Preventing Veteran Suicide with Connectedness

It’s hard to consider all the aspects of suicide without recalling the very public self-immolation of Thich Quang Duc, the Buddhist monk who sacrificed his life to protest government mistreatment of Buddhists in 1963. This symbolic and ancient act of defiance inspired many others during that era, including a few who used suicide to protest the war in Vietnam.

We are all aware of the astonishing frequency of Veteran suicide these days, but did you know that, in some cases, the Veteran intended his or her suicide to be an act of protest? In most cases, however, Veteran suicide appears to be an act of frustrated desperation.

What if one aspect of Veteran suicide is the martyrdom of war?

While it may feel noble to want to prevent one from taking his or her own life, I would like to boldly suggest that preventing all Veteran suicide may be misguided hubris.

Logically, if we truly intend to end all Veteran suicide, we ought to end all war. Clearly, while threats such as ISIS exist, there’s no way to end all war.

So how do we embrace both the desire for an end of war and the reality of its existence? How do we both stand up for peace and pay the cost of battle? How do we attempt to prevent some types of suicide while allowing the pathos of “suicide as protest” or “physician-assisted” end of life? The costs of war are as old as war itself: post-traumatic stress, sexual trauma, traumatic brain injury, loss of limbs, and loss of life itself. Normal human responses to such things include suicide and even “assisted” suicide (whether by physician or peace officer), just as they always have.

And, in some parts of the world, the peaceful human protest of oppression and war also includes suicide, just as it always has.

I write this with great sensitivity to those of us who have a personal belief that suicide is “wrong;” I myself believe that violence is wrong, especially violent death, whether or not it is self-inflicted.

However, if we suspend judgment for the purpose of a thought experiment, and allow the paradox of both “good” and “bad” suicide, perhaps we can reach a new kind of compassion for those who are suicidal, regardless of whether we agree with their choice of death or not.

Evidence suggests “connectedness” is a factor in preventing suicide. My understanding of “connectedness” is the kind of one-to-one association you might have with a peer, colleague, mentor, friend or, perhaps, a therapist or religious leader or teacher.  This is in contrast to the deeper kind of “connectedness” in a committed relationship such as marriage, but let us keep our thought experiment at the more detached level of “human connection.”

We know that members of a military unit are highly connected, both for task and support purposes. This high degree of purpose-driven “connectedness” changes dramatically when warfighters become civilians, and to a lesser extent when combat deployment ends, since the original purpose for the connection (war) is missing. One could conclude that becoming disconnected from one’s fighting unit is itself a risk factor – but not the only one – for suicide.

As loving and connected as some military families are, the family cannot replace the connectedness of the military unit. A family clearly has a different purpose, and its human connections serve that purpose as opposed to the purpose of war. A highly connected family helps minimize suicidal risk in its own way, but does not remove the risk.

As one who has thought carefully about suicide – both in terms of taking my own life and as a survivor of those who have taken theirs – I want to say how grateful I am for having a loving and supportive family around me. I also want to note that, at my most vulnerable, I had no desire to share this with my family. That feeling of utter aloneness, for me, was the riskiest place in my journey. Like the warfighter returning from deployment or the newly minted Veteran, at my most vulnerable I felt cut off from everything I needed most to keep going.

I am also grateful also for the talk therapy I had. Fortunately, I was having therapy before and after my moment of crisis. Sadly for many suicides – people who may have been helped by talk therapy – reaching out for help doesn’t always happen. Even with the therapy I had, when my moment of crisis came, I did not pick up the phone and call anyone, let alone my therapist, and I suspect that process of isolating oneself is typical of many in the same position.

There is evidence supporting the fact that suicide rates are dramatically lower when a therapeutic modality is in place.

For active duty soldiers, a recent study found that the cognitive behavioral therapy (CBT) modality reduced suicide attempts among high-risk patients [sic] by 60% over a two-year follow-up period. (Another citation of that study can be found here). (While such post-trauma studies are necessary, I suspect a more powerful therapeutic intervention for suicide would be possible if we could find a way to introduce CBT tools to high-risk warfighters before they encounter stressors.) The question, to me, is not so much the modality, but whether offering this form of one-on-one “connectedness” to the “patient” was of itself the reason for the drop in suicide attempts.

Here in the San Diego County, California, Veterans Services world, we find peer mentoring to be a powerful indicator of a program’s potential for success, whether the objective is expunging a DUI in Veterans Treatment Court, successfully serving time in a Veterans-only cell block in a jail without recidivism, being treated for addiction in a Veterans-only residential facility, or training a newly-hired Veteran using the buddy system. This makes sense; peer mentoring is a powerful reminder of the military unit where both mentor and mentee enjoy common success in pursuit of shared goal.

It’s possible that, since Veterans are highly trained human connectors, removing the “connectedness” factor from a Veteran’s day-to-day increases his or her risk factors. Instead, if a program provides a framework for a high degree of human connectedness, Veterans thrive. So how do we get out in front of the risk factors, perhaps even before a new recruit goes to boot camp?

There are a number of programs with a focus on resilience already at work on military bases and in the National Guard and Reserves. This is absolutely necessary! There are also several programs training civilians to better interact with Veterans professionally, therapeutically, and as co-workers. One of my favorites is Psycharmor. Conversely, there are also programs that teach or remind Veterans of the nature of non-military civilian “connectedness” such as The Reboot Workshop. Why do these programs exist? To teach all of us how becoming more effective connectors – as peers, mentors or friends – improves the success of our endeavors.

Returning to our thought experiment, let us ask: how effective we are as peers, mentors or friends? If you or I were to grade ourselves on the scale of the “connectedness” we offer, how would we measure up? Let’s be clear: we aren’t interested in the number of digital connections we have on Facebook, LinkedIn, Instagram or the latest behavioral healthcare app on our mobile devices. We are talking about real live one-on-one human beings sitting across a table from each other, maybe not saying anything, but sharing some sort of authentic bond.

A Veteran buddy whose job is peer outreach was assigned a particularly difficult case: a recent, young Veteran who had many unseen combat wounds. Every week for more than a month, my buddy met his “case” at a coffee shop for an hour. Normally, my buddy told me, the “case” would just sit there, avoiding eye contact and messing around with his smartphone. It took many weeks before the “case” even looked up. One week, the “case” looked up at my buddy, made eye contact, and said: “You know, you’re OK.” That was the moment when effective connectedness became possible. If we are to believe the evidence, that was also the moment when the “case” took a step away from risk and towards reward. The lesson here is that sometimes it takes a lot of “showing up” before any useful opportunity for change can happen.

I hope this discussion helps crystalize the potential for each of us to become better connectors. I happen to believe that listening to or making music together helps improve connectedness. Other powerful examples include structured groups, be they faith-based, therapeutic or “12-step” style. What do you believe? Can you use your beliefs to strengthen your skills as a connector?

Your skills are useful far beyond someone “at risk” of becoming a “case” – the world needs you to use those skills now, with everyone you know and everyone you meet. I think you will find that being a better peer, mentor or friend has rewards that go well beyond lowering the suicide rate.

At least one highly responsible military leader agrees with this approach. Army General Martin E Dempsey, Chairman of the Joint Chiefs of Staff, recently signed a letter to all transitioning service members in which he encourages them to become leaders in their communities. I would like to share that short letter with you because it shows great sensitivity to the issues Veterans face that is the nexus of the points we have been discussing here. It also has the welcome expectation that civilians such as you and me will do our part as well.

2 February 2015
To All Who Have Served in Uniform Since 9/11,
          You and your families stepped forward as volunteers when our Nation needed you, and you excelled. For over a decade of war, you demonstrated the courage, resilience, and adaptability that are the hallmarks of the American military. Thank you for wearing our Nation’s uniform.
          Your dedication to those serving on your right and left has been unwavering, and your commitment to a cause greater than yourself has been inspiring. Be proud of what you have done for your country and for those people in other countries who share in the dream of a better future.
          Over the last 13 years, you have written a new chapter in American military history while honoring the legacy of the generations of veterans who served before you. Their sacrifices paved the way for our welcome home—we build our legacy on their shoulders. It is appropriate to recognize and thank them as we join their ranks.
          It is also appropriate to follow the example they set when they took off the uniform. Those previous generations of veterans understood that they had an opportunity—and a responsibility—to continue serving. Your generation will also help guide our country’s destiny.
          While the transition to civilian life brings new challenges, the American public stands ready to welcome you home. As a veteran, your country still needs your experience, intellect, and character. Even out of uniform, you still have a role in providing for the security and sustained health of our democracy. No matter what you choose to do in your next chapter, you will continue to make a difference. The opportunity for leadership is yours.
          We trust that you will accept this challenge and join ranks with the business leaders, volunteers, and public servants in your communities. You have made your mark in uniform and represent the strength of our Nation. We know you will do the same as veterans, setting the example for the next generation of veterans to follow.
          We thank you and your families for your service and for your continued dedication to the United States of America. It has been our greatest privilege to serve with you, and we look forward with pride to what your future holds. We know it will be extraordinary.

Sincerely,
Martin E. Dempsey, General, U.S. Army, Chairman of the Joint Chiefs of Staff
James A. Winnefeld, Jr., Admiral, U.S. Navy, Vice Chairman of the Joint Chiefs of Staff
Raymond T. Odierno, General, U.S. Army, Chief of Staff of the Army
Joseph F. Dunford, Jr., General, U.S. Marine Corps, Commandant of the Marine Corps
Jonathan W. Greenert, Admiral, U.S. Navy, Chief of Naval Operations
Mark A. Welsh III, General, U.S. Air Force, Chief of Staff of the Air Force
Frank J. Grass, General, U.S. Army, Chief of the National Guard Bureau
Paul F. Zukunft, Admiral, U.S. Coast Guard, Commandant of the Coast Guard