Our VOINCAs the wars in Iraq and Afghanistan grind on, another threat is growing here at home. And though it’s invisible, it has the same potential to spawn abuse, maiming and death.

This threat targets the families and loved ones of untreated or poorly treated soldiers suffering from posttraumatic stress disorder and other emotional conditions triggered or exacerbated by war.

North Carolina touts itself as the “most military-friendly state,” and the numbers—limited and hard to find though they are—seem to support that slogan.

According to the Institute for Southern Studies, the Tar Heel State has sent more soldiers to Iraq and Afghanistan than any other. In addition, North Carolina is listed as one of the top eight states in the nation for recruitment. The institute also reports that as of 2005, more than 12 percent of the nation’s war fatalities—nearly one in eight U.S. soldiers killed overseas—were from North Carolina.

North Carolina at War, a March 2007 study by the institute, found more than 2,200 members of the Army’s 82nd Airborne Division (based at Fort Bragg, N.C.) deployed in Iraq and Afghanistan. The report tallied more than 40 of those soldiers killed and 450 injured in the two wars. North Carolina has also sent one of the largest detachments of National Guard troops to Iraq. Deployment peaked at 6,000 in January 2005—the state’s biggest mobilization since World War II, according to the study.

The state’s close ties to the military reflect a pattern seen throughout the southern United States, according to the institute. Its study found that 42 percent of U.S. troops were born in one of 13 Southern states, and 56 percent were housed at military bases in the region.

So when I read the recent Reuters report that after five years of war in Afghanistan and Iraq, nearly 40,000 soldiers have posttraumatic stress disorder as defined by the U.S. military, I shuddered at the implications.

According to the Pentagon, the number of PTSD sufferers in the armed forces has shot up from 9,549 in 2006 to 13,981 in 2007—a 46.4 percent increase. No surprise there: War is hell, and living with trauma is like living in hell; traumatized people are constantly at war.

This has significant implications for veterans and local mental-health professionals in Asheville and Western North Carolina.

PTSD is a mental-health condition that can result from wartime trauma, such as being physically wounded or seeing others hurt or killed.

Symptoms can include irritability, outbursts of anger, difficulty sleeping, trouble concentrating, nightmares, hypervigilance and an exaggerated startle response. People with PTSD may also constantly relive the traumatic events, with images (commonly known as flashbacks) playing over and over in their heads.

In recent years, the Pentagon has been pressured to enhance PTSD treatment amid criticism its programs were inadequate, and it is now scrambling to recruit more therapists. There have also been reports of Pentagon “diagnosis tampering” and deliberate misdiagnosis to keep the PTSD numbers down. For now, however, let’s go with the numbers we have: They’re bad enough.

So what accounts for the dramatic rise in PTSD?

The U.S. Army says the numbers reflect the military’s enhanced awareness of the disorder. The Army’s surgeon general notes the increase in troops seeing combat. Other experts cite extended tours of duty that expose troops to additional trauma.

And as recruiting has become more difficult, standards have been lowered. Recruits with histories of trauma have been sent to war, even though they are more susceptible.

PTSD could be called a normal reaction to repeated, extreme stress. There are two main types of traumatic stress: event-driven (hurricane, car accident, sexual assault) and chronic or complex (child and adult physical, sexual or emotional abuse, war, neglect). And if a soldier has experienced trauma before enlisting, it becomes extremely likely that wartime experiences will trigger that trauma or make it worse.

Repeated extreme stress can significantly compromise daily living: Many people suffering from complex trauma become substance abusers, and men in particular also tend to abuse others.

In Western culture, women are often socialized to internalize their trauma, whereas men are taught to externalize it. To simplify a complex situation, this often shows up in treatment as follows: Traumatized women tend to internalize their pain, hurt themselves and develop somatic illnesses, while men tend to externalize their pain, “armor themselves” and hurt others. This despite the growing number of suicides among returning Iraq War veterans.

Further complicating the picture is many men’s rejection of both medicine and talk therapy, which they see as signs of weakness. Real men, they believe, live by a set of bumper-sticker rules: Tough it out, brush it off, get over it. I hear this again and again from both men and their worried/frightened partners.

They could not be more wrong. In fact, it takes tremendous courage to face the fears trauma creates. The courage to be a man is the courage to seek help for problems that won’t go away on their own.

Not everyone exposed to trauma develops PTSD; most don’t, in fact. But for those who do, the cost to them and those around them can be exceedingly high.

And as more veterans return to WNC, here are the outcomes we can expect to see: increased child abuse and domestic violence, substance abuse and homelessness. The invisible threat will become an all-too-visible war at home—with tragic consequences.

We may leave the war, but the war doesn’t leave us.

[Stephen Snow is a licensed professional counselor in Asheville who specializes in treating child and adult chronic trauma and also domestic violence. He can be reached at .(JavaScript must be enabled to view this email address).]

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