Land of the Free Because of the Brave

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Yochi Dreazen, The Invisible Front: Love and Loss in an Era of Endless of War (Crown Publishers, 2014)

Back from Iraq for less than a year, I went to check a friend’s blog only to find the obituary of a shipmate, a sailor I had served with at CENTCOM at the beginning of Operation Iraqi Freedom. I had run into him again the day of my retirement ceremony and later at Camp Slayer, Iraq. He had returned to civilian life and was serving in the Navy Reserve, but he was also suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). On that early August day, the darkness took over and he died by his own hand. Several months later, walking behind the horse drawn caisson carrying my shipmate, my friend, past the thousands of white stones in Arlington National Cemetery, the question remained: Why? Suicide was not new to me. Driving across the Coronado Bridge in San Diego, every light pole held a sign with an “800” suicide help-line telephone number reminding me that suicide happens every day, both in the military and in the broader civilian world.

And yet, my experiences did not prepare me to read Yochi Dreazen’s The Invisible Front: Love and Loss in an Era of Endless War. This is the story of service members, veterans and families who battled the darkness of depression and suicide in the military, including the stories of Mark and Carol Graham. “Land of the Free Because of the Brave” was written on a white cloth and left at the graveside of their son Jeff, killed in Iraq by an insurgent’s IED. He was buried next to his brother Kevin, a college student and ROTC cadet who died by suicide a few months earlier. Maj. Gen. (Ret) Mark Graham described his family— his wife Carol, their two sons and daughter Melanie — as the “Disneyworld family.” The photographs of the family traveling from assignment to assignment paint a picture of a loving and happy military family, but hidden under the surface was Kevin’s mental illness.

In seeking to understand PTSD, Dreazen reaches back to the classics, quoting Homer’s question of Achilles in the Odyssey: “Must you carry the bloody horror of combat in your heart forever?” Leaders throughout history did not understand the lasting trauma of combat and its effect on the fighting man.

But it isn’t just about PTSD. This story brings to light the many challenges faced by military men and women who suffer from mental illness. Kevin Graham, an ROTC cadet at the University of Kentucky, had suffered quietly with mental illness. As his grades declined, he reached out for help and a campus clinic diagnosed him with clinical depression. He was prescribed anti-depressants. But with his ROTC summer camp approaching and fearful that the Army would find out about his illness, he stopped taking the medication. Weeks later, his sister would find him dead by suicide.

The family faced its second tragedy when a bomb emplaced by insurgents along a roadside in western Iraq killed Jeff, a newly commissioned second lieutenant. Although Jeff’s death was not related to depression or PTSD, his death and his brother’s together illustrate the different way society views a battlefield fatality —a hero’s death—and suicide in the military. A brigadier general at the time, Mark began to see clearly the problems in the way that both the American public and the Army understand issues of mental health.

Combat is not the single causal factor in whether a service member will develop mental illness. In many cases, mental illness predates military recruits’ time in service. Histories of mental issues that may have been suppressed, alcoholism or drug dependency create personal challenges that are compounded when service members face separation from family, lifestyle changes or combat. A recent National Institute of Mental Health study found:

…nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment; and soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.

… In fact, approximately one-third of post-enlistment suicide attempts tied back to pre-enlistment mental disorders. Pre- and post-enlistment mental disorders accounted for 60 percent of first suicide attempts in the Army.”

The effects of PTSD do not only affect service members, but also their families. The author brings out the second order effects of PTSD: sexual abuse, family violence and alcohol abuse after a member returns home. As Dreazen notes, commanders have found an increase in instances of domestic violence, with some cases ending tragically with spouses murdered after their husbands returned from combat.

A pervasive attitude of hazing and humiliation in the military by both leaders and service members toward mental health has deterred many of those suffering from seeking treatment. The stigma of having received treatment has compounded the issue, causing members who have sought treatment to not follow through with it. How can this be changed? It has been suggested that it might take generations to change attitudes. Do we have that much time? As Mark Graham has said, “One more suicide is one too many!”

At the book’s launch sponsored by the Center for New American Security in Washington, D.C., the author discussed the process of researching and writing the book, his experiences with the Graham family and his time as an embedded journalist in the same area of Iraq where Jeff died. His experience gave him a unique perspective on the daily grind of fighting in Iraq. The Graham family shared with him intimate aspects of their private lives, showing how the three kids bonded as they moved from base to base and depended on each other, even sharing an apartment at the University of Kentucky. Because of their openness with the author, it felt while reading the book that the Graham kids lived around the block from me, and that I was at their parties in Lexington.

Many mental health professionals were in attendance at the book launch, some of whom consulted with the author during his research. They offered professional insight during the discussion, but just like the disease itself, too many questions remain unanswered. How will the military change the attitudes of leaders and service members toward those suffering mental illness? Should the military hold leaders accountable for mental health issues in their units?

Mark Graham used his family’s experience to make changes in the procedures, units and bases that fell under his control. Often Graham faced down the Army’s entrenched bureaucracy to do what was right for the soldier. The Army has instituted many initiatives that Graham started, which were frequently considered as “being soft” by others. For example, the Army now has a professionally attended hotline available to any soldier, an idea first implemented at Fort Carson during his command.

Now retired from the Army, Mark and his wife Carol have devoted their lives to suicide prevention and mental health, both in the military and on college campuses. Mr. Dreazen echoes the mental health professionals and veterans service organizations like the Iraq and Afghanistan Veterans of America (IAVA) that understand there is “no single cause and there is no silver bullet… Dreazen closes the book quoting Mark Graham with the same quote adding “… but that doesn’t mean we should give up.”

…There are too many Kevins out there. So here we are. We won’t stop.  –Mark Graham 2013

Postscript: At Jeff’s funeral, a friend delivering the eulogy described Jeff and Kevin’s love of University of Kentucky sports “And I know Saint Peter can’t be too happy, because I can see them trying to scheme a way to let all the UK fans in and keep all the Louisville fans out.” I am a Louisville grad but I would love to have watched a Kentucky game with these two guys!

David A. Mattingly is retired from the U.S. Navy as a Master Chief Petty Officer and is now a consultant on National Security issues. He served at CENTCOM during Operation Iraqi Freedom and in Baghdad as a senior intelligence analyst for MNF-I and USF-I.