- freely available
Int. J. Environ. Res. Public Health 2019, 16(21), 4274; https://doi.org/10.3390/ijerph16214274
Go ahead and throw moneyYou don’t hear meYou have all the answers, you seeBut still you don’t hear meYou know it all booksmarts of societyProfessionals are real good at talking, but not hearing meAs long as you can change my identity….You label me with anxiety, depression, PTSDThis lifelong cycle by society is not capable of hearing me….You’ll wonder why then you didn’t listen to me….Hank Wentz
1.1. Evolution of Suicide Prevention Policy: Staking a Claim in Pathology
1.2. Implications of Suicide Staking a Claim in Pathology
Meaning Interpretations: Analysis
- Each transcript was read individually twice with a focused interest of pulling out the descriptions and experiences related to the military workplace and services, with emergent themes created in the margins for each transcript
- Placed together in an excel, one tab for each person, all the experiences related to policy were captured with emergent themes with beginning dialogue of what is common and not so common among the group
- The development of moving from individual analysis to group analysis, placing themes and looking across the group, connecting experiences to policy mandates.
- Organization of a paper trail, from initial review and comments of transcripts, emergent themes, and quotes, tracing from individual to group analysis
- Development of full narratives, drawing heavily on participant descriptions
3. Collaborators’ Lived Experiences Categorized into Themes
3.1. Theme One: Lack of Confidentiality of Service Members in the Workplace
3.1.1. Subordinate Theme A: Ripples of I’m Tired of Being Told I Can’t Do Something When I’m More than Capable of Doing It
Trish:So, I was kind of labeled, like when you’re in high school and you’re labeled as the kid that can’t do anything, put in the corner. That was me. Everybody treated me like I was some fragile victim that they couldn’t trust to do anything because they didn’t know when I was going to fall apart. When I had proven to everyone that I didn’t have panic attacks at work, I was still fully capable of doing my job and I fought for three years to prove to everyone that I was capable of living and working and it was so stressful and so time consuming and drained me so much all the time because nobody wanted to trust me or give me the big project that would help me with my career and they wanted to give me the office filing work because they didn’t want to put me under too much stress…so when I got to my second base I didn’t say anything about my past”.Gummo:To take it even further as a part of pararescue men, if we go and seek help, they ground us so now we cannot do our job. If I go and tell them that I have nightmares of combat experiences, they take me off the flying status and I cannot do my para-rescue duties so it further isolates and reduces meaningful existence.”
Most important is on a team, a Special Forces team, a Green Beret team, whatever. Any form of mental weakness, especially, when I was serving in these rotations and stuff, number one, your security clearance was at risk and folks still even feel that way, even though that taboo is supposed to be gone…if you take them off of that team, you just took their life. What they’re going to do is self-medicate. They don’t want to expose that to anybody, to their wife, anybody.
As a matter of fact, when I went to the ER…and I was having all of these physical things going on, one of the Flight Surgeon doctors called me and he said, “I’m going to give you a prescription of this stuff called “planipan” or whatever it was called and I’m not going to put it in your medical record…
…But I do understand why people don’t seek help. Especially military soldiers, because I’ve seen sometimes people treat the military as their sole career and it is probably their last option or choice and they don’t want to screw it up. The military is all about perception, and they don’t want anything that is deemed dysfunctional or defective…Anything that’s not considered “normal” is dysfunctional or defective, and that is not allowable in the military. Some people try to hide it.John:My sister is a psychiatrist, so we would joke about it for years. “As soon as I’m done with the Air Force, my first appointment is going to be with a psychiatrist so I can get on pills.” We would laugh about it, but that’s really how I felt. I’m a pilot, so it’s against our nature completely to accept medication of any kind because that involves waivers, you’ll be grounded…There’s a negative stigma with it. I wish it wasn’t that way, but if you’ve got somebody who says…It’s common sense that the squadron is full of type-A personalities, a bunch of pilots. If a guy says, “I’m a depressed case. I see a psychiatrist. I’m on these pills. I can’t fly for six months until I get a flight waiver approved,” it’s like, “Oh, jeez, dude. Sorry. Go sit in that back office over there and work on awards and decorations until you get your life figured out and can fly again.” (imagine writing awards and decorations for other members in the unit to progress in their careers, as your career is diminished). That’s the harsh stigma of being in.
The stigma is service wide. I think it’s less than it used to be because there has been a lot of success with it but at the same time when good people are put through the wringer for seeking the treatment that just increases the stigma and it makes people want to not recommend it and not do it themselves because it can have a huge negative impact as opposed to just figuring things out on a different level…If I would have known that this whole situation would have happened there’s no way I would have went to mental health and there’s no way I would have recommended it to anybody else either. The stigma is use.
Gummo:Just a young infantryman, a young grunt, he wouldn’t want to speak up because then he thinks his weak. Whereas most of the guys in my career they’re a little more mature and so they see past that. It’s not weakness, it’s just really just basics of, “Well, I’m ending my career if I do this.” It’s not who gives a shit if someone thinks I’m weak or not, that’s irrelative, it’s career ending…When they’ve got a wife and kid that’s hard to swallow.
…If you think that I’m embarrassed (for taking psychiatric medication), you’re out of your mind, but it was a taboo and a stigma. At that point in the game (nearing retirement and higher ranking), I didn’t care because I figured, who’s going to come up and challenge me? Bring it, is the way I looked at it…I do yoga. Would I come out here and tell a bunch of Green Berets on my team that I go home each night and I’m doing 30 minutes of yoga? No. I might now, but back in the day? Absolutely not. You went to the gym, and you ran 20 miles with 100 pounds on your back and threw it off and said, “That didn’t hurt.” You’re not going to say, “I go and watch the sunset.” No. It’s just not something you do. You’re surrounded by warriors, and at a minimum, you’re going to maintain that outward appearance and that dominant, Alpha male presence, period.
I would love to see that change because you can’t persist and say, “Hey we’re here to help you, we care about you, you’re a member of our family” if you will but then turn around and completely disregard everything you just said. That’s my two huge things is that as long as we’re still able to do what we’re supposed to be doing we shouldn’t be judged any differently. The fact that the whole Air Force philosophy of being honest and open and seeking help and being a wingman that needs to be followed. It’s not one of those things that you can just say because it sounds good. That’s why there’s a stigma is because people are concerned that they’re going to be just treated differently, that they’re going to risk their careers.
3.1.2. Subordinate Theme B: Units Being Super Supportive and/or Not
…I had to tell them what was going on and that’s when they were like, “You could have told us from the beginning. Everything’s okay. We’re here for you. Here’s our numbers. Here’s this. Here’s that. Hopefully everything works out. You should check in with us while you’re gone.” And that’s when I realized that I could have told them the whole time, but because of how terrible the experience was at my first base and how I hated feeling like a victim, I didn’t say anything…
…They also valued my privacy which was a big thing because in the military you really don’t get a lot of privacy. At my second base the leadership was really big on making sure that even when they called me into the office to talk about some stuff, they would say that they were going to talk to me about something else just in case somebody heard something. They’d be like, “Hey, do you have a minute to talk about this thing that we’re working on?” And I was like, “Yeah. Sure.” Go to their office and they’d be like, “Hey, are you okay?…That cut down on a lot of my stress and anxiety because I was able to actually trust some of the people that I worked with which, at my first base I wasn’t able to do.….It was the best people ever. I felt a lot more support. I wasn’t as depressed all the time because I wasn’t just dreading going into work because I enjoyed going to work. The people cared; the people were nice. They wanted to help, and they knew that I was going through a lot and they weren’t treating me like I was different. They were still trying to give me a job to do and keep me busy and do as much as they could on the side to make sure that I was okay.
McKenzie:Things were at their worst; my command went from super supportive to non-existent and my first shirt (sergeant) and the other co-worker have been really the only two who’ve not abandoned me in the whole process….Take for instance the first time I was in-patient my command visited every week, like older colonels visiting driving two hours each way. They visit every week; they called every week and then the second time not only did the calls never come the visits only came when they had to. When I got out they literally isolated me from every person I knew. They themselves would sit and look at me with one of those, yeah, okay I’m hearing it or I’m listening but not really paying attention to what you’re saying type stares. There was never two-way conversations. The fact that even today one person from my old unit we talk, there’s a couple of people that will be cordial and they’ll be like, hey how was your day kind of thing but never in-depth about anything.That’s the majority of the people won’t have anything to do with me. They literally will walk down the hall right past me not smile, not nod, not say hey, how was your day? You treat strangers better than my old unit treats me and I never did anything wrong. That whole we’re here for you line is a complete load. I don’t know, that’s huge for me because I was just like I know at least in the past being in the service it meant something. It was that family, that sense of security and pride and it’s turned a huge corner and becoming just another corporation and yet I still want to stay.”…Okay, we’re going to get you through this.” Then to turn around and have them completely abandon you it’s like, oh, another learning curve of just because somebody starts out showing that they care for a lack of a better word doesn’t necessarily mean that they’re true and loyal to what they’re saying. Their actions have to continuously match their words.
….It wasn’t as negative as I thought it was going to be. I was expecting I was going to get out of that detox ward, I’d have letters of reprimand, article 15s for dereliction of duty, all of this stuff. I was very paranoid that the bender I went on…I called off sick for two days while I was going through this bender. I was paranoid about that. It was a really different response from my chain of command. I’m an executive officer at a group level, so I’m working directly for an 06 (Colonel). He came down and saw me. His response was pretty amazing. He didn’t give me any formal paperwork. There was no letters of reprimand, article 15. He basically gave me a slap on the wrist. About the most negative thing that happened was, they had me in line to be a Director of Operations at one of the XX squadrons, so he put the kibosh on that.…It was a real good wing-man concept. In a way, it was a success story for the leadership. I felt that’s why they praised it. Here’s a guy who’s struggling. Here’s somebody who intervened. Self-admitted, got treatment. They said, “Given the circumstances, you did the right thing. If you do it again, you’re going to get crushed.” That’s basically what they said.
3.2. Theme Two: Unit Members Surveillance and Command Directed Evaluations
My previous commander gave me a set of initiating protocol, like the Command Directed Evaluation (CDE), I had to get a CDE evaluation where the mental health clinic was basically in charge of stating if I’m still able to continue my career…he did initiate it. He saw that I was seeking treatment and he saw improvement. He didn’t think it was necessary (to be discharged). I got a bunch of awards, I passed my test…what initiated the (2nd) CDE evaluation for the briefing I got from my new commander, is he saw that I was receiving…The (new commander) saw that I was getting, not written up, but counseled a lot, like verbal counseling from my supervisor over minor, trivial stuff like hair…what else…and there was other things that were mentioned that I’m fighting against because the way she (supervisor) worded it made it seem like it was just over exaggerated and false information. He was wondering if all those allegations that were made by supervisor was regarding my mental state. I’m like, “How is having your hair wrong…” and these allegations, that I propose are wrong, contribute to my mental state? I’m perfectly fine. You know?”
The day that I went to see mental health had been a really tough week for me and then my supervisor, flight commander and flight chief ganged up on me unexpectedly and were like, “You need to see somebody either the chaplain or mental health”…not forced me to go but basically said, “Hey we’re telling you to go kind of thing.” Once I was there, I’m like, ‘I might as well just be honest and say everything that’s been going on kind of thing.’ I think it was to the point where if I didn’t volunteer to go they would have command direct me to go so again that’s one thing that I don’t want any kind of negative outcomes because they’re telling me I have to go. If I volunteer then that shows that I am straight up and willing to get help and just being the honest, straightforward person that we’re supposed to be as we serve.
“They also got involved…what really set it off is when I had an altercation with these two airmen that I caught gossiping at work about myself and my…it was not only about myself, but it was also about the Non-Commissioned Officers (supervisors) during that time. I caught these two airmen gossiping, I got upset and I confronted them…and there was a portion that was mentioned during their little gossiping session about why I was going to so many appointments, because I had a high interest list. I told them why I was on the high interest list.I told them the reason I was always going about, running about, was because I guess that I could trust them, like I could involve that information because I could trust them. I told them the reason why I’m gone so much and the reason why leadership…although they know about it, it’s okay with them, you don’t have a right to be doing this because you really don’t know what all is going on. The reason I’m doing this is because I’m on a high interest list which is for people that are on suicidal watch because they are thinking of attempting suicide or have suicidal thoughts and I guess what rung into his mind was, “Oh, suicide, suicide, suicide,” you know?”He set the alarm for everybody. He contacted my first sergeant, he contacted my supervisor, both of them did. They didn’t call my phone because I was so tired of arguing with them and teaching them what is right and what’s wrong, that I just left because I was exhausted. You know how you hard it is to educate, I was like you know what, I feel like I’m just repeating myself, I need to leave and just take a break, so I just left. I was going to somebody’s house, a friend of mine…another airman’s house that I was okay to talk with at that time, because there’s usually a person who I would go and vent to and I was on my way, I get phone calls from not only my supervisor, my first sergeant and stuff like that. “Are you okay? You’re not thinking about committing suicide, because that’s what the airman told me, that you were thinking about something…” you know. I never said I was committing suicide; I’m just going to an airman’s house right now.
At that time, it was an education piece for me, as the leader of the company, was I brought them all in there I said, “It pains me to be on the lookout for this. Yeah, there’s nothing wrong with drinking a beer after work or whatever, that is still a normal thing, but when you see a guy walking around with a cup all day…You need to realize that we have been at war for 15 years and maybe he’s doing exactly that. Maybe he is self-medicating. I’m not saying send him to the shrink because he’s not going to go. He just won’t drink in front of you anymore, he’ll go hide it. You can be a little bit smarter and try and out shrink the shrink there a little bit…The leadership in these environments need to me more in tune with their people, and when they see these red flags, figure out methods to extract information and even provide assistance without letting on that you know what the problem might be because that would mean that he’s exposed now and you could even exacerbate the situation.
That wouldn’t work here. It wouldn’t work at all because that individual, again, his intelligence level is way up there or he wouldn’t be here. He will go over there to check that block, he will convince the shrink that he is beyond good, and he will come out of there and it will cause more damage. I’m not trying to say these are a bunch of Einsteins around here, but we purposely select above average intelligence folks, and the guys that are here are extremely intelligent. A lot of them have advanced degrees, masters, doctorate degrees, and they’re E6s. You’ve got some crazy smart people here that know how to…in special forces, probably one-fifth of the job is your ability to bullshit somebody. That’s just a fact. You’ve got to go work with indigenous people from other countries and convince them to work for you or die for you to make their country better. If you put that into context, it’s pretty easy to navigate around a psychiatrist.
When I came back from the ER, the whole command knew it was all stress-related, and two weeks later, I was back fighting in Afghanistan. Of course, I would’ve have wanted it any other way, but somebody in that command should’ve said, “You’re going to take a break.” They should have. I would have fought them tooth and nail, but the reality is they should have said, “There’s red flags going off all over this guy, now to where it’s translating into physical problems. He’s thinking he’s having a heart attack and we’re just sitting there yapping,” I was sitting there talking to my company commander. Next thing you know, I’m back charging up mountains two weeks later. He didn’t know no better, and of course, he asked me, “Are you good?” What do you think I’m going to say? “Absolutely, I’m golden.”
3.3. Theme Three: Military Mental Health Services: Diagnosis and De-Contextualization of Experiences
3.3.1. Subordinate Theme A: Loss of Ability to Articulate Humanity to the Authority of Pathology Language
The thing is with the diagnosis it’s…because I’ve read everything. It’s not so much that I have the disorder; it’s the way that they worded it that it’s so severe that I can’t function in a military environment which is completely BS (bullshit) because I am doing just fine. It’s the fact that here, here’s this diagnosis and we’re just going to lop all kinds of crap onto it to make it seem like you’re completely unstable…Then the paperwork dropped for the discharge and I filed a congressional…and I filed a congressional complaint. After that, she (the military mental health provider) was like, ‘We can’t work together anymore’ because it was like me attacking her license and decisions, which is the exact same thing they were doing to me…As I said earlier, the first time I went to mental health the two providers were anything but therapeutic or sympathetic or I felt very attacked by them just based on what they were saying and how they were saying it. It made me shut down where I’m like, “I’m not going to say anything”.
They diagnosed me as…well, they diagnosed me on base as schizotypal disorder, a schizotypal personality disorder, where I…very odd, had an odd…which is very…I just don’t agree with…Well, there’s a diagnosis that you really don’t have proof that you had that diagnosis. I got a different diagnosis from taking a test, two tests from the VA hospital, and I got a diagnosis, and it said those tests were valid. Therefore, this is what she has, we constructed a treatment plan to help her, but when you share those same notes to somebody else and they come up with a different diagnosis and they try to construct a…I guess their treatment plan, (on base mental health) they called me schizo typo and just don’t agree with it. I don’t agree with what you’re saying. I don’t agree with both of them because I’m neither nor one of those things. I’m neither avoidance or schizo typo, because later on in my visits, in my follow up visits with my VA clinic for the VA psychologist at the hospital. He filed my improvement because they had me on personal treatment at another clinic, and I told the lady that I just don’t…I stopped taking treatment at that time (on base)…
When it was reported to the new commander…the new commander ordered a Command Directed Evaluation (CDE) on me, so he scheduled…he called me into his office, briefed me on what he was about to do, the very next day I went up to the mental health clinic where my supervisor…because I had new supervisor at that time too…he got me to the clinic, they had me sit there and do a 560 question test. I don’t see how it would normally take 45 minutes to do a 560 question unless they were really bored, and they just started clicking. It took me at least two hours to complete…When I was done a psychologist that was there, I’d never seen her before…I never talked to her, I never had any visitation, she was this person I’d never seen. She asked me some questions I guess to get a sense of my background, then she dismissed me for lunch and I came back and heard the results of the test and she told me that it seemed like I was making over…the answers I was giving or putting on the test, like I was over esteeming myself, like over…shining myself in a good light. It was based on how I was feeling that day. I was going based on how I was feeling. There’s a big difference…She said, ‘it was just how the test was…’ in the test, if you answer questions that normally other people would have answered the same way, it will trigger something within the test to make it seem like you’re lying or you’re trying to go with the test…I was upset because I was just thinking about going through all of the questions all from that day, I was so upset. Of course, they probably documented my response to that. I was just so upset. I think anybody would be upset when she put it on paper, it made it seem like I was just…I just went off, or something like that. That I was unstable. She was going to use my previous test I’d taken at the VA clinic, and I pushed…why would you use answers from my test, you know, use answers so that I take another test? Why can’t they just use the one on how I’m feeling now?…I’m like, “It’s not about the test, it’s about my improvement…improved over the month. You’re not looking at my improvement, you’re looking at when I was not feeling at my best.
Gummo: You’re a liability to them and that’s really what the function that they serve as. A provider for the military is basically just there to judge liability or not……Yeah it’s difficult and then at the end of all that, at the end of your career you’re like, “Okay here’s what going on.” (turning in all the civilian healthcare documents). They’re turning in all these papers. They are going to turn in all of my documentation. It’s here you go. That’s very telling. It’s like, “Holy smokes” and that’s the position that I’m in right now.” You’re like, “Okay, you’re going to get medically boarded (medical panel that makes decisions on fitness of service member to continue to serve).” It’s like, “All right, do whatever you got to do.”
3.3.2. Subordinate Theme B: I Am Your Textbook and Theory, Study Me
…All textbook, it’s all, you go to school, and it’s all textbook. It’s an ongoing training for doctors and psychiatrists, and psychologists, but the true professional can get into my head. The true professionals can get in there, and help me, just Google in the word help is, it’s not going to be there. It’s not going to work. The textbook…When you sit down with different doctors, and different psychiatrist and different psychologist. Hearing the same thing, over and over and over. Finally, you’re sitting back, and you’re kind of laughing about it, because nothing has changed. Everything is textbook, and it’s a check of luck and move on. Now I understand that this conversation that we’re having right here, is to maybe push this mental health, in a different direction, I think it needs to be pushed in this different direction.…It goes back to the getting of our conversation; they could research job or the individual prior to trying to help them. Go watch. I challenge you ladies, go watch History Channel, or Google, we go back to that Google, we can Google anything. Special forces, green berets, rangers, Navy SEALS, watch their training. Get a perspective…I think some of the things that they (mental health providers) would be missing, (my) life experience. Go see, go see…Have them therapist go see the training. Have these therapists go out of their office, go to the location of soldiers, get a little bit more perspective of what they do day to day, their mentality…
I would say this, and I’ve told this to several mental health providers that I’ve dealt with as a Sergeant Major. If you truly want to help these guys, especially where I’m at… Actually, it doesn’t matter where the person’s at, you need to look at the organizations that they come from and try and do your homework and understand the organization and what they do. Because my biggest frustration point is sitting there talking to somebody, and they have no idea in what capacity we function and what we experience and how we live and breathe.I would say do the homework on the patient, and in the military case of this, the organization in which they come from. Because each organization (and person) is different, and some of them are extremely intense like, the one that I’m sitting at right now, and others are very passive or pleasant or whatever. I’d say research the organization, what they’ve done and how they function, because you might better understand the person.…Because you feel like you’re not wasting your time. Like I told the military family life people is, if I’m going to take two hours out of my schedule, which I don’t have, to come to your office and talk to you, and you’re just going to tell me two or three things that came out of a book or I can Google search, what is either one of us getting out of this? Nothing. If you can understand me and get me to open up to you a little bit and dialogue with me and speak to me on the same level, for example, it’s a little bit different.In my personal opinion, a psychologist or psychiatrist should be an extremely intelligent person, and if they are, which I’m sure they are, they should do that homework and figure out, ‘How do I get into this guy’s brain a little bit to get him into the box that I want him at so I can help him?’
Again, I felt like talking to the therapist despite their good intentions and their dedication to the profession, I truly felt that it was fruitless…I immediately felt like I was barking up the wrong tree because whenever I went to see a counselor and not to minimize this person’s qualification or their experience or who they are as a human being but it was a really bad fit…I was trying to articulate some of my combat experiences to her and the surreal nature of my nightmares and my grief issues and I intermingled this with the overwhelming situation I have with having a special needs son. It was just a horrible fit, in fact I walked out of the first appointment. I was really disenchanted with it.I think a lot of my suicidal ideation came directly from the desperation of not seeking adequate help but the people that…What I mean by that is me not seeking but whenever I would go to the providers, they would completely offered no help whatsoever.…I wanted to feel as if someone understood what I had gone through and what I was going through and I did not feel that that was adequate and a lot of the providers themselves they were like ‘Holy smokes, this is surreal.’ In a very real way for us to even hear what you’re saying that you’ve been through let alone us attempt to help guide you through your emotions on this.…Again, it’s all about finding that right fit obviously but it’s very hard when no one else has experienced the things that you’ve experienced and so now they’re just applying theory to you.
…I need to feel that safety to know that I can talk about what’s going on and something positive is going to happen instead of either not talking or talking and it being used completely against me…It’s just them doing their job, which is very difficult when you’re in a very vulnerable place.
… I stopped taking treatment at that time. I didn’t want to do treatment anymore because it was almost as though she was, like I heard it before from the group therapy session.
4. Researcher’s Conclusions and Responses to Participant’s Descriptions
4.1. Criticality of the Language of Suicide with Pathology and Narrow Specificity of How to Help
4.2. Effects of Saturation of Literature Pushing “Evidence Based” Structured Frameworks
4.3. Stigma Created by DoD Policy
“A large number of the policies we reviewed prohibited specific job opportunities or actions if a service member had a Mental Health Disorder (MHD) or sought mental health treatment. For many of these policies, the language is unclear, stating only that a service member is prohibited if he or she has a mental health issue…In 12% of policies, we identified language that was pejorative and characterized MHDs and treatment in a negative light.”(, p. xxi).
5.1. Possible Ways Forward
- Military policy organizations revamp their internal mechanisms to include speaking with service members in each military specific mission as a critical means to inform policy efforts. Each mission is different in the effects of certain policy and unit contexts as the participants’ experience highlighted.
- In suicide prevention efforts, include service members at the local level to participate in the national level conversation and vice versa. Annually or every few years, we suggest employing a three- or five-day solution finding event at local units, not specifically focused on suicide per se, but to better understand local occupational and/or other cultural stressors (pay, housing, deployment schedules, work and family balance, and other base specific nuances), thereby providing local solutions to these nuances. This information could be useful to collect for policy makers to also utilize to make decisions that are mission and unit specific.
- DoD add to their local and national measures individuals’ experiences of therapy, and services provided to inform ongoing policy and services transformations. This is to compliment already existing outcome measures captured by the military.
- Consider removing the command and supervisor directed mental health evaluation mandates in DoD policy.
- Consider updating the DoD policy related to confidentiality, particularly in the workplace requirements.
- Consider rethinking the narrow specificity of utilizing CBT therapies outlined in the VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. As the clinical guidelines indicate, there is no interventions more useful than others in stopping one from committing suicide . In addition, all therapies work for some people and not others [37,38,39,43,44], the diversity in theoretical ideas and interventions could be celebrated in clinical practice guidelines.
5.2. Limitations of the Study
Conflicts of Interest
- Wentz, H.; You Don’t Hear Me. Anchorage Press. 2018. Available online: https://www.anchoragepress.com/opinion/you-don-t-hear-me/article_91a9f0ae-d2f4-11e8-8183-673c9da6b172.html (accessed on 12 December 2018).
- Marsh, I. Suicide: Foucault, History and Truth; Cambridge University Press: Cambridge, UK, 2010. [Google Scholar]
- Marsh, I. Critiquing contemporary suicidology. In Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century; White, J., Marsh, I., Kral, M.J., Morris, J., Eds.; University of British Columbia Press: Vancouver, BC, Canada, 2016; pp. 291–646. [Google Scholar]
- U.S. Department of Health and Human Services. National Strategy for Suicide Prevention: Goals and Objectives for Action; U.S. Public Health Service: Rockville, MD, USA, 2001.
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|Theme One: Lack of Confidentiality of Service Members in the Workplace|
|Subordinate Theme A: Ripples of I’m tired of being told I can’t do something when I’m more than capable of doing it.|
|Subordinate Theme B: Units Being Super Supportive and/or Not|
|Theme Two: Unit Members Surveillance and Command Directed Evaluations|
|Theme Three: Military Mental Health Services: Diagnosis and De-Contextualization of Experiences.|
|Subordinate Theme A: Loss of Ability to Articulate Humanity to the Authority of Pathology Language.|
|Subordinate Theme B: I am your textbook and theory, study me|
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