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“When we are no longer able to change a situation, we are challenged to change ourselves.” -Victor Frankl
The suicide rates in the military will continue to rise until it transitions to an innovative strategy that places more focus on strengthening the neuropathways of the brain to counter the negative emotions influencing suicide. This new strategy must create self-reliant empowerment of the warfighter who can personally apply the lifestyle changes and psychotherapeutic techniques that enable preventive maintenance of the mind and body. This shift moves away from the current reactive vs. proactive approach of applying behavioral therapy. We must address suicide in a preventive maintenance approach and train our warriors with the skills to be cognitively dominant in the face of military stressors.
Research on the brain and suicide shows us the areas of the brain that influence suicidal behaviors and the areas that fight against the influence of suicide. Research has also demonstrated that through evidence-based psychotherapeutic approaches such as mediation, mindfulness, and relaxation, one can control the mind and bodily systems, influencing suicidal behavior. We must train warriors to understand the science of stress and empower them to apply these techniques, thereby developing a preventive maintenance approach to the brain. This article aims to provide a recommended solution to address suicide in the military and a brief explanation of key components of the brain and body. Through education of the brain, we can empower the warfighter to take charge of the negative stress-induced emotions. In this article, I will provide some baseline knowledge of the key components of the brain involved in emotions and stress, why the brain reacts the way it does, and how one can control these automatic responses and develop resiliency in the face of the day-to-day military stressors. My goal is to empower the reader to learn new ways to develop cognitive dominance.
A Metaphor on the Current Military Approach to Suicide Prevention
Our military excels at training and preparing our warriors to win our nation’s wars. Yet, it lacks at developing cognitive strong warriors capable of overcoming the effects of the trauma and adversity that comes with being in the military. The current strategy trains leaders to look for signs of suicidal ideation, approach those with suicidal indicators, and train leaders to know where to send them after they are broken. The fields of psychology and behavioral health have applied evidence-based approaches to treat PTSD, depression, and anxiety; applying these approaches in a reactive mode, after the warrior is broken, rather than a preventive application to empower the warrior with the skills to combat the future stressors that they will face in the military.
Using a metaphor, the military’s strategy to prevent suicide is compared to an organization with a poor vehicle maintenance program. When vehicles constantly fail for mechanical issues, the underlying cause is typically due to the vehicles’ lack of preventive care. Operators of military vehicles are required to follow a technical manual to provide them with easy-to-follow routine checks. Failure to conduct routine checks leads to a variety of mechanical issues. Vehicle maintenance becomes a problem for a commander once vehicles are no longer serviceable. Commanders become involved and begin to react to save the broken vehicles. A vehicle will have only minor mechanical problems when the operator conducts the proper preventive maintenance checks and routine services. Over time, a vehicle operator becomes intimately familiar with their vehicle; so intimate that they know their vehicle very well and can sense when something is abnormal with the operating system. This intuition allows for preventive approaches to the vehicle to maintain its resiliency, preventing a malfunction that would require mechanical repair.
Imagine if we as warriors, operators of our own bodies, did this with our minds! Imagine if we could visualize inside our mind and the body’s operating system, understand what is happening inside us when triggered by trauma and have the knowledge to take control of our body and slow or stop the stress response. Similarly to the relationship between a vehicle and its operator, we can train the force to develop an intimate relationship with their minds and bodies. This will empower the warrior to sense what is happening in their body during the moments of intense stress and empower them to apply tools and techniques to slow or stop the automatic processes in the brain that influence negative behavior caused by stored traumatic emotions.
We must teach the warfighter how to do proper personal cognitive preventive checks and services on the brain and body, reducing the effects of the natural wear and tear of daily military life. However, we are not doing that now. We wait until the mind is damaged. We train our force on how to look for broken minds and direct them to the ‘brain mechanics’ who can fix them. We are running a sick care system rather than a health care system. Why not empower them with the behavioral health tools as an annual cognitive checkup rather than wait until they are damaged to receive cognitive repair from specialists?
We cannot avoid trauma and adversity in life, but we can choose to control the automatic responses influenced by this trauma. Viktor Frankl, a well-known psychiatrist who developed an approach to finding meaning in life, once said: “When we are no longer able to change a situation, we are challenged to change ourselves.” We cannot avoid the variables that influence the false perceptions leading to suicide, but we can strengthen the decision-making process to question the cognitive distortions influencing suicidal behavior.
This preventive maintenance approach to the brain is emergency preparedness for the tornados of life that will create destruction when we least expect it.
Key Actors of the Brain’s Emotional and Behavioral Responses
The following components of the brain play a key role in responding to stress and suicidal behavior. You can spend hours going very in-depth in understanding the complexities of the human brain, and I encourage you to become a lifelong learner in the science of your brain. Still, I will keep it simple and empower you with some basic understanding. Visualizing these components of the brain will help you understand the areas of the brain that you can control. It will help you understand the relationship between various components of the brain, the cause, and effect of the interaction with environmental variables resulting in a clearer understanding of the triggers influencing suicidal thoughts and behaviors. Some traumatic emotional triggers are so powerful that the automatic response can be more than you can handle. However, through psychotherapeutic exercises, you can weaken the areas of the brain that influence this dark response and strengthen the areas that will fight against it.
The Amygdala is a member of the limbic system, primarily know for the processing of emotions; it is the fight, flight, or freeze. Research has shown that it takes 100 milliseconds[i] to travel to the amygdala when a physical or emotional threat is sensed (this is why the body will automatically respond to a threat before one is consciously aware of what is happening). Research, both live and postmortem studies of the suicidal brain, have shown increased activity in the amygdala, giving this area of the brain the strongest behavioral influence, convincing one to end their life.[ii] Weakening the capability of the amygdala will reduce the automatic responses influencing suicidal behavior.
The Hippocampus is a member of the limbic system responsible for memory and learning. It works with the amygdala to recall emotional, traumatic memories and plays a key role in releasing chemicals to prepare the body for the fight or flight response. Research has shown that those with larger hippocampus volumes tend to display a higher resiliency to everyday stressors.[iii]
The Hypothalmic Pituitary Adrenal Axis (HPA) is the system that influences the release of chemicals after the amygdala and hippocampus have agreed, based on historically recorded data, that an emotional response is required. The HPA responds to this perceived threat by releasing a chemical that stimulates the pituitary gland; this, in turn, stimulates the pituitary gland’s release of a chemical stimulating the adrenal glands, located above the kidneys releasing cortisol. The release of these chemicals creates physiologic changes throughout the body. Research has shown an abnormal increase in HPA activity in suicide victims. Psychotherapeutic techniques can rapidly turn off the HPA, creating a state of relaxation and improved decision-making.[iv]
The Autonomic Nervous System is comprised of the Sympathetic Nervous System (SNS), fight or flight, and the Parasympathetic Nervous System (PNS) rest and digest. The ANS is responsible for regulating the overall operation of the human body. During a stress response, the ANS activates, preparing the body for a fight. This can be a physical fight or an emotional fight. This results in dilated pupils, shallow breathing, increased heart rate, turning off digestion, and relaxing the bladder. The PNS will activate, returning the body to its normal function once the limbic system has perceived an end to the threat. Constant activation of the SNS increases the susceptibility to the influence of suicide.[v] Through psychotherapeutic techniques, we can choose to turn down the SNS and activate the PNS reducing suicidal thoughts and behaviors.
The Pre-Frontal Cortex (PFC) is the frontal lobe region of the cerebral cortex. Research has shown that it takes twice as long for information to travel to the PFC than the amygdala[vi]. The PFC plays a key role in decision making, problem-solving, and making sense of our emotions. The following subcomponents of the PFC play a key role in countering suicidal thoughts and behavior: Dorsolateral is involved in cognitive functioning. Ventrolateral is involved in inhibition and goal-oriented responses. Orbitomedial is involved in the processing of taste and smell. Postmortem suicide research on the brain has found that the chemicals released by the HPA during acute stress create a malfunction to these areas of the PFC, decreasing the ability to question the amygdala’s influence to commit suicide. [vii] Strengthening the PFC will enable it to dominate the decision-making process and weaken the amygdala’s suicidal influence.
Understanding the Mind, Emotions, Perceptions and Negative Behavior
In addition to how the brain operates, it is key to understand why the stimuli we are exposed to influence the brain to respond in a self-damaging manner. Everything processed in our minds is open to various definitions that are influenced by multiple sources that we have been exposed to throughout our lives. We do not see reality. We see our brain’s definition of reality. Our brain gives us a definition of what we see. [viii] When someone commits suicide, their brain has convinced themselves through their assumed perception of reality that killing oneself is the best option. The brain will automatically make sense of the current situation by accessing how it has historically perceived the stimuli in the past. Emotional memories imprinted in our brains called associative networks are stored in our brains permanently. They will continue to influence our thoughts and behaviors if we choose to allow them to. [ix]
Our emotions are influenced by faulty thinking. It is faulty because it is false; it’s our assumed perception of reality. This automatic faulty thinking, influenced by the limbic system, creates suicidal thoughts and behavior. All negative emotions are based on the amygdala’s assumed perception of fear. Any level of anger, stress, anxiety or worry is the limbic system’s assumed perception of fear. To develop cognitive dominance, we need to weaken the areas of the brain that influence suicidal thoughts and behavior and strengthen the areas of the brain that can take control, solve problems and make a decision where the best outcome is not taking one’s life.
The science behind the neuropathways of suicide and its strong influence on behavior teaches us that we could all become victims of suicide. We must acknowledge this and prepare our minds now by influencing the mind to know that suicide will never be the option.
Tools to conduct Preventive Maintenance on the Mind to Prevent Suicide
Behavioral therapists have treated me with a variety of evidence-based psychotherapeutic approaches. None of these techniques were effective to me personally until I had developed an intimate relationship with my mind and body similar to the relationship I described with the vehicle operator. My recovery greatly improved once I learned about the key components in the brain and was able to visualize and sense in my own body how these techniques were creating this positive change and countering the negative emotional influence in my mind. I learned how to reduce the emotional effects of influencing suicidal ideation by targeting certain brain areas through psychotherapeutic technics.
Below are a few proven psychotherapeutic practices to reduce suicidal thoughts and behaviors by taking control of the areas of the brain discussed in this article. These techniques will weaken the areas of the brain influencing suicide and strengthen the areas of the brain that counter suicidal thoughts and behaviors. If you are struggling with suicide, PTSD, anxiety, or depression, I urge you to seek help. I also urge you to research further these practices listed below and develop a personal desire to learn more about your mind and body:
Mindfulness will turn down the flight fight, activate the PNS, and create a state of relaxation. Mindfulness is “the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us (Mindful.org[x]. When conducting mindfulness, you turn off the busy mind, full of worry and fear. You focus on only one thing and push all other thoughts from your mind. Research has demonstrated an increase of grey matter in the PFC and decreased the amygdala through just five minutes of daily mindfulness.[xi]
Download the mobile application Mindfulness Coach and begin your mindfulness training now. This mobile app is developed by the Department of Veteran Affairs.
Cognitive Behavioral Therapy will weaken the emotional response to variables encountered. It is a thought process of evaluating your emotions, identifying faulty thinking, and looking for alternate perspectives. This process will slow the fight or flight, influence relaxation, and improve decision-making.
Breathing Exercises and Heart Rate Variability (HRV) will empower you to lower your body’s stress response. You can control your heart rate, reducing your current level of stress and improving decision-making. When the SNS is active, the HR increases, increasing pain, muscle tension, and stress. Through breathing exercises, applying mindfulness with a focus on your breathing will enable relaxation and the activation of the PNS. Using a watch with an HR monitor, the HRV can be monitored live, and you can see your HR decrease and feel a sense of relaxation. Placing your hand on your heart creates an immediate feeling of calm and greatly accelerates a drop in HR when conducting this exercise.
Download PTSD Coach for HRV tools and more.
A preventive maintenance approach to the brain is the only way to slow the rise of suicides in the military. Shift the focus from sick care to a preventive health care system will require mandatory annual interaction with the warfighters. In his book, “A Man’s Search for Meaning,” Viktor Frankl, when describing how he prepared the mind for what was about to occur as he was placed into a concentration camp in Nazi Germany, stated: “I made myself a firm promise, on my first evening in the camp, that I would not “run into the wire.” (term used by prisoners referencing suicide). The science behind the neuropathways of suicide and its strong influence on behavior teaches us that we could all become victims of suicide. We must acknowledge this and prepare our minds now by influencing the mind to know that suicide will never be the option. We must lean on psychiatrists and behavioral health specialists to treat our warfighters annually, similar to an annual medical or dental checkup.
We must find ways to incorporate training on the brain into the existing training schedules. The first step is to use the existing training on suicide prevention that focuses on what to do about our “broken” and use time to discuss what is happening in the brain and how each of us can prepare our minds now to combat stress. There is no white space on a unit’s busy training schedule, yet innovative ways to incorporate this training into their existing training plans. If you are a small unit leader, you can start to empower your warriors with these skills. Learn them and incorporate them into your physical fitness plans. Please take five minutes before meetings or training to talk to your warriors about these techniques and practice them. These techniques reduce stress, anxiety, and PTSD and develop a clear mind, making you more effective critical thinkers and innovators. I use these simple techniques before driving, studying, or preparing to give a brief.
Over time, when these psychotherapeutic techniques are applied routinely, the neuropathways in the brain will change one’s perception and reaction to the negative emotions that influence suicidal behavior. The mind will begin to view these techniques as required daily and necessary for your survival. Just as water is needed for the body or engine oil for the vehicle, these techniques will be necessary to maintain your mental health. You will soon learn that these techniques become preventive steps necessary for the human body to survive and operate in the healthiest state possible. Strengthening the area of the PFC and weakening the ability of the amygdala will empower the warfighter to be resilient in the face of any level of adversity or trauma, influencing an end-of-life option. We cannot avoid the stressors in life or the long-lasting imprint they create in our minds, but we can learn to control our response to the emotional influences of these stressors. This preventive maintenance approach to the brain is emergency preparedness for the tornados of life that will create destruction when we least expect it.
References:
[i] Keller, Eric, et al. Unlearn Your Pain, Third Edition. 3rd ed., MInd Body Publishing, Pleasant Ridge, 2021.
[ii] Lutz, P. E., et al. “Neuropathology of Suicide: Recent Findings and Future Directions.” Molecular Psychiatry, vol. 22, no. 10, 2017, pp. 1395–412. Crossref, doi:10.1038/mp.2017.141.
[iii] Boldrini, Maura et al. “Resilience Is Associated With Larger Dentate Gyrus, While Suicide Decedents With Major Depressive Disorder Have Fewer Granule Neurons.” Biological psychiatry vol. 85,10 (2019): 850-862. doi:10.1016/j.biopsych.2018.12.022.
[iv] Lutz, 2017.
[v] McGirr, Alexander. “Dysregulation of the Sympathetic Nervous System, Hypothalamic–Pituitary–Adrenal Axis and Executive Function in Individuals at Risk for Suicide.” Journal of Psychiatry & Neuroscience, vol. 35, no. 6, 2010, pp. 399–408. Crossref, doi:10.1503/jpn.090121.
[vi] Keller, et al. 2021.
[vii] Pandey, Ghanshyam N., and Yogesh Dwivedi. “What Can Post-Mortem Studies Tell Us about the Pathoetiology of Suicide?” Future Neurology, vol. 5, no. 5, 2010, pp. 701–20. Crossref, doi:10.2217/fnl.10.49.
[viii] Lotto, Beau. Deviate: The Science of Seeing Differently. Illustrated, Hachette Books, 2017.
[ix] Keller, et al. 2021.
[x] “What Is Mindfulness?” Mindful, www.mindful.org/what-is-mindfulness. Accessed 28 Apr. 2021.
[xi] Taren, Adrienne A., et al. “Dispositional Mindfulness Co-Varies with Smaller Amygdala and Caudate Volumes in Community Adults.” PLoS ONE, edited by Allan Siegel, vol. 8, no. 5, 2013, p. e64574. Crossref, doi:10.1371/journal.pone.0064574.
