For some families, this Memorial Day will be especially hard. Their loved ones -- spouses, parents, sons and daughters -- didn't die the hero's death. They were one of 160 soldiers last year who committed suicide, despite the military's unprecedented effort to stem the tide.
How does it happen? After surviving harrowing combat, why would a young soldier decide to take his or her own life? The Army is spending $50 million to figure it out, and we may get an answer in a couple of years. But for some, that will be too late.
While no one can truly understand the tormented heart and mind that would lead someone to actually pull the trigger, swallow the pills, position the rope that will end a life, there are some conditions that can certainly explain the despair. The story of Ryan' Doc' Krebs, featured on The Wounded Platoon (Frontline May 18, 2010), gives some clues.
'Doc' Krebs had spent two tours in Iraq as an infantry company medic and he saw more than his psyche could possibly handle. His favorite sergeant died in his arms and too many friends lost their lives to IED's and snipers. He asked for help from mental health, but didn't get what he needed. A little medicine and encouragement to go back to the front, his buddies needed him.
When he got back to the States, he slipped into a downward spiral of drugs and erratic behavior that made his life even worse. He was getting medication for depression and PTSD, but it did little to alleviate the depression, the anxiety, the horrifying flashbacks of combat, the paranoia. So 'Doc' Krebs tried to kill himself, but failed. His story does not actually have an unhappy ending. After several years and some luck in getting into treatment, he is attending group therapy, off most of his medications, and his mind feels clear. He is lucky that he didn't die. But what he lost is unable to be calibrated.
His story, while individual, has universal themes. He was traumatized. He reached a crisis point where there were no means of escape, not a glimmer of light at the end of the tunnel. Sadly, there are too many young men and women who share his experience: they wake up in agony and can't imagine that this day will be any different from the day before. And the response from the military has been well intentioned but often ineffective.
When I talk with some of these troubled soldiers, I am reminded of a young man I saw many years ago when I started my practice. He was 24 years old and had been brought to the emergency room because he tried to kill himself. As far as he was concerned, his biggest problem was that his suicide attempt failed because he had severe cerebral palsy and could not move his arms and legs to even eat. He begged me to help him die. He was a prisoner in a body that could not function, while his mind was agile and ambitious and frustrated and tormented.
These soldiers who want to kill themselves are imprisoned by their experiences. Terrified by nightmares, they can't get out of the fog created by drugs and medications designed to alleviate their pain. Their intimate relationships fall apart, and they get into trouble with the law. Their lives spiral out of control right in front of them. They get talked to, and subjected to lots of lectures about responsible behavior.
Recovery is hard, but not magic. Soldiers like Krebs, and his battle buddies, need a hand when they are falling; and they need caring helpers who will dry them out, be there when they relapse, connect them with peers and help them transition into a more productive and saner life. Certainly the military and many civilian service providers are trying to address the needs of the soldiers, but there is not a uniform system and the demands on the troops are relentless. These young traumatized soldiers need time to get straight and grow up, and fix the mess they have gotten into. But time is the one thing that is in very short supply when a fighting force is overextended.
Not all young men and women who commit suicide fit this kind of profile. Some are just plain reckless. It's hard to tell who can be helped. But, one lesson from the story of 'Doc' Krebs stands out. Simply lending a hand along the way, providing some support in a way that doesn't judge or demean the troubled spirit of the young man or woman goes a long way. The soldier thinking about suicide needs to know that there is hope -- that not all is lost, that there is a personal and professional future. The goodness and kindness of another human being can lift even them up, away from the brink.
Something to remember on this Memorial Day.
Follow Brigadier General (Ret) Stephen N. Xenakis, M.D. on Twitter: www.twitter.com/SteveXen