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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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by Jules Crittenden

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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Comments (6)

Benson [TypeKey Profile Page]:

CBS knows most people never learned that back in 2004, a similar report on the US military's high suicide rate was no less dishonest than the current story. Fortunately this... [medienkritik.typepad.com/blog/20...] ...is still available.

In 2004, the full truth, though exposed by a few webloggers, was not given any significant coverage by the major media. Propaganda is 50% lies and 50% censorship. Together, they keep the public under- and dis-informed.

My suspicion: this factually and ethically bankrupt suicide story is being recycled because the real news from Iraq must be countered.

It's a desperate deceit. I hope the internet throws a fit.

Nov 16, 2007 03:56 AM

kat-missouri :

I commented on Jules original post on this subject and will do so again.

First of all, a little misleading, PTS (acute, short term, Post Traumatic Stress) and the more chronic disorder, PTSD, are fairly recent adds to the list of psychiatric disorders with its own diagnosis code. In previous wars, even during Vietnam, the condition was referred to as "battle fatigue" or "shell shock" and were not considered official, psychiatric diagnosis. Often, these conditions were not even identified as such, but were associated with other disorders such as manic depressives or bi-polar disorder.

Post Traumatic Stress didn't even make it into our lexicon until almost 15 years after Vietnam. Since "battle fatigue" and "shell shock" were stigmatized as the conditions of the weak or the insane, reporting the numbers from say WWII and trying to compare them to modern war in the last half of the century when we actually started tracking it is also a bit misleading. Trying to compare suicide numbers from one time period to another, equally so.

Even after it became recognized, PTS and PTSD were so stigmatized and associated with "crazy" that troops were highly unwilling, even after years from discharge, to admit any symptoms. Here's another fact, while we're trying to discredit these numbers, what we're losing site of is that, people with the "acute" short term version of PTS that actually do seek some sort of assistance are more likely to see a total recession of their symptoms and not drift into the more chronic "disorder". It is among those suffering the "disorder" that suicide is the highest. Thus reduce PTSD episodes to PTS, reduce suicide rates (whatever they are).

While I appreciate the concern over inflated numbers and sensationalism in the press and Hollywood (I never liked Rambo for that reason), I am more appreciative that Mr. Crittendon talked a little about his own experiences and that he said it was "normal". Lifting the stigma attached to such conditions is an important factor in improved recognition, treatment and resolution.

Frankly, I don't see such discussions as trying to make our troops "victims". I believe that our troops, particularly as an "all volunteer force", deserves the best that we can give them and that it is our responsibility to insure that, when they come home, we bring them "all the way home".

That includes advanced prosthetics, improved reconstructive surgery, the best rehabilitation and the best mental health care we can provide them.

I would like to see Mr. Crittendon, with his contacts and wide readership, do an article about that. Then I would be comfortable that such articles trying to debunk sensationalized media reports were really about defending our troops and not about some political disagreement with our media.

Nov 16, 2007 04:29 PM

Benson [TypeKey Profile Page]:

Kat-Missouri:

What, exactly, are you trying to say? I ask because there are several aspects of your comment that seem to me to be mischievous, or at the very least puzzling.

1. You describe various diagnoses and give a brief history of their development, employment and meanings. Why? The dispute here is over the way the suicide story was manipulated, whether meaningful comparisons were deliberately ignored, and whether the public has been propagandized.

2. You refer to "inflated numbers". I confess I missed that accusation. I do recall that in 2004 the issue was that US troops in Iraq had a lower suicide rate than did the German army, which was stationed in Germany. That fact was ignored by the media both before and after it was reported by a few webloggers. My guess - CMIIAW -- is that nobody ever faked any data then or now. Are you saying that someone has accused the media of generating incorrect statistics??

3. You place quotes around the words "all volunteer force." Why? Whom are you quoting? Or are you implying that the volunteer status of the US military today is a hoax? If you are, whom do you accuse of deceit? Do you have documentation suggesting that people are being inducted?

4. You seem to me to insist that Crittenden has gone off the rails: you want him to write about medical and psychological help for veterans, not about "...some political disagreement with our media." Aren't you telling Crittendon to shut up when he sees propaganda that misleads the public, and talk about something else?

My view: this issue begins with the ethics of journalism, and ultimately returns to that fundament. My speculation regarding the media's motives has to do with politics, true; musings of that sort are nothing new, and now that the suicide rate story has been exhumed and is being used to dupe the public, we do need to ponder the media's reasons for resorting yet again to this deceitful tactic. Yes, I did use the word "lies" when I defined propaganda, but this story, the suicide rate ploy, is about one half of propaganda: censorship. My complaint regards the deliberate withholding of data that provide essential perspective.

Don't these considerations introduce politics into the discussion, and legitimately so? Why should we avoid discussing the politics of the media? Don't democracies have to depend on the veracity and principles of journalists?

We do have a serious problem with the disgraceful VA, and we should correct it (I am very upset with Bush over this). We can talk about that, and I believe you and I would agree on it.

We also have a problem with the media that goes to the heart of our nation's values. You want Crittenden to shut up about that, and deal with with other matters.

Why?

Nov 17, 2007 01:44 AM

syn :

Wouldn't it be nice if the Democrat- controlled Congress would pass the current VA bill which was advised by James Baker instead of using the our returning troops to score political points in their quest to get Bush?

Dems, if you really support the American troops then show it by passing a clean VA bill!!!!

That said, CBS News lost credibility when 'fake but accurate' became their professional standard of journalism.

Nov 18, 2007 09:59 AM

ChrisPer :

The story appears to be a non-story designed to score points against Bush and the Iraq decision, but there is something much worse to it.

Suicide stories in the media kill people for real.

Contagion and copycat suicides are a proven result of publicity for suicidal behaviour. Like school shootings, like terrorism, media exploitation is a driving force creating the stories as well as reporting them.

Remember in the late 1970s how Vietnam vets were written in TV drama as snapping and committing mass murders? This story has potential to grow, and be built up in people's minds, and result in a significant number of veteran suicides that would not otherwise have occurred.

Stomp on them, and hard. It could save dozens of lives.

Nov 18, 2007 04:38 PM

kat-missouri :

Benson,

I'll address this directly and I apologize for not returning sooner to review any answers.

First, when I quoted "all volunteer force" it was a quote, not scare quotes or implying anything else.

Second, Jules was implying that these numbers were inflated or otherwise manipulated to infer something that was not. Frankly, without seeing the data, I can't tell whether Jules or CBS is providing anything more accurate as to actual suicides of veterans, the reasons or the purpose for quoting them. Everyone seems to have some sort of political agenda or attempting to discredit the media. Neither of which I care about.

My main concern is that we don't treat PTS, PTSD or suicides among veterans as something that we should shrug off because it is some how less than at some other point in history or the numbers don't jive with our conceptualization of the issue.

The main reason PTS and PTSD with attendant suicides is less than at other points is because we have taken great strides in studying the effects and instituting programs. Some of which are under staffed and under funded to make the impact that is needed.

As far as telling Crittendon to "shut up", I hardly believe I have the ability or status to do so. Neither was it the intent. My concern, as I note, is that we spend a lot of time trying to debunk numbers and having discussions about who is doing what for what reasons. The best way to counter bad information is not only to debunk numbers, but to talk about the real issues sensibly. Further, we have a lot of veterans who read at many sites who may be put off exploring treatment or considering their situation because of these discussions. I'm afraid that we're projecting the "shut up and suck it up" concept above a more healthy "check out this info", "you're normal if you feel this way", "no you're not crazy" and "no, we won't think that you're lame or weak if you're experiencing these issues".

Although, I recognize Mr. Crittendon making an attempt at that subject, it's not his focus in this article. My request was simply to put a thought in Mr. Crittendon's head about a possible future post on the subject.

If I simply wanted to support Mr. Crittendon's points, I would tell him to go to the NCPTSD website and get the data regarding PTSD for Iraq and Afghanistan veterans compared to Vietnam Veterans that states 30/100 Vietnam veterans experienced PTSD as opposed to an estimated 18% for Iraq and 11% for Afghanistan. Iraq being higher due to more intense combat.

My view: I am less concerned about the media than I am about our veterans and returning soldiers. Some of whom might benefit from having the discussion and issues written about by someone who has shared their experiences, like Mr. Crittendon whom, I believe, was on the march up country?

We have 175k in Iraq with tens of thousands that have redeployed since 2005 when the last analysis occurred. Appx 20k in Afghanistan with an equal number who have redeployed in between. In Iraq, 2006 to mid 2007 was the most violent time period. thus, it is likely that there will be more veterans with combat related stress that were not considered in 2005 and were not considered during part of the budgeting process that is the VA funding bill that is still not passed today.

In other words, we are two years behind the gun on this issue.

How do I view the media coverage then? I dislike the sensationalism and the potential for stigmatizing our troops with such coverage, but I have come to view it as the proverbial two edged sword: stigma on one side and the potential to drive such issues as, yes, VA funding, added programs and the military continuing to find ways to address this situation up front where it makes the most difference.

As we know, American voters are notorious for being "emotional" voters. I imagine a nice scholarly conversation on the effects of PTSD, etc probably doesn't drive them much. Sadly, sensationalism does.

For a thoughtful discussion on combat stress and other post deployment issues, please see the veterans at Blackfive: On Coming Home

Nov 18, 2007 04:50 PM

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