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In a week when President Barack Obama mulled his strategy for Afghanistan and the nation paused to remember veterans from numerous conflicts, another kind of war is being waged in the hearts of many soldiers.
Nearly 20 percent of military service members who have returned from Iraq and Afghanistan report some symptoms of post-traumatic stress disorder or major depression, according to a 2008 survey by the RAND Corp.
Not far from here is a place they can seek help, at the inpatient combat PTSD program at Coatesville Veterans Affairs Medical Center.
The Chester County medical center offers one of only 35 inpatient PTSD programs in the national VA system. The center also offers outpatient treatment for PTSD.
During its last fiscal year, almost 250 people were admitted to the inpatient program, the only one of its kind in the state.
Some were veterans. Some were active-duty soldiers.
About half were involved in the Iraq or Afghanistan wars. The other half were from wars or conflicts in Vietnam, the Persian Gulf, Panama, Grenada and Beirut. The unit even recently treated a Korean War veteran.
"This is something that they deal with for their whole lives," said Dr. Robert Whitney, 56, a Coatesville resident and psychologist who is the clinical coordinator of the program. "It's not something typically that goes away."
Modern warfare has presented soldiers with terrors such as the roadside bomb, death wrapped in an ordinary-looking pile of garbage or hidden in an animal carcass.
But soldiers who have fought in Iraq and Afghanistan discover they have more in common than they expected with those who fought in Vietnam and other wars, Whitney said.
"Vietnam had a lot of casualties from booby traps," he said.
And all warriors share similar sorrows.
"Veterans are often surprised that when they talk to veterans from other wars, they really can relate," he said. "Your feelings are the same if your best friend gets shot in Vietnam, and you are trying to help him and you have that feeling of helplessness and desperation.
"The fear, the sense of helplessness, the grief, it all kind of overlaps, even though the terrain and the enemy have changed."
It's tempting to stuff away those emotions, but it can be very harmful when you are back home in a safe place with family and friends.
The signs of PTSD include "re-experiencing" traumatic events, which leads to nightmares and intrusive thoughts.
People also might become withdrawn and try to avoid situations and places that remind them of the trauma, such as avoiding driving or staying away from busy roads.
And they might have problems with anger, Whitney said.
In battle, soldiers learn to turn fear into anger for survival reasons. Instead of freezing, they become angry and counterattack.
"You learn to respond to painful emotions by getting angry," Whitney said.
But that doesn't work so well in civilian life, when you erupt in fury when someone cuts you off on the road or when someone approaches you in a crowd.
The inpatient program offers soldiers individual and group counseling. Treatment methods include having soldiers go over a specific trauma numerous times until their emotions die down and they can think about what happened. Gradually, it does not feel as painful.
Group therapy helps soldiers help each other. They realize they are not alone and do not have to be ashamed of how they are feeling, Whitney said.
The medical center even has a therapy dog, Cooper, who comes in and brings a smile to the soldiers' faces.
Veterans and soldiers voluntarily enter the unit — there are no mental health commitments — and are free to go home on weekends to see their families, who also may come to the center and participate in therapy or learn more about PTSD.
The average length of stay in the 34-bed unit is six weeks.
"You can see in the course of the program how people get better," Whitney said. "They socialize more, they report on their passes home that they are getting along with their families better, their families are happier with them.
"They can talk about their trauma without getting very emotional, and their anger decreases."
