JACKI LYDEN, HOST:
This is WEEKENDS on ALL THINGS CONSIDERED from NPR News. I'm Jacki Lyden.
In a moment, we'll hear about how prisoners can get lost in the system and sometimes get released before they're due, and a visit to a photographic exhibit in Florida Seminole territory in Southwest Florida.
But first, after a dozen years at war, an estimated two million active duty servicemen and women will have returned home by the end of 2013. Some reintegrate without much struggle, but for others, it's not so easy.
Beyond the physical wounds, the psychological wounds of war can prove to be just as fatal. Military estimates say that as many as one veteran a day is choosing to end his life. That's our cover story today: American vets and suicide.
Thirty-three-year-old Tomas Young was severely injured as an Army soldier in the early days of the Iraq War. And after years of surgeries, medications and pain, he says his physical and emotional deterioration is too much to bear. He's decided to end his life.
Frank Morris of member station KCUR met Tomas Young and his family in Kansas City, Missouri, and he has this story.
FRANK MORRIS, BYLINE: Before 9/11, Young was an athletic, rambunctious 22-year-old. Now, he's a man at the very end of his rope. Young enlisted two days after the attacks. He wanted revenge against the Taliban in Afghanistan but was deployed instead to Iraq, a country that he believed had nothing to do with 9/11. Days later, a sniper's bullet left him paralyzed from the chest down, impotent and very angry. His terse, powerful way with words propelled him to the forefront of the antiwar movement. The documentary "Body of War" follows Young's activism and physical struggles.
In this scene, his mom, Cathy Smith, tries to attach a urine catheter in the back of a car.
(SOUNDBITE OF DOCUMENTARY, "BODY OF WAR")
TOMAS YOUNG: Hey, mom. Mom. We generally tend to watch what goes on up there.
CATHY SMITH: I'm trying to move it so it doesn't just go everywhere.
YOUNG: Good plan.
(SOUNDBITE OF LAUGHTER)
YOUNG: I'm glad that it came out, and people saw the reality of war.
MORRIS: Young now spends most of his time here, lying flat on his back smoking in his dimly lit bedroom in Kansas City.
YOUNG: But now, I can't even watch it because it serves as a reminder of what I used to be able to do.
MORRIS: Young's life got progressively worse. A blood clot lodged in his lungs months after the film came out. That damaged his brain, twisted his hands and left his speech impaired. His mom, Cathy Smith, says it's been a long, hard fight.
SMITH: To be a paraplegic, deal with that, and then you wake up and you're quadriplegic, and you can't use your voice, which was what you were learning to use. And so many people wanted him to speak, and then he couldn't speak anymore.
MORRIS: Young spent months in rehab. And then last spring, he married a woman named Claudia Cuellar, a Buddhist with a sunny disposition. Young is a devout atheist, but they both love music and literature, and share a keen understanding of the hardships of war.
CLAUDIA CUELLAR: He is, of course, my number one hero along with all, you know, Iraq, Afghanistan, Vietnam, all veterans.
MORRIS: They settled into what they hoped would be a few good years together. But last summer, a horrible new chronic pain hit Young. Doctors cut out his colon, hoping to ease his suffering. And that worked for a while, but the pain came back.
YOUNG: And I decided that I was no longer going to watch myself deteriorate.
MORRIS: In February, Young announced he was going to remove his feeding tube and stop taking nearly 100 pills a day. Cuellar understands.
CUELLAR: I feel like it's a kind of, you know, his body's been mutilated. I mean, he had the injury, but then there's all the surgeries they've done on top of that. It feels dehumanizing.
MORRIS: And in the nine years since he was shot, his mother's had a lot of time to contemplate losing him.
SMITH: I've mourned the son that I sent to war that didn't come home. I've mourned the grandchildren that I'll never have. And the worst part about all of this for me is that none of this had to happen.
MORRIS: Hearing of Young's plight, activist Ralph Nader suggested he write an open letter to former President George Bush and Dick Cheney, one final broadside against the war and its chief proponents.
YOUNG: And so I went along with that and wrote my letter. And I guess that thing's taken off like wildfire too.
MORRIS: Young's "Last Letter" from a dying veteran went viral. But he insists that while the letter is political, his impending death is entirely personal.
YOUNG: There are people who want to frame it as a political decision or a political issue. That's their prerogative, yay for them. But I myself don't see it that way.
MORRIS: Young sees it as a solution to intractable suffering, but he knows that other veterans also suffer mightily and choose to live. He's also aware that many people abhor suicide. In fact, his mother is one of them.
SMITH: It's not a suicide. He's not killing himself. He's just stopping.
MORRIS: Young says he'll stop talking to the media on April 20th, his wedding anniversary, and likely end his life a month or two thereafter. For NPR News, I'm Frank Morris in Kansas City.
LYDEN: Tomas Young's decision to end his life is no doubt painful for him and his family, but we also wondered if what he was doing was legal.
Sandra Silva is the vice president of education at the Center for Practical Bioethics in Kansas City.
SANDRA SILVA: In the state of Missouri, as in all states, any competent adult has the right to refuse or authorize any medical or surgical treatment. And a health care provider can follow the instructions of a patient and not provide or withdraw medically administered nutrition and hydration. And that's because of the Patient Self-Determination Act that was passed in 1990.
LYDEN: That act laid out Americans' right to make their end-of-life medical decisions, sometimes called a living will. So while refusing care is technically different from suicide, the end result will be the same.
KIM RUOCCO: I mean, it's a personal choice for him, and I would never question his right to take control of his body.
LYDEN: Kim Ruocco counsels the families of suicide victims. She's the director of postvention programs at TAPS, the Tragedy Assistance Program for Survivors.
RUOCCO: What we hope for people is that they can find something to hold onto and some hope and that they can decide that they want to live, but in the same hand never tell anybody that they must live if they've come to the point where that's not their wish.
LYDEN: Kim Ruocco lost her own husband to suicide eight years ago. He'd just come home from Iraq. After three months stateside, he gave up hope that he could make the transition. I asked her why so many service members like her husband succumb to suicide.
RUOCCO: Marines, airmen, soldiers are very closely tied to their identity as a Marine or as a soldier. And so when things like posttraumatic stress, traumatic brain injuries, addiction start to interfere with that identity, then that's when they really start to have trouble. And so it's really important for them to get help when they first start to have issues with anxiety or sleeplessness or things like that that they need to address them immediately and not let it fester into a problem.
LYDEN: So it's so key.
RUOCCO: Yeah, it's so key. And if I could do anything different, I would've forced my husband to go and get help to process some of those early traumas 10 years before his death, really. I think he'd be alive today if he would've really gotten help.
LYDEN: Quil Lawrence covers the military for NPR. We asked him to give us a sense of how widespread the problem is.
QUIL LAWRENCE, BYLINE: The number last year across the military was almost one a day, 349 suicides. And once you start looking into the numbers, they get very hard to nail down, and you end up comparing a lot of apples and oranges. For veterans, we don't know the number of suicides because most states do not track veteran status in their coroner's reports. So, for example, older white men have a higher rate of suicide than younger men or women, and that seems to be the same for vets and for non-vets.
But there seems to be a significant increase in active duty suicides. So that is mostly young men. Those are people who in the civilian population are not committing suicide at a higher rate. So that's the figure that people are finding alarming, a spike in suicides among these young active-duty Army and Marines.
LYDEN: Does the military have a sense of why there are so many suicides?
LAWRENCE: It's very complicated. You've just discussed this case of a severely wounded vet, like Tomas Young, but there are some cases, anecdotes, that might speak more to the root of this problem.
One of the most chilling is former Army Captain Peter Linnerooth, who was an Army psychologist. He got a Bronze Star for his work helping prevent troops from taking their own lives. And in January of this year, he killed himself. He was suffering from PTSD, and that's one of the factors that might be contributing to the high number.
LYDEN: So is the thought that the trauma from combat is a key factor?
LAWRENCE: There's debate about that as well. There's some studies that say PTSD, traumatic brain injury from bomb blasts contribute mental illness, is a high contributing factor. Some people are theorizing that the feeling of purpose and camaraderie that troops have when they're deployed is very devastating when it's taken away.
LYDEN: Seems like questions, Quil, are outstripping answers. Does the military and the VA know why this is happening? And what are they trying to do about it?
LAWRENCE: There's been a big push to try and raise awareness, to try and reduce stigma. Some people talk about restricting access to the means of committing suicide, although that can get into the whole gun control debate.
At an Army base in Texas, Fort Bliss, they've - seems to have had some success reducing the rate of suicide there with a big blitz on awareness. Everyone who comes into the base has to take a course. And they're trying to push this idea that there's no shame in getting help and that troops should help each other out. But this is something we've been hearing from the military for years with mixed success.
President Obama ordered a big increase in mental health staff for the VA last year, including a crisis hotline. They have thousands of documented saves where they had a veteran on the phone who had a plan and intention to carry it out. And they were able to talk him or her down. But there are still so many cases of veterans who are frustrated with their situation, especially issues with the VA.
I've spoken to vets' families who say they're bracing themselves for the next suicide attempt from their veteran while they're waiting to get their VA benefits claim approved.
LYDEN: NPR's Quil Lawrence, thank you very much.
LAWRENCE: Thank you.
LYDEN: It's all a troubling, overwhelming phenomenon, but any serviceperson in need of confidential advice can call the Veterans Crisis Line at 1-800-273-8255 and press one. For the families of veterans who've died, call the Tragedy Assistance Program for Survivors or TAPS at 1-800-959-8277. This is NPR News.