Suicide numbers on rise with combat stress

By Alan Gomez - USA Today
Posted : Wednesday Mar 25, 2009 17:49:46 EDT

BAGHDAD — In Maj. Thomas Jarrett’s stress management class, troops are urged not to accept post-traumatic stress disorder as an inevitable consequence of war.

Instead, Jarrett tells them to strive for “post-traumatic growth.”

During a 90-minute presentation titled “Warrior Resilience and Thriving,” Jarrett, a former corporate coach, offers this and other unconventional tips on how troops can stay mentally healthy once they return home. He quotes Roman Emperor Marcus Aurelius, “Paradise Lost” author John Milton and German philosopher Friedrich Nietzsche, among others.

Walking through the crowd of young GIs in the makeshift classroom, Jarrett urges them to fight their “internal insurgents.”

The overriding theme of the course: Troops have the power to determine how they react to the horrors they may experience in Iraq. They can either accept them as traumatizing events, or transform them into learning, even empowering, experiences.

“Pain is inevitable. Suffering is optional,” says Sgt. Michael Venutto, a member of Jarrett’s team of instructors.

The class is part of an urgent initiative aimed at halting an epidemic of suicides, which has killed almost as many American troops this year as combat operations in Iraq and Afghanistan combined. The trend has left top military psychologists puzzled and resulted in a new emphasis on programs that alleviate stress and prevent possible suicides while troops are still on the battlefield, where doctors say many mental health problems begin.

To that end, every soldier arriving in Iraq is now handed a card detailing the warning signs for depression and suicide. Two-star generals appear on the Armed Forces Network to talk about their experiences with mental health specialists and how that helped. And mental health experts are spending more time on the front lines to make the counseling process informal and accessible to troops who may be reluctant about seeking out a psychiatrist.

The challenge is to get soldiers to open up about their troubles and to break what Lt. Col. Peyton Hurt, the senior psychiatrist in Iraq, calls the old Army way: “You suck it up and drive on.”

“We’re rolling out program after program and making a very concerted effort at lots of levels,” Hurt said. “The government is just pouring money into this stuff right now.”

In January, suspected suicides in all branches of the armed forces reached an all-time monthly high of 24, doubling the number of combat deaths in Iraq and Afghanistan combined, according to military data. (Military investigators often take months to confirm suicide as the cause of death.) The number of suspected suicides was 18 in February.

The majority of the suicides happen after soldiers return home, but Hurt and other doctors say the problems tend to take root while troops are still at war, meaning it’s crucial to address their mental health as early as possible.

The strains that the armed forces have endured as they fight two long wars are well-documented: extended deployments, a rash of brain injuries and sometimes insufficient military health care, among others. But military psychologists and troops in Iraq interviewed by USA Today also mentioned other, less conventional explanations. They ranged from boredom as combat operations cease in Iraq to, paradoxically, the improvement in communications that allows troops to keep in better touch with their loved ones — but also immerses them in family problems while they’re still at war.

Ultimately, Hurt says the military isn’t really sure what’s causing the suicides. He has hope in programs like Jarrett’s, but he also worries that the military’s outreach effort relies on “marketing” techniques to make soldiers aware of the problem without adequately addressing the core causes.

“I don’t want to be cynical about it, but I’m not convinced that necessarily it’ll make much difference,” Hurt said. “It might. We don’t know.”

Enormous time pressures
Hurt says the military has worked hard to overcome the traditional stigma associated with mental health issues — one that, despite the hard-learned lessons of previous wars, prevailed again early in the Iraq war.

Lt. Col. Benjamin Matthews says he laughed at the idea of mental health counseling back in 1993, when he was a young lieutenant in Somalia during the Black Hawk Down incident, where 18 Americans were killed and more than 80 others were wounded.

“I got two 800-milligram Motrins and was told “Go back out and fight,’” Matthews said.

He said there was also little opportunity for counseling during the 2003 invasion of Iraq and the months after because it was such a “mobile battlefield.” He said soldiers were so focused on securing cities and establishing bases throughout the country that there was no time to get stressed. “The only stress you had was a lack of sleep,” he said.

In 2006, Joshua Moreland, an Army staff sergeant who is serving his second tour in Iraq, said he rarely spoke about the roadside bomb that hit his convoy of Humvees in Samarra that year. He didn’t speak to a chaplain, a counselor or even his wife.

His wife didn’t find out about the blast until he returned home and she asked about a new badge on his uniform. It was the combat action badge he received for the bombing. Even then, he barely spoke of it. “She wanted me to,” Moreland said. “But I didn’t want her to worry. I knew I was coming back again.”

During a deployment near Baghdad’s explosive Sadr City from 2006 to 2007 — the peak years of the sectarian violence — Sgt. Christopher Dunne said his unit was hit by roadside bombs five times. Six soldiers in his unit died. He lost count of the number of firefights they got into.

Yet Dunne, 25, a father of two from Kansas City, Mo., said the option of mental health counseling was never there.

“There were people who were messed up,” Dunne said. “A program can be there six, eight years, whatever, but it doesn’t matter if nobody knows about it. I know guys in my unit that could’ve used the programs.”

More assessments being done
Now the Army is hoping to get soldiers to open up about those experiences. That’s why counselors are spending more time closer to the front lines. Just as most units have a doctor that they become familiar with, Hurt said they are trying to use the same principle with counselors.

“It’s different if you know the guy,” Hurt said. “If I sit next to you in the chow line and we chat and you seem like a regular guy, I may be happy to talk to you about all my stuff because you’re going to get it.”

All troops leaving combat undergo a Post Deployment Health Assessment to screen for signs of depression, PTSD and other mental health problems. Four years ago, the Army added another round of screening after the troops return home. The Post Deployment Health Reassessment is now done three to six months after soldiers return to ensure that they are adjusting to life back home.

“You’ve got to figure out what’s effective. It’s a long, complicated road to figure it out,” Hurt said.

The efforts are to eliminate as much stress as possible to minimize suicidal tendencies, he said.

On his second tour, Dunne said things are completely different. He said they are receiving briefings from mental health experts that are catered to their phase of deployment: the first 100 days, the middle of the tour, the last 100 days and adjusting to life back home.

“The briefs have been more often. More targeted,” he said.

Matthews now sees the mental health of his soldiers as a critical aspect of his job and as a way to prevent suicides.

“I call it ‘getting personal with your personnel,’” Matthews said. “I know who the high-risk soldiers are, and I know who the lower-risk soldiers are. I know which soldiers have a privately owned weapon. I know the soldiers who have motorcycles. I know the soldiers who party hard at night.

“It’s not about invasion of privacy. It’s about the people.”

Roles are winding down
Just as military leaders settle on a systemwide approach to mental health, the security situation on the ground in Iraq has changed the kind of treatment they must give.

When violence peaked in Iraq during 2006 and 2007, it was clear what psychiatrists had to watch for.

“Usually, it was something really horrific, like “The guy next to me was cut in half by a (bomb)’ or ‘My truck commander’s head was blown off and his severed head hit my head and knocked me out,’” said Navy Capt. Gregory Firman, a Vietnam War veteran who runs a PTSD clinic in Massachusetts and is now counseling troops in Iraq.

As the pace of the war has slowed and troops transition into more of a peacekeeping and advisory role to the Iraqis, troops are struggling to downshift.

“I’ve had guys say, ‘This is my fourth tour here and I haven’t done anything. I haven’t shot my weapon once,’” said Maj. Kevin Gormley, commander of the 98th Combat Stress Control unit stationed in Baghdad. “And I say ‘That’s a good thing, right?’ and he goes ‘I guess, sir.’”

Pfc. Joe Funderburk said he’s tried to settle into life on Camp Liberty. He and his roommate separated their room with their two wall lockers to give a sense of privacy. Funderburk put up pictures of his mother and father. He put up a flag of his alma mater, Alabama. He bought a rug at the military store to make the small room feel homier. He works out, watches DVDs, anything to pass the time.

“But you do get kind of stir crazy,” he said.

Navy Lt. Edmund Clark, a psychiatrist at Camp Liberty, said the lack of constant fighting doesn’t mean a tranquil state of relaxation, either. Battles are still raging around the northern city of Mosul and other parts of the country and car bombs and mortar attacks still target Americans, if not as frequently.

Clark said the constant threat of the infrequent, random attack is still a heavy burden for any American in Iraq.

Clark said the slower tempo of the war has led to another surprising complication: too much contact with relatives. Soldiers have more down time and more access to satellite phones and computers — where soldiers can e-mail, instant message or video chat with their families.

Clark said in previous wars, when communication amounted to maybe a letter a month, family problems back home would usually be resolved without any input, or stress, from the deployed service member. Now, soldiers are in the middle of any problem back home.

“I’ve had to encourage commands to keep their soldiers engaged, have them do something, have them stay busy with something,” Clark said. “Because having them just sit and instant message with the girlfriend that’s cheating on him — that kind of thing is not always helpful.”

Tragedy not always traumatic
The Army provides marriage counselors, financial assistance and several other “family readiness” programs to help soldiers straighten out their lives back home. But it’s now up to people like Jarrett and his instructors to get their soldiers straight on the battlefield, and hope they will help turn more soldiers away from committing suicide.

Venutto, the instructor, explains how a soldier will become traumatized and depressed if that is what they expect to happen following a tragedy. If you expect to suffer, you will.

He urges them instead to listen to the words of Epictetus, a former Greek slave turned stoic philosopher. “It is not the thing itself, but the view we take of it which disturbs us,” the quote reads.

During a break in a recent class, Jarrett explained that the military had no such training when he was in the 82nd Airborne Division in the early 1980s, or during his first tour in Baghdad in 2005.

As he saw the war in Iraq escalating and kept hearing reports of soldiers struggling to cope with the stresses, the 47-year-old corporate coach who was working toward a doctorate at New York University returned to the military and started the training course.

To explain its purpose, he points back to his home in Maplewood, N.J., and a weed that was growing outside. He tried to cut it away. He tried weed killers. He doused it in gasoline. But still, it grew.

“Everything I did to it caused it to be stronger,” Jarrett said. Completing the analogy, he explained that “soldiers are made stronger by what they go through.”