New York Times: Marine Battalion Suicides

This lengthy and distressing article is a must read. I have highlighted a few quotes below worthy of deep consideration and discussion. Whereas we cannot stop the unstoppable our service delivery system and my profession is pathetically misguided, fractionated, grandiose and blinded by weak studies and poor training. The noted dropout rate for the gold standard treatment obscures the many veterans refusing to even start. We need better outreach, drastically reduced dropouts and a massive infusion of talent, interpersonal  skill training and a seamlessly integrated system capable of delivering care to the wide spectrum of symptoms, as well as co-occurring addictions. It pains me to validate the comment from clinician comparing his pain to a “bad breakup with a girl; it  is congruent with reports from veterans I have worked with. Too many professionals blame the client for failing to comply. Too often the problem is the hubris, arrogance, fear and entitlement of those chartered to provide care. Our soldiers put their lives on the lines; our models must mirror the commitment.  Whereas we cannot stop disaster we can and must dramatically upgrade our care. We need a revolutionary zeitgeist and a return to humanistic care. 

In Unit Stalked by Suicide, Veterans Try to Save One Another

Members of a Marine battalion that served in a restive region in Afghanistan have been devastatedby the deaths of comrades and frustrated by the V.A.

Some outtakes from the full article:

Back home, he was getting counseling at the V.A., family members said, but faced delays and struggled to find a therapist who he felt understood him. In April 2014, he hanged himself in his apartment.

He sat down with a therapist, a young woman. After listening for a few minutes, she told him that she knew he was hurting, but that he would just have to get over the deaths of his friends. He should treat it, he recalled her saying, “like a bad breakup with a girl.”

The comment caught him like a hook. Guys he knew had been blown to pieces and burned to death. One came home with shrapnel in his face from a friend’s skull. Now they were killing themselves at an alarming rate. And the therapist wanted him to get over it like a breakup?

Mr. Bojorquez shot out of his seat and began yelling. “What are you talking about?” he said. “This isn’t something you just get over.”

He had tried getting help at the V.A. once before, right after Mr. Markel’s funeral, and had walked out when he realized the counselor had not read his file. Now he was angry that he had returned. With each visit, it appeared to him that the professionals trained to make sense of what he was feeling understood it less than he did.

He threw a chair across the room and stomped out, vowing again never to go back to the V.A.

A 2014 study of 204,000 veterans, in The Journal of the American Psychological Association, found nearly two-thirds of Iraq and Afghanistan veterans stopped Veterans Affairs therapy for PTSD within a year, before completing the treatment. A smaller study from the same year found about 90 percent dropped out of therapy.

The therapies, considered by the department to be the gold standard of evidence-based treatments, rely on having patients repeatedly revisit traumatic memories — remembrances that seem to cause many to quit. Evaluations of the effectiveness of the programs often do not account for the large number of patients who find the process disturbing and drop out.

Dr. Kudler of the Department of Veterans Affairs said data showed that 28 percent of patients drop out of PTSD therapy, but that most veterans stay in treatment and report improvements.