Suicide PTSD Veterans

Introduction

Active military personnel and veterans within the United States of America can be seen to have a complicated but connected culture. To understand this particular culture it is important to specify what it is. Culture can be defined as the values, norms, and assumptions that guide human action (Wilson, 2007). This paper will examine the culture of military personnel at a large scale and then narrow it down to a more individual level in an attempt to give a portrayal of the cultural aspects of note.

Suicide has been becoming a growing problem within the veteran and active military personnel population for many years now. Since 2004, suicides by active and veteran military personnel have increased, even acquiring higher rates than those of the civilian U.S. population (Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces [DOD TFPS], 2010).

PTSD is also a problem that many veterans face when the try to integrate back into society after having served. It can be seen that the PTSD diagnosis is present in 11% to 20% of veterans of the Iraq and Afghanistan war, 10% of veterans who were involved in the Gulf War, and 30% of veterans who served in the Vietnam War (Coll, 2011).

Is there a correlation between PTSD and suicide in military veterans? After examining the data, there is not a consensus among researchers to indicate if there is a direct correlation with PTSD alone and suicide. Some researchers even go on to argue it creates a protective effect (Gradus, 2017). Apart from the research looking at the correlations, there is little data to evaluate past military suicides and if they had a PTSD diagnosis. This could be due to privacy laws in place to protect that individual and their family.

Cultural Relativity

According to Wilson, there are numerous criteria that need to be met to build the complicated but strongly connected culture of the military personnel. The relevant culture building facets are: a mission, relationship to the state and other institutions, relationship to society, and internal structure (2007).

These aspects will help to build an image of the larger systems in place that help to promote the military culture. Which will later be examined in its relation to suicide. The first facet to be examined is a mission. A mission provides an institution with a mutual commitment that validates its existence and right to “”resources, self-worth, rewards, and privileges of its members”” (Wilson, 2007). This aspect of military culture can establish many shared difficult experiences, which can allow for strong bonds to be established. Secondly, a relationship to the state and other institutions is another important aspect of military culture because it allows for the destruction of personal life and private property (Wilson, 2007). This characteristic creates a mutual breaking of the societal norms with your peers and could build shared societal taboo experiences with your peers (Wilson, 2007). The way the military has a relationship to society is another important property to consider within the culture of military personnel it allows it to continue its service and grow. This brings forward the idea of recruitment to replace members as needed (Wilson, 2007). The internal structure can be seen in its “”complexity, formalization, and centralization”” (Wilson, 2007). As the armies grow to larger sizes, it is significant to see how the division of power gets passed down and how it encourages building permanent units in its wake (Wilson, 2007). These permanent units have the opportunity to further build connections with ones peers in a shared environment to further their identity in military culture.

By looking at these institutional aspects of the way the culture is designed there is appears to be a common theme. The building of bonds with the peers could be an intentional design within military structure.

After reviewing the institutional systems in place that promote the military culture, it is equally important to examine some of the mind frames in place that help to define what military culture is for the individual.

As touched on previously, the military is the only organization within the United States of America where its design is for the members to be trained in the skill to kill other human beings (Bryan, Jennings, Jobes, & Bradley, 2012). Military personnel are being trained as “”warriors”” and to collectively embrace aspects that are opposite of the societal norms (Bryan, Jennings, Jobes, & Bradley, 2012). Pain is an aspect of the culture that is crucial to master on the battlefield. Military veterans are taught from the get go to tolerate pain and discomfort (Bryan, Jennings, Jobes, & Bradley, 2012). For on the battlefield, it is life or death if they get hurt. Some of the ways they build their capacity is to use psychological tricks similar to “”it’s just a minor wound”” or “”ill get a medic later”” (Bryan, Jennings, Jobes, & Bradley, 2012). The difficult aspect of this applied to integration back into society in veterans is that this mental mindset establishes a system of avoidance. It has been shown that avoidance, coming from a mental health lens, has been associated with mental health conditions and disorders (Bryan, Jennings, Jobes, & Bradley, 2012) and is also linked to “”non-suicidal self-injury, suicidal ideation, and suicide attempts”” (Bryan, Jennings, Jobes, & Bradley, 2012; Najmi, Wegner, & Nock, 2007).

Another feature that is taught within the military, as touched on prior, is the idea of collectivism (Bryan, Jennings, Jobes, & Bradley, 2012). By establishing that the end goal is larger than the individual gives them a unique lens. This lens leads to multiple mentalities that help to build a unique culture within the United States of America military. Self-reliance and self-sacrifice are integral to the goal of military mind from and which can then lead to a mentality that creates a fearlessness of death (Bryan, Jennings, Jobes, & Bradley, 2012).

When one takes all of these culture aspects into account it has the possibility to create a strong “”warrior”” but unfortunately, it can create a difficult time for individuals to integrate back into society (Bryan, Jennings, Jobes, & Bradley, 2012). With these culture aspects in mind, eliminating an individual from the collectivism and paired with one who has experienced trauma can make for a difficult re-adjusting period after one has served.

Disparities

Within veterans and active military personal is a mental health diagnosis of posttraumatic stress syndrome (PTSD). Posttraumatic stress syndrome, according to the DSM 5, is a trauma and stressor related disorder. To qualify for this, a set of requirements must be established to attain this diagnosis. These requirements are: “”the person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, he traumatic event is persistently re-experienced, voidance of trauma-related stimuli after the trauma, negative thoughts or feelings that began or worsened after the trauma, trauma-related arousal and reactivity that began or worsened after the trauma, symptoms last for more than 1 month, symptoms create distress or functional impairment, and symptoms are not due to medication, substance use, or other illness. Within these requirements there are also 2 specifications: dissociative specification and delayed specification”” (DSM 5). As noted prior, PTSD diagnosis is a problem existing in many of veterans who have served in battle. PTSD is present in 11% to 20% of veterans of the Iraq and Afghanistan war, 10% of veterans who served in the Gulf War, and 30% of veterans who served in the Vietnam War (Coll, 2011).

With the military culture and PTSD in mind, the next point of note is suicide. Since 2004, suicides by active and veteran military personnel have increased, even acquiring higher rates than those of the general U.S. population (Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces [DOD TFPS], 2010).

One of the focal points of this paper is to examine veterans with PTSD who die by a suicidal means and examine, if any, cultural impacts to this population. In regards to suicide, there have been many studies that examine suicide within the veteran population and PTSD. However, there has been no conclusive evidence that PTSD alone is a factor in increasing the suicide risk alone. In fact, in some studies, it has been shown to have a protective effect (Gradus, 2017).

Suicide among the general population will always be a concern. However, the suicide rate among veterans has increased at a 21% greater rate than civilian personnel (Office of suicide prevention, 2017). Some key takings from the data is that from 1999-2010 the average rate that suicides occur in the united states was 19.4 males per 100,000 people and 4.9 females per 100,000 people; in veterans, the number increased to 38.3 males per 100,000, and 12.8 per 100,000 in females Office of suicide prevention, 2017 (office of Suicide Prevention, 2017).

Reliable statistics on veterans in the United States of America diagnosed with only PTSD who commit suicide could not be found. A reason that this information may be not be available could result from privacy concerns. However, within the Canadian Armed Forces, 7.1% of the males who committed suicide were diagnosed with PTSD (Rolland-Harris, 2017).

The disparities between civilian suicide and military personnel suicides are large and of concern. Canadian military personnel who committed suicide and diagnosed with PTSD is a relatively small percentage. There is room for more research on the connections, if any, of veterans diagnosed with PTSD alone and committing suicide.

Analysis of disparities

The gap between civilian suicide and military personnel suicide could be due to a multitude of factors. After noting the elements of the military culture we can examine the main differences from military culture and other cultures within the United States of America.

The collectivism mentality could be built into the military infrastructure from the beginning to the end of a person’s experience. This cultural development creates the idea of being a part of a unit and having a shared goal/mission, with the end result being more important than the individual’s life. This cultural implementation being a core aspect of the military culture could create a difficult experience for individuals having to suddenly being required to operate at an individual mentality as a civilian (Bryan, Jennings, Jobes, & Bradley, 2012).

Apart from the collectivism the individual mentalities that make up the military culture are worth considering. The facet of tolerating pain and discomfort to a point of avoidance may be a strong skill on the battlefield. However, in regards to mental health, it is show to have negative consequences for ones mental health (Hayes, Wilson, Gifford, 1996) and can lead to “”non-suicidal self-injury, suicidal ideation, and suicide attempts”” (Bryan, Jennings, Jobes, & Bradley, 2012; Najmi, Wegner, & Nock, 2007).

These military cultural facets that create the identity of military personnel are quite different from the ordinary civilian. “”As of 2012, one military suicide a day occurred in the military, and the number of service members who took their lives surpassed the number killed in combat indicating a more than 30-year high”” (Thompson & Gibbs, 2012). These alarming numbers have, for some, been a call to arms to help combat the rates of self-inflicted death.

Implications for social work practice

Being informed of best practice within the social work field could be seen as a duty to yourself as a social worker, but more importantly, a duty to the client. It is crucial to be able to serve the target population in the best manner possible. By recognizing the cultural applications of military personnel, social workers will be able to understand more about the client and can understand how some of the their symptoms come to be.

Military personnel cultural information, the increasing rate of military personnel committing suicide, and the rate at which PTSD is being diagnosed leave room for much work to be done in the social service field. Social workers can take the cultural information to develop and implement new programs to assist in countering the issue of military personnel and suicide.

Unfortunately, more research is needed to establish reliable correlations between PTSD and suicide before it can be directly applied to developing programs designed for military personnel with PTSD and suicide risk.

Bryan, Jennings, Jobes, & Bradley takes into account the militaries exclusive culture and have come up with some alternatives strategies to assist to the traditional models that could assist with the increasing suicide rate. Their suggestions are: “”Suicide Prevention Efforts across the Full Spectrum of Care Should Adopt a Strengths-Based Approach, Prevention Efforts Should Re-conceptualize Deployment as a Life Experience through Which Significant Personal Growth and Development Are Possible, Suicide Prevention Efforts Should Augment Traditional Models of Mental Health Care with a Population Health Model of Prevention, Suicide Prevention Efforts Should Be Integrated into All Aspects of Military Life and Should Address Daily Quality of Life Issues , Suicide Prevention Efforts Should Incorporate a Multimodal Approach for Education and Awareness and Be Evaluated Routinely for Effectiveness, Mental Health Clinicians Should Routinely Implement Evidence-Based Treatments for Mental Health Conditions, Including Suicide Risk”” (2012).

Personal Biases

My personal biases towards the military can be very difficult to address. Military personnel are trained to kill people; they are trained to be dangerous. With that in mind, a personal bias that I have would be that they get angry easily and cannot control themselves. This bias was developed from past experiences with friends who were veterans. After speaking to them about it, they informed me that when they got to a certain point in anger, they would “”see red”” and not be able to control their body, their actions, or their emotions. This resulted in a bias that military personnel are angry and violent. Eliminating this bias will likely require personal awareness and exposure to completely be eliminated.

Another bias I have against military personnel is that they use substances such as alcohol and marijuana in abnormally high amounts. This is also a result from personal experience. One friend told me that marijuana was the only way to “”calm his mind so he wasn’t actively looking for threats.”” I believe this bias will need to be addressed with exposure. The more exposure I have the more broad my understanding of the population will be.

When making a clinical diagnosis of this population it is important for me to understand that each individual has different experiences and to not assume if they get mad once or use marijuana every now and again that it is abnormal and there is an issue with it. I believe things of that nature are worth exploring further to serve my client as effectively as possible.

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