March 25, 2015: Commanders in U.S. SOCOM (Special Operations Command) are concerned that the suicide rate still alarmingly high. While declining, is still among the highest in the military. In 2014 it was 25 per 100,000 troops. That’s down from 33 in 2012. The rate for the entire military that year was 17.5 which was down from a peak of 23 in 2009. The rate continued to decline and is headed for the pre-war (2009) rate of nine. What was missed in all the discussion was the higher suicide rate in the army was far below the rate for civilians of military age (17-60), which was 25 per 100,000. The SOCOM rate was not the highest one recently. The U.S. Navy submarine force (about 20,000 sailors) saw their suicide rate spike to 35 in 2005. Operating nuclear subs is stressful but the senior leadership quickly made some changes to make it less stressful (especially when not at sea) and got the rate down.

The fact of the matter is that the military seeks to recruit only people who have an above average ability to deal with stress. It’s not just combat stress the military worries about, because only 15 percent of troops in the ground forces have combat jobs. The rest are doing civilian type jobs but often under stressful (combat zone) conditions. In fact, most of the military suicides are of men who were never in combat or even overseas. But since the military suicide rate is so much lower than those of comparable civilians, it hardly matters. There are so few actual suicides in the military each year that a few soldiers having family problems can cause the rate to seemingly spike.

It’s different in SOCOM, where nearly a third of the 70,000 personnel are liable to experience very intense situation, including combat, on a regular basis. While the actual number of SOCOM suicides was only 18 in 2014 that is in a population that was carefully selected to eliminate (as much as possible) people who cannot handle stress. The problem is that SOCOM personnel are under more pressure than troops in general. While suicide is one indicator of stress there are less noticed indicators, which impacts a lot more people. That is the use of anti-stress medications. These have gone up nearly 80 percent since 2001. Over 17 percent of all troops now take these drugs, about a third of those are troops in combat zones. In 2001, the troops used these drugs to about the same degree as the civilian population (ten percent.) The impact of these drugs, especially in combination, can be unpredictable. The army is still waiting to see how this increased use of anti-stress medications will play out. This is all unknown territory.

The losses due to stress were but the tip of the iceberg. For example, for every soldier killed, one was sent back home for treatment of acute stress. For every one of those cases, there were several less serious cases that are treated in the combat zone. The rate is less for SOCOM, but it is still high. Many of these stressed troops are no longer able to perform all their duties. This is sometimes the case with troops taking anti-stress drugs. Some of these medications slow you down, which can be fatal if you find yourself in combat, or an emergency situation. Many troops on these medications are no longer sent overseas. They can perform well back in the United States, but this complicates the job of finding enough troops to go to combat zones.

All this was seen as an inevitable result of so many NCOs and officers doing their third or fourth combat tours (in Iraq or Afghanistan). The number of combat and overseas tours was even higher for SOCOM troops and many commanders expected there to be more stress-related losses. In effect a PTSD (Post Traumatic Stress Disorder) epidemic was been created by the unprecedented exposure of so many troops, to so much combat, in so short a time. Once a soldier has PTSD, they are often no longer fit for combat, and many troops headed overseas again n are falling into this category. PTSD makes it difficult for people to function, or get along with others. With treatment (medication, and therapy), you can recover from PTSD. But this can take months or years.

Nearly a century of energetic effort to diagnose and treat PTSD (including much recent attention to civilian victims, via accidents or criminal assault), had made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD for American troops. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, had Internet access, lots of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This extended their useful time in combat, before PTSD sets in. SOCOM operators overseas often go without many (or any) amenities because where they operate they are expected to go native. No one is yet sure what the new combat days average is for stress. It is known that SOCOM operators can handle more than your average combat soldier or marine, but not an infinite amount. New screening methods are an attempt to find out what the limits are for individuals and groups. But now, with major combat over, more troops appear to have hit, or are approaching, the limits because of the delayed reaction to stress and PTSD in many people.

What the army did discover by 2010 was that a large percentage of its combat troops had over 200 days of combat. Some had three or four times that. A major reason for army generals talking about the army "needing a break" (from combat) was the growing loss of many combat experienced troops and leaders (especially NCOs) to PTSD. The army won't give out exact figures, partly because they don't have much in the way of exact figures. But over the next decade, the army will get a clearer picture of how well they have coped with PTSD, among troops who have, individually, seen far more combat than their predecessors in Vietnam, Korea or World War II.

The army is dealing with PTSD head on, believing that a lot of troops have experienced a lot of combat stress. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated, and its effects reversed. SOCOM commanders have been warning their bosses (Congress, the Pentagon and the White House) that if you depend too much on the limited number of SOCOM operators you are going to lose a lot more of them to stress and PTSD.

All this military research into stress has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's why military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress.