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Nate Self's military record was impeccable. A West Point graduate, he led an elite Army Ranger outfit and established himself as a war hero in March 2002 for his leadership during a 15-hour ambush firefight in Afghanistan. The battle resulted in a Silver Star, a Purple Heart, and a position as President Bush's guest of honor for the 2003 State of the Union. But by late 2004, Self had walked away from the Army. In another surprise attack, post-traumatic stress disorder (PTSD) had taken his life captive.

"I just hated myself," says Self. "I felt like I was somebody different. And since I didn't feel like I could be who I was before, and hated who I was now, I just wanted to kill the new person. I felt like I had messed up everything in my life. The easiest way, the most cowardly way to escape, was to just depart."

When Andrea Westfall returned from her 10-month deployment in Kuwait with the Oregon Army National Guard in 2003, she too found herself fighting an invisible battle with PTSD. Unable to cope with the enemy, she isolated herself and drank every night to numb the pain and aid sleep.

Self and Westfall are among the untold number of soldiers who leave the battlefield only to fight another war in their mind and spirit. Studies show that nearly one in five returnees from Iraq and Afghanistan suffer from PTSD, an anxiety disorder introduced into the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980. Reported wartime PTSD cases jumped roughly 50 percent in 2007; Army statistics showed there were nearly 14,000 newly diagnosed cases in 2007, compared with more than 9,500 new cases the previous year and 1,632 in 2003. About 40,000 troops have been diagnosed with PTSD since 2003. Officials believe the actual number may be much higher—possibly as high as 30 percent of all U.S. vets—and think many are in denial or keep their illness hidden for fear that it could harm or end their military careers and preclude future benefits.

Those who suffer from PTSD continue to react, sometimes more intensely than ever, to a traumatic or life-threatening event even after the danger is past. The main symptoms include troubling memories and nightmares, hyper-vigilance, depression and anxiety, emotional detachment, and avoidance of crowds or anything associated with the event. The symptoms often lead to substance abuse, chronic unemployment, and homelessness. Two out of three marriages in which one spouse has PTSD fail. The suicide rate among those with PTSD is almost twice the national average. Suicides were up in all the armed services in 2008, with 125 confirmed suicides in the Army alone—the most the Army has seen since it started keeping records.

Since PTSD wasn't officially recognized until 1980, many of today's veterans carry scars from not being properly cared for upon coming home from previous wars.

In 1970, after 14 months in Vietnam, James Knudsen returned as a decorated combat veteran. A Christian and regular churchgoer, he has suffered from PTSD ever since, resulting in long-term unemployment, severe depression, and a failed marriage.

John Blehm also returned from war in 1970, but wasn't diagnosed with PTSD until 27 years later. "Before then, people just thought I was a crazy alcoholic," he says. Today, Blehm and his wife, Karen, teach classes at Skyway Church in Goodyear, Arizona, for those with PTSD and their family members. The nondenominational church offers professional counseling at an affordable price on its campus, at the Window to Healing Center.

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July 2009, Vol. 53, No. 7