A Viable Plan for Identifying Veterans At-risk for Suicide

  • The program office for VA/VHA Suicide Prevention does not have any valid and replicable tools for the identification and assessment of veterans at-risk for attempted suicide.
  • Since around 2010, the DVA/VHA has spent nearly $3.5 billion on ineffectual programming in the establishment of a basically sedate administration for the stated purpose of suicide prevention.
  • Why was the suicide rate among Vietnam war veterans, from 1965 until 1975 and from 1975 until 1990, so much lower than among Iraqi/Afghani war veterans from 1990 until 2018, and especially from 2003 to 2018?

In looking closely at a practical scenario picturing a veteran at-risk for attempted suicide, one may clearly detect the serious flaws in the DVA/VHA programming that is currently being represented to the American public by the U.S. Department of Veterans Affairs as an effective use of the approximate $1.3 billion that have been appropriated to fund VA Suicide Prevention, since around 2012.

One of the most important laws about Veterans’ Suicide Prevention is the Joshua Omvig Veterans Suicide Prevention Act (JOVSPA) of 2007, supporting the creation of a comprehensive program to reduce the incidence of suicide among veterans. Named for a veteran of Operation Iraqi Freedom who died by suicide in 2005, the act directed the Secretary of the U.S. Department of Veterans Affairs (VA) to implement a comprehensive suicide prevention program for veterans. Components include staff education, mental health assessments as part of overall health assessments, a suicide prevention coordinator at each VA medical facility, research efforts, 24-hour mental health care, a toll-free crisis line, and outreach to and education for veterans and their families. In the summer of 2009, VA added a one-to-one “chat service” for veterans who prefer to reach out for assistance using the Internet.

With the approximate 19 million male and female veterans currently in the USA between the ages of 20 and 80+ years, the valid and replicable assessment and identification of the honorably discharged veterans, who decide very quietly that life is not worth living and attempt, or successfully complete, the act of suicide, is currently impossible.  The program office for VA/VHA Suicide Prevention does not have any valid and replicable tools for the identification and assessment of veterans at-risk for attempted suicide.

The highly paid clinicians, analysts, and administrators in suicide prevention are conducting a lot of meetings, writing a lot of proposals, and congenially agreeing with each other about the way things ought to be, but, in-reality, they haven’t directly prevented one of those amorphous millions of at-risk veterans from attempting to commit suicide.

This, of course, is at a national-level, and the prospect of saving an at-risk veteran from attempting suicide at the national-level is basically negligible.  The local-level is the place where the greatest concern should be placed, but since there are no practical, that is, reliable and replicable, tools being used presently by the VA to identify and assess at-risk veterans, the attempted, and successfully completed, suicides continue to occur at a very rampant rate.

Let’s examine how unidentified and unassessed predisposing diathesis stress can cause and trigger an unidentified at-risk veteran to contemplate, and pursue, attempted suicide.  John Q. Combat Veteran, age 36, lived in Dallas, Texas, with this wife and five-year-old child, and had been honorably discharged from the U.S. Marine Corps ten years earlier, having served in continuous combat operations in Iraq and Afghanistan from 2004 to 2008.

Since leaving the Marine Corps, John had held three jobs working in construction, and had a severe drinking problem.  He was fired from the first two of those jobs because of tardiness and public intoxication.  John did not want to have any contact with the VA or any veteran service organization, and was filially estranged from his father, mother, and one younger brother who live in El Paso, Texas.

What the USMC/DOD did not know about John Veteran was that he had started having severe nightmares after killing his first human beings in Iraq, and seeing several of his close friends die during firefights. That was when he was in his early 20s.  Later, in 2005, his only girlfriend, to whom he was engaged, sent him a dear-John letter while in Afghanistan, ending a seven-year relationship.

Rarely talking about his personal worries, fears, and family troubles, John subsisted emotionally for the rest of his enlistment, and the USMC/DOD had no idea that he suffered from severe PTSD and a severe neurosis in 2008 when he was honorably discharged from the Marine Corps.

A few weeks after being discharged, after returning to Dallas, John met a woman in a nightclub there, had a one-night stand, and the woman became pregnant.  Thinking that he was doing the right thing, John Veteran married the woman, even though he didn’t love her; and soon thereafter he discovered that the woman had no love for him, but only for his financial support. John rented a house in east Dallas and began a series of extra-marital affairs, while having severely violent dreams and periodic flashbacks to Iraq and Afghanistan.

John had only a high school education and no other formal training except for the infantry training he received in the Marine Corps.  One night a few weeks later John came home from his menial construction job drunk, went into his bedroom and locked the door, and pulled-out the 9mm handgun he brought home with him from Afghanistan.  Then he tried to kill himself; but only wounded himself by inflicting a nonlethal wound to his face.  Two days later, John woke-up to find himself in a Dallas County psychiatric hospital where he was declared a danger to himself and was committed by a judge to a lengthy period of psychiatric treatment.

How could John Q. Veteran’s dysfunctional and pathogenic predisposing stress have been properly assessed and identified through an effective DOD/VA interactive cooperation long before his stress-level became unbearable as a civilian and he became self-destructive?  Like I’ve said, the U.S. Department of Veterans Affairs (DVA) Veterans Health Administration (VHA) has had no valid, reliable, and replicable tool to use to effectively identify and assess just one of the 19 million male and female veterans who reside with their immediate or extended families, by themselves, or are homeless on the urban and rural streets, and in the woods and forests, of the USA since the inception of VA Suicide Prevention.

Since around 2010, the DVA/VHA has spent nearly $3.5 billion on ineffectual programming in the establishment of a basically sedate administration for the stated purpose of suicide prevention. Quite a few PhD and master’s degree-level clinicians, drawing salaries of well-over $100,000 per year, have been hired since around 2010 by the DVA/VHA, to sit behind the desks, organize meetings, travel frequently to DVA/VHA facilities, and create agendas promoting the presumption that the money being spent by the DVA is justified by the incredible amount of computer processes and paperwork.

Yet, from 2010 until the present day, not one veteran has been successfully identified and assessed independently by VA Suicide Prevention as a potential victim of suicide without that veteran first contacting the VHA at a VA medical center or clinic; and those veterans have been very few since approximately 9,000 veterans are successfully committing suicide every calendar year.  That averages-out to approximately 25 veterans committing suicide every day, and that does not include the many other unsuccessful attempts made by veterans to commit suicide, which actually go unrecorded.

The MMPI was designed as an adult measure of psychopathology and personality structure in 1939. Many additions and changes to the measure have been made over time to improve interpretability of the original Clinical Scales. Additionally, there have been changes in the number of items in the measure, and other adjustments which reflect its current use as a tool towards modern psychopathy and personality disorders.

The cooperative and interactive process that I’ve alluded to, which may be used to effectively assess and identify sorely depressed veterans within the first year after they have been honorably separated from the military, begins with the DOD during the processes of discharging a GI from active-duty.  There are many procedural tasks required of the GI who is being discharged, and he, or she, is required, according to the UCMJ, to complete every task.

During the last week of processing, every separating soldier, marine, airman, and sailor should be required to sit for the Minnesota Multiphasic Personality Inventory (MMPI), which has numerous diagnostic and clinical scales, one of which is the MMPI-2-RF Suicidal/Death/Aggression Ideation Scale.  The MMPI, designed in 1939, is probably the most valid and replicable personality inventory ever developed, and has been tested and proven valid and replicable, again and again, in prison settings with prison inmates exhibiting all types of violent and non-violent psychopathologies.

A negligently flagrant disregard by the DOD/DVA of the culminative effect of accumulative diathesis stress on veterans from the combined both military and civilian stressors has proven, over the preceding decades, to be the dependent variable that epitomizes the one-dimensional approach that has been ineffectually used to determine why veterans will choose to harm themselves in a civilian environment, years after being discharged from active-duty.

In the introduction to his 1976 book, “Grunts,” the deceased author Charles R. Anderson, U.S. Marine Corps Vietnam officer veteran, made some statements about how his book addressed combat infantry marines/soldiers fighting in Vietnam, which are as applicable today to any combat situation, such as Iraq and Afghanistan, as they were to Southeast Asia.  I will replace the words “Vietnam and Vietnamese” with “Iraq/Afghanistan” in order to illustrate the significantly exigent comparison.

“This book is an attempt to describe the Iraq/Afghanistan wars as they were experienced by the individual infantryman, the grunt.  But in fulfilling its purpose this work moves in different directions than others, because it incorporates a different view of the experience of the “Iraq/Afghanistan” wars.  Earlier accounts have presented the wars as a one-dimensional experience; only that which occurred in the war zone was recounted.  This account, however, presents the Iraq/Afghanistan wars as a two-dimensional experience.  Both that which the combat participant (marine/soldier) did in the war zone and what he found on his return to America are examined.  Such a definition of the total experience of the Iraq/Afghanistan wars requires that the account take a radical change of focus, from the microcosmic to macrocosmic. . . In experiencing the war and then his, or her, postwar hometown, the combat participant was forced to rapidly expand the focus of his action and concern from an environment small and concentrated to one large and diffuse. . .”

In his graphically cogent work, Anderson used the word “experience” to connote the gamut of cognitive and emotional sensory stimuli that had caused reactive infantry GIs (grunts) to recoil from death and despair during the midst of combat, during the interim periods between combat, and at home in America after the combat ended.  This gamut of stress-producing cognitive/emotional sensory stimuli is present in every wartime combat environment, and every GI experiencing it reacts differently to it.  The two-dimensional environmental effect described by Anderson is greatly important in determining the GI’s state of mind/emotion after experiencing what he, or she, did in combat and then, later, at home.

The sensory reaction dichotomy between how the average combat GI handled the sensory stimuli in Vietnam, and how the average combat GI, between 1990 and 2016, handled the same approximate gamut of stimuli in Iraq/Afghanistan, gives rise to a poignant dichotomous issue.  Why was the suicide rate among Vietnam war veterans, from 1965 until 1975 and from 1975 until 1990, so much lower than among Iraqi/Afghani war veterans from 1990 until 2018, and especially from 2003 to 2018?

The only sensible explanation for this disparate dichotomy was the extreme combat diathesis stress experienced by the soldiers and marines during combat operations in Iraq/Afghanistan directly coupled with the equally pathogenic diathesis stress from the civilian life stressors at home after combat operations had ceased.  The Vietnam combat veterans did not experience the same type of pathogenic stress from the American civilian public, in their hometowns, on returning from combat operations in Southeast Asia, as the Iraq/Afghanistan veterans have received on returning from combat operations in the Iraq and Afghanistan.

The Vietnam War, also known as the Second Indochina War, and in Vietnam as the Resistance War Against America or simply the American War, was an undeclared war in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975.

It seems quite strange, but the dichotomy revolves around general unacceptance versus total acceptance.  The Vietnam veterans returned to an America that was generally unfriendly, hostile, and greatly reluctant to show appreciation for the time spent by those veterans in combat operations in Southeast Asia.  Those soldiers and marines returning from Vietnam were publicly regarded as baby-killers and murderers by a great many American civilians, while, suddenly beginning after Operation Desert Storm, marines and soldiers returning from Iraq and Kuwait were treated as heroes, or as the words in the song was sung, “the wind beneath the wings of America.”  These marine/soldier combat veterans were suddenly extolled by the entire American public for their killing of other human beings, as much as, or more than, the World War II combat veterans were extolled for their killing of Nazis and the Japanese.

While, according to Anderson, most Vietnam combat veterans were generally confident that what they were doing to fight communist aggression in Vietnam was for the common good, despite how they were treated by the American public, there has been an apparent conflict in the minds of combat marines and soldiers returning from Iraq and Afghanistan stemming from what they personally experienced in combat operations versus the unequivocal acceptance that they have received from the American public for doing it.  There was probably an ambiguity in the minds of these marines/soldiers as to the morality and rightness of what they were expected to do in combat operations before they arrived in Iraq and Afghanistan.  They probably didn’t know what to believe at the time combat operations commenced, and most of them were not prepared to take human life in combat. Moreover, they were not prepared to return home to receive accolades for their killing.

For how, in name of sophistry, can a marine or soldier be persuaded that the people he, or she, killed in combat deserved to be killed, when the cognitive thoughts and emotional-feelings going through that person’s mind is convincing him, or her, of just the opposite?  This enigmatic dichotomy must be addressed before there can be any semblance of a plan to identify and assess veterans at-risk for suicide.

Once this is addressed, the plan to assess each and every GI honorably separating from the U.S military for suicidal ideations is the only proper methodology for identifying at-risk veterans.  The use of the MMPI-RF personality inventory would be the most reliable tool for determining suicidal ideations in veterans.  After the veteran is tested, his score report and a copy of his DD-214 are sent to the VA medical center closest to the veteran’s home of record.  Then MSWs at the VA Medical centers will assess the scores on the MMPI-RF and determine which veterans are at-risk for suicidal ideations.  Once the veterans are identified through testing, contact with them may be made.

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Norton R. Nowlin

Born in Oklahoma, raised in Texas; USMC Vietnam veteran 1971-77; B.A., M.A., 1980, 1992 U.T. Tyler; One-year of law school, Thomas Jefferson School of Law, 1981-82; Graduate of San Diego County 72nd Sheriff's Academy, 1985, Certified Texas Educator, 1992, seven-years classroom teaching experience; Certified, ABA-approved Advanced Paralegal, Edmonds Community College, Lynnwood, WA, 2004; U.S. Department of Veterans Affairs, 2006-present; reside in Northern Virginia; owner and operator of Expert Writing & Paralegal Services in Northern Virginia; professional writer for over 30 years; published article and op-ed writer on the Internet and for "The Seattle Times;"

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