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Suicide

Are We Our Own Worst Enemy?

The impact of stratifying military service based on combat exposure.

It should go without saying there is a need to reward combat capability and experience in our Armed Forces. As a nation with a standing, professional military engaged in a variety of theaters of operations around the world, the incentivization of combat exposure is critical.

Point of fact, the Department of Defense’s primary line of effort is to build a more lethal force (read: increase the military’s capacity to cause death and inflict damage).

Resultantly, demonstrable performance under fire, literally and metaphorically, is institutionally recognized and rewarded. It also carries immense social cachet, in the military and out. From medals and promotion points to book deals and sponsorships, Americans prize and privilege the proven combat veteran.

Lethality is a necessary yardstick while in uniform but it should not become the tool with which other veterans beat each other upon transitioning out—particularly as the label "combat veteran" is an increasingly elusive and faster-moving target in common lexicon.

To be clear, there are concrete definitions in use that confer benefits. For example, for tax purposes, the term combat can apply to any service member who is serving in a combat zone established via executive order. The designation allows military members to exclude military pay from federal income taxes.

At the VA, post-9/11 combat veterans can receive cost-free medical care for any condition related to their service in a combat theater for five years after the date of their discharge or release. Again, combat theater is designated by executive order.

However, that is not the sole qualifier for veterans to receive treatment at the VA and that belief, that only those who served in combat theaters are entitled to care, has prevented many, especially women, from seeking care.

Concerns about eligibility remain a large barrier to treatment.

Relatedly, belief systems regarding qualification for treatment are not limited to women. Veterans cite belief “they do not meet criteria necessary to qualify” for treatment as a primary reason for not showing up. Moreover, many do not seek treatment for “worry and concern about what others think.

It is a mistake to assume that fear is solely grounded in either the "crazy vet" or “failed stoic" stereotypes.

Veteran attitudes towards other veterans is an under-researched and unexplored phenomenon. However, experiential knowledge suggests that stratified in-grouping and out-grouping (veteran vs. combat veteran) of an already in-group/out-group prone population (i.e. the civilian-military divide) is both occurring and capable of producing pernicious effects.

Contrastingly, there are often times during the transition from active duty to civilian life that the reverse is true, in which veterans become the out-group and civilians become the in-group.

Regardless, these are more than just labels. There are very real outcomes, attitudes, and behaviors that result from intergroup bias. In-group favoritism arises as a result of the formation of cultural groups. These groups are, at times, established on seemingly trivial traits that over time lead to the association of those traits with certain behaviors. The result is a pattern of favoring members of one’s in-group over out-group members. This is expressed in a variety of ways, to include, evaluation of others, allocation of resources, and interpersonal treatment.

In no small way, the combat veteran is fetishized by our society. While this is not a new phenomenon by any means, it appears to be entering the national conversation in current and divisive ways at a time when nuanced conversation around service and it’s impact is desperately needed.

The most recent example occurred recently when Robert O’Neil, a former SEAL Team 6 member, self-acclaimed for having fired the shots that killed Osama bin Laden during the raid in May 2011, tweeted that Democratic Presidential primary hopeful Pete Buttigieg “is not a ‘combat veteran.’”

His platform is not small, with his followers numbering in the hundred thousands. Frankly, it would be easy to dismiss his comment as an aberration or extremism but his denigration of Buttigieg’s service is endemic of a greater issue regarding a self-imposed hierarchy in the veteran space and beyond.

It is, perhaps, worth widening our aperture and considering the social landscape in which veterans exist and that the piecemealing of service is a practice that bears consequence.

This past Friday the Department of Veterans Affairs released a report outlining the number of deaths by suicide from 2008 to 2017. The toll: 60,000. To put that in perspective, the government documents that there were 58,220 military casualties during the Vietnam War, over 46,000 known by enemy action. In short, more American veterans have died by suicide than were killed in the Vietnam War.

The reality is that combat, in many ways, is peppered by timing and luck—both in its myriad manifestations and outcomes but also by who experiences it and to what extent.

For better or worse, the search for combat is oftentimes a somewhat selfish and fruitless pursuit. If service is increasingly tied up as meaningful solely if and when it is experienced via the crucible of combat we are omitting a large swath of the veteran population.

There were many who saw extensive combat in Iraq and Afghanistan in the first years of those conflicts who enlisted or commissioned during peacetime, never knowing those days would come. Conversely, there are those who volunteered post-9/11, with the wars raging, who deployed often but never saw the combat, or level of combat, they craved.

As a proxy for what so many desperately desire—the opportunity to prove themselves worthy—exposure to combat has become a veteran’s litmus test. Sadly, we implicitly reinforce the counterpoint—unworthiness, or inadequacy—by stating only those who saw “real” combat are true veterans. This further begs the question, who gets to define what real combat is or isn’t?

More importantly for our understanding, unworthiness is the rapid undercurrent of shame. Shame feelings are often triggered by social events in which a drop of personal status or feelings of rejection are perceived. Shame is an especially painful and debilitating emotion that impacts one’s sense of self. Shame is associated with low self-esteem, hostility, and psychological distress in consistent ways across both genders (Velotti, Garofalo, Bottazzi, & Caretti 2017).

All that to say, in attempts to understand and combat veteran suicide and distress, it is past time we viewed veteran “influencers” as gatekeepers. In the field of suicide prevention, the term gatekeeper refers to “individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine."

Many veterans know their worth and value but for those on a precarious edge, statements like the one above are not a hand up but quite possibly a push.

References

Burnette, C., Ramchand, R., & Ayer, L. (2015). Gatekeeper Training for Suicide Prevention: A Theoretical Model and Review of the Empirical Literature. Rand health quarterly, 5(1), 16.

Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., … Pyne, J. M. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC health services research, 18(1), 591. doi:10.1186/s12913-018-3346-9

Markowitz, J. C., Meehan, K. B., Petkova, E., Zhao, Y., Van, P. M., Neria, Y., ... & Nazia, Y. (2016). Treatment preferences of psychotherapy patients with chronic PTSD. The Journal of clinical psychiatry, 77(3), 363-370.

Velotti, P., Garofalo, C., Bottazzi, F., & Caretti, V. (2017). Faces of shame: Implications for self-esteem, emotion regulation, aggression, and well-being. The Journal of psychology, 151(2), 171-184.

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