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Suicide

Guilt and Suicide Risk in Combat Veterans: A Case Example

Guilt over past actions can exacerbate suicide risk in combat veterans.

Willie* is a 72-year-old veteran of the war in Vietnam. He graduated from high school in June 1967 and, like most of the boys in his high school class in rural Virginia, was drafted soon thereafter. His father was an auto mechanic and farmer. Willie grew up on the farm with his six brothers and sisters. In a way, Willie was relieved to be drafted — as long as Willie was in Vietnam, his two younger brothers wouldn't have to go. Willie described his childhood as "good — I thought it was good. We weren't rich but we were clean and had plenty to eat. There was always something to keep us busy with on the farm." He noted that he had "a lot good, hardworking kin — before I went to Vietnam I never drank, smoke, or cursed. When I came back, I was doing all three."

Willie was assigned to a rifle company in Vietnam, spending most of his time on remote fire bases out in the "boonies." "We'd go out on small patrols sometimes, but most of the time we just got the crap shot out of us with mortars and rockets and sniper fire. I sat up all night scared to death that some [North Vietnamese soldier] was going to come through the perimeter and cut my throat." After the opening of the Tet Offensive in early 1968, "everything changed. We got sent up to Hue City. That was a real war. First time I actually laid eyes on a real live NVA soldier. He jumped out from being this burning truck and unloaded a whole clip from his AK right at me — I have no idea how he could have missed. Them Catholic boys in the platoon talked about guardian angels and I guess maybe I had one too somehow. Me and that Vietnamese fellow just stood there looking at each other for a second and, and then...well, um, then...he didn't have the luck I had."

A half century has passed since coming back from Southeast Asia and "there's not a day that goes by that I don't think about Vietnam. There's always something that brings it up to me. Smells, a lot of time. Mud. Sewer type smells. The whole country smelled bad. Rotten things. Damn worse thing I ever saw — they loaded us in trucks and were sending us somewhere and, there were lots of VC bodies along the road, and some of them were all blown up big because they'd been in the sun and the rest of 'em were half churned to jelly by all the trucks and tracked vehicles running up and down that damned road. After a couple of months of being in combat, it's pretty natural to start wondering when you're going to end up all torn up yourself. Not if, mind you. When. When's that bullet or shell or hunk of shrapnel or booby trap or what-have-you with my name on it going to come up and say, Hello, Mr. Willie, I been waiting for you? Ain't no way I thought I was going to ever get back home 'cept in a box."

Willie has been married for nearly 45 years but "that's because I got myself a wonderful woman. She's put up with a lot. I yell and cuss at her sometimes, over nothing. Just this morning I got all heated with her because she stuck her finger in the toaster to get a piece of toast out of it. Like she's not a grown woman who's been making toast her whole life." Willie and his wife sleep in separate bedrooms because "she says I yell and thrash around in my sleep too much. Back right after we were married, I done knocked her out of bed a few times, yelling, 'Incoming!' or something." He has nightmares about specific incidents that occurred in Vietnam on "more nights than not." When he wakes from these nightmares he cannot return to sleep. He takes a rifle or a shotgun and sits outside on his front porch, "just watching things."

Sometimes he feels "like I'm there again. It's hard to explain. It don't make no sense. I had to play golf with these fellows from work one time. Some charity thing. I didn't want to go. I'd rather just stay at work by myself, you know? But there we were on the golf course and I don't know if it was the sun or what but it just felt like it was 100 degrees out with all that humidity in Vietnam and that sewer smell to things and this feeling — like at any second one of us might get shot by some sniper. I was scared to look down at my clothes because I was sure I'd see that I was wearing fatigues. I kept my eyes straight ahead because I knew I was holding a rifle, not no golf club. It went away after a bit, but I don't think I said another word to any of those fellows the rest of the day."

Willie has spoken about his Vietnam experiences to "not a damn soul — not even my pastor. When I got back I just tried to forget all about it. I didn't do much when I got back except drink and fight for a couple of years. One night I got real loaded and tried to drive myself off a bridge. Guardian angel again, I reckon. In the hospital's where I met my wife. She straightened me up. I never drank like that again after we got married and had kids." At first she encouraged him to join the American Legion or the VFW but "she figured out I didn't want nothing to do with all that. I don't watch war movies — even westerns get those nightmares going. The news is bad enough. All this talk about Iran and China these days. It gets me real mad — I don't know." Most of the people he has worked with or who are members of his church have no idea that Willie is a veteran. "If I did tell somebody about Vietnam, they'd never understand it."

"I get tore up sometimes when I get to thinking about some of those fellows who didn't come home. I see their faces. Just boys, you know. Younger than my grandson. They never got to do what I did, get married, have kids, work and retire. And you think about what a louse you are and how they deserved to live, not you. You can't help what's true. The best of us didn't come back. And then you get to thinking about all the things you did, and the things you could've done but didn't. It's a big What If game. What if I had heard that VC coming through the wire that night — maybe that little fellow from Texas would have made it?"

Willie spends most of his time "just mowing grass, tinkering around in the yard" or "in the den, watching old timey shows, like Andy Griffin or Beverly Hillbillies." Except for Sunday services he rarely leaves his home. When his grandchildren visit he enjoys their company for ten minutes or so but then finds "all the noise and talking and moving around" too overwhelming, and he retreats to the yard or to his den. Fireworks and gunshots in the hills around his house during deer season "put me in a bad place. I don't jump like I used to. I just feel like a ball of cold sweat." He grew up hunting and fishing but "after I got back from Nam the idea of going out into the woods with a couple of guys with rifles just didn't appeal. I haven't gone fishing for more than twenty years. I guess I lost the taste for killing things."

He sleeps with an old .45 automatic pistol within arm's reach. The firearm is loaded because "it wouldn't do much good if it wasn't." Willie denied having any recent thoughts about killing himself. Aside from the incident on the bridge in his 20s, he denied past suicide attempts. But when I asked if he had ever held a loaded firearm with suicide in mind, or if he ever put the barrel of a firearm in his mouth, he said, "Well, sure, I get to doing that sometimes. On the regular, I suppose. Things get real bad around Christmas time and then again around Tet. It gets hard to fall asleep and I might have a slug or two of bourbon to quiet my nerves. Some nights, real late, I could swear that that NVA I shot in Hue was coming to get me. It don't make sense, I know. But right then, I'd swear it. And I wouldn't blame him if he was."

*"Willie" is a composite character drawn from the many hundreds of combat veterans I have known either in clinical practice or in private life. If you think you might be "Willie," it is because so many other veterans have had experiences just like yours.

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