Nassir Ghaemi M.D., M.P.H.

Mood Swings

The Bell Tolls: Military Suicide in Iraq

Why are soldiers killing themselves?

Posted Feb 13, 2009

Last month, suicides in the military exceeded combat deaths. 24 soldiers killed themselves; 16 were killed by al-Qaeda. In a rare move, Army brass met with congressional leadership to brief them specifically about the rise in suicide.

We psychiatrists have generally been taught that suicide rates are lowest in the military; the social cohesion of military command, we are told, is protective.

The source for this lore is a late 19th century French sociologist, a conservative thinker named Emile Durkheim. In a classic study, he claimed that increasing rates of suicide in the industrializing West was due to "anomie," the loss of traditional social connections. The military was an exception, an oasis of connectivity in a sea of individualism.

So why are all these soldiers committing suicide?

That is hard to say. But what these soldier-suicides might be teaching us is that the conventional wisdom we all learned is wrong: As the historian of medicine, Howard Kushner has noted, Durkheim's theory about social cohesion may not protect against suicide as well as we thought. It may be, instead, the self-reliant individualist, not the duty-bound follower, who can stay alive, when all about him seems worthy of despair.

Another feature may be relevant, something Durkheim - focused on social factors - did not consider. The inner psychology of someone seriously considering suicide almost always involves despair, a sense of loss of any hope for the future; time, in effect, becomes truncated, and the future falls away, with nothing but a horrible present and a painful past in its place. It is this despair that seems to be the proximate cause of most suicides. Family, friends, military comrades - they all can fall away as protective factors, if the internal despair is deep enough.

Emerson, long ago, in his classic essay on "Self-reliance" intuited a cure for this kind of despair. Long ago, he realized that it had to come from inside, from a sense of comfort with oneself, an acceptance of one's lot, a feeling that one had accomplished good and would do so again; in short, through a mental filter that saw more good than bad in this world that is sometimes constituted by more bad than good.

He put it this way:

What is Success?
To laugh often and much;
To win the respect of intelligent people
and the affection of children;
To earn the appreciation of honest critics
and endure the betrayal of false friends;
To appreciate beauty;
To find the best in others;
To leave the world a bit better, whether by
a healthy child, a garden patch
or a redeemed social condition;
To know even one life has breathed
easier because you have lived;
This is to have succeeded.

There is wisdom here, but perhaps it can be more fully appreciated in the peaceful confines of Concord than in Baghdad and Bagram.

About the Author

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston.

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