Said Shahtahmasebi, Ph.D.

In 2009, Leo Sher and Alex Vilens published two books on suicide in the context of the military and war. In the books, aspects of military life and war were discussed as potential triggers for suicide. As a contributing author, I argued that despite decades of failure to bring down suicide rates, we still stubbornly insist on the same model of suicide prevention that presumes mental illness as the cause. The mental illness-suicide model cannot prevent suicide and questions have arisen about how effective it is in intervening and stopping suicide. The model misses the majority of individuals who do not show, or are good at hiding the ‘warning’ signs, or, simply do not have them.Nevertheless, decades of insisting on the same model of prevention has resulted in blaming suicide rates on problems with access to mental health services. Thus, policy after policy has diverted resources to address the accessibility of mental health and psychiatric services, whilst over the same period lives are lost unnecessarily to suicide. This is an unacceptably high cost for society to pay for stubbornness. In other words, every new suicide prevention policy and initiative offers more of the same year after year, thus the authorities, scientists, researchers, policy makers, and the public have become part of the problem. See Shahtahmasebi 2013.

Unsurprisingly, the military follows the mental illness-suicide approach to prevention.  In other words, when symptoms of mental illness and depression are detected in soldiers they are referred to psychiatric services. This is an intervention, the success of which depends on the correct diagnosis, an appropriate and relevant course of action. Furthermore, civilian life processes are very different to that of the military. So even in the military, decade after decade, suicide prevention policy has been to offer more of the same irrelevant treatments in order to prevent or treat suicide.
Recently as I was ploughing through my inbox I came across an email from a colleague alerting me to an article in the Guardian newspaper highlighting suicide in the US Army (http://www.guardian.co.uk/world/2013/feb/01/us-military-suicide-epidemic-veteran). The article reports that more active-duty soldiers in the US military died by suicide than in combat in the previous year. The report then describes suicide in the military through a single case.

The story is a harrowing account of the life and post combat duty of William Busbee until his death at the young age of 23. The article’s focus is the impact of the symptoms of trauma from active duty on the mental and physical wellbeing of William Busbee. Clearly, the hardship he suffered made his life unbearable. It is sad that a life is lost unnecessarily in this way. It is even sadder and shameful that after decades of research we are still unable to help people like William Busbee.

Taking the media’s reporting at face value, it appears that society is not equipped to deal with such cases nor is it willing to learn from its mistakes. Ironically, society is the answer to preventing suicide (and other undesirable health and social outcomes e.g. teenage pregnancy, smoking, drinking and drug abuse). See Shahtahmasebi 2013.

One interpretation of the article is that William Busbee’s problems began before joining the military and being posted for active-duty in Afghanistan. His only ambition from the age of six was to join the military which led him to active-duty in a war zone far away from home during which time he suffered, what the article calls, psychological damage. Naturally, the military provided psychiatric services to support him. After a failed suicide attempt he was taken off normal duties and prescribed large quantities of psychotropic drugs which according to his mother made his condition worse. And subsequently, he was constructively dismissed. The military, the love of his life, issued him with an ultimatum: retire yourself or we will discharge you on medical grounds. He was forced to take the former. Subsequently he was inconsolable and told his mother: “I’m nothing now. I’ve been thrown away by the army.” A very typical reaction to disappointment due to high expectations and a lack of any alternative back up plan.

Other clues from the article indicate that William Busbee was desperate to tell his story but perhaps was not sure how or where to start. Possibly due to the complications in his life he was waiting for that one question or an invitation to start. For example, the constant washing of his hands and declaring to his mum that it [blood] was not coming off, or, sleeping in a closet despite having bad dreams and being scared of the dark. Another example is the short conversation between William and his mother that the article reported:
William told his mother: “You would hate me if you knew what I’ve done out there.”
“I will never hate you. You are the same person you always were,” she said.
“No, Mom,” he countered. “The son you loved died over there.”

Often the authorities use information that may have been available to help the person in need as an explanation for the outcome instead of utilising it to do good. For example, the article quotes the psychiatrist stressing: “the impact of being discharged from the military that can also instil a devastating sense of loss in those who have led a hermetically sealed life within the armed forces and suddenly find themselves excluded from it.” If this indeed is the case then one would expect that this information would be used to implement a planned discharge with some sort of support other than medication.
Not utilising the available knowledge is an artefact of a top-down and authoritarian approach. For example, following a drop in suicide rates in Christchurch (New Zealand) after the 2010/2011 earth quakes, the authorities reported an expectation that it will rise after a year or two. Therefore, one would have expected preventional measures to be put in place to stop suicide rates rising, other than “look for signs and refer”.

Unfortunately, the top-down approach (authorities know best) has blocked the flow of appropriate information to the community and individuals. More importantly, the culture of secrecy prevents parents, siblings, teachers, frontline health and community workers to take preventative action because of the scarcity of quality information. This is particularly true in New Zealand where the culture of secrecy is based on an uncritical and selective use of literature and poor and flawed research disguised as evidence.

A grassroots approach to establish suicide prevention at grassroots in New Zealand involved providing communities with human development/behaviour information. Since its start in 2010 we continue to receive comments “had we known then what we know now our son/daughter would be alive” from parents who have lost children to suicide.

Unfortunately, the authorities appear oblivious to the heavy cost to the communities: the human lives lost while waiting and hoping that one day the failed current model may work.

REFERENCES
Shahtahmasebi, S. (2009) Suicide prevention in a top-down society. In Leo Sher & Alex Vilens (Eds.). Suicide in the military. Nova Science Publishers, Inc., pp121-136.
Shahtahmasebi, S. (2009) War, massive social change and suicide. In Leo Sher & Alex Vilens (Eds.). War and suicide. Nova Science Publishers, Inc., pp27-42.
Shahtahmasebi S (2013) De-politicizing youth suicide prevention. Front. Pediatr. 1:8. doi: 10.3389/fped.2013.00008, (open access) URL: http://www.frontiersin.org/Journal/Abstract.aspx?s=1411&name=child_health_and_human_development&ART_DOI=10.3389/fped.2013.00008