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Images from the Ukraine conflict are triggering survivor's guilt in combat veterans

ARI SHAPIRO, HOST:

Violent images like those coming out of Ukraine can stoke trauma suffered in combat. Steve Walsh of member station KPBS in San Diego looks at one vet plagued by survivor's guilt. And a warning - this story references suicide.

STEVE WALSH, BYLINE: In the months prior to the fall of Kabul in August 2021, Nick Pilozzi was reaching out to help other veterans. Last July, he described for NPR the helicopter crash he narrowly survived 15 years ago and its lasting impact. The crash killed 10 soldiers in Afghanistan.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

NICK PILOZZI: The damage that comes from this stuff is unbelievable. None of these families are ever going to be the same.

WALSH: Pilozzi questioned why the war had dragged on so long. On a virtual panel about the war in September, he sounded weary when I asked him about how he was doing.

N PILOZZI: It's been pretty tough to watch what's going on over there. Having so many friends that died and, you know, I was wounded and tons of friends were wounded, you kind of question what it was all about.

WALSH: In February, months after most of us turned away from the daily images coming out of Afghanistan, Pilozzi killed himself. After the war ended, his brother, Anthony, says Pilozzi fixated on the idea that his friend's sacrifice was meaningless.

ANTHONY PILOZZI: He just immersed himself in to news articles, YouTube, news stations on TV. It was pretty rough. The easiest way I could describe it was he was a drug addict. The news was his drug.

WALSH: Anthony says Nick was getting counseling at the local VA and working with veterans groups near his home in upstate New York. Occasionally, he would open up to his brother, but he didn't see this coming. Sonya Norman is with the San Diego VA and the VA National Center for PTSD.

SONYA NORMAN: Even if it's just I didn't deserve to survive, who am I when these other people had families, were doing these other things?

WALSH: She never met Pilozzi, but she says survivor's guilt is strongly linked to PTSD. It can come up years later as a person's view of what happened changes and the guilt gets in the way of treatment.

NORMAN: With this, I don't deserve to feel better. And I don't deserve good things and kind of that self-destructive piece. And you can see how it can be this - be involved in this downward slide toward suicide.

WALSH: Duane France is a combat vet who is also a therapist who counsels veterans.

DUANCE FRANCE: Dozens of things have to go wrong in someone's life for them to get to the place where they're in a suicidal crisis. But maybe only one thing needs to go right. So there are a number of protective factors that may keep service members and veterans from getting into a suicidal crisis.

WALSH: Keeping connected, seeking counseling. Overall, the number of veteran suicides are slowly declining. Still, veterans make up about 7% of the U.S. adult population but account for 20% of all suicides. It wasn't a factor in Pilozzi's death, but a majority of veteran suicides involve firearms. So asking a friend to hold a firearm or at least keeping their guns under lock - the VA and other organizations will provide free trigger locks - It can be just enough time for a veteran to reconsider.

ROSS BERKOFF: You want to be able to be with them, to be there with them when they need you the most.

WALSH: Ross Berkoff is a retired captain. He served two tours in Afghanistan with the 10th Mountain Division. Pilozzi is the fourth suicide among those he's served with. Berkoff always feels like he needs to do more to keep in contact.

BERKOFF: The Facebook I'm here for you, buddy, kind of message, that's fine. I'm sure it's well intended, but I don't know the answer here. How do we stop this from happening again?

WALSH: He answers his own question - you just need to keep reaching out. For NPR News, I'm Steve Walsh. Transcript provided by NPR, Copyright NPR.