Charlie Mahoney / Prime for msnbc.com
Kim Ruocco poses outside her home in Newbury, Mass., on Thursday. Ruocco is the national director of suicide education and outreach at the Tragedy Assistance Program for Survivors, or TAPS. Marine Maj. John Ruocco, her husband, killed himself after a deployment in Iraq in 2004.
For the family and friends of service members who died by suicide, Memorial Day can be not only a solemn day, but also a painful reminder that military suicides are not treated the same as combat deaths.
Kim Ruocco, the national director of suicide education and outreach at Tragedy Assistance Program for Survivors, or TAPS, has experienced this isolating grief firsthand. This weekend, she is bringing together about 100 suicide survivors at TAPS' annual Memorial Day weekend National Military Survivor Seminar and Good Grief Camp for Young Survivors.
"[Suicide survivors] are surrounded by people whose loved ones were killed in action," Ruocco said. "There's a real sense that their loved one's death was not an honorable death."
Ruocco's husband, Marine Corps Maj. John Ruocco, killed himself seven years ago. He was a Cobra helicopter pilot who ran 75 combat missions during a five-month deployment in Fallujah, Iraq, in 2004. He had struggled with depression in the past, particularly after a training accident in the 1990s when two Cobras collided in midair, and he lost four friends.
In February 2005, while living temporarily in a hotel room near Camp Pendleton in California, awaiting a redeployment to Iraq and considering mental health counseling, John Ruocco hanged himself.
"He was so ashamed of being depressed and not being able to do his job," Kim Ruocco, 49, said. He was going to seek treatment, but she believes that "when he sat there and thought about what it meant to get help, how people would see you, how young Marines viewed him, how his peers viewed him ... he thought the problem was him."
Kim Ruocco, who has a master's degree in social work, provides counseling resources to suicide survivors, helps family members secure benefits and facilitates support groups. TAPS also tries to change procedures and policies that can be hurtful to suicide survivors, such as the exclusion of service members who died by suicide from state memorials and the distribution to suicide survivors of different Gold Star pins than the ones given to families when a service member dies in action.
This weekend's four-day event for survivors is expected to draw more than 2,000 participants. It will feature panels and peer support groups on dealing with grief, sessions on spirituality and meditation, and events for children.
In 2011, 301 active-duty service members died by suicide, according to the Department of Defense. More than half of those deaths occurred in the Army, where the suicide rate last year was projected at 24.1 per 100,000, outpacing the national rate adjusted for the comparison of 18.6 people per 100,000. A study released earlier this year by the U.S. Army Public Health Command found that the number of active-duty soldiers who committed suicide increased 80 percent between 2004 and 2008.
Though the Department of Defense has worked to de-stigmatize mental illness in recent years through various initiatives and training programs, challenges remain. On Thursday, Maj. Gen. Dana J.H. Pittard, commanding general of Fort Bliss in Texas, retracted a blog piece he posted on Jan. 19 in which he called suicide "an absolutely selfish act."
"I am personally fed up with soldiers who are choosing to take their own lives so that others can clean up their mess," he wrote.
Dennis R. Swanson, a public affairs officer at Fort Bliss, told msnbc.com that the post was written in an emotional moment after Pittard had attended two memorial services for soldiers who killed themselves, and then learned of a third suicide. In the 2012 fiscal year, there have been six suicides at Fort Bliss.
In his retraction, Pittard apologized for his "hurtful statement," which he said was "not in line with the Army's guidance regarding sensitivity to suicide."
"We must continue to do better each and every day, reaching out, encouraging and helping those in need," he wrote.
Ruocco worries that Pittard's original comments, which were removed from his blog, may have done damage. "By saying those words, he is telling the troops and their families that thinking about suicide is a weakness, it's not a mental illness," she said.
Culture of stoicism
Leslie McCaddon, 36, knows this conflict well. Her husband, Army Capt. Michael McCaddon, a doctor, killed himself in March. McCaddon, who served on a bomb squad on a deployment to Bosnia in the 1990s and was a first responder at the Oklahoma City bombing, battled severe depression for seven years and had a family history of suicide.
McCaddon said she urged him to seek help and he sporadically attended counseling sessions. But Michael, 37, was in his residency at Tripler Army Medical Center in Hawaii, and the demanding schedule made it difficult to seek intense treatment, she said. Michael also did not want to let his colleagues down or become a liability, McCaddon said.
"Personally, I have visions where mental health counseling is as standard and routine and mandatory as physical training," said McCaddon, who will attend the TAPS gathering for the first time with her three children this weekend. "All the men and women can grumble and say that’s a waste of time, but they’d still go because it’d be their place of duty. Someone like Mike, if he’d been told he had to be there, he would have gone."
McCaddon believes that the military culture of stoicism, and the stigmatization of mental illness, kept her husband from seeking help for fear of ruining his career. Many service members worry that they'll be passed over for promotions or even discharged after admitting and receiving treatment for a mental illness, Ruocco said.
'Somebody's got to talk to people'
It is the same fear that Bob Bagosy says keeps friends and colleagues of struggling service members from admitting how severe mental health issues can be. His son, Tommy, was considering in-patient mental health treatment in 2010, but repeatedly heard from fellow service members that it might hurt his career. Tommy, a 25-year-old Marine sergeant, had completed a tour in Fallujah, Iraq, from 2006 to 2007, and a second tour in Afghanistan in 2009. He sustained a traumatic brain injury during his deployment and had post-traumatic stress disorder.
When he threatened suicide to his wife, Katie, she asked Tommy's psychologist at Camp Lejeune in North Carolina to mandate in-patient treatment. Tommy was brought in to make those arrangements, but then walked out of the office, and after an encounter with the military police, shot himself to death.
Bagosy believes that Tommy's life might have been saved had there been more candid discussion about struggles like his. "Somebody's got to talk to people," Bagosy said. "They've got to hear that just because you’re a Marine, and you survived the wars, does not mean you're not subject to having these thoughts."
Bagosy, a former Marine reservist, does his part by telling Tommy's story to groups of Marines, urging them to seek help if they need it.
He has been involved with TAPS' suicide survivor program since 2010 and will attend the gathering this weekend. "This group of people became my other family, my surrogate family. It’s an automatic bonding," he said.
Providing that support is the core of Ruocco's work, and her focus is helping survivors change their perspective on the tragedy they experienced. Their loved ones served and sacrificed, sustaining psychological and sometimes physical wounds, Ruocco tells survivors -- they just died differently.
"How they died defines it instead of how they lived," Ruocco said. "I try to get them to shift to how they lived."
Rebecca Ruiz is a reporter at msnbc.com and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.
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