On Aug. 4, 2009, Master Sgt. Jason Swain says he dumped all his medications into his hand. Cupping the little pile of pills, he flashed back to his brother's attempted suicide, and the image of his mother's pain-distorted face.
Every day, on average, 18 American veterans commit suicide. Through the haze of guilt and pain, Swain realized he didn't want to be one of them.
Swain's voice quivers as he talks, as if sobs are just one random memory away. But the 38-year-old's first words betray the nearly clinical training of the Army intelligence analyst he is.
"I've been here since Aug. 5, suffering from some bad complications from my PTSD, severe depression and suicidal ideations."
In the Miami Veteran's Affairs Hospital's Post Traumatic Stress Disorder ward, Swain is in the middle of a 14-week inpatient program.
In the wake of the shooting rampage at Fort Hood, Texas, Nov. 5, that left 13 people dead, allegedly at the hands of a fellow soldier, Army Maj. Nidal Hasan, soldiers who struggle with stress like Swain, have come back into the spotlight.
When he was posted in the 1st Cavalry in Fort Hood, Swain worked across the street from the site of the rampage.
"My first thought was there is no way that just happened at Fort Hood. I sat there watching the television as the reports got in and I actually got tearful, I actually sobbed," Swain said.
Everyone Is on the Front Line
Rates of PTSD, which may or may not have played a role in Hasan's case, along with traumatic brain injuries, are soaring, and are a leading cause of suicide among veterans and active duty troops, officials say.
By some estimates, as many as 40 percent of veterans of the wars in Iraq and Afghanistan suffer from one of the two, or both.
Veterans Affairs officials blame the dual hazards on multiple deployments and roadside bombs.
During the Vietnam War, said Dr. Daniella David, program director of the Miami Veteran's Affairs Hospital's PTSD ward, troops were only deployed for about 14 months during each four-year enlistment period.
Today, troops are often deployed twice in the same time span.
And because of the randomness of roadside bombs, or IEDs, everyone is, in effect, serving on the front lines.
"Soldiers who are not traditionally in combat roles, such as truck drivers, mechanics, cooks, who are on the road a lot, are very much exposed to combat experiences because they are exposed to IEDs," David said. "They are exposed to seeing dead bodies and civilians and enemy combatants getting killed."
According to David, there is no "rear" any more for U.S. troops in Iraq and Afghanistan -- there is only the front line.
As a result, she says, calls for help are up.
"I think it puts a little more pressure on us," she said, "but at the same time, I think it's something that we want to have happen in order to help earlier."
For Swain, it didn't happen early enough. Round-faced, with the paunch of a soldier who never had to run for work, he confesses that, as an imagery analyst, he'd never been in a combat unit.
But the violence came to him one August day in Iraq. He had changed the shift of one of his charges, 22-year-old Sgt. Princess Samuels. As she walked back to her bunk after her shift, an incoming mortar killed her.
PTSD Disrupts Family Life for Some Returning Troops
"For the longest time, I held myself responsible," Swain said as he sucks in what seems a gallon of air, "because I had changed her shift; if I hadn't changed her shift, she wouldn't have been in that spot when the mortars came in."
Swain was deployed back to Fort Hood, Texas, and then to Southern Command in Miami. He grew moody and distant from his wife and 8-year-old daughter. Plagued by forgetfulness, he ploughed ahead with work.
Tortured by memories of Samuels, now buried in Arlington National Cemetery, he worked harder to ensure his new troops were safe. But as he labored, he was stricken with the guilt of spending too little time with his family. Once he was home, all he could think about was work.
"A gap developed between me and my wife. It got to the point where I was a scary person, I'd ball up my fists, get red. I was not the same person that she had married, and was not the same father to my daughter."
Trying to Break the Silence Is Key
Victor Montgomery, whose book, "Healing Suicidal Veterans" was published this year, says most troops can't communicate what they're feeling, until there's a crisis.
"Sometimes troops have a hard crust around them. And even when they sit down for a psychological screening after a deployment, they often don't divulge what they're feeling and thinking. They're just trying to suck it up and get on with their lives," Montgomery said.
Healing active duty troops and veterans requires greater awareness and better trained counselors. Montgomery cites a Rand Corporation study that found 75 percent of veterans don't get the type of help they need.
A Vietnam veteran, Montgomery cites a startling fact: it's estimated that as many as 100,000 Vietnam veterans have committed suicide -- nearly twice the number of troops killed during the war.
I asked Swain why an 18-year veteran of the Army, an intelligence analyst with a lot to lose would risk going public with his story. Swain grew silent for a moment, then leaned forward in his metal hospital chair.
"One of my goals, without even realizing it, when I agreed to do this, was to let people know who might be suffering or know someone who is suffering that it's OK to come in and get help."
He paused for a second, then continued. "Because what you have left to live for is the rest of your life."