But on this Veterans Day, some of America's top military brass finally are showing signs that they recognize the magnitude of the problem. In fact, Army Chief of Staff Gen. George Casey recently named PTSD as "the defining military issue of our era."
The occasion itself was evidence that the military is finally breaking with its tradition of hiding or downplaying the real costs of war to the men and women who fight it. Casey spoke as part of a panel that followed the screening - at the Pentagon, no less - of "Wartorn, 1861-2010," an HBO documentary that traces evidence of PTSD back 150 years to the Civil War. The screening brought together military officers, professionals who treat PTSD, and soldiers and families who must deal with combat injuries that are no less real just because they are unseen.
The statistics are disturbing - 100,000 diagnoses of PTSD since 2000. More soldiers now commit suicide in Iraq and Afghanistan than die in combat. Those figures don't include the veterans who kill themselves at multiple times the rate of other people their age.
"Nobody is really unscathed," Col. Charles Engel, of the Center for the Study of Traumatic Stress, tells his interviewer, actor James Gandolfini, in "Wartorn."
Casey and other officers pointed to signs of improvement: The percentage of service members who avoid psychological treatment because of a perceived stigma has dropped from 90 percent to 50 percent. The Department of Defense now has 500 PTSD-trained therapists available to treat active-duty military, and the Veterans Administration has 3,000 to deal with veterans once they return. Families of soldiers facing deployment are invited to attend "family readiness" meetings to learn what to expect - although we wonder: How can any family be made "ready" for the experience of dealing with a loved one who will never be the same.
It's impossible to calculate the true cost of doing our duty to the men and women who did theirs, but we must pay it. That includes more education of officers, more research into modes of treatment, more effort to reduce the bureaucracy veterans must cut through to get help.
But while proper treatment can and does bring some healing to veterans with these invisible wounds, the trauma of war that caused them can never be truly erased. The best way to prevent combat-related PTSD is to engage in combat as little as possible, and only then for a good reason.
There is no better day than today to ask the ultimate question: Are the two wars the United States is fighting today worth what our veterans and their families have to pay for it? *