When it comes to talking about military veterans, Posttraumatic Stress Disorder (PTSD), and suicide, nothing is simple. What is known is that these three categories are connected in complex and tragic ways. Whereas knowledge increases each year thanks to new research and a systematic observation and discussion of clinical implications and treatment outcomes, the inherent complexity within each of these categories means that their interactions are still largely a mystery. Deborah Huso examines many of these conundrums in her article “Sharing the Burden” for this September's Military Officer magazine.
The discussion begins by noting that we're not going to be able to make clear assumptions about suicide when assessing veterans as a broad group. After all, within this group are multiple variances: branch of service, Military Occupation Specialties (MOS) or job performed, number of deployments, combat and direct combat experiences, among many others. We are also not going to be able to draw perfect generalizations or find clear lines of distinction between individual case studies. As one source quoted in Huso's article says: “No two deaths are alike.”
That same source— Jackie Garrick who serves as acting director of a suicide prevention office in the Department of Defense (DoD)— goes on to point out that seemingly important risk factors for suicide might not be as relevant as they seem on first glance. A DoD report cited in the article indicates that people with a history of behavioral disorders, for instance, comprises a smaller percentage of completed suicides (about 45 percent) than those without such history.
Through research, we are able to better account for variables that may be overlooked or overinflated by pure numbers. For example, the raw data suggest that non-deployed veterans may make up a larger percentage of suicides than those who had been exposed to combat firsthand. However, deployment status records reveal there are more non-deployed veterans than combat-deployed veterans to begin with. Research can aid analysis by making the raw data more meaningful, e.g., by determining relative percentages of each group rather than sheer numbers. Does combat impact suicide? There have been numerous studies of exactly this question, generally indicating that there are not enough differences between and within these groups to identify deployment and combat experiences alone as a predictor of suicide.
It's notable that combat veterans have a high rate of PTSD (significantly higher than civilians who did not serve in the military, for instance). PTSD, along with its effects— including relational distress, substance abuse, chronic depression, and isolation— are what we identify as risk factors for suicide. So, while deployment status, in and of itself, is not seen as a predictor, combat does appear to play a role in the development of factors which lead to suicide. Ultimately, however, there is no clear indicator of suicide. Make no mistake: valuable insights are gained each year through research. But as too many grieving families know, answers and support can't come fast enough when it comes to veterans, PTSD, and suicide.
Between 2011 and 2012, suicide rates within the military increased by 15 percent. When Huso's article shares that unofficial figure from the DoD, it sets the stage for all-too-common criticism of the DoD and associated organizations, like the U.S. Department of Veterans Affairs (VA). There are indeed places where the VA is failing to deliver adequate care, but I would argue that, by and large, pressure keeps the system accountable. For each story of failure, there are many more unwritten stories of success. Many veterans are getting the help they need and as a result are returning from the brink of suicide, reengaging life, and thriving post-trauma.
The VA may not be as fully prepared to meet the overwhelming need of all our veterans as we could hope. However, the department is helping many people in significant ways. It has been a frontrunner, for instance, in the fields of PTSD, traumatic brain injury, and prosthetics. The VA houses many of the leading experts in these fields. VA providers have the ability to coach veterans on filing claims, accessing medical treatment, receiving vocational rehabilitation, connecting to housing, and much more. Specially trained VA counselors are now on call 24-7 to aid veterans in crisis. There are more than 1,700 VA locations across the country, including hospitals, community based outpatient clinics (CBOCs), vet centers, PTSD clinics, community living centers, domiciliaries (for residential rehab and treatment), as well as inpatient and outpatient facilities.
Fortunately, the community is joining the fight in preventing military suicides. Organizations like Give an Hour, Wounded Warrior Project, The Soldier's Project, Operation I.V., and others are stepping up and working alongside the DoD and VA to support our military men and women. I am encouraged to see Somatic Experiencing® as a very welcome addition to this array of resources. For practitioners of SE® who hope to do their part, I offer a few Tips for Working with Military Populations at Risk for Suicide (they are just brief tips, not meant to replace any formal training).
On the heels of Suicide Prevention Month, I encourage my fellow trauma healers to set a year-long intention to bring our resources to the aid of all those members of the military who have served.
Author Vanessa Hughes is a veteran of the United States Marine Corps, having served as a firefighter both in the military and as a civilian. Today she is an MFT (marriage and family therapist) with the VA, treating returning combat veterans with PTSD. She is pursuing her doctorate in clinical psychology at Fuller Theological Seminary Graduate School of Psychology, emphasizing neuropsychology and intercultural studies. Her areas of research include trauma-related hypoarousal and dissociation among veterans. She incorporates somatic therapies in her treatment of combat trauma— including Somatic Experiencing, yoga, movement, and dance— along with other state of the art and empirically validated treatments. Vanessa is married to a Presbyterian pastor and they have four boys aged 7, 6, 4, and 3 years old.