For many veterans of the wars in Iraq and Afghanistan, their injuries are psychological and emotional.
These men and women return home with no physical wounds. But their psyches are damaged from the pain and despair that comes from living too close to death and in constant fear.
They see friends blown apart by roadside bombs. They witness children maimed and killed at military checkpoints. They find battered bodies strewn about like bags of trash. They see things no one should witness, and things no one can ever forget. These soldiers worry that they may be the next casualty of war. When is their number up?
The lucky ones make it home safe and sound -- at least physically.
But for some, the war still rages on in their minds. Car alarms send them diving for cover. A whiff of a chemical jolts flashbacks to battlefields. They awaken at night in cold sweats and panic from recurring nightmares of the hell they endured on repeat tours in combat.
Most of these brave veterans are able to put the horrors of war behind them and lead relatively normal civilian lives.
But too many of them can't forget. They want to, but their scarred minds won't allow it. So they turn to drugs and alcohol to dull the pain. They are quick to anger and start fights, often with spouses or family. They suffer depression and divorce. They lose jobs, go into debt and commit crimes.
For too many, their only escape from the unbearable private torment is suicide.
Call it post-traumatic stress disorder, battle fatigue or mental illness, it's a growing problem of our long wars and repeat tours of duty in the Middle East.
Nearly 15 percent of overall U.S. military casualties result from suicide, say studies and military officials. On average, there are 18 suicides a day among America's 25 million veterans, according to statistics.
Experts acknowledge that veterans are nearly twice as likely to commit suicide as people who have never served in combat. A study by the Rand Corp. found that roughly one in five veterans of Iraq and Afghanistan have symptoms of post-traumatic stress disorder, a common denominator in suicides among military veterans.
The armed services and Veterans Administration are aware of the problems and have set up counseling programs, suicide prevention hot lines and advertising campaigns to inform homecoming veterans of available help.
But all the programs in the world won't do any good if veterans don't know about them or won't use them.
"The military releases these (veterans) who need help, but there is no follow-up or attempt to get them help," says Michael Lehmann, a counselor in the Elmira office of the New York State Division of Veterans Affairs. "They're released and that's that."
That's why the Veterans Administration has launched a national suicide prevention awareness program featuring the slogan: "It takes the courage and strength of a warrior to ask for help."
That slogan is important, as the Rand study found that some 300,000 people who served in Iraq or Afghanistan suffer from post-traumatic stress disorder or depression.
That's why representatives from the Veterans Administration in Bath are going door to door, visiting returning veterans.
"If we know where you live, we'll come visit you," Lehmann says. "But we often don't know these veterans are coming home or where they live. So we're beating the bush trying to find them and get them to come in and talk to us. If they don't have any problems, fine. But if they do, we want to get them the help they need."
Too often, hurting veterans don't seek that help because they can't get past the "warrior code" that trained them to be tough, brave and self-reliant. They believe that seeking counseling or even antidepressants are a sign of weakness.
Even worse, they fear that acknowledging a mental health problem and seeking help could jeopardize their military careers.
So they avoid professional treatment and try to tough it out, or more commonly, self-medicate with binge drinking and illegal drugs to quiet their demons.
Drugs and alcohol are often the first stumbling steps into a hole that too often ends in suicide.
"It's not a sign of weakness to seek help," says Karen Aikman, the suicide prevention coordinator for the Bath VA Medical Center. "It's a sign of strength that they realize they need help.
"Veterans need to understand that they have earned the right to access to mental health treatment."
We need to do more for our veterans. It begins with the armed services telling their combatants that it's all right to seek mental health counseling. Even more important, the military branches need to screen homeward-bound veterans for mental problems and make sure that those who need help get it.
I often see bumper stickers and signs that say "support our troops."
But those signs and slogans don't mean much if we stop caring about our troops when they return home.
As we prepare to honor and celebrate another Veterans Day, we need to give pause and thoughts to the warriors who come home but can't escape the war.
They are the casualties of battle we don't often hear about.
Jim Pfiffer's Real Life column about people, places and life in the Twin Tiers appears Mondays, Wednesdays and Fridays. Contact him at (607) 271-8277 or [email protected].