Tuesday, January 19, 2010

No Condolence Letter For Families of Soldiers Who Commit Suicide

When a soldier is killed while in the military service the President writes a condolence letter to the family. However, if a soldier is psychologically injured and then commits suicide, there is no Presidential letter of condolence. There is apparently an unwritten policy that this does not include families of soldiers who have committed suicide.

It is easy to imagine how hurtful that must be for families who are burying a loved one who came back from war with psychological problems and then committed suicide or perhaps did it overseas.

One Such Family
After my blog on this subject appeared in PsychiatryTalk.com

I received a comment from Gregg Keesling the father of one such soldier and then had a correspondence with him. His story was also written up in the NY Times.

His 25-year-old son Chancellor served two deployments . He committed suicide in Iraq after sending his parents an email telling them of his decision. He said that “ military investigations demonstrated, our son Chancellor was a good soldier. He succumbed to an illness as much as someone who dies in the war theater from food poisoning or infection, and we believe that the President should send condolences and express the country’s appreciation of our family’s sacrifice.”

A spokesperson for President Obama said that the policy in regard to who should receive a letter of condolence is currently undergoing a review.

What Reasons Are Given For Opposing A Letter of Condolence ?
I have tried to understand why anyone would advocate that the President should not express condolence to families such as the Keeslings I heard one view that many soldiers would feel that their comrades combat death would be demeaned if the families of soldiers who suicided were given an equal letter of condolence. Another view is that treating suicide the same as other war deaths might encourage mentally frail soldiers to take their lives by making the act seem honorable.

I believe these ideas are misguided and resurrect the stigmatization of mental illness. Soldiers cannot will themselves to avoid these emotional states anymore than a soldier can avoid a bullet or an explosive device. Once you are in a combat zone, you are vulnerable to injury. I know of no evidence that people on the verge of suicide would be driven to it because their family would get a letter of condolence.

They Are All Heroes
If a soldier in Iraq were accidentally killed in a car accident, would his death be any less deserving a letter of condolence than a soldier who was killed in an enemy ambush? Would the family be any less deserving of the letter if the soldier made a tactical error leading to his death as compared to someone who bravely fell on a grenade to save others lives? Similarly, would you compare a soldier who faced many horrific combat situations and developed PTSD with another soldier who became severely depressed shortly after arrival in the combat zone if both ended up having intolerable suicidal feelings, which led to their death? I don’t believe that we judge some soldier’s deaths as being more worthy than others.

Yes, we do give out medals for unusual acts of bravery but this in no way diminishes the sacrifices that others have made.
Every soldier has volunteered and knows that he or she could be exposed to combat. For this they deserve our thanks and when they make the supreme sacrifice, their families deserve a letter of condolence.

Recent Actions To Attempt to Influence The President
On December 23rd a bipartisan coalition of 44 House members initiated by Reps Patrick Kennedy and Dan Burton sent a letter to President Obama. They wrote “ By overturning this policy on letters of condolence to the families of suicide victims you can send a strong signal that you will not tolerate a culture in our Armed Forces that discriminates against those with a mental illness.”

The American Foundation for Suicide Prevention in a letter to the President on January 5th wrote “We agree with members of Congress that you can send a strong signal that you will not tolerate a culture in our military services that discriminates against those with mental illness. Please Mr. President, overturn this policy as soon as possible.”

On January 7th Mental Health American announced the adoption of a position requesting the President revoke the policy of not writing condolence letters to families of soldiers who have committed suicide They also started an online petition on Facebook.

Write to the President Now
I continue to urge anyone concerned about this issue to write to the President Those who are mental health professionals should state this and explain your views based on your understanding of mental illness. The email address to write the President is http://whitehouse.gov/contact

Michael Blumenfield, MD

Dr Blumenfield is The Sidney E. Frank Distinguished Professor Emeritus of Psychiatry and Behavioral Sciences at New York Medical College. He is a recent Past Speaker of the Assembly of the American Psychiatric Association. Dr Blumenfield lives and practices in Woodland Hills, CA, where he also writes a weekly blog, PsychiatryTalk.com.

1 comment:

  1. The puzzle of Army suicide rates obviously has many pieces. Psychiatrists within and outside the military should review On Killing by Col. Dave Grossman (2nd ed. 2009). A military historian, psychologist, and consultant on training of police as well as troops, Grossman examines the revolution in training that dealt with the fact that only one in five soldiers fired at a visible enemy in WWII and Korea (and before). In Vietnam the proportion reached 90 percent. These more effective soldiers experienced PTSD at higher rates, due in part to the overthrow of natural inhibitions, in part due failure to prepare them for civilian life. Many recruits are de facto conscientious objectors who discover that only when it is too late apply for that status. Grossman finds that only three percent of men are uninhibited about killing and that these score high on measures of psychopathy.
    News and entertainment media give a distorted notion of how easy killing is. Most Americans have a greatly exaggerated idea of of the prevalence in society of psychopathy and violent crime. Because conscientious objection is the norm, restoring hardened yet battle-weary troops to civilian life is a major challenge. Success depends upon training methods, unit cohesion, public support of the mission, and gradual readjustment to civilian life while maintaining buddy contact. These findings certainly shed light on the current military suicide problem. Clinicians and researchers must take account of the well-documented reluctance to kill--and the consequences of undoing the inhibition. To some, the inhibition implies weakness, to others a fundamental contradiction between warfare and religious values. Regardless, the phenomenon must be considered if we hope to succeed in reducing PTSD and suicide among our servicemen and women.

    E. James Lieberman, M.D., M.P.H.
    DLF, APA
    Clinical Professor of Psychiatry, Emeritus
    George Washington University School of Medicine