The second battle

It was only 5:30 a.m. in Iraq, but already Sergeant Jared Shumate lay on the ground, clutching his gear in fear. As he huddled in the darkness, he could hear hissing sounds followed by louder booms. Each explosion sounded closer. Once, he felt the ground shake. Would a rocket come through his window? he wondered. Where would the next mortar hit?

Mr. Shumate didn't die that morning in 2004, but his voice grows softer and he glances down when he remembers how close those rockets were-two Iraqi men were killed in the house just across the street from him.

Today, Mr. Shumate is a recently returned soldier who must fight a different battle: one against his mind. Troops arriving home may experience flashbacks, isolation from others, depression, and anger. In response, many organizations are offering programs to help soldiers readjust to civilian life. Often, readjustment means soldiers must learn to cope with the symptoms of post-traumatic stress disorder (PTSD).

In 2004, The New England Journal of Medicine reported that one in six soldiers returning from Iraq showed signs of PTSD, major depression, or severe anxiety. Nearly 50 soldiers have committed suicide or murder after arriving home from Iraq.

"Conflict equals stress," explained Jaime Cavazos, public affairs supervisor for the U.S. Army Medical Command. Colonel Elspeth Cameron Ritchie, psychiatry consultant to the Army surgeon general, told WORLD that the Iraq war presents "unique" stressors, such as "not knowing who is friend and who is enemy, insurgency, constantly feeling vulnerable, suicide bombs, and exposure to casualties."

Although Mr. Cavazos said soldiers are "conditioned mentally" to expect such trauma and are required to participate in a one- to two-week post-deployment health assessment, many don't experience symptoms of a mental disorder until weeks and even years later. That's why, beginning this year, soldiers also attend a post-deployment health reassessment 90-120 days after returning from combat.

For Mr. Shumate, life after combat involved "spouts" of depression. "You return from an environment of such threat and critical demand and suddenly you have no purpose," he said. "Coming back is not what you expected, not what you think it will be. You relax and memories of everything come back." Mr. Shumate tried to return to "normal" life by re-enrolling at Pensacola Christian College, but he often found it hard to concentrate while in class: "I was used to the earth shaking from exploding mortar shells. My thoughts kept wandering and it was hard to focus."

Twenty-nine-year-old Marcus King, who was also a sergeant in Iraq, can relate. After returning to the United States in 2003, Mr. King suffered from recurring flashbacks and nightmares. He would relive the first time his Humvee hit a roadside bomb: "It was just chaos. . . . You check yourself to make sure you're still breathing, but when you're that close [to an explosion] you can't really hear anything." Mr. King also experienced bouts of uncontrollable anger. Once, he even felt an unexplainable urge to hit his 2-year-old son with a baseball bat. This incident prompted him to seek help from his chaplain, and an army doctor later diagnosed him with PTSD.

But many returning soldiers don't look for help because they're embarrassed or afraid of being stigmatized. In 2004, the New England Journal of Medicine found that only 23 percent to 40 percent of soldiers with symptoms of a mental disorder had sought health care. The army responded by launching programs to raise awareness of mental health issues, but Mr. Cavazos recognizes that ultimately, "soldiers must open up and talk about issues." Some private organizations are trying to provide a less-threatening environment for soldiers who would otherwise hesitate to seek help.

Colonel Ritchie believes private organizations also serve a vital role in ministering to soldiers who don't live on or near military bases. Hearts Toward Home, founded by Bridget Cantrell, reaches soldiers through a variety of channels. A PTSD specialist with the Washington Department of Veteran's Affairs, Dr. Cantrell not only travels across the country giving seminars to troops, but she also educates family members on adjustment problems, provides individual, group, and couple therapy, and works with children of returning veterans. Recently, she's co-authored a book titled Down Range to Iraq and Back.

"You have to support the soldier going over and coming home," said Dr. Cantrell. "Vietnam veterans had no one to turn to, so they resorted to substance abuse-either alcohol or over-the-counter drugs." Many Vietnam veterans found that even self-medication didn't help. While government records show 58,000 American soldiers were killed in Vietnam, they showed that during the first five years after discharge, deaths from suicide were 1.7 times more likely among Vietnam veterans than non-Vietnam veterans.

Vietnam veteran Phil Kinsey told WORLD, "We're trying to prevent that from happening with those soldiers returning from Iraq." Mr. Kinsey volunteers as the Ohio state coordinator for Pointman International Ministries (PMIM), a nonprofit, nondenominational Christian organization that helps returning soldiers. Mr. Kinsey also oversees one of PMIM's 239 U.S. "Outposts"-places where veterans can communicate with other soldiers who have had similar experiences.

While working at a Landing Zone Refuge (which offers food, clothing, and fellowship for veterans), Mr. Kinsey explained that Outpost volunteers attend military homecoming ceremonies where they pass out business cards and talk with soldiers and their family members. When soldiers call the Outpost, Mr. Kinsey lets them know that he's always willing to talk-even in the middle of the night: "If they can't sleep, they can call me. I've talked a lot of guys out of suicide."

He said the most commonly discussed issue is "things they had to do that they didn't want to do, like killing people."

Mr. King agrees that talking about the war, even with loved ones, can be difficult. "I don't feel a lot of times that people feel what I've been through," he said. After Mr. King's diagnosis, his psychiatrist prescribed several anti-depressants. But the medicine caused a new set of problems: hallucinations, loss of emotion, and lethargy. These side effects escalated until Mr. King's wife left him and threatened divorce. That's when Mr. King discovered the PMIM website and began e-mailing and chatting online with other veterans. Eventually, he and his wife reunited.

The Kings aren't the only family to struggle through a soldier's homecoming. Last June, USA Today reported that the number of active-duty soldiers getting divorced had risen 28 percent since 2003, the year of the Iraq invasion. "Sometimes veterans aren't ready to love their families," Mr. Kinsey explained. "The vet has to decompress." Individual units and bases, especially larger ones like Fort Bragg and Fort Drum, have responded to this need by offering support programs for returning soldiers and their families. Hearts Toward Home and PMIM have similar programs.

Churches can also help returning soldiers and their families. Mr. Kinsey recommended that churches located in a strong military community have a "qualified veteran in the congregation begin a ministry to returning soldiers." Dr. Cantrell has designed a reintegration workbook, and several churches have organized retreats that use it to help troops and their families. Since isolation is a symptom of PTSD, Dr. Cantrell hopes more churches will reach out to hurting soldiers.

"A lot of problems are spiritual," Mr. Kinsey said. Often, veterans have tried unsuccessfully to overcome PTSD and they're ready to try something new: "I don't hit them on the head with Scripture, but the Bible is a book of medicine. I tell them, 'PTSD may never heal, but God can help you live with it.'"

Although Dr. Cantrell described her approach to counseling as secular, she said that faith is an important component in a soldier's recovery: "If we stay on our level as humans, we can't make sense of things. There are no answers or reasoning to explain war, so we have to rise above that and find some spiritual significance."

Mr. Shumate agrees: "I'm more mindful of the grace God has given me, and the struggle of others around the world." He believes God helps him now, just as He did in Iraq: "Everyone else [in Iraq] had an ever-present fear of the unknown. I could trust in the Lord, knowing that I was no safer at PCC [Pensacola Christian College] than I was in Iraq because I was still in the hand of God."