The Drum Circle.

I was heading to the drum circle for his family, and for the others who knew him. A friend stopped by earlier that day, could tell I wasn’t doing well, and mentioned she was going too. I took my time leaving. Not going would have been noticed, and I would have been ashamed of myself if I didn’t.

The whole drive there I was angry at him. How dare he do this. The nerve of it, with all of us left here to miss him. The angrier I got the more I cried, and by the time I pulled up I had been crying so hard my face was swollen and my nose had stuffed completely shut.

My best friend saw me first. She said: glad you made it. Then the door opened and his daughter came running toward me with her arms out, yelling Chris, and my friend gave a small nod toward the backyard and headed that way.

The girl hugged me and said I missed you, followed by how are you doing?

I said I’m not so good kiddo, sorry.

I don’t know why I apologized. She looked me right in the eyes and said: I love you. It’s ok because daddy’s always with us. Even right now. Then she hugged me again.

She took my hand and said come on, everyone is in the backyard.

So we went through the house. I tried not to make eye contact with anyone. My face hurt and I was breathing through my mouth and I had just apologized to an eight-year-old for being sad at her father’s memorial drum circle. She led me through to the backyard, gave me one more hug, and walked off to be with her friends. I stood near the hot dogs. They were very well done, which is better than rare, I suppose.

Friends found me by the food. We stood together, shared some memories, and made plans to see each other more.

I’ve lost a handful of friends to suicide. I’ve learned what I could on the subject. That’s what I do with things that upset me, I research them.

Any problem hits and I go looking for answers. My friends bust my chops about how often I cite peer reviewed studies when making even mundane decisions like what to order at my favorite diner. Suicide and PTSD have received a substantial amount of my attention.

I keep coming back to a set of research findings that feel too important to leave inside academic journals, findings about what actually protects people from developing PTSD, or from reaching the point where they decide they’re done. The research matters because it confirms something I’ve watched play out in the lives of people I loved, and I hope it may be useful to others.

Three things keep coming up in the literature, across decades of study, across military and civilian populations, across cultures and continents.

Connection.

Anticipation.

Moral clarity.

Each one operates as a shield, and when all three are present, people survive things that should have destroyed them. When all three are absent, people break under loads that are generally considered manageable. The size of the trauma matters less than the presence or absence of these factors, and that single insight could save lives if we treated it with the seriousness it deserves.

“Love is the expression of the one who loves, not of the one who is loved. Those who think they can love only the people they prefer do not love at all. Love discovers truths about individuals that others cannot see”

• Soren Kierkegaard

A 2021 analysis of 67 studies covering more than 32,000 participants found that the more social support a person had, the less likely they were to develop PTSD. The data ran in both directions: social support reduced the risk of developing PTSD, and PTSD eroded social support over time, creating a feedback loop that could pull a person under.

An eight-year study of physical assault victims confirmed what the larger analysis suggested: people who felt they had strong social support were less likely to develop PTSD symptoms, while people who felt they had little were more likely. The researchers called social support one of the most powerful factors in determining who recovers and who does not.

The word “perceived” carries more weight than it first appears. The size of a person’s social network, the number of contacts in their phone, none of that predicts outcomes. What predicts outcomes is whether someone believes, in their gut, that the people around them are reliable. A person with three close friends who show up when called carries more psychological armor than a person with three hundred acquaintances who might.

And there’s a harder version of this that doesn’t get discussed enough. A person can have people who genuinely love them, who show up every time, and still not be able to feel it. Certain personality disorders and trauma responses rewire the perception of relationships at a neurological level. Fear of abandonment becomes the default setting. The brain reads even reliable people as unreliable, reads love as temporary, reads presence as the prelude to loss. The support is real; the ability to receive it isn’t. This is one of the reasons treatment matters, not as a character issue to resolve but as a survival variable, the same way a broken leg needs a doctor and not a pep talk.

The National Vietnam Veterans Readjustment Study, one of the largest and most rigorous investigations of combat trauma ever conducted, found that for both men and women, the most important factor in whether veterans developed PTSD after coming home was whether they felt they had people they could count on.

That same mechanism helps explain one of the most devastating and least discussed public health patterns in America. LGBTQ young adults who grew up in households where their families actively rejected them were 8.4 times more likely to have attempted suicide than their peers from accepting families. The Family Acceptance Project at San Francisco State University, tracking these young adults across years, found that those who reported low family acceptance in adolescence were more than three times as likely to report suicidal ideation and suicide attempts even after controlling for background characteristics.

The reason maps directly onto the perceived support finding. When a teenager comes out to their parents and gets thrown out, or told they are broken, or treated as a stranger in their own home, they don’t just lose a relationship. They lose the people they counted on most to answer the phone. The perceived support network collapses at the exact moment they most need it to hold.

Researchers at the University of Michigan placed people who had recently experienced intense social rejection inside brain scanners and found that the same regions that register physical pain became active, regions virtually never activated by ordinary emotional distress. The brain treats being cast out by the people you belong to as an injury; over the course of human evolution, it was one.

I think about the word “perceived” when I think about my friends who didn’t make it. I can’t speak to what they felt in their worst moments. I don’t know whether they believed, in those hours, that someone would pick up the phone. The people who loved them would have. And the gap between “someone would answer” and “I believe someone would answer” is where people die.

“Even if the words were terrible... the word always retains its redeeming power, because all despair and all the horror of evil expressed in one word are not as awful as silence.”

-- Soren Kierkegaard

The data on the second protective factor is clear: people who see the hard thing coming fare better than people who get blindsided by it.

Soldiers who both expected combat and saw it as part of their professional identity showed significantly fewer PTSD symptoms after exposure. Neither variable alone did the work. Expecting combat without valuing it offered no protection, and valuing combat readiness without expecting actual combat offered none either. Only the combination shielded them.

The soldiers most at risk deployed without expecting to fight, held no framework for what combat meant, and then found themselves in a firefight anyway. Two soldiers in the same ambush, taking the same fire, could walk away with radically different psychological outcomes depending on whether one of them had a mental frame that said this is what I trained for and the other had nothing to hold the experience.

I recognize this from my own time in the Air Force. USAF Security Forces train for the worst day. You rehearse it. You walk through it. You build a version of it in your head so that when pieces of it arrive in the real world, your brain has somewhere to file them. I’ve talked to combat veterans from other career fields, people whose jobs were supposed to keep them behind the wire, and the ones who struggled most often often hadn’t built that file through formal channels. Nobody told them they might need it.

When the brain doesn't know something bad is coming, it stays in a constant state of alarm, scanning for threats it can't predict. When it does know, even roughly, it can prepare. It can feel a degree of control over the situation. That sense of expectation and preparedness is often a substantial factor in the intensity of traumatic responses. The threat is still real, but the nervous system isn't running on emergency mode the whole time. Predictability gives the brain somewhere to put it.

"Nothing contributes so much to tranquilize the mind as a steady purpose, a point on which the soul may fix its intellectual eye." '

-- Mary Wollstonecraft

Moral injury occurs when a person commits, witnesses, or fails to prevent something that violates their deeply held moral beliefs. The concept emerged from clinical work with Vietnam veterans, and it has since expanded to describe the psychological damage experienced by healthcare workers forced to make triage decisions during COVID, by law enforcement officers who witness systemic abuse, by anyone caught in a situation where their actions or inactions collide with who they believe themselves to be.

PTSD is driven by fear; moral injury is driven by the collapse of meaning.

Vietnam is the clearest American case study. The United States sent those men to invade a foreign nation. Robert Jay Lifton, who spent years in group therapy sessions with veterans, argued that the United States had placed these men in what he called “atrocity-producing situations,” circumstances where atrocities weren’t aberrations but natural outcomes of the orders they had been given. The weight of an act with no answer, no context, no place to file it, just sits there.

A study of Bosnian war veterans found that soldiers with stronger religious moral frameworks had fewer PTSD symptoms and greater mental health stability. That finding deserves a careful read, though. A moral framework that dissolves guilt by declaring everything forgiven lets people do real harm and walk away clean. Some things deserve to be felt. Fortunately, you can build an ethical framework that acknowledges what you did wrong, places it honestly in the context of good and evil, and still says: I'm here, and I'm going to use that fact improve the lives of the people around me.

“The most common form of despair is not being who you are.”

-- Soren Kierkegaard

Before Auschwitz, before Theresienstadt, before the Nazis separated his family and shipped them to camps where most of them would die, Viktor Frankl spent a decade treating people who wanted to kill themselves.

As a medical student in the late 1920s, he organized free youth counseling centers across Vienna to address the epidemic of teen suicides that spiked every year around report card season. The city of Vienna sponsored the program, and psychologists like Charlotte Buhler and Rudolf Dreikurs joined him. In 1931, not a single Viennese student died by suicide during report card season. Zero. In a city that had been losing teenagers to self-inflicted death every semester, a 25-year-old medical student and his colleagues brought the number to nothing.

After earning his medical degree, Frankl took charge of the Suicidals Pavilion for Women at Steinhof Psychiatric Hospital, where he treated roughly 3,000 patients each year for four years. Twelve thousand suicidal women passed through his care before the camps. His central therapeutic technique sounds almost reckless in its simplicity. He would sit with a patient who had tried to end her life and ask her a single question: Why do you not commit suicide?

“There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living …”

• Albert Camus

The question requires the person name something. A child. A project. A promise. A garden. Whatever they answered, that became the thread Frankl pulled. That became the tether to the future. He built the entire course of therapy around whatever the patient named, helping her construct a framework of meaning around the thing she’d identified as worth living for. He had patients write eulogies for themselves or imagine looking back on their lives from their deathbeds, and from those exercises they discovered purposes they hadn’t consciously recognized.

Frankl walked into the concentration camps at 37 already studying what keeps people alive. And when he watched prisoners in the camps, he saw the same three factors at work. Those who survived were often the ones who had someone to return to, who could anticipate a future beyond the wire, and who could locate their suffering inside a framework that gave it meaning. He observed how a death of the spirit often occurred shortly before a death of the body.

We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread, he wrote.

Americans tend to tell the Frankl story as though he discovered his ideas in Auschwitz. He discovered them in a psychiatric ward in Vienna, one conversation at a time, with women who wanted to die and chose not to. The camps confirmed what the clinic had already reliably indicated.

“In the depth of winter, I finally learned that within me there lay an invincible summer.”

-- Albert Camus

I need to say something I haven’t said yet. I’ve called the 988 Suicide and Crisis Lifeline myself, and I’m very grateful it exists. A number existed, a voice picked up, and someone on the other end of the line did exactly what Frankl did in that psychiatric ward in Vienna and asked me what was still worth holding onto. That’s part of the reason I’m writing this today.

My friend was the one who built these things for everyone around him, tending the fire, waving somebody over who stood at the edge of the circle not sure if they belonged. What I know, because he told people when he was struggling, is that he didn’t believe any of it came back to him. He thought he was everyone’s burden. He thought everyone would be better off without him. The illness rewired his perception so completely that the love his friends and family actually had for him couldn’t get through. That’s not a failure of the people who loved him and it’s not a character flaw for him. That’s a disease, and it can be treated, which is why the number exists, and why I’m asking you to use it if you need it.

So find your people and tell them they’re yours. Say it out loud, because assuming is exactly where the illness gets in. And if someone you love can’t feel it no matter how many times you say it, help them find help. Let yourself think honestly about the hardest thing you’re likely to face in the next year and what your optimal or preferred response could be, because the mind that has rehearsed the hard thing bears it differently than the one that hasn’t. And ask yourself what you actually believe. Write it down. A moral framework sturdy enough to hold the weight of a painfully unjust world is also the thing most likely to keep you in it.

That eight-year-old girl has no training in trauma psychology. She’s never read Viktor Frankl. She walked up to her dad’s friend, looked him right in the eyes, and said in nine words what just took me 2,700 words to say. I love you. Daddy’s always with us. Even right now.

I grabbed one of those hot dogs off the table. No plate. No fork. I just held it in my hand and carried it over and sat down in front of the fire. Some of the people drumming I already knew. Some I had never met. There were all smiles as they played a steady rhythm.

The fire burned and the sparks went up.

I watched the flames and listened to people I loved and it seemed like any second I’d feel a hand on my shoulder and hear him say hey buddy, grabbed you a burger.

If you or someone you know is struggling, these resources are available around the clock.

988 Suicide and Crisis Lifeline: Call or text 988. Available 24/7. Veterans can press 1 after dialing 988 to reach the Veterans Crisis Line, or text 838255. Live chat is available at 988lifeline.org.

Crisis Text Line: Text HOME to 741741.

The Trevor Project: Call 1-866-488-7386 or text START to 678-678. Available 24/7 for LGBTQ youth.

En espanol: Llama o envia un mensaje de texto al 988 y presiona 2, o envia un mensaje de texto con AYUDA al 741741.

Rest in Power

M.R.

T.R.

N. D.

M.W.