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Casting Light on the Invisible Wounds of War

It could be the smell of fresh wheat bread in a kitchen, the chirping of crickets on a hot night, or even the cold touch of a puppy’s curious nose – within moments of experiencing any of these senses, one would instantly recall memories connected to such prompts. One would become unintentionally and instantly flooded with memories, the power of which could remain for seconds, minutes, or even days. Experiences and memories make us who we are as individuals. They make our interactions with others unique, impacting and changing groups, even communities. They help us self-identity, revealing what brings us joy, sorrow, pain, and even fear.

No soul is immune to such basic human nature – not even a soldier at war can be safe from the mind’s inevitable, humanistic need to link memories of events to a sight, sound, smell, taste, or touch, all in an effort to better understand what the soul experiences. The mind becomes a filing system of sorts; for combat veterans suffering from Post-Traumatic Stress Disorder (PTSD), the mind can become its own enemy.

According to the U.S. Department of Veteran Affairs, PTSD is a mental health condition that can happen to anyone who has suffered through a traumatic event, directly or indirectly. In combat situations, the mind is still reacting instinctively, collecting and storing memories that can be excruciatingly difficult for the warrior to endure during the inevitable recall process. Therefore, the mind’s “filing system” and unintentional memory recall, can elicit great harm to a combat veteran’s mental health and wellbeing. Veterans suffering from PTSD have recalling prompts, typically referred to as triggers, which are linked to situational or emotional experiences and memories from the combat zone. For instance, soldiers with PTSD may hear the sound of popcorn popping or fireworks exploding and recall an improvised explosive device attack, or a random experience of anger, sadness, or anxiety can trigger them to relive the experience and emotion from losing a friend in combat.

With advancements in battlefield medicine and technology, an unprecedented percentage of service members are surviving combat injuries that would have previously been fatal. To date, more than 52,000 service members have been physically wounded in the current conflicts, and it is estimated that as many as 400,000 service members live with the invisible wounds of war, including combat stress, Traumatic Brain Injury (TBI), depression, and PTSD. 

While these injuries are considered to be the invisible wounds of war, with increased awareness, symptoms could become more noticeable, and treatment more accessible. According to the U.S. Department of Veteran Affairs, PTSD has four types of symptoms: re-experiencing, avoidance, negative changes in beliefs and feelings; and hyperarousal.

The Wounded Warrior Project® (WWP) Combat Recovery team explains that when memories are too painful to recall, warriors may self-medicate and withdraw from family, friends, and community. In large part, shame and guilt are two triggers that make it difficult for a warrior to cope with daily life as it negatively impacts his or her confidence, hope, and sense of worth.

The impact of these symptoms on the lives of the combat veteran and his or her family members is substantial.

“When someone is dealing with PTSD, it’s the people closest to them – their family – who suffer most,” said John Roberts, WWP warrior relations executive vice president and wounded service member. Roberts was medically discharged from the U.S. Marine Corps after suffering third-degree burns over 80 percent of his body from a helicopter crash in the seas of Somalia at the beginning of Operation Restore Hope. Raising awareness and breaking the stigmas associated with PTSD and other invisible wounds of war became one of his goals in life.

According to the WWP Combat Recovery team, sometimes the symptoms in warriors dealing with PTSD become so pronounced that they tax the family and create added dysfunction. There becomes difficulty communicating, trusting, and feeling safe. Often, injured veterans lose interest in family activities, leaving family members feeling isolated. This cycles into the family's sense of helplessness and depression, which can lead to the formation of additional unhealthy coping mechanisms, such as eating too much or not enough, self-medicating, or just pure anger.

“In my experience, when I have triggered in the past, it’s like being right back in the event that caused me to develop PTSD,” said Roberts. “I tend to shut down emotionally because I am reliving the event in my head.” He continues to explain how coping mechanisms can impact every aspect of the warrior’s life – and that of his or her family. 

In order to elude an injured veteran’s episode or behavioral breakdown, family members may begin compensatory behaviors, explains the WWP Combat Recovery team. For instance, if a warrior deals with PTSD triggers through avoidance, family members may learn the same habits, isolating themselves in life as well. 

“Those who suffer from PTSD will do anything to avoid a trigger,” said Roberts. “They may even provoke an argument to avoid having to do something or go somewhere that may potentially trigger them. PTSD triggers are either known or unknown to the individual. Most of those who suffer from PTSD cannot avoid all things that may trigger them.”

Roberts explains the importance in identifying specific triggers for each combat veteran and understanding the mental and physical impact during an episode. It’s only then those suffering from PTSD can begin to develop the skills that can help reduce the symptoms during an episode.

However, seeking treatment is not as easy as it may seem. Many suffer in silence due to the stigmas associated with mental health conditions. According to the WWP Combat Recovery team, combat veterans suffering from PTSD may not seek help or treatment for fear of retribution (e.g., termination of employment, loss of parental rights, loss of freedom, and loss of respect). The judgment and labels add to the injured veteran’s struggle to not only survive, but to thrive in life. 

“I was reluctant to get treated,” said Roberts. “I believed that I had to be tough. I was a Marine, and we are taught to be tough. Unless you’re bleeding, you’re not hurt. It took me years to understand that it takes a much stronger person to ask for help than to suffer in silence.”

With PTSD and TBI being the two most prevailing injuries from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), the need for increased resources for PTSD treatment is evident. According to the U.S. Department of Veteran Affairs, between 11-20 percent of OIF and OEF veterans are diagnosed with PTSD in a given year. These numbers are determined by how the government defines PTSD cases, principally a patient having at least two outpatient visits or one or more hospitalizations at which PTSD was diagnosed. According to the Wounded Warrior Project 2014 Annual Alumni Survey, which measured 21,120 injured veterans, 75.2 percent reported that PTSD was the second most commonly experienced injury and health problem – second only to sleep problems at 75.8 percent. 

“We need to raise awareness and educate the public,” said Roberts. “PTSD is a normal reaction to a very bad situation, and no one should be ashamed of suffering and seeking help. Combat veterans need to know that PTSD does not have to be a lifelong sentence,” Roberts says. “It can be treated and managed. Life can be better.” 

May is Mental Health Awareness month. If you or someone you know is interested in PTSD or other mental health support, please contact the WWP Resource Center at or 888.WWP.ALUM (997.2586).

About Wounded Warrior Project

The mission of Wounded Warrior Project® (WWP) is to honor and empower Wounded Warriors. WWP’s purpose is to raise awareness and to enlist the public’s aid for the needs of injured service members, to help injured servicemen and women aid and assist each other, and to provide unique, direct programs and services to meet their needs. WWP is a national, nonpartisan organization headquartered in Jacksonville, Florida. To get involved and learn more, visit 

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