When they can't see the enemy

"We don't know who we're fighting over there, who's friendly and who isn't," he said. "They're always watching us. We're basically fighting blind."

This is what they bring back home. They fight an enemy they can't see just as they did in combat. PTSD is the enemy hidden in the shadows of their minds. It is as dangerous as a bomb waiting to explode but this one waits to claim every part of their lives, is more cunning than any human and more patient. The bombs they encounter in Afghanistan and Iraq are hidden by the enemy refusing to face the US forces. They explode hitting anyone nearby yet for the troops escaping the physical damage they have all the images frozen in their minds. While we count the dead and the wounded, there is no real way to count the true magnitude of the walking away wounded.

We talk about the rates of PTSD placed between one out of five or one out of three. Most experts use the 30% range but this figure is used for one traumatic event, not multiple incidences.

Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to a traumatic event or series thereof and is characterized by long-lasting problems with many aspects of emotional and social functioning.

Statistics regarding this illness indicate that approximately 7%-8% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans and rape victims ranging from 10% to as high as 30%. Somewhat higher rates of this disorder have been found to occur in African Americans, Hispanics, and Native Americans compared to Caucasians in the United States. Some of that difference is thought to be due to higher rates of dissociation soon before and after the traumatic event (peritraumatic), a tendency for individuals from minority ethnic groups to blame themselves, have less social support, and an increased perception of racism for those ethnic groups, as well as differences between how ethnic groups may express distress. In military populations, many of the differences have been found to be the result of increased exposure to combat at younger ages for minority groups. Other important facts about PTSD include the estimate of 5 million people who suffer from PTSD at any one time in the United States and the fact that women are twice as likely as men to develop PTSD.

Almost half of individuals who use outpatient mental-health services have been found to suffer from PTSD.

As evidenced by the occurrence of stress in many individuals in the United States in the days following the 2001 terrorist attacks, not being physically present at a traumatic event does not guarantee that one cannot suffer from traumatic stress that can lead to the development of PTSD.

PTSD statistics in children and teens reveal that up to more than 40% have endured at least one traumatic event, resulting in the development of PTSD in up to 15% of girls and 6% of boys. On average, 3%-6% of high school students in the United States and as many as 30%-60% of children who have survived specific disasters have PTSD. Up to 100% of children who have seen a parent killed or endured sexual assault or abuse tend to develop PTSD, and more than one-third of youths who are exposed to community violence (for example, a shooting, stabbing, or other assault) will suffer from the disorder.

Although not all individuals who have been traumatized develop PTSD, there can be significant physical consequences of being traumatized. For example, research indicates that people who have been exposed to an extreme stressor sometimes have a smaller hippocampus (a region of the brain that plays a role in memory) than people who have not been exposed to trauma. This is significant in understanding the effects of trauma in general and the impact of PTSD, specifically since the hippocampus is the part of the brain that is thought to have an important role in developing new memories about life events. Also, whether or not a traumatized person goes on to develop PTSD, they seem to be at risk for higher use of cigarettes, alcohol, and marijuana. Conversely, people whose PTSD is treated also tend to have better success at overcoming a substance-abuse problem.

Economically, PTSD can have significant consequences as well. As of 2005, more than 200,000 veterans were receiving disability compensation for this illness, for a cost of $4.3 billion. This represents an 80% increase in the number of military people receiving disability benefits for PTSD and an increase of 149% in the amount of disability benefits paid compared to those numbers five years earlier.

read more hereComplex posttraumatic stress disorder

During a year of deployment one may encounter ten, twenty, thirty or more times when they have witnessed catastrophic events. They bury the pain with practice but they do not defeat it.

This is from the above article.

PTSD At A Glance
Posttraumatic stress disorder (PTSD) is an emotional illness that was first formally diagnosed in soldiers and war veterans and is usually caused by terribly frightening, life-threatening, or otherwise highly unsafe experiences but can also be caused by devastating life events like unemployment or divorce.
PTSD symptom types include re-experiencing the trauma, avoidance, and hyperarousal.
PTSD has a lifetime prevalence of 7%-30%, with about 5 million people suffering from the illness in any one year. Girls, women, and ethnic minorities develop PTSD more than boys, men, and Caucasians.
Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to traumatic event(s) and is characterized by long-lasting problems that affect many aspects of emotional and social functioning.
Symptoms of C-PTSD include problems regulating feelings, dissociation, or depersonalization; persistent depressive feelings, seeing the perpetrator of trauma as all-powerful, preoccupation with the perpetrator, and a severe change in what gives the sufferer meaning.

There are many levels of Post Traumatic Stress Disorder.

38 C.F.R. § 4.130, DC 9411
GENERAL RATING FORMULA FOR MENTAL DISORDERS:

Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation occupation, or own name 100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships 70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining Effective work and social relationships 50%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) 30%
go to Vietnam Veterans of America for more

While some experts disagree on the numbers, what they all agree on is the sooner survivors of trauma seek help, the more of their lives they can reclaim. What we are seeing today is only the start of too many more survivors needing to put their lives back together again. While most say they want to go back to the way they were before, this is not possible any more than it is possible for any of us to go back to our younger days. Life changes all of us. For the survivors of trauma with the right kind of help they can be better than they were before!

Now that you have a better understanding of how complicated all of this is, read the report of Marines in the battle for Sangin Afghanistan. It may help you understand what is coming in the next few years and how many will need help to heal.

Lance Cpl. Juan Dominguez, 26, left, practices using a biometric prosthetic arm with Todd Love, also from Camp Pendleton, at Walter Reed Army Medical Center in Washington, D.C.

(Carolyn Cole / Los Angeles Times)

Marines pay a price trying to secure an Afghan hot spot
What happened to them in Sangin district of Helmand province shows the sacrifices in a campaign aimed at crippling the Taliban in a stronghold and helping extricate the U.S. from a decadelong war.

By Tony Perry, Los Angeles Times
January 22, 2011, 8:33 p.m.

Reporting from Camp Pendleton — Marines tell of snipers who fire from "murder holes" cut into mud-walled compounds. Fighters who lie in wait in trenches dug around rough farmhouses clustered together for protection. Farmers who seem to tip the Taliban to the outsiders' every movement , often with signals that sound like birdcalls.

When the Marines of the 3rd Battalion, 5th Marine Regiment, deployed to the Sangin district of Afghanistan's Helmand province in late September, the British soldiers who had preceded them warned the Americans that the Taliban would be waiting nearly everywhere for a chance to kill them.

But the Marines, ordered to be more aggressive than the British had been, quickly learned that the Taliban wasn't simply waiting.

In Sangin, the Taliban was coming after them.

In four years there, the British had lost more than 100 soldiers, about a third of all their nation's losses in the war.

In four months, 24 Marines with the Camp Pendleton-based Three-Five have been killed.

More than 140 others have been wounded, some of them catastrophically, losing limbs and the futures they had imagined for themselves.

The Marines' families have been left devastated, or dreading the knock on the door.

"We are a brokenhearted but proud family," Marine Lt. Gen. John Kelly said. He spoke not only of the battalion: His son 1st Lt. Robert Kelly was killed leading a patrol in Sangin.

When Lance Cpl. Juan Dominguez slipped down a small embankment while out on patrol and landed on a buried bomb, the explosion could be heard for miles.

"It had to be a 30- to 40-pounder," Dominguez said from his bed at the military hospital in Bethesda, Md. "I remember crying out for my mother and then crying out for morphine. I remember them putting my legs on top of me."

His legs were severed above the knee, and his right arm was mangled and could not be saved. A Navy corpsman, risking sniper fire, rushed to Dominguez and stopped the bleeding. On the trip to the field hospital, Dominguez prayed.

"I figured this was God's will, so I told him: 'If you're going to take me, take me now,'" he said.

His memories of Sangin are vivid. "The part we were in, it's hell," he said. "It makes your stomach turn. The poor families there, they get conned into helping the Taliban."

Like many wounded Marines, Dominguez never saw a Taliban fighter.

"We don't know who we're fighting over there, who's friendly and who isn't," he said. "They're always watching us. We're basically fighting blind."

read more here
Marines pay a price trying to secure an Afghan hot spot

There is also the issue of when they can see the enemy right in front of them. A Marine killed an Afghan Police Officer he was working with after he pulled a gun on the Marine.

US marine kills Afghan policeman after dispute
KABUL | Sat Jan 15, 2011 4:54am EST
(Reuters) - A U.S. marine shot and killed an Afghan police officer Saturday after a dispute between the pair during a security operation in southern Afghanistan, the NATO-led International Security Assistance Force (ISAF) said.

ISAF was investigating the incident in Helmand province. It said initial reports found that after a dispute, the police officer made threatening statements and handled his weapon carelessly and the marine told his commanding officers.

"After departing his post, the uniformed police member returned with his weapon raised and pointed toward the marine," ISAF said in a statement.

"The marine responded with escalation of force procedures, including shouting at the individual to put the weapon down."

When the police officer failed to put down his weapon, the marine fired two shots and killed him, ISAF said. More information would be made available, it said, when the investigation into the incident at a patrol base in Sangin district was complete.
read more of this here
US marine kills Afghan policeman after dispute

There is a history behind this and many times someone they were training ended up turning on them and killing US Forces. This leaves them not knowing who to trust wondering who will be the next to turn against them.