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Dr. Prudence L. Gourguechon

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Closing the Hope Gap: President Obama as Psychoanalyst-in-Chief

Posted: 02/02/11 09:45 AM ET

President Obama's campaign to unite the Executive Branch around the imperative to help military families in any and every way possible way is innovative, inspiring, and may just turn out to be more effective in stemming the tragic epidemic of military suicides than any psychotropic drug or psychotherapeutic intervention.

Most of the military personnel who attempt or commit suicide are not suffering from long-term mental illness. They are often depressed, yes, but they don't necessarily have the biology for life long mental illness. What they are is profoundly hopeless, and emerging from an experience where the meaning of life, both theirs and others, has radically shifted on its axis. They suffer a crisis of meaning and connectedness. And often they panic. Suicidal acts are frequently undertaken in a state of temporary, extreme panic, when the mental doors shut down; the individual can not see any alternatives and cannot stand the agony of the panicky, despairing state.

We read that military suicides are often linked to marital problems. I've often pondered that. In my long career as a psychiatrist and a psychoanalyst, I've never seen marital problems are a frequent and core issue in the incidence of civilian suicide. So what accounts for the difference? In large part the answer has to do with hope, anxiety and connections.

From a psychoanalytic point of view, soldiers returning from war or non-combat military service have to negotiate a profoundly difficult transition to civilian life. To do that successfully, they need certain absolutes:

Hope: hope that they will be able to connect to the world back home, that they will have the opportunity for a good civilian life, that they will be able to survive any physical and emotional war injuries they have suffered and will receive the help they need to do so.

Human Connections: Few people can survive without strong human connections. But the returning soldier cannot rely on connections the way most of us can. His buddies may have scattered when everyone returned stateside. Repeated deployments may have weakened her community ties. He may find that his family doesn't know how to talk to him. She may feel a profound sense of isolation and disconnectedness when confronted with the internal experience that she has seen and known terrible and strange and even exciting things. Nobody can understand. For many soldiers, the best and most useful connections are with fellow soldiers, who understand the experience because they shared it. After the Vietnam war, the VA system and other mental health agencies set up "rap groups" where veterans could talk to each other, fellow survivors of war, and come to terms slowly, over time, with the changes in themselves and their lives. This was found to be a very useful method of treatment. Other soldiers are more comfortable talking one to one with a therapist.

Anxiety: Severe anxiety is one of the most painful internal states, and takes on a life of its own. It is not necessarily amenable in its fierce immediate intensity to the cognitive restructuring of CBT and certainly not to reassurance. One clinical researcher recommended years ago that suicidal patients be treated immediately and powerfully with anti anxiety agents to get them past the propulsive panic to a state where other interventions might be helpful. Like a field dressing, a little bit of anti-anxiety medication could be readily available to all military personnel in psychological danger, to stem the hemorrhage before more enduring treatment is available.

So how does Obama's program provide these essential treatment factors?

Surely the sense that the whole government is thinking about and working on how to help military families decreases anxiety and increases hope.

Surely the experience that every single department of government has searched for a way to help military families is a solid representation of hope that may actually save some lives, as soldiers return and experience a country devoted to the care of them and their families rather than a country pretending that those who have served in our longest war do not exist.

Surely the image I saw yesterday of the cabinet members around the table with President Obama, each bringing forward their contribution to the campaign to help military families is a concrete representation of the human connectedness that returning military personnel absolutely need in order to make the transition from the battlefield to the homeland without falling into the chasm of suicidal anxiety and despair.

I was most impressed, as I think those in military service will be, with the immediacy, practicality and "actionability" of the 50 ideas contained in the plan "Strengthening our military Families" http://www.defense.gov/home/features/2011/0111_initiative/Strengthening_our_Military_January_2011.pdf. Picture yourself in Afghanistan, if you dare, and you find out your teenage son has a job in the national parks next summer, part of a program initiated by the Interior Department. Picture yourself as a military parent, and you see that your kids are getting better teaching in school, and your wife has new job training opportunities, and therefore is happier and less frightened. That's the stuff of hope.

The Department of Defense and the Department of Veterans Affairs have been furiously at work trying to solve the problem of the increasing incidence of suicide among active duty personnel and veterans. But they could never solve the problem alone, without the involvement of the entire country.

Hope, anxiety reduction, and increased human connectedness. Now I have some hope.