CALGARY - Sometimes the wounds sustained on the battlefield aren't visible at all.
As Canadian soldiers continue to hunt on foot for the Taliban in southern Afghanistan or face yet another suicide bomber while on a convoy, it's not just the number of dead and wounded that rises.
Many of those who watch their friends and comrades being killed or hurt are themselves left with psychological wounds that may haunt them for a lifetime.
Some already realize that the readjustment at home is going to be difficult.
"You wonder if you're going to be normal. I know I've caught myself wondering if I will ever be the same again," said one member of the Princess Patricia's Canadian Light Infantry in a Christmas Day interview with The Canadian Press in southern Afghanistan.
"I wonder sometimes how I'll adjust to not being able to kill guys when they piss me off."
The soldier is a gunner on an LAV (light armoured vehicle) stationed on the front lines in the Panjwaii District, once a stronghold of the Taliban. He is scheduled to return home this month, and said his biggest fear is that he feels nothing about those he has killed.
"You wonder why it doesn't bother you to see bodies explode or chopped to little pieces by a machine gun and know that you did it."
That feeling of numbness, along with anger and an inability to cope, is a common symptom of post-traumatic stress disorder.
Once known as shell shock, its sufferers were originally viewed as cowards. But that has changed dramatically over the past 10 years, and it's now accepted that psychological wounds are as debilitating and can ruin a life.
"It was surprising to find how impaired patients are with chronic complex post-traumatic stress disorder in areas of functioning interpersonally, within families, within relationships and with motivation," said Dr. Stephen Boucher, a psychiatrist at the Carewest Operational Stress Injury clinic, which treats military veterans suffering from the disorder.
"A lot of people haven't been sleeping for years," added clinic leader Dr. Harvey Smith, a psychologist who spent 20 years in the military.
"They haven't had any appreciable sleep at night, and then there are the nightmares."
Ninety-three patients have been referred to the Calgary clinic since it opened last April. About a third are over 65 and veterans of the Second World War and Korea. The majority are still suffering from missions to Bosnia, Cypress, Rwanda and Haiti. There have been none yet from Afghanistan, but it's just a matter of time.
Some soldiers are already having problems. In a submission to the Senate committee on national security and defence last week, the commanding officer of the Calgary Highlanders expressed concern about reintegrating returning reservists back into regular life.
"When they come back as reservists, it's very difficult for us to determine if they are suffering from any kind of post-traumatic stress, because we only see them for a couple of hours a week," explained Lt.-Col. Tom Manley.
"We don't know what they're like for the other 6� days of the week," he said. "In a case where one of our soldiers committed suicide at this time last year, the regiment mobilized by itself and found that soldier's body, but we're experiencing some kickback on that."
Manley said two of the soldiers involved in the search are now suffering themselves.
It's not just the battlefield that can bring on the disorder - just being away from home and in a dangerous locale can wear anyone down.
"The organism is stressed by dehydration, by noise or multiple factors, and that may make someone more prone to develop post-traumatic stress disorder," Boucher said.
"If I take anyone off the street and subject them to enough environmental stress, I can make them ill."
With 2,500 soldiers on extended tours of Afghanistan, the stress on both regular force and reservists is likely to take its toll in the coming years. It only makes sense, say the doctors, that more soldiers will be looking for help.
"I think just with the greater numbers I would say that," said Smith.
"We don't really know, but Veteran Affairs and DND will say 10 per cent of persons coming back from combat operations will incur some long-term mental health issues that they have to deal with."
