Military faces a quiet enemy – suicide Published Nov. 30, 2012 By Gene Kamena Air War College MAXWELL AIR FORCE BASE, Ala. -- -- Medic -- I'm hit!" On the battlefield, a call for help from a comrade in trouble triggers an immediate response. Teammates do not hesitate, and often risk all to answer calls and cries from a buddy in distress. Combat is indeed dangerous, and during the past decade, a heavy toll has been exacted on the military members whose profession is to answer duty's call. Sadly, this year, military suicide rates have exceeded combat deaths in Afghanistan for the same period. During the first six months of 2012, the Army averaged one suicide a day, and in July, surpassed even that tragic level. This commentary, however, is not about statistics, for numbers are too sterile a medium to do justice to the anguish, harm and sorrow imposed by even one suicide. Life cannot be accounted for on a PowerPoint chart. What changes from the battlefield of Afghanistan to the battle raging within one's mind? Why do people in distress fail to call out, and why do people who are able, fail to render aid? To begin to answer this question one must consider perspectives from the person in danger, as well as from those who are postured to assist. Service members who are engaged in their own internal battle become withdrawn and distant because their personal battle is all consuming. In fact, in a recent survey of 72 service members who attempted suicide, it was determined that "a desire to end intense emotional distress" was a key contributing factor leading to suicide. Their battle is a personal one. They feel ashamed and often try to hide their thoughts. Sometimes there is no cry for help since they feel their problems are unsolvable, nothing can be done. Teammates who contemplate suicide, although trapped in a world of quiet desperation, also feel as if they are letting others down. There are usually symptoms that, if looked for, can be recognized by others: changes in behavior, substance abuse and financial or marital problems being common. If trouble signs are present, why do others not act? Those closest to a service member in trouble often do not detect or understand the level of conflict and desperation present. Sometimes friends, family members and teammates see the old person, the person from the past, not the person presently in conflict -- they look, but do not see. There may be no audible cry for help, no call for a medic or a buddy will sound above the din of battle. Suicide is a silent and internal fight of emotions and last resorts. What to do? Just as service members prepare to deploy to a combat zone, so too must they train and prepare to deal with suicide within the force, a deadly close-in fight. Just as first aid and lifesaving skills are required in physical battle, so too is this very knowledge required by every service member if they are to vanquish suicide from the ranks. Here are some specific and immediate actions all must take: Study the enemy: Know the warning signs of suicide, know your people and know what to do. Observe the battlefield: Look for changes in behavior, look for mood swings, determine those who are at risk, and be present and accessible. Report and render aid: Know what to do and who to call. Have the number to medical facilities and suicide prevention hotlines available. Evacuate: Where suicide could be a possibility, the service member comes before the mission. Deployments and work schedules become irrelevant if a teammate needs help. The military is now facing a more elusive, silent, but just as deadly enemy in suicide, as those who wish to do us harm on foreign battlefields. To defeat this silent foe, all must first recognize and acknowledge that the force is in a fight, and then prepare to do battle. Know your teammates, know the signs of distress, know what immediate action to take, and know who to call. Saving a life from suicide is just as heroic as running to assist a fallen comrade in battle; in fact, there is no difference.