While serving in the United States Marine Corps, during training, Silouan Green had just taken off when his jet caught fire, forcing him to eject. During the crash, his copilot died, and Green’s back shattered. Although he was in agonizing pain, doctors at the nearby Oceana, Virginia, hospital didn’t do an MRI, misdiagnosing the extent of the damage he sustained during the crash. “When I returned to flying again, I was in pain all the time,” he said. He also had survivor’s guilt.
After realizing they’d underestimated Green’s injuries, the Marine Corps sent him to the Wilford Hall United States Air Force Hospital in San Antonio, Texas, which, at the time, specialized in flight injuries. The experience separated him from all that was familiar—the Marines and his family. He also was unsure if his career had come to an end. “I didn’t know if I would ever be able to fly again,” he said.
As the days in the hospital stacked on top of one another, Green deteriorated. The worse he felt physically, the worse he also felt emotionally, and vice versa. “When I was depressed, I wouldn’t work out, which caused me to be in more physical pain, and, in turn, I became more depressed.” The doctor gave him prescriptions for Percocet, Vicodin, and Zoloft, adding to the collection of medication he had from the previous hospitalization.
“The day I received a disability discharge, I had a hundred pill bottles on my bedside table,” he said. “I wasn’t thinking about suicide—just that this sucks.”
Green’s physical and mental health symptoms worsened, but he didn’t want to talk about it; nor did he believe anyone would understand. “I was in a lot of pain but also felt weak for struggling,” he said. When he met with an Air Force psychiatrist, the appointment was quick, and the doctor made little eye contact with him. “He asked me these ‘how do you feel on a scale of 1 to 10’ questions.” The doctor finished the evaluation and handed Green his medical record to take to the Navy clinic across town.
“When I got into my car to drive to the clinic, I opened up the medical record,” he said. “There’s a cover sheet over the evaluation, and scribbled across it in big letters is: severe post-traumatic stress disorder—will probably kill himself.”
Weeks later, when Green returned home, his commanding officer was outraged by the diagnosis. “He asked me if I was a baby,” he said. “Spit was flying out of his mouth.”
Instead of feeling outraged at the commanding officer’s treatment of him, Green believed he was right. “I thought, well, I must not be tough enough.” He returned to outpatient housing and made a suicide plan. “I had a gun collection and decided, ‘I’m going to check out,’ and a couple of times, it was close.” Thankfully, Green soon met a military psychiatrist who he says helped save his life.
The doctor worked to get to know Green, pushing him not to get hung up on labels. “So many veterans have issues with labels,” he said. “I had started to think I was PTSD and suicide. That’s who I’d become.” He says that being in the military is an identity, and when that’s shed, there’s an identity vacancy. “Even if my diagnosis is an identity that could kill me, it’s an identity, and the alternative was scary.”
Today, Green is a suicide prevention advocate. He works with law enforcement and other first responders who, like people in the military, often experience trauma and see their job as core to their identity. According to an article in the journal Policing, law enforcement have a higher proportionate mortality ratio for suicide than other workers. The study, looking at death certificate data for over 4 million people ages 18 to 90, found that law enforcement were 54% more likely to die by suicide. Black, Hispanic, and female law enforcement personnel had the highest proportionate mortality ratios.
The study included retired police officers. When police officers retire, they feel a profound loss of identity, said Green. “It’s arguably worse for cops and firefighters than even people coming out of the military because there is no Veterans Affairs available to them.”
“One day, you’re at work,” he said. “The next day, you’re home.” “Whatever’s in your head a lot of times, you’ll suddenly have to deal with it because you no longer have the routine, the identity, or the comradery you had before. And you’ve been given no tools on how to unpack it.” (There are innovations and programs to help first responders debrief after traumatic calls. Among them is Grand Mental Health’s “mental health machine iPads.” The Certified Community Behavioral Health Clinic distributes the iPads to first responders and hospitals, helping connect people in crisis with the center’s crisis line. If a first responder needs to debrief, they simply press a button on the iPad to get professional counseling.)
Green highlights that the military psychiatrist he worked with didn’t just teach him tools but also provided care and connectedness. That’s the most vital component of suicide prevention, he said. “People aren’t looking for a counselor. They’re looking for a reason to live. They’re looking for social connection.”
While informal and formal connectedness can be life-saving, Green believes both must be in place to help veterans and retired first responders. “We have to be intentional about providing help and connection to combat suicide and the growing number of deaths of despair,” he said. “Many of us are drinking ourselves to death.” Deaths of despair include suicide and drug- and alcohol-related deaths, a growing focus of the Department of Veterans Affairs. In 2020, Dr. Ira R. Katz told #CrisisTalk that the agency is evaluating the increased mortality associated with mental health conditions in veterans, including deaths of despair. When Dr. Katz and his colleagues examined all-cause and cause-specific mortality after discharge from psychiatric hospitalization, they found the rates of other external deaths were higher than the suicide rate among younger veterans. “In fact, deaths from accidental overdoses and injuries were more frequent than deaths from suicide,” he said.
Green says deaths of despair similarly impact first responders. He shares the story of a police officer who spent his hours outside of work watching TV and drinking beer. “He’d get home, grab a beer, turn on the TV, and just sit there,” he said. Then, when night came, the man would turn off the TV and go to bed. “Then he repeated it for four years. Nobody knew.”
That’s why Green works with police sergeants to create buddy systems where officers check in with one another. “You just have to get the person in front of you outside of work to see how they’re doing and ask, ‘How’s your family, health, finances, faith, or whatever,’” he said. That’s part of regular mental health maintenance. “If you hear crickets, you know something is going on.”
When someone is in the midst of mental health challenges, they feel no one cares, said Green. “They feel no one understands what they’re going through and that they’re walking through life alone. That makes it hard to connect with someone.” The buddy system helps foster connection and what he calls the power of being known by another.
“People feel more valued, more validated,” he said. “They suddenly feel like someone cares.”
Learn more about Silouan Green at MASoS Film, episode one.