FORT HARRISON -- It was a hot day in July 2004 when Chris Evans saw her husband off to war. Like any other wife, she prayed for his safety. She also knew that when she saw him again 18 months later, she'd have to open her arms to a different sort of man.
"You don't know how your soldier is going to change while he's gone," Evans said. "The reunion can be just as scary as the deployment. It's like walking on an uneven surface. You have to constantly adjust your balance."
Adjusting that balance may be a challenge for any couple separated for more than a year, their relationship reduced to occasional letters and phone calls. If you don't grow together, the adage goes, you grow apart.
But Evans and her husband have a strong union and their communication is open. So when Evans noticed her husband's short temper and his problems sleeping at night, she told him he needed help, and he agreed.
"If I hadn't nagged at my husband, I don't know if he'd have gone and gotten help," Evans said. "I think married couples have that benefit. The single guys don't always have that close person to turn to."
A study published by the New England Journal of Medicine in 2004 looked at a group of soldiers and Marines who'd served in Iraq or Afghanistan early in the war.
The study noted a strong correlation between PTSD and intense combat. Handling dead bodies, being shot at, and killing enemy combatants were among the group's many battle experiences -- things soldiers with the 163rd Infantry Battalion, Montana National Guard, saw during their own tour in Iraq.
Those experiences, traumatic for some, lead to problems down the road. Figures supplied by VA Montana show a 30-percent increase nationwide in the diagnosis of PTSD since 2005. Other post-combat issues on the rise include depression, employment problems, and substance abuse.
Veterans from past wars, including World War II and Vietnam, say their generation didn't address post-combat stress. In fact, it wasn't even a term. After the war, many soldiers were left to deal with the lingering problems on their own.
"We didn't know what to call it," said Joe Upshaw, a Word War II veteran who served with Montana's 163rd Infantry Regiment in New Guinea. "They didn't have any words for it. We just learned to live with it. We got home and went about our way."
Times have changed and mental-health care has improved. PTSD was added to the Diagnostic and Statistical Manual for Mental Disorders in 1980.
Those around the military agree that today's soldiers receive better care and more understanding than soldiers from past wars. Many of those same people, however, also admit that the military has work to do in helping combat veterans reintegrate back into society when they come home.
"Before we left Iraq, we conducted a post-deployment health assessment," said Lt. Col. T.J Hull, who commanded Montana's 163rd Infantry Battalion in Iraq. "You sat down with these folks and talked to them about anything and everything, from environmental exposures to explosions and loud noises. Did you see people dismembered? Were you ever shot at?"
A soldier's answers were entered on what Hull called a "smart card." The cards followed each soldier stateside and through the demobilization process, where the questions were asked again. Any red flags are supposed to lead to an intervention, requiring the soldier to get immediate help.
It's a good concept, but some say the process is short-sighted and doesn't work. Expecting a soldier to reach out when he or she just wants to get home may be naÃ¯ve. Many are reluctant to admit to having any problems, especially those that would further delay their homecoming.
"It's widely known among the troops that if you say the wrong thing you will probably be kept back for evaluation," said Master Sgt. Dan Stewart, a former recruiter and retired soldier. "After spending 12 months in Iraq, most of these people just want to go home, so they deny any problems."
The 163rd Infantry returned home in November 2005. In March 2006, during the group's "Freedom Salute," another post-deployment health assessment was held. At that event, Hull said, the soldiers sat down with providers and filled out a form. The interview focused on anger issues and depression, among other things.
"By then, they're just starting to realize if they're having any readjustment problems," Hull said. "The provider can make a referral right there on the spot and get the soldier into an environment without the command being aware of it."
Not long after the 163rd Infantry returned home, the Montana National Guard underwent a major reorganization, taking it from a cold-war structure to a more agile force that could respond quickly to the war on terror.
Many soldiers were transferred to other Montana units, which placed them under the command of people who, some say, were unfamiliar with their personalities or wartime experiences.
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"They spread out amongst people who didn't know them well... and couldn't relate to what happened specifically to them while deployed," said Evans, who served as the family readiness leader for Troop E of the 163rd. "They lost their unit support. We were like a family. They came home and it was like, all of a sudden, your family was gone and you had no support."
One soldier, who asked that his name be withheld, served with the 163rd Infantry in Iraq with Chris Dana, the 23-year-old Helena soldier who killed himself in March. The soldier went to the VA last November for help, about the time that Dana began to withdraw from his own family.
In recent e-mails, the soldier said he hadn't left his home in nearly seven months, except to visit the VA. He also said he has a difficult time controlling his anger, to the point it makes him unemployable.
"Up until this month, not one person has called to see what was wrong with me, or see how I'm doing," the soldier said. "Not until Dana killed himself did I hear from anyone, and it was only because I had called the chaplain because I was upset about Dana."
Now, the soldier said, the calls he does receive aren't from his company command, but rather, from higher military authorities. He accused the Montana Guard of caring more about troop strength and retention than about the troops themselves.
Others have shared similar concerns, including Matt Kuntz, a former Marine and Dana's stepbrother. Kuntz would like to see post-combat counseling mandatory for all Montana soldiers.
"These soldiers are hurting and every moment matters," Kuntz said. "We need to dedicate ourselves to fixing this problem and jump in with both feet."
The Montana National Guard has taken steps to address the issue and get ahead of the curve.
Maj. Gen. Randy Mosley, adjutant general of the state guard, discussed the subject during a recent visit with Sen. Jon Tester earlier this month.
The guard is also developing a new task force to help soldiers returning from Iraq better recognize post-combat stress and get them help when mental-health issues arise.
Gov. Brian Schweitzer has directed Mosley to work quickly to bring the task force up to speed. The group, which will hold its inaugural meeting this week, is devising ways to work more closely with returning soldiers and for a longer period of time, possibly up to two years after demobilization.
"This has needed to happen," Maj. Garth Scott, public relations officer for the Montana Guard, said of the program. "We're seeing so many post-deployment problems throughout the community."
The 2004 study from the New England Journal of Medicine found that the concern over stigma was greatest among those who needed help the most.
Those soldiers and Marines most at risk of getting PTSD were twice as likely to be concerned about being stigmatized by their peers. In the ranks, illness or injury is often seen as weakness, and there's littler tolerance for slackers.
To deal with the issue and still provide care, the Montana VA has started a new program to help vets share their feelings in a therapeutic setting. Dr. Rosa Merino, chief of psychiatric services for the Montana VA, said the peer-to-peer program, or vet-to-vet, works something like a support group. Nearly 20 veterans attended the first meeting, held at the VA last month.
By helping others, Merino believes, veterans learn to help themselves. The setting also removes the stigma that often prevents combat vets from getting the help they need.
On her computer, Merino keeps a PTSD slide presentation for lectures. Part of her presentation includes a saying from Psychiatry Times, which notes that purple hearts -- awarded for enemy-inflicted injury in combat -- aren't awarded for post-combat stress.
The mental scars of war can be just as deadly, leading to suicides and accidents. Over time, Merino said, those mental scars can increase the risk of death from cardiovascular disease or cancer.
"We all have our responsibilities, and we all have to manage what we do best," Marino said. "I feel strongly that this has to be a community response. Everyone has to take ownership."