Rarely does a soldier enter my office and become so profoundly sad and upset that it is difficult to find out what happened. Such was the case with this 38 year old noncommissioned female officer who arrived recently. All she could say between crying spells was, “He did not show up for work.” “Who?” I asked.
She described an outstanding soldier with whom she had been deployed to Iraq. Although an enlisted soldier, he was the unspoken leader of the unit. He volunteered to take photos of individual soldiers, write stories of their experiences, and send them to their families. He kept up the spirits of soldiers and their families. Everyone in the unit went to him for guidance. When the unit completed its tour of duty and returned to the United States, the soldier was also completing the terms of his service and was being discharged. He had a high IQ, good social skills, and scored well on aptitude tests. He was enrolled in college and had a bright future at age 22 years.
Transitioning out of the military can be difficult. One of this officer’s jobs was to conduct an exit interview. She was in charge of the base suicide prevention program so she knew what to look for and what questions to ask. She had received all the training. She taught others what to monitor. She knew the “key words and signs” to observe. To her ear, the soldier sounded healthy and ready to leave. He had family, was connected to fellow soldiers, and not depressed. He was not impulsive, always well groomed and well behaved with no behavioral health problems. He was a leader. Yet it is never possible to know what is on another’s mind.
When he did not show up for work, she went to his room. “It smelled of death” she said to herself. “There he was hanging from the ceiling. Apparently I missed something.” As she spoke I could see the pain in her face and her posture as if she were still looking at the dead soldier hanging from the ceiling. His peers apparently kept secret that every weekend he would drink alcohol to the point of unconsciousness. Is binge drinking by-young people so common place that no one thought it was worth mentioning? How could she not have been made aware of this fact?
Her description of what she observed felt to me that it had happened yesterday, but actually it was one year ago. Why after a year of suffering could she not forgive herself? So I asked. “Do you blame yourself for the loss of this soldier?” “Since childhood every time I got close to people, I feared losing them and then the funeral experience made it so much more complicated.” She and four other soldiers accompanied his casket to the family funeral. Upon introducing herself and offering condolences to his parents, the soldier’s mother turned to her and said, “It is your fault. I put my son in your care and you allowed him to kill himself.” Not only had she been blaming herself, but now the blame came from outside as well. It is never possible to know what is on another’s mind.
I wondered with whom she talked to share her guilt and her perceived responsibility. “Not with my husband,” she said, although he was also in the military. “His baggage from deployments is worse than mine,” she said. “Not with my peers, either” she said. “We are expected to keep busy and keep going. “Keeping busy works for a while,” but
“the military spends millions for suicide prevention and counseling, and yet there are no programs for leaders whose soldiers have killed themselves like my soldier did.”
Our time was over and yet I knew virtually nothing about this patient’s background — an essential for a proper evaluation. I wondered what was really on her mind behind all that pain. As she exited my office I realized that I faced the same dilemma as did she when that soldier was leaving her unit. I asked her if, being so distressed, she had ever thought of hurting herself. “I love myself and my family. I would never hurt my family by hurting myself.” A strong enough response for me! I thought it was all right for her to leave. The reasons behind her intense feelings of responsibility would have to wait until the next visit.
Most soldiers are indoctrinated with banding together to care for fellow soldiers, but her reaction over the loss seemed excessive. Beginning the next visit I decided to ask how she accounted for such strong feelings of responsibility for the death of this soldier. She said she had done virtually everything possible to prevent it. She acknowledged being called “Mother Teresa” by her family since childhood. And yes her childhood history revealed many clues about what I called “ambiguous” deaths and her sense of responsibility for ones that were hard to explain like the death of this soldier.
This female officer’s feelings of responsibility probably stemmed from the early loss of her father for which she inexplicitly blamed herself. This emotional reaction was cemented by other family deaths. Her older adolescent sister died in bed. She was the one who found her. Her adult brother died mysteriously. Her first born son died after ten days of life. If one survives all these experiences with a self-blaming response, it is almost a prescription for becoming a “caretaker” as an adult.
Is this the type of soldier typically drawn to the military? One who cares so much for others’ lives that it becomes a total personal burden! The Army teaches defense of country by banding together, by killing the enemy and protecting others, and by what some might call altruism. This teaching may be effective in preventing deaths, but what happens when some deaths do occur.
When a soldier dies in combat, fellow soldiers are troubled and feel guilty about not having been able to save that comrade. When a soldier kills himself in his own room, fellow soldiers may be even more troubled about not saving their comrade. The Army can teach altruism, which is critical for the survival of the unit. But when that altruism, that concern for others, is built on top of her type of family structure, it can stretch human empathy to an unhealthy vulnerability.
At this moment, in the face of this death, forgiveness, not altruism, is sorely needed. One can never fully know what is in another’s mind. For this officer to forgive herself for all she believes she “missed” has not seemed to enter her mind. I hope that I can help this soldier find a place in her own mind for self forgiveness. But can forgiveness be taught? Can she stop blaming herself for not knowing in spite of her efforts what was on the mind of her dead soldier?
Ted Beal
Edward W. Beal, MD, Psychiatrist, Department of the Army, Department of Tele-Health,
U. S. Army Medical Department Activity, Fort Meade
