The other battle: coming home

"In war, you are crossing a line you never expected to cross," says Lt. Col. Spencer Campbell, an expert on combat stress at Fort Bragg, N.C., who was wounded as a marine in Vietnam. "So you question, If my wife knew what I was capable of, would she show affection for me? And having done what I have done, how do I nurture my children?"

In essence, troops must grapple with the way their role in missions of death has changed their very identities.

"Grunts are required to kill," Colonel Campbell says. "But in walking with death, there [still] has to be meaning in life."

Lt. Col. Gary Mauck, an Army chaplain, looks out a window at the moss-draped trees of this Georgia garrison and describes "as if it were yesterday" his March 17, 1969 return from the jungles of Vietnam.

"I got on the jet and in 24 hours I was at Fort Dix, and in another 24 hours I was on the plane home. There was no debriefing and no decompression," he says with a note of bitterness. Once back in rural Danville, Ill., the 25-year-old Mauck was at loose ends. "Home wasn't home anymore, because no one understood."

It wasn't until decades later, during a 1991 parade for Desert Storm veterans, that Mauck discovered what he had missed. "I marched as a National Guardsman, and up front they had a bunch of Vietnam vets. I realized that's what I should have had, a parade. I didn't. Nobody cared."

Vietnam veterans like Colonels Mauck and Campbell are powerful advocates for ensuring a better homecoming for US troops in Iraq. Above all, they want to prevent the sense of isolation and alienation that they believe contributed to the high rate (50 percent) of full or partial PTSD reported by veterans from Vietnam.

"The worst thing that can happen is people come back and feel like the Lone Ranger," says Mauck.

Since the 1970s, the understanding and treatment of postwar trauma have improved dramatically. Meanwhile, the creation in 1973 of an all-volunteer military has led to more professional, better-trained and educated, and cohesive units. All these factors point to "greater resilience, even in the face of grotesque trauma," says Dr. Litz.

After the brief 1991 Gulf War, surveys of veterans showed an increase in trauma, depression, and substance abuse compared with those who did not deploy - but the overall rates were far lower than those among Vietnam veterans. Estimates of PTSD among Gulf War veterans range from 1 to 8 percent.

Today, a new mandatory, Army-wide program aims to identify at-risk soldiers early and intervene quickly to lessen war-zone stress. It involves social workers, mental-health experts, doctors, and chaplains reaching out to troops and their families at each stage of deployment. The policy is driven by a stark reality: With today's rapid-fire deployments, easing stress on soldiers and families is crucial to retention.

While still in the theater, commanders use a new "Tip Card" to identify soldiers at risk. The card poses 14 wide-ranging questions on soldiers' alcohol use, unruly behavior, or conflicts with the chain of command during deployment, suicidal thoughts, anger, domestic violence or troubled relationships, financial difficulties, and combat experiences. Any checked item requires counseling by leaders, the chaplain, or health professionals.

During a "cooling off" period overseas, soldiers turn in equipment and may enjoy some R and R. In Kuwait, for example, troops from 1-39 Field Artillery rotated through a morale, welfare and recreation center known as the "marble palace" - complete with a pool, tennis courts, and miniature golf.

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