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January 30, 2009

Comments

For the first time, the Army has broken the civilian percentage for suicide for similar demographics: That is tragic, but it seems to be a statistic that has been missing over the last 5 years (that the Army typically has a lower suicide rate than the rest of society).

I don't understand the stigma against suicide. They made their choice. People whose lives aren't a living hell are upset because people whose lives were a living hell decided to not live those hellish lives any more.

I don't understand what the big deal is. I've had friends eat the wrong end of a shotgun for reasons I thought were stupid at the time, but I'm not the final judge of their pain, it's not for me to decide. Bury another friend and move on.

War sucks, but it is a paycheck. People make choices, sometimes they regret them, and sometimes they decide they don't have to regret them any longer.

Not sure why we are supposed to care about a military suicide more than a civilian one. I'm probably missing something obvious.

now_what,

People care about soldiers because they endure immense hardship in order to serve the nation: people care about the suicide of soldiers because they care about soldiers.

But, as my initial comment indicated, this is the first time that military suicides were greater than civilian suicides (within the given demographic).

I suspect the part you are missing is the hardship on the part of the nation that may be a cause of the increased rate.

People care about soldiers

Did I argue this point?

"People care about soldiers

Did I argue this point?"

I think it is implicit in the question about why we care about military suicides more than civilian suicides.

People care about soldiers because soldiers serve the Constitution.

This is all so....not surprising. Endless back to back repeated meat grinder deployments in fruitless wars of occupation predicated on lies, has the effect of destroying a persons grip on reality. Expect the trend to carry on for a long, long time.

Anna,

Did you miss the part that this is the first time that the rate was unfavorable to service? In other words, that during the rest of you previous life, civilians killed theselves at a greater rate?

People care about soldiers because soldiers serve the Constitution.

Oh really?

now_what,

Yes. Your disagreement with that is why you are an outlier.

Although the theory may be different, soldiers serve the state* not the constitution. Otherwise the troops would have mutineed against the Bush Cabal.
Btw, are there any reliable numbers about suicides in earlier wars (esp. WW2 and Vietnam)**?

*or the leader and his deputees. Rummy tried to introduce constitution free oaths.
**those were wars in the times of draft which could make a difference though

… and appealed for more mental health professionals to join and help out.

Er, that’s just ridiculous. Unless I am misreading this, I read “join” as “join the Army” – mental health professionals should join the Army to help solve the problem. The Army hires civilians to wash dishes for Christ’s sake…

OK, on second thought I have to be misreading because using this as some kind of recruiting ploy is just too twisted to contemplate.

OCSteve, I am not really sure you are misreading it. And actually, it would be better for the mental health provider to be a part of the service.

One of the things I know from my past experience is that members of the military with emotional problems are more open and comfortable with a therapist who is/was also a member of the military than some darn civilian who obviously has no idea what military life is like.

People care about soldiers because soldiers serve the Constitution.

i have to admit, this is the first time i've encountered this idea.

Not sure why we are supposed to care about a military suicide more than a civilian one. I'm probably missing something obvious.

I don't see how the suicide rate among soldiers should concern us more than the rate among other groups, but then I'm not sure if hilzoy is saying that it should, though some of the comments make it sound like it. If someone puts up a post on the suicide rate among teenagers, college students or drug addicts, it doesn't mean we should be less concerned about the rate in other groups. If any one group shows a significant rise in the suicide rate, that is generally indicative of something being wrong. In the case of soldiers it is related to high stress levels and the trauma that comes with killing people or witnessing the killing of people - and there has been a lot of that in the last couple of years.

I don't understand the stigma against suicide. They made their choice. People whose lives aren't a living hell are upset because people whose lives were a living hell decided to not live those hellish lives any more.

The thing is that such choices are made at a specific point in people's lives and in a specific state of mind. Unless people are experiencing chronic pain with no hope of relief, it is reasonable to assume that with some help they might be able to change their situation and their state of mind. Often suicide is not a rational choice, because the current situation and mental state are taken as an unchangeable given even though there might be the possibility of change. And there is something paradoxical about it, since it's a choice to end all choices. That doesn't mean suicide should be stigmatized, but there are easily identifiable factors that increase the suicide risk so why not try to reduce them and help people who find themselves in such a situation.

john miller,

I think the medical officer (or nurse officer) is not necessarily very well acquainted with the service life. All U.S services (except the USMC which is served by Navy doctors) commission nurses and physicians directly. They have a short introductory course, but that is nowhere near the boot camp.

The ideal would be a medical officer who has served as an enlisted for some time before embarking on a medical career. (Indeed, I cannot understand how the US can commission anyone who has not served as an enlisted first.)

At the risk of being pedantic and in order to discourage further derailment on a side issue, the current oath of enlistment reads as follows:

I, _____, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God.
And the oath for commissioned officers reads:
I, _____ (SSAN), having been appointed an officer in the Army of the United States, as indicated above in the grade of _____ do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign or domestic, that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservations or purpose of evasion; and that I will well and faithfully discharge the duties of the office upon which I am about to enter; So help me God.
So saying that soldiers "serve the Constitution" is not so utterly ridiculous that people should be scratching their heads in puzzlement.

I'm probably missing something obvious.

Yes, you are.

The folks we're talking about are living "hellish lives" in no small part because we have, collectively, asked them to go to hell. And then to go back, and back, and back again.

So we own some responsibility for them.

I don't share your "Hey, WTF" attitude toward suicide generally. I find it tragic, in pretty much all contexts.

But in this particular context, it touches us, because the living hell was experienced in our name.

Soldiers go to war because we ask, or rather demand, that they do so. We owe them our best effort to make them as whole as they can be.

Sorry about your friends.

This is tragedy.

When do civilian suicides, especially among the suits who sent these soldiers to hell, start to catch up?

When Rush Limbaugh, Sean Hannity, and Michelle Malkin are punished for their sins, can it be made to look like suicide so they go out with honor, something they never experienced during their miserable excuses for existence.

It's looking like we're way past the time when the VA needed to be reformed in a way similar to the way the IRS was reformed several years back.

The VA is currently an adversarial organization that is run more like a profit-maximizing insurance company, with little regulation, than an organization to take care of veterans. Imagine if your doctor was also your insurance company, and furthermore that your doctor had no interest in all in your general health, and that's a scratch on the surface.

I've got a friend who's right now involved in a dispute with the VA, and they're withholding his medical records because he's in a dispute with them. It's their policy, they say.

Now imagine the huge number of veterans out there, most of them completely unaware that they have any recourse at all, and you get a sense of what a complete CF the VA is.

I've had my disagreements with Eric Shinseki in the past, but I sincerely hope that he's given the authority to kick ass at the VA, and that he uses that authority to the extent possible.

My friend has some particular advantages over most others who are seeking care from the VA; namely, he's articulate and says exactly what he means, with the amount of force necessary to get his point across. Some of the guys who get regular care at the local VA office have been watching him for months, and they asked him to help them.

He had them go out to Denny's or some such for dinner, on the assumption that no one would care to eavesdrop on them. He basically told them what they had to do, and how they had to channel their anger to get the desired result, and how to deal with the VA, and gave them the name and number of a local advocacy group that would give them free advisory assistance.

Someone anonymously picked up their check.

I think that if more people were aware of what's going on, more things would happen. My friend has a contact in Bill Nelson's office, and he CCs that guy every time he has correspondence with the VA.

For me, it matters that he gets the care he deserves, but it also matters whether that painful wrenching of the VA to do right by him also ripples out to the organization as a whole, and as great a guy as he is, I don't think he's going to be able to do that.

I haven't said much about the "I hope he fails" thing, but I completely and utterly reject that. I hope Obama succeeds. We need him to. We should all be rooting for him to. There's a fundamental difference between policy and ideology disputes and sheer obstinacy toward the end of trying to make your opponent fail, and I think some folks have crossed that line. These people need to take a hard, realistic look at what they're doing. Me, I wouldn't do that any more than I'd monkey-bump someone on the opposing team before a race, just to win. It's not how anyone should be wanting to win. I don't expect to agree with everything Obama wants to do, and I won't support those things I disagree with, but I'll still be out here supporting him in being effective, because he is my President.

the current oath of enlistment reads as follows (...)

That's all wonderful, but one cannot simply assume that everything soldiers are asked to do is constitutional and if faced with the choice between following orders or following their conscience, soldiers generally choose the former.

It's looking like we're way past the time when the VA needed to be reformed in a way similar to the way the IRS was reformed several years back.

Well, if you want to reform the place into a disfunctional, demoralized bureucracy with perverse incentives and render it almost incapable of performing its core function for years in certain areas, and also leave it underresourced and understaffed to this day, then yes, the reform of the IRS is the place to look.

"Stressed by war and long overseas tours, U.S. soldiers killed themselves last year at the highest rate on record, the toll rising for a fourth straight year and even surpassing the suicide rate among comparable civilians."

But PTSD should not qualify for a Purple Heart . . .

Also, what russell said.

It's a good thing I didn't imply anything of the sort, novakant. I merely quoted the words in order to help prevent a 300-post diversion on whether soldiers can accurately be said to "serve the Constitution." The answer is: On paper, yes. I'm painfully aware of the often yawning gulf between words and behavior.

I didn't say we should model the VA on the IRS, Ugh, just that the IRS has become much less adversarial since 2000 or so.

Also, the web presence is very useful.

Well, if you want to reform the place into a disfunctional

I'm sorry that was your summarization of my rather lengthy comment. I failed rather badly, I think.

So saying that soldiers "serve the Constitution" is not so utterly ridiculous that people should be scratching their heads in puzzlement.

sure. but the assertion in question is: "People care about soldiers because soldiers serve the Constitution."

it's the "because" that seems strange to me.

That's all wonderful, but one cannot simply assume that everything soldiers are asked to do is constitutional and if faced with the choice between following orders or following their conscience, soldiers generally choose the former.

True, but soldiers should be able to assume for the most part that they're serving the Constitution (which might well be different than "following their conscience" by the way). And usually they are, in the sense that they are taking orders from the Executive Power authorized by Article II. If the President himself is not following the Constitution, obviously the system is corrupted, but to what extent each soldier has the duty to examine the trickling down of Constitutional corruption is questionable.

The lack of mental health professionals continues to be a problem on Army posts. I serve overseas, and a friend of mine was recently going through severe depression issues (unrelated to deployments). She made several attempts to get help, but the local behavioral health unit was so overloaded, she could get appointments only once every three weeks. Meanwhile, chaplains are almost always available, but can only listen, and can't monitor whether medication is working correctly. My friend's medication didn't, and she got drastically worse before her next appointment. It was only an actual suicide attmept that prompted the Army to send her to get the help she needed so badly, and had gone through every available channel to obtain.

My friend, thank God, is now doing much better, and was actually able to return to service. Too many people are falling through the cracks, and it's only getting worse.

Slarti - Eh, your comment just seemed out of place with what I know about the supposed 1998 IRS reforms, some of which were ok but most of which ruined the IRS's ability to do its job effectively, which continues in some respects to this day.

I don't think this constitutional discussion is terribly relevant. The Constitution isn't the first thing (or the second, third, ...) that leaps to mind when considering my concern for soldiers. Mostly it's that they're people, some of whom I know personally, who are going into danger on my behalf. What more do you need, really?

I don't know that the discussion of the stigma associated with suicide is very relevant. The stigma attributed to the suicidal is not the issue. The issue is that we don't want people we care about to die, and we don't want people we care about to feel so bad about their lives that they want to kill themselves (and die), and that trends in suicide rates among particular groups are indicative of their mental health. The point here is that there seems to be a rather large mental-health problem among our military people, and that problems are the kinds of things that people tend to want to, you know, FIX.

Ah. Well, from my POV things got dramatically better. Please disregard any references to the IRS, then; clearly those were misguided.

"I don't think this constitutional discussion is terribly relevant . . . The point here is that there seems to be a rather large mental-health problem among our military people, and that problems are the kinds of things that people tend to want to, you know, FIX."

Thank you, hairshirt.

True, but soldiers should be able to assume for the most part that they're serving the Constitution (which might well be different than "following their conscience" by the way). And usually they are, in the sense that they are taking orders from the Executive Power authorized by Article II. If the President himself is not following the Constitution, obviously the system is corrupted, but to what extent each soldier has the duty to examine the trickling down of Constitutional corruption is questionable.

Sorry, but "I was just following orders" is the oldest excuse in the book and just doesn't cut it. They should be expected to examine the constitutionality and the ethics of both their orders and their actions.

Sorry for derailing the discussion re: service.

I thought the most interesting part of the article is that the military has typically had a lower suicide rate (when corrected for demographics) than the US population as a whole. When this was discussed at Obwi last May, was it obvious to everyone else that at that time, military suicides were lower than the similar non-military population?


"Sorry, but "I was just following orders" is the oldest excuse in the book and just doesn't cut it."

Doesn't cut it if they're being ordered to commit atrocities which would be illegal even if duely ordered persuant to a Congressional declaration of war and so on, and so forth. But when the argument isn't that the order is unconstitutional as to what was ordered, but only based on arguments about whether the basis for the war was honest, yeah, "just following orders" does cut it. Soldiers are expected to know an atrocity when they're ordered to commit one, not to know whether the war they're in was properly authorized.

On suicide, clearly suicide should not have a stigma attached to it, because nobody choses to end up suicidally depressed. Outside of situations involving intractable pain and terrible quality of life, suicide is a result of mental illness, and the real issue is why it wasn't caught in time.

"I don't understand what the big deal is."

People don't have to suffer major depression. It's not comparable to, say, being at death's door with an incurable disease.

And not understanding why it's a "big deal" to the friends and family of someone who kills themselves: wow. Just: wow.

Since it doesn't happen that often, let me say that I completely agree with Brett's 12:40 PM.

Ditto what "bedtime for bonzo" said at 9:24. The Purple Heart issue is the very first thing I thought of when I saw the Army Secretary's claim: "We can tell you that across the Army we're committed to doing everything we can to address the problem."

All Americans should be able to get prompt and competent mental health care, period. Especially Americans who we have asked to go into harm's way, in ways that can contribute dramatically to their ability to maintain their mental health.

The Purple Heart issue is a symptom of the larger reality that soldiers and Marines et al. aren't getting this care, and in some quarters are not even deemed worthy of it.

Time to write another letter to the editor, I guess. Maybe my senators too.

"War sucks, but it is a paycheck. "

You're not clear on the differece between a soldier and a mercenary. It's the same as the difference between a prostitute and a wife, but then, maybe you're not clear on that difference.

"Sorry, but "I was just following orders" is the oldest excuse in the book and just doesn't cut it. They should be expected to examine the constitutionality and the ethics of both their orders and their actions."

That's easy for someone to say who is not risking a very long stretch of federal jail time if he gets the answer wrong, or more to the point, if the Court Martial board doesn't see his reasoning and come to the same conclusion. Sorry, but second-guessing from a safe legal distance just doesn't cut it.

"but one cannot simply assume that everything soldiers are asked to do is constitutional and if faced with the choice between following orders or following their conscience, soldiers generally choose the former."

Conscience? Why would anyone simply assume that their conscience would be a better authoirty on the constitutionality of an act than any number of outside authorities?

"One of the things I know from my past experience is that members of the military with emotional problems are more open and comfortable with a therapist who is/was also a member of the military than some darn civilian who obviously has no idea what military life is like."

In general people tend to do better with health care provided by people of their own culture, and that would be especially true of mental health care for obvious reasons.

"I think it is implicit in the question about why we care about military suicides more than civilian suicides.
People care about soldiers because soldiers serve the Constitution."

I think it's a lot less dry than that. I think people care about soldiers because they have a sense that soldiers are serving tham and the nation. To the extent the Constitution is the core of the nation, well, then soldiers serve the Constitution, but I really doubt that most people go that far into it.

I care about soldiers because they're serving their country by doing difficult and dangerous work for small tangible reward. (That remains true even if what they've been asked to do is sometimes a very bad idea.) For that, they deserve the best of medical care, including mental health care, and if something about their current situation is causing a significant increase in depression, that needs to be investigated and dealt with.

To follow up on my earlier comment and what Jim said above.

Back in the days when I was doing therapy, I had several Vietnam vets referred to me, usually due to marital problems. It didn't take me long to realize that there was no rapport being created and I referred them to a colleague of mine who had served in Vietnam. Although, due to confidentiality issues he could not provide me with details, he did mention that a couple of them told him they just didn't believe I could understand them because I had never been there.

Another quick anecdote. 2 years ago, we had a family reunion in Wisconsin and my older son was there with his family. One night, while we were all outside around a ffire, someone across the lake started shooting off firecrackers. My son quicklly excused himself and went inside. I followed him in and before I could say a thing he said words to the effect of " Don't try to tell me you understand. You weren't there (Iraq). You can never understand."

In my experience, it's not just the lack of mental health professionals in the military, it's the quality/attitudes (at least of those I encountered).

While my husband was in the Army, I started experiencing symptoms of depression. I didn't really understand what was going on for several months. When we eventually moved to another duty station, I was busy, and better for a while, but then things got worse. I realized I needed help, and made an appointment. I only recently told my husband how bad it was - he didn't know I was starting to feel suicidal. He was amazingly supportive, but I knew his unit was deploying soon and he had enough to deal with, so I left that part out. Obviously, I wasn't thinking clearly.

My first therapist seemed nice enough, but I never got the impression that he was listening to me. He sat there and looked through his paperwork, rarely asking me anything. Eventually, he decided (probably correctly, considering family history that I didn't find out about until later)that my depression was the result of a chemical imbalance, made worse by external circumstances though not caused by them. He had this epiphany after a month. It was the first time I'd gotten the impression that he'd actually heard anything I'd said, especially since I was repeating something I'd mentioned before.

Unfortunately, my timing with all of this was pretty terrible. It was early 2003, and almost the entire post was prepping to deploy. The psychiatrist who prescribed my drugs made it quite clear that he thought I was faking to get my husband out of the deployment. He said some very rude things to me. I was to stunned to explain that my husband's chain of command didn't even know about any of it, that I'd never attempted to try to prevent his deployment, and that I'd been having problems well before we'd even considered that it could happen. I stammered something, and he eventually gave me the prescription.

His attitude was not uncommon - there was a reason I hadn't mentioned it to the chain of command, and asked that my husband not mention it either. Many of them shared the attitude that any family problems (including serious medical problems) were made up or being exaggerated and used as excuses to keep soldiers from deploying. Army wives are just supposed to suck it up and deal, no matter what problem is. Those who don't are whiners or b*thches (usually the second is the one that's verbalized). Heck, later, even the severe illness of my grandmother, whom I was close to, was viewed as just an excuse to get my husband some leave - someone actually said something to him along the lines of, "Well, it's just her grandmother, what's the big deal?" This wasn't even around the time of a deployment or even a training exercise, so I'm not sure what they thought I was trying to do. Of course, a soldier who is complaining of some problem is even worse.

I did finally get a therapist who paid attention to what I was saying - only accidentally, because I made an urgent appointment to deal with drug side-effects on a day my normal therapist was busy. Thank goodness, but at that point I was just trying to get away from the anti-depressants (which I had a hard time with) and get away from that place. I dreaded that clinic. And I was a dependent - from everything I've seen and heard, dependents get quicker and better medical care than soldiers.

I really, really hope that I'm wrong, and that soldiers who manage to get into the system are given much better care than I received. I know, though, that the stigma is there for both mental and physical health care - a soldier who needs care for something that's not bleeding profusely is weak in some way, or just trying to get out of something. It's sad to know that the treatment I received was positively amazing compared to what happens to many soldiers, even those in far worse shape than I was.

Sorry about the long story and rant, but this issue is one I really care about. If our soldiers are expected to be physically and mentally capable of serving their country, then their country has an obligation to keep them fit to do so and to help them if that service causes them harm. It makes me ill that our obligations to our soldiers aren't being met.

When this was discussed at Obwi last May, was it obvious to everyone else that at that time, military suicides were lower than the similar non-military population?

I think this is a commonplace of health statistics -- whenever you identify a specific group, it's likely to be healthier than the rest of the population. Roughly this is because the sickest tend not to be members of identifiable groups (that is, someone with lifelong severe mental health problems wouldn't, for example, be able to join the military.) So the class of very unhealthy people, on whatever axis, tends to drag down the average for the general population compared to each specifically identified subgroup.

“It's looking like we're way past the time when the VA needed to be reformed in a way similar to the way the IRS was reformed several years back.

The VA is currently an adversarial organization that is run more like a profit-maximizing insurance company, with little regulation, than an organization to take care of veterans. Imagine if your doctor was also your insurance company, and furthermore that your doctor had no interest in all in your general health, and that's a scratch on the surface.

I've got a friend who's right now involved in a dispute with the VA, and they're withholding his medical records because he's in a dispute with them. It's their policy, they say.

Now imagine the huge number of veterans out there, most of them completely unaware that they have any recourse at all, and you get a sense of what a complete CF the VA is.”


Err, I am sorry your friend has had these problems with the VA. I have been deployed twice in the past 6 years and have no complaints at all about the VA. I tend to agree with Longman when he said it was the best large scale healthcare organization in the US. I received post deployment checkouts and minor surgery with no problems at all, aside from a minor billing dispute for something that happened after my 180 days of free care.

http://www.washingtonmonthly.com/features/2005/0501.longman.html

One caveat is that my deployments weren’t that stressfull (I was essentially a fobbit in low threat areas of Iraq). I didn’t need mental health services so I can’t comment on the directly. I do think the VA is probably having its biggest problems in this area, because they didn’t realize just how many PTSD and other psych casualties there would be.

A second point is that Longman was writing a few years ago. While I have had good experiences, I wonder how well funding has kept up with a large increase in patients over the last several years.


Well, Gary, I do have the dubious advantage of having once been suicidal, gives me a little insight I should think. I hope so, cost me enough.

Let me bring that to bear: You'd think that getting the suicidally depressed help would be a no brainer. But the suicidally depressed are not easy to identify. They can be good actors, putting on a cheerful front. Paradoxically, the decision to commit suicide frequently results in an apparent lifting of depression. (The end is in sight at last!) And some of the 'tells' for depression, such as poor hygiene, may be particularly difficult to detect in the enlisted, given front line conditions and enforced routine on base.

It's not an easy problem, in other words.

Tracy: thanks, and I hope you're doing OK.

now_what: I think it's awful when anyone feels as though death is their best option. I feel it in a special way when one reason they feel that way is because of a job they are doing in my name.

I don't think military suicides are worse (or better) than other kinds. Lots of different kinds of suicides have their own peculiar horrors, and I don't know that I'd care to rank them.

Lizardbreath,

Good point. Thanks.

a job they are doing in my name

Sorry, but I really don't get this part: you were against the Iraq war, right? How were the soldiers invading Iraq doing that in your name then?

"Well, Gary, I do have the dubious advantage of having once been suicidal, gives me a little insight I should think."

Brett: Have never been suicidal. But having suffered -- and that is definitely the word -- a nervous breakdown in 1991, a life-changing event, to put it mildly, I understand your phrase "dubious advantage" and it truly does give me insight into this deep, dark condition that I might otherwise not have.

I often think that having had a NB puts me in much better shape for never having one again -- for many reasons, not the least of which is I would recognize (and have recognized) the signs, at their very earliest of another one coming one. Hopefully, I'll never live to see the day again when the car radio is talking to me, which sounds funny but is fncking frightening as all get out when it is happening -- when you can't distinguish reality from a heightened sense of a reality-that-definitely-isn't.

I imagine suicide can be similar in that losing your mind, really losing it, makes you feel completely powerless and, yet, powerful in a very weird way.

The loss of one's inhibitions is shocking: lending money to total strangers (and I don't mean $10 or $20); taking a walk in the bad side of town and telling those who approach you that you are Jesus Christ -- which offers an odd sort of protection, in retrospect.

My "recovery" (to where I could get back to work with my editor not worrying about me freaking out on the job) took three weeks in the hospital, and they were the longest three weeks of my life.

I remember my roommate -- a soft-spoken, white-haired, middle-aged DuPont engineer who I instantly bonded with as if he were a father figure -- leaving a week before I did and feeling as if I would never get through "it" (and on with my life) without Bob. But I did, of course. You go back to work, everyone treating you with the utmost kindness, even former rivals, because, after all, you had been felled by "exhaustion," a wonderful, bullshit catch-all phrase, and before long, you're back in the God-damn rat race.

My experience left me bitter about hospitals and the treatment they provide for mental illness -- sometimes I think I'd still be there if it had not been for my Mom who unearthed this iconoclastic, rule-breaking, but respected, Freud-looking shrink I still see to this day. And even he made it too easy for me in post-recovery to become overmedicated -- an addiction to Xanax leaving me with little memory of 1992. Recovery, for better or worse, seems to have to come largely from within.

Knowing the pain, hardship and, yes, terror I went through (and put my family through) -- and not having gone through it in defense of or service to my country -- is why I feel it is total bullshit that PTSD is not deemed a battlefield injury worthy of a Purple Heart.

P.S. For those that are predisposed to this sort of thing, Patty Duke's -- yes, that Patty Duke -- autobiography on her bipolar manic depression, "A Brilliant Madness," is very telling and left me feeling like I was not alone, which is a wonderful comfort.

Suicide is really a bad idea whoever you may be. I understand that most of them are greatly affected mentally so it means that they need more extra care, attention, patience and strong medical and psychological assistance. Lack to any of these may lead them to end their life. People around them should know how handle them properly and appropriately.

"Sorry, but I really don't get this part: you were against the Iraq war, right? How were the soldiers invading Iraq doing that in your name then?"

novakant: I think that usage -- "in my name" -- is fairly common when talking about our men and women in uniform even though one may not necessarily be "for" the war they are fighting. (There is a better way of saying what I just wrote, but it's late.)

"Suicide is really a bad idea whoever you may be."

With all due respect, I think once someone goes so far as to commit suicide I think they have lost the ability to rationally weigh the fact that it is a bad idea, given that at that point it may seem quite rationally to that person to think it is a very good idea.

And while this is probably a case-by-case thing, I know in my case a little tough love from time to time to get me "to snap out of it" was helpful. (Notice I said "a little.") I know, in my case, I did not like feeling "babied" and often responded rebelliously by the hospital staff who clearly weren't trained to handle their case loads as effectively as I'd hope -- and definitely did not like a rebellious response of any kind (think "One Flew Over the Cuckoo's Nest," which is a lot more realistic than polite company would realize: this was 1991, so things may have changed, but you act up a little and they thing nothing of sticking you with a damn needle that totally zombies you out, and they really do have such things as padded cells and men in white coats.)

it is reasonable to assume that with some help they might be able to change their situation and their state of mind

It is also reasonable to assume that for some of them, they might not be able to do that and a completely intolerable situation will continue to get worse. I don't think suicide in general is any less of a rational choice than most other human behavior. Which is not the same as arguing that it is rational.

That doesn't mean suicide should be stigmatized, but there are easily identifiable factors that increase the suicide risk so why not try to reduce them

Everyone is going to die, why is slow deterioration always best? We're all going to the same place.

Soldiers go to war because we ask, or rather demand, that they do so

I ask of soldiers the same things I ask of others. Mostly, leave me alone and don't drive slow in the fast lane. I neither ask nor demand that they go to war. If someone wants to do something in my name, they can respond to a violent, unnecessary and unprovoked attack by shrugging their shoulders.

The issue is that we don't want people we care about to die

Desire is the root of suffering.

You're not clear on the differece between a soldier and a mercenary. It's the same as the difference between a prostitute and a wife, but then, maybe you're not clear on that difference.

I believe both the distinctions you are making are less clear than you seem to think. My relatives who have served in the military did so for far less lofty reasons than serving their country or the constitution. They did it to get out of some crap small town or learn a trade or get put through college. Is my family infested with mercenaries, in your opinion?

I care about soldiers because they're serving their country by doing difficult and dangerous work for small tangible reward.

There are plenty of jobs more difficult and dangerous than soldier done for small tangible reward. And no one seems to take notice when those people off themselves, unless they do it in a particularly interesting way.

brett and btfb: I'm so, so sorry that that kind of thing happened to you. It sounds truly awful. And despite not having been suicidal ever (I think this comes of having had the older sister of a friend jump under a subway when I was about ten and getting to see what it did to her family, which left me incapable of imagining e.g. that the world might be better off without me), I get the part about the dubious advantage.

About the tough love: I have talked several people down from being suicidal, and have had to go on instinct, as far as what the best approach is. On some occasions, I've taken out the big guns, meaning extended and vivid descriptions of what I think the effects of their suicide on other people they love will be, and on one occasion, I've said that I think it's an act of utter cowardice. (For that person at that time, I think it would have been. This is not a general view.)

It's completely terrifying: I have nothing to go on but instinct, but the idea that I could just completely do the wrong thing is truly horrific. Not as terrifying as the time one of my friends went homicidal, which I think I mentioned round about the time of the Virginia Tech massacres, but still. The stakes being so high, and having no clue whether I'm saying anything that even remotely resembles the right thing. The cowardice time: it did seem to me that that person, right then, needed something like a verbal bucket of cold water more than anything. But wtf if I had been wrong? For all I knew, I was. Just thinking about it, years later, makes me shudder.

concerning soldier vs. mercenary
The literal meaning of these words is the same: person paid (for fighting). In German the terms are even more similar: Soldat/Söldner (and a soldier's pay is still officially called "Sold")
The very concept of the modern armed forces is derived from the mercenary forces with the main difference today that a soldier is supposed to have loyalty beyond the cash. The opposite to soldier/mercenary would be warrior and/or militia, i.e. tribesmen/citizens that fight for their community and were traditionally not paid but (at best) compensated for expenses.
As for the wife/prostitute analogy, the difference is not as clear cut as one would wish and I could quote some pretty conservative authors that at least discuss marriage as a "business" transaction legalizing sex for gains (not even counting the practices in some cultures where prostitution has to include a formal short-term marriage between whore and customer).
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The problem with soldiers refusing unconstitutional/criminal orders is that the authorities issuing said orders are likely to be the same that preside over the trials deciding about the claim. If the orders are indeed legal then there is no problem with punishment for the refusal but if the orders are not, the law-abiding soldier is in trouble (although as of yet there are few cases of "Either you shoot these people or we will shoot you together with them" in the US that I know of).

As for suicide and rationality, there can be a rational decision about it but I think this is rare. The discussion is millenia old (cf. ars moriendi), the stigma is much younger.

hilzoy: I think you are spot-on about following your instincts, which, even then, as you say, it isn't failsafe.

Time really can be great healer. For a long while, I remember feeling tortured and enduring many, many sleepless nights throughout the month of March.

Even now, this stuff seems to be locked away in a part of my brain, rarely to come out and letting those demons loose, which is one reason I think support groups never worked for me.

If you let the past take over the present, it is scary. Getting ready for work this morning in the shower, for instance, I could not stop thinking about March 1991. I was remembering coming back from spring training after two weeks covering the Phillies in Florida and asking the middle-aged woman whom I rented part of her house from if she had read about the plane crash.

"The plane crash?"

"Yeah, the plane crash I was in, over the Carolinas. A lot of people died."

She looked at me like I was half nuts, which I was. She laughed, but then realized I was being serious and kept reassuring me there was no plane crash and I more or less gave her an, "OK, if that's the way you want to play it," and didn't press it.

Looking back, I feel terrible for that poor lady. In her mind, she did the right thing, letting go of the incident and not telling anyone how crazy her boarder was. But, on the other hand, I look back and there were plenty of these signs that I was going off the deep end.

Needless to say, once I realized I wasn't Jesus Christ -- my episode all took place during Good Friday/Palm Sunday/Easter Sunday -- I wasn't too keen about flying and, too this day, dread takeoffs.

Another strange thing that happened to me: lovely Clearwater, Florida, where the Phillies train, is the Scientology Capital of the World and a lot of them wear some sort of standard uniform of black pants, white shirt, black tie, like waiters, where they eventually manage to fade into the background. I'm walking back late to my motel one night from a Denny's, feeling vulnerable, and two guys stop and open the car door and give me a warm invite for a ride. Thank God, something, my inner sanity, I guess, told me to give them the brush-off.

Before that, next to the TravelLodge where I was staying, I go next door to get a haircut. What a friendly and good-looking staff. So I get a massage, too, maybe the best massage I have ever had to date. This girl with this strangely soothing way about her brought out these oils that practically left me comatose. I figure out, before I leave the place, it is run by Scientologists: To this day, I swear there was something wicked in those oils.

Weirdly enough, I am filing stories during this whole time -- and good stories, more creative than normal.

And on it goes, until one day, the whole world is trying to track you down and you're in bed and can't pull yourself out of it, as if you are weighed down by a million bricks, and you look up, feeling like you are in a dream that never wants to end, and there are these concerned faces and you laugh and ask everybody, "What's wrong?"

(I always seem to share more on this blog than I intend. But if you treat mental illness like some big, bad secret, your not doing yourself or possibly someone you could help any favors.)

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