Preventing Veteran Suicide: A New Approach to the War on Hopelessness

Nov. 9, 2018- We may not all serve in the military, but we can all serve our country. When I accepted a position as a frontline psychologist in the Department of Veterans Affairs about 10 years ago, I did so with the mindset that this would be my way to serve our country.

Working with veterans continues to be one of the greatest blessings in my life. Doing this work renews me with meaning and purpose. At times, however, especially when several of my patients were in crisis, I struggled with feelings of profound helplessness. I felt responsible for my patients’ well-being, even though on some level, I understood that feeling responsible for other peoples’ decisions is not healthy.

Some nights, I carried this heavy feeling of responsibility home with me. During these times, I often stayed up very late trying to work out how to become better at my job, to be the healer my patients needed me to be. One night, around 3 a.m., as I was thinking about the stories of my patients’ most desperate hours, I realized these narratives fell into two discrete categories – some involved suicidal crises, and others involved nearly being killed in combat.

When a warrior was hit in the combat zone, their comrades would drag them to safety, call in a medic and stay with them. They would say things like, “Look at me. Stay with me!” Commonly, as reported to me by my patients, time would seem to slow down, and the faces and voices of loved ones would mentally appear to the person, urging them to stay in the fight – maybe the face of their child or spouse, imploring them to come home safe. Sometimes, they would envision a fellow warrior who had previously fallen in battle, saying things like, “You don’t have permission to die!” Many expressed that these visitations gave them the will to stay in the fight, despite life-threatening injuries.

The stories I would hear of suicidal crises were different. These patients often reported feeling profound emotional detachment from their loved ones. Rather than hearing the voices and seeing the faces of the important people in their lives, the thoughts of patients as they experienced a suicidal crisis obsessively looped on the theme of being a burden, a danger, or a liability to others. Their perception, during this time of despair, was extremely distorted: they saw suicide as the only logical choice, the same way an individual struggling with advanced stage anorexia might see him or herself as fat.

Once I noticed the divergent themes in these two categories of near-death accounts I encountered working with veterans, I noticed a shift in the way I viewed the work of suicide prevention: instead of asking a patient, “How can we come up with a plan to help you pull yourself out of a crisis?” I realized a better question might be, “How can we help you draw from the strength of your tribe to give you the will to stay in the fight?”

Many who serve in our military are not very self-protective by nature; but they often have a very strong instinct to protect those they love. This principle may have broader application, since a good number of civilians – our first responders, our firefighters, our police officers – may also think in this way. For some people, re-activating an attachment to those who love and need them may pull them out of a tunnel of despair.

These concepts were the original idea behind the Warrior Box Project, a suicide prevention tool I co-developed with Brian Vargas, a Marine whose life was saved by the application of this idea. (Brian’s story was recently featured on NPR). The Warrior Box Project gives people a tangible way to reconnect with the tribe of those they love and trust, and the values that drive a meaningful life. Brian and I believe that the same bonds of love that lead us to risk our lives for the people and values we hold sacred can help more of our citizens stay in the good fight.

Suicide prevention is a battle we must take on together, and it calls for the combined efforts of researchers, clinicians, those who struggle, and their loved ones. I believe it is a fight we can win.

To learn more about the Warrior Box Project, click here.


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