The murder of five U.S. soldiers by their comrade exposes the depth of the military's mental health troubles. Elspeth Reeve on why the culture of humiliation and stigma makes matters worse.
The U.S. Army has changed its policy on treating suicidal soldiers in response to an article on The Daily Beast. Read the Army's comments and Elspeth Reeve's original story below.
UPDATE, MAY 18: On Tuesday, May 11, The Daily Beast ran Elspeth Reeve's article detailing the Army’s humiliating treatment of suicidal soldiers. Among Reeve’s most troubling discoveries was that the Army sometimes forced suicidal soldiers to wear an orange vest that advertised their depression.
In response to the article, the Army has banned the use of the orange vest to single out suicidal soldiers. Under the comments to Reeve’s article, General Pete Chiarelli, the vice chief of staff to the U.S. Army, wrote:
I would like to personally thank Elspeth for writing this post and bringing the issue to our attention. We are committed to caring for our Soldiers and their Families, and her article has helped us do better. I have been working the stigma issue hard since January when I was designated to lead the Army's suicide prevention efforts. Because of Elspeth's posting, we identified a very few leaders who were using orange vests to identify soldiers that might harm themselves.
While the intent of using orange vests was isolated, she was correct in stating that it contributes to the problem of stigma; therefore, it has been stopped. Commanders will identify Soldiers needing help through other, more discreet, methods. To ensure everyone "gets the word", I have communicated this guidance throughout the Army. Reducing the stigma that keeps many Soldiers from asking for help is one of the most important things we can do as we implement measures to reduce suicides.
GEN Pete Chiarelli, Vice Chief of Staff, U.S. Army
ORIGINAL STORY, POSTED MAY 11: It was graduation day at U.S. Army basic training at Georgia's Fort Benning last fall, and families were milling around the post, congratulating the new soldiers on their achievement. At a charge-of-quarters desk (a sort of barracks reception), two privates were signing in and out fellow recruits who had day passes to leave post for celebratory dinners with their families. The two privates weren't able to graduate themselves. Both had been injured, were put on medical retention, and would be recycled through basic training. In the evening, after hours of watching their buddies prep for graduation, one private told the other, "I've had enough of this shit," and went up to his room. At around 8 p.m., the second recruit went up to the private's room to get him to come back to the desk and help sign in people due back the next hour. The room was empty, but a light was on in the bathroom. It was there that the recruit found his buddy dead. He had hanged himself with 550 cord, an all-purpose green string that looks like a shoelace and can hold 550 pounds.
The orange vest makes you a pariah. “It’s like you’re walking around in a zoo,” says one recruit, “and you’re the animal."
The surviving recruit's superiors were concerned about him. For two weeks, he was put on suicide watch, a common but not entirely standard procedure for at-risk soldiers. "Two battle buddies watch you 24/7," the recruit, who is still in training to become a radio operator, says. "You have to wear a road guard vest—there's no shoelaces, no bedsheets, no belt." On an Army base, where everybody is wearing the same digitized camouflaged uniform—and everybody is trained to spot small differences, like rank and unit, from a distance—just wearing boots held together by rubber bands instead of laces would draw attention. But a road guard vest is bright, construction-zone orange. In a sea of green, you can't miss it.
"You're in an isolated state," the recruit says. The orange vest makes you a pariah. "You've got the reason you're on suicide watch to begin with on top of the fact that you stick out like a sore thumb," he says. "It's like you're walking around in a zoo, and you're the animal."
As of April 10, 56 soldiers had reportedly committed suicide this year—about the same number of American soldiers who have died in Iraq since President Obama was inaugurated. In 2008, the Army suicide rate climbed above that of the civilian population (it has historically been lower because people with certain mental problems are screened out and few military members are over 65—the most at-risk age group for suicide).
The attention that these suicides have received has mostly focused on the Army’s failure to treat post-traumatic stress disorder in soldiers returning from combat, but little attention has been paid to the culture of shame that the Army has created around suicide within units that later on may inhibit depressed soldiers from seeking the help they need. Suicide watch (also called unit watch, buddy watch, or command interest profile) is how the Army deals with soldiers in garrison who express suicidal thoughts but don't appear to be in immediate danger of harming themselves. It's been around in some form since the 1980s, and generally involves a suicidal soldier being watched by one or two fellow soldiers around the clock, and having his gun, shoelaces, and belt taken away, so he can't kill himself.
It’s unclear how widespread exactly the use of the road guard vest is. Not every base uses it, though it is used at Fort Benning, where infantry soldiers, who are more at-risk for killing themselves when they come back, are trained. One soldier-blogger at an unspecified base wrote in the summer of 2008 that “there are around five kids that have to wear big red vests for suicide watch because they tried to.”
The purpose of the vest is, ostensibly, to make it easy for others to keep an eye on a suicidal soldier, but forcing a soldier to advertise his own depression creates a powerful stigma. "When you see what happens to someone on suicide watch—the orange vest, the trips to the chaplain, the drill sergeant talking about them when they're not there, saying they can't handle the military. … When you see that, you're going to think twice about speaking up and saying you need some help. It makes you not want to talk to someone. You don't want to be like that guy," the recruit from Benning says.
One soldier describes suicide watch on his blog like this: “[E]veryone can see you because you're wearing a bright orange vest in a yard of green uniforms. Your baggy camouflage pants are always falling down and you can't walk any way but awkwardly without loosing [sic] your boots. Two guys who don't like you are constantly at your side and you'd damned well better do whatever they say. Drill Sargeants [sic] go out of their way to make fun of you for the captive audience. You are fodder. You are an example.”
"I can't think of anything worse in the ethos of the military," says Polly Coe, a therapist who treats soldiers stationed at Fort Campbell, in Kentucky. Singling out suicidal soldiers, she says, "makes them more suicidal."
Her view of the practice's social consequences is echoed in a letter one soldier who was on unit watch wrote to the family of another: "My family warned me about the old Army—blanket parties, DSs [drill sergeants] smacking you. A DS smacked my mom in the back of her head with his boot when she was in a foxhole qualifying. They don't do that now. They do it all inside your head. The pressure is incredible."
In 2000, two recruits died less than six weeks apart while on suicide watch at Fort Leonard Wood, Missouri. In the wake of those incidents, a study of unit watch was published; the study said that, though unit watch presented some problems, it was "an appropriate intervention for junior-grade enlisted soldiers," and that it is less stigmatizing than hospitalization, as well as "less costly and resource intensive." The study also noted that soldiers "benefited from the increased attention and assistance provided." An article in Military Medicine written by Army doctors last year offered guidelines for the use of unit watch, writing, "We believe that the military unit is a unique and cohesive community that allows the unit watch to be a responsible way to minimize suicide or homicide risk."
But often times, suicidal soldiers test rather than confirm the “uniqueness” and “cohesiveness” of a unit. I talked to many soldiers who remember seeing guys in orange vests at Fort Benning, though few of them have much sympathy for those recruits, who are often seen as wimps trying to get out of their contract. One soldier says of the kid on suicide watch he remembers from basic, "I think it was a case of a kid who played too much Halo and got scared when he found himself in the real Army." Adds another, who is stationed at Benning and sees guys in orange vests occasionally, "In basic, guys will say they're suicidal or gay. They do a lot of things to try to get out of the Army."
The Army, when asked for comment on suicide watch, emphasized that soldiers are currently undergoing a “chain-teaching session based on the Army’s ‘ Shoulder to Shoulder, No Soldier Stands Alone’ video and ACE (Ask, Care, Escort) suicide intervention card.” But Coe says that since she began treating soldiers in 2004, the stigma has not lessened "at all." And as recently as March 19, 2009, you can find a soldier writing on her blog, “There was an Army-wide mandate for soldiers to watch a series of videos and slides about suicide prevention. I think it's a good idea but what's going to change the Army's suicide numbers isn't going to be a video or mandatory classes. What will change it, is how the Army treats the soldiers that are on ‘suicide watch.’”
I first heard of the orange vest when I was living on an Army base in Germany. A veteran was having combat-stress symptoms. He wanted to make an appointment to see a military counselor, but the line was three weeks long. He told them it was an emergency, he needed to speak to someone right away. They told him, OK, we'll see you in three weeks. He said there was no one else he could talk to about his problems, because if he told anyone else what was going on in his head, he'd be put in an orange vest. (The orange vest doesn't seem to be used after basic training, but this soldier didn't know that.) Later in the year, before deployment, he became worried he wouldn't be able to do his job in Iraq. His wife showed me two handfuls of prescription pill bottles, all containing different drugs to treat his mind. He flirted briefly with going AWOL. He wasn't very seriously considering the option, but even the thought of AWOL followed by a few months in military prison seemed preferable to his leadership—and the soldiers he led—finding out that he "couldn't handle it." Eventually he returned to combat with his unit. He was more scared of a road guard vest than he was getting blown up in Iraq.
Elspeth Reeve is a writer living in New York. She has written for Time, New York, and The New Republic.