U.S. Army Staff Sgt. Jeff Ethington returned home to Madison two days before Christmas after serving two back-to-back tours in Iraq. He's humble, but proud of what his unit accomplished.
"During the time that I was there we opened maybe four hospitals, six schools, and built all these parks all with the help of the 2nd Brigade, 2nd Cavalry Division," said Ethington.
Ethington's unit also trained Iraqi National Police and renovated one of the most dangerous boulevards in Baghdad, WISC-TV reported.
"It used to be known as Purple Heart Boulevard," said Ethington. "You'd get out of your truck and get shot at, you'd get out of your truck and someone would throw a grenade at you."
Ethington said he didn't dwell on the fact that he was in constant mortal danger.
"It was always in the back of my mind," he said.
In the back of his mind for the 29 months he served in Iraq.
After returning home in late December, Ethington re-enrolled in classes at the University of Wisconsin, eager to get back to his degree, back to his friends, back to his life.
"Between my first and second deployment, my brother said I didn't seem the same," said Ethington. "It seemed like I wasn't transitioning well. I thought about getting help then and then I got deployed again."
This time, when he re-entered campus, Ethington himself noticed the change.
"One specific day when school was starting, the crowds are bigger, you're always in the crowds, and you're in class. I just started to feel shaky and panicky, like really, really uncomfortable," he said.
Ethington was experiencing symptoms of post-traumatic stress disorder.
"PTSD looks the same whether you're someone who was tortured in Africa, or if you're a woman who's been raped, or you're a combat veteran," said Veterans Hospital psychologist Dr. Tracey Smith. "It's the body and mind's way to make sense of these terrible events."
PTSD is a serious anxiety disorder, health professionals said.
"We're evolutionarily primed to respond to danger," said Smith. "PTSD is that you were really good at responding to danger and threat and now that system is sort of over-sensitized."
Smith is part of a dedicated PTSD team at Madison's VA Hospital. The hospital had 352 PTSD referrals in 2007. In the first quarter of 2008, the numbers were up 38 percent, officials said.
She said PTSD usually peaks in soldiers four to six months after returning from Iraq. Symptoms can include re-experiencing the event.
"They are intrusive thoughts," explained Smith. "That you remember the event when you don't want or have to and you try to push the memory away and it just keeps coming back or chronic nightmares where the trauma gets played over and over again.
Another symptom is hyper-arousal.
"That is like an exaggerated startle response if they hear a car backfire, or they are always on edge," explained Smith. "When they go into a restaurant they have to sit with their back to the wall or they are always scanning the environment not sure who to trust."
Ethington said this is the symptom he was having trouble with.
"I went to the doctor and there was a fish tank. I sat next to the fish tank and that's all that was there, a few chairs next to me and I could see the whole room," said Ethington.
He also said he found it difficult to walk to class in the sea of students and was constantly scanning rooftops for snipers.
The final symptom for some veterans is avoidance or numbing.
"That means they work so hard to try to avoid thinking about the event or having their negative emotions work so hard at suppressing or they constrict their life so much to avoid being triggered by events that happen in the outside world that they end up sort of never working through the traumatic event," said Smith.
At Madison's Veterans Hospital, PTSD programs are individualized for each soldier. The hospital offers substance abuse programs, group sessions and classes for couples, but the most widely-used program for veterans is the Cognitive Processing Therapy, or CPT, which is a 12-week program where a veteran meets one-on-one with a therapist.
"We focus on the connection between events thoughts and feelings," said Smith. "We ask veterans to think about the traumatic events that occurred, write about those events, discuss them with the therapist and try to figure out, 'How do I make sense of this and fit it into my life now?'"
"It's difficult to do," said Ethington. "It's the stuff you don't want to remember, but if you keep it buried inside you're just going to keep having problems."
Ethington is a few weeks into his CPT.
For veterans who are unable or unwilling to write or talk about the most traumatic experiences, there is another form of CPT where no trauma is discussed in group, WISC-TV reported.
"We are trying to give access to care and reach out to veterans who are struggling," said Smith.
Reaching more veterans is why the VA Hospital also offers tele-mental health, where veterans don't have to come to Madison to meet with a therapist. They can attend therapy sessions in a private teleconference from a VA satellite clinic, anywhere across the state.
"For some veterans, that's it," said Smith. "They get markedly better with the treatment and don't feel they need more treatment."
But for veterans who don't seek treatment, PTSD could have long-lasting psychological and physical impacts on their lives and bodies. Smith likened it to a ripple effect.
"They have problems controlling their impulsivity and emotions so many times they'll end up getting divorced because they're not good at sitting down and rationally discussing things with their partners," said Smith. "Some veterans end up having multiple jobs because they get fired or divorced several times."
It can lead to depression and suicide, officials said.
Ethington said the sessions are helping him refocus on what is important in his life right now, which is his education.
"It's to help realize what happened in Baghdad is in Baghdad, here is civilian life. I don't need to be looking at rooftops looking for people who are going to try to shoot at me, I can walk down the street and be fine, these crowds, no one is going to try to blow themselves up in front of you and try to kill people here in Madison at all."
Ethington said if there is no additional deployment, he'll graduate in May 2009 and begin medical school. He's enlisted through 2013.