During and since the Vietnam War, American combat leaders developed a policy and personal commitment of never leaving a warrior on the battlefield. Living, wounded or dead, every effort is made to physically bring our warriors home. Psychologically, we have not achieved that goal. Far from the bullets, explosions and death, the victims of what is now being identified as post-traumatic stress disorder are still living the battles and suffering the results of their experiences. Rather than decreasing from Vietnam numbers, the PTSD casualties from America’s Global War on Terrorism has escalated at an alarming rate.

Wounds resulting in loss of legs, arms and other parts of the body are immediately identifiable. The unseen wounds are more difficult. It took a long time to realize the seriousness and extent of brain injuries resulting from explosions. Even more difficult to identify and address is traumatic stress. No physical exam or X-ray can detect it. It is not a simple problem with an easy one-cure-fits-all solution.

The tension of combat deployments, hostile engagements, loss of teammates, physical and mental injuries, separations from families, memories of what was left behind, exhaustion from never-ending hours, and adjustments of returning home have produced a significant number of long-term and permanent impacts on America‘s warriors. Meanwhile, the families who had not seen the warriors for months were going through stresses of their own. Reintegration can either be mutually supportive or create more problems.

Coming out of combat, it is very common for a warrior to experience three phases: sheer exhaustion, inability to focus and concentrate, and feelings of guilt about being safe while fellow warriors continue to fight, bleed and die. Overlapping and mixed throughout are anxiety, frustration with oneself and others to the point of sudden or enduring anger, and a host of other reactions.

To varying degrees, these reactions have the potential to affect all warriors, regardless of their rank. These feelings can further intensify when fellow warriors are killed or seriously wounded in combat. Within the survivors, the event itself can be over-analyzed until it takes on a life of its own. The guilt of surviving can consume the PTSD victim no matter how many successes were achieved. Simply put: “When you beat the enemy, you feel good about it. When he beats you, you live with it.” Easing of this doesn’t pass quickly. Sometimes it takes years or not at all.

The military’s difficulty in dealing with PTSD has not been through lack of trying, but rather a lack of understanding. In many cases, well-intentioned efforts have been counterproductive. Cast upon many PTSD victims for decades were prescriptions of anti-psychotic and anti-depressant drugs. The drugs only masked problems suffered by PTSD victims and were successful only about 5% of the time. On the reverse side, these drugs sometimes caused warriors to spiral further out of control. The same truth applies to PTSD victims “self-medicating” with alcohol and illegal drugs. No intelligent decision ever came out of the use of either.

The best successes have been achieved through alternative methods of stress reduction and refocus of energy. These are nothing new. World War II fighter pilots formed motorcycle clubs. Vietnam veterans stationed in Germany became involved in Volks (Peoples) March events hosted every weekend in multiple communities throughout the country. Martial arts programs channel inner energy not just to build physical skills, but to teach patience and self-discipline. Programs have been developed to bring veterans to ranches and farms. Caring for animals and working the land have a special medicinal capability that can’t be found in any prescription or alcohol bottle.

In 2005, U.S. Army Walter Reed Medical Center developed an effective program. Now nationwide, Project Healing Waters Fly Fishing Inc. has expanded to other Department of Defense hospitals, Warrior Transition Units, and Veterans Affairs medical centers and clinics. This was clearly out-of-the-box thinking that combined psychological therapy with a skilled hobby. Once an idea, it is now a nonprofit organization with 6,458 volunteers. In 2023, 6,056 veterans representing all services benefited from the program. Coaching on all aspects of fly-fishing is provided. But it is the veterans who go out, practice those skills, and focus their energy.

Hundreds of other programs are now in existence to help PTSD victims. It should be no surprise that some of the most successful therapy programs involve outdoor activities. Nature has a beauty and a tranquility that cannot be found elsewhere.

Just as there is no one-cure-fits-all solution, no one activity will satisfy all needs. Everyone is different and has different interests. What are common denominators in these programs is that each creates an environment where internal energy can surface and desire to heal can succeed.

Like physical wounds, psychological cuts don’t heal unless properly attended. American warriors have earned the right to receive our nation’s support in helping them overcome the negative impacts on their lives, especially when considering it is a result of their answering the call to duty.

Wes Martin, a retired U.S. Army colonel, served multiple combat assignments in Iraq, to include as Senior Antiterrorism/Force Protection Officer for all Coalition Forces.