What awaits at home?

They are our “heroes.” So we say about America’s fighting men and women in Iraq.

Just look at all those “support our troops” ribbons. Even in the angry debate over the war the warriors don’t get roughed up in the middle of these arguments very often. Or visit Iraq and witness the arriving mountains of care packages and well-wishes sent to troops from families, friends and multitudes of strangers.

That’s today.

But what about tomorrow?

When Johnny and Jane come marching home, what awaits them in this country that sent them to fight a long-running, grinding and divisive war on the far side of the world?

We should be concerned.

I say that not just because experts are concerned. I’m concerned; I have reason to be. I put this account in personal terms because 36 years ago I came home from a distant war wearing the uniform of my country.

The back of the civic hand landed like a slap in the face. Many memories from my youth have faded, or at least softened. Not this one. I still feel the sting of Vietnam from time to time.

My country grew to doubt me, occasionally fear me. That’s because in the background, a question rose up and hangs over me to this day.

Not everyone asks it, of course. And it isn’t personal -- it shadows the lives of all of us who took the long trip into the anguish of a war that Americans watched on their televisions until they could bear it no more.

Was I, to call up the most frightful phrase of my generation, “a baby killer?” Would I have violent “flashbacks?” Had I seen and done things that churned in the dark corner of my soul, someday to burst forth for everyone to read about in one of those telling parenthetical phrases that pop up in the newspaper?

The phrase I have in mind goes like this: “John Balzar, a former Marine and Vietnam veteran, yesterday ... “

We all know that what follows in that sentence would not be good. That phrase would not lead into a story about a philanthropic contribution or career achievement. It would appear only if I went berserk and committed some awful deed, or made some belated confession, that lived up to the stereotype of the unstable, hair-trigger Vietnam veteran.

So why am I apprehensive about the welcome, and the future, awaiting this new generation of heroic Marines and soldiers and sailors and airmen? Because I have on my desk an inch-thick stack of news reports that are, or at least could be, planting seeds of the same stereotype. It is a collection that grows taller and more unsettling by the week.

I’ll quote a phrase from the first paragraph of a recent news account from this newspaper: “ ... growing mental health crisis among troops who have fought in Iraq....” Here’s the New York Times: “ ... suffering serious psychological problems as a result of combat duty in Iraq....” The San Francisco Chronicle: “ ... as many as 100,000 new combat veterans nationwide will suffer from mental issues ranging from depression and anxiety to the more debilitating post-traumatic stress disorder, characterized by angry outbursts, flashbacks, nightmares and hyper-vigilance .... “ From U.S. News & World Report: “... those returning from Afghanistan and Iraq are facing a host of service- related psychological problems ....” CNN: “ ... those invisible scars of war ....”

The list goes on. The U.S. Department of Veterans Affairs has been backlogged for months with interview requests from journalists eager to explore the story.

I know something about the eventual impact of loaded words like those being used today. I can still get a rise out of a stranger if I’m feeling devilish. I’ll look the person in the eye and I’ll say, “I was a sergeant in the Marines in Vietnam. And, you know, I haven’t had a flashback -- yet.”

Today’s heroes are in danger of becoming tomorrow’s damaged goods.

If this image of mentally troubled Iraq and Afghanistan combat veterans gels without challenge, without sober civic reflection about the implications, the troops who serve in that war could pay an unwarranted toll, in ways large and small, perhaps for the rest of their lives.

There are about 8 million veterans of Vietnam who can tell them how. As one of them, I’ll say that it’s not fair.

Societal stigma

WHAT is occurring today in wartime America can be described as the convergence of two powerful truths: a collision of psychology and sociology. The result is the most obvious kind of chain reaction.

Psychology has made far-reaching advances in the study, diagnosis, labeling and treatment of stress-induced mental conditions. Sociology, meanwhile, has made strides explaining exactly what happens when society imposes stigma on an identifiable group of people.

Combine the two with the explosive ingredients of violence, war and a “mental health crisis,” and innocent people are bound to get hurt.

To take the sociology first: In the 1950s, the term “labeling theory” was devised. To simplify it, labeling theory explains that if you call your children stupid, they are apt to think of themselves as such and actually grow up that way.

“This has profound effects for veterans of Iraq,” says Barry Glassner, professor of sociology at USC and author of “The Culture of Fear: Why Americans Are Afraid of the Wrong Things.”

Among the potential consequences: veterans’ success at employment, romance, social standing and, yes, their mental health -- that is, truly important things in life.

Labeling theory can be seen at work in all varieties of human interactions, from the most obvious, like law enforcement “profiling,” to more subtle, if no less insidious, social judgments.

For Iraq veterans, a case in point could be employment. If society accepts the label that men and women who served in Iraq are part of a group suffering widespread mental problems, they are likely to meet resistance when they seek jobs.

“If you are turned down for a job because you might be unstable, it’s going to have an ongoing effect on your life,” Glassner says. “Having been turned down, you will become less employable. You will suffer diminished self-esteem. You will be angry.”

The label “trouble” induces troubles.

In myriad other ways, veterans could face problems, regardless of whether they had problems to begin with.

“Exactly the same behavior by two different people will be perceived differently if one of them is from a group suspected of having a higher incidence of mental illness,” Glassner says.

Today, veterans organizations and other champions of those serving in the military are buoyed by public attitudes. Politicians, marketers and other opinion-shapers seem bent on outdoing each other in praise of military veterans.

Yet, Vietnam offers a lesson. Doesn’t it always? Public opinion can be fickle.

When I returned to California after the Tet offensive in 1968, the stigma of the veteran had barely begun. It was still possible to get free drinks and a handshake at mere mention of being fresh home. Over time, the reaction grew chillier -- the benefit of the doubt given veterans gradually losing out to just plain doubt. That has not happened this time. But I’m not the only one who hears a distant echo of My Lai in the words, Abu Ghraib.

I wasn’t alone in wincing when one of the most celebrated commanders of the Iraq war, Marine Corps Lt. Gen. James N. Mattis allowed that, “Actually, it’s a lot of fun to fight. You know, it’s a hell of a hoot. It’s fun to shoot some people ....”

Lucky for him, Mattis doesn’t have to go job hunting in a year or two. But many of his Marines will.

Perhaps contemporary politics offers a lesson, too. In our polarized nation, majorities are fashioned out of small shifts in thinking.

Already, Americans have read news accounts of a 19-year-old Marine accused of ambushing and shooting two police officers in Modesto -- his service in Iraq central to speculation as to his motive.

When stress persists

Meanwhile the psychology: There’s plenty of the obvious at work here too. Exposure to violence is stressful. Living under threats to life and limb for months at a time is stressful. Having to make instantaneous decisions with your finger on a trigger is stressful. Being away from home, enduring the death of friends, being wounded, living with the noise and screams and the perpetual wary anticipation -- all are stressful.

In the 1980s, the consequences of these kinds of stress was given an official medical designation: PTSD, post-traumatic stress disorder.

A mountain of scientific literature now exists to attest to this malady. And researchers are quick to note that it is not a new condition, but beset humans long before it was given a diagnostic name. In previous wars, the mental toll of combat was described as “battle fatigue” or “shell shock.”

PTSD can be and usually is a manageable matter: an emotional plunge after exposure to a shocking experience. Recovery can be quick and complete.

In exploring the topic recently in an article titled “Get Over It,” the New Yorker writer Malcolm Gladwell concluded: “ ... human beings are naturally endowed with a kind of psychological immune system, which keeps us in balance.”

On the other hand, the mental consequences of traumatic stress can last a lifetime -- and sometimes destroy lives in the process. Alcoholism, social isolation and drug abuse are only some of the consequences.

According to the National Center for Post-Traumatic Stress Disorder, 10% of all the women in America and 5% of men qualify as having had PTSD. Those numbers rise in parallel with repeated exposure to stress, as in, say, combat.

A study by the Walter Reed Army Institute of Research, published last summer in the New England Journal of Medicine, found that about one in six Army and Marine Corps veterans of Iraq “met the screening criteria for major depression, generalized anxiety, or PTSD.” This study and subsequent medical speculation that the numbers may eventually grow are the basis for news accounts of the impending “mental health crisis” for Iraq war veterans.

For an individual who has nightmares or adjustment problems with family or a bad case of jittery nerves, the return home may feel very much like a crisis. But for society at large, crisis may be too charged a word.

“I’m not sure we have a crisis. Most people with PTSD function very well, and if anything they are over-controlled,” says Matthew J. Friedman, executive director of the National Center for Post-Traumatic Stress Disorder and professor of psychiatry at Dartmouth Medical School.

The stereotype of the combat veteran as society’s damaged goods, he continues, “is a shoe that doesn’t fit.”

The diagnosis of PTSD is similar to learning that someone has high blood pressure or diabetes. “It says nothing about severity, nothing about a person’s ability to function,” Friedman says.

‘Not damaged goods’

Still, the phrase “mental disorder” has deep stigma for the veteran. The Walter Reed Army Institute study found that soldiers and Marines who most needed mental health treatment after serving in Iraq were the least likely to seek it, proving that they might be troubled but they aren’t crazy.

They know, as Friedman puts it, “that a scarlet P could doom their careers.”

“These folks are not damaged goods,” says Tom Berger, chair of the Post-Traumatic Stress Disorder Committee of the Vietnam Veterans of America and a human development specialist on the faculty of the University of Missouri, Columbia.

You can almost hear the shudder in Berger’s voice. “This is a mind-set that we must avoid.”

Mental health experts find themselves attempting a difficult juggling act with Iraq’s combat veterans. With unprecedented determination, doctors are urging troops to seek help, to open up to the swat teams of counselors that the armed forces have dispatched to the battlefield.

To a lesser degree, these experts find themselves trying to reassure the rest of us about veterans lest there be an overreaction to reports of the war’s toll.

How society collectively greets and treats overstressed veterans, now and in the years to come, is one of the most significant factors in whether they heal and how quickly, medical experts agree.

“One of the major determinants is the recovery environment,” Friedman says.

In fact, Friedman and others say this is the only variable that can be controlled. Veterans have no choice in the matter of their parents and the environment in which they were raised. They have no say about the circumstances of battles they endure. When they come home, all they have is their own mettle, their families and the judgments of society -- the three being intertwined.

Evidence of the fact requires only a moment’s reflection on wars past.

Veterans of World War II endured combat every bit as brutish as anything since -- in many cases, far worse and for longer sustained durations than today’s fighting men and women. Medical experts are virtually unanimous in believing that these veterans suffered, and still suffer, their share of mental health problems, including PTSD.

Coming home, their sacrifice was honored as great. They were given latitude for their lapses. Their needs were met with helping hands in the sincere social belief that they deserved it. In turn, they gave us “The Greatest Generation.”

It hardly seems necessary to dwell on Vietnam by way of contrast.

For me, the latest installment of the melancholy story can be heard today when two veterans meet. Upon learning they both served in Vietnam, they offer each other the ritual words, “Welcome home.”

Veterans of Iraq? The tough slog doesn’t end with the return flight out of Baghdad. They face us now.

Will they encounter friend or foe in the readjustment battle? Will they wind up with mental health or mental trouble in the years ahead?

“They should not be looked at with a suspicious eye,” says Michael O’Rourke, assistant director of veterans health policy at the VFW, Veterans of Foreign Wars.

I’ll do my part. I’ll be looking for the chance to offer my editors a story that begins something like this: “A former Marine who served two tours in Operation Iraqi Freedom was chosen parent of the year yesterday ... “