Female Veteran Suicides
Women are generally a lot less likely to kill themselves than men, but female veterans are an exception with shockingly high suicide rates, according to new Veterans Affairs Department research. Among women of all ages who have served in the military, the suicide rate is 28.7 per 100,000—higher than the rate among male civilians, nearly six times the rate of civilian women, and approaching the 32.1 rate among male veterans. "It's staggering," a Northeastern University epidemiologist said to the Los Angeles Times. "We have to come to grips with why the rates are so obscenely high." Women vets ages 18 to 29 kill themselves at nearly 12 times the rate of civilian women the same age, but the rate was up to eight times higher even among women who served in the 1950s. It is not clear what is driving the rates. VA researchers and experts who reviewed the data for The Times said there were myriad possibilities, including whether the military had disproportionately drawn women at higher suicide risk and whether sexual assault and other traumatic experiences while serving played a role.
The VA suicide study involved data on 173,969 adult suicides in 23 states over 11 years, which included the deaths of 40,571 male vets and 2,637 female vets. The article in Psychiatric Services also says that that people who join the military are more likely to have had troubled childhoods; and it could be the case that women who signed up were at higher risk of suicide in the first place.
• While the percentage of all suicides reported as Veterans has decreased, the number of suicides has increased.
• A majority of Veteran suicides are among those age 50 years and older.
• Male Veterans who die by suicide are older than non-Veteran males who die by suicide.
• The age distribution of Veteran and non-Veteran women who have died from suicide is similar.
• The demographic characteristics of Veterans who have died from suicide are similar among those with and without a history of VHA service use.
• Among those at risk, the first 4 weeks following service require intensive monitoring and case management. • There is preliminary evidence in 2012 indicating a decrease in the rate of non-fatal suicide events for VHA utilizing Veterans.
• Decreasing rates of non-fatal suicide events are associated with increasing age.
• The data show a decrease in the 12 month re-event prevalence in fiscal year (FY) 2012.
• The majority of Veterans who have a suicide event were last seen in an outpatient setting.
• A high prevalence of non-fatal suicide events result from overdose or other intentional poisoning.
• Continued increases in calls to the Veterans Crisis Line may be associated with efforts to enhance awareness of VHA services through public education campaigns.
• The majority of callers to the Veterans Crisis Line are male and between the ages of 50- 59.
• Differences in the age composition of callers to the Veterans Crisis Line are associated with gender.
• A large percentage of callers to the Veterans Crisis Line are identified as Veterans.
• Approximately 19 percent of callers to the Veterans Crisis Line call more than once each month.
• The percentage of callers to the Veterans Crisis Line who are currently thinking of suicide has decreased.
• The percentage of all calls resulting in a rescue has decreased, indicating that the calls are less emergent and callers are using the Crisis Line earlier.
• The percentage of callers receiving a referral for follow-up care is increasing.
• Approximately 93 percent of all Veterans Crisis Line referrals are made to callers with a history of VHA service use in the past 12 months.
• Service use continues to increase following a referral for care.
• Between FY 2009 – FY 2011, use of inpatient and outpatient services increased following a rescue.
• The 12 month re-event prevalence has decreased among those who have been rescued or received a referral for follow-up care.
Aging Brain? Not So Bad...
At middle age, the brain begins to draw on more of its capacity for improved judgment and decision making.
If you forget a name or two, take longer to finish the crossword, or find it hard to manage two tasks at once, you’re not on the road to dementia.
What you’re experiencing is your brain changing the way it works as you get older. And in many ways it’s actually working better. Studies have shown that older people have better judgment, are better at making rational decisions, and are better able to screen out negativity than their juniors are.
Although it may take you a little longer to get to the solution, you’re probably better at inductive and spatial reasoning at middle age than you were in your youth.
The brain changes as we get older, and in some ways it works better as we get older.
How is it possible for older people to function better even as their brains slow? “The brain begins to compensate by using more of itself,” explains Dr. Bruce Yankner, professor of genetics and co-director of the Paul F. Glenn Laboratories for the Biological Mechanisms of Aging at Harvard Medical School. He notes that MRIs taken of a teenager working through a problem show a lot of activity on one side of the prefrontal cortex, the region we use for conscious reasoning. In middle age, the other side of the brain begins to pitch in a little. In seniors, both sides of the brain share the task equally. The cooperative effort has a payoff. “Several studies suggest that seniors who can activate both sides of the brain actually do better on tasks, while those who can’t do worse,” Dr. Yankner says.
If you’ve found that it’s a little harder to carry on a conversation while searching your bag for your keys, MRI studies offer some clues. They show that in younger people, the area of the brain used to do a task goes dark immediately once the task is completed, while in older people it takes longer to shut down. As a result, it’s harder for the older brain to take on several tasks, because not only do you need to use more of the brain for any single task, but the brain also has a harder time letting go of a task. So even after you fish out your keys, you may have trouble getting back into the conversation.
What about the moments when you find yourself driving down the street without any recollection of having passed the last few blocks? Or the times you’ve locked the car door with your keys in the ignition? On those occasions your brain may have slipped into the default mode, which controls processes like remembering and daydreaming that are not required for a directed task. Imaging studies show that interconnected regions of the brain dubbed the “default network” grow more active with age, indicating that as we age we spend more time daydreaming.
THE GOOD NEWS ABOUT "THE MORE MATURE" BRAIN
At The Center for BrainHealth, as at Harvard, we are discovering that the more mature brain actually has advantages over its younger counterpart. These findings came as a surprise to many people, who were accustomed to seeing “senior moments”—groping for the right word or taking longer to articulate your thoughts—as a sign that the brain was on the skids. Yet even in professions where youth is valued, testing has shown that maturity has advantages.
For example, in a study of air-traffic controllers and airline pilots, those between ages 50 and 69 took longer than those under 50 to master new equipment, but once they had, they made fewer mistakes using it. (Keep this in mind when you’re trying to conquer a new computer program or adapt to a new car!) The mastery that comes with maturity is due to changes in your glands as well as your brain. Declining levels of testosterone—even in women—result in better impulse control. The end of the hormonal roller coaster of menopause may also contribute to emotional stability. After midlife, people are less likely to have emotional issues like mood swings and neuroses that interfere with cognitive function.
Most importantly, the wealth of knowledge from decades of learning and life experience enables you to better assess new situations. At midlife, most people are more adept at making financial decisions and getting to the heart of issues than they were when they were younger.
In most people, these abilities improve with age:
Inductive reasoning. Older people are less likely to rush to judgment and more likely to reach the right conclusion based on the information. This is an enormous help in everyday problem solving, from planning the most efficient way to do your errands to managing your staff at work.
Verbal abilities. In middle age, you continue to expand your vocabulary and hone your ability to express yourself.
Spatial reasoning. Remember those quizzes that require you to identify an object that has been turned around? You are likely to score better on them in your 50s and 60s than you did in your teens. And you may be better at some aspects of driving, too, because you are better able to assess the distance between your car and other objects on the road.
Basic math. You may be better at splitting the check and figuring the tip when you’re lunching with friends, simply because you’ve been doing it for so many years.
Accentuating the positive. The amygdala, the area of the brain that consolidates emotion and memory, is less responsive to negatively charged situations in older people than in younger ones, which may explain why studies have shown that people over 60 tend to brood less.
Attaining contentment. Years ago, researchers were surprised to find that people seem to be more satisfied with their lives as they age, despite the losses that accumulate with passing years. This is probably because they tend to minimize the negative, accept their limitations and use their experience to compensate for them, and set reasonable goals for the future. Dr. Yankner notes that this trait may be innate, because it is prevalent even in the United States and other Western nations, which tend to value youth over age.
Be a Better Spouse or Partner
#1 Be nice as often as you can.
A lot of modern relationship therapy is based on the research of John Gottman, a prolific psychologist famous for videotaping thousands of couples and dissecting their interactions into quantifiable data. One of his most concrete findings was that happier couples had a ratio of five positive interactions to every negative interaction. “That just leapt off the pages of the data analysis,” he says. It was true in very different types of relationships, including those in which the people were very independent and even distant or argumentative. These positive interactions don't have to be grand gestures: “A smile, a head nod, even just grunting to show you're listening to your partner—those are all positive,” Gottman says.
#2 Think about what your partner needs, even when fighting.
To resolve conflicts, Gottman says we can learn from game theory—the study of conflict and decision making used in political science, sociology and economics. It used to be widely accepted that negotiations were mostly zero-sum situations, meaning one party's gain was the other party's loss. In 1950 mathematician John Nash proved there was another, better outcome: a solution in which the parties may have to compromise, but in the end all of them come out satisfied. (This now famous “Nash equilibrium” won him a Nobel Prize in 1994.) I'm reminded of a recent situation in my own marriage—my husband hated the house we bought a couple of years ago and wanted to move to a different neighborhood; I liked the house just fine and didn't want to goanywhere. After much discussion, we realized that what we both really want is to settle in somewhere for the long haul. If the current house is not a place my husband feels he can settle in, then I can't truly settle in either. So we're moving next month, for both our sakes! Find the Nash equilibrium in your conflict, and you'll both get your needs met.
#3 Just notice them.
“People are always making attempts to get their partners' attention and interest,” Gottman says. In his research, he has found that couples who stay happy (at least during the first seven years) pick up on these cues for attention and give it 86 percent of the time. Pairs who ended up divorced did so 33 percent of the time. “It's the moment we choose to listen to our partner vent about a bad day instead of returning to our television show,” explains Dana R. Baerger, assistant professor of clinical psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine. “In any interaction, we have the opportunity to connect with our partner or to turn away. If we consistently turn away, then over time the foundation of the marriage can slowly erode, even in the absence of overt conflict.”
#4 Ignore the bad, praise the good.
Observations of couples at home reveal that people who focus on the negative miss many of the positive things that their partners are doing. Happy spouses, however, ignore the annoyances and focus on the good. “If your wife is irritable one morning, it's not a big deal. It's not going to become a confrontation,” Gottman says. “Then when she does something nice, you notice and comment on that.” Guess what that breeds? More of the good stuff.
Treatment Philosophy
My approach to psychiatric practice reflects many years studying human nature and working to help people who are having a hard time in life. By the time most people see a psychiatrist, they are worried, or they are sad, or they are very confused about something I will just call “the problem,” or “the complaint.” Let me make some general comments about my approach, and then I will discuss my thinking on the use of medications.

People seek psychiatric help for a variety of problems, but everyone wants the same result: to feel better, to think more clearly, to rediscover satisfaction and happiness, and to regain a sense of self control and personal freedom. The problem may be related to mood, energy level, motivation, sleep, worry, relationships, anger, troubled behavior, obsessions, compulsions -- it’s a long list. People who drink too much, use drugs, or misuse prescription medication are often using these chemicals to find relief. Alcoholism and substance abuse are widespread in our culture.
Dealing with life is never easy.
Most persons first try to solve the problem or deal with the complaint on their own. Frustrated that things aren’t improving, they may seek advice from others. Sometimes a person hides the problem or lives in silence with the complaint. They may read a book, go to a support group, consult the internet, or try a new religious practice. We all have problems and complaints, and we all do the best we can to solve the dilemmas of life. When someone calls me about consultation, I almost always hear them say that they have a problem, they have tried to solve the problem, and they are looking for someone who knows how to help make things better.
One of the individuals consulting with me said, “I feel like I’m in a box, and the directions for getting out of the box are printed -- on the outside of the box.”
A successful airline pilot, a Vietnam combat veteran, said, “Doc, I’m out of altitude, airspeed, and ideas.”
Often the person seeking help has waited so long that demoralization has begun to set in, and they are beginning to lose hope. This doesn’t mean that the individual is suicidal or, in fact, any more unhappy than many of the people at the workplace or in the neighborhood. It means that they are resigned to always feeling this way, never feeling any better than this. Demoralization means a state of mind in which a person considers accepting fate, giving up, and abandoning the idea that things can get better.
Fear, anger, resentment, feeling constantly wounded, feeling overwhelmed, feeling unappreciated, feeling worthless -- all of these emotions are part of our lives. But when we feel negative all the time, or most of the time, most days, then we need help. There are very few emotional problems that defy intelligent therapy and reasonable efforts toward a solution.
When I meet someone for the first time in consultation, I have three major concerns. First, I want to get to know the person and hear about the problem are the complaint. My first question usually is simply, “How can I help?” or “What brings you to see me?” Second, I want to explore the individual’s point of view or understanding of the problem, including what solutions have been attempted. Third, I want to consider what we can do, working together, to improve the situation. I tend to focus more on results than on reasons. I’m not always sure about why things happen, but I am very focused on what we can do now. Sometimes I explain in detail how the brain works, and sometimes I discuss how life works. The process of recovery involves growth, change, and even personal transformation.
Research shows that psychotherapy can help, medication can help, and intelligent problem solving helps. Psychotherapy is not for everyone, and medication is not for everyone, but the vast majority of people who want help can find it. One of my favorite expressions is, “You have to do it yourself, but you can’t do it alone.”
Over the years I have developed a style that I call “sober conversation.” The word “sober” does not apply just to alcohol and addictions. To be sober is to be serious, to focus on what is most important, and to try to get it right. I believe in the importance of what we care about, and in this regard I have seriously studied the specific problem of human will. I call it “the problem of human will” because we are often confused about what we will ourselves to do, or not to do. When I work as a psychotherapist, I am most interested in what people care about, how their beliefs and assumptions about life have been formed, and where they feel stuck or at odds with themselves. Sometimes we have conflicting feelings about the same thing. For example, someone wants to take life in a certain direction, but he or she feels conflicted about it. Or someone tries to solve a problem, not realizing that it’s part of a bigger problem, or a different kind of problem. My definition of psychotherapy is that it is a form of personal consultation, focused on the situation of the client, with the goal of solving problems and feeling better.

Not everyone is cut out for in-depth or long-term conversation. Some people like to come for a few visits, and some like to keep going for weeks, or even months on a weekly basis. Some people prefer to come two or three times a week because they want to do the work and get on with whatever is next. Some people come for an hour, and some come for an afternoon.
Psychotherapy does take time, because the process is basically two people getting to know each other in the context of a specific purpose. Psychotherapy at its best is about taking life seriously, getting it right, and feeling the satisfaction that comes from clarity of thought, commitment to integrity, and comfort with the complexity of one’s own emotions and ideas. Some say that psychotherapy is a dying art, and this may be true. Psychiatrists today (and perhaps psychologists as well) do not receive the extensive training in psychotherapy that we did thirty years ago. Many psychiatrists and psychologists are not interested in psychotherapy. And many psychotherapists are not really very good or very well trained. Today there are thousands of people who call themselves “life coaches,” and anyone can hang out a shingle and call himself a “life coach.” There are several private organizations that offer “certifications,” but there are no license requirements, there is no government regulation, and no educational standard that is generally accepted. For these reasons, I think the concept makes sense, but in practice let the buyer beware -- caveat emptor!
Medications can be very helpful in treating some specific psychiatric problems. Today we have excellent medications for anxiety, depression, moodswings, insomnia, attention deficit disorder, and other conditions. Bipolar disorder, for example, is a devastating condition that can be very effectively managed with medication, restoring individuals to a life of normalcy and stability. I have absolutely no doubt about the value of psychiatric medications. I also believe that what is most important is getting the right diagnosis and the correct strategy for intervention and treatment. I see many people who have been misdiagnosed, and even mistreated, because they have not been well assessed. Assessment can take time, and I never jump to conclusions about diagnosis. After knowing someone for a few weeks, together we may decide that we see the condition in a different way.
Psychiatric medications are powerful, effective tools when used properly, but they also have side-effects, and they are expensive. Getting the right medication for the right diagnosis is extremely important. And there is an old saying from Hippocrates, creator of The Hippocratic Oath: “It is more important to know what sort of person has a disease than to know what sort of disease a person has.“