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Kevin Patterson is a novelist and internist who served as civilian physician in Kandahar, Afghanistan.

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As important and familiar a problem as it is, veterans' suicides remain on one level fundamentally mystifying. What would make people who have fought in and survived war, kill themselves later, when they are home and safe and among people who love and care for them?

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The mystifying part comprises much of the problem. We think of war victims as being those who fall with rifle rounds in their bodies, or who are thrown high in the air by an improvised bomb – a pressure cooker filled with diesel fuel and fertilizer, perhaps – and when that happens we talk about the cruel caprice of fate, which seems always to select the soldier in the platoon with the most promising future. The happiest one.

The witnesses of these horrors, who are many times as numerous as the victims, think that they are supposed to feel grateful for not having been hit themselves. But they are often left anything but unscathed. Lacking visible wounds can make them feel unentitled to their distress – and that feeling of unentitlement is much of what makes psychic injuries so damaging. (At least 54 Canadian soldiers returned home from Afghanistan only to end their own lives, a Globe and Mail investigation has found.)

The suffering of soldiers is cruelly amplified by a lack of bodily wounds. They may feel unentitled to the peace and ease that should be their reward. And if they do poorly in consequence, they feel unentitled to even talk about that. Because this is how mental health issues are often responded to: We feign support, and say the right words about mental health care being simply health care, but the truth is, this acceptance is not widely felt. Not sincerely.

In hospitals, there are medical/surgical beds. And there are psychiatric beds. Emergency room doctors would usually prefer to treat the failure of mental-health care – the overdoses – than to provide supportive psychotherapy to someone considering suicide. That part is just too scary, too intimate. And often it is so difficult to know what the problem is, exactly. There are no relevant lab tests to order. No scan of anything will ever identify despair.

Every suicide of an apparently whole person prompts the same three words, often posing as sympathy while in truth dripping disdain: What a waste. As if the heart attack in the next bed weren't, or the lung cancer case on the other side of the war was in some way just and necessary.

Visible wounds win soldiers the admiration of their country. Blood-soaked dirt has an indisputable truth to it. But the most terrifying thing that ever happens in war is not a sniper shot, it's a rout. Aortas and spines are not the most vulnerable part of a soldier in battle – it is the psyche. And every person under strain, whether in battle or in a stressful workplace, wonders sometimes if they are not at the point of mental illness. That is why, if our colleagues become mentally ill, they may scare us in a way that no number of cancer sufferers or gunshot victims ever could.

Such fear is irrational and superstitious and medieval; disdain for the mentally ill is sadistic. The loneliest people are those who most need our love and care. And of course it is the mind that is most easily shattered by war. To lose an arm you have to actually be hit. To lose your faith in humanity, or to lose your sense of safety in this world, all you have to do is see war, and know it.

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Whatever those who have not seen it may think, no one knows war until they have experienced it in an unmediated way.

Eviscerated children are not shown on network television. Depictions of war always contain ordering narratives; these are soothing to those watching at home. The fight is about goodness and tolerance against hate and oppression. Our soldiers are strong and restrained; they are ennobled by their fight against the brutes. Surgical strikes. Smart weapons. Minimum necessary applications of force.

It is civilians who manufacture these sorts of war narratives. Persuaded by them, young men and women go off to play their part. Then they descend into the most chaotic and morally disordering experience possible.

And then they come back. Our debt to them is incalculable.

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