Forgive me for being naive, but I had no idea "suicidology" was such a sophisticated profession. Such specificity! Such granularity! Such nice maps, even. (Thanks, Centers for Disease Control!) Finding out who kills themselves nationally by type -- race, age, gender -- is seemingly pretty doable -- and if you know where to look, the maps already exist. There's something called "the Atlas of United States Mortality," and it's a veritable treasure-trove online of useful and useable data. Here, for instance, is a map of where 20 year old white males, are most likely to kill themselves in the U.S. -- followed by a similar map for 20 year old black males. Notice that, apart from some places in the Southwest, there's actually not much overlap between the two maps.)
Want that same data for 20 year old white women or 20 year old black women? It exists, too. Not sure if anyone's done the Hispanic data yet, but if not, they should. (All the above data is from the PDF, linked here.) Want to find the same data about how many people use a firearm to commit suicide, mapped against a map of the United States? Here it is. Want to find the same information about those who die by motor vehicle accidents (among whom is a certain percentage of undisclosed suicides)? It's here.
In an Op-Ed piece from the Boston Globe from August of 2004, Michael Craig Miller, M.D., editor-in-chief of the Harvard Mental Health Letter, talks about what he learned from doing his own suicide map of the United States. (Ironically, he found that it coordinated roughly with political lines, but that wasn't his only observation, so we'll set that one aside for now, lest it inflame but not inform.) He was surprised to see a roughly three-fold difference between high and low states, even after accounting for age and ethnicity. Searching for the factors that might contribute to this, he speculated:
"Local and individual factors are important: personal loss, family conflict, economic travail and unemployment, the quality of the support system, and cultural or religious beliefs about death or suicide. Easy access to guns is risky for a vulnerable person. Access to mental health services, on the other hand, reduces the risk of suicide, which is usually a result of mental illness. But stigma is an enormous obstacle to treatment. Most people with mental disorders fear a negative or patronizing response, even from health-care providers. The more severe their distress, the greater the dread of reaching out."
I'm interested in this whole topic because I'm trying to figure out how to plot the average age of military members in various states, and their ethnicity -- against their likelihood of committing suicide, even before combat -- to see if we can ascertain whether mental health services are adequate for returning and deployed military in those states. This is pretty much a work in progress, and not the quickest thing I've ever done -- so bear with me over the next few days, as we find this out -- together.
One positive remark by Dr. Miller, concerning military efforts: "The US Air Force has recently achieved remarkable success in preventing suicide. In 1996, the leadership instituted a service-wide program to increase awareness of suicide risk factors and make resources available for treatment. High-ranking officers championed the cause, which helped reduce the stigma attached to seeking help for problems like depression. The result was a 33 percent reduction in the rate of suicide among Air Force personnel."
If this is true/has remained true, I'm curious to know whether the Air Force's program served as a model for the other services. From the absence of any talk confirming that in the media, it would seem that it either hadn't or didn't -- either that, or no one saw fit to mention it. (They have one of the lower profiles of the services in the OIF/OEF efforts.) Another possibility is that there just isn't that much coordination among the armed services on mental health issues, so each service is developing a program on its own -- the time-consuming, re-inventing the wheel kind of way. I really can't speak to that, because I don't know anything about it -- but over the coming days, maybe we'll find that out as well.
Editor's Note: Dr. Miller's Op-Ed piece from the Boston Globe is linked here.
I was hunting around on the Web tonight for material for a different post entirely -- one about the rumor that military chaplains are being pressed into service as stop-gap mental health counselors -- and whether this is a good, albeit temporary solution -- or an overly simplistic band-aid with unforeseen complications -- when I came across this news item instead. It's a pretty good wrap-up, from a good reporter at the Air Force Times, Karen Jowers, about some solutions the military, particularly the Air Force, is offering its servicemembers to cope with combat trauma, PTSD, and long deployments. The article is worth reading, and is linked here.
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As far as the chaplain topic goes, which I wasn't able to find enough information about to verify that it is indeed contemplated, here are some off the cuff thoughts. One is, and probably paramount, anything is better than nothing, if it goes to the good of the afflicted servicemember. If there's too long a wait at the VA to see somebody, provided that the chaplain is generally qualified and perhaps even recently trained in PTSD and related issues, far better to see someone, quickly, than no one, or to have an unduly long wait. It sounds like too many people can't endure the wait, when they've got troubling topics on their minds.
That said, let's hope that's not being proposed as anything other than a stop-gap solution, while the VA fixes the problem it has of too much demand and too little supply (qualified counselors, able to make appointments with veterans.) I only know anecdotally of three different chaplains in the military lately, and the stories are mixed. Story #1, referenced earlier in a blog entry here, is about a chaplain who himself suffered PTSD after being deployed to Iraq, then was sent to Hurricane Katrina while he was still affected, and though he was a middle-aged man with a wife and family, was so stressed out by the experience that he is now divorced and homeless. That's not a good story, but it was told to me by the mother of an Army soldier who committed suicide after coming back from Iraq, and ironically, it was the chaplain who had been a source of support for him earlier; until the chaplain's own exposure caused troubles larger than what he could handle. That's Story #1 that I know about, and it's negative.
Story #2 is the cheery-seeming, snappy-sounding, highly quotable, funny and cool chaplain from the Minnesota National Guard, who's quoted in so many of the NPR stories from 2006. (References to Chaplain John Morris of the Minnesota National Guard on this blog are here, here, here, and possibly here, not to mention, most recently, here.) He sounds generally delightful, sane and grounded -- and really an asset to those he's around. That's Story #2, and it's uniformly positive. We don't know the man personally, of course, but he's made a great impression on us, and, it would seem, on NPR as well.
Story #3 I was exposed to the other night, when I was chasing down more information on the Web about the wonderful Maxine Hong Kingston and the book she edited, Veterans of War, Veterans of Peace. I was able to see her and a panel of combat veterans and interested others, whose pieces make up that book, in Santa Rosa, CA recently, and wrote about it on this blog. I've also watched the Bill Moyers special that aired over Memorial Day weekend last year about her book, which covered a few of the participants as well. There are only two videos I've found on the Web that relate to Maxine Hong Kingston and her work with the veterans' writing project, and recently I watched both of them. They're located here and here. In the second one, one of the panelists at the talk at the Commonwealth Club in San Francisco, in April of this year, is a young Marine named Jim Castellanos, who tells a quite cautionary tale of turning into a conscientious objector as a Marine, and more particularly, for the purposes of this blog entry, about being what amounts to "blamed and shamed" by the chaplain he's required to see, which only serves to further burden the already conscience-stricken young man. (If you want to watch the video, it's embedded below, and Castellanos starts telling his story at about the half hour point into the video -- minute 30 or so.) (See Wikipedia, linked here, for a definition and background of what a conscientious objector is, a term familiar to many of us from the Vietnam War.)
Again, the focus of this blog is apolitical, so including this story isn't to be pro-war or anti-war or anything but pro-veteran. However, his story is pretty troubling, in terms of the communication he had with the chaplain assigned to him. It sounds like the chaplain was a South Vietnamese guy who had immigrated to the U.S., joined the military, and been deployed several times with the Marines. Perhaps his OWN experience of living in war-torn Vietnam as a maturing adult contributes heavily to his own bias, but he appears to not be aware of this bias when he is "counseling" Castellanos.
The synopsis of the story is that Castellanos, who had joined the Marines at 17 in high school, later had a change of heart -- perhaps due to the maturing process, perhaps due to reading more philosophical texts in college, whatever -- and decides that he's really not cut out to be in the military after all -- doesn't want to carry a gun and doesn't want to kill people, for any reason -- in other words, pretty much the poster boy for a well-reasoned, Conscientious Objector -- the chaplain he meets with is someone it's hard to picture has ANY people skills or therapeutic counseling skills. Castellanos tells the story from his own perspective, of course, but it sounds like the chaplain was pretty harsh with him -- and really taunted him, in a fairly unprofessional way -- about his ideology, to the point that Castellanos apparently felt worse off from meeting with him, than if he never had had the conversation.
Later, he's able to meet a more reasonable person and talk to him about his feelings -- not that the Marines ever ultimately accept his plea to become a Conscientious Objector -- but to say that the first chaplain "got all up in his grill" is pretty descriptive. Castellanos was already troubled about his decision, just based on internal pressures he was feeling, and the chaplain did nothing but mock him and essentially increase the external pressures. Someone like this isn't someone you'd really like to see doling out any pastoral care to troops with sensitive issues and psychological pain. Don't take my word for it, watch the video, and hear it from Castellanos himself. So that's Story #3, and the chaplain was very destructive, and insensitive to the point of being actually harmful. So out of three stories: that's one positive and two negative. Granted it's a small sample but it's not filling me with confidence on the topic as a whole. What I'd like to see, and what I'm sure a lot of us would like to see, is the VA just stepping up to deliver the care that's needed, with qualified counselors and speedy wait times for veterans. Stop-gap measures probably shouldn't be anything but the most temporary solution. That said, if it brings any veterans needed relief in the meantime, while the system is being fixed, more power to 'em.
