Suicide can be found in every culture at some point or another and is usually the result of complex factors that are social, cultural and religious as well as a result of mental health.1 According to WHO, the World Health Organization, suicide is responsible for almost 800,000 deaths worldwide every year. Between 1999 and 2014, in the United States the rate of suicide was 10.3 to 13 suicides per 100,000 people a year.2 Within the last ten years, Korea has had one of the highest suicides rates of 28.5 suicides per 100,000 people a year. 3 Within the population, those in the military are not immune, with suicide being the second leading cause of death in the US military. 4 It is therefore no surprise that suicide rates have raised public and professional concerns. However, suicide is a complex topic with multiple influencing factors. In order to understand the alarming levels of suicide in service members, it is important to reflect on the cultures surrounding those in the military, to understand how different countries’ handling of mental health affects the rates of suicides in service members. It is also important to compare whether voluntary or mandatory service might be a factor in the higher rates of suicide found in countries with mandatory service, such as Korea and Turkey, and those of voluntary service such as those in the US and UK.
Suicide is often a result of mental illness, and access to psychological help can aid in lessening the number of suicide deaths each year.5 Over the years several signature mental health wounds have impacted military service members. During the Civil War there was Soldier’s Heart, during World War I, there was Shell shock, during the Gulf War, there was Gulf War syndrome and during Iran and Afghanistan there was PTSD. Mental health in the military has not been a rare occurrence and yet, many times the cultural perceptions of mental health have prevented those suffering from reaching out for help.6 In an interview conducted during PBS’ series, War on the Brain, US veteran Soledad O’Brien, spoke of his struggles with accepting that he had PTSD and needed help. He said that one of the main things he learned from the military, was that as a leader he had to override pain and doubt; having PTSD was not something that he could identify with. In the military, he learned to fight through every challenge he faced, and he believed that PTSD was no different, he could simply fight it out on his own.7 This concept that, as a solder, admitting you have PTSD or mental health issues, portrays you as weak because you are not fighting through it, is a primary factor to many service members not seeking out help which can lead to dire consequences such as suicide.8
In the UK, social stigma against mental health is also prevalent. In a study conducted by Iverson et Al., they showed that many service members were afraid of getting help during and after their time in the military. Many reported they feared that their employers would blame them for their mental health. Service members currently in the military were afraid that the members in their unit would have less confidence in them if they sought help.9 South Korea and Turkey showed similar opinions on military service members and mental health. Negative cultural views on mental health, are impairing service members from seeking help, and this problem seems to be shared among the US, UK, South Korea, and Turkey.
The difference between the US, UK, South Korea and Turkey is whether their military is volunteer based or mandatory. The United States and the United Kingdom both have All-Volunteer Forces. South Korea has retained their draft mostly due to unresolved conflict and the feeling of constant threat from North Korea. Turkey has retained its’ draft for the same reasons, they are under constant threat by their surrounding neighbors.10 The UK was one of the first nations to switch from a draft to an All-Volunteer Force and was soon followed by many more, leaving those who opt to retain a draft as a shrinking minority.11 The changing to an AVF, in the US and UK, changed the societal views of the military from being negative to bringing a sense of respect and prestige.12 Due to the large amount of advertising and recruitment, and joining the military becoming a choice, there has been a heightened social regard toward those in the military.13 Surveys have shown that the military is seen as one of the most respected public institutions in Europe.14 This begs the question as to whether the positive view on the military and the ability to decide whether to join the military or not impacts quality of life and reduces the amount of suicides within the military.
In an article in The Guardian, Justin McCurry tells the story of Sergeant Lim who killed five colleges and was later pursued by troops and caught. Before being drafted he had been flagged as “special attention’ and was considered a suicide risk but was still drafted.15 Two weeks after this happened, two soldiers hanged themselves while on leave.16 Sergeant Lim’s case might be an isolated incident, but South Korea has been reported as having one of the highest rates of suicide in the military.17 This would suggest that having to join the military has led to decrease in quality of life and increased suicide rates. While this might be the case in South Korea, it would be inaccurate however to make this assumption globally, based on Turkey’s suicide rates. Suicide rates in Turkey make up only 1.72% of total deaths, this places them at lower rates of suicide than the United States.18 As a result, there is no clear indication that changing from a draft to an AVF has a significant impact on suicide rates. In order to reach a more definite answer, more research into several other countries and their militaries would be needed.
General Suicide rates
According to the latest WHO data published in 2017 Suicide Deaths in South Korea reached 16,078 or 6.56% of total deaths. The age adjusted Death Rate is 24.21 per 100,000 of population ranks South Korea #10 in the world- worldlifeexpectancy
population : 58,065,097
According to the latest WHO data published in 2017 Suicide Deaths in Turkey reached 6,861 or 1.72% of total deaths. The age adjusted Death Rate is 8.61 per 100,000 of population ranks Turkey #114 in the world.- worldlifeexpectancy
According to the latest WHO data published in 2017 Suicide Deaths in United States reached 45,986 or 2.01% of total deaths. The age adjusted Death Rate is 12.70 per 100,000 of population ranks United States #47 in the world.- worldlifeexpectancy
UK- kings college of london-do this one
According to the latest WHO data published in 2017 Suicide Deaths in United Kingdom reached 5,500 or 1.17% of total deaths. The age adjusted Death Rate is 7.52 per 100,000 of population ranks United Kingdom #123 in the world.- worldlifeexpectancy
Military Suicide Rates:
The number of suicides in the military steadily rose from 67 in 2004 to 97 in 2011 before falling to 79 by 2013.
The current rate stands at a little over 11 per 100,000 which, the defence ministry notes, is lower than the national average of 23.5 suicides per 100,000 for South Korean men aged 20 to 29. (2014)
“Suicides Spark Concern over South Korea Military Service.” ABC News, ABC, 12 Aug. 2014, www.abc.net.au/news/2014-08-12/an-south-korea-military-suicides/5666658.
“In the last 10 years, 818 Turkish soldiers were killed in clashes, while in the same period, the number of soldiers who committed suicide amounted to 934” (This is the closest information that I could find for military suicide rates)
Atakan, Didem. “More Turkish Soldiers Died from Suicide than Combat in 10 Years: Panel.” DailySabah, Www.dailysabah.com, 15 Mar. 2015, www.dailysabah.com/turkey/2015/03/14/more-turkish-soldiers-died-from-suicide-than-combat-in-10-years-panel.
(2018) “A total of 321 active-duty members took their lives during the year, including 57 Marines, 68 sailors, 58 airmen, and 138 soldiers.”
The last DoDSER was for 2016, when the rate across all the military services was 21.1 deaths per 100,000 active-duty service members.
Rates for the individual services that year were:
- 19.4 per 100,000, based on 61 deaths, for the Air Force;
- 26.7 per 100,000, based on 127 deaths, for the Army;
- 15.3 per 100,000 based on 50 deaths, for the Navy;
- and 21 per 100,000, based on 37 deaths, for the Marine Corps.
Kime, Patricia. “Active-Duty Military Suicides at Record Highs in 2018.” Military.com, Military Advantage, 30 Jan. 2019, www.military.com/daily-news/2019/01/30/active-duty-military-suicides-near-record-highs-2018.html.
From 2015 to 2016, Veteran suicide rates decreased from 30.5 per 100,000 population to 30.1 per 100,000 population.
The number of Veteran suicides per year decreased from 6,281 deaths in 2015 to 6,079 deaths in 2016 (Figure 1).
In 2016, the unadjusted suicide rate among Veterans was 30.1 per 100,000, while the rate among non-Veteran adults was 16.4 per 100,000… In 2016, the age- and gender-adjusted rates of suicide were 26.1 per 100,000 for Veterans and 17.4 per 100,000 for non-Veteran adults.
https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_2005-2016_508.pdf (VA Suicide report/Article)
Department of Veterans Affairs, Veterans Health Administration, Office of Mental Health and Suicide Prevention. Veteran Suicide Data Report, 2005–2016. September 2018. https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_ 2005-2016_508-compliant.pdf
The suicide rate among males aged 16-59 years in the UK general population in 2016(latest data available and used as a proxy for 2017) was 18 per 100,000 compared to a UK Armed Forces rate of 8 per 100,000 in 2017.
To understand the ethical impact of both voluntary and mandatory military service throughout multiple countries, we must first understand the implications of becoming a service member. As Mobbs and Bonanno stated in their article, the entry-level training (most commonly known as boot camp) is meant to strip away both the civilian and individualistic identity of a person. This then forces a person to integrate into an institutionalized routine where one learns of their obligations to the person next to them, creating a more collectivistic nature. 19 Going through this and becoming a part of the subculture that is the military can be in and of itself a traumatic experience for some, but how does this change as one goes to and returns from war?
A country’s decision to go to war means asking a service member to walk into a morally complicated situation in which they have a high chance of killing a person,witnessing someone getting killed, getting injured, and many other potentially traumatic experiences. While these are all things a service member knowingly and willingly walks into, It nonetheless has a huge impact on their personal well-being. One potential consequence is Posttraumatic Stress Disorder (or PTSD), in which a service member constantly relives their traumatic experience, thus impacting their overall quality of life. 21 A second potential consequence is moral injury, where there is a transgression against one’s strongly held moral belief about something. 22 Both PTSD and moral injury do not just impact a service member after they leave the war, but can impact them while they are still on active duty. This creates a unique challenge in that service members suffering from one or both of these conditions are highly unlikely to seek treatment due to stigma within this subculture and the fear of potential career consequences. 23 Not seeking help when a traumatic experience first arises can prolong the service member’s suffering, carrying over to when they return home. Their return home and how well they adjust back to civilian life can be impacted greatly by whether they live in a country that has voluntary military service or mandatory military service.
Within a country that has voluntary military service, such as the United States and the United Kingdom, there are both non-problematic and problematic issues. The main non-problematic issue is that having a voluntary military service means people often join the military to be a part of something much bigger than themselves. 24 Therefore creating an environment where people are more motivated and thus have a better overall morale which can lower the risks of developing mental illnesses. However, having an all-volunteer force means that when these veterans return home, they are returning to a society that by and large, does not understand them. 25 The gap between veterans and civilians is one of the most problematic issues within this system, because it creates a world of isolation for the veterans leaving them between a state of military and civilian worlds, known as the concept of liminality. 26 Liminality therefore consequently increases a veteran’s struggle with mental illness and raises their risk of suicide. This state of liminality is also why a service member often deals with the complexity of both missing and not missing war.
On the other hand in a country, such as South Korea and Turkey, where military service is mandatory one can see the opposite of this system. Having a mandatory system means that when a veteran returns home they are returning to a society where everyone understands them, subsequently lowering one’s risk of feeling isolated and the issues that come with it. However, having a mandatory military service creates the ethical dilemma of autonomy which is a person’s capacity and right to self-determination and self-governance. 28 By making military service a requirement a country’s government is in essence taking away one’s autonomy and freedom to choose. By doing so, a government can have service members who are greatly unhappy and at higher risk of developing mental illnesses and suicidal ideation.
In conclusion, a service member goes through difficult stages as they both transition from civilian to service member and service member back to civilian. The level of mental illnesses and suicides that are experienced within this subculture is greatly impacted by the system a government has in place regarding its military. While there are ethical issues with both voluntary and mandatory military service, the responsibility to understand and care for these veterans falls to everyone. After all, they risk a great deal to protect us.
Angel Daniel Andrade
1 Niederkrotentaler, T. “Characteristics of Suicide Decedents Receiving Mental Health Treatment Prior to Suicide: United States, 2005-2010: Thomas Niederkrotenthaler.” European Journal of Public Health 24, no. 2 (January 10, 2014). https://academic-oup-com.libproxy.lib.unc.edu/eurpub/article/24/suppl_2/cku163-041/2839338.
2 N Niederkrotentaler, T. “Characteristics of Suicide Decedents Receiving Mental Health Treatment Prior to Suicide: United States, 2005-2010: Thomas Niederkrotenthaler.” European Journal of Public Health 24, no. 2 (January 10, 2014). https://academic-oup-com.libproxy.lib.unc.edu/eurpub/article/24/suppl_2/cku163-041/2839338.
3 N Lee, Sang-Uk, Jong-Ik Park, Soojung Lee, In-Hwan Oh, Joong-Myung Choi, and Chang-Mo Oh. “Changing Trends in Suicide Rates in South Korea from 1993 to 2016: A Descriptive Study.” BMJ Open, September 28, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169778/.
4 NDepartment of Defense. “2015 Department of Defense Suicide Event Report Annual Report.” June 21, 2016.
5 N Parcesepe, Angela M., and Leopoldo J. Cabassa. “Public Stigma of Mental Illness in the United States: A Systematic Literature Review.” Administration and Policy in Mental Health. September 2013. Accessed April 09, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835659/.
6 N Niederkrotentaler, T. “Characteristics of Suicide Decedents Receiving Mental Health Treatment Prior to Suicide: United States, 2005-2010: Thomas Niederkrotenthaler.” European Journal of Public Health 24, no. 2 (January 10, 2014). https://academic-oup-com.libproxy.lib.unc.edu/eurpub/article/24/suppl_2/cku163-041/2839338.
9 N Iversen, Amy C., Lauren Van Staden, Jamie Hacker Hughes, Neil Greenberg, Matthew Hotopf, Roberto J. Rona, Graham Thornicroft, Simon Wessely, and Nicola T. Fear. “The Stigma of Mental Health Problems and Other Barriers to Care in the UK Armed Forces.” BMC Health Services Research 11, no. 1 (2011). doi:10.1186/1472-6963-11-31.
11 N Boene, and Bernard. “Shifting to All-Volunteer Armed Forces in Europe: Why, How, With Wh…” Forum Sociológico. Série II. February 18, 2009. Accessed April 09, 2019. https://journals.openedition.org/sociologico/347.
12 NBoene, and Bernard. “Shifting to All-Volunteer Armed Forces in Europe: Why, How, With Wh…” Forum Sociológico. Série II. February 18, 2009. Accessed April 09, 2019. https://journals.openedition.org/sociologico/347.
13 N Boene, and Bernard. “Shifting to All-Volunteer Armed Forces in Europe: Why, How, With Wh…” Forum Sociológico. Série II. February 18, 2009. Accessed April 09, 2019. https://journals.openedition.org/sociologico/347.
14 N Boene, and Bernard. “Shifting to All-Volunteer Armed Forces in Europe: Why, How, With Wh…” Forum Sociológico. Série II. February 18, 2009. Accessed April 09, 2019. https://journals.openedition.org/sociologico/347.
15 N McCurry, Justin. “South Korean Soldier Sentenced to Death for Murder of Five Comrades.” The Guardian. February 03, 2015. Accessed April 07, 2019. https://www.theguardian.com/world/2015/feb/03/south-korea-soldier-death-murder-comrades.
16 N McCurry, Justin. “South Korean Soldier Sentenced to Death for Murder of Five Comrades.” The Guardian. February 03, 2015. Accessed April 07, 2019. https://www.theguardian.com/world/2015/feb/03/south-korea-soldier-death-murder-comrades.
17 NLee, Sang-Uk, Jong-Ik Park, Soojung Lee, In-Hwan Oh, Joong-Myung Choi, and Chang-Mo Oh. “Changing Trends in Suicide Rates in South Korea from 1993 to 2016: A Descriptive Study.” BMJ Open, September 28, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169778/.
19 N Mobbs, M. C., Bonanno, G. A. “Beyond War and PTSD: The Crucial Role of Transition Stress in the Lives of Military Veterans.” Clinical Psychology Review 59 (2018): 137-144
21 N “PTSD Basics.” PTSD: National Center for PTSD. Accessed April 3, 2019. https://www.ptsd.va.gov/understand/what/ptsd_basics.asp.
22 N Maguen, S., Litz, B. “Moral Injury in the Context of War.” PTSD: National Center for PTSD. n.d. https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp.
23 NGreene-Shortridge, T. M., Britt, T. W., Castro, C. A., “The Stigma of Mental Health Problems in the Military.” Military Medicine 172, issue 2 (2007): 157-161
24 N Klay, Phil, “The Citizen-Soldier: Moral Risk and the Modern Military.” Brookings. Last modified May 24, 2016. http://csweb.brookings.edu/content/research/essays/2016/the-citizen-soldier.html.
25 N Mobbs, M. C., Bonanno, G. A. “Beyond War and PTSD: The Crucial Role of Transition Stress in the Lives of Military Veterans.” Clinical Psychology Review 59 (2018): 137-144
26 N Herman, A., Yarwood, R., “From Services to Civilian: The Geographies of Veterans’ Post-Military Lives.” Geoforum 53, (2014): 41-50
27 N Sebastian Junger, Why Veterans Miss War, directed/performed by Sebastian Junger (2014; New York: TEDSalon, 2014), TED Talk.
29 N Quirk, Danny. De-facing PTSD. Depression Awareness. Twitter. April 5, 2014. https://twitter.com/UKDepression/status/452439414451355649.