Arquivo da tag: Trauma

How to mend your broken pandemic brain (MIT Technology Review)

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technologyreview.com

Life under covid has messed with our brains. Luckily, they were designed to bounce back.

Dana Smith – July 16, 2021

Orgies are back. Or at least that’s what advertisers want you to believe. One commercial for chewing gum—whose sales tanked during 2020 because who cares what your breath smells like when you’re wearing a mask—depicts the end of the pandemic as a raucous free-for-all with people embracing in the streets and making out in parks. 

The reality is a little different. Americans are slowly coming out of the pandemic, but as they reemerge, there’s still a lot of trauma to process. It’s not just our families, our communities, and our jobs that have changed; our brains have changed too. We’re not the same people we were 18 months ago. 

During the winter of 2020, more than 40% of Americans reported symptoms of anxiety or depression, double the rate of the previous year. That number dropped to 30% in June 2021 as vaccinations rose and covid-19 cases fell, but that still leaves nearly one in three Americans struggling with their mental health. In addition to diagnosable symptoms, plenty of people reported experiencing pandemic brain fog, including forgetfulness, difficulty concentrating, and general fuzziness. 

Now the question is, can our brains change back? And how can we help them do that?

How stress affects the brain

Every experience changes your brain, either helping you to gain new synapses—the connections between brain cells—or causing you to lose them. This is known as neuroplasticity, and it’s how our brains develop through childhood and adolescence. Neuroplasticity is how we continue to learn and create memories in adulthood, too, although our brains become less flexible as we get older. The process is vital for learning, memory, and general healthy brain function.

But many experiences also cause the brain to lose cells and connections that you wanted or needed to keep. For instance, stress—something almost everyone experienced during the pandemic—can not only destroy existing synapses but also inhibit the growth of new ones. 

One way stress does this is by triggering the release of hormones called glucocorticoids, most notably cortisol. In small doses, glucocorticoids help the brain and body respond to a stressor (think: fight or flight) by changing heart rate, respiration, inflammation, and more to increase one’s odds of survival. Once the stressor is gone, the hormone levels recede. With chronic stress, however, the stressor never goes away, and the brain remains flooded with the chemicals. In the long term, elevated levels of glucocorticoids can cause changes that may lead to depression, anxiety, forgetfulness, and inattention. 

Scientists haven’t been able to directly study these types of physical brain changes during the pandemic, but they can make inferences from the many mental health surveys conducted over the last 18 months and what they know about stress and the brain from years of previous research.

For example, one study showed that people who experienced financial stressors, like a job loss or economic insecurity, during the pandemic were more likely to develop depression. One of the brain areas hardest hit by chronic stress is the hippocampus, which is important for both memory and mood. These financial stressors would have flooded the hippocampus with glucocorticoids for months, damaging cells, destroying synapses, and ultimately shrinking the region. A smaller hippocampus is one of the hallmarks of depression. 

Chronic stress can also alter the prefrontal cortex, the brain’s executive control center, and the amygdala, the fear and anxiety hub. Too many glucocorticoids for too long can impair the connections both within the prefrontal cortex and between it and the amygdala. As a result, the prefrontal cortex loses its ability to control the amygdala, leaving the fear and anxiety center to run unchecked. This pattern of brain activity (too much action in the amygdala and not enough communication with the prefrontal cortex) is common in people who have post-traumatic stress disorder (PTSD), another condition that spiked during the pandemic, particularly among frontline health-care workers.

The social isolation brought on by the pandemic was also likely detrimental to the brain’s structure and function. Loneliness has been linked to reduced volume in the hippocampus and amygdala, as well as decreased connectivity in the prefrontal cortex. Perhaps unsurprisingly, people who lived alone during the pandemic experienced higher rates of depression and anxiety.

Finally, damage to these brain areas affects people not only emotionally but cognitively as well. Many psychologists have attributed pandemic brain fog to chronic stress’s impact on the prefrontal cortex, where it can impair concentration and working memory.

Reversal time

So that’s the bad news. The pandemic hit our brains hard. These negative changes ultimately come down to a stress-induced decrease in neuroplasticity—a loss of cells and synapses instead of the growth of new ones. But don’t despair; there’s some good news. For many people, the brain can spontaneously recover its plasticity once the stress goes away. If life begins to return to normal, so might our brains.

“In a lot of cases, the changes that occur with chronic stress actually abate over time,” says James Herman, a professor of psychiatry and behavioral neuroscience at the University of Cincinnati. “At the level of the brain, you can see a reversal of a lot of these negative effects.” 

“If you create for yourself a more enriched environment where you have more possible inputs and interactions and stimuli, then [your brain] will respond to that.”

Rebecca Price, associate professor of psychiatry and psychology at the University of Pittsburgh

In other words, as your routine returns to its pre-pandemic state, your brain should too. The stress hormones will recede as vaccinations continue and the anxiety about dying from a new virus (or killing someone else) subsides. And as you venture out into the world again, all the little things that used to make you happy or challenged you in a good way will do so again, helping your brain to repair the lost connections that those behaviors had once built. For example, just as social isolation is bad for the brain, social interaction is especially good for it. People with larger social networks have more volume and connections in the prefrontal cortex, amygdala, and other brain regions. 

Even if you don’t feel like socializing again just yet, maybe push yourself a little anyway. Don’t do anything that feels unsafe, but there is an aspect of “fake it till you make it” in treating some mental illness. In clinical speak, it’s called behavioral activation, which emphasizes getting out and doing things even if you don’t want to. At first, you might not experience the same feelings of joy or fun you used to get from going to a bar or a backyard barbecue, but if you stick with it, these activities will often start to feel easier and can help lift feelings of depression.

Rebecca Price, an associate professor of psychiatry and psychology at the University of Pittsburgh, says behavioral activation might work by enriching your environment, which scientists know leads to the growth of new brain cells, at least in animal models. “Your brain is going to react to the environment that you present to it, so if you are in a deprived, not-enriched environment because you’ve been stuck at home alone, that will probably cause some decreases in the pathways that are available,” she says. “If you create for yourself a more enriched environment where you have more possible inputs and interactions and stimuli, then [your brain] will respond to that.” So get off your couch and go check out a museum, a botanical garden, or an outdoor concert. Your brain will thank you.

Exercise can help too. Chronic stress depletes levels of an important chemical called brain-derived neurotrophic factor (BDNF), which helps promote neuroplasticity. Without BDNF, the brain is less able to repair or replace the cells and connections that are lost to chronic stress. Exercise increases levels of BDNF, especially in the hippocampus and prefrontal cortex, which at least partially explains why exercise can boost both cognition and mood. 

Not only does BDNF help new synapses grow, but it may help produce new neurons in the hippocampus, too. For decades, scientists thought that neurogenesis in humans stopped after adolescence, but recent research has shown signs of neuron growth well into old age (though the issue is still hotly contested). Regardless of whether it works through neurogenesis or not, exercise has been shown time and again to improve people’s mood, attention, and cognition; some therapists even prescribe it to treat depression and anxiety. Time to get out there and start sweating.

Turn to treatment

There’s a lot of variation in how people’s brains recover from stress and trauma, and not everyone will bounce back from the pandemic so easily.

“Some people just seem to be more vulnerable to getting into a chronic state where they get stuck in something like depression or anxiety,” says Price. In these situations, therapy or medication might be required.

Some scientists now think that psychotherapy for depression and anxiety works at least in part by changing brain activity, and that getting the brain to fire in new patterns is a first step to getting it to wire in new patterns. A review paper that assessed psychotherapy for different anxiety disorders found that the treatment was most effective in people who displayed more activity in the prefrontal cortex after several weeks of therapy than they did beforehand—particularly when the area was exerting control over the brain’s fear center. 

Other researchers are trying to change people’s brain activity using video games. Adam Gazzaley, a professor of neurology at the University of California, San Francisco, developed the first brain-training game to receive FDA approval for its ability to treat ADHD in kids. The game has also been shown to improve attention span in adults. What’s more, EEG studies revealed greater functional connectivity involving the prefrontal cortex, suggesting a boost in neuroplasticity in the region.

Now Gazzaley wants to use the game to treat people with pandemic brain fog. “We think in terms of covid recovery there’s an incredible opportunity here,” he says. “I believe that attention as a system can help across the breadth of [mental health] conditions and symptoms that people are suffering, especially due to covid.”

While the effects of brain-training games on mental health and neuroplasticity are still up for debate, there’s abundant evidence for the benefits of psychoactive medications. In 1996, psychiatrist Yvette Sheline, now a professor at the University of Pennsylvania, was the first to show that people with depression had significantly smaller hippocampi than non-depressed people, and that the size of that brain region was related to how long and how severely they had been depressed. Seven years later, she found that if people with depression took antidepressants, they had less volume loss in the region.

That discovery shifted many researchers’ perspectives on how traditional antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), help people with depression and anxiety. As their name suggests, SSRIs target the neurochemical serotonin, increasing its levels in synapses. Serotonin is involved in several basic bodily functions, including digestion and sleep. It also helps to regulate mood, and scientists long assumed that was how the drugs worked as antidepressants. However, recent research suggests that SSRIs may also have a neuroplastic effect by boosting BDNF, especially in the hippocampus, which could help restore healthy brain function in the area. One of the newest antidepressants approved in the US, ketamine, also appears to increase BDNF levels and promote synapse growth in the brain, providing additional support for the neuroplasticity theory. 

The next frontier in pharmaceutical research for mental illness involves experimental psychedelics like MDMA and psilocybin, the active ingredient in hallucinogenic mushrooms. Some researchers think that these drugs also enhance plasticity in the brain and, when paired with psychotherapy, can be a powerful treatment.

Not all the changes to our brains from the past year are negative. Neuroscientist David Eagleman, author of the book Livewired: The Inside Story of the Ever-Changing Brain, says that some of those changes may actually have been beneficial. By forcing us out of our ruts and changing our routines, the pandemic may have caused our brains to stretch and grow in new ways.

“This past 14 months have been full of tons of stress, anxiety, depression—they’ve been really hard on everybody,” Eagleman says. “The tiny silver lining is from the point of view of brain plasticity, because we have challenged our brains to do new things and find new ways of doing things. If we hadn’t experienced 2020, we’d still have an old internal model of the world, and we wouldn’t have pushed our brains to make the changes they’ve already made. From a neuroscience point of view, this is most important thing you can do—constantly challenge it, build new pathways, find new ways of seeing the world.”

How to help your brain help itself

While everyone’s brain is different, try these activities to give your brain the best chance of recovering from the pandemic.

  1. Get out and socialize. People with larger social networks have more volume and connectivity in the prefrontal cortex, amygdala, and other brain regions.
  2. Try working out. Exercise increases levels of a protein called BDNF that helps promote neuroplasticity and may even contribute to the growth of new neurons.
  3. Talk to a therapist. Therapy can help you view yourself from a different perspective, and changing your thought patterns can change your brain patterns.
  4. Enrich your environment. Get out of your pandemic rut and stimulate your brain with a trip to the museum, a botanical garden, or an outdoor concert.
  5. Take some drugs—but make sure they’re prescribed! Both classic antidepressant drugs, such as SSRIs, and more experimental ones like ketamine and psychedelics are thought to work in part by boosting neuroplasticity.
  6. Strengthen your prefrontal cortex by exercising your self-control. If you don’t have access to an (FDA-approved) attention-boosting video game, meditation can have a similar benefit. 

Perdoe e se liberte (AEON)

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aeon.co

The First Cloud (1888) by William Quiller Orchardson. Courtesy the Tate Gallery/Wikipedia
As mágoas – as suas ou aquelas que outros lhe causam – mantêm você preso. A terapia do perdão pode ajudá-lo a mudar de perspectiva e seguir adiante com a sua vida

Nathaniel Wade – 14 de agosto de 2020

Quando eu tinha 26 anos, meu mundo desmoronou. Eu tinha acabado de começar a pós-graduação e viajava constante entre Richmond, Virgínia e Washington, DC, porque minha esposa estava terminando sua pós-graduação em uma cidade diferente de onde eu estudava. Em uma dessas viagens, eu estava lavando roupa e encontrei um bilhete amassado no fundo da secadora. Estava endereçado a minha esposa por um de seus colegas de classe: “Devemos sair em horários diferentes. Te encontro em minha casa mais tarde”.

Minha esposa estava tendo um caso, embora não tenha sido confirmado até meses depois. Para mim, foi um golpe de proporções monumentais. Eu me senti traído, enganado e até ridicularizado. A raiva explodiu em mim e, ao longo de dias e semanas, essa raiva se transformou em uma confusão fervilhante de amargura, confusão e descrença. Nós nos separamos sem um plano claro para o futuro.

Embora essa dor me apunhalasse com uma intensidade que eu nunca havia sentido, eu não era o único a passar por isso. Muitas pessoas experimentam dores semelhantes, e muito piores, em suas vidas. Estar em um relacionamento geralmente significa ser maltratado, magoado ou traído. Como pessoas, frequentemente sofremos injustiças e dificuldades de relacionamento. Uma das maneiras que os humanos desenvolveram para lidar com essa dor é por meio do perdão. Mas o que é perdão e como funciona?

Essas eram as questões nas quais eu estava trabalhando ao mesmo tempo em que passava por minha separação. Eu estava fazendo pós-graduação na Virginia Commonwealth University, e o psicólogo Everett Worthington era o meu orientador. Ev é um dos dois pioneiros na psicologia do perdão e, desde o primeiro dia, ele me fez explorar o perdão de uma perspectiva acadêmica (deixei seu escritório depois de nosso primeiro encontro com uma pilha de meio metro de artigos científicos para revisar). Desde então, tornei-me psicólogo e professor de aconselhamento psicológico na Iowa State University, com especialização em perdão como parte do processo de psicoterapia.

Os primeiros trabalhos produzidos por Worthington e por mim, e por outros pesquisadores, identificaram o que o perdão não era. Robert Enright, da Universidade de Wisconsin-Madison, outro pioneiro na psicologia do perdão, foi fundamental neste trabalho. Por exemplo, ele e seus colegas distinguiam entre perdoar e tolerar, desculpar ou ignorar uma ofensa. Para que o verdadeiro perdão ocorra, afirmaram, é necessário que haja uma verdadeira ofensa ou mágoa, com consequências reais. Uma boa ilustração pode ser a dos clientes que Enright e uma de suas alunas, Suzanne Freedman (agora professora da University of Northern Iowa), descreveram em um artigo: mulheres sobreviventes de incesto infantil. Para que o verdadeiro perdão ocorresse neste contexto, argumentavam, as mulheres precisavam primeiro reconhecer que uma mágoa real lhes fora infligida quando crianças. Negar sua própria dor ou ignorar a atrocidade não seria perdão. E, se viesse, o perdão só ocorreria depois de trabalhar a difícil realidade do que aconteceu. Ao longo de muitos meses e através de um trabalho pessoal desafiador, as mulheres do estudo resolveram grande parte do medo, amargura, raiva, confusão e mágoa, e alcançaram um nível notável de paz e resolução em relação aos abusos anteriores.

Outra questão principal que se tornou rapidamente aparente na pesquisa foi se a reconciliação precisava fazer parte do perdão ou não. Para acadêmicos e terapeutas como eu, interessados ​​em ajudar as pessoas a obter o perdão por ofensas muitas vezes graves, como infidelidade conjugal ou violências do passado, o perdão é restrito a um processo interno. Assim, o perdão não inclui necessariamente a reconciliação, mas é o processo interno pelo qual alguém resolve a amargura e a mágoa e se move para algo mais positivo em relação à pessoa que o ofendeu, como empatia ou amor. Em contraste, a reconciliação é um processo pelo qual as pessoas restabelecem um relacionamento de confiança com alguém que as magoou. Essa distinção tornou-se fundamental em minha própria cura.

Embora esta distinção seja importante, não significa que a reconciliação não seja uma opção valiosa para aqueles de nós que vêem o perdão desta forma. Em vez disso, a reconciliação se torna um processo separado, independente do perdão, mas importante e valioso por si só. Isso foi um bálsamo considerável para mim nos meses que se seguiram à minha separação. Apesar da dor, raiva e confusão que ainda sentia meses depois, eu sabia que gostaria de buscar o perdão em algum momento no futuro. Eu não queria que minha amargura do passado contagiasse minha felicidade futura em relacionamentos amorosos. Eu não queria carregar esse fardo pelo resto da minha vida. Em vez disso, imaginei um momento em que gostaria de deixar isso de lado e seguir em frente. Meu verdadeiro medo, porém, era que, ao perdoar, eu necessariamente tivesse que me reconciliar com minha esposa ou, alternativamente, que se eu não quisesse me reconciliar, não me livraria da raiva. Ao ver o perdão como um processo separado da reconciliação, novas opções apareceram. Entendi então que poderia perdoar ou não, e poderia me reconciliar ou não.

Um processo semelhante ocorreu para muitos clientes com quem trabalhei. Por exemplo, lembro-me do alívio sensível que senti em um grupo de pessoas que estava tratando quando trouxe à tona a diferença entre perdão e reconciliação. Os membros desse grupo estavam lutando contra violências diversas, de serem financeiramente roubados por um ex a casos de traição e outras experiências negativas. Quando apresentei a possível distinção entre perdão e reconciliação e discutimos como isso poderia acontecer em suas próprias experiências, senti um suspiro coletivo. Houve um peso tirado dos ombros dos participantes simplesmente pelo entendimento de que perdoar não significa necessariamente reconciliar. Os membros do grupo sentiram-se mais livres e isso ajudou em seus processos de perdão de maneiras novas e ricas.

Por exemplo, Jo (nome fictício) estava sofrendo com um noivo que lhe roubou dez mil dólares e desapareceu. Obviamente, não havia maneira de Jo trabalhar na reconciliação, mesmo que ela quisesse, e ainda assim, com essa distinção, ela podia ver como ela ainda poderia seguir em frente com o perdão.

Por outro lado, Maria, que trabalhava para perdoar a filha adulta pelas coisas que a magoara, queria manter o relacionamento; ela estava muito interessada em reconciliação. Compreender a diferença ajudou-a a ver que ela poderia trabalhar tanto no perdão quanto na reconciliação de maneiras diferentes para ajudar a curar seu relacionamento com a filha.

Em suma, uma compreensão adequada parece ajudar as pessoas a aceitar o perdão e abre novas possibilidades de cura e crescimento. Mas como funciona e de que forma as pessoas podem usá-lo para seu próprio benefício?

Passei a maior parte da minha carreira acadêmica tentando responder a essa pergunta. Especificamente, estudei maneiras de ajudar as pessoas a perdoar os outros quando têm dificuldade para fazê-lo. A ciência sobre isso ainda é muito nova, mas parece haver um núcleo comum de intervenções que fornecem ajuda para que as pessoas caminhem em direção à resolução de suas feridas.

A primeira é uma estratégia testada e comprovada em quase todas as formas de psicoterapia: compartilhar a história pessoal em um ambiente seguro e sem julgamento. Quase todas as intervenções de perdão estabelecidas prescrevem um momento para compartilhar a mágoa ou ofensa. Isso é particularmente poderoso em um ambiente de grupo, no qual os participantes compartilham suas experiências diferentes uns com os outros, testemunham suas dores e se apoiam mutuamente. No entanto, contar a própria história de forma individual é também eficaz, em um contexto em que não se tenta dar conselhos, não se diminui a importância de sentimentos negativos e não se estimula a raiva (evitando reações como “sim, ele é a pior pessoa do mundo!”). Frequentemente, em nossos programas de perdão, os participantes nos dizem que uma das partes mais importantes e eficazes é a oportunidade de compartilhar com os outros o que lhes aconteceu. Afirmam que a parte mais útil costuma ser “saber que outros tiveram dificuldades semelhantes” e “ser capaz de desabafar, podendo dizer ali coisas que eu não poderiam ser ditas em outros lugares” e “sentir que foi ouvido, realmente compreendido e que poderia tirar isso do peito”.

Essa reação é compreensível, visto como pode ser difícil falarmos sobre momentos em que fomos magoados ou agredidos. Para alguns, é difícil compartilhar porque vítimas de violência em geral sentem vergonha e humilhação com a sua situação. Poucas pessoas querem compartilhar abertamente os momentos em que foram fracas ou maltratadas, traídas ou rejeitadas. São histórias de vulnerabilidade. Além da vergonha que as pessoas sentem, muitas vezes há o desejo de evitar a dor associada à mágoa: se eu compartilhar, terei que reviver a dor e talvez não seja capaz de lidar com isso. As intervenções que podem ajudar as pessoas a superar esses obstáculos, compartilhar sua dor e receber apoio podem ser de grande ajuda para ajudá-las a se recuperar.

Após uma recontagem completa da história, a maioria das intervenções oferece um tempo para as pessoas considerarem o ponto de vista do ofensor. O objetivo geralmente é ajudar as pessoas a desenvolver compreensão ou até empatia pela pessoa que as magoou. Existe um grande poder na empatia, ainda que existam também perigos envolvidos aí.

Três anos depois de encontrar aquele bilhete amassado, pedi o divórcio e segui em frente com um novo espírito de perdão

Quando bem feita, esta parte da intervenção ajuda as pessoas a expandirem sua perspectivas e ganharem nova consciência para as complexidades dos eventos que cercam suas feridas. Isso pode leva-las a uma visão mais ampla dos eventos, fazendo a ofensa parecer-se menos com uma maldade ou com sadismo e mais com uma situação complexa em que alguém tomou decisões prejudiciais ou ruins. Essa mudança de perspectiva e compreensão podem abrir as portas para o perdão. Um excelente exemplo disso é o trabalho de Frederic Luskin, diretor do Stanford Forgiveness Project, e do reverendo Byron Bland, capelão da Universidade de Palo Alto. Em 2000, eles reuniram protestantes e católicos da Irlanda do Norte que haviam perdido parentes devido à violência religiosa naquele país, e criaram um workshop de perdão de uma semana na Universidade de Stanford, na Califórnia. Grande parte dessa experiência foi ajudar cada grupo a ver o outro sob uma luz mais humana, a abandonar a amargura associada ao outro grupo e a alavancar a empatia para avançar em direção ao perdão. Como um participante que perdeu seu pai relatou: “Por anos eu tive ressentimento dos católicos, até vir para Stanford.”

É claro que, se feito de maneira inadequada ou sem precauções, tentar desenvolver empatia pode reduzir-se a culpar a vítima e encorajar aqueles que foram feridos a questionar ou minimizar seus sentimentos, permitindo que outros os magoem no futuro. A parte importante e difícil desse processo é ajudar as pessoas a manter a legitimidade de sua dor enquanto exploram outros pontos de vista. O objetivo é ajudar as pessoas a aceitarem seus sentimentos como compreensíveis e suas reações como justificadas, mesmo enquanto desenvolvem uma apreciação mais nuançada da perspectiva da pessoa ofensora. Isso leva tempo e muitas vezes não deve tentado até que um período considerável tenha decorrido desde a ofensa. A quantidade de tempo depende de muitos fatores, como a gravidade da mágoa e o relacionamento que se tem com a pessoa que o ofendeu.

Em minha própria jornada de perdão, foi de grande valia o compartilhamento da experiência e o desenvolvimento da empatia. Recebi ajuda considerável de vários parentes e amigos e de um terapeuta atencioso que ouviu minha história sem julgar o que eu deveria ou não fazer. Em vez disso, eles todos me ouviram, apoiaram-me em minha dor e permitiram que eu me expressasse livremente. Meu melhor amigo suportou o peso disso tudo. Tínhamos marcado uma viagem à praia no mesmo verão em que encontrei aquele bilhete para minha esposa. Eu a confrontei um pouco antes da viagem, e ela admitiu o caso pela primeira vez pouco antes de meu amigo e eu partirmos em nossa viagem. Passei dois dias na praia na Carolina do Norte vomitando minha raiva e confusão, compartilhando história após história de todos os pequenos enganos e equívocos que só agora eu estava juntando. Como ele tolerou tudo isso, eu não sei. Mas, para mim, foi um descarrego inicial que me ajudou a caminhar em direção ao perdão definitivo.

A parte importante seguinte na minha jornada de perdão foi construir empatia por minha ex-esposa. Isso não aconteceu imediatamente. Na verdade, tardou muitos anos até que eu fosse capaz de desenvolver uma nova perspectiva sobre a questão. Foi necessário esse tipo de distância até que eu me tornasse humilde o suficiente para ver como eu mesmo contribuí para o fim do relacionamento. Eu vi minha parte. Eu vi como ela pode ter se sentido aprisionada por mim, pela família e pelos amigos para entrar em um casamento que parecia invejável para estranhos, mas muito provavelmente nunca foi totalmente confortável para ela. Comecei a ver como essas forças podem tê-la influenciado a fazer as escolhas que fez. Agora posso sentir por ela e quão difícil e confuso tudo isso pode ter sido, e posso ver que ela provavelmente não tinha intenção ou desejo de me machucar. Ela se sentiu aprisionada e reagiu a essa experiência. Longe de tudo isso e distante daquela dor que senti, posso dizer que eu realmente queria o que era melhor para ela. Eu esperava que ela tivesse uma vida plena. Por fim, optei por perdoar minha esposa e optei por não me reconciliar. Três anos depois de encontrar aquele bilhete amassado na secadora, decidi pedir o divórcio e segui em frente com um novo espírito de perdão e paz.

Além de ajudar as pessoas a perdoar os outros, os pesquisadores também começaram a explorar maneiras de ajudar as pessoas a perdoar a si mesmas. Marilyn Cornish, psicóloga conselheira da Auburn University, no Alabama, e eu desenvolvemos uma dessas intervenções, com base em um modelo amplo de quatro etapas. As etapas incluem: responsabilidade, remorso, restauração e renovação. Concentramos essa intervenção em ajudar as pessoas que carregavam consigo uma grande culpa por ter ferido outras pessoas.

A abordagem geral de nossa intervenção é ajudar as pessoas a assumirem as devidas responsabilidades pela ofensa ou ferida que causaram, identificando as formas pelas quais elas são culpadas pela dor da outra pessoa. Fora dessa responsabilidade, elas são incentivadas a identificar e expressar o remorso que sentem. Acreditamos que é saudável abraçar nossa culpa e colocar esse sentimento em um contexto realista. A partir deste ponto, é possível avançar para a restauração. Nesta etapa, a pessoa é incentivada a fazer reparações, a restaurar os danos causados ​​aos outros e a seus relacionamentos e a se comprometer novamente com valores ou padrões que possam ter violado ao magoar os outros. Finalmente, a pessoa é capaz de passar para a renovação, que entendemos ser uma substituição da culpa e da autocondenação por um renovado autorrespeito e autocompaixão. Essa renovação é apropriada somente após uma verdadeira contabilidade da ofensa. Uma vez que isso tenha sido feito, é benéfico para a pessoa mudar para um senso renovado de autoaceitação e perdão.

O perdão a si mesmo a ajudou a enfrentar os filhos com mais honestidade e a restaurar o relacionamento com eles.

Testamos essa intervenção em um estudo clínico. Para isso, convidamos pessoas que haviam magoado outras pessoas e queriam se perdoar a participarem de um programa de aconselhamento individual de oito semanas. Das 21 pessoas que completaram o estudo, 12 receberam o tratamento imediatamente e nove o receberam após estarem na lista de espera. Aqueles que receberam o tratamento imediatamente relataram autoperdão significativamente maior e significativamente menos autocondenação e sofrimento psicológico do que aqueles na lista de espera. Na verdade, depois de controlar sua autocondenação e autoperdão, a pessoa média que recebeu o tratamento foi mais indulgente do que aproximadamente 90% das pessoas na lista de espera. Além disso, uma vez que aqueles na lista de espera receberam o tratamento, sua mudança na autocondenação, no perdão a si mesmo e na angústia psicológica igualou o grupo de tratamento.

Vários meses após a conclusão do estudo, recebi um e-mail de uma das clientes. Vou chamá-la de Izzie. Ela escreveu para nos agradecer pelo aconselhamento; ela disse que mudou sua vida. Izzie entrou no estudo porque estava lutando com as implicações de ter tido um caso extraconjugal no passado. Além de se sentir sozinha e desconectada da família como resultado do divórcio que se seguiu, Izzie ainda lutava com a vergonha e a culpa de suas ações. Essa vergonha a levou a se afastar dos filhos e, então, a sentir mais culpa e vergonha por sua incapacidade de cuidá-los e ser a mãe que desejava ser. Em seu e-mail, ela detalhou como o processo de autoperdão a ajudou a assumir a responsabilidade pelos eventos de maneira apropriada e superar o remorso para renovar seus relacionamentos. Ela nos contou como conseguiu encarar os filhos com mais honestidade e ter um relacionamento restaurado com eles. Depois de ter investido tanto tempo em sua própria autocondenação, ela agora estava livre para se relacionar com eles de uma nova maneira e ser mais a mãe que ela queria, e eles precisavam que ela fosse.

O perdão, dos outros e de si mesmo, pode ser um processo poderoso de mudança de vida. Pode mudar a trajetória de um relacionamento ou até mesmo a vida de uma pessoa. Não é a única resposta que uma pessoa pode dar ao ser magoado ou magoar os outros, mas é uma forma eficaz de administrar os momentos inevitáveis ​​de conflito, decepção e dor em nossas vidas. O perdão abrange tanto a realidade da ofensa quanto a empatia e compaixão necessárias para seguir em frente. O verdadeiro perdão não foge da responsabilidade, recompensa ou justiça. Por definição, ele reconhece que algo doloroso, até mesmo errado, foi feito. Simultaneamente, o perdão nos ajuda a abraçar algo além da reação imediata de raiva e dor e da amargura latente que pode resultar. O perdão incentiva uma compreensão mais profunda e compassiva de que todos nós temos falhas em nossas diferentes maneiras e que todos nós precisamos ser perdoados às vezes.

Ceremonial PTSD therapies favored by Native American veterans (Science Daily)

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Date: June 30, 2014

Source: Washington State University

Summary: Traditional healing therapies are the treatment of choice for many Native American veterans, — half of whom say usual PTSD treatments don’t work — according to a recent survey. In the Arizona desert, wounded warriors from the Hopi Nation can join in a ceremony called Wiping Away the Tears. The traditional cleansing ritual helps dispel a chronic “ghost sickness” that can haunt survivors of battle.

Urquhart is a Native veteran and graduate student in the WSU College of Education. Credit: Rebecca E. Phillips

Native American veterans battling Post Traumatic Stress Disorder find relief and healing through an alternative treatment called the Sweat Lodge ceremony offered at the Spokane Veterans Administration Hospital.

In the Arizona desert, wounded warriors from the Hopi Nation can join in a ceremony called Wiping Away the Tears. The traditional cleansing ritual helps dispel a chronic “ghost sickness” that can haunt survivors of battle.

These and other traditional healing therapies are the treatment of choice for many Native American veterans, — half of whom say usual PTSD treatments don’t work — according to a recent survey conducted at Washington State University. The findings will be presented at the American Psychological Association conference in Washington D.C. this August.

The study is available online at https://www.surveymonkey.com/s/nativeveterans.

Led by Greg Urquhart and Matthew Hale, both Native veterans and graduate students in the College of Education, the ongoing study examines the attitudes, perceptions, and beliefs of Native American veterans concerning PTSD and its various treatment options. Their goal is to give Native veterans a voice in shaping the types of therapies available in future programs.

“Across the board, Native vets don’t feel represented. Their voices have been silenced and ignored for so long that they were happy to provide feedback on our survey,” said Hale.

Historically, Native Americans have served in the military at higher rates than all other U.S. populations. Veterans are traditionally honored as warriors and esteemed in the tribal community.

A 2012 report by the Department of Veterans Affairs showed that the percentage of Native veterans under age 65 outnumbers similar percentages for veterans of all other racial groups combined.

The WSU survey provides a first-hand look at the veterans’ needs, but more importantly, reveals the unique preferences they have as Native American veterans, said Phyllis Erdman, executive associate dean for academic affairs at the college and mentor for the study.

Cultural worldview

Urquhart said many Native veterans are reluctant to seek treatment for PTSD because typical western therapy options don’t represent the Native cultural worldview.

“The traditional Native view of health and spirituality is intertwined,” he explained. “Spirit, mind, and body are all one — you can’t parcel one out from the other — so spirituality is a huge component of healing and one not often included in western medicine, although there have been a few studies on the positive effects of prayer.”

For many years, the U.S. government banned Native religious ceremonies, which subsequently limited their use in PTSD programs, said Urquhart. Seeking to remedy the situation, many Veterans Administration hospitals now offer traditional Native practices including talking circles, vision quests, songs, drumming, stories, sweat lodge ceremonies, gourd dances and more. Elders or traditional medicine men are also on staff to help patients process their physical and emotional trauma.

“PTSD is a big issue and it’s not going away anytime soon,” said Hale who identifies as Cherokee and was a mental health technician in the Air Force.

Urquhart, who is also Cherokee and developed mild symptoms of PTSD after a tour as a cavalry scout in Iraq, said there have been very few studies on Native veterans and PTSD. He and Hale designed their survey to be broader and more inclusive than any previous assessments. It is the first to address the use of equine therapy as a possible adjunct to both western treatments and Native ceremonial approaches.

Standard treatments disappointing

So far, 253 veterans from all five branches of the military have completed the survey, which includes 40 questions, most of them yes or no answers. It also includes an open-ended section where participants can add comments. The views reflect a diverse Native population ranging from those living on reservations to others who live in cities.

The majority of survey takers felt that “most people who suffer from PTSD do not receive adequate treatment,” said Urquhart. For Native veterans who did seek standard treatment, the results were often disappointing. Sixty percent of survey respondents who had attempted PTSD therapy reported “no improvement” or “very unsatisfied.”

Individual counseling reportedly had no impact on their PTSD or made the symptoms worse for 49 percent of participants. On the other hand, spiritual or religious guidance was seen as successful or highly successful by 72 percent of Native respondents. Animal assisted therapy — equine, canine, or other animals — was also highly endorsed.

“The unique thing about equine therapy is that it’s not a traditional western, sit-down-with-a-therapist type program. It’s therapeutic but doesn’t have the stigma of many therapies previously imposed on Native Americans,” said Urquhart.

Strongly supportive of such efforts, Erdman is expanding the long-running WSU Palouse Area Therapeutic Horsemanship (PATH) program to include a section open to all veterans called PATH to Success: A Warrior’s Journey.

Giving veterans a voice

Urquhart, Hale, and teammate, Nasreen Shah say their research is gaining wide support in Native communities throughout the nation.

The team plans to distribute the survey results to all U.S. tribes, tribal governments, Native urban groups, and veteran warrior societies. They also hope the departments of Veterans Affairs and Indian Health Services will take notice and continue to incorporate more traditional healing methods into their programs.

As one Iroquois Navy veteran commented on the survey, “Traditional/spiritual healing can be very effective together with in depth education and background in modern treatment methods.”

A Nahua Army veteran agreed, writing, “Healing ceremonies are absolutely essential, as is story telling in front of supportive audiences. We need rituals to welcome back the warriors.”

Story Source:

The above story is based on materials provided by Washington State University. The original article was written by Rebecca E. Phillips. Note: Materials may be edited for content and length.

The War on Suicide? (Time)

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Monday, July 23, 2012

By NANCY GIBBS; MARK THOMPSON

Leslie McCaddon sensed that the enemy had returned when she overheard her husband on the phone with their 8-year-old daughter. “Do me a favor,” he told the little girl. “Give your mommy a hug and tell her that I love her.”

She knew for certain when she got his message a few minutes later. “This is the hardest e-mail I’ve ever written,” Dr. Michael McCaddon wrote. “Please always tell my children how much I love them, and most importantly, never, ever let them find out how I died … I love you. Mike”

She grabbed a phone, sounded every alarm, but by the time his co-workers found his body hanging in the hospital call room, it was too late.

Leslie knew her husband, an Army doctor, had battled depression for years. For Rebecca Morrison, the news came more suddenly. The wife of an AH-64 Apache helicopter pilot, she was just beginning to reckon with her husband Ian’s stress and strain. Rebecca urged Ian to see the flight surgeon, call the Pentagon’s crisis hotline. He did–and waited on the line for more than 45 minutes. His final text to his wife: “STILL on hold.” Rebecca found him that night in their bedroom. He had shot himself in the neck.

Grand Praire, TX. Rebecca Morrison with some of her husband Ian’s belongings in her parents homes. Ian, an AH-64 Apache Helicopter pilot in the U.S. Army committed suicide on March 21, 2012. Ian chose ‘Ike’ for Rebecca. Peter van Agtmael/Magnum for TIME.

Both Army captains died on March 21, a continent apart. The next day, and the next day, and the next, more soldiers would die by their own hand, one every day on average, about as many as are dying on the battlefield. These are active-duty personnel, still under the military’s control and protection. Among all veterans, a suicide occurs every 80 minutes, round the clock.

Have suicides spiked because of the strain of fighting two wars? Morrison flew 70 missions in Iraq over nine months but never engaged the enemy directly. McCaddon was an ob-gyn resident at an Army hospital in Hawaii who had never been to Iraq or Afghanistan. Do the pride and protocols of a warrior culture keep service members from seeking therapy? In the three days before he died, Morrison went looking for help six times, all in vain. When Leslie McCaddon alerted commanders about her husband’s anguish, it was dismissed as the result of a lovers’ quarrel; she, not the Army, was the problem.

This is the ultimate asymmetrical war, and the Pentagon is losing. “This issue–suicides–is perhaps the most frustrating challenge that I’ve come across since becoming Secretary of Defense,” Leon Panetta said June 22. The U.S. military seldom meets an enemy it cannot target, cannot crush, cannot put a fence around or drive a tank across. But it has not been able to defeat or contain the epidemic of suicides among its troops, even as the wars wind down and the evidence mounts that the problem has become dire. While veterans account for about 10% of all U.S. adults, they account for 20% of U.S. suicides. Well trained, highly disciplined, bonded to their comrades, soldiers used to be less likely than civilians to kill themselves–but not anymore.

More U.S. military personnel have died by suicide since the war in Afghanistan began than have died fighting there. The rate jumped 80% from 2004 to 2008, and while it leveled off in 2010 and 2011, it has soared 18% this year. Suicide has passed road accidents as the leading noncombat cause of death among U.S. troops. While it’s hard to come by historical data on military suicides–the Army has been keeping suicide statistics only since the early 1980s–there’s no denying that the current numbers constitute a crisis.

The specific triggers for suicide are unique to each service member. The stresses layered on by war–the frequent deployments, the often brutal choices, the loss of comrades, the family separation–play a role. So do battle injuries, especially traumatic brain injury and posttraumatic stress disorder (PTSD). And the constant presence of pain and death can lessen one’s fear of them.

But combat trauma alone can’t account for the trend. Nearly a third of the suicides from 2005 to 2010 were among troops who had never deployed; 43% had deployed only once. Only 8.5% had deployed three or four times. Enlisted service members are more likely to kill themselves than officers, and 18-to-24-year-olds more likely than older troops. Two-thirds do it by gunshot; 1 in 5 hangs himself. And it’s almost always him: nearly 95% of cases are male. A majority are married.

No program, outreach or initiative has worked against the surge in Army suicides, and no one knows why nothing works. The Pentagon allocates about $2 billion–nearly 4% of its $53 billion annual medical bill–to mental health. That simply isn’t enough money, says Peter Chiarelli, who recently retired as the Army’s second in command. And those who seek help are often treated too briefly.

Army officials declined to discuss specific cases. But Kim Ruocco directs suicideprevention programs at the nonprofit Tragedy Assistance Program for Survivors, or TAPS. She knows what Leslie McCaddon and Rebecca Morrison have endured; her husband, Marine Major John Ruocco, an AH-1 Cobra helicopter-gunship pilot, hanged himself in 2005. These were highly valued, well-educated officers with families, with futures, with few visible wounds or scars; whatever one imagines might be driving the military suicide rate, it defies easy explanation. “I was with them within hours of the deaths,” Ruocco says of the two new Army widows. “I experienced it through their eyes.” Their stories, she says, are true. And they are telling them now, they say, because someone has to start asking the right questions.

The Bomb Grunt

Michael McCaddon was an Army brat born into a uniquely edgy corner of the service: his father served in an ordnance-disposal unit, and after his parents divorced, his mother married another bomb-squad member. McCaddon entered the family business, enlisting at 17. “When I joined the Army I was 5’10” and weighed 129 lbs,” he blogged years later. “I had a great body … for a girl.” But basic training made him stronger and tougher; he pushed to get the top scores on physical-fitness tests; he took up skydiving, snorkeling, hiking. If you plan to specialize in a field in which a single mistake can cost you and your comrades their lives, it helps to have high standards. “Ever since I was new to the Army, I made it my personal goal to do as well as I can,” he recalled. “I thought of it as kind of a representation of my being, my honor, who I was.”

The Army trained him to take apart bombs. He and his team were among the first on the scene of the 1995 Oklahoma City bombing, combing the ruins for any other devices, and he traveled occasionally to help the Secret Service protect then First Lady Hillary Clinton. He met Leslie in 1994 during a break in her college psychology studies. They started dating, sometimes across continents–he did two tours in Bosnia. During a Stateside break in January 2001, he married Leslie in Rancho Santa Fe, Calif. They had three children in four years, and McCaddon, by then an active-duty officer, moved with his family to Vilseck, Germany, where he helped run an Army dental office.

He was still ambitious–two of Leslie’s pregnancies had been difficult, so he decided to apply to the military’s medical school and specialize in obstetrics. But then, while he was back in Washington for his interview, came a living nightmare: his oldest son, who was 3, was diagnosed with leukemia. Just before entering med school, McCaddon prepared for his son’s chemotherapy by shaving his head in solidarity so the little boy wouldn’t feel so strange. McCaddon may not have been a warrior, but he was a fighter. “I became known as a hard-charger,” he wrote. “I was given difficult tasks, and moved through the ranks quickly.” He pushed people who didn’t give 100%; he pushed himself.

The Apache Pilot

Ian Morrison was born at Camp Lejeune in North Carolina, son of a Marine. An honor student at Thomas McKean High School in Wilmington, Del., he sang in the chorus, ran cross-country and was a co-captain of the swimming team before heading to West Point. He had a wicked sense of humor and a sweet soul; he met Rebecca on a Christian singles website in 2006 and spent three months charming her over the phone. One night he gave her his credit-card information. “Buy me a ticket, because I’m going to come see you,” he told her before flying to Houston. “The minute I picked him up,” she recalls, “we later said we both knew it was the real deal.” He proposed at West Point when she flew in for his graduation.

Morrison spent the next two years at Fort Rucker in Alabama, learning to fly the two-seat, 165-m.p.h. Apache helicopter, the Army’s most lethal aircraft. He and his roommate, fellow West Pointer Sean McBride, divided their time among training, Walmart, church, Seinfeld and video games, fueled by macaroni and cheese with chopped-up hot dogs. Morrison and Rebecca were married two days after Christmas 2008 near Dallas. The Army assigned him to an aviation unit at Fort Hood, so they bought a three-bedroom house on an acre of land just outside the town of Copperas Cove, Texas. They supported six African children through World Vision and were planning to have some kids of their own. “We had named our kids,” Rebecca says.

Morrison was surprised when the Army ordered him to Iraq on short notice late in 2010. Like all young Army officers, he saluted and began packing.

Triggers and Traps

One theory of suicide holds that people who feel useful, who feel as if they belong and serve a larger cause, are less likely to kill themselves. That would explain why active-duty troops historically had lower suicide rates than civilians. But now experts who study the patterns wonder whether prolonged service during wartime may weaken that protective function.

Service members who have bonded with their units, sharing important duties, can have trouble once they are at a post back home, away from the routines and rituals that arise in a close-knit company. The isolation often increases once troops leave active duty or National Guardsmen and reservists return to their parallel lives. The military frequently cites relationship issues as a predecessor to suicides; that irritates survivors to no end. “I’m not as quick to blame the Army as the Army is to blame me,” Leslie McCaddon says. “The message I get from the Army is that our marital problems caused Mike to kill himself. But they never ask why there were marriage problems to begin with.”

As McCaddon made his way through med school in Maryland, he encountered ghosts from his past. He was reaching the age at which his biological father had died by suicide, which statistically increased his own risk. But he wasn’t scared by it, Leslie says; he told associates about it. What did bother him was that he was gaining weight, the physical-training tests were getting harder for him, and the course work was challenging to juggle with a young family. He hid the strain, “but inside it is killing me,” he blogged. He called Leslie a hero “for not kicking me out of the house on the several times I’ve given her reason.” And he told her he sometimes thought of suicide.

“But he would tell everyone else that he was fine,” Leslie says. “He was afraid they’d kick him out of medical school if he was really honest about how depressed he was.” McCaddon sought counseling from a retired Army psychiatrist and seemed to be turning a corner in May 2010, when he graduated and got his first choice for a residency, at Tripler Army Medical Center in Honolulu.

“He loved being a soldier,” Leslie said, “and he was going to do everything he could to protect that relationship.”

Leslie had relationships to protect as well. He was increasingly hard on her at home; he was also hard on the kids and on himself. “He was always an amazing father–he loved his children–but he started lashing out at them,” Leslie recalls. “He wasn’t getting enough sleep, and he was under a lot of stress.” Leslie began exploring options but very, very carefully; she had a bomb-disposal problem as well. “When I was reaching out for help, people were saying, Be careful how you phrase this, because it could affect your husband’s career,” she says. “That was terrifying to me. It made me think that by advocating for him I’d be making things worse.”

The Pilot’s Pain

Captain Morrison headed to Iraq in early 2011. Once there, he and Rebecca Skyped nearly every day between his flight assignments. When he took R&R leave in early September, they visited family in Dallas, then San Antonio, and caught concerts by Def Leppard and Heart.

There were no signs of trouble. “He was so mentally stable–he worked out every day, we ate good food, and we always had good communication,” his wife says. “Most people would say he was kind of quiet, but with me he was loud and obnoxious and open.”

Morrison never engaged the enemy in direct combat; still, some 70 missions over Iraq took their toll. His base was routinely mortared. After one mission, he and several other pilots were walking back to their hangar when a rocket shot right past them and almost hit him; he and his comrades ran and dived into a bunker, he told Rebecca once he was safely home. He impressed his commander–“Excellent performance!” his superior raved in a formal review of the man his buddies called Captain Brad Pitt. “Unlimited potential … continue to place in position of greater responsibility.”

It was not the war that turned out to be hard; it was the peace. Morrison returned to Fort Hood late last year and spent his month off with Rebecca riding their horses, attending church and working out. He seemed unnerved by slack time at home. “He said it was really easy to fall into a routine in Iraq–they got up at the exact same time, they ate, they worked out, they flew forever and then they came back, and he’d talk to me, and then they did it all over again,” Rebecca says. “When he came back to Texas, it was really difficult for him to adjust.”

Morrison was due to be reassigned, so he and his wife needed to sell their house, but it just sat on the market. His anxiety grew; he was restless, unable to sleep, and they thought he might be suffering from PTSD. The couple agreed that he should see a doctor. Military wives, especially those studying mental health, have heard the stories, know the risks, learn the questions: Is their spouse drinking more, driving recklessly, withdrawing from friends, feeling trapped? Be direct, they are told. “I looked him right in the face and asked, ‘Do you feel like you want to hurt or kill yourself?'” Rebecca recalls. “He looked me right in the face and said, ‘Absolutely not–no way–I don’t feel like that at all. All I want to do is figure out how to stop this anxiety.'”

The Stigma

When troops return from deployment, they are required to do self-assessments of their experience: Did they see people killed during their tour? Did they feel they had been at risk of dying? Were they interested in getting counseling for stress or alcohol use or other issues? But a 2008 study found that when soldiers answer questions anonymously, they are two to four times as likely to report depression or suicidal thoughts. Independent investigations have turned up reports of soldiers being told by commanders to airbrush their answers or else risk their careers. A report by the Center for a New American Security cited commanders who refuse to grant a military burial after a suicide for fear that doing so would “endorse or glamorize” it.

The U.S. Department of Veterans Affairs (VA) and all the services have launched resiliency-training programs and emergency hotlines, offering slogans like “Never leave a Marine behind” and “Never let your buddy fight alone” that try to speak the language of the unit. Last year the Pentagon released a video game meant to allow soldiers to explore the causes and symptoms of PTSD from the privacy of their homes. “We want people to feel like they are encouraged to get help,” says Jackie Garrick, who runs the new Defense Suicide Prevention Office. “There are a myriad of ways you can access help and support if you need it.”

But faith in that commitment was shaken this year when Army Major General Dana Pittard, commander of the 1st Armored Division at Fort Bliss, Texas, complained on his official blog that he was “personally fed up” with “absolutely selfish” troops who kill themselves, leaving him and others to “clean up their mess. Be an adult, act like an adult, and deal with your real-life problems like the rest of us,” he continued. He later said he wanted to “retract” what he called his “hurtful statement,” but he didn’t apologize for what he said. Many soldiers and family members believe Pittard’s attitude is salted throughout the U.S. military.

Just a Lovers’ Quarrel

In August 2010, Leslie went to McCaddon’s commanding officer at the hospital. She didn’t tell Michael. “It was the scariest thing I’ve ever done,” she says. She recalls sitting in the commander’s office, haltingly laying out her concerns–McCaddon’s history of depression, his struggle to meet his high standards while doing right by his family. She was hoping that maybe the commander would order him into counseling and defuse the stigma somehow: he’d just be following orders. She watched the officer, a female colonel, detonate before her eyes. “No one at the medical school told me he had a history of depression, of being suicidal,” Leslie recalls her shouting. “I have a right to know this. He’s one of my residents. Why didn’t anyone tell me?” The commander was furious–not at Leslie, exactly, but at finding herself not in command of the facts.

The colonel called several colleagues into the room and then summoned McCaddon as well. Leslie registered the shock and fear on his face when he saw his wife sitting with his bosses. “I was shaking,” she says. “I told him I continued to be concerned that his depression was affecting our family and that I was really concerned for his safety but also for the well-being of our children and myself.”

The commander encouraged McCaddon to get help but wouldn’t order him to do it. He left the room, livid, and Leslie burst into tears. “Honey, don’t worry,” Leslie remembers the commander saying. “My first marriage was a wreck too.”

Can’t you make him get some help? Leslie pleaded again, but the colonel pushed back. McCaddon was doing fine at work, with no signs of a problem. “‘Leslie, I know this is going to be hard to hear, but this just doesn’t sound like an Army issue to me,'” McCaddon’s wife recalls the colonel saying. “‘It sounds like a family issue to me.'” Leslie felt her blood run cold. “No one was going to believe me so long as things were going fine at work.”

McCaddon did try to see an Army psychiatrist, but a month or more could pass without his finding the time. “I’d say, ‘He’s in the Army,'” Leslie recalls telling the doctor, “‘and you make him do everything else, so you should be able to make him go to mental-health counseling.'” But McCaddon was not about to detour from rounds to lie on the couch. He barely ate while on his shift. “Everybody here is under stress,” he stormed at Leslie. “I can’t just walk out for an hour a week–I’m not going to leave them when we’re already short-staffed.”

The marriage was cracking. Back in Massachusetts, Leslie’s mother was not well. Leslie and the kids moved home so she could take care of her. She and Michael talked about divorce.

The Waiting Room

Early on Monday, March 19, Ian Morrison showed up at a Fort Hood health clinic, where he sat waiting in his uniform, with his aviation badge, for three hours. Finally someone saw him. “‘I’m sorry you had to wait all this time,'” Rebecca says he was told. “‘But we can’t see you. We can’t prescribe you anything.'” He had to see the doctor assigned to his unit. When Morrison arrived at the flight surgeon’s office, he told Rebecca, the doctor was upset that Morrison hadn’t shown up at the regular daily sick call a couple of hours earlier.

“He told me this guy was so dismissive and rude to him. ‘You need to follow procedure. You should have been here hours ago,'” Rebecca says. “Ian wanted to tell the doctor he was anxious, depressed and couldn’t sleep, but this guy shut him down.” Morrison acknowledged only his sleeplessness, leading the doctor to give him 10 sleeping pills with orders to return the next week. He’d be grounded for the time being.

But that didn’t seem to affect his mood. Morrison toasted his wife’s success on a big exam that day–she was close to earning her master’s in psychology–by cooking a steak dinner and drawing a bubble bath for her that night. “He was dancing around and playing music and celebrating for me,” she remembers. “He seemed really hopeful.” He took a pill before bed but told Rebecca in the morning that he hadn’t slept.

On Tuesday, March 20, Morrison tried to enroll in an Army sleep study but was told he couldn’t join for a month. “Well, I’ll just keep taking Ambien and then go see the flight surgeon,” he told the woman involved with the study. She asked if he felt like hurting himself. “No, ma’am, you don’t have to worry about me at all,” he said. “I would never do that.” That day, Morrison typed an entry in his journal: “These are the things I know that I can’t change: whether or not the house sells, the state of the economy, and the world … these are things that I know to be true: I’m going to be alive tomorrow, I will continue to breathe and get through this, and God is sovereign over my life.”

Rebecca awoke the next morning to find her husband doing yoga. “I’m self-medicating,” he told her. She knew what that meant. “You couldn’t sleep again, huh?” Rebecca asked.

“No,” Morrison said. “I’m going back to the doctor today.” Given the lack of success with the medication, she told him that was probably a good idea. She left the house, heading for the elementary school on post where she taught second grade.

A System Overwhelmed

The Army reported in January that there was no way to tell how well its suicide-prevention programs were working, but it estimated that without such interventions, the number of suicides could have been four times as high. Since 2009, the Pentagon’s ranks of mental-health professionals have grown by 35%, nearing 10,000. But there is a national shortage of such personnel, which means the Army is competing with the VA and other services–not to mention the civilian world–to hire the people it needs. The Army has only 80% of the psychiatrists and 88% of the social workers and behavioral-health nurses recommended by the VA. Frequent moves from post to post mean that soldiers change therapists often, if they can find one, and mental-health records are not always transferred.

Military mental-health professionals complain that the Army seemed to have put its suicide-prevention efforts on the back burner after Chiarelli, a suicide fighter, left the service in January. “My husband did not want to die,” Rebecca says. “Ian tried to get help–six times in all … Think about all the guys who don’t even try to get help because of the stigma. Ian was so past the stigma, he didn’t care. He just wanted to be healthy.”

The Breaking Point

On March 15, McCaddon gave a medical presentation that got rave reviews. Then he called Massachusetts to speak to his children and sent Leslie that last e-mail. He regretted his failures as a husband, as a father. Don’t tell the children how I died, he begged her. “Know that I love you and my biggest regret in life will always be failing to cherish that, and instead forsaking it.” Leslie read the e-mail in horror. “In the back of my mind, I’m saying to myself, He’s at work–he’s safe,” she recalls. “It never occurred to me that he would do what he did at work.” But she immediately dialed the hospital’s delivery center. She had just received a suicide note from her husband, she told the doctor who answered, and they needed to find him immediately. The hospital staff fanned out.

“They’ve sent people to the roof, the basement, to your house. We’re looking everywhere,” a midwife told Leslie in a call minutes later. As they talked, Leslie suddenly heard people screaming and crying in the background. Then she heard them call a Code Blue. They had found him hanging from a noose in a call room. It had been less than 30 minutes since McCaddon had sent his final e-mail to his wife. Among the voices Leslie thought she recognized was that of McCaddon’s commander, whose words came rushing back. “Does it seem like a family issue to her now?” Leslie remembers thinking. “Because it looks like it happened on her watch.”

It took 15 minutes for the first responders to bring back a heartbeat. By then he had been without oxygen for too long. Leslie flew to Hawaii, and Captain McCaddon was taken off life support late Tuesday, March 20. He was pronounced dead early the next day.

That same day, Wednesday, March 21, Morrison saw a different Army doctor, who in a single 20-minute session diagnosed him with clinical depression. He got prescriptions for an antidepressant and a med to treat anxiety but hadn’t taken either when he called his wife. Rebecca encouraged him to stop by the resiliency center on post to see if he might get some mental-health counseling there. Just before noon, Morrison texted Rebecca, saying he was “Hopeful :)” about it. She wanted to know what they told him. “Will have to come back,” he responded. “Wait is about 2 hrs.” He needed to get back to his office.

Rebecca was still concerned. At about 4 p.m., she urged her husband to call a military hotline that boasted, “Immediate help 24/7–contact a consultant now.” He promised he would. “I said, ‘Perfect. Call them, and I’ll talk to you later,'” Rebecca says. “He was like, ‘O.K., bye.'”

That was the last time she ever talked to him. Their final communication was one more text about 45 minutes later. “STILL on hold,” he wrote to her. Rebecca responded moments later: “Can’t say you’re not trying.”

Morrison called Rebecca at 7:04 p.m., according to her cell phone, but she was leading a group-therapy session and missed it. He didn’t leave a message.

Two and a half hours later, she returned home from her grad-school counseling class. She threw her books down when she entered the living room and called his name. No answer. She saw his boots by the door; the mail was there, so she knew he had to be home. “I walked into our bedroom, and he was lying on the floor with his head on a pillow, on my side of the bed.” He was still in his uniform.

Rebecca stammers, talking softly and slowly through her sobs. “He had shot himself in the neck,” she says. “There was no note or anything. He was fully dressed, and I ran over to him and checked his pulse … and he had no pulse. I just ran out of the house screaming, ‘Call 911!’ and ran to the neighbors.”

The Next Mission

At a suicide-prevention conference in June, Panetta laid down a charge: “We’ve got to do everything we can to make sure that the system itself is working to help soldiers. Not to hide this issue, not to make the wrong judgments about this issue, but to face facts and deal with the problems up front and make sure that we provide the right diagnosis and that we follow up on that kind of diagnosis.”

But what makes preventing suicide so confounding is that even therapy often fails. “Over 50% of the soldiers who committed suicide in the four years that I was vice [chief] had seen a behavioral-health specialist,” recalls Chiarelli. “It was a common thing to hear about someone who had committed suicide who went in to see a behavioral-health specialist and was dead within 24, 48 or 72 hours–and to hear he had a diagnosis that said, ‘This individual is no danger to himself or anyone else.’ That’s when I realized that something’s the matter.”

There’s the horrific human cost, and there is a literal cost as well. The educations of McCaddon and Morrison cost taxpayers a sum approaching $2 million. “If the Army can’t be reached through the emotional side of it–that I lost my husband–well, they lost a $400,000 West Point education and God knows how much in flight school,” Rebecca says. (The Army says Morrison’s pilot training cost $700,000.) Adds Leslie: “They’d invested hundreds of thousands of dollars into this asset. At the very least, why didn’t they protect their asset?”

Captain McCaddon was buried with full military honors on April 3 in Gloucester, Mass. A pair of officers traveled from Hawaii for the service and presented his family with the Army Commendation Medal “for his selfless and excellent service.” Leslie and their three children also received the U.S. flag that had been draped over his casket and three spent shells fired by the honor guard. They visited his grave on Father’s Day to leave flowers, and each child left a card. After two years of chemotherapy, their oldest child’s leukemia remains in remission.

Captain Morrison was buried in central Texas on March 31. The Army had awarded him several decorations, including the Iraq Campaign Medal with Campaign Star. There were military honors graveside, and a bugler played taps. At his widow’s request, there was no rifle volley fired.