The invisible front Love and loss in an era of endless war

Review by New York Times Review

WHEN JEFF GRAHAM was killed in Iraq in 2004, the Kentucky State Legislature passed a resolution hailing the young second lieutenant. Tens of thousands of fans applauded when his boyish face was displayed on the scoreboard at a University of Kentucky basketball game. Hundreds of mourners waved American flags as his hearse passed. One sergeant even named his son after the fallen hero. When Jeff's younger brother, Kevin, committed suicide in 2003 while enrolled in a University of Kentucky R.O.T.C. program, his aunt opposed holding his funeral in a local church. His memorial service was sparsely attended. Members of the community suggested to Kevin's parents, Mark and Carol, that their son had been "a weakling, a coward and even a sinner." "Strangers told them that Kevin's suicide had been a sin in the eyes of God," Yochi Dreazen writes in his new book, "The Invisible Front," "something Carol, a deeply religious woman, often worried about." Jeff, Kevin and their deaths are the spine of this harrowing book, a courageous effort to examine the military's abysmal initial response to rising numbers of post-Iraq and -Afghanistan suicides. To his credit, Dreazen takes the book a step further. He uses one American military family's tragedy to expose a vast double standard - and spreading epidemic - in American society. By 2012, more American soldiers were killing themselves than were dying in combat. But the problem goes beyond those in uniform. Suicide rates among American adults between 35 and 64 are at record rates as well, notes Dreazen, the managing editor of Foreign Policy and a former military affairs writer for The Wall Street Journal. He offers a sophisticated examination of an act of ultimate despair that irreversibly wounds the living and remains hidden, stigmatized and largely misunderstood. In alternating sections, Dreazen's book describes how war functions as a psychological caldron and how the American military serves as a social science laboratory. To its credit, the military once served as a largely successful testing ground for overcoming America's racial divides. But its initial effort to address its warriors' psychological wounds was appalling. Surveying accounts of war from the "Iliad" to Iraq, Dreazen details how soldiers have returned from combat suffering from depression, anxiety and sleeplessness. Called "shell shock" after World War I, "combat fatigue" after World War II and "post-traumatic stress disorder" after Vietnam, the condition has been remarkably consistent. Yet a deep-seated military culture that views mental illness as a weakness helped make America's post-9/11 military a psychic charnel house. Dreazen uses the story of Kevin Graham, the doomed R.O.T.C. cadet, to investigate depression in detail. From a young age, Kevin struggled with the disease, which ran in his family, but strived to join the Army like his father. Tall, bookish and outwardly successful, Kevin took Prozac but knew that disclosing his use of it would destroy his military career. From boot camp on, Dreazen writes, American soldiers are told mental illness is a character flaw: "Roughly 75 percent of the troops surveyed ... told pollsters that they wouldn't seek help because they were afraid it would make their colleagues think less of them, harm their chances for promotion, or bring their military careers to a premature end." Fearing he would be deemed "mentally ill and not fit for military duty," Kevin stopped taking Prozac in the late spring of 2003. Weeks later, he hanged himself from a ceiling fan in the off-campus apartment he shared with his younger sister, Melanie, who discovered his body. Melanie and her parents, like other friends and relatives of suicide victims, entered a world that was "darker and emptier," Dreazen writes. Shame and guilt consumed them. Four years on, Kevin's father, then an Army general, saw firsthand how poorly the Army treats mental illness when he was appointed commander of Fort Carson, in Colorado, home to 100,000 soldiers and members of military families. In Mark Graham's first full year in command, eight soldiers killed themselves at the base, triple the Army rate and four times the national average. Violence was rampant as well, with 14 Fort Carson soldiers linked to 11 murders and attempted murders around the base in a three-year period. Yet many officers at the base continued to dismiss mental health problems as character defects. In 2006, when one Fort Carson soldier told his commander he had gotten drunk, nearly killed himself and needed psychiatric treatment, the officer tried to have him arrested for failing to attend that morning's drill. Eventually, he and another soldier who also self-medicated with alcohol and sought psychiatric treatment were discharged for "patterns of misconduct." The discharges rendered them ineligible for free medical care for veterans, their military pensions and G.I. Bill benefits. "I think some people are just weak," a sergeant told a reporter for NPR at the time. "You know, you just have to buck up and be a man and face it." After a young soldier in another unit scrawled a suicide note in black paint on the wall of his barracks room, his commander threatened to charge him with "defacing government property." When the soldier's panicked mother flew to Fort Carson to plead for leniency, she offered to paint over the note if it would help her son. "To her surprise, the officer said yes," Dreazen writes. The mother "spent the next day painting the wall and covering up her son's scrawl." Disdain for anyone who sought psychiatric help was rampant among soldiers as well. Troops in one unit left a mock "Hurt Feelings Report" near the sign-up sheet for soldiers seeking counseling, listing reasons they needed care. "I have womanlike hormones," the sheet said. "I am a queer; I am a little bitch; I am a crybaby; I want my mommy; all of the above." Even those who were charged with treating mental illness were skeptical. The base's top military psychiatrist wrote a memo to counselors warning that many of the troops who sought help were "dead wood" who faked their symptoms. One military chaplain claimed that witches living in nearby mountains had cursed Fort Carson soldiers. The Grahams battled against the military culture at Fort Carson and other bases, speaking publicly about their son's suicide, but the struggle took its toll. At one point, so many people told Kevin's mother her family was cursed that she tried to find a priest to perform an exorcism. "THE INVISIBLE FRONT" has its shortcomings, with some slow-moving early passages. But the book steadily gains power with each chapter, and Dreazen lays out a series of simple steps the military could take in order to save lives. The Israeli Army, for example, reduced suicides by 40 percent in 2006 by barring soldiers from taking their weapons home. Dreazen also calls for a greater commitment to suicide prevention: "It should begin by making the ways commanders and enlisted personnel handle mental health issues within their units a formal part of the written evaluations that help determine whether they're promoted." But leadership remains lacking. Dreazen found no cases, for example, of officers being punished for their actions, including the officer who had a traumatized mother paint over her own son's suicide note. And in all the time he spent researching his book, Dreazen was able to identify only three American generals who have gone public about suffering nightmares, jumpiness, flashes of anger and other symptoms of PTSD: "Even now, at the very pinnacle of their professional lives, most of the generals afflicted with PTSD suffer in silence because they are afraid other soldiers will see them as weak." Dreazen warns that military suicide rates could rise as an estimated 80,000 soldiers are forced out of the Army by Pentagon spending cuts. And he notes that civilian adult suicide rates are at record levels as well. Today, more people die in the United States by their own hand than die in car accidents. In public speeches about his son's death, Mark Graham quotes a line from the elegiac Archibald MacLeish poem "The Young Dead Soldiers." "They say: We leave you our deaths," MacLeish wrote. "Give them their meaning." This vital book is a stirring call for action to better aid American soldiers who struggle alone with depression - and civilians who suffer from our most stigmatized disease as well. By 2012, more American soldiers were killing themselves than were dying in combat. DAVID ROHDE is an investigative reporter for Reuters, a contributing editor for The Atlantic and a former reporter for The New York Times.

Copyright (c) The New York Times Company [November 2, 2014]

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Review by Publisher's Weekly Review

Dreazen, deputy editor of Foreign Policy, offers up an often painful family story involving recently retired U.S. Army General Mark Graham, his wife, Carol, and their sons, Jeff and Kevin-both of whom served in the military. Kevin, the high-achieving middle child who suffered from depression, hung himself in 2003. Less than a year later, Jeff was killed in action while serving as an Army officer in Iraq. After Kevins suicide the Grahams devoted themselves to making the Army more responsive to mental illness within its ranks. Dreazen makes a convincing case that Mark Grahams persistence in working on suicide prevention, PTSD treatment, and other issues put a premature end to his military career when he was he was passed over for a third star. Since Mark Grahams retirement in 2012, he and his wife have devoted themselves to working for organizations dedicated to military suicide prevention. In telling this story, Dreazen leans heavily on the hundreds of hours of interviews he conducted with the Grahams and their friends and family. The result is a journalistic tale that shines a revealing-and a disturbing-light on the ongoing emotional legacy of Americas two most recent wars. Agent: Gary Morris, David Black Literary Agency. (Oct.) (c) Copyright PWxyz, LLC. All rights reserved.

(c) Copyright PWxyz, LLC. All rights reserved

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Review by Library Journal Review

Dreazen (editor, Foreign Policy), who specializes in covering military affairs, looks at issues of mental health care and treatment in the army. He argues that the army's traditional system of negatively casting mental health issues as potential liabilities has created a situation that puts both soldiers and civilians at risk. The narrative focuses on a story of loss, that of the Graham family, whose one son was fatally wounded by an IED in Iraq and the other committed suicide after serving in the ROTC. The author carefully describes the impact mental health has on one's service in the military and the struggles survivors and sufferers alike experience. By emphasizing the response of patriarch Mark Graham, an army general devoted to changing the stigma of mental illness on the bases under his command, Dreazen presents one possible future for a military that accepts mental health issues on the same footing as physical health concerns. VERDICT Mental health care workers, sociologists, and military historians will find this book a useful first step in a much larger conversation. Readers dealing with mental health issues can take comfort in knowing they are not alone, and others may find motivation in the stories Dreazen relates to help generate change.-Elizabeth Zeitz, Otterbein Univ. Lib., Westerville, OH (c) Copyright 2014. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

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Review by Kirkus Book Review

An examination of the mental health crisis through the trials of one military family. In his debut, Foreign Policy deputy editor Dreazen explains how retired Maj. Gen. Mark Graham and his wife, Carol, serve as representations of all the pain borne within America's military community since 9/11. When the Grahams' son Jeff was killed by an IED during his first tour in Iraq, they were already contending with the trauma of Jeff's younger brother Kevin's suicide. Kevin had been in a downward spiral after concealing his antidepressant usage from the ROTC program he'd felt compelled to join; his grieving parents saw "how differently the deaths of their two sons were treated by friends, relatives, and even other army officers." As the Grahams dealt with their own anguish, they realized that the military was experiencing a spike in suicide and homicide rates in tandem with the Iraq and Afghanistan conflicts. Even as Mark received plaudits for his emergency management during Hurricane Katrina and command of Fort Carson, he perceived that the "military mental health system looked down on soldiers who said they were suffering from PTSD." As base commander, Mark concluded that many soldiers would avoid treatment rather than face the same stigma Kevin had feared. "Mark would turn Fort Carson into a laboratory for testing new methods of eliminating the stigma around mental health issues and getting troubled soldiers the help they needed," writes Dreazen. These innovations, such as mobile assessment teams, both won Mark admiration as the first general to openly acknowledge the crisis and probably shortened his career: "Carol had heard whispers for years that other senior officers resented how often she and Mark spoke out publicly." Although an epilogue suggests progress has been made, Dreazen clearly feels these "changes were motivated by what army leaders could no longer deny to be a full-blown suicide epidemic," much as the Grahams had argued. A sad accounting of the burdens shouldered by military families and the military's institutional resistance toward compassionate change. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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Chapter 1 Murray, Kentucky, July 1976 Mark Graham had a plan. It was the summer of 1976, and he was finally ready to propose to Carol Shroat, his girlfriend of almost twelve months. Like the military officer he was training to become, Mark had spent months secretly working over the details of how he would ask Carol to marry him. Earlier that summer he snuck away from Murray State, the small state university he and Carol attended, and purchased an engagement ring from a pawnshop in St. Louis. He spent pretty much every dollar he had, but Mark smiled every time he looked into the small white box holding the ring and saw its diamond sparkle brightly in the light. The second part of Mark's plan involved taking Carol to nearby Kentucky Lake, rowing her out to the middle of the water, and then gazing deeply into her eyes as he told her how much he loved her and how excited he was for the two of them to build a life together. He was certain that it would be both romantic and memorable. It was, though not for the reasons he'd thought. Mark had hidden the ring inside a rolled-­up magazine so Carol wouldn't see it during their walk to the lake. He stumbled as they left his apartment, and the ring slipped out and bounced down the stairs. "Don't move," Mark said quickly. "That's your engagement ring." "My what?" Carol replied. Mark picked up the ring and got down on one knee. Carol, laughing, said yes. Mark and Carol had taken very different paths to Murray State. Carol saw it as the family school; her parents were alumni, as were two of her three sisters. Carl, her father, had met her mother, Jackie, when he gave her a ride home from class in his blue Studebaker during a heavy rainstorm. Jackie soon began noticing that Carl would park near her house virtually every morning to offer her a ride back to campus. A few months later Carl asked her out to a local drive-­in movie theater to see a western starring Randolph Scott. They got engaged in the summer of 1952 and married the following year. Carl attended medical school and then moved to Frankfort to start his own practice. He became one of the city's best-­known doctors, famous for serving as the personal physician of Kentucky governor Wendell Ford--­he saved the politician's life by diagnosing a brain aneurysm before it could do much harm--­while still finding time to make house calls to ordinary citizens throughout Frankfort. The Shroats enjoyed a comfortable, upper-­middle-­class life. They drove late-­model luxury cars like Chrysler Fifth Avenues and lived in a custom-­built, three-­story house in an upscale part of town. A white brick post at the edge of the driveway was engraved with the words c.e. shroat m.d. When they graduated from high school, Carl paid for each of his daughters to take a monthlong trip through Europe. Carol never worried about how she'd afford Murray State. Thanks to her father, she didn't need to. Mark wasn't so fortunate. He was born in St. Louis, the only child of Russel and Pat Graham. Russel was a self-­educated truck driver who switched to the real estate business and quickly found success selling condominiums throughout St. Louis. Russel used his year-­end bonuses to send Mark to summer baseball camps and told Pat to quit her job at the grocery warehouse where she worked. She put in her two weeks' notice and started to prepare for a new life as a stay-­at-­home wife and mother. Russel began telling friends that he would take Mark into the family business and one day open a real estate company called Graham and Son. A few days later Pat noticed that her husband's nose had started bleeding and wouldn't stop. Alarmed, she had him rushed to the hospital. The doctors assured her that he'd be out in a few days, but Russel's condition worsened and he began spitting up large amounts of blood. One afternoon a doctor walked into the room and brusquely said, "This man is dying." Russel died from a heart attack a few hours later, barely three days after he'd checked in. He was thirty-­three; Mark was eleven and still very much a boy. When a neighbor knocked on his door to say that Russel wouldn't go to heaven because he hadn't been religious, Mark promptly flattened him with a punch to the face. With her husband gone, Pat took a new job at a factory that supplied parts to Westinghouse and spent long hours painstakingly winding copper wire onto spools for its washing machines and dryers. At night Mark watched his mother put Vaseline on her chafed and cut-­up fingers and then gingerly slip them into a pair of white cotton gloves. The little family held on, but just barely. Pat would sometimes drive to work with only a quarter in her purse in case she had to use the telephone in an emergency. She spent evenings counting nickels, quarters, and dimes at the kitchen table, sorting the coins into neat piles. Mark, watching her work, often wondered why the stacks were so small. After his father's death, Mark stopped going to summer baseball camp and started taking odd jobs to earn spending money. He bused ­tables at a country club restaurant, mowed lawns, raked leaves, sold greeting cards, and served as a Little League baseball umpire. He didn't take a full-­time job until he joined his mother at the grocery warehouse the summer after his senior year in high school. Pat had married a sweet-­natured bricklayer named Bill Conrad and returned to her old position with the wholesaler, and Mark worked eight-­hour shifts filling trucks bound for individual grocers with boxes of milk, meat, and produce. He joined the Teamsters at age eighteen, and Pat jokes that he may have been the youngest union member in the entire state of Missouri. It was a physically taxing job, and Mark would occasionally nap on a grassy field outside the warehouse. One afternoon Mark and a friend were sleeping when a coworker stumbled across their prone bodies and worried that both young men were dead. He kicked their feet to be sure. When Mark opened his eyes, the man screamed and ran into the warehouse. Shortly before his death Russel took out a $10,000 life insurance policy that listed Pat as the sole beneficiary. When Mark was getting ready to graduate high school, Pat told him that she'd be able to use the money to help pay for college. Those funds, plus the money he'd earned over the summers, meant that Mark was able to afford the tuition at Murray State, which he'd visited as a senior and fallen in love with because of its bucolic campus and small-­town feel. His high school guidance counselor told him that the military's Reserve Officers' Training Corps would pay part of his tuition if he agreed to spend a few years in the army after he graduated. Mark enrolled in the school's ROTC program, figuring it would help him quickly decide if the military was right for him. Mark's army career almost ended before it started. Murray State's ROTC cadets spent most of their time marching through empty classrooms and practicing military formations. Mark found those exercises so boring that he quickly dropped out of ROTC altogether. Mark had barely resumed his classes the following semester when one of the professors running the program called and asked that he give it another chance. "We've got some different things we're doing with the program here, and I think you'll like it," the professor told him. "Why don't you just try one class?" The instructor was right--­Murray State's program had changed significantly. The cadets practiced rappelling down mountains and conducting mock patrols of potentially hostile areas rather than endlessly drilling proper military formations. They studied marksmanship and practiced firing M16s and .22 rifles, which was an entirely new experience for a nonhunter such as Mark. They ditched the classroom and spent long, happy days in a nearby national park learning how to read maps and navigate using nothing but the sun and stars. Mark thrived; he was finally spending time in the outdoors with other driven young men who were willing to serve in the military during a time of war. When a military recruiter offered him a formal ROTC scholarship that would pay for his senior year at Murray State in exchange for four years of army service, Mark said yes. It was a chance to see the world and have the kinds of adventures that he'd dreamed about growing up. He planned to do his stint in the army and then go to law school. It was the start of what would eventually be a thirty-­four-­year army career. Carol was just as driven, but in a very different direction. She studied social work and psychology with an eye toward helping others deal with the kinds of depression and anxiety that had hung over her own life like dark clouds. "My favorite class was abnormal psychology, because it was the one thing that made me feel normal," she said. During the summers Carol stayed at Murray State to take extra classes and work as a campus phone operator, answering calls with a chirpy "Good morning, Murray State." The summer classes allowed her to finish her undergraduate degree in three years, but she decided to spend an additional year at Murray State so she could get a master's degree in counseling while waiting for Mark to graduate. Her father, old-­fashioned and protective, wouldn't allow her to get her own off-­campus apartment. Carol dutifully stayed in the dorms. She didn't wear jeans. Mark tried, but he just couldn't get past that one detail. She didn't wear jeans. It was the early 1970s, but Carol looked like she belonged in an earlier, more innocent time. Her classmates wore bell-­bottoms, let their hair grow long and unkempt, and made a point of not wearing lipstick or eyeliner. Carol wore skirts or dress pants around campus, carefully styled and blow-­dried her hair, and wore makeup to class. Her classmates drank, smoked pot, and had sex. Carol played the tenor saxophone in Murray State's marching band and largely focused on her rehearsals and schoolwork. "I was a bit of a nerd," she said. But Carol wasn't a saint; in high school, she and her younger sister Debbie had snuck out of their house and driven to parties where they could drink with their friends years before any of them were of age. Still, she stood out on the Murray State campus for her dignified appearance and demure behavior. Before meeting Mark, Carol had been dating a devout young man who was now in Scotland studying for a degree in theology and preparing for a life as a Methodist minister. Mark was leading a very different kind of life. He and his best friend, Jeff Hohman, pledged Kappa Alpha, one of the wildest fraternities on Murray State's campus. KA brothers tied pledges to trees and pelted them with spoiled food. They'd replace each other's shampoo with baby oil. During Mark and Jeff's freshman year, the KA brothers took a group road trip to a nearby strip club called the Black Poodle to party with dancers with names like Heaven Lee and EZ Rider. It wouldn't be their only visit. The KA house had grimy bathrooms that women were reluctant to use and decrepit furniture speckled with mysterious stains. Jeff lived in a basement bedroom that had no real ceiling; any movement upstairs, especially dancing, would send dust and dirt cascading down onto his mattress. Mark's room was covered with so many loose mounds of socks, underwear, jeans, and T-­shirts that Pat remembers being shocked and somewhat horrified when she first visited the house. Mark and Jeff both had beards and flowing, shoulder-­length hair. "We looked like Jesus and the apostles," Jeff said. Appearances aside, Mark was flourishing. He was elected president of his pledge class and was quickly tapped to oversee the fraternity's finances. KA was broke, and Mark devised a plan to sell small books of coupons for local restaurants and stores. He and his frat brothers stayed up late at night stapling the crude packets together, and the project was an immediate success. Mark also worked to improve KA's crumbling headquarters. His stepfather, Bill Conrad, had taught him to mix mortar and lay bricks, and Mark used those skills to build a new cement deck, bar, and grill at the back of the house. He was elected president of the entire fraternity a short time later. He settled on political science as a major and watched his grades steadily improve. Academics seemed to come fairly easily to him, and so did girls. Mark was tall and thin, with piercing eyes and a muscular physique honed by the ROTC program's grueling early-­morning workouts, ­and he quickly earned a reputation as a campus Lothario. Jeff knew Carol from Frankfort and kept thinking that she and Mark would be a good match. He invited her to a KA party, and she was smitten with Mark the first time she laid eyes on him. "I just introduced them, and Carol kind of took it from there," Jeff said. "Mark never knew what hit him." Mark initially had his doubts about Carol, though they had nothing to do with her looks. She was a thin brunette with a radiant smile. She had been a baton twirler in her high school marching band and could easily have passed for a Murray State cheerleader. But Mark just couldn't shake the feeling that she was too straitlaced for his taste. "She was a bookworm, studying all the time, and I didn't even know where the library was," Mark said. "She smiled so much that I thought it had to be fake. I just felt like no one could possibly be that happy." A few months later Carol was at the KA house for a party, looking and feeling uncomfortable. There was a jukebox in the back room, and Mark asked her to dance. He didn't think things would go much further, but when he leaned in to kiss her, she kissed him right back. It wasn't the chaste, quick peck he'd expected. It was a full-­on kiss. "I was like, 'Wow, she kisses really good,' " Mark said. "I knew right away that there was something there. I just knew." Their first real date was far from romantic. Mark took Carol to see Carrie, a horror movie, which she sat through mostly with her eyes clenched shut. As their relationship progressed, another issue surfaced: Carol's parents were deeply uncomfortable about their eldest daughter dating a bearded young man who didn't look like any of her male friends and classmates from Frankfort. Carl Shroat wore a dark suit to work every day and kept his hair cut short. Mark favored jeans and T-­shirts and wore his hair long. "Daddy just didn't know what to make of Mark the first time they met," Carol said. "It was like opposites colliding." Carl and Jackie eventually came to cherish Mark and treat him like the son they never had, but it took time. Excerpted from The Invisible Front: Love and Loss in an Era of Endless War by Yochi Dreazen All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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