We shouldn't be so quick to blame PTSD for veterans' suicides

Brian Van Reet / Special to The Washington Post /

Published Aug 24, 2013 at 05:00AM

It has become an all-too-common story: A young person joins the military, deploys to war and later returns home, only to be troubled by the horrors of combat duty. This traumatic past intrudes on the soldier’s new life, tormenting him or her up to the point of substance abuse, criminality and even suicide.

This narrative of combat trauma and self-destruction has gained primacy, partly because it is easy to understand — it sounds true — and partly because it sometimes is true. It elegantly explains how acts of violence, directed inwardly and outwardly, resonate through time.

Science, however, is beginning to suggest that the link between war, post-traumatic stress disorder (PTSD) and self-harm is not what many expect, given our prevailing cultural narratives.

For instance, a study published this month in the Journal of the American Medical Association (JAMA) concludes that exposure to combat does not increase the likelihood that a service member will take his or her own life.

These counterintuitive findings demonstrate the need for further examination of war’s effects on those who fight it. As we attempt to understand this problem, it might be helpful to distinguish the experience of fighting a war from the experience of serving in the military during wartime.

The looming threat of year-on, year-off deployments places a psychological burden on all service members — regardless of whether one is ever deployed — and may encourage risk-taking behavior or a live-for-the-day mentality that develops in response to a highly uncertain future.

Compounding this phenomenon, young people who seek danger are perhaps more likely to join the military in times of war than in peacetime. People with a genetic predisposition to thrill-seeking might also be more likely to drink, to use drugs, to suffer financial ruin, to get divorced — in short, to act in ways that have been shown to correlate strongly with suicide.

In thinking about this problem, combat-related trauma should be a factor, but so should the character of military recruits before they see action. Other considerations are the structural character of the military, which is capable of rendering draconian shades of misery at a strength, if not intensity, that rivals the better-documented horrors of the battlefield.

In 2003, I received stop-loss orders. They meant that instead of getting out of the Army after two years, as I had expected, I would instead be deployed to Iraq. Eighteen months later, when the stop-loss order was finally lifted, I had spent almost twice as much time on active duty as I had signed up for.

After I was discharged, I remained a member of the Individual Ready Reserve but thought I was finished with the Army. Then one day, years later, I received a letter ordering me to report for “muster duty” at a mobilization center. There, after considering whether I wanted to chance being called back to active duty, I signed an addendum to my enlistment contract that obligated me to attend weekend drill once a month but that also guaranteed I could not be deployed for the remainder of my time in service.

Combat brings its own long-lasting privations — most notably to the civilians who live in places where wars are fought — but the institution of the Army caused me as much sustained mental hardship as any traumatic thing I saw or did while fighting overseas.

I know I am lucky to be able to make that statement. I am also lucky that even when I went through hard times, I always thought I had something to live for. I never considered suicide as a feasible escape.

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