Before a good friend of David Smith, Keith Branch and Daniel Burmeister committed suicide, he arranged all his medications on a tabletop, took a photo with his cellphone and sent the image to his friends. The picture spoke volumes to the fellow combat veterans.
For one thing, the trio look with a skeptical eye at the many pills prescribed to each of them. All three are former U.S. Marines who survived the battlefields in Afghanistan. Now that they are back home in Texas, they are trying to figure out how to survive the rest of their lives.
Their friend’s final message underscored that it will take more than enduring long waits for care at VA clinics and filling prescriptions.
Their friend’s death also came not long after the U.S. military announced a record-setting 349 soldiers had committed suicide in 2012. More soldiers died at their own hands than in combat.
And then came another report — a recent Department of Veterans Affairs study that found veteran suicides were increasing, too. U.S. veterans are taking their own lives at a rate of an estimated 22 per day, the study found.
Branch, 26, now a student at the University of Texas at Arlington, counts at least nine soldiers from his unit who have committed suicide since they all returned to the U.S.
Smith, 23, a student at the University of North Texas, said he knew something was wrong with his friend in the hours before he killed himself.
“The person I was hanging out with the day before was not him,” Smith said.
Thoughts of suicide
When he got to UNT, Smith knew to look for others like him — military veterans who hadn’t just served but who had also seen combat.
Soldiers train for cohesion in their company, but not all veterans are kindred spirits. Veterans who fired at the enemy, who were fired upon, who saw their buddies die, who had their own bodies mangled — those veterans share a different kinship, he said.
Smith soon found that friendship with combat veterans his age. He also found support from his mentor, UNT professor Guenter Gross, who is a combat veteran of the Vietnam War. Gross is quick to say that, even though he was shot at while piloting his missions, he didn’t see the kind of combat that Smith and the others did.
As Smith settled into his studies, which include helping in Gross’ research in the Center for Network Neuroscience, he began questioning the effects of some of his medications. Together, Gross and Smith looked at drug reference books so he could better understand the medicines.
At various times, in addition to pain medication, Smith was prescribed a sleep aid, an antidepressant, an anti-anxiety medication and, for his nightmares, a common blood pressure medicine. When he was taking both the sleep medicine and the antidepressant, both serotonin re-uptake inhibitors, he learned that taking more than one SSRI can cause thoughts of suicide.
Branch said he believes that some combination of his prescriptions had triggered ideas of suicide. He stopped taking some of them, even though he knew that meant he could get in trouble with his VA doctor for being noncompliant.
Burmeister, 24, and home for two years now, still waits for the VA to review his claim, but he knew that he, too, needed help.
“I went to mental health services by myself,” Burmeister said.
Smith also stopped taking some of his prescriptions and asked the VA for counseling instead. He believed that, like his friend who had committed suicide, his medications had put the idea of suicide in his head.
It was several tense months this spring as Smith waited for the counselor to find time to see him, he said.
“Suicide would be the very last thing I would do, but it puts those thoughts in your head,” Smith said.
That was the only time he thought about how bad his life was, he said.
In early June 2010, a water truck had arrived in Musa Qa’lah, where Smith and the rest of his unit were stationed outside Sangin Valley, in the Helmand province of Afghanistan. Something inside told him he was making a mistake by running up to the truck, Smith said, but he didn’t stop.
The truck’s back wheels hit an improvised explosive device. The resulting explosion injured the driver and nine Marines. Smith’s right leg and gut were badly injured in the blast.
He was sent back to San Diego to recover. His wounds required four major surgeries. He sees an ophthalmologist every three months to monitor his eyesight. Once, the doctors tried giving him Botox to help combat the headaches, he said.
It didn’t help.
While Smith was recovering, he got addicted to painkillers, he said. He hung around other combat veterans who were addicts, too. Some of his new buddies were homeless. His addiction didn’t bother him until one day someone offered him heroin. He entertained the idea. Then, he knew it was time to get clean.
It was three weeks of “hellacious withdrawal,” but he made it, the Frisco High School graduate said.
He got help through a well-known program in California, the Veterans Village of San Diego.
When it was time to go back home to Texas, Jack Lyon, one of five Vietnam veterans who helped start the San Diego program in 1981, told Smith to reach out and make friends in Texas who would understand.
Many veterans often struggle to reassimilate once they are back home, says Paul Bastaich of Denton County Veterans Services. Some veterans, like Smith and Branch, take full advantage of the GI Bill, which offers 36 to 48 months of support to finish a college degree.
Money for tuition and housing, as well as a stipend, go a long way, but many veterans soon learn attending college is stressful, too, Bastaich said.
The VA has good programs for combat stress, post-traumatic stress disorder and other mental health problems, he said.
“I’ve seen a lot of success with people coming back and being a civilian again,” he said.
But the VA also is a “socialized” health care system, and accessing that care and treatment can take a lot of time, Bastaich said.
“That time away can be the biggest problem,” he said.
Sometimes the degree of mental health care available to a combat veteran also depends on the battalion commanders, Smith said.
“A lot depends on how bad they think the deployment was,” Smith said.
Branch said he thinks the speed of care matters, too, and he thinks the VA could do more to focus on combat veterans.
“There are so many claims, but they should make combat claims a priority,” Branch said.
The VA’s own study appears to bear that out. Findings showed that the first four weeks following service were key, requiring intensive care and case management for those veterans most at risk of suicide.
When a buddy commits suicide, the questions many combat veterans are wrestling with resurface, said Lyon, one of the Veterans Village founders.
“If you’re a ‘grunt,’ a combatant, if you are doing the deal, the dance, you feel death on your neck,” Lyon said. “You are thrust into the nexus of life and death and you are never the same after that.”
Smith remembers another day, when he had the enemy in the scope of his TOW missile. His unit had taken heavy fire from that position in the mountains the night before.
In the morning, they spotted a small group of men they believed to be the shooters, but they had gathered in a prayer circle. Smith waited for hours to make his shot, waiting for the evidence that they, too, were combatants. Once he saw that, he fired. His shot traveled 3,967 meters and killed eight men, he said.
When one lives and another dies, and a soldier had a hand in it, Lyon said, the classic question returns: “Why am I here?”
Combat stress dates back to ancient Greece. Mental health disorders were rampant among World War II veterans, some of whom never got help, Lyon said.
“And to my generation, it was debilitating. It took us 10 years to find each other,” Lyon said.
He is hopeful that the current generation of soldiers will cut that time for help with combat stress even further.
If a combat veteran goes to the VA with panic attacks, the doctor might prescribe a medicine to deal with the symptoms, but that won’t get to the underlying problem, Lyon said.
Context is important, he said.
“That’s why the best treatment is warrior-to-warrior, one generation to the next,” Lyon said. “It’s a spiritual issue.”
That can be bewildering for others who knew the soldier before deployment and after.
Branch’s marriage fell apart.
“The anxiety and depression that resulted make it hard to have good relationships,” Branch said.
Combat veterans don’t have time to grieve on the battlefield, and that experience becomes a casualty of its own, Lyon said.
“The rage comes from being helpless, and watching a friend die,” Lyon said.
It takes a long time to learn to trust again. Yet, when a veteran comes home, family and friends expect the same person has returned, Lyon said.
“We have welcome-home events, and parades, and parties, and that’s very nice,” Lyon said.
But that’s not what the wounded soul of a combat veteran needs, he said.
“He needs to exhale and find someone with context, someone who can let him know it’s going to be OK,” Lyon said.
The program Lyon and his friends started 30 years ago is one that provides such context and has been a model for other programs that link combat veterans together for support, he said.
Friends and family need to know that is OK that the combat veteran has changed — it’s a gift even, Lyon said, that the veteran knows things about life and death that most of the rest of us don’t really understand.
“They know that space of silence and openness,” Lyon said.
PEGGY HEINKEL-WOLFE can be reached at 940-566-6881 and via Twitter at @phwolfeDRC.
June is PTSD Awareness Month
Veterans with combat stress, or who suspect they may suffer from post-traumatic stress disorder, can get help. The National Center for PTSD has information to help veterans and their families find local mental health services. More information on trauma and PTSD can be found on the center’s website, www.ptsd.va.gov.
Veterans in crisis should call 911, go to the nearest emergency room, or call either the Suicide Prevention Lifeline at 1-800-273-8255 or the Veterans Crisis Line at 1-800-273-8255 for a confidential chat with a counselor.