by Greg Wall and Jacob Mays
As we near the end of the calendar year, it seems that 2023 is likely to go down as the deadliest year in history for self-directed violence in the US military. In 2022 the DoD reported the highest Q1 suicide rate since record-keeping began in 2001. The active duty suicide rate remained at double the national average – a statistic that also reached an all-time high in 2022. Year after year, suicide kills more reliably and effectively than any of our present adversaries.
But data alone does not accurately reflect the magnitude of our loss. We offer the following tragic example, truncated for privacy and brevity, from the post we serve:
A seasoned sergeant, known for his benevolence and skill, quietly dealt alone with debt, marital discord, and depression. Just as quietly, he chose to end his own life.
Soon after, his young specialist came to the behavioral health (BH) clinic seeking help dealing with the loss of her mentor. Her background of poverty, poor grades, and a fatherless household made her loss all the more devastating.
Around the time of the sergeant’s suicide, the unit lost a young officer in a fatal training accident.
According to the specialist’s observations, the two deaths were grieved very differently. Appropriately, much was offered in honor of the officer: prompt memorials, days off work, and thorough, multi-disciplinary analyses aimed at improving the systems involved in the accident. For the sergeant, there was a delayed, brief memorial with no follow-up; work continued as usual the next day. The specialist, in the absence of community and unit support, felt solely responsible to care for her wife and children.
The specialist felt betrayed and alienated. An expedient BH appointment was not available, as upon walk-in she was triaged “low risk” and scheduled for the next available appointment in 2 months.
Her symptoms escalated and she became suicidal. She was discouraged by leadership to utilize non-military emergency rooms. She attempted suicide, but fortunately miscalculated and survived. She is now receiving better care.
In our view, military suicide is the failure that topples all our successes, the proof that we are not living up to our own standards. Our hope is that by comparing and sharing our observations on constitutive causes, we can illuminate a path to solving them. But before we can offer solutions, we must answer some important questions. Why, in peacetime, do our warriors keep choosing death? What novel social determinants are at work behind the scenes? To what extent are military institutions and its leaders responsible for a historically unprecedented suicide rate? We will attempt to answer these questions, drawing on research and first-hand experience to explain underlying causes of the suicide epidemic and its preventable catalysts.
Organizational Deficiencies
2022 DoD Suicide Prevention and Response Independent Review Committee (SPRIRC) paints a dire portrait of military suicide prevention efforts. BH providers, suffering from their own recruitment and retention shortfalls, can barely manage suicidal crises—much less reliably treat patients. Today’s chaplains are frequently confined to their ecclesiastic role and are thus unavailable for routine BH care. Military Family Life Counselors (MFLC) are limited in number by various nonsensical employment restrictions, and are further constrained by resources and bandwidth when they are available.
OneSource online counseling continues to suffer availability and reliability issues. Off-post treatment is often unaffordable and may be penalized under UCMJ. Punishment for sexual violence is increasingly absent and support for victims remains narrow in scope. Too often, Soldiers are left with little choice but to numb the symptoms and worsen the disease, washing up at the pharmacy or its more attractive counterpart, the Class Six liquor store.
Broken Institutions and Alienation
The failure of the DoD to form a robust organizational response is, of course, not the root cause of the problem, nor is it the sole reason for its severity. Social determinants of health strongly influence health outcomes, and our protective social institutions are dissolving rapidly. It has become increasingly common for children to be raised with fewer than two parents, to grow up without having relationships with extended family or neighbors, and to enter adulthood without any strong bonds or sense of belonging. The old have routinely become segregated from their families, unable to provide continuity with healthy traditions. Youth developmental clubs and sports teams have seen declining enrollment nationwide for decades. Three years of social distancing have accelerated these processes dramatically.
At work behind these trends are social processes new and old. Technology, social networks, the leveling of traditions, and the death of civil society have facilitated the unmaking of even the most intimate social bonds.With little at stake and few opportunities to practice, Americans have unlearned community participation much to their psychological detriment. The Alcoholics Anonymous mantra, “community is the opposite of addiction” expresses conventional wisdom about how the undoing of social bonds can leave a person defenseless against mental illness.
As sociologists observe, anomie – “the breakdown of social relationships and social solidarity” in recent years has exceeded the scope of industrial atomization and alienation. Psychologically vulnerable youth are further exploited with recklessness and skill. Attention spans are shrinking and cognitive control is waning. Addictive substances, addictive content and propaganda of a superlative quality dominate our attention, free time and discretionary spending. In an environment of disconnection and manipulation, the mind cannot remain sovereign. The young have become strangers to their labor, their values, their heritage, and each other – grasping at the simulacra of pleasure, borne back ceaselessly. As wartime journalist Sebastian Junger put it, “Humans don’t mind hardship, in fact they thrive on it; what they mind is not feeling necessary. Modern society has perfected the art of making people not feel necessary.”
Ethical Fading and Moral Injury
An intelligible moral code and a communalized good-faith commitment to it is prerequisite to shared identity – the ability to inculcate those values in a diverse population remains a major attraction for recruits. But the gradual erosion of their values and ethics outside of basic training has made Soldiers brittle, destroying trust and undermining conviction as a source of resilience. As Wong and Gerras demonstrated, a commander cannot complete assigned training requirements without lying, ensuring even day to day life dishonest.
But this “undoing of character” becomes most debilitating when combined with trauma, loss, and grief. Moral injury is the aftermath of witnessing or participating in immoral actions or betrayals in any context, and its salience has increased in the wake of Afghanistan. Trauma is natural and inevitable, its psychological effects acute and healing. Moral injury, however, is socially constructed, debilitating, unpredictable, and chronic. It narrows one’s loyalties from the nation, to the warrior class, to the platoon, to just a close few people, or solely to the dead.
The condition of the modern soldier is one of dependence without community. To survive on the battlefield or safeguard one’s career and family in garrison, one requires timely and reliable performance from a multitude of nameless, fallible bureaucrats and enablers. As such, betrayals and injustices (even if unconscious) are visible everywhere. The prevalence of moral injury may come from ritual dishonesty, from unpunished soldier crimes, from the “corrosive or enervating effects of combat fatigue and the relentless demands of continuous war,” from bearing witness to decades of terrorism, or from any other perceived injustice.
A paradigmatic example of moral injury’s ability to destroy character, fraternity and resilience is military sexual trauma. While emphasizing that the individual may still remain sovereign in spite of everything, Miller writes of rape, “It is rare that the meaning of a person’s harm is exclusively self-constituted… The harm can destabilize the identities and meanings that constitute a community, thereby greatly undermining the overall cohesion of that community.”
Healing often hinges on the victim’s reception by comrades, leaders, and family. As Dr. Shay writes, “The essential injuries in combat PTSD are moral and social, and so the central treatment must be moral and social. The best treatment restores control to the survivor and actively encourages communalization of the trauma.” For reasons small and large, few organizations facilitate moral injury like the US military, and few do a worse job of facilitating healing.
Missed Opportunities
Resilience hinges not only on ‘personal courage’ but on critical elements like a loving family, close bonds with comrades, moral values, experience with the transcendent, and confidence in the sovereignty of one’s mind. A force deprived of any of these factors is necessarily a brittle force.
To reclaim these sources of resilience a person must find a way to unlearn anomie, to break the grip of modern addictions, to form and preserve one’s character, to divine an understanding of one’s place in the universe. They must feel competent, authentic, and connected.
The armed forces have incredible potential to be the vehicle by which people regain these precious gifts; its very reason for existence prefigures adversity and shared goals. The military can curate training, indoctrination, and the garrison environment to encourage health and community. It can articulate its commitment to shared values and ethics consistently and legibly to its members. It can take people through inhuman tragedy and give the tools to heal. In years past, it has successfully accomplished many of these things, intentionally or not. But the increased rate of suicide and crime in recent years shows that the military has only intensified the modern experience of isolation and irrelevance.
Conclusion: The Wicked Problem
Suicide is what the SPRIRC has called a “wicked problem”. Suicide and the closely interwoven crises of mental illness, sexual assault, morale, and retention are so complex that addressing one facet in isolation may exacerbate other aspects of the problem. Yet leaving them untreated can create out-of-control feedback loops.
The varied nature of the wicked problem demands a similarly comprehensive intervention mindful of the interplay between all factors. The upshot of a problem with a thousand causes is that it also has a thousand solutions. Understanding the problem of suicide takes the determination to look squarely at a host of painful problems, individual and aggregate. As Colonel James Stokes wrote after his time in Vietnam, “Control of stress is a command responsibility.” The only wrong answer is to succumb to deference, point at Potemkin’s list of DoD Suicide Prevention Resources, and claim no liability.
With suicide being the number one killer of active duty Soldiers for many years now and only rising in prevalence, we are overdue in creating a proportional response. While engaging on various fronts and wars around the world, we have failed to address the war within. Once our leaders meet this threat with the time and resources that it is due, we might begin to heal, our brittle force made bold.
First Lieutenant Gregory Wall is an Armor officer stationed at Rose Barracks, Germany. He holds a bachelor’s in Slavic Literature from Princeton University and a certificate in Cyber Awareness.
Dr. Jacob Mays is a physician with two board certifications in psychiatry. He has a passion for Military medicine and has worked directly in both active duty and Veteran healthcare environments.
