Farewell to Suicide

“Did you come close?”
“To losing it? Giving up my hold on the ‘real?’ Oh, yeah. I pushed it straight to the edge. That’s why I had to come out now. To tell you I’m giving up. Just not the way you think.”
—Robin Williams, What Dreams May Come (1998)

“You don’t choose a life. You live one.”
—Emilio Estevez, The Way (2010)

“It’s common sense, right? The best way to learn about an issue effecting a community is to speak directly to people on the ground. Hear firsthand, from their perspective, what is contributing to the problem. We know the Corps is a unique culture. You cannot prevent suicide without understanding the culture of Marines.”

The congressman nodded along to my “elevator speech,” refined and performed for over a decade with lawmakers, community leaders, researchers, and helping professionals. Anyone who would listen.

For a moment, I thought the message might lead to action. I was speaking to a former Marine general, after all. Until the call devolved into war stories and political sidetracks. The staffer hovering off screen clutched an agenda in one hand and prodded the senator’s shoulder with the other. Visibly agitated that we talked for the full 20 allotted minutes about military suicide, he whispered in the senator’s ear. Gatekeepers. The people in charge of the agenda are never the people you think are in charge.

“You get with him,” the senator jerked his thumb toward the suit, “to see what we can do.” I saw my last chance for “the ask,” or in policy parlance, a clear, feasible request for support. I was prepared. I simply wanted to introduce a one-page policy memo urging research that prioritizes qualitative and ethnographic methods, and therefore, the lived experiences of service members and veterans. Something on the record that says, “listen to people on the ground, don’t just survey us from afar, using hit and run research tactics that do not lead to change.”

I reached out to the staffer. And other staffers, after other meetings and email conversations with other elected representatives. And to offices and organizations contracted to the tune of millions to conduct suicide and prevention policy research. I should not have been surprised at the radio silence and dead ends. After all, even the Defense Suicide Prevention Office was “not responsible for research” when I met with them to advocate for ethnographic approaches. How easily people want to contribute and lead, only to give different versions of “our-office-doesn’t handle-that” when pushed.

I sought changes that a brave and tireless minority, spread across military and academic contexts and who apply lived experience and critical eye to suicide, seek. Having repeatedly and stubbornly asked “why,” we recognize the immediate and existential danger of the status quo of suicide prevention. Our vision of what research and prevention should be sits at odds with the bureaucratically and politically acceptable picture of research and mental health care. One way to get politicians and bureaucrats behind your ideas is to propose solutions that sound supportive, are good PR, but require no meaningful change in organizational culture. Which is not my style.

Reality. The Cultural Reality.

The reality is that prisoners have more voice in behavioral health research conducted in carceral settings than servicemembers do in military contexts. Both are considered protected populations in human subjects research; however, servicemembers and veterans are hardly represented in the who, what, when, where, how, or why of research.

Like other attempts to systematically understand suicide and provide expert recommendations to DOD, the recent Suicide Prevention Research Independent Review Committee breezed past the need to understand the attitudes, experiences, and on-the-ground issues facing military personnel. Five of ten members were former military or had military ties, and therefore, the committee achieved all the “cultural familiarity” required. However, committee members touted as exemplars of military cultural expertise include individuals who served as psychologists or physicians, a military spouse, and a former enlisted servicemember who served briefly over 40 years ago.

Advocates, researchers, and lawmakers often, perhaps innocently, skip past the stark difference between the lived experiences of someone who entered military life as a career psychologist in their late 20s or early 30s, and a 17- or 18-year-old enlistee who started adulthood within the cultural and environmental milieu within which military suicide occurs. We cannot avoid being critical of who and what we rely on for insider knowledge, especially when such token representation cheapens lived experience and lessens the urgency to understand the perspectives of servicemembers, veterans, and military families. It is safe to argue that the SPIRC does not represent the perspective of servicemembers and veterans who deeply understand the stressors of today’s military.

One committee member, Dr. Bryan, may agree. His game changing recognition of the complex interplay between environmental factors and the timing of suicidal ideation challenges traditional risk assessment practices. The mounting awareness that environmental context is the fundamental contributor to suicidal ideation underscores the urgent need for research bodies and figures, who control and direct research priorities (and funding), to aggressively pursue ethnographic research.

Such research cannot be achieved through more polls or surveys, dished out by academics and contracted evaluators from afar (i.e., armchair researchers), only through listening in person to the experiences of servicemembers and observing social interaction and communication at military sites. We need researchers with boots and hearts on the ground, not academics with their heads deep in debate over statistical methods and perceptual models that wholly lack external validity. We need collaborative and critically oriented thinkers to work hand in hand with units to map out, demystify, and reveal the mental health processes that contribute to suicide, while producing actionable suicide prevention recommendations fitting the cultural realities that come with the uniform.

Yet…we continue to avoid culture as a major focus of suicide prevention. Why? We use taglines like leadership culture, military culture, and toxic culture when reacting to highly visible topics and events like suicide, military sexual assault, alcohol use, addiction, and related issues like recruitment, and fitness standards. The revolving door of command staff firings, often at the same installations, are always explained away with the ambiguous (infamous?) phrase “loss of trust and confidence.” Yet, there are no meaningful, impactful, or sustained studies of culture related to such issues.

Special units, programs, departments, contracted experts, and committees responsible for analyzing organizational culture and advising commanders and DOD leadership offer mixed results at best. As health policy analysts and psychologists, most do not have the appropriate background to conduct “boots on the ground” cultural research. Those who possess the aptitude or training in qualitative, ethnographic research do not have the authority or freedom to work directly with units. When given the opportunity to evaluate military culture through interviews or consultations with unit leadership, researchers are given paltry days or hours to collect and analyze vital information on the relationship between suicide, mental health, and culture.

Additional restrictions on useful research stems from, ironically, the oversight protocols and entities put in place to protect servicemembers and veterans from harmful research practices. The bodies that oversee and approve research with the military according to ethical standards are notoriously clunky, slow, and due to an ignorance of qualitative methods (as opposed to exclusively survey-based research) are not versed in evaluating cultural studies. Applying for human subjects research (IRB) approval is automatically hostile towards researchers attempting to include the voices of military personnel directly in the research process. As a result, many researchers, especially in academia, weigh the risks and benefits of A) pursuing research with a low probability of approval or completion, and which is less “prestigious” in comparison to randomized control trials or empirical research, or B) investing time and resources into studies and methods with a higher chance of resulting in publication within peer reviewed journals, further funding, and tenure. Can the reader guess which option most social scientists go with?

Add to these issues the nebulous nature of “culture,” a concept that encompasses what it means to be human and how humans make meaning. Culture (briefly) is any learned behavior, or any human act that is not solely biological (though biological functions, nonetheless, become cultural). Culture includes both extremely unique and utterly common behaviors, beliefs, and worldviews, and every social connection, from our most intimate relationships to society’s largest networks and systems. Therefore, culture is synonymous with power, authority, agency, organization, communication, control, and similar concepts and dynamics that dictate the lives of servicemembers and the environmental context within which mental health is achieved, exacerbated, performed, surveilled, controlled, and defined.

Whether culture is explored in the interest of improving mental health for servicemembers, however, hinges on the cultural reality of researchers, academics, service and civilian leadership, and helping professionals themselves. This reality, rarely faced within these communities and more rarely advertised is that researchers and helping professionals do not always prioritize servicemembers and veterans in research and prevention. Social scientists, who gather and confirm the evidentiary basis for clinical or public health interventions, are engaged in various paradigm wars on multiple fronts, the results of which dictate the direction of future research, policy, and truth claims. Suicide research is an extension of a zero-sum game whereby disciplines, professions, and leading figures battle for relevance, legitimacy, and reputation. Solutions and helpful interventions become the biproducts of achieving primacy within one’s field, through accumulation of degrees, grants, awards, publications in high impact journals, tenure, and endowments, and distinguished titles. Likewise, bureaucratic figures and organizations compete for promotion, position, funding, and a sense of agency and control over internal and external politics.

To use a military or geopolitical analogy: military suicide research and prevention is but one front of a “cold war” between various entities in academia, and by extension, the suicide industrial complex. Servicemembers and veterans are resource, front, and proxy in that war. Positioning servicemembers as assets or fronts does not go unnoticed, and potential manipulation only increases the preexisting apprehension that many communities have towards outsider agendas and objectives. Taking an authoritative stance and lacking collaborative approaches or reflexivity, many researchers (knowingly or unknowingly) communicate power, position, and coercion to a community already mistrustful of changes to organizational structure, policy, or practice.

Writing to broader audiences—on Mad in America, for instance—instead of a high impact academic journal, is actively discouraged. Writing critically on the failures and cultural realities of suicide research is considered an attack on disciplines and theorists who are considered the unequivocal authority, particularly psychologists. As one researcher working for a large military policy research firm warned me, criticizing the state of military suicide research is like “kicking in a door and getting outgunned by ten psychologists on the other side.” Is suicide research about results, then, or is it about control over the process?

Add to such violent dynamics, the political partisanship that pervades every corner of American dialogue. A fellow critical writer and veteran operating an active military news site, who likewise refuses to engage in ideological one-side-isms, cleverly compared taking a neutral political stance towards military issues to standing in the middle of a two-way street—“you’re gonna get run over from two directions.”

Dr. Bryan describes suicide as “death by a thousand cuts.” Veterans would have described it this way themselves, if asked. They would tell you in detail about each cut. They would describe daily battles and life stressors that social scientists are slow (or don’t want) to see, and politicians and career bureaucrats are even slower (or don’t want) to address. They would tell you there aren’t just wrong doors. There are trap doors. False doors. Locked doors. There are penalties for disclosing mental health challenges. Deadly prescribing practices. Unreliable insurance. Quality-of-life debacles. Mental health shortages for even the most basic forms of therapy and counseling. Any cursory investigation of suicides, especially clusters, is rife with gaps in treatment and low standards of care and leadership that, if addressed, would save lives of servicemembers and families from unimaginable pain.

“Death by a thousand cuts.” It’s an apt metaphor for true suicide prevention as well. True suicide prevention focuses on the elimination of an “at-risk environment,” including iatrogenic harms and structural violence, as opposed to habitual reliance on reductive explanations that blame the “at-risk individual,” protect the status quo, and provide zero accountability for leaders, institutions, and yes, cultures. You want to stop the “death by a thousand cuts”? Find out where the blades are, who’s holding them, and why.

At the end of the day, reductive theories, like the Interpersonal Theory of Suicide, fail to show sustainable, community wide results. We should ask: how reliable, really, are theories on suicide experiences? Suicide research is massively funded and resourced. The rate of doctoral degrees, tenured professors, publications, and research labs and consortia grow at an exponential rate. If current theories and evidence-based treatments are so well validated, then why is the strongest correlation the relationship between increases in suicide and increases in research and spending?

I’ve seen, asked, and heard enough to come to a frightening conclusion: We, as a society, are not preventing suicide, because we, as a society, do not want to. True suicide prevention, and true prevention of chronic health disparities, come with sacrifices of power and control. In other words, the conditions required for suicide to happen are the same conditions required for dysfunctional leadership, toxic organizational culture and communication, counterproductive policies, and deadly practices to thrive.

With such realizations, came a personal and spiritual epiphany: I cannot reverse the cultural attitudes of academia, behavioral science, healthcare, or the dense military and civilian bureaucracies of the DOD or VA. I have learned that I cannot take responsibility for others’ decisions or beliefs, especially at the cost of my own sense of ethics, agency, or wellbeing. Even if it means I will not receive a PhD after six years of study, abandoning the path that all but a rare few tell me I must take. So…what now?

A Farewell to Suicide.

We crested a steep hill and loped across the dusty flat toward the generous shade of an old tree. We sought any escape from the hard sun that had been dogging us for days along the Camino de Santiago, a 1,000-year-old pilgrimage route stretching for over 500 miles across northern Spain. Under the long, outstretched limbs, a young man sat on a bench in meditation. Maybe it was simply his way of sitting. He recently graduated university, he explained, taking time before embarking on a career as a jurist in France. I described my reasons for taking the Camino with my young son, which, among evolving reasons, was to understand what it meant to be a helper to those experiencing suicidal thoughts, and to communities, like my own, who face suicide.

“What advice would you give?” I asked. I collected advice as readily as Liam picked up “pretty stones,” threatening to stuff the whole of the Camino into his little pack.

“If you know people who suffered, keep them in your heart,” he replied.

Inspired by the ups and downs of the journey, in life and on the Camino, I pursue writing and poetry therapy, with a theme of pilgrimage and ceremony. Of journeying. Of The Way. Through the process of telling a story as a journey to the ideal self, I hope to help others find their “way” from a torturous suffering to a healing relationship with suffering, to live within the braided tensions of pain, joy, time, space, and relationships. This way of approaching suicide as an existential experience, grounded in reflexivity and strengths, allows me to practice a vocation and participate in community.

In the words of the film that inspired our Camino, The Way, I am seeing the difference between “living a life” and “choosing one.”

On one foot, it may sound like I am giving up. And in a way I am. I am giving up the convenience, prestige, and pursuit of legitimacy that comes with being a “social scientist” or “subject matter expert” or a “PhD.” I am giving up on one sense of community and its material benefits, for another and its spiritual gains. This is my farewell to suicide. But not to my fellow Marines and Veterans. Not to a community of Seekers. That’s why I had to write this now. To tell you I am giving up. Just not the way you think.

I hope one day to see you under the shade tree.