The U.S. Department of Veterans Affairs estimates that 10 to 18% 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 PTSD pose tremendous challenges for veterans and their families. And an enduring stigma around mental health care still discourages many veterans from seeking help.
Dexter Pitts deployed to Iraq at age 19, in 2004. Less than a year later, he was seriously injured by a bomb while driving a Humvee in Baghdad. He sustained some serious physical injuries, and was later diagnosed with PTSD.
"Soon after I got back," he tells NPR's Neal Conan, Pitts realized the damage he sustained was more than physical. When he was recovering at Walter Reed, he was laying in his room, and his cousin kept running in and bothering him.
When his cousin hit his injured arm, "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."
That's when he realized he needed help. He'd noticed other symptoms, but it's tough to admit may have PTSD. "I didn't really want to accept it," says Pitts. The military builds you up to be "larger than life, almost like a superhero. You feel like you're Superman." And if you're anything other than that, "you're weak-minded."
But Pitts was afraid to drive, afraid to talk to people he'd known his whole life. Over the years, 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.
He's now a police officer with the Louisville Metropolitan Police Department, and says he loves his job. He has two therapists who have helped him figure out how to control his actions.
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 most friendliest cops anybody's ever met."
Erin Finley interviewed more than 60 veterans for her book, Fields Of Combat. She says she's familiar with stories like Pitts'. "The folks ... who are most successful," she says, are the ones 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," having a mission helps veterans with PTSD succeed.
Pitts' story about his nephew resonates for Finley as well. "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," she says. Moments like that can "really become a catalyst for positive change."
Part of the solution for soldiers, however, might be trying to prevent PTSD in the first place.
Clinical psychologist Craig Bryan is trying to help find better ways to integrate the clinical world of mental health with the warrior culture of the military. He 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.
Stress inoculation training, he says, shows real promise. It's kind of analogous to a traditional vaccination.
"You introduce the service member to increasingly stressful situations that mirror the traumatic event as much as possible, and over time they learn to habituate," and become more immune to the effects of the situation.
Bryan doesn't think they'll ever be able to completely inoculate soldiers to the stress of war, but he believes it could make a real difference.