believed in it enough to sell all of my worldly possessions including my mercedes that i loved -- [laughter] i sold designer shoes, clothes, books. and so my house -- oh, who lives here? nobody. because james meant that much to me, to keep my word and to tell america -- which i will do -- he was good, he was kind, he was loving, he was generous, he was a human being who left a legacy in texas. in 2011 he was responsible for helping to persuade the legislature to pass the double blind sequential law. so james left a legacy. and that's what i want him remembered for. not that he died in jail, and that's all there was to him. he was loved by these men and by

me, and i just want to thank all of you for being here to share that with me. [applause] >> booktv is on twitter and facebook, and we want to hear from you. tweet us, twitter.com/booktv or post a comment on our facebook page, facebook.com/booktv. >> in "the invisible front," yochi dreazen talks about two brothers who died while serving in the u.s. army. he compares the reaction of the army to the two deaths and discusses the efforts made by the brothers' parents to bring awareness to ptsd and military suicides. during this event, hosted by the

center for a new american security, mr. dreazen is in conversation with major garrett of cbs news. [inaudible conversations] >> good evening, everybody. good evening. welcome, and thank you for joining us this evening. my name is richard fontaine, i'm the president of the center for new american security, and it's a real pleasure to welcome all of you here to celebrate the publication of yochi freeze p's new book, "the invisible front: love and loss in an era of endless war." yochi, as many of you know, is quite simply one of the very best national security journalists in america today. he's the managing editor of "foreign policy." he has spent nearly four years on the ground in afghanistan and iraq reporting and spending most

of his time embedded in front line combat units. he was, before that, a longtime reporter for "the wall street journal" and has served as a contributing editor to "the atlantic" and the senior national security correspondent for "national journal." above and beyond these accomplishments, yochi's readers -- which i think include most of us in this room -- discern in his writings a deeply human touch and a full appreciation of war's costs during and after the battle. in recognition of this, he has received the military reporters' and editors' association top award for domestic military reporting for his 2010 series on military suicide and the psychological traumas impacting veterans of iraq and afghanistan. at cnas we're privileged that yochi wrote his book while a writer in residence at the center. and during his year with us we

discovered that not only is he a world class author, but also a wonderful colleague and friend. his deep insight into the human side of war was vitally important into all of the thinking that we did on our own projects and writing, and it fully animates the book that we're here tonight to celebrate. in "the invisible front," he tells the story of the grahams, a couple who suffered the loss of two sons, one to combat and one to citizen. in their grief they turned towards service of their own and helped lead a drive to stem military suicide, and they embraced a cause that had become far larger than any individual or family. yochi tells their story with his characteristic grace, and it's a book that deserves to be very widely read and appreciated. now, if i've convinced you of that latter fact, you'll be pleased to though that books will be for sale, and you can purchase them after the conversation on stage, and yochi will be available to sign your copies. we are going to start the

proceedings this evening with yochi giving us a brief sort of synopsis and overview of the book, and then we'll go into conversation from there and then open it up to the audience for questions. but it's my special privilege and pleasure to introduce yochi deedsen. thanks. -- dreazen. thanks. >> thank you. [applause] >> thank you all for coming. before i start, i want to thank richard, thank some people in the back of the room, daryl clay, kate, carter, sean, there are a lot of people in the cnas family who made me feel welcome when i was trying to rustle up any food beyond granola bars to fuel the writing. i'm very grateful to them for that time and to all of you for m cooing. i look forward to talking, to hearing your thoughts and questions. mark and carol graham, the

family at the center of this group, had for a long time a norman rockwell-type family. they had three children who were extraordinarily close. kevin, who was the middle child, was sensitive. he would do things without hesitation, without thinking. jeff, his older brother, drank, he was very, very good with women, he was someone who was the life of the party. kevin would follow into the party but would sort of sit by himself in the corner. and then melanie, who is their young sister. she was the one that they tried to look out for wherever they went in the world. the three of them were a single unit. they were the three of them against the world because, like many military families as so many of you know, they moved from base to base, from country to country. had to rebuild a social network wherever they went. so the two boys, they were patriotic in every sense of the phrase. they looked at their father, they watched him ascend from his early start in kentucky to being a captain in germany to moving on to korea, to moving and doing some tours in saudi arabia and

kuwait. and to them, this was the highest honor, this was the highest tenet of public service. and they both wanted to do the same thing. so they went to the university of kentucky, they went through the rotc program. each one planned to be an officer. for jeff it was to lead in combat, for kevin it was to be a doctor to try to help others. flash forward a few years ago. jeff is out, he was the older of the two, he's commissioned, he was getting ready to go to iraq. his brother kevin, a year younger, about to enter his final summer. what no one knew, kevin had always been smart, the sweetheart of the family, was that there was a darkness inside of him that he was trying very hard to control and failing. and he was diagnosed with depression, with clinical depression and put on medication which brought his mood down. but that summer he thought if i enter the military, i -- and they discover i'm on this medication, they'll kick me out. so he stopped taking it.

and that decision sent him spiraling. after his death his family found a to-do list that he had left for himself, most of which was banal; do laundry, pick up food, and the last item was take toaster into the bathtub. but they didn't find this out until much, much too late. he and jeff had always played golf, that was their sport. and they were supposed to meet one morning, one of the last rounds before jeff left for iraq. and kevin didn't show up. and jeff was wondering and looking at his watch, and his brother wasn't there. so he called the apartment, he called his sister and said, melanie, have you seen kevin? she hadn't, and she knocked on his door and didn't hear anything. she opened his door and saw him hanging. he had hung himself from the ceiling fan. and at first she thought-a prank, her -- she thought it was a prank, and then the horror set in, and she realized it wasn't. and that sent her spiraling, mark and carol spiraling. mark thought i can't serve in the army anymore.

carol thought i may not be able to live anymore. she was suicidal. they pulled through, but just barely. a year later jeff was leading his men on a mission to clear a bridge near fallujah. it was a parking lot that i spent time in -- a part that i spent time in that at the moment was one of the most dangerous parts of the country. he was walking ahead of his men, and he saw something glimmering on the bridge, and he didn't know what it was, but something said it's not good. so he turned to the men behind him to say stay back, and as he turned, the bomb blew up. he died, his men didn't. so now the family has lost two sons. they find out that on his last mission when he left the base, jeff had on him in his wallet his brother's dreier's license, and the parents -- driver's license, and the parents thought they were so close in life, at least they were close in life. now mark and carol faced this question, to anybody with children, if you lose one child,

how do you pull through? and if you lose two, how do you get out of bed? how do you find anything, anything that could fill that void? and at first they thought they couldn't. they thought this was the end for both of them. for mark, the military's done. he thought if only i had refrom vented jeff -- prevented jeff from going to iraq, he'd still be alive. if only i'd said to kevin you don't need to do this, he'd still be alive. carol said to mark one night, this is either a chapter in our life, or this is the book. and they decided it'd be a chapter. mark came back, at this point he's beginning to ascend higher and higher up, and he has more power, and what he sees around him and what we all know to be true, tragically, is this wave of people coming back with ptsd, with wounds that you can't see, this wave of people who are beginning to take their own lives. the suicide rate is rising and rising and rising. first in 2009 it hits and then goes past the civilian rate, then in 2010 the difference continues to grow, then on and

on to where we are now where more people have killed themselves than died in afghanistan by a significant margin. where more people kill themselves every year than the year that preceded it. this year so far it's about 350 people, many of them in the army national guard and army reserve. so mark came back, and this was what he was discovering. what he found was it wasn't just this stigma, which is a real issue, i mean, the accurate phrase. but there was something in the culture of the army that he saw, the culture of the base that he was in command of, force carson, that had a -- fort carson, that had a cruelty. in one particular case at fort carson in the brigade headquarters near where you'd sign out to see a doctor, someone hung up a sheet that said i'm going to go see a psychologist because i'm a coward, i'm soft, c, all of the above. and this wasn't there for a few hours, this was there for days. someone wrote a suicide note on their wall. thankfully, they got to help before it was too late, but the

army court-martialed him for defacing army property. this was the stigma that mark was finding. and meanwhile, the numbers are ticking up higher and higher and higher. so he's confronted now at fort carson with a base with the highest suicide rate of any base in the military. and he's a person who understands more than any officer in the military what it is to lose someone to a wound that you can't see. what it is to lose someone who you love when you didn't know that they needed help until it was too late to give it to them. and he knows that for many of these young soldiers at the base and for their spouses and kids, that's exactly what they're struggling with, that exact same question. so mark decides to do what he can to change it. and the policies he puts in place are ones that, ultimately, are replicated across the army. so one which some of them -- they're so obvious sounding that even now i wonder how they were not done sooner, but the truth is, they weren't. one was hotline where if you called in, the call went to his personal assistant and then straight to him. so it wasn't something where you

call, and the call would bounce around, and by the time it got to somebody who could help, it was too late. it was a direct line to him. that's now been replicated where a call goes into a better, more defined system. another -- and, again, seems like it should be obvious, but it wasn't -- at fort car soften the mental health -- carson the mental health facility and the hospital were in the same facility. if you were brave enough to willing to accept that your career might literally end if someone saw you seeking help, if you were that brave and you walked into that elevator, you knew that at any moment somebody else would see you hit six, and they would know you were going there, that something that you felt you might need to keep secret was no longer going to be secret. so mark said that makes no sense, and he moved them to a different facility. another one, and this is one that's been replicated across the army, 'em -- embedded

behavioral health team, but a basic idea was rather than have a psychologist who might be a stranger to unit or a therapist where soldiers come back to someone they've never seen before and say tell me how you feel, and they clam up. so the idea instead was have a single therapist assigned to a single brigade from the beginning, before they deploy, while they're deployed, when they come back. so this'll be someone that that brigade has gotten to know and has gotten to know them, and this would not be a stranger, this would not be someone where the brigade or the soldier or the officer would say who the hell are you? they're someone that they knew. that worked tremendously, tremendously well. and mark had an ally that he did not expect at fort carson. i mention the story because, this next story because it gives you a sense of some of the people that were pushing against what he was doing and some of the people that were pushing for

it. the people pushing against were saying people who have ptsd, who have depression, they are weak. some of them are just trying to get out of military service. that was the phrase that people said about him when he wasn't around. they would think he was soft. and that's the word that hung over him. he was soft. but then you had people who were battled-hardened, the toughest of the tough, the people you would think would definitely not be the people that would agree that these wounds were real or yee with changes about how you -- agree with changes about how you treat them. randy george, brigadier general, was the toughest of the tough. he did multiple tours this afghanistan. this was a man who'd seen combat, he'd led men in combat, he'd been there as a lieutenant colonel, then as a colonel x. for him it was perm, but for a different -- personal, but for a different reason. in afghanistan a general, a soldier that was unusually gentle and thoughtful, just someone who in some ways

belonged, that wasn't the place for him, but he was in the military, he was in afghanistan, and he killed himself. and the question randy george faced was what do you do? i mean, how do you memorialize someone who killed themselves? do you treat them the same way you treat a person who died in combat? do you give them a military funeral? do you put them into a church? is what do you do? do you give him a cemetery? full military honors? what do you do. and randy george's men said, sir, he duds not deserve this -- he does not deserve this honor. he died because of what he saw and did, we will give him the same memorial. and they did. for many of you who have seen the way the memorials are done in iraq and afghanistan, they're extraordinarily powerful. it's the two boots standing, the gun facing down, the dog tags hanging from the gun, and often a helmet near it. but randy george became an ally, became someone that mark graham now had this very tough man who

was in his corner. and by the time mark left, the suicide rate at fort carson had plummeted. it had been the highest when he got there, it was one of the lowest when he left. i don't want to suggest that there is a happy ending to this. fort carson's suicide rate is still high. the army suicide rate is still high. it's not something where mark and carol left, went there, found a problem, solved it, moved on. things were hupg can key dory and good. the military now accepts there's a suicide problem. it did not accept it in the past, it does now. there is tremendous amounts of money being spent, hundreds upon hundreds of millions of dollars. so the military that exists today is not the military that existed then. but there's no silver bullet. this is not an epidemic where the with the best of intentions the best and strongest military people have been able to fix. but let me go back to mark and carol. mark and carol find purpose in this. the pain of what they were experiencing never went away. i've known them now for five

years. they worked with me on the book, they stayed at my house, they've spent time with my wife, and their family. i've seen them talk about their sons 10, 15 times, and every time they do it, it's a decade later now since kevin's death, almost a decade since jeff's, every time they do it, they tear up. the word "closure" is tossed around, there is no closure for people who have lost two children. that pain never leaves them. when they talk to a crowd of people that they don't know, they think maybe one person in that crowd is struggling, maybe one more in that crowd think -- person in that crowd thinks, if i take help, i'm flawed, maybe one person is hovering right on that line between getting help when they need it, surviving, not getting help when they need it, not surviving. and they think if that one person reacts differently, if that one person gets help, if that one person says to a friend of theirs as someone close to me

said once, you need help, if that person does it, then it's worth it for them reliving the pain. i'll close with this and take as many questions as we have time to ask. for them this is an 11-year fight, and they have found happiness. they have found a way of living, a way of finding a meaning and a purpose. their daughter melanie, she'll be here this sunday running the army 10-miler, she'll have ken's face on one side, jeff's -- kevin's face on one side, jeff's face on the other. she found happiness, she's found love. and occasionally, she feels guilty, you know? she wonders do i deserve to feel happiness, is something wrong with me that i'm able to laugh and love when i've lost my brothers? but she's found a way of getting through life and, fittingly, she's a nurse. she's trying to do what kevin wanted to do, help other people. so i leave you with that. it's very easy for us to say we

support the troops, easy to applaud at a baseball game, easy to put something on the back of a car, and that's wonderful. there's nothing wrong with it. but soldiers who come back, they're not simply people you applaud. these are real people. these are people who are drawn from our society, who reflect our society, and we reflect them. suicide is not an issue just the army's dealing with. when cars were created til 2010, the thing that killed the most people other than an illness were car crashes. that was from the model t until 2010. then in 2010 suicide took more lives than car crashes. and as with the army, that suicide rate, the difference is getting bigger and bigger. and for a long time in the civilian world, suicide was something high school kids did. they'd failed their parents, they killed themselves. and that's where you had to really worry about suicides, was

with those age groups. now we're seeing the biggest rise among men in their 50s and 60s. many cases these are men who lost their job and figureed i may never get another job. i may never be able to support my family again, i can't live like this, so i choose to not live. and that's where the rate now is rising. so i leave you with that. the military's a reflection, a microcosm. it's not as if welcome stand back and say it's them, it's not as if we can stand back and say it's not us, because it is. there are people in this room who are serving now or who have served in the past. they know this all too well. we know it all too well. there's a disconnect that does not need to be there, and on an issue like mental health, like suicide, can dangerously afford to be there. and i close with saying that for mark and carol 11 years on, they're doing what they can to bridge it. i hope in our way people who read the book, my hope in writing the book was to also

help bridge it in as best way as i can. i thank you all for your time and look forward to taking your questions. [applause] >> i think we can all see just how, excuse me, how vital the issues are and how insightful the work that yochi has done. now to take it into the conversational portion of the evening, we have major garrett with us who is probably well known to many of you as the chief white house correspondent for cbs news and also a correspondent for "national journal." major, over to you. >> i just want to apologize to everyone, the conspiratorial nature of d.c. traffic was indifferent to this event, but it is in no way a commentary on yochi's work or the extraordinary nature of this book. i just want, if i could, for a second this book is perm on a

couple -- personal on a couple of levels. you talk about mark after vietnam. my cousin craig, who just died two weeks ago of parkinson's disease, served in vietnam and decided to stay and be a part of that junior officer corps that changed the army for the better after vietnam. he did not go through these issues, but he is a brother of all those who decided to stick it out and make the army a better place after vietnam. so in that way as the book resonated to me, i have two dear friends whose children committed suicide in college as civilians. that also resonates with me. and if you read this book, you read a book about tragedy but also transformation. that's sort of where i want to begin with yochi. at the white house the president now signs letters in the same way he does to someone who has died in combat to someone who has committed suicide. and that was a transformation within the building itself. should the president do the same thing, should these be on equal levels. so the transformation is working

itself through gradually. there was something sort of beneficial about me not being here first because you heard from the author himself, and he can deal with it so much more articulately than i can. but i want to start with what you ended with, this isn't a happy ending. this is a beginning of a process that is going to carry on for a long time. where would you say we, army culture, military culture, society are in dealing with this, comprehending it, and how long do you think it will be before any of us can say a corner has been turned? >> i think that we're at a point now where it's understood and accepted, which is wonderful. it sounds like it's a low bar, but it's not. for a long time there was pubback at the tact that -- pushback at the fact that ptsd existed. there's now a deep acceptance that's there, a deep, deep push to try to solve it, and that's great. that's a massive improvement. the stigma is still there. when you look at polling of soldiers, they still feel scared

about seeking help. so it's understood, there's an effort to fix it. i think, major, one reason for it is the army is, obviously, the definition of hierarchy. we think of it, we think of the army for obvious reasons. i spoke to generals i had gotten to know in iraq and afghanistan, and i asked them about their own experiences, and many of them described what was textbook ptsd. their wives didn't recognize them, their kids didn't, they had night mauers, flashes of anger -- nightmares, flashes of anger. that is ptsd. and these are men at be kin of their -- pin call of their career -- pinnacle of their career. and i asked them can i use your story, can i use your name? the answer with the exception of one was, no. you can get through this, you can have a career, you can have a family, you can have a life that's healthy and full. until that changes, this issue won't change. >> mike wellman talked to you

about that. leadership must acknowledge their own post-traumatic stress while setting the example of seeking help. let me talk about the terminology, because some people on twitter said why don't we drop the d, just call it post-traumatic stress and not add to the stigma or at least validate part of the stigma by calling it a disorder? is that a conversation that you had in researching and developing the book? >> it is. and it's a fair question. to be honest, it's a question that's talked a lot about within the military. if you call it a disorder, are you saying that a person is sick, that they're broken in some way? and there are a lot of people who care about the issue, care deeply about the issue but believe when you say it's a disorder, a person hears that as i'm broken, i can't be fixed, why should i even come forward? and it is a serious issue. at the higher ranks of the army, general odierno, the current chief of staff, general -- the current heads of the joint

chiefs, general dempsey, when mike mullen was running the joint chiefs, when bob gates was secretary of defense, all of them felt the phrase should be pts, post-traumatic stress. one of the interviews was with bob gates, and this is not a man prone to be overly emotional. it's not a man who's a softie by any stretch. but i asked him about his own experience and what he had seen and what he'd done, and what he said to me was he felt by the time he left, he had post-traumatic stress of some sort because of visiting burn wards and going to cemeteries. he thought that it had changed him. he told me that he knew he had to leave the white house because whenever he was asked a question about any issue, strategy, all he thought of was the soldiers who would come back missing limbs, the soldiers who come back with burns, and he couldn't give advice to the president about anything at a higher level because all he thought was the human cost. and the phrase he uses is

post-traumatic stress. >> uh-huh. and we'll take questions as we move along, right? we can do that at any moment, so why don't we just do that and go to the questions. i know folks here want to jump into this. i see your hand, match, go right ahead -- ma'am, go right ahead. >> my name is ann, and i just spent the last five years at the walter reed medical center taking care of soldiers coming home. and you listen to their nightmares, you listen to their crying and their tears and their hopes and their dreams, and we can talk about this til the cows come home. i'm sorry, i'm from new england. [laughter] the problem that i see -- and i don't know if you have any insight on this -- is that middle management across the ranks needs to be held accountable when they tell, when they court-martial a soldier for writing a suicide note on the wall. i can't tell you how many times

soldiers have told me i asked my colonel to send me to the chaplain or i asked my colonel to send me to the psychiatrist, and he swore at me. i can't repeat what the soldiers tell me because, you know -- but anyway, this happens more than once a day. and it happened for years. the whole five years i was there. so i can't even imagine after leaving there three years ago and still hearing these stories. is the army, are the military in general doing anything across the board to hold the supervises and the colonels or whatever rank the supervisor is accountable and giving them like a sensitivity course and holding them accountable that if some, you know, and checking them and saying, you know what? if you can't look at your soldier and recognize

post-traumatic stress, then you don't need to be in this position? >> or at least not be hostile to them when they express a desire for help -- >> right. >> -- or do something that is suggestive of help. >> it's a great question, and it's a fair one. it's one that i talk about a little bit in the back of the book, so i'm glad you brought it up. right now the short answer is, no. the average officer or the average nonebb listed -- enlisted, noncommissioned officer, excuse me, is not held accountable if there is a suicide or spate of suicides in their unit. when pete corellly was the vice chief of staff, he would hold a monthly teleconference when ad is had taken place, the commander had to give him a very detailed explanation, but that is not what you're talking about, because that's at the very high level. to my mind, this will change only when you build in a system of accountability. if you're a colonel and you're up for promotion and they discover there were 50 people in your unit arrested for drinking and driving or for beating their wives or other serious things

like that, you probably won't get promoted. but right now if they discover that three people in your unit killed themselves. i don't think this goes away. there's a moment that illustrated this and to find a different angle about eight months ago when the joint chiefs of staff were summoned to the hill to talk about sexual assault, claire mccaskill who was pushing for and senator gillibrand about session yule assault -- sexual assault. if you've been raped, doesn't matter gender, but if you've been raped, you're likelihood of developing ptsd is exactly the same as a soldier in combat. if you remember the hearing, they were summoned there, so you have these intimidating men, and the question was, can you point to anyone that you've relieved of command because of sexual assault in their unit? went to the head of the marine corps, the answer was, no.

the head of the air force, the answer was no. and ultimately, there were two people who said yes, the head of the coast guard and general odierno. but in both cases they could think of one perp. there, too, you have this culture where this tragedy's happening, this horrific crime. you're beginning to the see suicides among female soldiers, mainly the victims of sexual assault. but in neither case was the person held accountable, and i agree with you, they should be. and until they are, this won't change. >> one of the things you brought out in the book is soldiers or marines who feel this are afraid if they raise their hand, they are canceling out their opportunity to be promoted. so you have it on both sides of the continuum. they're afraid to say anything because their career might be derailed. >> exactly. and it's -- to take one example that, again, the air force. don't mean to pick on the air force, but if you're a pilot, and especially this really hits a female pilot because the rape situation so often with female

members of the service. but if you're raped and you suffer ptsd or anything, you can't fly. that's taken away from you as a precaution. so inadvertently, basically, you're victimizing the person twice. that person who was assaulted, raped, whatever the issue, there's that horrible trauma, that crime committed against them, and then they also lose the thing they trained to do their whole life. so there are cases where a person is punished in a way with for two different reasons, but the end result is a person feels twice victimized. it remains real because if you seek help, your careers can end. it's in some ways very rational which makes it all the more heartbreaking. still today if you seek help, there is a chance your career will end. we talk about stigma. we have to recognize it's in the present. >> next question.

>> hi, i'm with an incredibly distinguished group of people including jackie garrett, head of the dod suicide prevention office. congratulations, fist, on your -- first, on your book. >> thank you. >> i wanted to emphasize one of the points you made, that in a downsizing military, it's just incredibly hard for anybody to come forward for treatment. basically, nobody will come and seek treatment unless they've already been identified as going out the door, and then that's where they'll get there. this is a problem that does not have an easy solution. but again, just something to recognize that no matter all the platitudes we have about reducing stigma, the reality is that be you want to have a career in the -- if you want to have a career in the military, you don't want to be seen as going to get help. and i think the recent rand report that just came out said

that again, service members won't go to seek treatment. >> yochi, do you think this is generational, that it will take a generation of those who are promoted to the middle ranks who have been exposed to this who have a different concept of this organically from their early service and their time in this particular space within our military, thatten generational transformation is what's ultimately going to be the answer? because they will have grown up in a culture and have come to different conclusions than those who are above them in rank now? >> i hope so. i really do hope so. >> i mean, do you think that that's really the only thing that's ultimately going to be the wave that transforms -- or do you think it can happen before that? because a generation away would be -- >> a long time off. >> 10-20 years. >> yeah. i think it could shift before that, but i think the age issue, it does matter. if you're growing up today, you're growing up where you see commercials all the time for zoloft, for xanax, it's part of the culture and something people

discuss openly. and i do think that matters. somebody younger coming up with this is openly discussed as compared to somebody older will see it differently. one thing that's interesting in researching the book and talking to people about the book is almost everyone i talk to says at some point in the conversation says, you know, i know somebody, and it's one of the few things, i know somebody who killed themself, who sought help, i know somebody in my family, me, my wife, my husband, my child. it reminds me of what alcoholism was 50 years ago where nobody felt comfortable talking about it. i think that's where we are with this. i think this is true probably of many people in the world, everybody knows someone for who this has been aen issue, but it's still not talked about openly. it's like right below the surface, one notch away, but it's not quite there. >> will next one. yes, sir. >> thank you so much. >> microphone's coming. it'll be right there. >> will. [inaudible]

>> thank you. department of mental health, johns hopkins university school of public health. for many years military regulations have prohibited the continued retaining and deployment of soldiers with diagnosed mental health disorders and soldiers on multiple psychotropic medications, and for good reason. because we know that soldiers with pre-existing mental health disorders when exposed to the stresses of trauma are at much higher risk of chronic morbidity as a result of this. and yet for many years the u.s. military turned a blind eye to the deployment of soldiers with diagnosed mental disorders on multiple psychotropic drugs, 10% or more of soldiers deployed with conditions that ordinarily would have made them nondeployable. and i think we can all recognize the reason for this is we could not have met our manpower requirements without this. what does the current epidemic of mental disorders in the

military and this practice say about the stand about of -- sustainability of the all-volunteer force? >> i think that when it comes to the kind of baseline question of, one, will the military continue to function, to be as effective as it has been, and two, a parallel part of this question is often implied of should we go back to a draft, in some way spread the burden so it's not the same 1% deploying again and again and again and again, i think the question that was asked before where you have a shrinking military, unfortunately, the problem gets worse. because people are now competing for jobs and feeling like, well, if i know that that guy's a it little bit off some days and that guy's not, i'm taking the one that's not off. i think the military's sustainable, but this is a bigger strain in many ways. a person comes back missing a limb, it's horrific, terrible burns, it's horrific, but we sort of know as a society how to view that person, how to treat

that person. if someone's missing their leg, we can kind of guess what might have happened. we can probably be compassionate because we can see they suffered in a very visible way. when a person comes back and you look at them and don't know that's the case, we don't really know how to process that. you know, i think we have a friend that has come back, he had had very serious issues, and he looked fine. nothing about how he carried himself, his demeanor, he was a muscular, kind of hulking guy, and he had a therapy dog. and he was walking through mcdonald's and people would say, get your dog out of here. you're find, you're not blind, you're not walking with a limp. he had crippling ptsd to the point he almost died, but because nobody could see it, nobody treated him the way you would of somebody who was missing a limb. sustainable? yes. people in that shouldn't be? yes. but that issue, that way of not being able to quite understand or quite have that level of compassion that you would with someone whose wound was visible,

that's a serious issue, and i don't know how long it takes for it to change a. >> let me enlarge that question a bit. sustainable, possibly. optimal though. it seems inherent in the book is ap underlying conclusion -- an underlying conclusion that multiple deployments, by their very nature, increase the likely hood of these very problems. and if you have a finite and shrinking force and are in a war footing, you are going to have multiple deployments. and each and every deployment i would think -- i don't know mathematically, but would increase the likely hood of these kinds of psychological traumas. is it optimal? it may be sustainable, but from the military's perspective, is it optimal? >> no, and that's a great point. no, it's not. it is known that the likelihood of something, obviously, it does go up if you're on 500 patrols as opposed to 100, but also that the traumas can build. if you hear an explosion and hear another explosion and x number on one tour and that doubles the tour after, even just the hearing, the seeing,

the smoke, if you're not hurt, if you're not seeing a body in front of you, even that builds up over time. ptsd itself builds up over time. it's not as if you have it and it's cured in five years and it's gone. you could have it for decades. you could be struggling with it for decades. so it could be something where you come back and you're pretty much okay, you're having nightmares now and then, but for the most part you're functional, and 20 years later something happens, and you have a break. it's hard to predict, to know, to cure, because it's not something where you can see the immediate illness, figure out a treatment med and then now -- method and then know that it's gone. one thing in mark and carol's own experience, there was a young soldier that was hired to be mark's aide, the guy who picked up his stuff and helped with his paperwork, a guy named mike. and when mark hired him, he was this perfect soldier, a guy that mark thought this guy is brilliant, this guy is organized, smart, good looking, he can do the job perfectly.

mike had deep depression. even mark, who had at this point already lost kevin, he didn't see it. his wife got glimpses, his chaplain had glimpses, but nobody saw it. and then it built and it built and it built, and suddenly it burst. and mike killed himself the day before he was supposed the start working for mark graham. but this was something where, as you say exactly and correctly, that it wasn't that he went on one tour, came back and, poof, everything was terrible. it was that he went, came back, things built and built and built until finally there was a break. >> when you get to that part of the book, as heartbreaking as everything in the narrative up until that point was, that was among the most devastating things i came across in the book, that this guy that mark believed in, was so confident ability, felt so good about and the proximity of this undiagnosed, unseen yet ravaging internal trauma hits him again. i mean, it's just, it's just devastating in the book.

and illustrative of so many things that are hard to see and even when you're intentionally trying to see can't always be found. and it's incredibly point i can't in the book. yes, sir, right here -- poignant in the book. yes, sir, right here. >> hello. dave mattingly. and going back to what you were saying about general gates and i think a point that you made in the book was that when soldiers -- with soldiers deployed to iraq and afghanistan and sometimes they were looked at as they were going -- oh, he's going to be a rear etch love, he was going -- 'em loan, he's going to be sitting on a fob, but seeing their buddies coming back from patrol or their fob coming under attack, that they were still going to sustain the additional drum of pts -- trauma of pfs. and it's not something you can say, well, he wasn't infantry, or he wasn't out walking the

line every day, that the ptsd is still out there for other people involved in the operations. >> it's a very fair point. in some cases i know people who believe that their ptsd came from hearing explosions again and again and again. it wasn't that they saw something horrific or they were shot or their friend was shot, but it was just the impact of explosion, explosion, explosion. never quite knowing is it going to hit you. i agree completely. it doesn't have to be something -- we think trauma, we think often of something really dramatic, you're walking on a foot patrol, and your friend next to you gets shot. no question, that's traumatic. but trauma can be different. it can be things that on its face don't look quite as bad, but when they build on top of the other, the end result is the same. it takes you to kind of the same dark place. >> yes, sir, right here. then i'll come to you, ma'am. >> thanks. vfw post one.

one quick question, though, what are we -- even if we're successful in getting the military, members of the military educated on dealing with pts and working with soldiers who are coming back and things like that, what are we doing to work with the civilian community out there? because if they were to, if they were remiss in terms of seeking treatment while they were in the service, they get out, there's all ciepth of stories out there -- kinds of stories about the ticking time bombs of veterans. we need to also educate the civilian community on that. so what are your thoughts on that? >> it's a great question. my dear friend phil carter is here, and it's something that he and i talk about a lot. it's an easy hollywood trope to have somebody come back who's a ptsd admiral soldier, whether it's the deer hunter in vietnam, a jack reach every movie two years ago -- reacher movie two years ago, it's easy. it's kind of a lizzie way of -- lazy way of writing a character. ..

he's back now. he has nightmares, he had alcohol problems and whenever he travels he has a level of

celebrity he uses a very similar speech he has to say that it doesn't make you weak that makes you strong. he goes through the intensity and you come back and have not changed. if it's the same as when you left and that is when something is wrong with you. going to the war should change you. you should be able to see the things you see, see the code here with you here and be the same and at this point i find it very powerful that only then there's something wrong with you if you are the same and all you can do is hope more people are out there and the more that read this book are talking to the veterans that are friends of theirs and realizing that he is not a psychopath but it's hard. i agree with you it's hard.

i'm very interested in this topic as many friends in the community. they helped to grow the programs while the young men and women are in training. it would be given automatically and that there be some sort of reintegration program where they are given tools to self assessed and that it becomes a normal thing that of course you're going to have these feelings and situations arise because i think once they make it an implied like you are saying that it's natural to have these anxieties

after months if not years of hypervigilance and the atmosphere that is completely different than anything we can even imagine that it would become a normal part of their training and reintegration into society. >> break everyone down and i'm sure we are maybe tampering. >> it is resiliency training and the idea is that you try to do exactly what you're suggesting is giving people tools so that it isn't something that they are struggling with and having no idea who to respond to and that they have an idea that may come and when it comes it is a sense of what to do on their own and i

don't mean this is funny but my mom sitting here with somebody that was deeply into yoga before it became cool and the thing everyone is doing and the military has adopted yoga and it's something they do to learn how to relax. they do deep breathing and some do it for acupuncture. where you see them walk into a room they are doing downward dog and if it is now how they prepare to go to work. >> i'm with the association of the united states navy. i hear everyone talking about the adverse reaction of someone serving in combat and ptsd kicks

in and they ultimately commit suicide. what about the nontraditional. our day feeling the mental fatigue every day on a breakdown scale. they come back to nothing. the lady over here asked about who. if you deploy av augmentees who is accountable because they may come back and at you might not understand what you just deployed to so when you start showing signs they may not understand what it is that you're going through. we see that more and more in the into reserves and i apologize for my phone ringing. sorry about that. i want to make sure this isn't just combat deployers, they are

not just in the operations, they are mortuary mortuary sciences, simple repairs and they are seeing this stuff every day on a breakdown scale. >> there was a tragic statistic in the numbers of the active-duty suicide at. the system wasn't perfect. but if you come back to fort bragg and to the community that it is to serve they know what it's like to have your husband and wife away. you come back in the national guard where you live in a not have met someone that served let alone have a support system so they may come back to an imperfect system or no system

and that is a heartbreaking part of this and the reason the numbers may not go down as much as we would hope they would anytime soon. >> i'm the director of the defense suicide prevention office and i know that mark is working very hard tonight because you've been texting me. he's the director for the warrior program which is a program that we stood up under the defense suicide prevention office. so i am going to take a moment and maybe speak a little bit from mark a-alpha that's hard over that part because he's usually right out in front of me. but he's not here and i have the microphone. one of the things that we have spent a lot of time and energy

and effort on it building a support network within the military community for the active-duty guard and reserve service members. i'm tearing a the a lot of misperceptions tonight about who is at risk and there's a lot of things being thrown around. we know that our biggest risks are among the young junior enlisted who have never deployed, have not been in combat only 12 to 14% that have died by suicide have ever been in combat. we know that this is a problem among the youngest of our troops predominantly. so, what mark has worked with me on, that's for warriors.com would be the way to get into the peer support call center. you can call it and you can chat

and e-mail. we are about to launch a mobile app that would make it more accessible and i think it is what we are doing that get lost in what's not being done and i'm hoping this could be sort of a take away message because i know that he is passionate about reaching out and asking the right questions, showing that you care, the nonjudgmental and educating the community come educating about what you can do, not what's wrong in the system and the bad dod and va but what we can do within the services at the guard reserve everybody should leave here tonight knowing that there are resources available and mark is phenomenal at running back for warriors. >> my point isn't to say that

it's bad that the people that are working in these issues care profoundly about this. it's just another assignment. one issue that has come up in in researching the book is an issue that again it is the means restriction and what that means if you try to make it harder for a person could literally kill themselves, so israel a few years back had a very high suicide rate in what they were discussing is that for decades they would go home and bring their guns with them so you would see they were in uniform and often shockingly young they looked like they were 15 and then they would have a backpack

on one side and then they are discovering that they are killing themselves in large numbers and what they did is take the guns away. you do not bring your gun home with you on leaving the numbers fall. and how do you do that in the sphere of soldiers. they have their military weapons and even then personal weapons. what do you do so this is

governmentwide. it's the biggest offender of keeping it as it is and so they look at the santa fe soul that this is nuts. if this is in place. you could make your clearance. you're never going to change with it and it's been for two

years. they finally got changed, but this is a multi-year fight chugging along beneath the surface totally and completely. you think about changing the question on before him and that took several years the kind of change they were talking about with the best intentions but they tried to make that isn't easy. >> next one. >> may be some things that i can add some clarity on this you are not suggesting that there is a disorder so that when you incorporate ptsd something is out of order. so the stigma is attached to this is also a label and this label if you can compare that

type of scenario we don't ask don't tell you will understand that you are hiding the pathology. the behavioral health is something that is a taboo. there is a lot of embarrassment associated with it so if you can look at it in that regard and realized that it is real and that is the term, one thing that came up there is a debate in the military and it's an honest one and it's a nice way for us to wrap up the conversation to continue in the back of the room but the question of how do you commemorate and memorialize the soldiers that call themselves and they should be memorialized in the same way. he was in iraq in 2004 when i first met him lost soldiers to

combat. and they had the names of the combat not the name of the ones that killed themselves. so put themselves. so today the biggest regret is life. but they say that there's a difference between being shot on foot patrol in shooting yourself and people say that one deserves to be honored one way and one deserves to be commemorated in the other way. they are not bad people. this isn't something on the hold we can accept and we should. we can accept that and as a society there are people trying to do just that. but this is nuanced. you can't look at somebody that needs a prosthetic and say his life goes on mc