Boston Globe

IRAQ VETERAN Daniel Cotnoir learned that Baghdad rules don't apply in Lawrence (Mass.). The former Marine sergeant, who was named 2005's ''Marine of the Year" by the Marine Corps Times newspaper, was charged earlier this month with two counts of armed assault with intent to murder after firing a shotgun near a crowd of revelers outside his home. He had already reported their noise to police and, when a glass bottle shattered his bedroom window, Cotnoir allegedly feared for the safety of his wife and children.

As a Marine officer from 1999 to 2003, I led platoons in Afghanistan and Iraq. Following two combat tours, I left active duty to go to graduate school, thinking I could seamlessly return to normal life. But even with a loving family, supportive friends, and solid future prospects, homecoming derailed me for a year. I woke up to nightmares, shook uncontrollably during Fourth of July fireworks, and felt myself switch into ''combat mode" when challenged. After a driver cut me off on my morning commute and I envisioned gutting him with my car key, I recognized classic symptoms of post-traumatic stress disorder.

According to the American Psychiatric Association, the disorder may result when people survive events ''that involved actual or threatened death or serious injury." Combat stress disorder, in its simplest form, is the persistence into civilian life of behavior that was necessary to survive in battle: hyper-vigilance, fear of crowds, aggression.

None of us can know what Cotnoir was thinking before he pulled the trigger, but he is certainly an eligible candidate for the stress syndrome, and I see in his actions the anguish I felt after my own homecoming. What makes this so tragically significant is that Cotnoir is not alone.

A study at the Walter Reed Army Medical Center in Washington found that at least 17 percent of Iraq veterans experience anxiety, depression, or post-traumatic stress disorder. 425,000 American troops have served in Iraq since March 2003, which means that more than 70,000 may be suffering from psychological trauma. Indeed, its visible manifestations are growing. The divorce rate for Army officers has tripled in the past three years, and the National Coalition for Homeless Veterans reports that its affiliates helped 67 veterans of Afghanistan or Iraq in 2004.

Some studies indicate that virtually everyone who experiences trauma experiences some difficulty with traumatic stress. Post Traumatic Stress Disorder is a highly specific diagnosis, so specific that many people who are disabled by the trauma don't fit the diagnosis. That's, in part, appropriate given that traumatic stress often serves as the triggering event in a major mental illness. Repeated trauma can lead to the chronic maladjustment of personality disorders. How ever some people recovering from trauma fit into the DSM IV-TR diagnostic criteria of Adjustment Disorder, Panic Disorder or Generalized Anxiety Disorder but not PTSD. That is a problem because the diagnosis doesn't carry with it the presumed cause and that can present a problem in future treatment episodes. The roots of the problem can get lost in the pile of paperwork and a client's understandable reluctance to discuss the details of his/her history over and over again.

My own professional practice suggests traumatic stress is the number one reason a person seeks treatment. In other words, trauma is either a precipitant or a major part of a treatment seekers mental health history. We need a better understanding of the effects of traumatic stress and research on effective treatment. Traumatic stress certainly warrents more attention in the DSM standards of diagnosis.

NAMI | Support the Goals of Mental Illness Awareness Week

In 1989, Congress designated the 90's as the "Decade of the Brain" and proclaimed the first week of October as Mental Illness Awareness Week (MIAW) as a means to increase research and public awareness on issues related to mental illness. On this, the 15th anniversary year of Mental Illness Awareness Week, I am writing as your constituent to ask you to work for policies that achieve equitable services and treatment for the more than 15 million Americans living with severe mental illnesses and their families.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Mental illnesses are the leading cause of disability (lost years of productive life) in this country. Yet, according to the President's New Freedom Commission Report, America's mental health system is "in shambles." Much progress has been made during the last 15 years in the scientific research on the genetic and biochemical causes of mental illness. But I am very alarmed that, despite this new research and evidence, most adults and children are still denied access to the help that they need.

I am an active supporter of the National Alliance on Mental Illness. NAMI is one of the most effective voices for the rights and needs of people affected by mental illness.