Thirty thousand dead from suicide in 20 years among American service-members and veterans. Brown University’s Costs of War Project, utilizing data from the Department of Defense (DoD) and the Department of Veterans Affairs (VA), calculates that four times as many men and women who have served in the US military since 9/11 have died by suicide than were killed in the post-9/11 wars. The vast majority of those killed by suicide have been veterans, meaning men and women not still in uniform. While the rate of suicide among active-duty service-members is alarmingly high, the rate among veterans is even more so, and, in particular, it appears highest among combat veterans.

Anyone who served in combat in Iraq or Afghanistan may likely now know more friends killed by suicide than killed by the Taliban or by Iraqi insurgents. The same possibly for veterans who fought in Vietnam, Korea, and World War II. Suicide after taking part in war, and its killing, is not a new phenomenon, and its likely cause, guilt, is understood if seldom discussed.

Greek and Roman histories speak of suicide and what we now call invisible wounds. Our greatest literary voices, like Shakespeare and Homer, wrote of it. Following the American Civil War, period sources describe suicide, alcoholism, drug overdose, and exposure due to homelessness that killed and debilitated hundreds of thousands of veterans.

In America’s other “good” war, World War II, 1 in 7 combat veterans were discharged as psychiatric casualties. In an era where a psychiatric diagnosis was often shunned and avoided, and when post-traumatic stress disorder would not become a medically recognized diagnosis until the 1980s, hundreds of thousands of World War II veterans were mentally and emotionally devastated. However, the discussion of what World War II veterans were going through, and then Korean veterans, was censored by the US government. The Vietnam War, as it did so many other things in our society, changed the discussion on the psychological and psychiatric consequences of war. Suicide among Vietnam veterans became an open secret widely discussed, if not among the public than among veterans.

It would not be until the 1990s that the VA and the DoD would begin addressing these issues in a manner that demonstrated any commitment to understanding the problem and, perhaps, finding a solution. In 1991, a VA study of Vietnam veterans found that combat-related guilt was the best predictor of suicide in veterans. While this may have been apparent to those who have been to war and those who understood war’s true nature, this was a politically difficult finding. This idea that guilt within veterans over their actions in war was the leading cause of high suicide rates goes against the moral and religious core of American Exceptionalism and the narratives of freedom and democracy that support American wars and interventions. For if soldiers are coming home and killing themselves, in large numbers because what they had done was morally wrong, then what did that say about the wars these men and women had been fighting and about the government and society for which they were fighting?

It was not until 2001 the DoD started cohesively tracking suicides across all armed services, and it was not until 2010 that the VA began accurately tracking veteran suicides nationwide. Before 2010, the VA estimated veteran suicides off reporting from a handful of states. After retired General Eric Shinseki took over the VA and made this a priority, the VA began to assemble data on suicides in veterans from all 50 states. This resulted in the publication of suicide reports, starting in 2013, by the VA that have provided startling and horrifying confirmation of the prevalence of suicide in those who have been trained by the US military and been to war.

Yet even this information over the years seems to have fallen to political concerns, particularly the fear of running foul against the moral narratives of America’s wars. The 2014 VA suicide report has been the most detailed and the most disturbing report released. In this report, we find information as to some details as to who within the veteran community is killing themselves. This is the only VA report on suicide, of which I am aware, that details the suicide rates of veterans who deployed to the Iraq and Afghan wars against those who did not.

It is here, in this sole report, one can realize that in 2014, a young man, between the ages of 18 and 24, who deployed to Iraq or Afghanistan had a ten times greater likelihood of suicide than a young man who had not been in the military. Compared to the entire veteran population of the same age, a veteran deployed to Iraq or Afghanistan had a greater chance of suicide than the general veteran population. This disparity in rates of suicide held the same for all age groups who had deployed to Iraq and Afghanistan in the years surveyed after data collection began from all 50 states.

2014 was the only year the VA provided such information on the effects of deployment on suicide rates. What should be noted is the suicide information does not distinguish between those who had deployed to Iraq and Afghanistan in terms of who had seen combat or not, and it does not break down suicide data by branch of service. If this information was provided, I would expect to see higher rates among combat veterans and veterans who served in the Army and Marine Corps. The VA and DOD could assemble this data, if they haven’t already, and publish it; the question is: why they don’t, because it is clear that combat veterans suffer suicide at a greater rate than others.

Look through the information provided by the VA on suicide rates. You will see that while the general rate of suicide for veterans is approximately 1.5 times higher than the population, the rate of suicide among veterans in age groups that correspond to the major wars of the last 75 years, World War II, Korea, Vietnam, and the Iraq and Afghan wars, is higher than in those demographic groups for which “peacetime” occurred.

Absent such official data, as provided in the 2014 VA suicide report, it is apparent through the veterans’ community and journalist reports that the extremely high rate of suicide continues in combat veterans. The father of a soldier tells me that his son’s brigade had 11 combat deaths in their year in Afghanistan but over 100 suicides in the ensuing ten years after coming home. A New York Times story from 2015, tracking a Marine Corps infantry battalion returned home from combat in Afghanistan, found that those young men had a suicide rate 14 times their civilian peers.

This epidemic of veterans killed by suicide does not seem to get better with time, age, or the perceived justice of the war. In 2010, a study of World War II veterans in California found that World War II veterans were killing themselves at a rate four times higher than those the same age who had not been in uniform during the war. It should be very troubling that men in their 80s and 90s, who had fought against Nazi Germany and Imperial Japan, would still be putting guns in their mouths over seven decades later.

What is clear is that the connection between suicide and combat is real, as evidenced in dozens of studies. In 2015, a meta-analysis of research studies by the National Center for Veterans Studies at the University of Utah, investigating the link between combat and suicide, found that in 22 studies examined, 21 showed a clear relationship between combat, guilt, and suicide. From the report: “The study found a 43 percent increased suicide risk when people were exposed to killing and atrocity compared to just 25 percent when looking at deployment [to a war zone] in general.”

More recently, a study in 2020 by researchers from the University of California-San Diego and the VA found that: “Combat experiences involving direct exposure to death, killing, or grave injury were independently associated with [suicidal ideation /suicide attempts] whereas several general combat experiences (e.g., combat patrols) were negatively associated with [suicidal ideation/suicide attempts].”

While another study that same year into the effects of guilt related to combat and suicide found: “Reports of potentially morally injurious experiences are prevalent among US combat veterans, and associated with increased risk for suicidal behavior, above and beyond severity of combat exposure, PTSD, and depression.”

Other studies have shown that combat veterans have much greater rates of suicide than non-combat veterans. One such study found combat veterans have a 68% greater chance of suicide than non-combat veterans.  Meanwhile, studies, such as the 2015 meta-analysis discussed above, and other more recent studies, such as in 2017, demonstrate that it is taking part in the act of killing, directly and indirectly, that leads to increased suicidality in veterans. Why did I kill?,why were my friends killed?, who was it for?, and was it just? are the thoughts that prompt the torturous distress that leads to suicide in combat veterans. That these thoughts may not occur to someone until they are out of uniform and removed by time and circumstance from the war, and away from the group-think, or bubble, of military life, may help explain the difference in rates of suicide between veterans and those still in uniform; just as these thoughts explain the great difference between those who went to Iraq and Afghanistan, but did not take part in the killing, and those that did.

The Costs of War Project at Brown University is aptly named. The cost of war, to many veterans, is a deep and permanent wounding of the soul and the conscience. This is clinically known as moral injury. For me, it was as if the very foundations of who I was had been destroyed and that moral darkness, in turn, led to my suicidality. While there are undoubtedly many causes for veteran and service-member suicide, within the sub-group of combat veterans, we see clearly elevated rates of suicide. The primary reason behind those deaths to suicide may be the guilt, shame, and regret that come home with us after the war. The obstacle, and thus the very thing that will keep these veteran suicides continuing, is the unwillingness of American politicians, generals, bureaucrats, the media, and, yes, the population as a whole, to honestly ask and answer why so many combat veterans kill themselves.