Condolence letters for suicides fuel debate over war wounds

President Obama's decision to send condolence letters to the families of troops who commit suicide in Iraq or Afghanistan will fuel the ongoing debate about what it means to be wounded in combat and whether psychological maladies like depression should be accorded the same respect as physical injuries like scars or lost limbs.

The White House move comes after years of lobbying by the families of the more than 1,000 military personnel who have taken their own lives since the start of the two wars. In a written statement, Obama said he was "committed to removing the stigma associated with the unseen wounds of war" suffered by the troops who committed suicide in recent years.

"This issue is emotional, painful, and complicated, but these Americans served our nation bravely," Obama said. "They didn't die because they were weak. And the fact that they didn't get the help they needed must change."

Like its predecessors in the Bush White House, the Obama administration has been haunted by an ongoing spike in military suicides. The Pentagon has spent hundreds of millions of dollars to develop new military-wide training programs and hire thousands of additional mental-health personnel, but troops continue to kill themselves at record numbers. In 2010, 301 active-duty, reserve, and National Guard soldiers committed suicide, up from 242 in 2009. In 2008, the military's suicide rate exceeded that of the general population for the first time ever. The latest civilian figures from the Centers for Disease Control and Prevention are through 2006.

Beyond the grim statistics, the military's suicide epidemic poses a series of painful and complex questions that the White House and Pentagon are still struggling to answer. Under Army policy, the families of troops who die on active-duty-whether in combat or suicide-are entitled to receive the same death benefits and military burials, complete with folded flags given to their loved ones by a white-gloved honor guard. Informally, though, some relatives of troops who committed suicide have complained of being ostracized by other bereaved families or of having individual commanders choose to leave their loved one's name off unit memorials or other public monuments dedicated to troops who fell in combat.

The question of how the military should look at suicides is a subset of a broader debate about what it truly means to be a casualty of Iraq or Afghanistan. With troops serving repeat deployments in the grinding guerrilla conflicts, psychological maladies like post-traumatic stress disorder and hard-to-spot physical injuries like traumatic brain injury are emerging as the signature wounds of the long wars. In 2008, for instance, the RAND Corporation estimated that one out of every five Iraq and Afghanistan veterans have symptoms of PTSD or major depression. Both are closely linked to suicide. But some suicides had little to do with deployment. In its studies the Army found 79 percent of army suicides occurred within the first three years of service, whether soldiers were deployed or not.

Many within the military have been pushing senior commanders to treat troops who suffer invisible wounds like PTSD more like those with traditional injuries like lost limbs. In the summer of 2008, for instance, then-Defense Secretary Robert Gates said the military should consider awarding the Purple Heart, one of its highest honors, to veterans with PTSD. Supporters of the move argued that the change would reduce the stigma that surrounds the disorder and prevents troubled troops from seeking help; opponents argued that it would cheapen an award intended exclusively for those with physical injuries. In the end, the Pentagon dropped the idea.

Still, the debate about mental health and military suicide has only intensified in recent years as more troops took their own lives.

In the summer of 2009, 25-year-old Army Spc. Chancellor Keesling sent a chilling e-mail to his family with the subject line, "I'm sorry for everything." A few hours later, he walked to a portable latrine on his base in Iraq, placed an M-4 assault rifle to his head, and pulled the trigger. Weeks after his death, Keesling's parents received his personal effects. When they went through his uniforms, they found an Army-issued suicide prevention card in one of the pockets.

Keesling's parents said Obama's failure to send them a condolence letter compounded the grief they felt after their son's suicide, and they spent the past several years lobbying the White House to change its rules. Their quest drew support from a bipartisan array of lawmakers. In 2009, for instance, Republican Rep. Dan Burton and Democratic Rep. Andre Carson, both from Indiana, wrote joint letters to the White House asking Obama to reconsider the policy.

Gregg Keesling, Chancellor Keesling's father, said in an interview that he hoped Obama's move would reduce some of the stigma within the military that surrounds troops seeking mental health assistance. He was particularly moved by the president's blunt statement that troops who committed suicide "didn't die because they were weak."

"My son died because he was too strong to admit that he needed help, not because he was weak," Keesling said. "If Chance had died from food poisoning, the condolence letter from the president would have been a small way of saying to the public, 'this is unacceptable and needs to be fixed.' But when it came to suicide, it was as if the president was saying it was a lesser kind of death. Hopefully, the new rules will change that."

Gregg Keesling said the rule change was a "bittersweet moment" for him and his family because it won't bring his son back to life or lesson the lingering pain of his suicide. Still, he expressed optimism that the shift would lead other troops contemplating suicide to seek help. Such a change in the military's culture, he said, would help to properly honor his son's memory.

"It would mean the world to us if that happened in Chance's or because of his death," Keesling said. "No family should have to lose a child this way."