Healing Combat Trauma

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

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Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

Prevention Talk and Prescriptions Apparently Not Doing It: Army and Marine Suicides Both Up

"The grand essentials of happiness," Allan Chalmers wrote, "are something to do, something to love, and something to hope for." Those words echoed in my mind yesterday when I met a remarkable woman vet in Seattle, who ten years ago was homeless, suffering from MST and PTSD. (Today she's a vital, contributing member of her community, solving problems for herself and other veterans in need, on a large scale.) 

We were talking about suicide prevention, a cause close to her heart, because she'd lost a daughter to suicide, and recently a friend as well (Orrin McClellan, who we wrote about recently on this site.) We were talking about suicide, and how Army and Marine numbers are still up, despite prevention strategies. She said, pointedly, that she'd learned that veterans (and others) who are struggling with suicide need "three things" in their lives to keep from killing themselves. What they need are: "a reason to live, a way to live, and a purpose to live for."

Salon magazine had an excellent but gut-wrenching article earlier this week by Mark Benjamin called "A Predictable Suicide at Camp Lejeune," subtitled, "A doctor warned that mental health care for violent, disturbed Marines was inadequate. Sgt. Tom Bagosy proved it." The story profiled the violent death of Marine Sgt. Tom Bagosy, 25, on the way out of the Deployment Health Center. (Bagosy leaves a wife and two children.) Less than a year ago, Salon had run another article by Mark Benjamin about a Marine Corps psychiatrist, Dr. Kernan Manion, and his specific, whistle-blowing warnings about the inadequacy of mental health care at Camp Lejeune -- warnings he took all the way to the president, and seemingly for which he was fired a few days after voicing them. (Here's the link to that earlier article, including his warnings.)

Marines initiated a new suicide prevention program last year; but suicides have only increased. They lead the services at this point. Army numbers are up as well. According to a report released Thursday, and carried on CNN, 32 soldiers killed themselves in June, "the highest number in a single month" since Vietnam. Twenty-one of of the soldiers were active duty, 11 were inactive Guard or Reserve; and seven of them killed themselves while deployed. A quote from the article, "Army officials admit they still haven't answered the question of why troops are committing suicide at a record rate."

While Marines sometimes mock the Army's slogan of an "Army of One" -- preferring instead to focus on the group -- the reality is, both branches are seeing heavy combat and neither one is excelling at helping troops not commit suicide. New programs get trotted out, new initiatives, new videos. But none of them are getting the job done: not alone, not together. Troubled troops and veterans are simply not listening; or not hearing what they need to hear. And what would that be?

Well, Mass. General Hospital is having their second annual conference right now on the "Complexities and Challenges of PTSD and TBI," and they're doing a great job "Tweeting" the speakers' points in real time. Here are a few excerpts of note, starting with a crucial one: "Only 30% of troops self-identify as needing help before committing suicide -- despite all the proactive intervention points." And again: Only 42% of troops who screened positive for mental health problem actually sought help from doc or spiritual advisor." PTSD is initially difficult to distinguish in troops because upon their return home, "initial relief and euphoria" at being back can mask it. But over time,"After 8-10 weeks and adjusting to a different life schedule at home, symptoms start to present."

This fits right in with the stories you hear from people coming back, that they don't want to talk about it or think about it (PTSD); they just want to get on with their lives, and fit right back in to where they were before. It's later on, when this adjustment doesn't work, that things get more stressful. High unemployment can't help: veterans' unemployment is significantly higher, in the recession, even that the national average. And troops have gone from being highly focused on the battlefield and engaged in their warrior purpose to losing that and perhaps not being able to replace it immediately with another. They've also gone from a high level of camaraderie with their buddies often to being quite geographically separated from those they were close to when deployed. Marriages and family life can be rocky as well. The relationship they were dying to get back to on the battlefield may have evaporated by the time they got home; or not make the adjustment intact. Again from the MGH conference: "78% of marriages end in divorce for first-time deployment troops."

Against all these backdrops of difficulty -- and an awareness that the "gold standard" of treatment is still talk therapy and psychopharmaceuticals -- the problem persists, compounded by sleeping pills that can be dangerous, and the ever-present self-medication strategies of alcohol and street drugs. It's hard to get the formula right for the correct medication(s) at the correct dosage(s), and until that happens, veterans frequently talk about feeling numb, in a stupor, not feeling like themselves, etc. Vets don't necessarily want to talk about what they've been through -- except perhaps with one another, and even then, not that much -- and ignorant questioning about how many people they've killed while they were over there, etc., just exacerbates the problem. So enough of the bad news...of which there is plenty...what can vets possibly do to increase their chances of surviving and adjusting? Because I highly doubt it's gonna be another prevention video or poster that does the trick, however well-meaning.

If everyone wants an easy answer, maybe they won't like this. But it seems to be that it's time to return to replacing one purpose (warrior) with another (warrior on the homefront), and putting some time and thought, effort and resources into what that will be. One veteran who made the transition from serving to the fire department, felt he literally replaced his one purpose, and one set of buddies with another; and that "substitution of purpose," as it were, was what helped him survive. But not every vet will be so lucky, or have or make that opportunity. 

If we take a look back at the Chalmers quote that opened this discussion, what are the three "grand essentials" for happiness (i.e., well-adjustment) that he cites? Something to do, love and hope for. And what are the three things that help a vet prevent suicide, according to the suicide counselor vet? Three very similar things: a reason to live, a way to live, and a purpose to live for. Veterans are warriors...and cast aside from their purpose, without an effective way to replace that immediately, it's possible they flounder. As a society, as those who "support" our troops -- whether professionally or personally -- what can we do to make sure that they have all three? With a little reflection, we can see where they had them in combat. Something to do (be a warrior); something to love (family, country, buddies, the mission); and something to hope for (winning; getting back home alive; reuniting with family and friends; keeping your buddies alive). What I suspect, sadly, is that from those adrenaline-charged heights, life on the home front, potentially unemployed, over-medicated, and disconnected from family and friends, there can become a time when there's not enough "reason" to live; there's not enough way to live; and there's definitely a loss of purpose to live for.

A better use of resources than more videos, etc., though would be: focusing on what would it take to give veterans their purpose back? And not entirely how could be do it for them, but how could they join in that mission themselves? Every veteran affects the lives of 50 other people, minimum; so whatever happens with them back on the home front is a ripple effect. Let's focus some energy on the topic of continuing life with a purpose; versus watching on with sadness and despair the continuing tragedy of young vets (and older) taking their own lives. They've given too much; and they deserve so much better. So while pep talks on prevention and prescription pharmaceuticals don't seem to be doing the total job when it comes to suicide prevention, maybe it's time to bring back talk about purpose -- and how to continue that successfully, after the deployment is over and the uniform is hung up for the time being.

In a related side note, apparently mental health plummets when distressed individuals can't "do" to solve their situations with personal effort. There's been talk in the news lately about mental health issues soaring in the Gulf states after the BP eco-disaster, and that money needs to be set aside to help with those; but in that, there's also discussion of what happened after Hurricane Katrina. Apparently, after the hurricane hit, those affected started immediately to do what they could to restore their lives. (Think of all the news footage we've seen of residents after large-scale disasters, sawing up downed trees, hauling lumber to shore up makeshift housing, etc.) What's now surfacing anecdotally are stories about while this busy-ness after the disaster was therapeutic for people -- helped them to get their minds off the tragedy by putting themselves back to work -- when FEMA came through and made everything grind to a halt while they inventoried the situation -- people's grief and despair rose up in waves, with nothing to "do" to distract them.

Much is made of the "adrenaline rush" of combat, and how it's very hard (hmmn, likely impossible) to match that in civilian life -- but at the same time, there's also definite "purpose" -- of getting the job done, of keeping your buddies alive, etc. After combat...it's suddenly very quiet, and boring by comparison. "War is hell, but peace is boring!" some veterans joke. Cast adrift without the shared common and energizing purpose of combat, in their early 20s, veterans need quickly to find something to "do" that matters to them -- something they can live for, love and enjoy, that satisfies them and makes life worth living. Sadly, far too many people are checking out when they can no longer find a reason to live, and in tragic stories like that of Marine Sgt. Tom Bagosy, or Orrin McClellan, you get the impression they don't feel like they had any other choice. Tragic. Not just for them, but for the people they left behind, whose lives will also forever be marked by this experience. Such a tremendous loss...and possibly, preventable: If not for them, at least for some others. Let's try.

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

This is an article I'd first started writing two years ago now. I did the research, and located the main, most often-cited study's principal investigator, long since retired, and asked him to confirm whether the trend is still true, though he first published it back in the 1970s. He affirmed that it was. What it is is an important and often-overlooked "connection" that will make more sense when we start describing it. It also fits into the category of things where the information is out there, but for some reason is also strangely ignored. Another instance was a few years ago, when the military kept saying, "We don't know what PTSD is tied to"; essentially, "we have no idea." Yet at the time, and this goes back several years now, I was able to read through the existing literature and learn, PTSD is tied to combat exposure. In other words, the more combat, the greater the chances of developing PTSD. And I wrote about it, here, at the time the military was saying, in essence, we don't know what it's linked to.

So it isn't that that wasn't known...it's that no one was paying attention to what was out there. (And these days, several  years later, they ARE admitting publicly that more exposure = greater chance of developing PTSD. But it does make me laugh a little bit to hear that now, thinking, we were talking about it here well before that was being said publicly. And not because of some strange prophetic abilities on our part; just from reading the available literature, and drawing what seemed like obvious conclusions.)

There's the old saying that "those who refuse to learn from history are condemned to repeat it." Well, much of what's known about PTSD has been known for decades now, with another fair part of the knowledge base has been increasing exponentially. I read an article the other day about a Harvard-trained psychiatrist who worked at the V.A. in Boston during the Vietnam war, and was "shocked" to learn that there wasn't a single book on war trauma in the library there. Today, one would hope, that situation has changed quite a bit. 

But to the point at hand...

As I read through my Twitter feed today (you can follow us @HealingPTSD on Twitter), I noticed several suicides being Tweeted by various sources. One was that of Mel Turpin, a former All-American basketball player and NBA star, dead at 49; and then the troubling news, especially to us in the veterans community, of a Marine Corps veteran, James F. Popkowski, 37, who apparently died in a "suicide-by-cop" or armed confrontation outside the V.A. in Bangor, Maine. (See those stories linked here and here, as well as a longer quasi-obituary of Popkowski, here.) At first the headline said only "an armed man" had died in a confrontation with police near a local VA -- and as soon as I read that, I hoped -- but yet somehow knew -- that it would be a veteran, with a painful story of his own. Later the news matured to show that in fact he was a veteran, who was struggling with this illness (cancer) and its treatment. But the fact he was a veteran and committed suicide reminded me instantly of the news from the last few days, where the Seattle Times did such a good job covering the suicide of a veteran with PTSD from Whidbey Island, Orrin McClellan. (I wrote about Orrin's life and death here and here.) So many suicides in the media, and superstitious types tend to think those run in threes -- though technically McClellan's death was in mid-May, with the coverage of it in the media happening over the last few days.

I need to branch off in two different directions here, to cover this material. 

One is to talk about the V.A. suicide's statements about his own condition, because veterans with PTSD and their family members may recognize their own veterans in those words. And the other is to introduce something very different, which is the effect that media coverage of suicides has on "successful" suicide attempts by others during the same general news cycle, especially young men (who are, after all, the majority of those who serve.) 

On that second point, as the military has generally speaking tried and failed to lower the suicide rate lately, I haven't seen much recognition (OK, any) of the idea that suicides are to some degree contagious. There's quite a bit of medical literature on the subject...and it's been documented in studies around the world, starting in the 1970s, that suicides reported in the news will have a demonstrated effect on increasing suicide attempts from specific populations who hear the news. Since suicide is a broad category -- many single-car or single-motorcycle accidents are also suicides -- and the military attempts periodically to crack down on motorcycle safety, etc., it would also be wise to enlarge the conversation to not only what other methods qualify as suicides, but also to take a look at how one suicide making the news can, depending on how it's portrayed, have an effect on increasing the number of other suicides that take place in the same general time frame, especially among those prone to committing suicide, because of depression and other factors. And we haven't even mentioned yet here the effect that some prescribed pharmaceutical medications can have on increasing suicidal thoughts.

(While it's somewhat unlikely that Popkowski, in Maine, was reading the Seattle Times' coverage of Orrin McClellan's death -- one, we never know; and two, in the age of the Internet, geographical barriers have disappeared and the news is instantaneous -- especially if you include other social media, like Facebook and Twitter, which can serve as additional sources of the same news. We're so much more wired now than when these studies first started being done, so we can't assume Popkowski didn't read the Seattle Times coverage, even though it's most likely that he didn't. For the sake of this argument -- because if it didn't happen with this case, it surely does with others, let's pretend that Popkowski did spend some time over the last few days reading the coverage of McClellan's suicide on the Internet.)

There's enough material to cover here that I need to go as far as I can with it now and then circle back around to it again soon. We'll introduce the science (below) but also cover what Popkowski said about his failing health, because his words will resonate with other veterans, who struggle not with cancer but with PTSD.

According to the article in the Portland, Maine Press Herald today, Popkowski, who had undergone a stem cell transplant for his cancer back in 2003 at the National Institutes of Health, struggled valiantly with the effects of the cancer and its treatment (both difficult), as well as sleep problems, depression and the like. In a letter to the editor of the magazine "New Scientist" back in 2008 he wrote,

"Suicide is like a little devil, always on my shoulder and always tempting me. Concern for the care of my three dogs after I am gone, my dogs being the only things I feel anything resembling passion for, is the only thing I think that has kept me from pulling the trigger on the loaded pistol, which rests next to my pillow."

He continued,

"The best way to describe the mental and emotional issue is that I am numb and passionless. Nothing brings joy or pleasure. I graduated magna cum laude with a (Bachelor of Science degree) in computer info systems and business management in just three years. Now, I cannot mentally focus enough to read a newspaper."

He added,

"I have lost count of the number of sleep aids NIH and my local VA have tried. Like the anti-depressants, none have worked."

And he described leaving his bunker, in terms that a veteran with PTSD would understand, only for brief forays out to re-provision with groceries and return, if his health even allowed him that. He wrote:

"For weeks at a time I will only leave my house once, and only briefly at night, to buy groceries and other supplies. Most of the time, the only time I drag myself into the shower, is when I have to go into town to buy groceries."

---

Now, we hope that no veteran ever crosses the bridge to suicide in his or her lifetime, and especially is not discouraged enough reading news of how another distressed veteran felt to contemplate it. Please use the resources at your disposal, including hotlines, buddies, and compassionate others as lifelines to not give up hope, because there IS hope, and you can get better. But for the rest of us, we need to keep pushing on with this narrative because there's something to learn here, including for decisionmakers who wonder about how better to educate about suicide prevention. This is where the element about the notoriety/publicity level of a suicide influences other at-risk populations.

To the science on this.

• Back in 1977, in the journal Science, DP Philips showed that "motor vehicle fatalities" (including "suicides by motor vehicle") increase in the time frame "just after publicized suicide stories." From the abstract: "The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents."
• In 2006, an Australian journal, Social Science Medicine, published a similar study, further demonstrating the "relationship between media reporting of suicide and actual suicide." They studied data on "4,635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. The study found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide." They concluded, "Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm."
  
• Versions of the original study were repeated over and over in the intervening years, and 30 years later, in 2007, the International Journal of Epidemiology published a study which showed "the influence of media reporting of the suicide of a celebrity on suicide rates," where a male television celebrity in Taiwan committed suicide, followed by a wave of somewhat "copy-cat" suicides among young men. (The "celebrity" element may initially confuse, but think of it this way -- it's a well-publicized suicide when it happens, which means it reaches most of the target audience. It also happens, according to other studies, when non-celebrities commit suicide. The distinguishing factor is how well publicized the suicide is/how much media attention or coverage is given to it. The more coverage, the more people know about it, including those in somewhat fragile populations.) Back to the study's results: "After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV  actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect."
• Also in 2007, a study was conducted in Taiwan around the fact pattern of the same television celebrity's suicide and published in the Journal of Affective Disorders. It attempted to define the "influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder," and what it found was "Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72)." The authors concluded, "This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt."
• This year (2010), another Taiwanese study took a look at suicide rates after media reporting of another celebrity suicide, this time a female singing star. Their premise was that "Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters." In their study, "Sixty-three suicide attempters registered in a surveillance system of Taipei City Suicide Prevention Center were assessed using a structured interview soon after media reporting of the suicide of a young female singing star." Their results? "Forty-three (68%) respondents had encountered with the suicide news. Among them, 37% reported being influenced by the media reporting on their subsequent suicide attempts." Most hard-hit by the news? "Men (adjusted OR 6.36, 95% CI 1.29-31.44) and younger age groups (adjusted OR 4.93, 95% CI 1.04-23.45) were more susceptible to the media reporting." And the authors concluded, "This study has provided further evidence for suicide imitation among vulnerable people encountered with media reporting of celebrity suicide, and for the need to actively restrain reporting of suicides to decrease the imitation effect."

It's also true that young men -- the dominant demographic of who the all-volunteer military is these days, though approximately 11% are women -- are more prone to suicide than other age groups. Back to the science:

• According to statistics from a fact sheet on youth and violence provided by the CDC, "In 2005, 17% of high school students seriously considered attempting suicide, and 13% made a plan about how they would attempt suicide during the 12 months preceding the survey." (The reference cited is CDC. Youth Risk Behavior Surveillance - United States, 2005.  Morbidity and Mortality Weekly Report 2006; 55 (SS-5): 1-112.)
• Similarly, according to the CDC, "approximately 14% of all deaths among children and adolescents aged 5-19 years result from suicides."  The numbers climb according to age ranges, with younger children having the fewest, and older children the most.  Suicided ages 10-14: 283.  Suicides ages 15-19: 1,700.  (The reference cited is CDC, National Center for Injury Prevention and Control, Office of Statistics and Programming. Web-based Injury Statistics Query and Reporting System (WISQARS). Online at http://www.cdc.gov/ncipc/wisqars/. Accessed September 6, 2007.)

There's more that we could talk about here -- responsible reporting guidelines about suicide, when disseminated and implemented, seem to have the effect of reducing the number of copycat suicide attempts after a successful publicized suicide (a study in Austria shows that) -- but the intended effect here, which we can elaborate on in future posts, is to introduce the idea that one publicized suicide by, say, a veteran, can also most likely encourage an increased number of suicide attempts, some of them successful, by members of at-risk populations, such as young/depressed/men. Do any of those words correlate with anyone who might be suffering from PTSD, or taking medications that might also increase suicidal thoughts? And we haven't even added into the mix the effects of alcohol, which many PTSD sufferers self-medicate with, and how that would affect suicidal thinking. There's much, much, much more to talk about on this topic -- not just here on this site but nationally -- but we hope this dense, rather convoluted post has at least gotten you thinking about not so much that we need to protect veterans with PTSD from seeing or reading the news, which might contain an item about another veteran's suicide -- but that suicides can almost go in waves (read the literature on prison populations, etc. for this), where one suicide spurs others in the same population -- because publicity surrounding a suicide has the unintended consequence of increasing suicidal tendencies in other affected people. Since many, many veterans with PTSD are to a degree on edge already...it might be good to realize the effect that reading about another veteran's demise could have on an already depressed, stressed or demoralized individual.

And since the larger goal for all of should be preventing suicides among PTSD-injured veterans, it's highly worth having this conversation.

Anatomy of a PTSD Suicide: Orrin McClellan Was "Only Halfway Home" from War

"Happy families are all alike," wrote Leo Tolstoy, the famous Russian novelist (and combat veteran), in the opening lines of "Anna Karenina," adding, "every unhappy family is unhappy in its own way." And certainly few families are unhappier than those who've lost someone they love deeply to suicide, as Orrin McClellan's parents have, who've recently lost their Airborne soldier son to the aftermath of PTSD.

We wrote about Orrin McCllelan yesterday, the 25-year-old OEF veteran who took his own life in May of this year. The article, "Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD," is linked here. The underlying Seattle Times article, also from yesterday's paper, is very good, and combines multimedia with the telling the story of McClellan's all-too-short life and struggle. It also documents the pain and suffering McClellan's parents are going through.

There is no "purple heart" for PTSD. There is no "war memorial" that lists those who died by suicide from PTSD, even when combat was the most likely explanation. And maybe there should be... But in the meantime, all we can do is try to reconstruct what we can find about who Orrin McClellan was in the 25 short years he was here.

Digging around on the Web, we can find out much about who McClellan was. The exercise becomes less macabre, or voyeuristic, than the assembling of an online shrine to the memory of someone we never knew, who's now too soon gone. There are the two online journals that McClellan kept, at MySpace and LiveJournal. There is his photo stream on Flickr. There is an obituary by a caring friend, who attended his memorial service. There is McClellan's listing at an online dating service, "Hot or Not," which he set up when he was in Afghanistan, and elsewhere pans with the single word, "whatever." There are some videos that a friend shot of him, who mourns his passing and wishes he had captured a few more shots of McClellan while he was still alive. There are the photos and the poems that his family shared with the Seattle Times, that are part of the original article. And there is a truly beautiful video about his deployment to Afghanistan, called "They Carry," that McClellan himself pieced together, shown on YouTube, and set to music: not heavy metal, but classical...He uploaded it in late September, 2007, after he got back from Afghanistan, and it carries the interesting descriptor: "this generation's wars from eyes on the ground...the faces and names are placeholders. those who were there remember. the rest can only watch." WELL worth viewing...

His interests, as he discloses them on one of the two online journals he kept, are nothing out of the ordinary: places he's been, music he likes, hobbies: "airborne, american beauty, army, dave barry, death cab for cutie, flickr, glen phillips, haruki murakami, italy, langley, lava lamps, led zeppelin, military, muse, orbital, photography, pink floyd, quentin tarantino, seattle, the big lebowski, toad the wet sprocket, vicenza, washington, whidbey island."

There's his brief description of the key dates and places in his short life, again from an online journal:

"Born in Milwaukee, WI. But home is between the Cascades and Olympics on the Puget Sound. Grew up in Langley, on Whidbey Island, Washington. Enlisted in the Army in late '03, started Basic in Feb '04, Airborne School that June, got to Italy that July, and to Afghanistan Mar '05. Getting out Feb '07."

(In September of 2007, he uploaded the excellent video, "They Carry," of his time in Afghanistan.")

And then there are the news items about him, focusing on an arrest, locally. And what look like three court cases: in July of 2008, January of 2009, and September of 2009, listed on King County Superior Court's website.

In July of 2008, he was in the local paper, for assaulting some cops at a concert, allegedly threatening to kill them, gouging one of their eyes, and basically asking for them to shoot him. In October of 2008, he's back in the news locally, after being acquitted of assaulting and threatening police officers in the earlier event. He spent time as an inpatient at the VA for PTSD. He also lived too far away to make regular treatment a likelihood, and getting there, via a ferry trip and highway driving on I-5, was triggering.

His parents, who describe themselves as self-employed and dedicated (i.e., more available than most) seem to be doing everything in their power to help him, but he is melting down. The previous article, yesterday, describes some of the symptoms of his raging PTSD. The two articles in the local papers also detail the attempts his family made to get him help.

In one of the articles, his mother is quoted as saying, "We must not stop with research and development of the healing of visible wounds and helping the veterans become whole with prostheses for severed arms and legs. We have a responsibility to get just as expert at healing the inner wounds of the body, mind, emotions and spirit.”

She also goes right to the heart of the matter when she says, also quoting from those articles, "Our military is well-versed at training our sons and daughters to be experts in weapons, combat and killing, and distrust of the other, but they fail to complete their warrior training of our troops by failing to train them in the skills of regulating the emotional responses of the body, mind and spirit after experiencing the traumatic horrors and terrors of war, and in the skill of reintegrating into families and communities.” 

When she talks about her son's difficulties, she is very clear: "Our son, only halfway, came home from the war; half of him is still fighting over there, within his body, mind, heart and soul,” Gorman said. “Every day, all the time.”

Unfortunately, on May 18, 2010, Orrin McClellan lost that fight. And his family, and everyone concerned about combat veterans and PTSD in America, grieves with them.

Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD

The Seattle Times has an article in yesterday's paper about a young Whidbey Island OEF veteran who unfortunately killed himself in May of this year. Orrin Gorman McClellan served with the 173rd Airborne Brigade Combat Team in Afghanistan in 2005-2006. He took a lot of photos of his experience in Afghanistan, and he also wrote, poignantly, about his experiences as a soldier in an online journal, where he wrote every day. (The article doesn't reveal the location of that journal.) In what's known in the journalism biz as a "package," the article also has two multimedia presentations included with it: a video of his parents leafing through a book they're putting together of poems Orrin wrote, linked here, and a video narrated by his parents of some of his photography from Afghanistan, linked here. "I've become numb," McClellan writes, "but not comfortably so."

It's wrenching watching his parents in the videos sit side-by-side on the couch, in a tableau no doubt repeated across America, as the parents of the approximately 18 veterans a day who kill themselves must do, trying to make sense of why Orrin had to go, and still actively grieving, trying to come to terms with their own loss. In Orrin's case, his mother is a social worker, who the article says specializes "in the treatment of traumatized individuals." Of course, not even a mother with this background can necessarily save her son, which only adds to the tragedy. It says his mother even "took a counseling job with the Whidbey Island NAS and helped her son navigate through the VA system." He was retired with a 100% disability due to PTSD. The article quotes the mom as saying that as a community, we all need to listen better to our vets. And practice "deep listening" to their stories of what they've gone through.

What makes the article good, from this reader's perspective, is that it positions Orrin McClellan's death against the backdrop of the statistics of veterans suicides across the country, and then projects how those statistics affect Washington state, where the Seattle Times is based, and where Orrin lived. Eighteen deaths of veterans a day, the number of suicides approximating deaths in combat this year -- these are shocking statistics, but like so many others, we become numb to them over time. Bringing it closer to home, those same statistics mean of the almost 36,000 OIF and OEF veterans from Washington state, a dozen would be lost to suicide. In 2010, Orrin McClellan was sadly one of that number.

(Army veteran Chris Loverro, who served with the Stryker brigade from Fort Lewis, Washington, did a poignant video of his own about PTSD and suicide in the life of a veteran. We've shown it in a recent article, linked here.)

McClellan's mother, Judith Gorman, says that her son never really came all the way back home, because of his PTSD. Retired Army General Eric Shinseki, now head of the VA, is also quoted in the article, as ruminating -- perhaps not about McClellan's death in particular but about veterans' suicides in general -- that he often asks himself, "Why do we know so much about suicides, but so little about how to prevent them?" That's a fabulous quote, but it's also quite a profound question.

Edwin Shneidman, the so-called "father of suicidology" -- who ironically got his start leafing through files at the VA, reading suicide notes of veterans -- is someone we've written about a fair amount on this site. He's also known as the originator of the concept of a "psychological autopsy," where someone, reasoning backwards from the fact of the a person's death, tries to reconstruct the extent and timing of the stressors in that person's life, to determine how and why it became too much for them (the "when" having already been determined.)

I'm not sure, but I would hazard a guess that, other than the families of veterans who commit suicide, who are directly involved, there isn't much of an effort made on a larger level to reconstruct what stressors became unbearable in the lives of those who kill themselves, during or after military service. Perhaps a broader study into this, a la Shneidman's methods, would produce important or helpful conclusions.

McClellan's story is in many ways all too typical...except for the social worker mother, and the wonderful legacy he left behind in the poems he wrote and photographs he took. He struggled, as many veterans with PTSD do, with drugs and alcohol, with trying to fit back into his life, with impulse control, with hypervigilance, with nightmares, with combining alcohol with prescription medications, with grief and perhaps blaming himself over the deaths of two close friends. And he struggled with long drives to the VA, which was located quite a distance from his home.

His parents sound like amazing people, who tried so hard. They even established a Veterans Resource Center, on the island where they lived, "to offer referrals, networking and other assistance," to help other veterans in addition to their son. In the wake of his son's death, they may also publish a book of his writings, to raise awareness about PTSD.

Digging around on the Web, especially within social media, it wasn't hard to find some of McClellan's thoughts. He had two journals where he kept his writings, one on MySpace and one on LiveJournal. I've chosen not to link to them, to protect his privacy in case that's an issue. But in one he quotes from T.S. Eliot's famous poem, "The Hollow Men," which closes with the memorable lines about "this is how the world ends, not with a bang but a whimper."

It also contains an entry from September of 2008, while McClellan was actively struggling with PTSD, but a full year and a half before he ended his life. In an entry called "What the hell happened to me?" he writes:

"I read some entries in my journal from two years ago" 

[2006, the end of his Afghanistan deployment and beyond]

I love who I was.

Why did I do this to myself?

Was it war?

Did I implode from all the shit I saw?

Or was it something else?"

Questions really with no answer. He goes on for a bit more, and then concludes with the poignant question:

Why did I let myself

Get so lost?

RIP Orrin McClellan, gone too soon, and comfort to your family and your friends.

Editor's note: The photo is of a point on Whidbey Island, a thoroughly beautiful place in Washington state.

Quotable Quotes -- Former U.S. Senator Bill Bradley on PTSD

Former U.S. senator Bill Bradley (D-NJ), NBA Hall of Famer, and Rhodes Scholar, had this to say in a commentary published in Vanity Fair today about PTSD. The occasion was the premiere of the Tom Hanks/Steven Spielberg/HBO miniseries, "The Pacific," about U.S. Marines in the Pacific during World War II, also getting screened privately at the White House today.

Bradley thinks there are several things that the president and the first lady should be thinking about while they watch the miniseries. One of those topics is PTSD. Says Bradley:

"Both The Pacific and Band of Brothers focus on the horrors of the war and the emotional trauma that a soldier or Marine can endure. P.T.S.D. should be treated with as much seriousness as a gunshot wound. If the president is going to send tens of thousands more troops [into combat], he also needs to consider the emotional payload. With suicide rates up among veterans -- accounting for 20 percent* of all suicides among Americans -- the government must dedicate more money to support programs for our returning troops."

Editor's note: If 8,000 veterans kill themselves every year, conservatively, and the national suicide rate is close to 34,000, according to the NIMH, the percentage of suicides who are veterans is closer to *25%. They also represent almost 50% of the homeless population. So yes, please, let's do that...and sooner rather than later...

(The full commentary is linked here.)

Shneidman and Camus -- Suicide as "the Fundamental Question" of Philosophy

"Suicide is up in the military once again, and it's also up among veterans -- those who have been deployed previously. While "National Mental Health Awareness Month" may still be a few months off -- in May -- but it's interesting to note what existential philosopher Albert Camus wrote in his book, "The Myth of Sisyphus":

"There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy."

And also humanity, we might add...because it figures in there, too.

Dr. Edwin Shneidman, the compassionate genius considered the "father" of suicidology, who sadly passed away a few months ago, wrote about how suicide is a narrowing of the distressed person's field of vision, until they can see only two options: staying or going. Without broadening the options to three or more, the way that healthier people think, a distressed person may vacillate between these two options until the pressure in their life mounts, and they can only "see" the one option, and their timing suddenly becomes a desperate "now."

(Clearly, suicide is an event with much collateral damage, particularly to those around the person in pain, who can have an understandably extraordinarily difficult time coming to terms with how or why that decision was made. Read Shneidman; he understands. In one poignant passage, quoted here, he describes the mind of the suicidal person closing down in restricted vision until, not that the victim doesn't care, that he or she can no longer see who else is in the picture, so great is their personal pain.)

While there's much material on this website about suicide, particularly here -- and also help numbers to call if you're in distress, linked here -- I mention the Camus quote to give a certain backhanded respect to the topic as a whole. Many times people claim, rightly or wrongly, that suicide is the quintessentially weak move, "the coward's way out," reserved for those who can't, or won't, face their problems, others say judgmentally or even sometimes accurately. Yet for those who are suffering greatly, and contemplate it periodically -- as many honestly do -- it's "nice" to see someone with real cultural weight give the question some credence or respectability as a topic. To paraphrase Shakespeare, "to stay or not to stay" may turn out to be the real question, after all...

What the Camus quote implies is that even robustly mentally healthy people, if they're philosophically inclined, have dwelt on or wrestled with at least the abstract reality of the question. (Ironically,  Shneidman's obituary in the L.A. Times, linked here, mentions the same quote, and that Shneidman was a fan of Camus.) If we combine their perspectives imaginatively, true mental health might mean wrestling with the topic conceptually, but then enlarging the field of choices so that it doesn't have to become an option that is used. Could open discussions arise from removing the stigma around even broaching or discussing the topic? More on that later...

Editor's note: Cribbed directly from my friend Kathie Costos' blog, Wounded Times, here are the phone numbers and the information for veterans questioning suicide -- some of which support family members as well:

• Vietnam Veterans of America, Crisis Phone Number. Special Notice: If you are a veteran in emotional crisis and need help RIGHT NOW, call this toll-free number 1-800-273-8255, available 24/7, and tell them you are a veteran. All calls are confidential. http://www.vva.org/.
• Also, Veterans’ Crisis Intervention Hotline: 1-888-899-9377. A Crisis Intervention Hotline has been established by the VA Heartland Network to assist veterans who may be dealing with a mental health crisis or difficult issue in their lives. The hotline will also aid family members or friends of veterans who need help in assisting a veteran in crisis.

More Vietnam Veteran Suicides Than Combat Deaths -- Poem

Miles of Bones

"58,000 suicides
is a lot of bullets

wrecked car's
ruined veins

dead bottles
kids without fathers

American flags

& miles of dirt dug

58,000
the number of Vietnam

veteran suicides...
it equals the names

on the Wall
today: 7/09/91 8:10 p.m.

tomorrow
we'll exceed it

more suicide
than combat death

If you can't feel
this pain

you're already
dead

all these
bodies

floating
home."

-- by Bill Shields.  Anthologized in "From Both Sides Now: The Poetry of the Vietnam War and Its Aftermath," Edited by Philip Mahony.

Editor's note: Sadly, of course, since the time this poem was written, many more Vietnam veterans and other combat veterans have taken their own lives.

No Easy Answers: Guide for Survivors after a Loved One Commits Suicide

The Mayo Clinic has produced a short, readable, highly useful guide, available online, to how to handle a particularly painful topic: "Survivors of Suicide: After a Loved One's Suicide," which is linked here. As they write, "Bereavement after a loved one has taken his or her own life is often more complicated, intense and prolonged than it is with a death from natural causes. Although as a survivor of suicide you may never fully recover and always feel a loss, you can learn how to cope better and eventually move forward in a way that's healthy." The short, succinct guide encourages the reader to: "brace for powerful emotions after a suicide;" expect certain "physical reactions after a suicide;" as well as "emotions in the weeks after a suicide;" ways to "find support and treatment;" and "healthy coping strategies" after a suicide, finishing up with "the future after your loved one's suicide." Worthwhile guide to bookmark. 

PTSD, Suicide and the Primary Importance of ... Sleep

There's a great article in today's San Antonio Express-News by Sig Christenson, called "War Lingers, GI Suicides Rise."  (The article is linked here.)

It quotes my favorite, retired Veterans Affairs psychiatrist, Jonathan Shay, M.D., Ph.D., and it quotes him on, among other things, the absolute primary importance of SLEEP, which we've talked about many times on the blog before. (Click here for a link to those posts, many quoting Shay himself.)

Quoting Christenson's article, from today:

"The armed services' high operational tempo for the past decade definitely is part of the problem, said (Jonathan) Shay (M.D., Ph.D.). Though alcohol abuse “is a major risk factor,” he said the military's rapid training and deployment cycles short-change troops on the one critical ingredient to good physical and mental health: sleep.

“I've been agitating for years the importance of getting truly realistic policy on sleep,” Shay said. “This is a slow slog because it is so contrary to the macho culture and so contrary to the self-sacrificial culture, which sees self-care like sleep as self-indulgence.”

Let's recap some absolute basics about sleep:

• It's absolutely necessary for mind and body healing, and down regulation of bodily systems;
• It's vital for decision-making and mental health. Studies on drivers who operate on lack of sleep of sleep show that it impairs functioning to the level of alcohol intoxification.
• It's hard to get in a war zone, for any number of reasons: from the operations that go on for days and nights at a time, to the noises of combat, etc.;
• It's hard to get after combat, thanks to nightmares, hypervigilance and arousal, and often the desire to avoid sleep (which brings on intrusive memories, nightmares, night sweats, and the like);
• Chronic lack of sleep impairs mental, physical and emotional health;
• And yet without adequate, nightly sleep -- how is healing going to take place?

There's a great story told about beloved Marine veteran, Travis Twiggs, who we've written about in other contexts.  Apparently his nickname was "War Pig," and it was given to him during a tour of duty at Guantánamo Bay, where after being up for umpteen hours straight, and finally getting a break, he had fallen into such a heavy sleep that he couldn't be roused, and a passing a general had stuck over his sleeping form a sign that said, “Here Lies the Mighty War Pig.”

I know another hardcore combat veteran and former Marine who came with me once to a program that was designed to help people learn how to sleep better.  He bitched and moaned while we were there, quite a bit, about how this wasn't really suited to combat veterans like himself, but whatever -- he persevered, and tried what they had to offer.  The next day, after he flew home, I worried about him because I hadn't heard how he was doing. A day later, he called me back. "I came home and slept for 31 hours straight," he said.  "I hadn't been able to sleep more than two hours at a time since before I left for Vietnam." So my guess is that the method was of some help to him ;-) But imagine not sleeping for more than two hours at a time?  How well would you be able to heal?

Editor's note: Read the rest of the articles we've included about sleep, from previous posts, linked here.