Struggle Well: A New Approach to Mental Health and Suicide
“Copyright U.S. Naval Institute. Reprinted with permission from Proceedings magazine, U.S. Naval Institute.”
By Master Chief Petty Officer Ken Falke, U.S. Navy (Retired)
Our nation is in the midst of a mental health epidemic that shows no signs of abating. The scope of this epidemic is evidenced by the suicide rate (up 33% since 1999) and large numbers of drug and alcohol overdoses.
Historically, the military was immune from these types of societal trends. Many of the protective factors for strong mental wellness—a clear sense of identity, purpose, mission, and community—are part of military life and underpinned much lower rates of mental health challenges and suicides.
Tragically, this is no longer the case. In 2018, the military recorded an all-time high in suicides. This despite the fact that the Department of Defense (DoD) is spending more money than ever on more programs than ever to solve the problem. Air Force Chief of Staff, General David Goldfein, recently noted, “I actually don’t know what’s going on, and I certainly can’t point to our programs today and say that they’re working.”
At its core, suicide is the result of hopelessness and loneliness. Suicide stems from a belief that tomorrow will always be the same or worse than yesterday, there is no path to a life worth living, and that nobody really “knows me or gets me.” Why is it that far too many service members find themselves on the precipice of suicide? What contributes to their struggle?
I would be the first to admit I do not have all the answers. If there is one thing I can conclude after 21 years in the Navy and 17 years working closely with service members and veterans in the nonprofit world—and attending far too many funerals for my brothers and sisters who died by their own hand—there is no such thing as a suicide expert. That said, years of experience working with military veterans who are victims of trauma has convinced me a new approach is needed.
A Misguided and Myopic Focus on Suicide Prevention
In response to this growing active-duty crisis, the DoD does what the DoD does well when they have a problem—throw money and people at it. Unfortunately, doing more of the same, as General Goldfein noted, will not prove effective in the slightest.
As a retired bomb disposal technician, I come from a profession that is always trying to improve our situation. We thrive on the concept that perfect practice makes perfect. We, the explosive ordnance disposal (EOD) community, are harder on ourselves in training than anyone else could be. When we have a problem, we find a way to squeeze it from all sides, hence the term, “left of boom.” In the improvised explosive device (IED) fight, this meant that just trying to locate and disarm IEDs was a fool’s errand; there had to be a way to identify the component supply chain, financing, and bombmakers and disrupt the manufacturing and placement processes.
When it comes to the topic of suicide prevention, we are not squeezing the problem. The so-called prevention efforts and public health approach are misguided and ineffective and miss the boat entirely. Why? Because the opposite of suicide is not prevention, it is creating a life worth living.
The Role of Leadership
Over the past 18 months, I have spoken to active duty units that have recently dealt with multiple suicides, and I have spent a great deal of time reflecting on the nature of the challenge and how we work to get left of boom. My hope in sharing these lessons is to catalyze a conversation about gaining a far deeper understanding of the nature of the problem, and more significantly perhaps, what to do about it.
At its core, I believe the growing active duty suicide epidemic can be traced to one word: Leadership.
Leadership in terms of individuals of every rank understanding how to effectively lead themselves first. And leadership in terms of the climate created up and down the chain of command—what some refer to as “toxic leadership.”
The good news is that I believe by focusing on the first type of leadership—lead yourself first, we can make a meaningful change in the chain of command leadership. At its core, this means focusing on a type of intelligence seldom discussed but for mandatory briefings and a few PowerPoint slides: Emotional Intelligence (EQ).
Harvard Business School research shows that great leaders possess three key attributes: a high IQ, strong technical expertise, and a high EQ. Emotional intelligence includes five skills: self-awareness, self-regulation, empathy, the ability to understand and motivate self and others, and social skills. I am aware of disparate efforts to train service members in EQ, however, this simply is not good enough. EQ often comes across as soft. This is the farthest thing from the truth. As a Master Chief Petty Officer, the highest compliment I could receive is that I was a “Sailor’s Sailor.”
When we think about the narrative of someone who dies by suicide, there usually are a series of difficult, challenging, or traumatic events followed by a descent downward that usually includes of a fair bit of self-medicating, perhaps an ineffective visit to a mental health professional, the pushing away of friends, family, and other forms of support, and then a tragic, far-too-preventable ending.
At the heart of this story is the inability to understand three things. First, that all lives are filled with ups and downs and, therefore, struggle is a normal part of the human experience. Second, the downs—the times of struggle, difficulty, and even despair—can serve as catalysts for growth and transformation (an area I spend a lot of time working on the context of the science of posttraumatic growth). And third, how to regulate one’s emotions so people do not get overwhelmed by stress and trauma to the point that self-medicating seems the easiest option for relief.
The Importance of Training
I was recently asked what I would do if I was “king for a day” and had the opportunity to reshape how the military addresses these issues while maintaining lethality and readiness. My response is that I would focus a great deal of time and energy on the leadership training continuums.
On the far left of the continuum, I would focus on recognizing that when a soldier, Marine, sailor, airman, or coastguardsman arrives on day one for basic training or boot camp, they likely have already been through a great deal of trauma. The research, and my personal experience, demonstrate that members of our all-volunteer force arrive with levels of childhood trauma (or adverse childhood experiences) 3–5 times higher than their civilian counterparts.
Second, I would integrate emotional intelligence—call it personal leadership training—in the leadership continuum. I would also focus on integrating such training into the service academies.
Third, I would work toward integrating an understanding of the elements of personal leadership —self-regulation in particular—into every day military training. This is not about more “mando” briefings, but the recognition that breathing training that is part of any shooting activity is also a great way to create calm during difficult times; that physical training is not just about being fit and able to hump your ruck, but actually releases great chemicals that reduce stress and make people happier; that volunteerism is not an award, but actually something that improves your well-being.
Fourth, I would stop outsourcing mental healthcare to a small group of people that are difficult to access, talk to, connect with, and understand. Especially when rank is involved. Somewhere along the way, our society decided that we would leave mental health stuff to mental health professionals. This is a huge mistake. As the pioneering psychiatrist Vikram Patel noted, “mental health is too important to be left to mental health professionals alone.” We have seen the result of a world dominated by mental health professionals—it is not good. As Dr. Thomas Insel, the former director of the National Institute of Mental Health, recently asked, “Are we somehow causing increased mortality and morbidity with our interventions?”
Fifth, we must focus on normalizing struggle, and democratizing our individual and collective ability to deal with it. This starts by stopping the artificial separation between wellness and readiness, and by starting to educate current and future leaders in the tenets of good well-being.
By all accounts, the military should not have a suicide problem. Military service comes with a myriad of benefits—from a profound sense of purpose to a “tribe” you can count on. The fact there is a growing active duty suicide crisis should raise all alarm bells. Doing the same thing over and over again and expecting different results is the definition of insanity. As General Goldfein noted, what we are doing is not working. It is time for a new, innovative, and comprehensive approach. This approach starts with some of the suggestions I have outlined, and a renewed focus on what great leadership is.
Master Chief Falke is a 21-year combat veteran of the U.S. Navy explosive ordnance disposal (EOD) community. Ken is the former founder and CEO of A-T Solutions, a world recognized leader and award-winning counter-terrorism company. He is also the founder and Chairman of both Boulder Crest and the EOD Warrior Foundation, and the co-author of Struggle Well: Thriving in the Aftermath of Trauma.