Sunday, 5 April 2015

Notes from the Other Side: The Evil Hours and The Invisible Front

This review originally appeared in Critics at Large April 5/15 and is reproduced on this site because I discussed PTSD in Chapter 19 of That Line of Darkness: The Gothic from Lenin to bin Laden (Encompass Editions, 2013). Had both books reviewed here been available when I was writing the manuscript, I would have incorporated their insights into my own study.

US soldiers participating in the Yoga For Veterans program. (Photo: Give Back Yoga Foundation)

“No other people in history has sent as many (soldiers) as far away with as little sacrifice demanded of the average citizen as we do. No other people in history is as disconnected from the brutality of war as the United States today. Were the truth of war to become apparent to Americans, we wouldn’t continue to train, equip, and deploy warriors the way we do. Nor would we ask them when they came home if they killed anyone.” 
—David F. Morris, The Evil Hours.
  
“Must you carry the bloody horror of combat in your heart forever?” 
—Homer, The Odyssey, cited by Yochi Dreazen in The Invisible Front.
  
Post-Traumatic Stress Disorder (PTSD) was officially recognized in 1980 by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in large part because of a decade-long campaign by Vietnam veterans to secure wider knowledge and research into the affliction they suffered. But as David J. Morris asserts in his compelling The Evil Hours: A Biography of Post-Traumatic Stress Disorder(Houghton Mifflin Harcourt, 2015), psychological trauma has always been “part of the human condition,” but badly misunderstood. Part memoir, cultural history, investigation into the scientific research and critique of modern treatment, Morris interweaves the wisdom of psychoanalysts, poets, novelists and historians, with his own struggle with post-traumatic stress. Recognizing that most PTSD sufferers are not veterans, Morris supplements his “biography” with the stories and insights of non-military victims of PTSD, including natural disaster survivors, mountain climbers, and raped women, thereby imbuing his study with a wider human dimension.


Morris joined the Marine Corps serving in the mid-1990s as a lieutenant. He found the experience unsatisfying. He resigned his commission and returned to school. Following 9/11, he realized that being a war correspondent would enable him to acquire the experiences he missed while serving in the peacetime military. During his time abroad as an embedded war correspondent for several periodicals, he repeatedly came under fire and witnessed terrible carnage, particularly in Fallujah, Ramadi and Baghdad where he lost friends. But it was his survival in 2007 from a harrowing explosion–a Humvee he was riding in hit a bomb hidden in roadside trash–that became the “trigger” for his PTSD.

Back home in California, Morris’ readjustment to civilian life went reasonably well for two years – until he fled from a movie theater after an on-screen explosion and “a black curtain fell over [his] head. The world disappeared for a few minutes ... [his] body was back in Iraq.” With no memory of leaving the theatre, he found himself pacing the lobby, studying the people around him and wondering which one of them might be concealing a weapon. He came to understand that the movie and later vivid flashbacks scrambled his sense of time, making him feel he was experiencing Fallujah in 2004 rather than America in 2010. Subsequently,  his “unconscious debriefed” him as wake-up-screaming nightmares and sleeplessness haunted him. He became increasingly hyper-vigilant with regard to his surroundings, intensely anxious and impatient with civilians who were blithely unaware of what was happening in Iraq. More interested in the banality of gyms and malls, they didn’t seem to care: “That these two worlds, war and home, could be kept isolated, one living in almost perfect ignorance of the other, was an obscenity surpassed only by the obscenity of the war itself.” Emotionally numb most of the time, his life careening out of control, his fits of anger were explosive and frightened his girlfriend. Rather than talking about it, he would retreat into sullen silence. Although she suddenly left him without any explanation, she later revealed to him: “You go off into this other place, and it’s like I can’t reach you.”Her departure prompted an introspective journey, spurring Morris to read voraciously about PTSD. 

One of the great pleasures of Evil Hours are the insights about PTSD that Morris acquired from the humanities: the psychic wounds that afflict the characters in Homer’s The Iliad and The Odyssey; war memoirs, especially those of Siegfried Sassoon with whom I think Morris most identifies and who provides Morris with his book title; novelists, among others, Ernest Hemmingway, Kurt Vonnegut and Tim O’Brien; the myriad interviews he conducted with friends and non-veterans who suffered from this condition; and the historians who wrote about the American Civil War, the Great War, World War II and Vietnam. Morris relates that after the Civil War ended, eight percent of the Union Army alone, some 175,000 men, was listed as suffering from “nostalgia,” which today would mean clinical depression or extreme panic.The bloodiest war in American history entailed not only psychological but social costs to the nation’s fabric. After the war there was an upsurge in criminal violence, including the racialized violence of the Ku Klux Klan, and genocidal campaigns against Native American tribes. A century later, the murder rate doubled during the Vietnam era. Not surprisingly Morris concludes:“Violence changes people in mysterious ways, and when the normal human prohibitions against murder and cruelty are lifted on a wide scale, it unleashes violent impulses that are not easily controlled.” 

Morris is also masterful at making connections gleaned from literary and historical insights that resonate with and provide deeper meaning to contemporary moments. When he reads Vonnegut’s Slaughterhouse-Five, he is able to relate the protagonist’s near-death experience in Dresden during World War II when Billy Pilgrim becomes “unstuck in time” to his own and other veterans’ shifts in time. When Robert Graves acknowledges his hallucinations long after the war ended, believing he was back in the trenches –“I was still mentally and nervously organized for war. Shells used to come bursting on my bed at midnight” – the poet could have been writing about the distorted perceptions of veterans from the Vietnam, Iraq or Afghanistan wars. In her memoir,Lucky, Alice Sebold recalls that after being violently raped when she was nineteen she realized that she “was now on the other side of something” that other people could not understand. “I could not understand it myself.” Morris has the same feeling explaining the chasm of misunderstanding between him and nearly everyone else. And both Morris and Sebold quote from Judith Herman’s 1992 landmark study, Trauma and Recovery, that bridged the worlds of war veterans, prisoners of war, battered women and incest victims. (Incidentally, Morris’s copious endnotes are most helpful and an excellent entry into further reading.)

Morris also delves into the clinical and scientific literature summarizing both sides of the controversial scientific debates, even though he leaves no doubt about where his sympathies lie. He argues that much of the funding for scientific research that is conducted by the Veterans Association focuses too much on large-scale empirical and impersonal studies based on quantitative data and disregards “the highly subjective experiences of survivors.”They pay no attention to veterans’ dreams and diminish the importance of empathetic therapists that Morris found so valuable when reading about William Rivers during the Great War and the psychoanalyst, Chaim Shatan, who listened to Vietnam veterans’ groups during the 1970s. Morris sees their role, that of encouraging narrative, as central to understanding PTSD. He quotes Isak Dinesen on one of the great advantages of narrative: “All sorrows can be borne if you put them in a story or tell a story about them.” Morris is also encouraged by his conversations with psychodynamic psychotherapists because they gave him “a deeper sense of the psychic cost of trauma, a humanist sensibility, as well as a refreshing willingness to think through issues relating to trauma.” 

By contrast, Morris became increasingly sceptical about the so-called “gold standard” of data-based treatments preferred by VA that he personally experienced in three different therapies. His foremost example is the “prolonged exposure” program, which requires the patient to recount the worst moments of trauma over and over again in an attempt to dampen the emotion and turn traumatic memory into ordinary memory. Even though Morris admits the treatment has been beneficial to some sufferers, he describes how PE has actually done harm, sometimes causing certain patients’ symptoms, including his own, to worsen. He shows that such cases can be erased from official reports because, in some studies, patients who want to stop the treatment are dubbed “noncompliant” and thrown out of research samples. Study results can end up looking more impressive when the statistics are manipulated. He is more supportive of CPT–cognitive processing therapy–that he describes as a kind of “light lifting,” and the non-invasive yoga after a friend relates to him how it transformed her life. He includes a separate chapter on drugs; Morris remains dubious about the efficacy of this treatment, though he concedes that prescribed drugs sometimes have saved lives. 

Throughout the process of evaluating the different therapies, he is always respectful of the soldiers and veterans he encounters. He is still irritable toward civilians, “their apathy and smallness of life” and their appalling ignorance about the realities of war, the politics that preceded it, and how the war was mismanaged. He remains angry at the citizenry for rewarding Bush with a 2004 re-election and for the civilian’s treatment of veterans who try to tell their story only to be interrupted with fatuous remarks. To his dismay, he even encountered therapists who knew nothing about the war. Yet, as he acknowledges, he lives in a culture that is preoccupied with celebrating hyper-masculinity as expressed in video games and movies. I was therefore curious about Morris’s evaluation of the top grossing current film, American Sniper, even though it was released after his book went to press. In an interview he did reveal that he was appalled by Chris Kyle's racist sentiments. He found them “shameful and embarrassing. I know a lot of Marines who felt a completely different response to Arab culture and taught themselves Arabic. His death was a real tragedy, but his book was also a real tragedy, and I think the movie just shows that Americans are not ready to have an adult conversation about the war yet.” Given that PTSD is currently the fourth-most-common psychiatric disorder in America, Morris’s study is timely and should be widely read, including by those who had positive responses to the film. They might rethink or temper their feelings about the film or, even better, initiate a national conversation about the emotional disorders that plague a significant number of veterans.

The Invisible Front: Love and Loss in an Era of Endless War(Crown, 2014) has a narrower focus,as author Yochi Dreazen narrates a harrowing but sympathetic account of Mark and Carol Graham, an Army couple with two sons, Jeff, Kevin and a daughter, Melanie. They lost both sons within a year. Their younger son, Kevin, an ROTC cadet, committed suicide, driven by depression, which deepened after he stopped taking Prozac because he knew that any admission of his problems and treatment would destroy his military career. His family knew nothing about his depression. Within a year an IED in Iraq killed their older son, Jeff, an Army tank lieutenant. The stark contrast of the two funerals in a deeply conservative and religious community in Kentucky is the galvanizing catalyst for Dreazen’s book. Jeff was lauded as a hero; the church was packed with friends and colleagues who paid tribute to his service. Kevin’s funeral service was sparsely attended, in large part because extended family members and former colleagues regarded the young man as a “weakling, coward and even a sinner.” In the next few years, the couple was met with silence whenever they attempted to talk about Kevin. Mark and Carol responded to their twin tragedies by channelling their grief into attempting to remove the stigma associated with mental illness, and their courageous story is deeply moving. 

Dreazen, who is the managing editor of Foreign Policy, has war reported for years, including multiple embeds in Iraq and Afghanistan; that experience serves him well in the riveting chapters leading up to Kevin’s death. Throughout his career, Dreazen’s has focused on the mental health issues confronted by service members and veterans. In telling the Grahams’ story, Dreazen does not flinch from exposing the military’s abysmal response to a spreading epidemic of suicide among soldiers and veterans, abysmal because the military is immersed in a culture that has long believed that if a soldier suffers from a mental illness, it is because of his character flaws. Dreazen documents how anyone showing signs of any psychological disorder, such as depression or PTSD, can be subject to open mockery from sergeants who, for example, force them to spend hours in a “dunce’s corner.” Lower-ranking soldiers harass and bully the sufferer, calling him a “shit-bag” to his face, until finally he feels desperate. Given these conditions, it is no wonder that “75 percent of the troops surveyed by groups such as the American Psychiatric Association told pollsters they wouldn’t seek help because they were afraid their colleagues would think less of them” and it would sabotage their careers. Changing the culture and the stigma associated with psychological injuries became the Graham’s goal. 

After losing both his sons, Mark Graham considered leaving the military but changed his mind after hearing Carol read a passage from a biblically-inspired memoir by a Presbyterian minister who came of age during the carnage of the Civil War. When he urged his readers to put their duty to others before their own suffering, that message began to resonate with the Grahams. When Carol wondered whether she could ever be happy again, Mark offered a powerful response: “We can let losing the boys be two tragic chapters in the book of our lives, or we can let it be the whole book.” At that point, they made it their life’s mission to do whatever they could to comfort the family members of those who had committed suicide and to publicly speak in military bases, churches and community halls sharing their own experiences and campaigning to lift the stigma attached to emotional problems by urging their audiences to consider psychological injuries as honourable war wounds comparable to physical wounds. 

General Mark Graham (Ret.) and Carol Graham
When General Graham was appointed base commander at Fort Carson in Colorado, home to 100,000 soldiers and military families, and a hotbed for suicides and violent crimes – the latter the subject of a 2010 PBS documentary, The Wounded Platoon – he encountered tenacious resistance. Base commanders, even the chief psychiatrist, adhered to the canard that so-called troubled soldiers were “malingerers” and “deadwood,” as if the spirit of General Patton, whose hatred of “shirkers” was infamous, still skulks military headquarters. Graham realized that soldiers would avoid treatment to stave off being stigmatized. Without regard for interfering in other officers’ turf, Graham became personally involved with vulnerable soldiers. He instituted an effective suicide hotline on base and a voluntary yoga program. He spoke to senior officers about his own grief and was not averse to going over the heads of senior officers who resisted his methods. He was one of the senior officers that made it possible for suicide victims to receive a full military burial service, and to convince the Obama administration to include suicide victims in President Obama’s condolence messages to the families of fallen troops. Yet despite the Grahams’ Herculean efforts to prevent the problem from getting worse, the suicides continue to spike. In 2012 there were more military suicides than soldiers killed in foreign wars. That trend will likely continue until the culture that underlies the stigma is changed not only at the senior level but among the sergeants and enlisted men. 

The Evil Hours and The Invisible Front deserve to be widely read. Although written in different emotional register –  the former, angrier and edgier, the latter infused with a poignant, even elegiac tone–  both authors honour the suffering of soldiers and veterans. Both share similar frustrations about the entrenched macho military culture and the rigidities of the VA. The increasing violence among veterans alluded to in the previous paragraph reinforces the insight in The Evil Hours that once violence is unleashed in war, it is difficult to bottle it up when the soldiers return home. These books illustrate both what is most honourable in the best sense about the military, as well as, the cultural divide between it and civilians who seem to possess little understanding about the realities of life for the tiny percentage of the population who become members of the American armed services. But they also reveal the fault lines within the military on how to respond to emotional vulnerabilities and PTSD. Both David Morris and Mark Graham share certain similarities.The former saw no military action as a Marine, the latter experienced only limited action during the first Gulf War. For different personal reasons, they both undertook a similar mission later in their life. They sought to draw attention to the emotional legacy of America’s most recent wars and to explore the most humane solutions for responding to the psychological pain of soldiers and veterans.Let us hope that they have some success in altering attitudes and reformulating national policies.

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