Mental health and suicide in the Army – A lesson from Mass Effect

Kelly Chambers. BA, Psychology.

Originally published in 2012.

This past week has seen a couple of sobering reports released by the Pentagon concerning suicide in the military. The first confirmed that in the first 155 days of 2012 there have been 154 confirmed suicides by active duty servicemembers across the force. 136 servicemembers were killed in Afghanistan during the same period.

On Wednesday, suicide was named as the second highest cause of death for servicemembers (after combat), outpacing car accidents, cancer, and other causes of death.

Suicide has been a growing problem for the Army over the past ten years. Understandably, people often point to the pace of deployment and the over-stretching of the all-volunteer force as the likely antagonizer. It makes sense to assume that deploying the same people over and over again might result in an increase in mental health issues (which it might). But in the Army’s 2009 study on suicide, 79% of soldiers who committed suicide had one or no deployments. So while the pace of deployments might have an effect on overall mental health, it does not correlate with the increase in suicides.

What this means is that we still do not know why this is happening.

For its part, the Army has worked hard to try to combat suicide. Even before I got out of the Army in 2006, suicide was already a topic that was treated seriously by commanders. If someone threatened to kill himself – even in jest – it was a threat that needed to be taken seriously.

I’ve been back in the Army for under a year, but I have already seen the introduction of some great programs that are intended to get ahead of mental health problems and ultimately suicide. Comprehensive Soldier Fitness (CSF) is a program designed to build “resilience” in soldiers (and family members) to prepare them for the rigors of not only combat and military service, but life in general.

I have not taken the Master Resilience Trainer Course (yet) but I have taken some of the individual modules while at IBOLC. Without question, the program requires a “buy in” from the participant. Essentially, the person engaging in CSF needs to “want” to get better or become more resilient. In a military where a mental health stigma still exists, getting that “buy in” is the hard part. Hopefully, I’ll get a chance to take the course before leaving Fort Benning. I’ve already bought in.

Anyway, like the title of this post hints, I’m going to talk about Mass Effect. Readers of this blog know that I take inspiration from fantasy – be it art, music, or video games. I’ve been playing the series for the past couple of months and recently began playing Mass Effect II. One of the things that stuck me was the presence of Kelly Chambers aboard the Normandy. Kelly serves as Commander Shephard’s Executive Assistant, but she also serves as the chief mental health officer. Her job is to monitor the mental health of the entire crew to ensure that any problems can be addressed before they come to fruition. It struck me as the kind of thing that would be helpful at the platoon, company, or battalion level.

Given the nation and the Army’s shortage of mental health professionals, it would be aspirational at best to try to implement something like that across the force.

Still, it made sense to me that there should be someone – a human being – monitoring the mental health of the fighting force over a period of time. Questionnaires and tests are okay, but they lack the understanding that a person who has been around for months or years would have. I think if CSF is implemented effectively across the Army, the platoon MRT might serve this role. While not a true mental health specialist, this would be preferred to the little that is in place right now.

Be it mental health specialists at the platoon/company/battalion level, effective use of the CSF program, or something we haven’t though of yet, it is clear that something more needs to be done to address suicide in the force. I don’t pretend to have the answer, but when I see something that I think might be helpful, I’ll bring it up. Thus, the vignette from Mass Effect.

Here is a great resource from the Army G1 on Suicide Prevention.

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Life is Strange: You can’t un-know what you already know

Gone Girl

The last episode of Life is Strange came out last week, and I rushed to finish it so as not to have the ending(s) spoiled by the internet. I didn’t think I’d be so engrossed by the game when I first read about it from eastern Afghanistan, but I honestly can’t remember the last time I’ve been so sucked into a game’s story. After each episode – and this one is no different – I suffer from a morose melancholy for a few days. From the moment the credits roll, I stumble through the drudgery of work and life, thinking about what happened and trying to make sense of it all.

I remind myself, on a number of instances, that’s it’s only a game. But that doesn’t really work.

It’s been a great journey. One that led me to think about the way we interact with one another, suicide, and how veterans are portrayed in the media.

I’m not reviewing the game here. I can’t really be objective about it because I loved it so much. There aren’t many games I would describe as beautiful, but that’s the word that comes to mind.

Like a lot of fans of the game, I’m sad that it’s over. As much as I love narrative based, choice-and-consequence games, once I finish them, they kind of lose their magic for me. I can achievement-hunt and explore the world, but I’ve already exhausted my path.

When I played Mass Effect, I played it as I think I would if I were actually Commander Shepard. When presented with choices, I chose what I thought I would choose in that circumstance. It’s for that reason that in my story, Commander Shepard never had a love interest. It’s generally frowned upon to sleep with your subordinates, as it goes.

Once I destroyed the Reapers (the only right choice), I thought about going back and replaying the game and playing as a totally different “character.” I liked the idea of doing it, and I even started, but I think I only lasted about an hour before I grew bored with it. It was hard for me to role-play the game as someone I’m not.

It was the same for Life is Strange. The decisions I made as Max were the decisions I think I would have made if I were walking in her shoes. Now that it’s over, I’m already thinking about how I can replay the game, to try to experience it some more. I can explore different decisions, or play as a different kind of Max, but that really doesn’t appeal to me.

I know how the story goes, and I can’t un-know what I already know.

Which leads me to the whole point of this post. A friend once described part of the problem with the civilian-miltiary divide as one that stems from the fact that once someone joins the military, they never really get out. Sure, they can separate from service, but instead of becoming a civilian, they are more likely to identify as a veteran, an identity separate from being a civilian. They’ve been militarized, and you don’t really ever become de-militarized.

Once you’re in, even when you get out, you can’t un-know what you already know.

When I finally finished Tactics Ogre last year, I wrote about how even though it felt good to finally beat it, the final playthrough was tainted by the first, some twenty years ago. The way I experienced it the first time was canon – I can’t go back and change things. And even if I do, it never feels quite right.

When a young man or woman chooses to join the military, that doesn’t become undone when they come home. They can never go back to “normal,” whatever that even means. You can’t un-know what you already know.

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Some random thoughts on suicide

I’ve been reading a lot about suicide lately.

Mostly, it’s because I’ve been a bit obsessed with Life Is Strange these past few months. If you haven’t played Life Is Strange, and you intend to, there are spoilers below.

Kate Marsh Roof Journal

In the game, one of the secondary characters – Kate Marsh –  kills herself by jumping off the roof of a school, with her fellow students watching. It’s her choice. You watch her jump, and it is terrifying.

One of the game’s dynamics allows the player to rewind time to make different decisions or use the knowledge you have about the very near future to go back and do things differently. Here, the game allows you to rewind and then essentially stop time so that you can get to the roof and intervene in the suicide. Once there, it becomes clear that you have exhausted your power, and whatever decisions you make, you’ll have to live with. There’s no going back, and since you know what’s about to happen because you witnessed it, the emotional tension is heightened.

Depending on choices you’ve made previously, how much you’ve payed attention to the details about Kate’s life, and the things that you say on the roof, Kate will either go through with her suicide or decide against it.

When I played it originally, I saved Kate. I felt great for it.

My wife played through the game recently, and she wasn’t able to save Kate. She felt terrible.

A few minutes later, as the episode ends, statistics are displayed showing what percentage of players managed to “save” Kate and what percentage were not. For a game as emotionally charged as Life Is Strange, it’s like an extra punch in the gut. Not only were you unable to save her, but others were, meaning, you are somehow shittier as a person.

It’s suicide as a game mechanic. It’s emotional, tense, and a little strange. It also puts the player in the unfair position of being responsible for Kate’s suicide.

For anyone who has been around suicide, the emotional toll that remains for the family and friends left behind is incredible, and they will forever wonder if there was something they could have done. Laura Dale tackled this exact topic in Polygon back in April.

All that said, I don’t think there is anything wrong with suicide as a game mechanicIt was part of the story, and it was handled in a delicate, but realistic way. It’s been done in other games, as well. And it is certainly better than “Press X to Pay Respects.”

More importantly, it has people talking about suicide.

For members of the military and veterans, it couldn’t be more relevant. While we are still a nation at war, suicide ranks as the top cause of death for members of the military by a wide margin. And it’s estimated that some 22 veterans die everyday by suicide.

Barely a week goes by where I don’t hear about an old Army buddy who took his own life or another Army buddy asks for prayers for the loss of one of his.

Over the past few weeks, probably because of Life Is Strange, I’ve been reading through a lot of the suicide articles that maybe I’d normally scroll past.

It started with a front page look at campus suicide in the New York Times which eventually led me to this longer piece about Madison Holleran, whose seemingly Instagram-idyllic life ended dramatically with a rooftop leap.

Last week I read about Stephen Akins, an Army veteran who killed himself in an apparent overdose.

Just a couple of days ago I read about the family of 24 year old Army veteran Ian Michael Curtis who killed himself last year. They are still trying to figure out why he did it. His wife thinks it was simply a chaotic moment of darkness, a spasm of anger.

There’s the dark story of Marine veteran Daniel Rey Wolfe who killed himself and posted the pictures to Facebook as he bled out. The gruesome photos were left online for two days while the family struggled with Facebook to have them removed.

Related is this article in Vice that chronicles the intersection between suicide and the internet – something that is likely to become more important in attempting to get help to those who need it.

Normally this would be the part of the article where I attempt to tie everything up neatly and provide some sort of synthesis, some greater idea that puts everything together neatly. After reading through all of these pieces, there really isn’t much for me to offer. As much as we know about suicide, it’s still a personal mystery, unique and difficult to understand.

The only thing I would add is I’m starting to think there is a greater role that youth plays in all of this. If you read through these articles, the underlying symptom is depression – mostly gone untreated, or at best, self-treated through drugs and alcohol.

Something I’ve recently begun to notice – and this might be one of the benefits of being the oldest platoon leader around – is my junior soldiers (~25 and younger) tend to fluctuate wildly in their moods. That is, one day they may seem happy, jovial, energetic. The next day they look down in the dumps and bummed out. My senior NCOs (~25 and older) tend to be more consistent in their mood. External pressure doesn’t push them too hard in one direction or the other. I think it’s easy to dismiss this as simply an effect of training and experience, but we now know that the brain continues to develop well into the mid-20s.  Yes, it’s true that at 18 a young man or woman can join the Army and go fight, but that doesn’t mean that everything is settled internally.

Thinking back to when I was a junior soldier, I could fluctuate wildly as well.

While I’m not offering anything here but anecdotal conjecture, I think there is a lot more we can learn about depression and suicide, especially as it relates to the military community, if we take a harder look at youth and emotion. While simply getting older doesn’t eliminate the risk of suicide, there is evidence that shows it is major youth problem.

Add the risk of youth suicide (of which young military men and women fall into) with a generally pro-firearm environment (firearms are the most common method of suicide for American men) and an “accomplish the mission” attitude likely instilled through the process of militarization, and the problem of military suicide becomes more apparent.

If video game developers can integrate suicide as a game mechanic, and do it in a way that treats it seriously, then we can at the very least talk about it seriously, understanding that it is not simply a thing that happens to other people. It happens to us.

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Life Is Strange: Learning to make better decisions through gaming

Reflections

If you’ve been following me on Twitter, mostly on very early mornings on the weekends, you know that I’ve been playing Life Is Strange. I learned about the game back when I was in Afghanistan, a time when the prospect of being an 18 year old female hipster in the Pacific Northwest seemed very, very appealing. I caught up with the game and recently finished Episode 4 (The Dark Room) and one Episode remains. The game is beautiful and highly emotional, and I’ve been convincing as many of my friends as possible to play it, mostly to make them as miserable and depressed as me.

I’m currently working on a longer post about one of the game’s seconday characters, David Madsen, who’s a combat veteran. I actually have quite a few posts in the works that will be coming out related to the game, mostly because the game tackles a lot of important issues (suicide, youth, emotions).

In the mean time, I wanted to comment on one of the interesting features of the game, or rather, one of the interesting side effects that I think the game has. I recently wrote about how through playing narrative-based games, like Life Is Strange or even Mass Effect, the game forces the player to grapple with difficult dillemmas, and that these in-game interactions have actually made me think about the way that I engage with real people. Following up on that idea, what I’ve started to really think about is the way that the game allows you to sit back and really think about what decision you are going to make before actually making it, and the inherent training value this has.

I remember when I was playing Mass Effect, there were times that I would get to a critical decision point and actually get up, pour myself some more coffee, and then sit there, face twisted in thought as I contemplated how my decisions might affect the fate of the galaxy.

In Life Is Strange, the stakes are usually smaller, but often feel more personal (and seemingly real). I’ve been playing the game – as I do most non-linear games – the way that feels right for me. That is, I’m making the decisions as I think I would make them. There are times where I feel like the game is pushing me in one direction over another, like in the scene where I choose whether to make fun of Victoria or comfort her. Seeing those options, I knew that comforting her would be the right thing to do, but I also didn’t think I would actually do that in person. Victoria, to this point, has been a total pain and this was my opportunity to get revenge. I wasn’t going to pass it up.

Mass Effect was much more deliberate in this regard. Decisions colored red pushed you towards being a “renegage” whereas decisions colored “blue” pushed you towards being a “paragon.”

The point is, these in-game conversations, and more importantly, the agency the player has over choice, potentially has real value outside of the game.

Months ago I reviewed a game for iOS that works in this regard (Together Strong), using narrative-based interaction to help prepare veterans and their family members to recognize and effectively communicate with veterans or military members who may need help. Although I thought it was good as a training simulation, I wasn’t that interested in “playing” it again because it never really felt like a game. It felt like effective training. I really ought to revisit it.

I think there is real value in this kind of computer based interaction. Game design has advanced to a point where these types of games can be used to help better prepare people – especially veterans – for facing the tough conversations all of us will undoubteldy find ourselves in. Suicide, depression, alcoholism, anger, PTSD – if you’re in the military or around veterans, these are things you are going to see. And as much lip service as we give to making people “aware” of these issues, very little of substance is done in terms of actually arming ourselves with the tools to help someone.

We like to play games. Instead of another class on recognizing signs of suicide, maybe we simulate a conversation with someone who is really struggling in a context that is comfortable for us – games.

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