In Unit Stalked by Suicide, Veterans Try to Save One Another — (The New York Times)

SSRI Ed note: Veteran's Affairs continues to push drugs, ignoring increased suicide risk

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The New York Times

By DAVE PHILIPPS

SEPT. 19, 2015

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

After the sixth suicide in his old battalion, Manny Bojorquez sank onto his bed. With a half-empty bottle of Jim Beam beside him and a pistol in his hand, he began to cry.

He had gone to Afghanistan at 19 as a machine-gunner in the Marine Corps. In the 18 months since leaving the military, he had grown long hair and a bushy mustache. It was 2012. He was working part time in a store selling baseball caps and going to community college while living with his parents in the suburbs of Phoenix. He rarely mentioned the war to friends and family, and he never mentioned his nightmares.

Manny Bojorquez sitting in the lobby of the church in Las Vegas where Eduardo Bojorquez’s funeral was held. Justin Rogers, left, and Mark Briggs also served in the Second Battalion, Seventh Marine Regiment.

Unraveling a String of Veteran Marine Suicides, One by One

He thought he was getting used to suicides in his old infantry unit, but the latest one had hit him like a brick: Joshua Markel, a mentor from his fire team, who had seemed unshakable. In Afghanistan, Corporal Markel volunteered for extra patrols and joked during firefights. Back home Mr. Markel appeared solid: a job with a sheriff’s office, a new truck, a wife and time to hunt deer with his father. But that week, while watching football on TV with friends, he had wordlessly gone into his room, picked up a pistol and killed himself. He was 25.

Still reeling from the news, Mr. Bojorquez surveyed the old baseball posters on the walls of his childhood bedroom and the sun-bleached body armor hanging on his bedpost. Then he took a long pull from the bottle.

“If he couldn’t make it,” he recalled thinking to himself, “what chance do I have?”

He pressed the loaded pistol to his brow and pulled the trigger.

Mr. Bojorquez, 27, served in one of the hardest hit military units in Afghanistan, the Second Battalion, Seventh Marine Regiment. In 2008, the 2/7 deployed to a wild swath of Helmand Province. Well beyond reliable supply lines, the battalion regularly ran low on water and ammunition while coming under fire almost daily. During eight months of combat, the unit killed hundreds of enemy fighters and suffered more casualties than any other Marine battalion that year.

When its members returned, most left the military and melted back into the civilian landscape. They had families and played softball, taught high school and attended Ivy League universities. But many also struggled, unable to find solace. And for some, the agonies of war never ended.

Almost seven years after the deployment, suicide is spreading through the old unit like a virus. Of about 1,200 Marines who deployed with the 2/7 in 2008, at least 13 have killed themselves, two while on active duty, the rest after they left the military. The resulting suicide rate for the group is nearly four times the rate for young male veterans as a whole and 14 times that for all Americans.

The deaths started a few months after the Marines returned from the war in Afghanistan. A corporal put on his dress uniform and shot himself in his driveway. A former sergeant shot himself in front of his girlfriend and mother. An ex-sniper who pushed others to seek help for post-traumatic stress disorder shot himself while alone in his apartment.

 

The problem has grown over time. More men from the battalion killed themselves in 2014 — four — than in any previous year. Veterans of the unit, tightly connected by social media, sometimes learn of the deaths nearly as soon as they happen. In November, a 2/7 veteran of three combat tours posted a photo of his pistol on Snapchat with a note saying, “I miss you all.” Minutes later, he killed himself.

The most recent suicide was in May, when Eduardo Bojorquez, no relation to Manny, overdosed on pills in his car. Men from the battalion converged from all over the country for his funeral in Las Vegas, filing silently past the grave, tossing roses that thumped on the plain metal coffin like drum beats.

“When the suicides started, I felt angry,” Matt Havniear, a onetime lance corporal who carried a rocket launcher in the war, said in a phone interview from Oregon. “The next few, I would just be confused and sad. Then at about the 10th, I started feeling as if it was inevitable — that it is going to get us all and there is nothing we could do to stop it.”

For years leaders at the top levels of the government have acknowledged the high suicide rate among veterans and spent heavily to try to reduce it. But the suicides have continued, and basic questions about who is most at risk and how best to help them are still largely unanswered. The authorities are not even aware of the spike in suicides in the 2/7; suicide experts at the Department of Veterans Affairs said they did not track suicide trends among veterans of specific military units. And the Marine Corps does not track suicides of former service members.

Feeling abandoned, members of the battalion have turned to a survival strategy they learned at war: depending on one another. Doing what the government has not, they have used free software and social media to create a quick-response system that allows them to track, monitor and intervene with some of their most troubled comrades.

Their system has made a few saves, but many in the battalion still feel stalked by suicide.

“To this day I’m scared of it,” said Ruben Sevilla, 28, who deployed twice with the 2/7 and now works for a warehouse management company called Legacy SCS near Chicago. “If all these guys can do that, what’s stopping me? That’s what freaks me out the most. I haven’t touched a gun since I got out of the Marine Corps because I’m afraid to.”

The morning after Manny Bojorquez tried to shoot himself in 2012, he opened his eyes to sunlight streaming in his window and found the loaded gun on the floor. Through his whiskey headache, he pieced together that his gun had jammed and that he had passed out drunk.

A week later, he stood alongside more than a dozen other Marine veterans at Mr. Markel’s funeral in Lincoln, Neb. The crack of rifles echoed off the headstones as an honor guard fired a salute.

Mr. Bojorquez offered his condolences to Mr. Markel’s mother after the funeral. He thought about how life seemed increasingly bitter. The thrill of combat was gone. Only regrets and flashbacks remained.

Mr. Markel’s mother pressed something into Mr. Bojorquez’s palm at the funeral, a spent brass shell casing from the honor guard. Promise me, she said to him, that you will never put your mother through this. Mr. Bojorquez promised.

That began a three-year odyssey in which the deaths of his friends weighed on Mr. Bojorquez, who tried repeatedly to get help from Veterans Affairs but ultimately gave up.

“I was lost then. I still am kind of lost,” he said in a recent interview. “I was just trying to look for something that wasn’t there. I was trying to look for an answer that I don’t have — that no one does.”

He was wearing a bracelet etched with the names of four Marines: one who died on the battlefield and three who died by their own hands at home…

Lacking Data on Suicides

The first few suicides struck the men of the battalion as random. It was only over time that they came to see the deaths as a part of their war story — combat deaths that happened after the fact.

Cpl. Richard McShan died first. He had survived a truck bomb in Iraq before deploying to Afghanistan. Four months after they returned, in the spring of 2009, he put on his dress uniform after an argument with his girlfriend and shot himself in his driveway.

In December 2009, Pfc. Christopher G. Stewart hanged himself from a door in his barracks.

In April 2010, Shawn Jensen, a sergeant who had just gotten out of the Marines and moved home to rural Washington State to work in construction, shot himself during an argument with his girlfriend and mother.

The Marines tended to chalk up these first suicides to foolish impulses or prewar problems. Then came the death that shook the battalion, and prompted many to ask whether something was wrong not just with the men who killed themselves, but with them all…

A 2014 study of 204,000 veterans, in The Journal of the American Psychiatric 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.

He added that dropout is an issue in all mental health care, not just among veterans, and that the department was constantly trying to provide alternative types of therapy, like meditation.

Craig J. Bryan, a psychologist and an Iraq war veteran, said that “the V.A. has done more to try to prevent suicide than anyone has done in the history of the human race.” Mr. Bryan, who runs the National Center for Veterans Studies at the University of Utah, added: “But most veterans who kill themselves do not go to treatment or give up. They are not interested. That is the challenge.”

Mr. Bojorquez tried the system one more time out of desperation. After the spate of suicides in 2014, he called and said he needed help. The V.A. had him see a psychologist and psychiatrist.

He told them that he wanted therapy but no drugs. Too many friends had stories of bad reactions. One, Luis Rocha, had taken a photograph of all his pill bottles right before shooting himself.

“We get it, no drugs,” he recalled them saying. But on his way out, after scheduling a return appointment in two months, he was handed a bag filled with bottles of pills. He calmly walked to his car, then screamed and pounded the steering wheel.

he said. His nightmares grew more vivid, his urge to kill himself more urgent.

After a few weeks, he flushed the pills down the toilet, determined to deal with his problems on his own…