June 16, 2008
DAILY NEWS STAFF
Ten Marines assigned to II Marine Expeditionary Force have died in Iraq and Afghanistan since Oct. 1. Twelve have taken their own lives in the United States.
Those statistics are troubling for Lt. Gen. Keith Stalder, commander of II MEF.
"My intuition tells me that we've seen a significant increase, in at least attempts and ideations, and maybe in suicides themselves," said Stalder, who pours through every agonizing detail of every II MEF death - whether from combat, a traffic wreck or the Marine's own hand - in an effort to prevent future losses.
"I don't know, statistically, if (the number of suicides in this fiscal year) compares with last year. I'm not worried about that. I'm worried about trying to understand if we can do something to knock this out," Stalder said. "It breaks your heart when you lose a Marine."
Though suicide data provided by the Marine Corps shows no consistent up or down trend within the service since January 2003, the rate of suicides in calendar year 2007 was significantly higher than 2006 - with 16.5 suicides for every 100,000 Marines, or a total of 33 suicides. In 2006, the rate was 12.4 suicides per 100,000 Marines, or 24 total suicides.
Of the 33 suicides in 2007, 15 had never deployed. Of the 18 who had deployed, six killed themselves in the combat zone.
The Department of Defense, the Marine Corps and Navy medicine are all working on new ways to identify risk factors and indicators in order to prevent suicide.
"It is a significant, overarching concern of ours," said Cmdr. Robert O'Byrne, head of mental health for the Camp Lejeune Naval Hospital.
But the most meaningful analysis comes from a detailed review of historical data, which makes it difficult to come to quick conclusions.
"The very thing you don't want - large numbers - is what you need," O'Byrne said.
Another challenge is that the demographic with the highest suicide rate in the general U.S. population is older white males, generally with health problems, money problems and no strong support network. Within the military, the demographic with the highest rate is young white males, generally healthy and with the job security and support network of their fellow service members, O'Byrne said.
Civilian data also lags about two years behind military suicide data, and civilian authorities define suicide attempt differently than military officials. In the military, a medical professional must rule that an act is a suicide attempt, while civilian authorities allow others to make that determination.
Those differences make it complicated to compare data and make conclusions about indicators of suicidal thoughts, he said.
And it is important to realize that regardless of data, anyone can be at risk, said Cmdr. Charles Springle, director of the Camp Lejeune Community Counseling Center.
Recently, the Navy has rolled out a new stress continuum model and charts for how to deal with various indicators - from anxious or irritable behavior to severe post traumatic stress disorder, depression and substance abuse.
The system gives service members a way to talk about mental health issues, O'Byrne said, while acknowledging that "it is normal, in abnormal situations, to have responses that in any other situation would be considered abnormal."
The charts show whom to alert and how to deal with the various levels of stress. They also contain definitions to indicate when mild symptoms have become persistent or anxiety has led to loss of function.
"Navy medicine has recognized the need to be able to have this conversation in a language that's not threatening, in terms that are consistent," O'Byrne said. "We want to be able to facilitate that conversation."
Stalder is also working on a method for addressing the problem within II MEF, which includes Marine units in North and South Carolina. He said he worries that the Corps' traditional approaches to suicide prevention were created for a different generation of Marines and sailors who viewed suicide in a different way.
"I think there are things about these young people, and by and large they're young people ... there are things we don't understand about the way they look at the world," he said.
The key, Stalder said, is talking to Marines and starting with questions, not answers.
"I really don't think we understand at the root-cause level as much as we need to, to really deal with this problem," he said. "I see a group of young people who appear to me to see suicide as just another option in the menu of dealing with life. They don't appear to see it as the tragic, catastrophic, permanent solution to a temporary problem that older Marines do. There is much less of a tendency to see it in the terribly grave light ... and that concerns me."
The traditional preventative approach has been to provide peers and leaders a number of signs that may precede a suicide attempt: talking about death, giving away treasured possessions, extreme changes in demeanor. But in the recent suicides, Stalder said he has seen none of that.
"We approach it from almost an old days perspective: They're going to give away their stuff, they're going to tell their friends. That didn't happen. We're not seeing any of that. So I think this needs a fresh approach," he said.
Stalder said he is seeing almost instantaneous decisions, mainly revolving around troubled relationships. So, though suicide rates historically tend to increase in times of war, Stalder believes the current suicide rate has less to do with combat than a slate of other factors.
Though the sample size is small, Stalder said he's hoping an in-depth analysis of the deaths within II MEF can provide some insights into what friends and leaders can look for, and also how to address it.
"It takes a special person to be a sailor or a Marine, and they bring with them their own unique perspectives about everything. And the good is you get a very focused, aggressive, hard-charging individual, but there might be some other elements in their thinking that make them a little more prone to this than the general population," Stalder said. "If we can get a glimpse inside of that, we'll have a better chance of putting things in motion that will really make a difference."
The result, Stalder hopes, will be a solution that will be implemented from the ground up.
"This isn't lieutenant colonel and sergeant major stuff. This is peer and near-peer stuff. This is at the foundation of the Marine Corps," he said.
The key to any approach or analysis, O'Byrne said, is creating something sensitive enough to identify the real issues but specific enough to weed out the false indicators. And, he agreed, the results of that analysis must be deployed to the individual Marines - all the way down to the private.
Everyone has a responsibility to take care of the people they care about and to notice the small changes that could be an indication of a larger problem, Springle said.
"We're all looking for what that answer is," he said. "One's too many. The more you do this, the more you realize, there is not one answer."
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