I’ve been shot in the leg. I've been beat up. But that's pretty minor," says a 41-year-old American security contractor who spent four years in Iraq. "But when you get a vehicle blown out from under you and ambushed by six or eight al-Qaedas, it does tend to affect one a little bit."

With a broken back, two broken feet and neurological damage, the man, who asked that his name not be used, spent the next three months in hospitals in Iraq, Germany and America. But though he was physically on the mend by the start of this year, he found himself incapacitated. "I was having nightmares right off the bat," he recalls. "I couldn't do anything. Mostly, I'd just retreat to a room and not leave."

Post Traumatic Stress Disorder, or PTSD, is the persistence of debilitating psychological symptoms. It can include flashbacks and nightmares, increased arousal in the form of insomnia, anger and an inability to concentrate, and impaired personal relationships. Although lasting psychological damage from horrific experiences has been recognised since time immemorial, it is only since 1980, when veterans were still experiencing stress from the Vietnam war, that PTSD has been a formal psychiatric diagnosis.

By 2005 72,000 American veterans were receiving disability payments for PTSD. A study two years later estimated that 12% of American veterans from the wars in Iraq and Afghanistan suffer from PTSD. Thus far, 1.8m Americans have been deployed in those two theatres, implying 216,000 eventual cases.

Yet most PTSD sufferers are not drawn from the ranks of those for whom trauma is an occupational hazard: 5% of American men suffer from PTSD at some period in their lives. For American women, the rate is double that, mostly from exposure to such crimes as domestic violence and sexual abuse. Two in five rape victims are diagnosable with PTSD six months after the attack. "It can go on for ever", says Kathleen Brady, a professor of psychiatry at the Medical University of South Carolina who studies the disorder, "but even after 30 years, PTSD is treatable."

... contd.