Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr. Jessica Zitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Suicides in the military have skyrocketed since the wars in Iraq and Afghanistan. The military’s suicide rate jumped more than 80 percent between 2002 and 2009. One military family is trying to change that. The Grahams lost two sons: one in combat in Iraq and one to suicide. But the Grahams were astonished by the different reactions their deaths received from the Army. The one killed in combat was lauded as a hero, while the other’s death was met with silence. In a new book, Yochi Dreazen, the managing editor of Foreign Policy, shows how this family channeled their grief into working to transform the military’s approach to soldiers with mental illness.
- Yochi Dreazen managing editor for news at Foreign Policy and author of the upcoming book "The Invisible Front."
Read An Excerpt
Reprinted from The Invisible Front Copyright © 2014 by Yochi Dreazen. Published by Crown Publishers, an imprint of the Crown Publishing Group, a division of Random House LLC.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The Graham family lost two sons, one in combat in Iraq, one to suicide. The military community reacted to their deaths in very different ways. The one killed in Iraq celebrated as a hero, the other son's death met with silence. A new book by Yochi Dreazen, managing editor of Foreign Policy, tells the story of this family's fight to transform the military's approach to mental illness.
MS. DIANE REHMHis book is titled, "The Invisible Front: Love and Loss In An Era Of Endless War." Yochi Dreazen joins me in the studio. As always, you are welcome to be part of the program. Give us a call at 800-433-8850. Send us an email to email@example.com. Follow us on Facebook or Twitter. Yochi, it's good to see you.
MR. YOCHI DREAZENThanks, Diane. Thanks for having me on.
REHMYochi, this such a powerful story. I'm interested in the entire Graham family. Such a loyal military family. The father, Major General Mark Graham, was a decorated two-star officer with decades of experience. How did you first come on the Graham family?
DREAZENIn 2009, I was back from several years of living in Iraq and Afghanistan and shuttling back and forth covering the war. And I began to notice that I had personal friends, military friends in those years, who had either talked to me about deep depression, in some cases attempted suicide, in a couple of cases, unfortunately, killed themselves.
DREAZENAnd I began talking to friends at the Pentagon about it, looking into the numbers and that was the first year where the suicide rate for the military exceeded that for the civilian world, which had never happened before. And in talking in the hallways of the Pentagon, I kept hearing about the story of this family, the Grahams. And when I first heard about the idea of having lost two sons, the notion to my mind of losing one child seemed almost unimaginable and losing two seemed beyond comprehension.
DREAZENI flew out to Colorado to spend some time with them. At that point, Mark was in command of the largest base in the U.S. military, Fort Carson, one of the largest bases, excuse me, which had a very high suicide when he got there which he managed to bring down. And we formed an immediate connection in part, to be very frank, because I was suffering, although I didn't realize it at the time, from PTSD myself, which Carol Graham, the mother of these two boys, immediately recognized before she knew me at all.
REHMIn you, she saw in you. What kinds of symptoms do you think you were expressing not even recognizing in yourself?
DREAZENOne of the first things she said to me in her house was, you remind me of Kevin. Kevin was her son who took his own life. She meant it as a compliment because he was thoughtful and kind and considerate so it was a very -- she meant it in the best possible way. But she was more accurate than she knew. When I came back, I would have flashes of anger. I couldn't sleep. If there was any loud noise, I woke up immediately.
DREAZENI would have very, very vivid dreams that once I had them would just keep me up all night. And I thought it was just something that would go away. I thought of myself as this tough guy journalist who had gone to cover a war in body armor and wasn't sitting in Washington in a suit. And it didn't occur to me that this could be PTSD and it should have.
DREAZENFinally, I hit what, for me, was a low point. An army friend, who was later the best man at my wedding, said to me just bluntly, you have PTSD. It wasn't you might have. It wasn't you should talk to someone to see if you have it. It was you have it. And the issues that I faced about trying to decide whether to seek help, where to go find help, whether to tell friends, whether to tell friends and colleagues like you, these were exactly the issues Kevin Graham faced.
DREAZENExactly the issues Mark Graham tried to change. And in writing the book, I understood their world because, unfortunately, I had lived it.
REHMThe issues you bring up in the book include the way -- the different ways in which one son who was killed in combat was treated, or the family was treated, and the way the family was treated when the other son committed suicide. What is the army's approach to suicide or what was it?
DREAZENAt the time, it was to pretend it didn't happen. By the time that Kevin took his own life, the numbers were beginning to rise, but they were not remotely at the epidemic levels that they have been these last few years. And it's worth noticing that more soldiers have killed themselves than died in Afghanistan, which is really, when you think about it, really shocking number. Even this year with the wars ending, you've had more than 319 soldiers, this year alone, kill themselves.
DREAZENLast year, you had about 350. No one I've spoken to within the military thinks those numbers are going to start declining any time soon. And when Kevin took his own life, the attitude then was these people in the military were cowards, they were weak, they were not worthy of wearing the uniform. One of the people I interviewed, General Peter Chiarelli, who later in his career would try to help fight stigma as best he could, was a commander in Iraq in 2004 who I knew very well.
DREAZENHe lost 168 soldiers to combat. One of his soldiers killed himself. When he came back, the memorial wall for the unit had 168 names, not 169 and he told me in an interview that that was the single thing he regretted most of his entire career, that he pretended that this other soldier who had fought alongside his other men, seen the same kind of horrors, but took his own life, was treated differently and was not seen as a casualty of war.
REHMYochi, I think everyone listening to this program has had a sense of what PTSD is, but doesn't quite understand it, the extent of the suicidal feelings, the extent of the depression, the extent of the nightmares. Perhaps you can make that real for us.
DREAZENSure. It's worth also remembering that the names for PTSD have changed, but it was shell shock at one point during World War I.
DREAZENIt existed during the Civil War, where after the Civil War, more than half of the veterans of the war that -- excuse me, more than half of the patients that were in mental wards were veterans of the Civil War. During World War II, this was something that shocked me when I found it, there were 500,000 troops during the war who were discharged for psychiatric wounds. So this is not now. What's new is that we have a name for it and we have numbers.
DREAZENAnd the estimates for the veterans of these wars, who all have some form of PTSD, range from 300,000 to 500,000. And PTSD doesn't go away. This is something that will last for decades, in many cases it may just be below the surface. In some cases, it could be 20 years from now a person has a break. Maybe they take their own life. Maybe they become alcoholic. Maybe they've become alcoholic, but didn't realize it was PTSD.
DREAZENAnd PTSD, post traumatic stress disorder, this comes from seeing trauma. This comes from seeing something that sticks with you and shocks your consciousness. You might have killed someone. You might have seen someone who you care about killed next to you. You might have, in driving, seen a car that was full of a family that had died, a child, a woman, an old person. And that nightmare sticks with you.
DREAZENOne person who I spoke to for the book made the point that if you go through war and you come back and you're not changed, something is very deeply wrong with you, that it's normal that when you're dealing with these kind of stresses, this kind violence, it's normal that you should change. And if you don't, that's where the issue sets in.
REHMWas here one image in your mind that took you deeper into that feeling of depression and loss?
DREAZENIn 2005, late 2005, I was in an interview in Southern Iraq where my translator who was in Iraq, he spoke fluent Arabic, of course, said to me, we need to go. There's been a suicide bombing. It's terrible. We need to go cover it in a nearby city. And when we got there, the hospital where the bodies had been brought was surrounded by people who had lost someone or thought they lost someone, desperately trying to get in and trying to knock down the gates.
DREAZENWe sort of snuck in. And inside the fences were rows of bodies covered in white sheets and what I'll never forget is seeing the families that had made it in, walk, pull one sheet back, pull the next sheet back, keep going along these rows till they found the person they were looking for, their son, their daughter, and just breaking down. And that was nearly a decade ago, but that image is one that I have never forgotten and I don't think I ever will forget.
REHMTell us about Mark's sons, both Kevin and the other son.
DREAZENJeff. This was a family that was, in some ways, a Norman Rockwell-style family. Mark and Carol, his wife, were deeply in love. They had been in college, got married right after. Mark was a very highly-regarded officer who was in Germany and then kept ascending and ascending and ascending and they had three children, Jeff who was the oldest who looked the most like his father and wanted to be a combat officer, Kevin who was a very sensitive child, the perfect son.
DREAZENThey would say get out of bed, he would be out of bed early. They would say, put away your teddy bear, you're a man now, when he was 8, he'd put it away and Melanie, who was their baby, their sister, the one that both brothers protected. Both of them wanted to go into the military. They saw what their father did as the most honorable thing you could do. They wore army uniforms as children.
DREAZENThis was the path they wanted. And they went about it different ways. Kevin wanted to be a doctor in the military. Jeff wanted to lead people into combat. Kevin had always had something that they didn't realize until much later was depression. He would sit in the corner of his room by himself. He would -- just see his mood change. He would talk about things, like at school he would learn about the Holocaust and then it would hang over him for days.
DREAZENAnd Jeff was more of a happy go-lucky guy. He drank. He was very successful with women. When they got to college, Jeff was a year older. He was doing very well, just like his father in the program to get him into the army. Kevin was not. His friends thought that he really, by that point of his life, did not want to be in the army and felt pressure. Not that the family was sort of telling him explicitly, but he felt that's what they wanted him to do.
DREAZENHe was diagnosed with depression and put on medication and his mood stabilized. Jeff, by this point, was in the army. And this one horrible day, he took himself off the medication. His feeling was if he joined the army and the army found out, they'd kick him out and his career would end before it started. So he took himself off the drugs and didn't tell anybody.
DREAZENOne morning, before Jeff was supposed to deploy to Iraq, they had made plans to play golf. At this point, they were all living together, to give you a sense of how close they were as siblings. Kevin and Melanie were sharing an apartment. Jeff had lived there, too, before he graduated. And Jeff was at the golf course and Kevin doesn't show up. So he calls his sister and says, can you see if he slept in, it's strange, you know, where is Kevin? Where's Kevin?
DREAZENShe goes into his room and he's hanging from the ceiling fan. So she finds her brother -- first she thinks it's a prank, but then, of course, realizes that it's not.
REHMYochi Dreazen, his new book is titled, "The Invisible Front: Love and Loss In An Era Of Endless War." Short break, right back.
REHMAnd welcome back. Yochi Dreazen is with me. He's one of our regulars on the Friday news roundup, but today we're talking about his new book. It's titled "The Invisible Front: Love and Loss in an Era of Endless War." He has written about the Graham family, military family where Mark, the father, had a very successful military career. His two sons, Jeff and Kevin, also aspired, one much more so than the other. Before finishing his ROTC and before entering the active military, the younger son, Kevin, hanged himself. Jeff went on and I gather, Yochi, was celebrated as a hero.
DREAZENSo Jeff had the choice at this point, after he lost Kevin, whether to go. And his father, who was a very successful officer, had friends throughout the army, said to him, I can, in one phone call, I can save you from this, I can find you another job. Jeff said, I have to go. It's what he'd always wanted to do and Mark didn't try to stop it, and for the rest of his life, Mark will wonder if he had, would his son still be alive? And Jeff went to a particularly dangerous part of Iraq, a part where I've spent a lot of time.
DREAZENMany of your listeners will know the name, Fallujah. He was right around Fallujah, which at that point was the bloodiest stretch of Iraq. And one day, he was leading his men on a foot patrol, crossing a bridge, and he led from the front. He was always the first one forward. And they were walking, and he saw something glimmering by the bridge, and something about it triggered a feeling of fear that made him think, it's something dangerous, and he turned to tell his men to stay back. As he turned, it was a bomb that went off. Jeff was killed, another American soldier with him was killed. Every other soldier in his platoon survived.
DREAZENSo Jeff was seen as this hero who killed, took his own life in a way, sacrificed himself so others could live. He was a hero. I don't think anybody would question that. When he came back, the Kentucky state legislature passed a resolution in his honor, there were flags at half-mast. His funeral, there were thousands of people lining the road to the cemetery site, hundreds of people there to present the -- see the flag presented to Mark and Carol. It was a big deal, I mean, this man was celebrated rightly as a hero. With Kevin, it was not that case. With Kevin, the family wondered, should he even have a church funeral of any kind?
DREAZENBecause he took his own life. Members of the family who were deeply religious thought he was a sinner. So for Mark and Carol, they saw the one son rightly hailed as a hero, very public, with the other son, it was something people didn't talk about, as if they were ashamed of it. One other thing, just about Jeff, in Iraq, he kept a journal, which the family very kindly gave to me. Every entry closed with a note to Kevin. It was, "dear Kevin, please help me with this," "dear Kevin, I miss you, I hope that you are here with me," "I hope I could talk to you."
DREAZENWhen he was killed, they found in his wallet that he had with him, Kevin's driver's license. So he had taken that with him to Iraq. He had it with him every day, including the day he was killed.
REHMWas it Mark and Carol's belief, the parents' belief, that Kevin had hanged himself because he couldn't face going into the active military?
DREAZENIt is. Their feeling was, he was so scared about letting them down, he was so scared about having his career end, he felt this need to make himself someone who his father would be proud of. And he was so scared that if they found out, they being the army, and he was right, frankly, if they found out that he was on medication, at that point in the history of the army, he would have been kicked out. So he was right to be afraid of what he was afraid of.
REHMSo how did the family react to Kevin's suicide?
DREAZENKevin's death knocked them into a very, very deep spiral. Carol, who's an extraordinary woman, told me for the book that she thought about killing herself. She thought, how do I live without my son?
DREAZENThey both, at this point, Mark started to think, I'm not sure I could do this any longer, when Jeff died, Mark thought, I have to get out. Carol, again, by this point, was in a profound, she was nearly catatonic. I can't emphasize enough how extraordinary people, the two of them are. Just, I don't have children yet, but the notion of moving on, finding a way to get out of bed in the morning, I don't know how they do it, even though I've known them now for five years. And Mark, when he was getting ready to retire, he had decided after Jeff's death that he just could not do it anymore, 'cause of this guilt.
DREAZENHe felt like his one son was trying to enter the army to please him, died, the other son was in the army, trying to follow him, died. And Carol said to him, this can either be a chapter in the book of our lives, or this will be the book. And those words resonated. He decided there was a flood of people coming back that he was seeing, with PTSD, there was a flood of soldiers beginning to kill themselves. The tide was rising, and he would try to stay in, in part to try to help bring those numbers down.
REHMDo we have any idea how many soldiers are estimated to have PTSD?
DREAZENThe number of soldiers in these current wars are estimated between 300 to 500. Some people put it higher, some people put it lower, but roughly in that range.
REHM300 to 500,000?
DREAZENThousand, excuse me, of people who've served in either Iraq or Afghanistan. There are more than two millions troops that have cycled through, so we're talking about roughly a third or slightly higher, depending on the number you use.
REHMAnd the question of how they are treated.
DREAZENIt's interesting, and many of my military friends, this chafes at them, people come home and people applaud at baseball games, at airports, people say thank you for your service. There's a bumper sticker on the car, we support our soldiers, we support our troops. Football games, there's always an honor guard. It's a very military-friendly society. On the one hand, that's a wonderful thing, veterans of Vietnam did not have that, of course. They were spit on, they were shoved, they were made to feel ashamed.
DREAZENSo on the one hand, that's wonderful. On the other, it's somewhat facile. It's the only relationship many people have to the military, is to applaud at a football game. A lot of military friends of mine feel that the word hero, for instance, is overused. What they will say is, I was at a base in Baghdad, I never left that base. I missed my family, but I'm not a hero. A hero is someone like Jeff Graham. A hero is someone who took risks, who may have sacrificed himself. And there's that dichotomy in our culture which we haven't addressed, of, does serving in the military, in and of itself, make you a hero?
DREAZENDo you have to have done something? And what can you do if you're a person who cares about the military to support those who need help? To support someone who has PTSD, to help them find a job, to help them if their family, they're getting divorced, if they're seeing family trauma. It's a question of what can we do for the people who care enough to try to help?
REHMAnd what about the Pentagon? To what extent has it, or does it now, acknowledge PTSD?
DREAZENIt acknowledges it. It acknowledges suicide, it acknowledges stigma, this issue that makes people fear for their careers about seeking help. At every level, you hear people talking about it. There's enormous amounts of money being spent, hundreds of millions of dollars, so that's all for the good. the problem is, the Pentagon is the definition of a hierarchy. We think, obviously. And until you have generals say publically, I suffered PTSD, I was suicidal, and my career did not end. I am still a healthy, brave soldier. You can go through this, you can talk about it, get to the other side. Your career will not end. Until you have people at the very highest ranks saying that, a lot of the talk and the money will be for naught.
DREAZENRight now, for the book, I spoke to about a dozen generals I knew from the two wars. Many of them said to me, even if they didn't use the word, that they had PTSD. When I said to them, can I use your name in the book? One. One was willing to let me do so. A general named David Blackledge, who talked for the book with his name. None of the others. None.
DREAZENNone. And until that changes, a lot of the talk about eliminating this won't help.
REHMThe whole question of what was going on at Fort Carson, where Mark Graham first began to address this. Why was the incidents of PTSD and the suicide rate at Fort Carson so high?
DREAZENSo, Fort Carson is in Colorado. It's one of the most beautiful bases I've ever seen. It's ringed by mountains, it's really stunning. And when Carol was first driving to the base with Mark, that's all she could think of, was how beautiful it was. But there was this really dark current running through the base, in part because the tempo of units from the base deploying didn't let up. So you'd have one unit go, come back, leave again within a year. And so this constant rotation of people doing two, three, four, five tours, horribly bloody tours in Iraq and Afghanistan.
DREAZENWhen Mark got there, there had been a unit of soldiers from the single unit who went on a killing spree in Fort Carson. So actually murdered civilians, in many cases -- a couple of cases, murdered other soldiers. That was when Mark first got there. And then was welcome to Fort Carson, you have this unprecedented case of a single unit killing other people, including civilians. Then he came to the base and found out that the suicide rate was among the highest of any base, anywhere. So he now is faced with this murder incident, and this much deeper PTSD/suicide issue. And that's where he started to try to get down to work. And that's where he thought, I have the power now to try to change it. I'm gonna use that power.
REHMNow, it's fascinating to me, Yochi, that you are so able to so closely identify with those who do suffer from PTSD, even though you've not actually served in the military with them. Tell me about the kind of treatment you sought out for yourself, and to what extent you still feel affected?
DREAZENIn my case, it took a long time to accept that I needed any kind of help. And the first thing I thought was, I would talk to someone and that would be enough, and it wasn't. And you know, Diane, you're a friend, we've known each other a long time, to be frank with you and with the listeners, it took medication. And until I was willing to take medication, nothing changed. I'm still on that mediation. I don't feel shame about it. For a while I did, for a while, frankly, I felt the same kind of shame that I think a lot of military friends felt of, why do I need this? Why am I this wounded, injured person?
DREAZENI came back, I had no scratches on me, why am I wounded? It took a long time to accept I was. It took a long time to accept the need for medication, which I'm on and which has changed my life.
REHMAnd do you still have flashes? Flashbacks, as it were?
DREAZENThere are nights where I'll still wake up having had some sort of dream that I couldn't get out of my head. There are nights where, and this, I don't think will ever go away, where a small sound, I'm wide awake and I don't go back to sleep. And it's worse when I was first back. I would be in a restaurant, I couldn't sit near the windows. I had to sit in the far back. I had to always see where the exit was. I was always afraid someone's gonna walk in and blow up and the glass will start flying.
DREAZENI'd hear a truck backfire and I would jump under a table, which, to my friends, was amusing at first, and then they realized, that's not something funny. That part of it is gone. And what's left is sort of like the little flickers of this issue, this little flicker of waking up, this little flicker of a nightmare.
REHMAnd your relationship with your wife, the whole idea of being married. Did you have doubts about going into that knowing that you were still suffering?
DREAZENI did. I did. By the time that we met, thankfully, I was through the worst of it. I did. My wife had been in Iraq herself, so she had some sense what it was like to go through it. She had some sense of the place. I did, but she's an extraordinary woman, in part because she understands me, and in part because in the first part of our relationship, she was patient. The biggest single among -- for suicides was in the military. The biggest single thing that happens beforehand is a family trauma.
DREAZENSo a soldier comes back and discovers the spouse was cheating, discovers that they're getting divorced, the kids have moved on. So for most people who kill themselves, that sort of support from the family isn't there. In my case, I'm very grateful that it was.
REHMAnd you're listening to "The Diane Rehm Show." You said you came close to suicide yourself. What was that instance like?
DREAZENIt was something where I wasn't at the point of having a plan. I wasn't at the point of having hurt myself in any way physically. Thankfully, I wasn't at that point. But the point I was at was thinking, these clouds hanging over me will never go away, and they only way to make them go away is to not be here anymore. That's where I was. It was at the thought of, I should do it, if only because these nightmares, this pain will disappear if I do. And thankfully I was not at the point of hurting myself or having a plan in which to do it.
DREAZENAnd that's where my friend, to whom I'll always be grateful, a captain named Adam Tiffen, said to me, you need help. I'm going to take you to a place to make sure you see someone, I'm gonna make sure you keep seeing someone. I will look out for you. And I honestly don't know. I'd like to think that I would still have never gone beyond thinking of it, but thanks to my friend, I never had to actually be in a place where I'd be prevented from doing something that might have taken my own life.
REHMDid your broader family of origin know that you were going through this?
REHMYou did not tell them.
DREAZENNot 'til much later. I'm an only child of a single mother. I did not want to scare her.
REHMI understand. But I think about all those in the military going to the VA, and not being able to get help.
DREAZENYeah, I mean, the way -- and this is true in the active military too, they can go to a base. At Fort Carson, let's take as an example, Fort Carson was dangerously understaffed. It just didn't have enough psychologists, psychiatrists. So they would -- a soldier who was brave enough to go seek help, and again, there was a stigma, so many soldiers felt that they couldn't, felt that they'd be kicked out if they did, because there was a cruelty that it's worth highlighting. So it isn't simply that there was this clinical antiseptic term, stigma.
DREAZENTo give it -- make it more human in some ways, there was one unit I found in which a sheet was put up near where you'd sign out to go see a doctor, that said, I'm seeking help because I'm A, a coward, B, soft, C, all of the above. And this wasn't there for an hour as a prank, this was there for days and days and days.
DREAZENIn one case, a sergeant said to a soldier with severe PTSD, just kill yourself so I can deal with the paperwork and get this out of the way. In another case, a soldier painted in paint on his barracks wall, basically a suicide letter. A friend of his, thankfully, got him help, he didn't kill himself, but the response of his unit was, you're now gonna be court-martialed for defacing army property. So there was a cruelty to this as well, beyond this sort of clinical issue. But there weren't enough doctors, there weren't enough counselors, and what would happen is, you might go.
DREAZENYou know, the VA scandal we all know about in Phoenix for medical care, but for this care for an invisible wound, a person might go and be told, it's a two month wait. And in those two months, you had soldiers who killed themselves waiting to see a single person. And once they did, the doctors were so overworked, there would be a five or ten minute appointment, the answer would be, here's medication. There wouldn't be anybody monitoring what they were taking, how much they were taking, but that would be it. They would either wait and see no one, or they'd see someone and have ten minutes, and that would be it.
REHMHow much do you think that situation has changed?
DREAZENThere are many, many, many more psychologists and psychiatrists who've been hired, so those times are much, much better. But there aren't anywhere nearly enough, in either the active military or the VA. Part of it is that the military itself, the bases, Fort Carson, for instance, are so far away from major cities that you have to really move people out there to do this job. If they were, let's say, outside Chicago or New York or Washington, if they were very close, you could just see a civilian in Washington and Chicago and New York. You can't do it at these massive bases kind of in the middle of nowhere.
DREAZENSo there are more people, there are more soldiers who are willing to go seek help, who feel less ashamed, less like they're gonna lose their career. But it's not something where it's been solved. It's not something where, as much as we might like it to be, the military found a billion dollars, spent a billion dollars, and suddenly the problem is solved.
REHMBut do you think that the derogatory attitude toward those who seek help has declined?
DREAZENIt's declined, but it's still there. I was at an event recently where I was approached by a major who had read my book, and army major who said that in his unit, when he was in Afghanistan, recently, a soldier killed himself. The rest of the unit pretended he'd never existed. So they took the Facebook page for the unit and sort of re-cropped the photos to take him out of the photos. So it is still there.
REHMYochi Dreazen, and his new book, "The Invisible Front: Love and Loss in an Era of Endless War." Short break here, we'll be right break.
REHMAnd welcome back. Yochi Dreazen is with me. He is, of course, managing editor of...
REHM...Foreign Policy and he's on this program quite frequently on our Friday News Roundup. He is the author of a brand-new book, "The Invisible Front: Love and Loss In An Era Of Endless War." That invisible front certainly refers to those who suffer perhaps not visibly or outwardly so that all of us can recognize it, but suffer from PTSD as Yochi himself has done. I'm going to open the phones now, 800-433-8850.
REHMFirst, to Dave in Springfield, Virginia. You're on the air.
DAVEHi. Good afternoon, Diane and Mr. Dreazen. Thank you. So I commanded a unit in Iraq a few years ago and I just wanted to talk about the difficulty that commanders have with dealing with suicide. It's a very important subject and I appreciate your show. I had a young soldier who committed suicide over there, 100 percent convinced that he was suffering from PTSD.
DAVEHe had been deployed earlier, had had a rough deployment, had just come into the unit and the day before he was due to go out on patrol the first time, he took his own life. And I'm convinced that he did not feel that he had the courage to go outside the wire again and this was his only solution. So I had no issues with honoring his memory, however I was so concerned, I've known several people who've committed suicide over a 25-year career and I really believed that if we had a memorial for him and invited everyone in and celebrated his life, that it may have caused others who were on the edge, who were suffering from depression, PTSD, problems at home, whatever to encourage them to also take their own lives.
DAVEAnd so it isn't an army policy to celebrate or not celebrate the life of a soldier who's taken his own life. It's often left to the junior commanders. In the case, I had a senior leader who talked to me and convinced me to have a memorial for him and, fortunately, we did not have anyone else hurt themselves.
REHMI'm glad to hear that. What do you think of that, Yochi?
DREAZENYou know, first, I think it's wonderful that Dave was a commander who was as compassionate to the soldier who took his own life, but it's a very fair question. I mean, and I don't mean to, in any way, think or suggest that this is a black and white issue. It's most definitely in the gray. His point is a fair one. There are people who do believe that if you honor them, it incentivizes in a weird way or says this is an acceptable behavior and that's a fair belief.
DREAZENThe other belief, which is certainly a fair one, is if a soldier is shot on patrol, that is, in some way, different than if he shoots himself. They may, if a soldier survived, to a shot, it's a PTSD issue the same way for a soldier who may not have been shot at all. But it's a fair point and I don’t mean to minimize people in the army who are compassionate the way Dave was who may wonder, do I incentivize it by honoring him, am I trying to say that they're equal when they're not.
DREAZENIt's a tough issue and Dave is exactly right that it is one that people struggle with to this day.
REHMHere's an email from Benita. She says, "the rise in U.S. suicides was reported in the news today, but they didn't say what percent of suicides are committed by our active military and veterans. How can we find out about that?"
DREAZENSo the numbers are a little difficult to find, frankly. And the military puts out numbers for active-duty troops and for troops in the National Guard and the Army Reserve. CDC and others who, on the civilian world, look at this, the VA looks at this, but the numbers -- there's no accepted methodology for it. The number that, in some ways, is the most compelling, I think, is the people who are still in. That number, among the active-duty troops, declined very slightly.
DREAZENBut among National Guard, among Army Reserves it spiked and that's something that I worry about very deeply. The military, whatever the problems at a base, at a minimum, you come back to a base where the people around you know what it's like to be in the military. They understand what the military is. You're in the Army National Guard, you're a lawyer perhaps come back to Washington, no one around you knows what the military's like.
DREAZENThere is no support for your family whatsoever. So even if it's flawed for the active army, there's nothing for the Guard and for the Reserve and that's where you're seeing the very dangerous, very heartbreaking spike.
REHMIn the general population, you said during the break that we used to focus so exclusively on high school kids with fear that they would commit suicide. But now, the rates among high school kids has dropped and the rate among men in their 50s has gone up.
DREAZENYeah, the military comes from our society. I mean, they come from the civilian world. They reflect it and they reflect it back, right? It's sort of a mirror. One is a microcosm of the other. So an issue that effects one also effects the other. In this case, suicide is not unique to the army and it's not increasing only in the army. Since cars were created, more people died in car crashes than anything else.
DREAZENI'm setting aside diseases, but outside diseases, car crashes were the biggest killer. 2010, suicides past it. Those numbers have gone up since. So when we think about it, we see car crashes on the news, maybe we know somebody who was hurt or killed, unfortunately, but more people kill themselves than die in a car crash. And what you were alluding to before, which I appreciate 'cause it's an important point, high school students face bullying. We know that, you know, especially gay high school students or people struggling with their sexuality.
DREAZENCollege students face the stresses of am I getting good grades, am I going to let down my parents. And those suicide rates have always been high. What you're seeing now is that men in their 50s, early 60s, are killing themselves in large numbers, in part because they've been laid off. They feel like, probably correctly, they can't find another job. They wonder how will I support my wife, my children, and that's where you're seeing a gigantic spike.
REHMHere's an interesting email from Bob. He says, "I don't even think we should use the term PTSD. It is not a disorder. It's a normal reaction to the horrors of the situation. If you do not react, there is the disorder. A better description would be PTSR for reaction." I think language makes a difference in the minds of those who are experiencing it.
DREAZENIt does and I think Bob is spot on to raise it as an issue. Within the military, you hear of many people refer to it as PTS, as post traumatic stress and they leave off the D. And their feeling is if you say to a soldier, you're sick, you have a disorder, you're flawed, that soldier may not seek help. In a way, that might even make it worse. Their feeling is, as Bob indicated, everyone who goes through this should have some reaction.
DREAZENIt doesn't mean you're sick. It doesn't mean you have a disorder that won't go away. It means you're reacting to something that anyone who goes through war should and probably will react to.
REHMAll right. Let's go to Milton, Florida. Hi, Patrick, you're on the air.
PATRICKGood morning. Thank you for taking my call. It's a great show.
PATRICKI'm a combat veteran and was treated for post traumatic stress disorder for about seven years and eventually ended up running a specialized treatment program in the VA called The Vet Center, which works specifically with combat-related stress problems and post traumatic stress disorder. It's been my observation after 20-some odd years of war that unlike World War II where the burden of taking the life of another is shared by the nation in the sense that everyone is tied into the war, be it sugar rationing, gasoline rationing, lights out, all kinds of things that were done in World War II so that the country shared an involvement daily with the war that since Korea, this has tapered off less and less and less.
PATRICKAnd now, the guys who are over there doing multiple tours and I don't, frankly, know how they did multiple tours, are really alone and isolated. And I think that until the country becomes totally involved and committed to a war, which means that everybody in the nation is involved in it and actually touches them, I don't see this changing. The responsibility of taking another's life, even when it is, in our minds, justified and correct, is a heavy, heavy burden.
DREAZENI think Patrick's exactly right. There is this divide, which is extraordinary. I mean, the statistic is one percent serve in the military, roughly. But if you live in a major city, the odds are you may not know a single person who has served or is serving. When I was working on the book, I spent some time in New York with Melanie Graham, with the surviving Graham daughter. Melanie, who is extraordinary, fell in love, she married a man who had lost a brother on 9/11, a Special Forces veteran.
DREAZENBut they have a beautiful marriage. They have found a way to have happiness, to have laughter despite this. And when I went to go see her, she called me on the train to say, I'm sorry, but I may be a mess when you get here and I'll tell you why. What had happened was the best man in their wedding had just died in Afghanistan. He'd just been killed. And we were walking through Manhattan and I was thinking to myself, we're probably passing a thousand people in the course of this 20-minute walk.
DREAZENI would bet none of them know somebody who's served. None of them have somebody who might have been hurt or wounded. Many of them don't even know we have a war going on in Afghanistan, it's so forgotten on the news. Meanwhile, here is this smart, accomplished woman who's just lost someone she loves and no one around them has any sense of what that's like or any sense that the military exists in the way that it does or that the war is still happening.
REHMAnd yet, the idea of a draft is apparently never coming back.
DREAZENAnd part of it is, when you talk to people in the army, they don't want it back. They said when you had a draft, you had people who were in because they had to be who were alcoholic, who were drug addicts, who had criminal records, who really didn't fit and in this way, you could be more selective. The issue is, during the Iraq war, they needed people so they lowered all of those standards. People who had criminal records could be brought in, people who had alcohol and drug problems could be brought in, people who did have obesity or other health issues were brought in.
DREAZENSo you're right. The draft is not coming back, but it's not that the military is this perfect institution without it.
REHMAll right. And so Sam who's in Cincinnati, Ohio. You're on the air.
SAMHi, thanks for taking the call. It's an excellent topic. I think having a conversation is a cheap phrase, but the fact that there are so many breakthroughs coming through on this topic, I think it's just great that you guys are, you know, with an MBMA discussion and all the different hypnotic therapies, it's just amazing. I wonder, as I was listening to your guest, if the next step is to talk about the training of these people before they experience the traumatic stress and what areas of the military are having lower numbers and what are they doing different to train these people?
DREAZENIt's a great question. And one thing that's worth highlighting is that some of the treatments include yoga. I mean, some people come back and they do deep breathing and they do yoga and they found that that actually helps tremendously. But the phrase the military uses is resilience training, resiliency and the idea is exactly as Sam suggested, train people before they go about how to react to what they see. There have been some signs that it could help. There have been some, unfortunately, that show it may on the margin help, but it may not or the impact will be very limited.
DREAZENBut he's right that that is where the research is going, where the money is being spent.
REHMWe talked the other day about the use of LSD and ecstasy, those drugs apparently one or two sessions could help that individual learn better how to deal with it.
DREAZENIt can. I mean, there are lots of things that were mocked as homeopathic or things that were for hippies that the army has now embraced. I mean, to see a room full of army guys with short hair doing yoga, I grew up doing yoga and it was sort of this silly thing my mom did from life in the '70s and now it's something these very tough men do and it helped.
REHMThat's very interesting. Pardon me. I just sneezed. Okay. Let's go to Adam in Chapel Hill, North Carolina, you're on the air.
ADAMAnd thanks to both of you for bringing compassion and empathy to what would otherwise be simple tragedy. I'm a family doctor and I've treated, over the last two decades, dozens of men and women who've had sexual violence, family violence and military violence. And I had a veteran recently, an older white male, and who is experiencing PTS and I just wanted to reflect on -- we think about psychologists and psychiatrists frequently as kind of sources of care, but access to the mental health system is fragile at best in the U.S.
ADAMAnd in the military, it may be far worse. Access to primary care physicians, however, is better and you mentioned medication. I wonder if you can expound because there are many who would see that there's biologically things that have occurred when people have experienced trauma and so the route of both medication and therapy can help correct both the biologic and perhaps the psychological issues. And I wonder if you can comment on that and also reaching out to your primary care or establishing primary care physician to help coordinate perhaps a team-based care.
DREAZENYou know, first, I would say that, Adam, patients of yours are lucky to have you. They're lucky that you're sensitive to this and you're exactly right. Chaplains, I mean, rabbis, religious figures are also places people can go and talk freely. Doctors like yourself are places people can go. There is a lot of research which has found that there are physical signs of PTSD in the brain and this helps because for people who still say it doesn't exist, it's fake, you can now point to scans of the brain of someone who's gone through trauma and it's different than the scan of a brain of someone who has not gone through trauma.
DREAZENSo there's research showing that his exists. But he's exactly right that, in some cases, the people a person might trust are no psychologists. They're people who are a doctor they've known for a long time. One of the pieces of research I found for the book is that many soldiers didn't want to see a civilian psychologist because they felt there's no way this person understands me.
REHMIs understanding, yeah.
DREAZENThey're gonna mock me. They're gonna think I'm just this grunt, this knuckle-dragger. But when it comes down to a doctor who may have treated their children and who they may have known a long time, they might unburden themselves more freely. I think Adam is exactly right and I hope, frankly, more people, maybe people who are listening, will speak to their doctors, will speak to their chaplains, will not think that they have to wait to see a psychologist or psychiatrist.
REHMYochi, you've covered wars in Iraq and Afghanistan. You did that for The Wall Street Journal. You've reported for more than 30 countries. You really faced into it by writing this book, didn't you?
DREAZENYeah, and it's personal to me. I mean, this is not something where I'm looking at it from the outside and thinking, hey, this is a good story, I want to tell this good story. This story of the Grahams is riveting to me and it's fascinating, in part, because they -- closure is a fake word that I find often kind of offensive -- they don't have that. They still tear up when they tell their story, but they have found a way to get out of bed every morning.
DREAZENThey've found a way to laugh. At Melanie's wedding, Mark gave a toast that kind of brought tears to my eye, but he was smiling. He said it was the happiest day of his life. So they have found a way to move through this and to try to find not only meaning, but happiness.
REHMAnd you have as well.
DREAZENAnd I have, too.
REHMYochi Dreazen, his new book is titled, "The Invisible Front: Love and Loss In An Era Of Endless War." Yochi is managing editor of Foreign Policy. Thank you all for listening and Yochi, thank you writing this book.
DREAZENThank you, Diane.
REHMI'm Diane Rehm.
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