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These Unseen Wounds Cut DeepIn soldiers like LaBranche — their bodies whole but their psyches deeply wounded — a crisis is unfolding, mental health experts say. One out of six soldiers returning from Iraq is suffering the effects of post-traumatic stress — and as more come home, that number is widely expected to grow.

The Pentagon, which did not anticipate the extent of the problem, is scrambling to find resources to address it.

A study by the Walter Reed Army Institute of Research found that 15.6% of Marines and 17.1% of soldiers surveyed after they returned from Iraq suffered major depression, generalized anxiety or post-traumatic stress disorder — a debilitating, sometimes lifelong change in the brain's chemistry that can include flashbacks, sleep disorders, panic attacks, violent outbursts, acute anxiety and emotional numbness.

Army and Veterans Administration mental health experts say there is reason to believe the war's ultimate psychological fallout will worsen. The Army survey of 6,200 soldiers and Marines included only troops willing to report their problems. The study did not look at reservists, who tend to suffer a higher rate of psychological injury than career Marines and soldiers. And the soldiers in the study served in the early months of the war, when tours were shorter and before the Iraqi insurgency took shape.

"The bad news is that the study underestimated the prevalence of what we are going to see down the road," said Dr. Matthew J. Friedman, a professor of psychiatry and pharmacology at Dartmouth Medical School who is executive director of the VA's National Center for Post Traumatic Stress Disorder.

Since the study was completed, Friedman said: "The complexion of the war has changed into a grueling counterinsurgency. And that may be very important in terms of the potential toxicity of this combat experience."

Mental health professionals say they fear the system is not moving fast enough to treat the trauma. They say slowness to recognize what was happening to Vietnam veterans contributed to the psychological devastation from that war.

More than 30% of Vietnam veterans eventually suffered from the condition that more than a decade later was given the name post-traumatic stress disorder. But since their distress was not clinically understood until long after the war ended, most went for years without meaningful treatment...........

Combat stress disorders — named and renamed but strikingly alike — have ruined lives following every war in history. Homer's Achilles may have suffered from some form of it. Combat stress was documented in the late 19th century after the Franco-Prussian War. After the Civil War, doctors called the condition "nostalgia," or "soldiers heart." In World War I, soldiers were said to suffer shell shock; in World War II and Korea, combat fatigue or battle fatigue.

But it wasn't until 1985 that the American Psychiatric Assn. finally gave a name to the condition that had sent tens of thousands of Vietnam veterans into lives of homelessness, crime or despair.

A war like the one in Iraq — in which a child is as likely to die as a soldier and unseen enemies detonate bombs — presents ideal conditions for its rise.............

Last year, 1,100 troops who had fought in Iraq or Afghanistan came to VA clinics seeking help for symptoms of depression or post-traumatic stress; this year, the number grew tenfold. In all, 23% of Iraq veterans treated at VA facilities have been diagnosed with post-traumatic stress disorder.

"And this is first-year data," Batres said. "Our experience is that over time that will increase.".......

At more than 200 storefront clinics known as Vet Centers — created in 1979 to reach out to Vietnam veterans — the VA has increased the number of group therapy sessions and staff. Three months ago, the VA hired 50 Iraq war veterans to help serve as advocates at the clinics.

Officials acknowledge that is only a start. The Government Accountability Office found in a study released in September that the VA lacked the information it needed to determine whether it could meet an increased demand for services.

"Predicting which veterans will seek VA care and at which facilities is inherently uncertain," the report concluded, "particularly given that the symptoms of PTSD may not appear for years."

The Army and the VA are also trying to catalog and research the mental health effects of this war better than they have in the past. In addition to the Walter Reed study, several more are tracking soldiers from before their deployment to Iraq through their combat experiences and into the future.

If Iraq veterans can be helped sooner, they may fare better than those who fought in Vietnam, mental health experts say. And they note that the nation, although divided on the Iraq war, is more united in caring for the needs of returning soldiers than it was in the Vietnam era. And in the last decade, new techniques have proved effective in treating stress disorders, among them cognitive-behavioral therapy and drugs like Zoloft and Paxil.

Whether people like Matt LaBranche seek and receive treatment will determine how deep an effect the stress of the war in Iraq ultimately has on U.S. society.

Before the war, LaBranche was living in Saco, Maine, with his wife and children and had no history of mental illness.

He deployed to Iraq with a National Guard transportation company based in Bangor. He came home a different person.

Just three days after he was discharged from Walter Reed, he was arrested for threatening his former wife. When he goes to court Dec. 9, he could be looking at jail time.

He lies on a couch at his brother's house most days now, struggling with the image of the Iraqi woman who died in his arms after he shot her, and the children he says caught some of his bullets. His speech is pocked with obscenities.

On a recent outing with friends, he became so enraged when he saw a Muslim family that he had to take medication to calm down.

He is seeing a therapist, but only once every two weeks.

"I'm taking enough drugs to sedate an elephant, and I still wake up dreaming about it," LaBranche said. "I wish I had just freaking died over there."

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