Recent veterans encountering transition to civilian life often face uncertainty, self doubt, sometimes serious. And some of those returning from Afghanistan after the abrupt U.S. withdrawal might find the transition extra difficult. While the Veterans Affairs Department has at least one staff psychologist who can empathize — a retired Army Ranger with four tours of Afghanistan behind him — he’s now co director of VA’s Transitioning Service Member Veteran and Suicide Prevention Center. Dr. Joe Geraci spoke to Federal Drive with Tom Temin.
Tom Temin: Dr. Geraci, good to have you on
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Joe Geraci: Good to be on. Thanks for having me.
Tom Temin: Hey, let’s begin with the center itself. The Transitioning Service Member, Veteran and Suicide Prevention Center. It’s a mouthful, what happens there?
Joe Geraci: Well, I think it’s important to identify that it is a mouthful, but from the Army Ranger perspective it’s very clear. So if you put all that together, it comes out to task. And so task and purpose. So from an infantryman, everything in my life that I’ve done has been focused on what is my task, and what is my purpose. So the task right now is to mitigate suicide risk and mitigate suicides for service members as they’re transitioning. And we’ve been able to identify in our research and our publications, and be able to coin this period of time as the deadly gap. So looking at, you know, from us working individually, with veteran patients that are in this window that we see clinically, to looking at interventions that help this population to, which I think is even more important, working at the macro level is how do we apply a universal public health approach. So everybody in the community really can kind of get behind them. And we can look at the evidence to see what really kind of works because we’re really kind of struggling right now in the field. What really kind of works with this population?
Tom Temin: And you mentioned there is this zone of danger. In particular, I guess, that’s for recent people that have mustered out of the military and are now in veteran status. Does the, I guess, danger or threat of suicide tend to go away as time goes on? Or how does that work?
Joe Geraci: I think that’s what we hope. I think that’s what we anticipate. The research will bear, but unfortunately at this point, you know, we’ve only been able to go out like, you know, seven to eight years to really kind of really kind of focus on this population. And if we look at even some of the most recent VA national annual suicide report that came out two weeks ago, we see that this is a trend and a phenomenon, especially for the 18 to 34 year olds that are within this first year window is we really kind of focused on them, that their rate of suicide is gone up to you know, exponentially from before 911, just you know, right about 20 per 100,000. We measure suicide rates per 100,000. And the most recent report, it’s above 40 — 40 per 100,000. And that’s a rate that significantly higher than their civilian counterparts of the same age group. And it’s also significantly higher than veterans that are over 35. So there’s definitely something happening within this window. So we can identify that it is a problem. And we’re still trying to catch up with the research to really be able to understand, like, what is contributing to this, but I’ll be honest, as an infantryman, I always don’t like to wait for the answers. I need to go kind of solve the problem. So that’s that’s kind of what my challenge has been for for many years in my deployment in Afghanistan. It’s, Joe, we’ve got a problem in this area, we don’t know exactly what the problem is, we just need you and your soldiers to go and fix and resolve it and make it go away. So I would say within the task, we very much are on that. We’re not waiting for the research to kind of show us what is causing this, we’re going to go try and fix it. But then also use the rigor of research to be able to kind of show what we’re doing actually is effective.
Tom Temin: We are speaking with Dr. Joe Geraci, co-director of the Transitioning Service Member, Veteran and Suicide Prevention Center at the Veterans Health Administration. Well, you’ve got a lot of variables to look at, because there is the nature of the specific deployments in Afghanistan, I guess in Iraq, and no two wars and battle zones I imagine are identical. There’s that issue. There is the change in societal makeup, the way people are brought up and raised, differences from generation to generation. Vietnam era veterans were raised in a different way than perhaps the current 18-to-34 year olds. I think that’s pretty definite. And then there’s the society that they returned to is very different. So what kind of research can you design to maybe ferret out and control for the variables?
Joe Geraci: Yeah, and that’s hard. One thing we can do is we can ask people that have transitioned that have had suicide attempts, like what was this process like for you, but we know that only 30% of the people are going to acknowledge and let us know that they’ve had a suicide attempt. So the majority of the population that we asked, you know, have you had a suicide attempt, they’re not going to be honest with us. And nor would I, as a veteran, be honest with somebody that’s wanted to ask me about my suicide risk. It’s very personal, delicate thing. And for us as veterans, we don’t like to identify weakness. We don’t like to identify things that are going wrong with us. And even going back to me, my first time I went to mental health care was after my second deployment. It was one of the most anxiety-provoking things I’ve ever done in my life. I was an active duty, and I was reticent to go to the army for care. I needed help, so I decided to go to — actually I’m very thankful to, you know, Vietnam veterans, they were advocates and created something across the VA we now have called Vet Centers. You know, storefront, a lot of them run by veterans, 300 across the country. And you know, I’ll never forget going into my psychologist there and saying, you can’t know my name, you can’t know anything about me, you just need to know that I need some help. And you know, right away — and she’s a phenomenal therapist — she used the term PTSD within the first five minutes of us sitting down and talking. And I was like, I just want to be clear, you not only can you not know my name, but we’re never going to use that term again. Like, you just need to know I need help, and I need the process. So I can really relate to the challenge we have in the research, because I’m one of those veterans that’s recently transitioned. And I wouldn’t be honest on those surveys. So then what do we do is we have to look at mortality data that those that actually have died. And then retro actively look at what were some of the indicators that kind of led to that. And I think the research is clear that those that have higher levels of psychological disorders, like depression or bipolar, you know, they’re going to have higher rate. But so many of those veterans also are reticent, like I was, to go and seek care. It’s an extremely anxiety-provoking experience. Obviously, we’ve mentioned aged. You’ve mentioned kind of the different types of traumas. And military sexual trauma is something that we got to watch very closely. And something that we’re really kind of putting a light on, and there’s been some other research has also put a light on it, as you talked about the challenges reintegrating to that civilian sector. So we call them reintegration difficulties. And so your difficulties getting a job, you know, being able to connect the school, to find school for your kids, the legal troubles that we find this population — DUIs, battery, utilization of illicit substances — but then also the aspect of just feeling connected to your community. Like who is on my left and my right? Who do I really kind of feel connected to? And also we’ll put medical care as a reintegration difficulty that’s there. So this is a variable that really kind of has gone under the current and hasn’t really be recognized and identified. But I think it’s truly a way that uniformly we can address this problem set at the universal level. So what we call it is like the disease model. When you really try to parse down and identify with extreme specificity, like only these people are the ones we need to help. And what I’m really kind of trying to do, and with the help of lots of other researchers much smarter than myself, is say like we’re going to continue to miss and fail if we try to look very specifically. What we need to do is apply an approach that’s aligned with the military culture, and help everyone. If we help everyone through this transition, because that’s what we’re used to in the military. We’re used to helping each other, we’re used to all of us being helped through the process as a team, you know, brothers and sisters, comrades in arms. And if we can really kind of help everyone through, then the hypothesis is that then we’ll see those suicide numbers start to trickle down. So the VA has done phenomenal work, you know, looking at this kind of this community based approach, how do we work with the community better? How do we work with those that are coming to the VA, so we can universally help this population?
Tom Temin: Getting to the issue of the recent withdrawal from Afghanistan, controversial, a lot of news, a lot of political arguing and bickering over it. Do you feel or do you sense that that will have a negative effect on the very recent veterans, that last crew. I think there’s a famous picture of the last guy boarding the aircraft, you know, the infrared picture, and so on. Do you think they’ll have a bigger problem, or a more intense problem, than those that might have left earlier?
Joe Geraci: So I think I want to start off by saying that most of us are very, very resilient, that most of us can get through difficulties and trials and tribulations based on our experiences. But I would say that’s very much a heterogeneous response, like a very individualized response on how we’re going to respond. So I can let you know how I’m responding and what this process has been like for me, and then what has been for some of the patients that I’m working with and what it’s been like for some of my comrade and just acknowledge it for me. That last person that was getting on that last aircraft is somebody that I first deployed with in Afghanistan and then right after 9/11 with the Ranger Regiment, and to see him as the last person leaving and we were one of the first ones there, it was pretty sentimental. And then having the 9/11 20th anniversary down at the memorial, this has been a challenging time for me, and kind of a is eliciting lots of lots of emotions. And when I work with my patients, like okay, so anger — that’s that’s not helping us. It’s like what’s under the anger that’s like this anger volcano, but what’s underneath? We got to get to the core, we got to get the molten level. What’s going on? And I think for us, there’s lots of sadness for the loss and what happened, and there’s, you know, lots of fear for our comrades that fought so valiantly with us there that are still left. And then what’s going to happen with with the women that are left there? So I think we all have an individual response. I think we all deal with it differently. But I think it’s really beneficial for all the veterans out there to recognize that we’re not the first generation to go through this. You know, Vietnam veterans went through something comparable. Iraq veterans went through something comparable. And we really need you to kind of come together, with our arms around each other. And you know, I’m thankful for all the Vietnam Veterans that have reached out to me and just kind of checked on me and say, hey Joe, how you doing? It’s something we really need to do as a community.
Tom Temin: We are speaking with Dr. Joe Geraci, co director of the Transitioning Service Member, Veteran and Suicide Prevention Center at the Veterans Health Administration. Sounds like there’s a little bit of that fish-out-of-water feeling when people return. Because you tell me if you have seen what combat veterans have seen and done what they’ve done in a difficult place like Afghanistan, and you come home and everybody’s worried about the latest TikTok video, or something like that, it must seem like a different universe at some level.
Joe Geraci: And I would say just not those who went to combat. I mean, so you go through a transition when you leave that recruiter’s office and then you go to basic training. Like that’s your first rite of passage, you are no longer in this needle fight in the local tribe. You are transitioned into this warrior class. And then some go through a second rite of passage when you kind of go through combat or other kind of trials and tribulations. And then you become fortified as warrior. And so when the 200,000 of us active duty service members transition every year, you do transition back into a place. From Joseph Joseph Campbell, he talks a lot about the hero’s journey. And so we can kind of get lost between worlds. And so there’s other other traditions, Native American or Greek or Roman mythology, that kind of talk about the critical role of the community really coming to be those elders, those guide, those Sherpas, to help to reintegrate us. It wasn’t our responsibility, it wasn’t us who sent us forth. It was the civilian populace and their elected officials that sent us forth. Comparably, it is that civilian community — as it has in traditions, and if you look at the collective unconscious, the warrior class over time — it was the civilian population that needed to bring us back and reintegrate us, and to help us to find our next mission in life and help us to become leaders. And without that guidance, without the help, without that assistance, we can get lost in that world. And as you mentioned, kind of being a fish out of water.
Tom Temin: And given the veterans hiring preference in the federal government, many federal employees are apt to encounter a recent veteran on the job. So what can they as always civilians do to make sure that the person, the veteran, does feel welcomed? Or what can they do to help that transition without being intrusive or patronizing?
Joe Geraci: Yeah, and I think that’s a phenomenal question. I do a lot of work training VA at non VA providers and HR individuals in training we call the veteran cultural competence — a day-long immersive training that we do to kind of address those problems. So you as a civilian, you want to help, what can you do to help? And and the biggest things I kind of teach is to assume nothing, you know, identify and to recognize those stereotypes that you possess. Don’t deny them, acknowledge them Like “I see veterans is angry, as damaged, as entitled, as somebody that’s a ticking time bomb.” Acknowledge those stereotypes are there, because that is what’s given been given to you from the media, and that’s what’s portrayed in the movies. So acknowledge recommends that do the internal kind of work to elicit, to talk about, to acknowledge and to learn from that. That’s step one: acknowledge our biases. Next one is to learn about the particular culture, learn about veterans. And this isn’t just for veterans overcoming certain types of biases and establishing positive personal relationships. This goes, you know, any demographic — somebody that’s different than you. And then with this skill set, what’s it like to be a servicemen? What’s it like to be a veteran? Immerse yourself in their world, and then apply those skills. And I always kind of tell people to allow yourself to be vulnerable with veterans, and they’ll be vulnerable with you. Be open, be personal. And I think the thing that veterans care about the most, and to be able to work through this divide, is a motto from one of the battalions I was in: Deeds not words. So demonstrate your deeds, that you really want to help us, you want to integrate us and not just your words. And we found that so many civilians, they want to do more than just say thank you for the service. They really want to kind of help you have tangible ways. It’s just they don’t know how
Tom Temin: Dr. Joe Geraci is co director of the Transitioning Service Member, Veteran and Suicide Prevention Center at the Veterans Health Administration. You’ve given us a lot to think about. Thanks so much for joining me.
Joe Geraci: Thank you for having me anytime.
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