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Sgt. Loyd Sawyer joined the Army to bring honor to death.

For years, he had worked as a funeral home director, and his children learned that death was part of the normal cycle of life — that it's good to mourn for a loved one, and that there was no reason to fear the bodies their daddy embalmed in a workroom of their home.

But then he spent six months working at the morgue at Dover Air Force Base, Del. And then six more months in mortuary affairs at Joint Base Balad in Iraq.

After that, Loyd no longer saw death as part of a natural cycle.

The faces of dead service members began to haunt his every minute. Awake. Asleep. Some charred or shattered, some with faces he recognized from life, some in parts.

Once, after an aircraft crash, Loyd spent 82 hours lining bodies side by side, the burnt remains still so hot they melted through the plastic body bags.

He took the images home with him, each of the dead competing for space in his mind. He spent hours crying on his family room floor, weeping as his dog Sophie licked away his tears, the only living comfort he could bear.

He pulled back as his sons moved in for hugs and his wife sought the snuggles they had shared daily, hourly, in the past. He lashed out with angry words to increase the distance. He had known his wife, Andrea, since they were each 16, but now he couldn't even touch her.

They would never understand what he had been through. No one would. Loyd was living a nightmare. And now his family was living one, too.

One among many

To date, 106,726 veterans of the wars in Iraq and Afghanistan have been diagnosed with mental health issues after leaving service, according to a Department of Veterans Affairs study published in the September edition of the American Journal of Public Health.

Of those, 22 percent have been diagnosed with post-traumatic stress disorder. But the actual figure is probably higher. That number doesn't include troops still on active duty or veterans who have sought care outside VA channels. Many veterans don't come forward for fear that a mental-health diagnosis may harm their post-military careers; active duty members worry about being stigmatized or accused of malingering if they seek help or are diagnosed with PTSD.

Many don't even realize they've changed. Symptoms can be subtle, and may intermingle with a variety of other diagnoses, such as anxiety, depression and even traumatic brain injury.

A soldier can't concentrate; a Marine is overcome by a general sadness that never seems to lift; an airman refuses to sleep to fend off nightmares; a sailor replays scenes from the battlefield over and over in his mind. PTSD is caused by exposure to a traumatic event involving intense fear, horror or helplessness, usually involving death or serious injury to oneself or someone else.

Symptoms come in groups:

• Distressing recollections —nightmares and flashbacks.

• Avoiding any thought of the event, inability to recall the trauma, avoiding activities that used to bring pleasure, feeling detached or estranged from others and an inability to love.

• Difficulty sleeping, increased irritability or outbursts of anger, and hypervigilance.

If one or more symptom from each group lasts longer than a month, according to the Diagnostic and Statistical Manual of Mental Disorders,it warrants a diagnosis of PTSD.

The hardest part is it's "not visible," said Audrey Burnam, lead author of a recent Rand Corp. report on caring for veterans with PTSD. "They're not things you can tell by looking at the outside of a person."

Getting troops to come forward is hard, admits Army Brig. Gen. Loree Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. But doing nothing is worse.

"Stigma kills," she said. "It's a deadly workplace hazard that must be eliminated. Our efforts right now are really aimed in that direction."

Trauma affects everyone differently. Some may have a genetic predisposition for PTSD; others may have trauma in their past that contributes to how they might react later.

And some people just see too much. Troops who work in mortuary affairs in Iraq serve six-month tours, rather than 12 months — an institutional effort to minimize the mental stress these jobs impose.

Most service members who lose a limb or face another serious injury deal with at least some symptoms of combat stress. One rocket attack can cause severe mental distress in some people, while others remain symptom-free even after 15 months of intense battle and loss. And sometimes, a person feels fine for months or years before the first symptoms of PTSD appear. Doctors rely on a service member's words and feelings to make a diagnosis. Even so, recent research shows different brain activity in those diagnosed with PTSD, raising the possibility that the traumatic event itself may cause physical changes to a person's brain chemistry.

'I'm bottled up'

A few years ago, Loyd Sawyer was known for his Southern-style storytelling and silly sense of humor. Every weekend, the Sawyers' townhouse in Colonial Heights, Va., filled with friends who felt the pull of Andrea's homemade chili and Loyd's need to make everyone feel at home.

"I was just taking care of my soldiers," he said, grinning at the memory. But after his time at Dover and in Iraq, having too many people around caused a sensory overload. He felt trapped, or angry, or overwhelmed. He could no longer enjoy his friends, family or his old way of life.

His PTSD, combined with back injuries and a traumatic brain injury, eventually would lead to his medical retirement from the Army in September 2008.

The problems began at Dover, in 2005. His job included assembling ribbon racks for the deceased, inevitably including Purple Hearts and often Bronze Stars, and putting together their uniforms.

On his days off, he would help embalm. The main embalmers would work on the bodies. Loyd would handle body parts. A Marine's right arm, identifiable by his Semper Fi tattoo. A foot. Skin from a face that he had to lay flat on a table.

He started to drink heavily — as much as a fifth of liquor before going out to drink more with friends.

When he returned home to Fort Lee, Va., Loyd quit the heavy drinking, but he didn't share his feelings with Andrea. As the wife of a funeral director, she had been used to listening to him talk about the details of his days. Now everything had changed.

"I wasn't supposed to discuss what I saw" at Dover, Loyd said. "You're not supposed to talk about people's personal trauma. Before, I'd get somewhat emotional. Now, I'm bottled up. I think it's a choice."

He fears that allowing any emotion to surface will bring all the pain and sadness and fear straight to the top. So he keeps himself numb — not happy, not sad. As life moves around him with all its good and bad, Loyd stays stuck in neutral.

In the summer of 2006, he headed to Tallil, Iraq, where a mortar destroyed a living unit near his. Soon after, he moved to Balad. His second night there, a mortar round that had been shot down busted out the windshield of the van he was in. Then a Turkish airliner crashed about 1,000 meters from his mortuary affairs unit, traumatizing them first with the horror of the crash, and then the misery of the recovery. For 3½ days, he and his team lined up 35 bodies in a parking lot to prepare them to go back to Turkey.

"When I got to the hospital, some of them were still smoking, pieces of arms and legs burned through the bags," Loyd said. "I loaded as many as I could in our little box truck [to take to the morgue]. I went back and got another load. And another load. It was human bodies in every imagined condition. They were smashed, torn apart, burned. A lot were soaked in diesel fuel."

For that, he earned an Army Commendation Medal and nightmarish images he could not stop thinking about.

His job in Iraq was to prepare bodies for eventual return home to Dover. He picked them up from the hospital, brought them back to the morgue, itemized all their belongings — searching through pockets and wallets for letters and lucky charms and sensitive items — and then put them in a bag and onto a flight.

If a vehicle had to be scrubbed of human remains before going to the scrap yard, Loyd took care of it. He became so sensitized to the smell of decay that he could tell if there was something in a truck without even looking.

"It's a very distinct odor," he said. "Even for a very small piece of bone."

A few times, he was called in after a service member committed suicide. "It'd be blood and guts and parts everywhere," he said. "You can tell when someone sticks an M-16 in their mouth. I was determined to come home. I saw too many people commit suicide over there that I had to go scrape up."

But when he got home in early 2007, he said he began to find himself thinking about joining them. He took to screaming at his family, pent-up rage seeking an easy target.

The Sawyers took a trip to Disney World — a vacation meant to bring the family back together. But Andrea said her "gentle giant" grew so agitated that she locked her two boys, Caleb, then 6, and Noah, then 5, in a hotel bathroom with her as Loyd raged over the children's inability to sit still as they watched cartoons.

Loyd said he hated "every minute" of the vacation — constant crowds with no escape, the happiness that pervaded the place flying in the face of the death he had seen, his family demanding his attention.

"I made it miserable for everyone," he said.

Downward spiral

Andrea thought it would take some time for her husband to recover, but fully expected that he would. But the nightmares scared him so badly that he couldn't sleep. Without sleep, his body and mind could not regroup. The guilt from simply being alive caused him to dread existing at all. And how could he stop thinking about those faces? To forget them would dishonor them.

Andrea moved her boys out of the home they shared with their father when she realized they might come home one day to find Loyd dead.

Indeed, Loyd began to believe he might find peace by joining the ghosts that seemingly had staked a permanent claim in his mind.

He began waking up in the middle of the night soaked in sweat. The scent of diesel exhaust or blood in the meat section of the market would jerk him back to Iraq. If he heard fireworks or a car backfiring, he wanted to run.

More subtle and puzzling to his family, he seemed to have no filter for what might come out of his mouth at any time.

At a family-style restaurant, he watched as an overweight woman added food to her plate and then heard himself say, "Lady, you're fat. You need to push yourself away from that buffet table."

He knew he was embarrassing himself and Andrea, but he could not find the kind man he had been before Iraq.

"Things just come out of my mouth," he said. "Sometimes it's like I'm standing next to me looking at this guy saying this stuff, like, 'My god, what is this guy thinking, saying that?' "

In his nightmares, he's the one who blows up. "Pieces of me going here, there, everywhere," he said.

Driving down the road, he has flashbacks.

"Have you ever been watching a movie and you get a blip — a frame or two?" he said. "It might be that. Or it might be just like you changed the channel. You see something, and you're in the desert. Everything changes. Reality's gone. You have switched the TV channel."

Loyd compared a flashback to having a movie play in his head, and that's all he can see, rather than the reality around him. His heartbeat speeds up; he begins to sweat; he's ready to fight.

"A sound, a smell, a word, a name — there's so many things that can cause me to relive those experiences," he said. "I'm there. Literally, it is happening again."

Perhaps the hardest part, for Loyd, is the guilt.

"Do you want to feel guilty?" he said. "Do you want to feel sad? I saw a lot of bad things over there. I think you're wrong not to feel bad. I felt like I was betraying those soldiers by saying I'm not going to care about that anymore, that I'm not going to think about that anymore. I felt like I was giving up on them, or betraying their memories by thinking I'm going to forget your face because it was half-blown off."

But he recognizes that feeling that way also makes him feel as if he's betraying his family.

"It's hard for my children to understand why I act the way I do," Loyd said. "Why I don't feel like going out and playing sometimes. It's sad."

His youngest boy, Noah, didn't remember Loyd before Iraq, so when Loyd acted angry, Noah just ignored him. Some days, they did not speak at all as Noah went to Andrea for all his needs.

It was different for Caleb, a year older.

"He's always been more tuned in emotionally to how you're feeling," Andrea said. "So that made him very nervous and anxious. Caleb always wanted to cuddle and hug. He'd say, 'Daddy? Are you OK?' Loyd would say things that were off-putting."

She tried to give Loyd basic direction: Get out of bed. Put the kids on the bus. But sometimes, as soon as she left the house, Loyd went back to bed and left the boys to get themselves off to school. Other times, he would head straight for the couch, open his laptop computer, and ignore the children.

Often, he would spend a whole day — and night — checking buddies' social network pages, downloading movies or looking up war tales.

His family could not breach the wall he built around himself: Don't talk to me. Don't touch me.

How long?

Andrea remembers, longs for the way Loyd used to be, when nothing much upset him.

Then, "he really saw the good in people," she said. "He came back very cynical, very sarcastic, and very, very angry — all the time. He was always very snuggly and cuddly, and he did not come back that way."

Soon after his return, he became so enraged because the Internet was not working quickly enough that he beat on the computer desk hard enough to send the keyboard flying.

"That was the only day since I've known him that I was physically scared of him," Andrea said. "I was terrified."

If she tried to talk with him, he responded with cursing or nasty comments — anything that might push her away.

"Right from the beginning, it was anger," she said. "Full-blown. I had only seen Loyd get really angry two or three times before that. But when he came back from Iraq, it was explosive and it was two or three times a week."

She didn't know where to go for help. None of the other spouses talked about their problems. No one told her how long it would last. No one said she might have to choose to leave.

"It kind of isolates you," she said. "No one tells you that you're going to have to make hard decisions. When he's yelling and he's cussing at you constantly, when do you know that he's crossed the line?"

In other words, how long should she endure her angry husband in hopes that the good husband might return?

The family clearly needed help, but Loyd wasn't ready.

"There was nothing wrong with me," Loyd said. "Everyone else had the problem."

Besides, he said, if he asked for help, he might lose his security clearance.

"I wasn't going to go to mental health because that was going to ruin my career," he said.

So he lived with his fists constantly clenched. At night, he thrashed around in bed and even gave himself a black eye trying to escape from an unknown dream. Andrea had to remind him to take a shower and brush his teeth or he'd sit at the computer avoiding people and sleep.

"I was crashing and burning," Loyd said. "You could look at me and tell — my eyes were black where I wasn't sleeping. I looked horrible. I wasn't shaving well. My uniforms just looked bad."

One month after arriving home from Iraq, hoping to regain a semblance of normalcy, Loyd Sawyer finally sought help.

More on PTSD

Read more about the Sawyers and others in our series

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