Post-traumatic stress disorder is nothing new to veterans coming home from war. It was called “combat neurosis” after World War II.

But repeated deployments to Iraq and Afghanistan are presenting many new veterans with unique challenges as they try to readjust to their lives at home, said David Bann, associate chief of mental health for VA Maine Healthcare System.

“One of the differences in the current conflict that is truly a new phenomenon is the use of the improvised explosive device and the total surprise attack,” Bann said. “These folks are very much keyed up and on edge. It’s not like seeing an enemy that’s in formation and visible from a distance. … Everything they confront in their environment could be a weapon.”

An estimated 20 percent of the 2.1 million American soldiers who have served in Iraq and Afghanistan since 2001 are suffering from PTSD or some other mental health problem, according to the National Institute of Mental Health. More soldiers die from suicide than combat, it says.

The rising mental health toll of the ongoing conflicts, and a better understanding of the illness, have led to better access to treatment for veterans in Maine and elsewhere.

“What these guys do have going for them is unprecedented levels of services and supports,” said Amy Marcotte, clinical team leader at the Sanford Vet Center. “The (Department of Veterans Affairs) really has pulled out the stops in terms of trying to make services available to this generation of vets.”

The invisible wounds of PTSD may have contributed to the recent death in Farmington of 28-year-old Justin Crowley-Smilek, an Army Ranger who served in Afghanistan.

Crowley-Smilek came home with severe post-traumatic stress, which led to substance abuse and repeated run-ins with police, his father said. The former Ranger was shot and killed Nov. 19 outside the police station after he called inside for help and then allegedly came at a police officer with a knife.

Many more vets are suffering quietly with the illness, and some are dismissing the lost sleep, bad memories and other symptoms as nothing they can’t handle, according to Bann and other experts.

More than 200,000 veterans of the Iraq and Afghanistan conflicts have been diagnosed as potentially having PTSD, according to the VA. About 12 percent of Maine veterans have PTSD to some degree, the VA said.

Bann and other experts say the numbers have increased here as they have nationwide. It is not clear how much of the increase is because of a better understanding of the illness and how much is because of the unique pressures on those currently serving in the military.

PTSD is caused by traumatic experiences such as the violence of battle. The more exposure to such events, the greater the risk of sometime later developing PTSD symptoms, including persistent frightening thoughts and memories, sleep problems, feeling detached or numb, or being easily startled.

It’s not known exactly what changes in the brain to cause the symptoms, or why similar experiences will trigger the illness in some people and not in others.

War is clearly a traumatic experience, but each war has its own kind of trauma.

“I think every single war era has its own challenges that makes it kind of unique for the people experiencing it,” said Marcotte, who also is an Army veteran who served in Somalia.

For Vietnam veterans, returning home to a hostile community added to the trauma. For Korean War veterans, the sense of simply blending back was a challenge.

The nine years of conflicts in Iraq and Afghanistan have presented other challenges. Because there is no draft, the burden is being borne by a smaller number of volunteer soldiers who have been deployed repeatedly into war zones.

“One thing we do know is that there is an increased incidence (of) post-traumatic stress disorder with (the) increasing number of deployments,” Bann said.

And the nature of the conflicts means servicemen and servicewomen have to be ready to defend themselves every minute. Enemies look like civilians and roadside bombs look like piles of litter.

That kind of readiness and being on edge cannot be immediately turned off when a veteran comes home to be with spouses and children and work in an office or factory. All veterans will go through a readjustment period, even if they don’t have PTSD.

“The majority of folks that come back from a combat zone are probably not going to have full-onset PTSD, but everybody is going to have to readjust,” Marcotte said.

Just how many new veterans will have PTSD will take years, even lifetimes, to find out.

“When folks come back, initially there is the tendency to want to get back with loved ones and family and present things as being fine,” Bann said.

In many cases, while family and friends can see the drinking or the stress, the veteran denies the problem.

“These are relatively high-functioning people to begin with,” Bann said. “They are also not very likely to identify with what they call or label weakness.”

Sometimes, a vet copes for decades before something triggers a flashback.

“There are many individuals that I’ve seen who are very high-functioning and who put their memories in the background and then, for whatever reason and nobody truly understands this, a memory may trigger this flood of information and it’s as though the 30 years in between never happened and that person is right back into that situation,” Bann said.

At the vet center in Sanford, “we are still seeing World War II vets walking in the door for the first time,” said Marcotte. They are seeking help with readjusting, although not necessarily PTSD, she said. “Sometimes it takes a while for people.”

The VA has enhanced the mental health treatment available at its health clinics, including those in Saco, Portland and other Maine cities, Bann said. Nationwide, the department has hired an additional 7,500 mental health professionals since 2005, giving it a total of 21,000.

For the past two years, the Maine Army National Guard has trained private mental health providers statewide to address PTSD and other conditions facing the veterans they care for.

And the veterans outreach centers in Sanford, Portland and other Maine cities also have expanded the readjustment services, including PTSD counseling, that they offer all war zone veterans and their families. Older vets who have recovered from PTSD volunteer at the centers, in part to give hope to the newcomers that the they can be treated.

The help also is free.

“The folks that come in and get services here earned this benefit a long time ago through their service,” Marcotte said.

Staff Writer John Richardson can be contacted at 791-6324 or at:

jrichardson@pressherald.com