Suicidal GI Meme
Keeps marching on. U.S. government shrink reports that Iraq/Afghan war vets’ suicides may outstrip the death rate. Bloomberg:
May 5 (Bloomberg) — The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government’s top psychiatric researcher said.
Community mental health centers, hobbled by financial limits, haven’t provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association’s annual meeting in Washington.
Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.
Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, “it’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,” Insel said.
It’s worth noting that for any group of 1.6 million American men, at the annual rate of 17.9:100,000, there are going to be nearly 300 suicides a year. Rates vary for different age groups and the women’s rate is significantly lower at 4.2:100,000. But I’d suggest that it’s beyond “quite possible” that the suicides will outstrip the combat deaths. Under normal circumstances, within the next 20 or 30 years or so, it sounds like a statistical certainty. This guy’s not offering a time frame, and in fairness, he’s probably suggesting deaths above and beyond the background noise of suicides any group this size can look forward to. Though, as we’ll see below, any group this size is subject to a good deal of PTSD as well as suicide, traumatic stress being a simple fact of life.
However well-intentioned Insel may be, the article’s shock value lies in its subtext about a heartless government’s vet-neglect rivaling the same government’s bloodthirsty warmongering as a killer. Unfortunately, the reporting on this issue, and apparently the word being put out by professionals, has been speculative, a tad tautological, if not sloppy. Not unlike much of the reporting about the war itself. This article is supposed to be about how effed up everyone is coming home from the war, and how they are being ignored. It sounds like it could be a problem, maybe one that needs addressing, though this article doesn’t actually provide much more useful information on that score than the periodic anecodtal articles on PTSD cases and suicides do.
Here’s the press release on that Rand study, which costs $50, so let me know how it was. With its estimate of a $6.2 billion two-year post-deployment PTSD cost to society, it sounds a little Lancety, and I don’t want to contribute to the nation’s already burgeoning annual PTSD cost by buying it. I’m a little suspect of PTSD numbers that I suspect both understate and overstate the case. As my pal Sig said about how many people come back from combat with PTSD: “Try 90 percent. The other 10 percent already had it when they got there.” A lot of people reporting some degree of symptoms may not necessarily need treatment, or much treatment, and if they don’t desire it, it may be not only due to concerns about stigma, but a desire to steer clear of shrinks.
So how does the 20 percent of returning solders that reportedly have some degree of PTSD or depression compare to society at large? Five percent of men, 10 percent of women, about 7.8 percent in general get diagnosed. I’m guessing a lot more never do get diagnosed, the low-grade cases that no one ever examines or makes assumptions about the way they do returning soldiers. What do you think the real number is? Just going by those diagnosis numbers, 1 in every 15 or so people you know has been traumatized and experienced afteraffects. It starts to sound more normal, and little less crazy war vet, though it would go along way to explain why most of the suicide and depression and rage and violence out there doesn’t actually involve war veterans. Life is a pretty traumatic place. There’s a lot of death, fear and stress involved, and people cope. There’s a heck of a lot of depression and substance abuse, too. About 7 percent of Americans experience depression each year, and only 20 percent of those get treatment, a significantly smaller percentage of a significantly larger number than the untreated soldiers. And that costs employers $51 billion a year, let alone other add-on medical and societal costs that must push that into the hundreds of billions.
Sounds like a mental health crisis. Doesn’t sound as interesting as an Iraq war mental health crisis, though, nor does it provide as good an opportunity to tut and rail, or seek funding.
None of this is intended to disparage combat PTSD cases or suicides, and the despair and isolation some people may be feeling. Nor is it intended to suggest the issue doesn’t deserve attention and investment. I’m just waiting to find out whether we actually have a crisis. Beyond war being a dirty business that can’t always be made right, that is.
A couple of footnotes about this issue as a political football:
For all the shortcomings of our military and veterans medical system, addressed in the scandals of the last couple of years as they have been in the wake of past wars, I doubt you are going to find anything like the amount and quality of resources and infrastructure devoted to men and women who have served their country anywhere else in the world. Or the number of powerful advocacy groups, or the same attention of legislators. Here’s the latest on the VA’s decision to maintain four major medical facilities in the Boston area, including the one where my friend Larry Gwin, Ia Drang vet, says his life was saved during a period of critical PTSD, and where another friend and Ia Drang vet, John Eade, receives what he considers to be top-rate care for severe wounds still requiring regular treatment 43 years later. Of others I know who’ve been through the system with severe injuries, reactions range from “I love this place. They gave me back my eyes,” to complaints about bureaucracy and inattentive nurses and aides. None of it is perfect, but if you’ve been through the private health care system lately, you’ll know it isn’t either.
For those who tut and rail, I’d suggest it’s not just a poor welcome home or lack of troop support that exacerbates PTSD, but also the denial of the value of the sacrifice and efforts to abandon what was gained at such cost. Put another way, Code Pink, MoveOn, the Democratic presidential campaigns and the Democratic leadership in Congress, however concerned they may profess to be, are bad for veterans’ mental health.
Here’s something about some people who aren’t looking for money and aren’t waiting around to lend a hand:
Here’s a quick Crittenden PTSD reader:
Topics: Afghanistan, Iraq, PTSD, military
Posted by Jules Crittenden at 1:11 am on Tuesday, May 6, 2008
7 Responses to “Suicidal GI Meme”
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May 6th, 2008 at 4:46 am
People seeking to disparage the Bush Administration will often cite Veterans’ health issues it seems. It will be interesting to see what happens if a Dem gets elected to Prez…will all that criticism go away? I’m guessing yes.
As for Veterans suicides, the military does a lot of screening for prior mental health issues before they let you join. It would follow that people in the military would have a “healthier” state of mind prior to joining and should see a lower suicide rate. But these numbers still seem high and suicides remain a problem. It’s a fine line to walk between the “crazy vet” meme and advocating for veterans health. That’s why it’s good that there is organizations like IAVA out there (run by OIF/OEF vets) because they don’t come off like aloof pundits on the issue.
May 6th, 2008 at 8:43 am
Iraq-related Blog Roundup for the week of 6 May
Iraq-related blog posts that are worth checking out.
May 6th, 2008 at 9:40 am
…but a desire to steer clear of shrinks.
Most of whom are crazier than their patients.
May 6th, 2008 at 10:55 am
TRJS, amen to that.
May 6th, 2008 at 11:20 am
The VA has been for a very long time the Nations #1 Medicare Supplmental Healthcare provider. Geriatrics has been its specialty for at least 20 years.
There are about 10 categories of VA eligibility.
The two major ones -
Care for service-related conditions is not means tested.
Care for non service related conditions is means tested.
Retirement is the #1 cause of new VA patient load.
May 6th, 2008 at 11:44 am
Psychiatrist association recommends higher spending on psychiatric treatment programs. Shocking.
You know, I would be very interested in seeing some proof that the treatment programs even work.
May 6th, 2008 at 1:29 pm
As a VA patient who at the time of enrollment was unemployed and without income, I have had nothing but the best care I could hope for or expect. I was treated for a melanoma and was told that I would be in the system till I died. As a result of my status I pay a copay when I’m working and none when I’m unemployed. That fact gave me the opportunity to live with my mother as a caretaker till she died and gives me the opportunity to shun the emergency rooms in favor of the people who really need them. I also do my best to integrate with the service connected patients because the system is for them and not for me. Anyone who has a problem with the VA has me to contend with if they want to shoot their mouth off.
As to the subject at hand, in Vietnam I was on a destroyer (1965-1967) and saw no combat although my ship hauled a lot of fat out of the fire with our shore support (5/38 batteries). When I returned to find out that my efforts on the behalf of my country had landed me in what was deemed a criminal activity, I started feeling symptoms that were similar to PTSD. For a number of years I couldn’t talk about the war, hippies, or the press without going into a rage. I was one of the ones who refused to put down that I was a Vietnam veteran on employment applications. The condition resolved itself with time and I only get mad now not enraged. To make blanket assumptions about how bad and how long a situation like PTSD will last is foolhardy to say the least.