By Richard Allen Greene
War veterans suffering the psychological after-effects of combat often try to handle the problem themselves. Many end up abusing alcohol, drugs, or the goodwill of those closest to them. But doctors and counsellors offer a range of genuine treatments which mean veterans do not need to turn to drink or drugs. BBC News talks to those on the front lines of treating trauma.
The New Hampshire National Guard doesn't want to see any more David Guindons.
The Air Force National Guardsman returned home in August 2004 from a six-month tour of duty in Iraq - to a hero's welcome. The next day, he shot himself in the head.
Tim Beebe ran counselling sessions for more than 800 veterans
"No-one saw it coming. He came home on Tuesday and was dead on Wednesday. It's still a mystery," says Tim Beebe, the regional director of the New England Vet - for veteran - Centers.
"Needless to say, that got everyone's attention," he adds.
The next time New Hampshire Guardsmen were scheduled to come home from Iraq, the commanders of the National Guard - the state's reservist military force - got in touch with Mr Beebe.
They had some questions, he said: "What kind of shape are these guys in? Are they safe to go home? How do we know?"
They wanted him to find the answers, and he agreed - without asking how many soldiers were involved.
The answer was 810.
One on one
A Vet Center typically has a staff of only four counsellors, so Mr Beebe brought in extra help from all across the region, and over the course of two weeks, his counsellors spent an hour with each returning soldier, one on one.
The counsellors were looking for signs of depression and post-traumatic stress disorder (PTSD) - both common conditions among soldiers who have served in difficult theatres like Iraq.
"We asked them if they would like a follow-up call in a month, and 48% said yes," Mr Beebe says.
Vet Centers are run by veterans as well as serving them
Ninety days after the exercise, about one in eight of the soldiers had been counselled at a Vet Center three times or more - almost exactly the same percentage that showed signs of depression or PTSD in a much larger study of Iraq veterans conducted by the US Army.
Mr Beebe is delighted with how the operation went.
"This is a luxury for us to do something preventative - we have been chasing veterans for 25 years."
The Vet Centers were established in 1979 as Congress recognised that a generation of young men had come home traumatised by Vietnam.
To date, about 200 centres have been established across the country, as community outreach programmes designed specifically to help veterans suffering from combat-related psychological stress.
Help from peers
Their advocates say one of their greatest assets is that they are staffed largely by veterans.
Tom Hannon, head of the Boston Vet Center, was with the Navy in Vietnam.
Tom Hannon had no veteran mentor to talk to after Vietnam
"What if someone had sat down with me when I came back from Vietnam and said: 'I served in Korea. It's going to be OK. I still have dreams. It's normal?'"
He says many veterans find it helpful simply to talk to other people who have been through similar experiences.
"We're 'de-therapising' the therapy, having a conversation or a discussion."
Aaron Jones, a Connecticut National Guard infantryman who was wounded in Iraq, found himself at a Vet Center almost by accident - he was looking for advice on home loans for veterans.
But, much to his own surprise, he soon found himself talking to a counsellor and participating in group therapy.
"Veterans talking to veterans - that's the best thing," he says.
Many other veterans have come to the same conclusion, formally or informally.
Websites like the US-based Iraq PTSD chatroom or the UK's Army Rumours Service buzz with personal stories, advice and encouragement.
And groups like the California-based Veterans and Families enable people to connect face-to-face.
Its executive director, John Henry Parker, says soldiers need alternatives to the military and government veterans' agencies.
"There needs to be a third safety net outside of the Department of Defense and the Veterans' Agency - a safety net of community organisations and families that can recognise what's going on, because if the symptoms last more than a few months, they can last a lifetime."
The US military, for its part, has been encouraging soldiers to talk about how they have been affected by war even before they leave the combat zone.
The Army has a combat stress control unit, the 55th Medical Company, consisting of trained therapists.
And marines have group therapy sessions before they are shipped home.
But there are questions about how effective counselling is.
"The research on debriefing is ambivalent. It is not always the be all and end all - for some people it can make it worse," says Leslie Carrick-Smith, a leading British expert on psychological trauma.
A study published in the Journal of the Royal Society of Medicine in 1998 found that some PTSD counselling was harmful because it dredged up distressing memories.
The US Navy is experimenting with video games to deal with trauma
Another form of treatment goes even further than group counselling in trying to help veterans confront painful memories: virtual reality "games" that put veterans back in combat situations.
The US Naval Medical Center in San Diego, California, has been getting traumatised veterans to play a version of the Full Spectrum Warrior video game to see if it helps them let go of painful memories.
The project is part of a three-year, $3m study into the effectiveness of virtual reality therapy. Results will not be available for several years.
In the meantime, the Pentagon is trying to keep a close eye on its veterans. In January, it ordered all military personnel to have mental health assessments three times in the first three months after they return from Iraq.
The UK military has no comparable monitoring, although the Ministry of Defence says it is "committed to providing the best available health care to the few servicemen and women suffering from mental health problems".
Troops have pre-deployment briefings about dealing with potentially stressful situations, and get a post-deployment package of information including leaflets about PTSD.
There has been little, if any, psychological monitoring in Iraq itself among soldiers or civilians.
"Mental health has not been a priority in terms of money or equipment," says Dr Majid al-Yassiri, chairman of the London-based Centre for Psychosocial Services in Iraq.
Even a country with the resources of the US can struggle to cope with huge numbers of people suffering from PTSD.
More than 400,000 US troops have served in Iraq since the invasion, and tens of thousands have shown some signs of serious stress on their return, a study from the Army's Walter Reed Medical Center has found.
Tim Beebe's Vet Centers were stretched to the limit properly to debrief 810 returning veterans.
When he is asked how they would handle tens of thousands, his eyes widen and he pauses a moment before answering: "We'd have to ramp the programme up significantly."