There is a call to action to address the suicide rate among veterans. With rates of an average 17.6 veteran suicides per day in 2018 (US Department of Veterans Affairs Office, 2020.), these equate to one and a half times higher than that of a non-military counterpart (Ammerman & Reger, 2020). Public health educators and mental health advocates are aware of the impact this has on the population as a whole, but also the challenges of conventional mental health care in the military veteran population (Cheney et al., 2018).
Kate Hendricks Thomas and Sarah Plummer Taylor take a different approach to addressing military suicide and mental health in their book, Stopping Military Suicide: Veteran Voices to Prevent Deaths, by challenging the warriors to own self-care and resiliency. The authors use this text to address the veteran community and posit that veterans do not have to rely on others to dictate what recovery and healing can constitute for them. Instead, veterans can use self-education as a tool of empowerment to propel healing, slow the spin of stress injury and post-traumatic stress, and rip off the often-unfit label of conventional diagnosis.
Dr. Thomas is a social and behavioral researcher and educator, author, speaker, and Marine Corps veteran, while Taylor, also a Marine Corps veteran, is a social work and mental health consultant among both military and business members, and a wellness consultant. Both advocate for resilience, self-care, and holistic health in their research and personal experience.
These two military veterans and authors use personal experience to relate to the reader as they relay their own histories throughout the book. Taylor discusses when she struggled during her deployment with severe mental anguish: recounting words from her father about the unapproved decision she made to be a Marine, being raped by a peer, and a marriage falling into disrepair. There was also the debilitating physical pain from years of personal brutality on her body, leaving her in a place of constant agony, creaks, and moans. It was at this point that she posed a “Y” in the road: choose to walk away from it all in the shot of a pistol or choose to face it all in a moment of quiet pose and steady breathing.
Thomas’ story may be vastly different from Taylor’s, but the “Y” in the road still remains; move forward in the same destructive trajectory of a marriage that was wanted but slowly crumbling or choose selfcare in a diversion to save herself. Hers is a love story that was lost but not forgotten. Married to a military veteran, Thomas recounts there was a feeling of constant warrior culture that led to hidden anguish, prideful fear, and the mentality of I can fix this too. It was not until a breaking point steeped in fear that Thomas knew she had to let go of the relationship for the health of both her and her partner.
The authors’ stories are not new. As many as 75% of married or cohabitating veterans report having family problems in a 7 day period; of those that are separated, approximately 54% report physical and verbal conflict, and 28% report that their partner is “afraid of them” (Sayers et al., 2009, Abstract). In many cases, the challenge of reintegration post-deployment is compounded when both partners in the relationship share military experience but not combat memories due to separate deployments or branches of military. In many cases, domestic violence is covered up in a culture that prides itself in strength and mental toughness while foregoing needed professional help (Williamson, 2012).
The same is true for Taylor’s choice while currently deployed between “the pistol or the yoga mat” (p. 11). When considering the suicidal ideation of military members during deployment, Street et al. (2015) report rates that are over three times greater for those women that are currently deployed in comparison to those that have previously deployed or never deployed (p. 222). This creates a challenge in changing the narrative that these women live by changing military culture, and is also further reason to teach resilience and self-care throughout a person’s military career and post-tenure.
Changing the narrative is what Thomas and Taylor set out to do in a very frank medley of science and storytelling that is laid out in verbiage that does not take a psychologist to interpret. It is a simple, yet profound, diction that reminds the reader that self-care does not have to include a workout of pain or competition, but can be a 10-minute session of purposeful breathing or a short session of yoga behind the closed office door to reset the mind, stretch the body, and consciously work toward a place of balance and repair. While this is a good reminder to many sitting at the desk all day, including this author, it is also a way to continually calm the anxiety and stress that so often comes with a military career and set back in motion a return to past normalcy.
The science behind these methods of self-care and preservation are well-published. Seppålå et al. (2014) conducted a 7-day intervention trial using Sudarshan Kriya yoga to evaluate startle reaction, depression, anxiety, and post-traumatic stress in military veterans. The results indicated a decrease in hyperarousal and anxiety. With approximately 18% of veterans reporting current use of mindfulness medication, this is the most widely used form of complementary and integrative health (CIH) approaches used outside of massage and chiropractic care (Goldberg et al., 2019).
This approach rings true for yoga as well. Yoga has been found to have positive correlations with improved cognitive function related to post-traumatic stress, as well as improve sleep and overall quality of life (Zaccari et al., 2020). While the practice is still stigmatized by many veterans (Cushing et al., 2018; Hurst et al, 2018), researchers have found that the benefits are known (Cushing et al., 2018), and practicing virtually can be just as beneficial as practicing yoga in-person, adding to the growing potential to help in CIH (Schulz-Heik et al., 2017).
As both Thomas and Taylor discuss throughout the book, social support, spiritualism, and resilience are key in the growth and healing of the mind, stress injuries, and imperative to reintegration of civilian life. Reintegration can be a challenge, even for those in long-term relationships with strong family ties or spiritual backgrounds due to the lack of understanding the experiences of those who served. It is hard for many to part from those that share the same service, deployment, and combat experiences. There is a level of bond that is so hard to break in military mind, which can make it difficult to reunite and connect with those on the outside. This is where social support, spiritualism, and resilience aid in self-care and re-entry for many.
Research indicates veterans diagnosed with serious mental illnesses also report low social support (Kilbourne et al., 2007). Negative correlations have been made among those with high social support and mental and physical health symptom severity (Painter et al., 2016). With mental and physical health being an ongoing issue among military veterans, sometimes leading to cases of domestic violence and self-harm (Albright et al., 2019; Sparrow et al., 2017), it is important to have more discussions are the prevention of violence and need for accountability and care. This text excels at delineating the importance of sustained and strengthened social support to both the veteran and the civilian in order to bridge the gap and gain commonality, as well as prevent further mental illness or possible self-harm.
The authors argue that another method of commonality often comes in the way of spirituality, whether formalized religion or simply common faith and beliefs. Researchers have found that, when comfortable in their religious and spiritual environments, veterans with post-traumatic stress are able to use the spiritual bond to facilitate deeper communication and strengthen the bond with their partner and others in their social network (Sherman et al., 2018). Spirituality also lends positivity and hope to the individual to build on resilience (Weber & Pargament, 2014). Both Thomas and Taylor echo this sentiment with practical application and tips for spirituality, most commonly, the practice of yoga and meditation as a means to connect with self and spirit.
Thomas and Taylor discuss candidly one of the most overlooked areas of self-care: resilience, which is often referred to the ability to bounce back or adapt positively to adversity (Herrman et al, 2011). This is a trait that is often taught in military settings as a method of coping with combat or deployment. The ability to stumble and keep going is crucial to the warrior culture. As the authors discuss personal experiences of pain and heartache, they both also discuss the pride in overcoming the challenges. These experiences are what makes them who they are.
Resilience can be taught in many more avenues than combat readiness. By integrating resilience into veterans’ lives from the early stages of service, the individual will continue to grow in emotional stability and purpose in life while having lower correlations with substance abuse and higher correlations with physical activity and mental health (Isaacs et al., 2017). The practice of resilience helps to close the circle of self-care described and discussed so ardently in the book. Selfcare is not a single method of action or a one-size-fits-all program. It is instead the notion that today the choice is the yoga mat over the pistol or the heartfelt decision to walk away from negative relationships in exchange for selfcare. This is a continual process of good and bad days, or even moments, with gradual improvement.
While Thomas and Taylor have both used their military experience and mental health-related educations to advocate for veterans and civilian support alike, there is still a gap of knowledge in broadcasting the benefits of CIH in military veterans. Thomas and Taylor have proficiently led the charge to do just that. Not only as accomplished public health and CIH educators, but also as veterans who understand what it means to walk a mile in the boots of the soldier next to them. This personal experience gives them the passion to make a change, but also the education to make that change productive to the individual’s health and mental well-being. These authors have effectively conveyed the importance of self-education and selfcare through experience, research, and compassion, challenging the veteran population to battle on in the fight again veteran suicide through mindful tactics.
I have no competing interests with the submission or authorship of this book review or with the authors of the book highlighted.
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