Suicide in the Military
Over the last decade, an increase in the number suicides has been noted in the military (Castro & Kintzle, 2014; Rudd et al., 2015). Research studies have related mental health issues such as anxiety, Post Traumatic Stress Disorder, depression, and substance abuse or dependence among active and inactive servicemen. Notably, the rate of hospitalization due to mental health problems and suicide ideation has risen rapidly in the military circles over the last ten years (Castro & Kintzle, 2014). Many social workers have used the military transition theory to illustrate the possible causes of increased psychological health issues among war veterans that result in suicides. This realization, however, has not had a measurable impact on decreasing the rate of suicides among military members.
Countertransference is a common occurrence when dealing with suicidal clients. The risk of emotional effects on the therapist is heightened when dealing with soldiers who have witnessed the horrors of war. Clinicians may begin to experience feelings of fear, aversion, anxiety, and hyper-vigilance particularly when they can relate personally to the experiences of the client. It is crucial for a social worker to be aware of such effects and maintain a system of self-evaluation so as to avoid interference with the healing process and self-harm. It is also advisable for a clinician to consult with peers or a supervisor in cases of countertransference or other emotional effects on the social worker.
Military servicemen and women experience unique psychological and physical trauma associated with combat and deployment. However, the stigma related to seeking psychological help and the service culture discourages service members from accessing physical as well as mental health care. Notably, most of the suicides that occur in military circles follow the diagnosis of psychological disorders such as PTSD, anxiety, depression, etc. A significant fraction of servicemen who commit suicide had a history of psychological health problems. Despite the use of regular treatment for suicidal ideation and attempts, repeat incidences still occur at a high rate (Rudd et al., 2015). The use of brief cognitive behavior intervention showed improved effectiveness.
It is important for a social worker to keep tabs with the military culture so as to relate with military troops and veterans respectfully without offending them as well as understand their point of view. It is essential to initiate interventions and monitoring of veterans’ mental health while they are still active. This would assist in identifying risk factors thus provide timely help before the client becomes suicidal. Social workers should encourage, regular assessment and monitoring of servicemen who are already diagnosed with various mental illnesses. To prevent suicides associated with the transition, psychological help should be extended during the transition period so as to assist veterans in developing adaptive habits that will help them realign with the civilian society. Incorporating brief cognitive behavior therapy in the treatment of suicidal military men and women can contribute to increasing the effectiveness of treatment.
Post-Traumatic Stress Disorder (PTSD)
PTSD is a common mental illness among military personnel especially those who have been deployed to war zones. According to Castro & Kintzle (2014), approximately 118,000 military servicemen were diagnosed with PTSD after the Iraq and Afghanistan wars. During the wars, about 17000 active duty veterans received a PTSD diagnosis annually (Castro & Kintzle, 2014). Physical injuries and witnessing the impacts of war firsthand are the main contributors to the high incidence of PTSD in the military.
Therapy sessions involving veterans often lead to the narration of horrific traumatic events that clients experienced in the battlefield. It is not surprising for a therapist to have cognitive-emotional responses related to his or her personal experiences such as childhood/adult traumas and painful events (Briere & Scott, 2013). Burnouts, compassion fatigue, vicarious trauma, and secondary traumatic stress are common among social workers dealing with military members. Awareness and regular self-evaluation help psychotherapists to deal with emotional impacts of working with trauma clients promptly. Although some counter-activation responses are positive, it is important to monitor them so as to avoid reactions that can cause disruption of treatment or clinical experiences that are detrimental to the client (Briere &Scott, 2013).
Military personnel struggling with PTSD may have a self-perception of weakness based on the fact that they cannot handle psychological pain and traumatic experiences. However, it takes bravery to struggle to deal with the often overwhelming pain and endeavor to grow beyond it. Availing oneself for therapy in itself, especially in the military setting, takes strength and courage (Briere & Scott, 2013) as opposed to taking the seemingly easy option of avoidance. Social science research shows that a client’s psychological availability to therapy is enhanced in an environment of respect, compassion, and positive regard.
As a social worker, it is essential to create an atmosphere of respect, positive appraisal and empathy so as to establish a rapport that will promote therapy. In military settings, it is imperative to understand and have a high regard for military ideologies if a therapist is to relate positively with military clients. Portraying a sincere and continuous appreciation of the strength and courage shown by the client by confronting distressing memories is a significant role of a social worker. A positive regard and recognition of the client’s bravery assist the military client to develop better self-perception as well as deal positively with stigmatization from peers.
Substance Abuse in the Military
Although service members are screened for substance abuse disorders (SAD) before enlistment and deployed, a significant incidence of substance abuse is seen in this population (Sirratt et al., 2012). Deployment and active combat have been associated with the SAD as well as other psychological disorders such as depression, anxiety, and PTSD in the military workforce. It is not surprising for service members to develop drinking problems post-deployment. Alcohol abuse and misuse of prescription drugs have a higher incidence in the military compared to the civilian population (Sirratt et al., 2012).
Emotional involvement of the therapist towards the client issues is a real possibility when dealing with cases of SAD. Anger, sadness, and rigid control are some of the ways that a social worker can react to a client. In some cases, a client’s distress may trigger a desire in the therapist to keep distance. Reduced emotional attunement to the client impedes therapy.
Substance Abuse Disorders in the military are associated with psychological co-morbidities such as PTSD, depression, and anxiety (Sirratt et al., 2012). Servicemen suffering from mental health disorders are therefore likely to resort to drugs and alcohol for pain alleviation and avoidance. This insight is helpful to a social worker as it prompts the psychotherapist to use SAD monitoring and prevention intervention on military personnel undergoing psychological treatment for other mental illnesses. This insight also advocates for the utilization of treatment approaches that enhance positive emotional framing that in turn facilitates effective coping in SAD as well as other psychological co-morbid conditions.
References
Briere, J. N. & Scott, C. (2013). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Los Angeles: Sage.
Castro, C. A. & Kintzle, S. (2014). Suicides in the Military: The Post-Modern Combat Veteran and the Hemingway Effect. Curr Psychiatry Rep (2014) 16:460.
Rudd, M. D., Bryan, C. J., Wertenberger, E. G., Peterson, A. L., Young-McCaughan, S., Mintz, J., Williams, S. R., Arne, K. A., Breitbach, J., Delano, K., Wilkinson, E. & Bruce, T. O. (2015). Brief Cognitive-Behavioral Therapy Effects on Post-Treatment Suicidal Attempts in a Military Sample: Results of a Randomized Clinical Trial with 2-Year Follow-up. Am J Psychiatry 2015; 00:1-9.
Siratt, D., Ozanian, A. & Traenkner, B. (2012). Epidemiology and Prevention of Substance Use Disorders in the Military. Military Medicine 2012; 177, 8:21
