Treating Wounds You Can't See

Sadly, he was leaving with guilt-driven thoughts. He was in chronic pain, partially disabled, but the thought of separation from the National Guard left him deeply dejected.

He joined when he was 18. The Army had given him years of memories, an identity, a sense of belonging and purpose, a way of life. "My military career is over," he said sorrowfully.

He was medically discharged with a 60 percent disability rating. He came up to say good-bye with his papers in hand. "I'm on my way," he said.

'You Have PTSD, Full-Blown PTSD'

The lieutenant refused to fill out the paperwork and wouldn't sit in the waiting room in case someone in his unit saw him. Recently returned from the war zone, he was visibly shaky. He was in his 30s and had worked in the mental-health field as a civilian. When he went home, he had felt only numbness, a chilling emptiness, when he saw his wife and young children. He'd touched his wife's arm and been flooded with memories from the past year in Iraq: a neck wound, blood, severed body parts. He couldn't have sex with her.

In my office, he seemed bewildered, almost shocked. "Why is this happening?" he asked.

"You have PTSD, full-blown PTSD," I told him. And I wondered how he could have missed his own diagnosis. He had given combat-stress briefings and counseled hurting soldiers.

We went back over his Iraq deployment, which had involved bloody rescue missions and constant mortar fire at his unit's base. He'd been protective of his troops. "I didn't like sending people out on missions," he said, "so I went out myself." As the months rolled on, he felt increasingly remote from his family, who seemed to be going on with life without him. And the vortex of war trauma ultimately engulfed him so fully that he lost the capacity to observe himself.

The unwarranted sense of shame, of depleted self-esteem he conveyed, troubled me. "If you went out on missions instead of sending other people out, you're a hero," I said the second and last time I saw him. He finally smiled.

* * *An older soldier came in, looking pale, a couple of days after getting off the plane. The hardest part of his deployment? "Just riding in a tank," he said. "The confinement. I was afraid we'd get hit from above."

I hadn't heard that before. "Did it remind you of anything?"

He reflected for a moment. "Khe Sanh," he said. "We were in underground bunkers. I thought they'd blow out the entrance, and we were all going to die." He had been 19 when he went to Vietnam; 38 years later, he was in Iraq as an officer in the National Guard, his hair gray, his face seamed and rough. "My wife said, 'It took you 20 years to get over the last war,' " he told me. " 'How long will it take this time?' "

In the 1980s, years after Vietnam, he and his wife had attended a talk on PTSD at their local Veterans of Foreign Wars post. "They were talking about me, that was what I had," he told me. "But before then, we just didn't know."