” Almost one-third of returning veterans are diagnosed with PTSD, and that is taking into account only those who honestly answer screening questionnaires and exams. A culture of silence, an omertà among warriors, regarding PTSD has long been a plague of the U.S. military.”

Along with hundreds of thousands of other veterans of the war in Al Anbar Province Iraq, I recently watched as Al Qaeda successfully captured the city of Fallujah, with Ramadi surely soon to follow. I watched as the same buildings I, and thousands of others, stood on now swarmed with mask-clad terrorists attempting to calm the local populace despite light resistance from local tribes. As I watched, the same angry sadness welled up inside me when anyone talks about Al Anbar for a bit too long. As they cheered on the TV in front of me in my warm suburban New England living room thousands of miles from those dirty streets, a stray tear fell and I thought about the friends who I lost and the ones I will continue to lose to the fighting that occurred on those streets. But for all the tears we who returned shed for our fallen brothers and sisters, we certainly are not out of danger, as the physical and mental tolls of deployments accumulate on our hearts and souls and strike us down like random bolts from vengeful gods. And when we see what is on TV right now, we have to ask ourselves, just what did we accomplish and at what cost?

Veterans’ health is an easy topic to make as bland as possible. It could read like a textbook entry in some vague college pre-med class – sterile, clean and full of detached pity. However, the health of our returning war fighters is anything but neatly packaged into various categories for the unknowing public to judge and lament at their leisure.

That red-blooded American youth returning from combat service in a foreign land can look forward to myriad health problems to plague him the rest of his life, long after glowing homecoming ceremonies and proud backslapping from relatives and neighbors subside. The nightmares and insomnia usually begin soon after coming home. They’re not even clear ones, but result in the kind of restless paranoid sleep that ends with a violent wakeup and fearful howl. Almost one-third of returning veterans are diagnosed with PTSD, and that is taking into account only those who honestly answer screening questionnaires and exams. A culture of silence, an omertà among warriors, regarding PTSD has long been a plague of the U.S. military. Too many fear diagnosis and treatment as a threat of being removed from units, placed on vague federal watchlists, or carrying a stigma of being mentally weak. And this culture of silence has led to epidemic levels of combat veteran suicides.

On the night of Easter Sunday 2011, I crawled into a bathtub in Middletown to die. I, like hundreds of thousands of other OIF and OEF veterans, had been diagnosed with PTSD, depression and anxiety attacks. The symptoms of these, along with a growing addiction to the pills being fed to me to fight them, and a fierce thirst for alcohol that had become a bottle-a-day habit, left me a despondent mess barely able to hold together my personal life. I swallowed every pill in my cabinet and waited for the end. I fortunately survived that night; however, the majority of my brethren in arms who chose to take that last and horrible step when the pain, fear and loneliness overtook them just one time too many, did not.

Anger will also rot the homecoming hero – anger toward the enemy, other units, people back home we used to care for, anger toward wives, friends and even the dog. It is a burning, resentful anger that simmers deep and leads to problems with high blood pressure and anxiety throughout life. This anger and resentment often leads to substance abuse used silence demons and build a lubrication to the world around us. Unfortunately, self medication along with the zealous prescription of strong medications often leads to disaster.

But not to worry, fellow veterans, recent studies have noted a strong link between suffering from PTSD as a young person and developing dementia later in life. So, maybe one day we can look forward to at least forgetting what we are so angry about.

Despite the sexy popularity of PTSD awareness, and more recently TBI awareness, among Americans during our generation’s war, there exists in American society an entire generation of youth who are just plain broke down and tired. Combat service and training, especially among the infantry and combat support units, is a physically strenuous activity even among those not wounded in battle. Musculoskeletal injuries, chronic arthritis, torn ligaments and dislocated joints are commonplace in the warrior profession, and those coming home, despite being at the peak of health and fitness, may suddenly find themselves struggling to keep up with their peers who don’t deal with pain. These ailments, when coupled with an already higher than average national unemployment rate among vets, hinder many in finding the type of jobs essential to post-war reintegration.

Then we come to the mystery ailments that the paranoid veteran underground likes to speculate on. Vietnam saw Agent Orange, and The Desert Storm had Gulf War Sickness, but what will be our war’s enduring lethal legacy? The asbestos that filled every building we stepped in and blew apart? The long-term exposure to foreign pathogens and old world diseases that most Americans have never been exposed to? Or perhaps the murky legality that surrounded the suddenly mandatory anthrax inoculations that began in 2007?

My money has always been on the burn pits. Any of the older vets can tell you of the time when everything in Iraq was burned next to the outposts, sometimes feet from sleeping and eating areas. Wood, clothing, old electronics, human waste, food, any and all garbage, old meds – you name it, into the burn pit it went to constantly smolder and melt as we inhaled the fumes night and day. Lawsuits have already been filed by service members against the large corporations like KBR and Halliburton who maintained the large burn pits at the large bases in Iraq.

Iraq and Afghanistan are not easy wars to be veterans of, not that it’s easy to return home from any war. We deal with the misunderstood stigma of combat veterans being violent assholes. We deal with watching a war we fought come apart on the evening news. And we deal with a confusing and often incompetent system of healthcare from the V.A.

As one Rhode Island combat veteran told me, “You don’t get PTSD from going to war. You get it from coming home.”

Indeed.