According to the Department of Veterans Affairs, 10 to 18 percent of Iraq and Afghanistan war veterans may have post-traumatic stress disorder, or PTSD.
The sleeplessness, anger, anxiety and sense of isolation that can accompany the disorder pose tremendous challenges for veterans and their families, and there's an enduring stigma around mental health care that still discourages many from seeking help.
Dexter Pitts deployed to Iraq in 2004, when he was 19. Less than a year later, he was seriously injured by a bomb while driving a Humvee in Baghdad. He tells NPR's Neal Conan that he sustained serious physical injuries.
Soon after he got back, Pitts says, he realized he had sustained more than just physical damage. He remembers lying in his room at the Walter Reed Army Medical Center and his cousin constantly running in and bothering him.
When his cousin hit his injured arm, Pitts says, "I just lost it. I blacked out. I chased him down the hallway, grabbed him by his shirt, picked him up and punched him in his chest as hard as I could."
Though Pitts had noticed other PTSD symptoms, he says that's when he realized he needed help. He was eventually diagnosed with PTSD.
"I didn't really want to accept it," he says.
Pitts says the military had built him up to believe he was "larger than life, almost like a superhero." And if you're anything less than a superhero, "you're weak-minded."
But it was clear Pitts had a problem: He was afraid to drive and afraid to talk to people he'd known his whole life. Over the years, he says, he's been able to piece himself back together, but he doesn't think he'll ever be the person he was before he deployed.
Pitts is now a police officer in Louisville, Ky., and he has two therapists who have helped him with his PTSD. He says he loves his job — and, unlike many who serve in law enforcement, Pitts says he doesn't worry about getting killed on the job.
"I worry more so about my name and my reputation," he says. "When I'm done with the police department here, I want to be known as one of the friendliest cops anybody's ever met."
The Stories Of PTSD
In the book Fields of Combat, author Erin Finley documents the experiences of Iraq war veterans living with PTSD. She interviewed more than 60 veterans for the book and tells Conan that she's familiar with stories like Pitts'.
She says the most successful veterans she's encountered have been those who focus on serving others in their post-military careers.
"Whether that's serving their community as a police officer or serving their family by having a career and supporting them," she says, having a mission helps veterans with PTSD succeed.
Pitts' story about his cousin also resonates for Finley.
"Many of the veterans I know who ended up in care and had a very positive experience with treatment were those who sought care because they saw the impact PTSD was having on others around them," Finley says.
Moments like that, she says, can "really become a catalyst for positive change."
A Vaccine For PTSD?
Part of the solution for soldiers, however, might be trying to prevent PTSD in the first place.
Clinical psychologist Craig Bryan is trying to find better ways to integrate the clinical world of mental health with the warrior culture of the military. He has served as the director of the Traumatic Brain Injury Clinic at the Air Force Theater Hospital in Iraq, and now researches suicide prevention and psychological resiliency.
Bryan tells Conan that stress inoculation training, which is kind of analogous to a traditional vaccination, shows real promise.
"You introduce the service member to increasingly stressful situations that mirror the traumatic event as much as possible," Bryan says, "and over time they learn to habituate." The hope is that they become more immune to the effects of the situation.
Still, Bryan says he doesn't think they'll ever be able to completely inoculate soldiers against the stress of war.