone and an additional 22.5 percent reporting a subclinical variant, said Richard McNally, Ph.D., director of clinical training in the Department of Psychology at Harvard University. Only 15 percent of all troops sent to Vietnam were assigned to combat units, yet two or three times that percentage appear to have experienced PTSD at some point.

Several hypotheses have been advanced to explain this apparent discrepancy, in addition to simple fabrication of war stories. Sampling errors or interviewer biases may account for some of the difference. Noncombat troops like medics or truck drivers might have been exposed to trauma. To some, mere deployment in a war zone might be considered stressful, even if not traumatic. Or there may be other reasons.

“Perhaps they are imposing a trauma narrative on their lives, attributing their problems to military service,” said McNally. The definition of “trauma” has broadened over the years to include pre- and posttrauma factors and noncanonical stressors, from fender benders to normal childbirth.

[...] The current increase in disability claims may be due to chronic PTSD that has existed since the war or to delayed presentation after earlier symptoms, she said, but PTSD may also serve as a “comforting cultural narrative” for life failure, induced by a “victim culture” or a crutch for “folks who need a retirement plan.”

This 2005 study found that only 41 percent of Vietnam-era veterans taken from a sample of people seeking outpatient care for PTSD had documentation of combat exposure, such as the Combat Infantryman Badge, Purple Heart or combat valor awards, while 32 percent were clerks, mechanics, etc., whose records indicated they served on large air bases and other rear-echelon locations.

This study concludes that “PTSD and combat experience in Southeast Asia have not had a major impact on the socioeconomic status of veterans.”

That is not the impression you’ll get from the latest news reporting on the subject.

Theoretically, the CBS report of a GI suicide epidemic -with U.S. senators now prompted to react- should improve treatment and help make life better for returning war veterans. Whether it actually will is debatable: whether the senators will in fact do anything useful and if the veterans are stigmatized as they were in the post-Vietnam-era. And beyond that, if they are encouraged to see themselves as maladjusted. The news organizations, as they report on various problems homecoming vets face, purport to care about the vets. And maybe they actually do.

A deeper concern, in a world that shows no signs of becoming less dangerous, where Russia and China are both building their militaries and Iran seeks to dominate the Middle East with terrorism and nuclear weapons, is that powerful voices within our own society are actively seeking to disparage and discourage military service and any exercise of military force. It is not a last option. It is an option so constrained by demands of proof and fears of the damage that will be caused that it is in danger of ceasing to be an option.

More simply put, we’ve become too sophisticated now to fall for the stories of great leaders and heroes. The flaws and failures are what fascinate us. And as we seek to spare everyone from all harm, we may find ourselves incapable of preventing greater harm from falling.

Jules Crittenden blogs at Forward Movement.

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