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As we find ourselves sickened and deeply saddened by the news of the suicide deaths of Parkland High School students Sydney Aiello and Calvin Desir and the suicide death of Jeremy Richman, whose beautiful daughter Avielle was killed in the Sandy Hook Elementary shooting, there is a risk for all of us to feel collectively helpless. I have seen the look of helplessness on the faces of many of my veteran patients. Much of my work these past 10 years has been focused on targeting these feelings of helplessness and engaging veterans in the growth process that is required for a successful transition out of the military.
Language and models are often overlooked as contributors to feelings of helplessness and disengagement in the recovery process. Consider these kinds of terms: Suicidal ideation. Self-injurious behavior. Major Depressive Disorder. Maladaptive Thinking. Hypnopompic Hallucinations.
Are veterans and military service members rolling their eyes when we use these kinds of terms?
When I can’t sleep, I often think about ways that we can become more effective in our work as healers. I think about how we might improve current approaches and find ways to adapt our thinking to the culture of those we are serving.
On one particularly sleepless night, I came to a realization that as mental health providers, we often expect patients to “come to us” by learning to use our language and models. What would happen if we were to use the language of our patients instead? What if we framed problems from their perspective, rather than applying what we have learned from so many years in graduate school?
On this sleepless night, relevant to my work with veterans, I asked myself, “What models and metaphors are most likely to hit the target for those who have served in the military?” I bolted out of bed to record the new “frame” that came instantly to mind: a tactical analysis of the war on hopelessness. This model has changed my work with veterans. I have seen my veteran patients and colleagues shift from relative disengagement to full and active engagement in treatment. Tapping into their intuitive grasp of familiar concepts transforms pervasive helplessness into purposeful action. The same thing has been true in applying this model during presentations and consultations with those in active duty service roles and those in first responder roles.
A full description of the tactical analysis of the war on hopelessness will be presented in my next book, WARRIOR: How to Support Those Who Protect Us. For the present, here are a few key concepts, borrowing from a few concepts outlined in the Marine Corps Rifle Squad Manual.
First of all, knowledge of the enemy is the basis for a good plan of attack. Veterans call this enemy “their demons,” so let’s go with that. “Demons” can be a metaphor for “the voice of hopelessness.” Their demons may have a shape, and they often have a voice. They may speak in a whisper at first and may become more insistent during times of stress. Some of my patients have described a process where they feel as though they become the demon that stalks them. This is a particularly dangerous shift because some veterans who reach this point start to think that ending their life is the way to end this threat. (The critical point to be made here though is that when these poisonous thoughts are flushed out in a safe space, with those that veterans trust, the voice of hope has the power to help them stay in the fight.)
The tactical analysis moves well beyond simply naming and describing the enemy. It includes developing an understanding of how the enemy fights, how it moves in battle, what things it targets, what weapons it uses, what gives the enemy victory, and what neutralizes the enemy. For example, tactically speaking, demons love to ambush a solitary individual…their battle plan is to isolate people in dark tunnels that get progressively narrower and more hopeless over time. Consider this language, also from the Marine Rifle Squad Manual: “An isolated unit is easily destroyed by the enemy.” The same principle applies to any isolated individual. So often, we mean well, but what we do actually plays into the enemy’s hand.[1] A friend of mine who is a Marine Corps veteran once told me about a time on active duty when a fellow Marine was determined to be at risk for suicide. As he described, “This Marine was put on a ‘suicide watch’—his cot was moved to the center of all of our cots, separated by about 10 feet from the circle of cots surrounding him.” While no doubt this instruction was well-intended, the struggling Marine was immediately separated from the Tribe of his fellow Marines, which is likely to enhance feelings of shame and irrelevance.
Going into an even deeper understanding, we discover that the “thought” campaigns of the enemy are in fact fairly predictable. They run along these four lines:
“You are a sh*tbird who is not worthy of the brotherhood.[2]”
“If your family really knew you, they’d see that you are a monster.”
“You are a danger/liability to those you should be protecting.”
“You are worthless/dead weight and a burden to those you love.”
In the context of these thought campaigns, the warrior ethos can play an important role. The warrior ethos involves self-sacrifice to protect others. When a warrior applies this ethos to their internal battle, they may be uniquely vulnerable to temporarily seeing suicide as an honorable act—in a way that resembles the Japanese cultural tradition of hara-kiri (a “death before dishonor” practice of throwing oneself on one’s sword). As I said earlier, this is a particularly dangerous mindset. In tactical terms, what has happened is that the enemy has infiltrated a warrior’s mental defenses to such a degree that the warrior now feels that the enemy is grafted onto her and can only be conquered through an act of self-destruction. This is a major reason (among several) why veterans have a higher suicide rate relative to the population at large.
This tactical understanding of the war on hopelessness helps us to see with more clarity the assets we have at hand and the strategies we must deploy to meet this enemy. For instance, I have often told my Marines that while they are some of our country’s most capable warfighters, their individual capacity as warriors is not the true genius of Marines. The true genius of our Marines lies in how they fight together, in fire teams, coordinating their skills to take out the enemy. In the same way, while demons will ambush a lone Marine, they can’t easily overcome a group of Marines, united in purpose. Those who fight this battle with the support of a “fire team” of those they love and trust greatly multiply their strength. And even though my work these past 10 years has been focused on veterans, I believe this is true for all of us.
[1] Other ways of playing into the enemy’s hand include spreading messages that associate suicide with anything positive or desirable (e.g., songs that glorify dying at a young age, clothing or gear that promotes a link between suicide and being a warrior).
[2] I use the term “brotherhood” in a gender-neutral way to refer to warriors of all genders.
