He's "learning to live with it," but former Army Sgt. Carl Oliver says troubling memories of the day he lost two comrades and was seriously wounded in Baghdad "stick with you."
More than seven years later, the Trenton man battles an enemy that has gone by many names - from melancholia and shell shock to battle fatigue and war neurosis.
He's one of more than 223,000 veterans of the wars in Iraq and Afghanistan who have been treated for post-traumatic stress disorder (PTSD) at Veterans Affairs hospitals. The number represents at least 17 percent of the 1.3 million who have served in the wars.
New PTSD cases are coming in at a rate of more than 3,000 a month, even as the United States completed its withdrawal from Iraq over the weekend and continues the longest conflict in the nation's history in Afghanistan.
The influx has strained the resources of the U.S. Department of Veterans Affairs, which is hiring more mental-health professionals to meet the growing need. Nearly 300 were added over the last quarter, from July 1 to Sept. 30.
Last month, about 200 area Army reservists in the 77th Sustainment Brigade returned home from Iraq through the Joint Base McGuire-Dix-Lakehurst, and more will follow. On Tuesday, about 15 airmen in the 108th Wing's Security Force Squadron members arrived home.
As the service members resume civilian lives, the VA is reaching out through its "Make the Connection" campaign, started last month, to link veterans with peers and help them and their families find VA services, said Sonja Batten, the VA's deputy chief consultant for specialty mental health. The campaign's focus is a website: MakeTheConnection.net.
And on Dec. 13, the Defense Department announced the national launch of Vets4Warriors, a program begun in 2005 by the University of Medicine and Dentistry of New Jersey to provide military peer-to-peer counseling to national guardsmen and reservists. It provides 24-hour toll-free help (1-855-VET-TALK and vets4warriors.com), where vets can air their concerns.
"We're doing all we can to identify problems and address them," Batten said. "It goes without saying that there are unprecedented numbers coming in" for PTSD treatment.
That means delays for new mental-health patients at some VA hospitals. Officials said the agency was adjusting to offer more help. In the Philadelphia region, it meets its target of limiting waits for therapy to 14 days.
Oliver, 56, entered one of the VA's PTSD programs in 2007 and plans to undergo another 45-day program at the VA in Philadelphia. He finds himself wrestling with his feelings over the end of U.S. involvement in Iraq and American losses there. "I don't know if Iraq can make it without us," he said. "But I'm glad we're out of there."
A former member of the 112th Field Artillery of the New Jersey National Guard, Oliver said he has found "there's help [at the VA] if you want to get it. They're there for you. I can call the VA hospital any time I need them."
He still dreams about the day an explosion ripped through his humvee, wounding him and killing two fellow soldiers as they tried to deliver ammunition to a police station in Baghdad in 2004. "What happened with me was tragic," Oliver said. "Lives were lost and I was hurt."
Efforts to identify service members who need help are under way before they return home. They are assessed "in theater," then screened during demobilization at U.S. military installations such as the Joint Base.
"They're checked physically but especially for PTSD, traumatic brain injuries, and behavioral health issues," said Mark Paris, chief for behavioral health in the Army's Northern Regional Medical Command in Washington. "They fill out questionnaires that ask whether they have trouble sleeping, if they have nightmares, anxiety, depression, and alcohol problems.
"If they answer positively to any of them, then there's an in-depth interview by [mental-health professionals] to determine if they need a referral for ongoing care."
If the number needing services is greater than caregivers can handle, "more staff will be procured through a contract process," Paris said. Soldiers "are screened again six months after they return. They go from war to a regular job, and waiting for a bus," he said. ". . . There is an adjustment period."
Mental-health professionals are "seeing increased numbers as part of the push to get people out of Iraq and back home," said Army Col. Dan Cruser, deputy commander of clinical services for the Walson Medical Support Element at the Joint Base.
More soldiers also are being evaluated because of a congressional mandate requiring assessments and because the stigma associated with getting help has been reduced, said Army Lt. Col. John Shaffer, officer in charge of the Walson Behavioral Health Clinic.
Still, many returning service members "aren't totally honest" about their symptoms, said Harry Croft, medical director of the San Antonio Psychiatric Research Center who also served in the U.S. Medical Corps at Fort Sam Houston. He has evaluated 7,000 veterans in the last 10 years.
"If you want a military career and you report PTSD symptoms, then your security clearance goes away and you're less likely to be promoted," said Croft, author of a new PTSD book, I Always Sit With My Back to the Wall. "A lot of veterans fail to report it because they don't want to let their brothers down."
The number with PTSD issues is likely higher than what's reported because many soldiers either don't seek help or get it from civilian caregivers, he said. "They might not even tell the physician or private therapist that they are veterans," Croft said.
Adding to mental-health problems is the unusual nature of the wars in Afghanistan and Iraq: Service members have served in one or both repeatedly - "four, five, or six times" - and return with a "warrior mind-set," he said.
The large number of PTSD cases resulting from that much combat exposure has strained the VA. "With so many people waiting to be seen, the vets get frustrated and say: 'To hell with this. I don't want to be seen,' " Croft said. "The system is overwhelmed."
Meanwhile, veterans "face powerful public silencing" unlike that experienced in previous wars, said Michael Addis, a psychology professor at Clark University in Worcester, Mass., and author of Invisible Men: Men's Inner Lives and the Consequences of Silence. "During the Vietnam War, for example, the country was engaged in a public debate about the war.
"In contrast, most Americans today are unaware that we are even at war, and often unable or unwilling to hear about the pain and vulnerability veterans bring home with them."
At the Joint Base, Air Force Staff Sgt. Amber Merefield, noncommissioned officer in charge of the Mental Health Resiliency Element, has begun "outreach and prevention," offering stress-management classes and information on finding help. "We encourage a 'wingman culture,' " she said. "If you see someone suffering, talk to them, and point them in the right direction to get help."
Unable to cope, some service members end up taking their lives. "Eighteen veterans commit suicide every day," said Rene Campos, deputy director of government affairs of the Military Officers Association of America, the nation's largest officers association with 370,000 members from every military branch.
"That's one every 80 minutes," she told a congressional subcommittee this month. "Twenty-two percent of all suicides in the U.S. are former service members."
More than 2,200 active-duty military members took their lives from 2001 through 2010, officials said. Last year, 293 killed themselves.
"Too many veterans are coming home with mental wounds, and they are suffering in silence," added Sen. Frank Lautenberg (D., N.J.), following the announcement of the national Vets4Warriors program.
An appropriations bill - with $40 million to support suicide prevention - passed the Senate and House of Representatives last week, said U.S. Rep. Rush Holt (D., 12th District), who had proposed the funding.
The VA's "Make the Connection" website augments the mental-health effort by providing messages from other veterans who face the same issues.
For Oliver, there's comfort in knowing that there's help if he needs it. "I'm still thinking about June 4, 2004," he said. "I'll never forget it . . . but maybe I can live with it."