The year was 1928 and antibiotics as we know them today did not exist. A simple scratch often became a nasty bacterial infection resulting in swelling, high fever and a potentially fatal diagnosis that doctors mostly treated with hope and prayers. The risk of bacterial infections left medical experts essentially powerless, as they could only treat the symptoms and not the root cause of the infection. Though scientists desperately searched for ways to replicate naturally existing antibiotic agents in the laboratory, they had little success.
Competing scientists of the period previously saw the beneficial effects of Penicillium on bacterial strains in a petri dish, but it was Alexander Fleming’s intuition and innovative persistency that allowed him to see patterns where others only saw chaos. Fleming observed the same data that other scientists often disregarded as inconsequential, but he drew a conclusion that was so alien that it took him 12 years to convince chemists to purify and stabilize the crude antibiotic strain. Penicillium was a breadcrumb on Fleming’s path to cracking the antibiotic code. His insight and dedication resulted in effective treatments for a wide array of potentially fatal infections.
Today’s medical challenges equivalent to the bacterial infections of a century earlier include mental health, depression and suicide. American society has devolved to a point where 1 in 4 people say they have no one to talk to about personal tragedies, while research shows that loneliness can lead to depression, a lack of sleep, an increase in stress hormones and a less meaningful life. We may lack Fleming’s petri dish, but the following question can still be posited with regard to military suicide: If a solution to military suicide already exists, what mental shift is necessary to perceive it?
An effective response to military suicide continues to evade military leaders, mental health experts and troops who seek to bring this invisible enemy to its knees. Millions of dollars in research, more than 900 suicide prevention programs and a barrage of suicide prevention PowerPoint training slides have resulted in a message that’s loud and undeniably clear: The current paradigm is not working. Why? Because like the doctors during the pre-antibiotics era, we’re attacking the symptoms of military suicide and not the root cause.
Admiral William McRaven recently stated that, “The last two years have been the highest rate of suicides we have had in the special operations community, and this year I am afraid we are on the path to break that.” The Department of Defense currently lists suicide as the second-leading cause of death among U.S. military personnel; 22 veterans take their own lives each day, and military leaders continue to stigmatize suicide and depression. For example, Maj. Gen. Dana Pittard blogged, “I am personally fed up with soldiers who are choosing to take their own lives so that others can clean up their mess.... Be an adult, act like an adult, and deal with your real-life problems like the rest of us."
Until the root cause of the problem is identified and addressed, military and veteran suicides will most likely continue to increase. So what’s at the core of this problem? As it turns out, a single tragic life event of Phineas Gage in 1848 may be our breadcrumb equivalent to Fleming’s Penicillium.
Antonio Damasio beautifully captures the true story of Phineas Gage in his book "Descartes' Error." Gage was born in 1823 and is considered by many as “patient zero” of the human brain’s frontal lobe research. At the age of 25, he was known as an ambitious, healthy, reliable, well-mannered man who worked diligently at his trade. One day in 1848 he suffered an explosion that sent a six-foot metal rod completely through his head. The rod entered his lower left cheek and exited his upper forehead. Not only did he barely lose consciousness, but he was immediately patched up by the doctor and given a clean bill of health a few months later, while maintaining full mobility and intelligence.
Gage’s accident completely destroyed his frontal lobe, while leaving the rest of his brain intact. The brain’s frontal lobe is located immediately behind the forehead and is considered the emotional headquarters of the mind. It allows us to exhibit deeply embedded human secondary emotional functioning such as creative thinking, decision making, artistic expression, planning and social behavior. If you were asked to point to where “you” lived in the brain, the frontal lobe would be your best bet.
What happened to Gage after the accident was a complete surprise to everyone who knew him. Following his release from medical treatment he transformed into a belligerent, foul-mouthed, inconsiderate alcoholic. His friends and family couldn’t recognize or deal with Gage’s “new” personality and soon disowned him. He died homeless and alone on the streets of San Francisco in his mid-thirties and was buried with his famous steel rod.
When Gage lost his frontal lobe in the accident, what he essentially lost was his ability to feel deep secondary human emotion. The last 30 years have produced a plethora of research on the effects of frontal lobe damage due to car accidents, falls, and so on, each detailing symptoms such as social self-isolation, emotional numbness, increased drinking, increased risk-taking, increased depression, muted empathy and increased aggression.
In short, the symptoms of frontal lobe damage overlap almost perfectly with the symptoms of depression and suicidal ideation. So the question naturally arises: How could a soldier with a physically intact brain become “Gage-like” and lose the ability to feel secondary emotion? Enter the 21st century science of neuroplasticity; that is, the brain’s ability to actively rewire itself based on life experience.
As stated in Daniel Coyle’s book "The Talent Code," the brain continuously adds layers of a protein called myelin to neurosynaptic pathways that are heavily used and energized throughout the body. Myelin insulates highly used paths of the nervous system, converting a repeated experience into confident levels of knowledge. For example, professional pianists have deep layers of myelin that insulate specific nervous system routes, granting them the skill of expert piano playing. They don’t have to “think” about playing the piano; they sit, close their eyes and make beautiful music, seemingly effortlessly. The process of myelination occurs for every action or thought, whether positive or negative. If, however, a neurosynaptic pathway in the brain is not energized because the associated experience or action is lacking, the myelin insulation breaks down and that specific knowledge becomes more difficult to retrieve. For example, not speaking a second language for an extended period leads to the loss of the ability to speak it fluently.
While Phineas Gage physically lost the ability to use his frontal lobe, the science of neuroplasticity has shown us that it may be possible to achieve the same ends via a different means. Should a physically intact frontal lobe never energize those neurosynaptic pathways of deep secondary human emotion, there will be scant amounts of myelin insulating that specific knowledge path. Therefore over time that person may lose the knowledge of how to feel secondary emotion, just like Phineas Gage.
As it turns out, our military culture has very little tolerance for emotional expression. Emotions are synonymous with weakness and are considered a liability that can get an entire unit killed. The stigma of feeling, sharing, or exhibiting emotions is astronomical, producing service members who bottle up their feelings for years or even decades. Even though military leaders continue to encourage subordinates to seek mental-health treatment if necessary, many troops refuse to tarnish their record or believe that seeking help will affect their chance for promotion. When soldiers are placed in an environment that essentially prohibits deep secondary emotion for a prolonged period, those neurosynaptic paths representing secondary emotion in the frontal lobe are basically “turned off” from lack of use. So while the brain remains completely intact, the soldier loses the emotional functionality of the frontal lobe, leading to Gage-like symptoms.
From day one of basic training, unquestioning 18-year-old recruits are stripped of their personalities and essentially transformed into numb, emotionless machines who can follow orders to accomplish the mission without fail. They then spend the next three to five years serving in an emotionally sanitized environment -- and those are the final years of a young brain’s last major push for myelination. The result is a person who is very motivated and skilled in their position, but has lost frontal lobe functionality.
The emotional vacuum of military culture may very well be the sine qua non of military suicide, depression, substance abuse and many other personality ailments. With the identification of deeper root causes to the problem, more effective solutions are only limited by creativity.
Learning from Alexander Fleming’s experience requires enough humility to realize that our generation is capable of repeating the mistakes of his era. Effective solutions to military and veteran suicide will continue to elude military leaders until an honest look is taken at how military culture might be contributing to its effects. Just as a fish is unaware of the water it’s in, those immersed in an emotionally sterile military culture are typically ignorant of it and the associated negative effects on the human psyche over time.