THE Deadly recipe for veteran suicide

No fail mentality
Familiarity with death
Impulsivity
Isolation
Purposelessness

Death Before Dishonor

The Deadly Recipe for

Veteran Suicide

Over the last decade the rate of veteran suicide has steadily increased (U.S. Department of Veterans Affairs , 2018). Since 2001 I have lost eight comrades to suicide. In 2012 I began studying veteran suicide in an attempt to understand why so many of my brothers had chosen to kill themselves. Every article and journal I studied, pointed to isolation, purposelessness, and PTSD as the main contributing factors. Although PTSD is a significant factor of suicide, when present, there are too many cases of suicide where the individual had no diagnosis or symptoms of PTSD, to be a main cause for all veterans. Feelings of isolation and purposelessness, however, seemed like a logical explanation, especially when one understands how prone veterans are to those feelings because of the intense acculturation of the military and the difficulty of transitioning back into the civilian world. The truth is, isolation and purposelessness are important, but they do not explain why veterans kill themselves at a rate nearly 2.5 times greater than civilians. Many “veterans” who kill themselves are on active duty, connected to their team and intensely purposeful in their lives, and yet they still decide to die by suicide. Civilians and veterans both experience times when they feel isolated or purposeless. To account for the higher rates among veterans we need to think clearly about what makes veterans different than civilians.

Veterans are fundamentally different from civilians because they have been specifically conditioned to be different by the military. Military culture values the Death before dishonor mentality, a willingness to die for a cause, spontaneous decision making, teamwork, and mission focus. These values are necessary to create warriors who are willing to die for a cause greater than themselves, but these values also create a deadly recipe for suicide.

No Fail mentality

Throughout a veteran’s career, they hear the message “Death before dishonor” over and over again. This phrase conveys the message that failure is never an option and that completing the mission is the only thing that matters even if it means their death. For many veterans the option of suicide is more palatable than facing failure. The concept of honor is deeply ingrained in the psyche of the warrior during basic training and is nested in the warrior ethos. Each branch of the service has codified aspects of the Warrior Ethos for use in their training process. The Army began a campaign to instill its values into all ranks in the early 1990’s. This campaign included defining and codifying The Army Values, The Warrior Ethos, and The Warrior Creed. Every Soldier was and is expected to be able to recite these three statements of belief on command.

“The Army Warrior Ethos states, "I will always place the mission first, I will never accept defeat, I will never quit, and I will never leave a fallen comrade." The Warrior Ethos is a set of principles by which every Soldier life...(It)is a way of life...The Army has worked to instill the Warrior Ethos in all our Soldiers by the way we train, live, and fight. Every Soldier that has entered into the Army family has been taught that ... service to our nation is an honor and a responsibility that requires self‐sacrifice‐belonging to and giving to something larger than ourselves.” (Army G‐1, 2011)

The values the military trains into its’ members is good and necessary to create warriors who are willing to sacrifice themselves for a greater purpose but when the individual generalizes the death before dishonor mentality into day to day life (especially outside of the military context) the ethos can quickly become a maladaptive schema of unrelenting standards. The following are examples of ways in which the warrior ethos can become maladaptive.

A Soldier realizes that he has failed to cultivate his relationship with his spouse and now his marriage is likely to end in divorce. He feels like a failure. In his mind failure is never an option and he feels dishonored. His deeply ingrained value of death before dishonor surfaces in his mind and suicide seems like a reasonable solution.

A veteran has become addicted to prescription opioids because of his overuse and attempts to manage his pain. When he can no longer attain the prescriptions, he begins to use illegal drugs and his life spirals out of control. He has become “the loser” whom he used to judge so harshly. He thinks to himself, “Warriors never accept defeat” but he feels defeated. For him suicide may seem like an honorable choice.

A Guardsman loses a friend to suicide. He has been trained to notice the sign and symptoms but somehow, they escaped his attention and now his comrade is dead. Warriors never leave a comrade behind. He is a failure. Failure is not an option. Death before dishonor.

There has been little or no research on the death before dishonor mentality, and suicide. This may be the piece that has been missing in all of the attempts to stem the epidemic of veteran suicide.

 

Familiarity with Death

From the moment a veteran enters basic training they begin to internalize the possible reality of dying or of killing. Service members are often reminded that their life expectancy during a conventional war is only 70 seconds. They are taught that their lives do not matter but accomplishing the mission does. Every breath for a Service member is a breath beyond what they expected and peace is something only others may enjoy. The conditioning and behaviors learned during training, and through combat experience, create a familiarity with death that is uncommon in the modern western world. Trying to connect the dots between suicide and familiarity with death is difficult because there has been very little study about the connection between the two. Some research does indicate that previous suicidal ideation and/or attempts significantly increases the chances of a person attempting suicide.

(Smith, et al., 2008).

People who wish to kill themselves must expend a great deal of mental energy in order to overcome their natural aversion to death. For those who are able to make this cognitive shift once, (and survive) the next iteration is much easier. Veterans, in many cases, have at some point in their warrior lives, accepted the possible reality of their death. Their natural defense mechanism and aversion toward death has been systematically denied” (Grossman, 2014)and for them suicide is a much easier choice than for civilians who have these defense mechanisms in place.

Impulsivity and Spontaneity

Veterans who return home after combat experience or training, often feel that their lives are meaningless compared to the excitement and purpose they experienced in the military. They are

“Engaging in self‐harm is something that usually involves great pain and is fear‐inducing to most

people. In order to overcome this ingrained fear, it is necessary to habituate in some way to

stimuli associated with self‐injury... the acquired capability for suicide develops after one has

been repeatedly exposed to painful and/or provocative stimuli. A recent study has shown that

these painful and/or provocative stimuli include but are not limited to past suicide attempts,

self‐injecting drug use, non‐suicidal self‐injury, and exposure to physical violence ...”

trained to make fast decisions and execute orders under duress. These experiences and training can cause veterans to think and act in impulsive and spontaneous ways.

“Combat exposure is associated with increased rates of mental health problems such as post‐ traumatic stress disorder, depression, and anxiety when Soldiers return home. Another important health consequence of combat exposure involves the potential for increased risk‐ taking propensity and unsafe behavior among returning service members.” (Killgore, et al., 2008)

 

Individuals who exhibit higher levels of impulsivity also tend to exhibit higher levels of suicidal ideation and behavior. “There is clear support for some role for impulsivity in suicidal behavior. For example, research has consistently found links between impulsive personality characteristics and suicidal ideation and behavior ... Moreover, Dougherty and colleagues ... found that higher levels of impulsivity were related to more previous suicide attempts.” (Smith, et al., 2008)

 

Isolation

Warriors from the time they enter basic training live, eat, sleep, and fight together. There are few opportunities to ever be alone during duty hours. Experiences in training and combat solidify and intensify the sense of collectivism. Sebastian Junger a well know photo journalist spent years living among Soldiers across the world and describes this collective sense in his book Tribe.

“...you are almost never alone. Day after day, month after month, you are close enough ... touch, a dozen or more people. ... The outpost was attacked dozens of times, yet I slept better surrounded by those noisy, snoring men than I ever did camping alone in the woods of New England.” (Junger, Tribe: On Homecoming and Belonging, 2016)

In an interview with National Public Radio Junger goes on to explain how this shared intimacy can turn into isolation after leaving the military: “I mean, the odd thing about war ‐ one of the many odd things about war is that the experience of combat produces an incredible human closeness between the soldiers involved. And when soldiers come home, there's this sort of existential loss of community. You're not in a platoon. You're not sleeping shoulder‐to‐shoulder with other people that you would die for. And that transition is at the root of a lot of what we erroneously, I think, call PTSD.” (Junger, Sebastian Junger Examines Veteran Life After leaving tribe, 2016). 

 

The isolation experienced by veterans after service can be intense and unexpected. It is difficult to form bonds that are as intimate as those formed in combat or simulated environments. Many veterans come to believe that they can no longer relate to the civilian world. Most veterans and civilians, do not understand that what the veteran is experiencing is difficulty in adjusting to a “new” culture that does not share the values of the veteran.

“The military transition theory postulates that the absence of a shared military cultural identity, along with an unrecognized sense of privilege, can interfere with the modern veterans feeling of community belongingness, as well as hinder the modern veterans’ establishment of a new effective social support network that includes civilians.” (Castro & Kintzle, 2014, p. 7)

Purposelessness

People in the military do not have jobs, they have missions. This simple linguistic twist represents a schema of military culture which is embedded deeply into the psyche of most veterans. Military life is purposeful. When boiled down to the most savage elements of combat, it could be said, that there is nothing more purposeful than killing or trying to stay alive. Sebastian Junger during a “Ted Talk” presentation talks at great length about the excitement and sense of purpose experienced by combatants on the battlefield. He explains that there is no feeling in the world that can match the level of excitement and clarity of purpose which one experiences in battle.

“What's happening in your brain is you're getting an enormous amount of adrenaline pumped through your system. Young men will go to great lengths to have that experience...At Restrepo, every guy up there was almost killed, including me... There were guys walking around with bullet holes in their uniforms, rounds that had cut through the fabric and didn't touch their bodies.” (Junger, Why veterans miss war, 2014).

“The majority of veterans find purpose and meaning in their military service. It can be a struggle to find that same sense of purpose as a civilian which may ultimately lead to feelings of despair.” (Castro & Kintzle, 2014).

Viktor E. Frankl in his book “Man’s Search for Meaning” writes extensively about despair and the need for human beings to have purpose in their life. He says,

“Woe to him who saw no more sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost. The typical reply with which such a man rejected all encouraging arguments was, “I have nothing to expect from life anymore.” What sort of answer can one give to that?” (Frankl, Kushner, & Winslade, 2006).

 

The veteran who has nothing more to expect from life is at risk of suicide.

 

The Solution

 

Research

Grants and funding need to be made available to individuals and institutions to research the way in which the warrior culture predisposes veterans to suicide with a specific focus on veterans’ relationship with death.

Prevention

The current strategies of prevention often depend upon a “helper” being able to recognize the symptoms of suicide and then be skilled enough to intervene before the individual at risk takes action. Most prevention efforts take the form of educational briefings that place the onus of prevention on the “helper”. For many of my friends, the suicide happened so fast that there was never an opportunity for anyone to intervene. If the real problem of veteran suicide is a matter of culture and conditioning then the solution must be a solution of culture and conditioning. The focus of prevention needs to shift from external to internal. We at Valhalla believe that adding one phrase to the warrior ethos’ of all the services may be the key to solving the death before dishonor problem. That phrase is “I will never kill myself”.

We understand that what we are proposing flies in the face of the modern efforts to reduce the stigma of suicide but reducing stigma has not worked. It is time to change the way we think about veteran suicide by recognizing that veterans are not civilians and our value system is the key both to the problem and the solution.

Intervention

Training people to intervene is a critical task that must be implemented into any suicide prevention program. When a “helper” is equipped and trained to recognize and respond to suicidal invitations it increases survivability for Warriors who are struggling. This is why Valhalla Veterans Services trains people using the Applied Suicide Intervention Skills Training workshop. The workshop builds confidence and competence in people who want to help prevent suicide. We offer these programs at no cost to participants.

 

Follow‐on Care

The situations that lead people to suicide are often complex and require follow‐on care in the form of one‐on‐one counseling. Valhalla Veterans Services provides one‐on‐one counseling at no cost to Warriors and their families to mitigate the situations that contribute to suicidal ideation. We are uniquely equipped to deal with Warriors because we are Warriors, and we speak the same language and understand the culture.

 

Education

VVS takes every opportunity to conduct briefings and educational seminars to educate people about “The Deadly Recipe of Warrior Suicide”. Briefings conducted for the Army National Guard have resulted in interventions and follow‐on treatment.

 

Networking

We know we can’t solve Warrior suicide on our own. There are multitudes of resources available to Veterans but the chore of connecting to those resources is often a daunting challenge. VVS is working with other groups to create a comprehensive online based network that will assist all groups involved in assessment of suicidality and referral to either clinical or social support organizations.