TURNING THE TIDE
11.14.12 9:45 AM ET
A Proactive New Response to the Service-Member Suicide Crisis
“There are only two kinds of people that understand Marines,” said U.S. Army Gen. William Thornson: “Marines and the enemy. Everyone else has a second-hand opinion.”
Working with the Corps to try and help stem its suicide crisis, I have come to learn that there is some truth to that claim—but if we can’t bridge that gap, things aren’t going to change.
I grew up in a Jewish suburb of Los Angeles. I never knew anyone in the military, nor did any of my high-school friends join after graduation. A few years ago, I was approached to do some short-term anonymous counseling at the Marine Corps Recruit Depot in San Diego. Being a psychotherapist, I was fascinated by the military and wanted the opportunity to work with its members. I put my private practice on hold for a couple of months and headed to the base with hopes of giving back.
But by the end of my second week, not a single Marine had approached me. It didn’t take long for me to realize that the likelihood of them voluntarily coming in for help was very slim. These are men and women that carry enormous pride, and asking for help can be seen as a sign of weakness. Plus, accessing mental-health services has the potential of hurting one’s chance for promotion. Depending on what is discussed, the content could end their permanent military file and the repercussions of that disclosure could be huge. What’s more, I had been placed at the Family Advocacy Center, which is where Marines are required to go if they face an allegation of domestic violence. I knew if I wanted to work with service members, I was going to have to go out and find them.
Fortunately, I met some incredible Marine leaders and together we came up with an idea to bring mental-health services to the Marines proactively rather than reactively. Every few months, each drill instructor was required to participate in a short, individual session with no notes taken. I quickly learned that when everyone participates—from the top of the chain to the bottom—there is no stigma. Marines shared all types of things when they knew it was truly off the record.
I remember one Marine telling me how his wife had packed up the kids and left town. He was devastated and didn’t know if there was anything he could do. He didn’t want to tell anyone because he was embarrassed and was afraid they’d think he didn’t know how to take care of his family. When he pulled out his phone to show me pictures of his baby, he started to sob. I made sure he had the right referrals to help him out. I’ll never forget the drill instructor that whispered to me that he had a lump on his testicle. He was afraid he had a hernia (which is common, with all the yelling they do). He didn’t want to tell anyone because it could be seen as sign of weakness. I explained to him that he had to see the doctor. Reluctantly, he went, and it was a good thing because it turned out he had testicular cancer.
The drill instructors and I would talk about stress and how they personally responded to it. Everyone responds to stress differently. Some of the Marines drink too much, others socially isolate, and some spend money they don’t have. I learned to speak with them in language that penetrated their behaviors. They gained emotional intelligence about how to stop or moderate harmful behaviors before they reached damaging levels. Once they recognized the early warning signs, they knew when to implement the specific action plan that we’d devised. The sessions were well received, and before long they were executed on a larger scale with every recruit company in the Depot. I was routinely seeing more than 500 drill instructors on a quarterly basis.
Along with these individual sessions, we initiated group counseling with the units. Building camaraderie and learning to rely on each other for emotional support turned out to be a key to keeping Marines mentally engaged during the sessions. For example, if someone in the group had a newborn at home and his wife was frustrated because he had to work late every night, I’d ask other members of the unit if anyone could relate and how they handled it. Inevitably, that Marine would get loads of suggestions and new contacts for his wife. My greatest group moments were when someone would push past their comfort level and share a personal hardship. It’s beautiful watching fellow Marines offer one another genuine support and friendship, and to see somehow who’d been suffering alone was relieved of that isolation.
My three months turned into a year, and watching firsthand how Marines opened up and made positive life changes made me a believer in and advocate of proactive therapy. Over the course of our post-9/11 wars, the average Marine has experienced many more combat deployments than in prior decades—and the suicide rate has shot up at the same time. Without the draft, just 1 percent of our population has been entrusted with fighting our wars overseas, and they have had to return again and again to maintain the fight.
But while the nature of our wars and deployments has changed, we have continued to provide reactive mental-health programs that are overpriced and underutilized. The result of this dynamic—the subject of my book The Inside Battle: Our Military Mental Health Crisis—is that most people don’t start getting help until they urgently need it, which is often too late.
Thankfully, the Marine Corps leadership at Camp Pendleton has also seen the benefits of equipping Marines with emotional and psychological armor, and consequently the reactive culture is finally going to begin to change. In the first step of that transformation, I am excited to be implementing a mandatory, ongoing counseling program for thousands of Marines in the First Marine Regiment—the Corps’ largest, made up of Infantry Marines—at Camp Pendleton. The services will be brought to them, whether out on a training mission or at the rifle range. They will not have to feel like a sick person or a patient, having to walk into a doctor’s office. The counselors will fit into the Marines’ schedules and will become well versed with the unique stressors they are exposed to. If only Marines “understand” Marines, then the next best thing is for mental-health providers to immerse ourselves in their world. Every one of them will get the opportunity to sit with a licensed clinician and talk about anything they want to. Everything discussed will be anonymous and confidential, with the exception of duty to warn. The main purpose is to give these Marines an outlet before any potential problems grow to the point where they need help and tools to circumvent issues when they arise. Of course the proactive counselors will collaborate with the Marines’ extensive existing resources to make referrals when needed.
This approach is intended not as crisis care, a check in the box, or a one-size-fits-all programming, but as an initial screening and a safe place to talk to a professional without having to seek one out. The curriculum has been carefully and meaningfully devised with close attention paid to details, with a large emphasis on training on military culture.
Of course initially not every Marine will respond enthusiastically to this—many distrust outside involvement, and even the concept of mental health, with its suggestion of an unhealthy mind.
Systemically there’s resistance toward prevention and it takes time for those attitudes to shift. Now it is commonplace for woman to have a yearly mammogram and men to have routine colonoscopies, but it wasn’t always that way. I am grateful that the Marine Corps is looking to get to the left of the suicide issue, and hopeful that this preventive approach can in time be put to use across all military branches.