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They went off to war awash with aplomb and acquisitive for the action in Iraq and Afghanistan. They returned, abounding of them, assuming no arresting wounds but absolutely adapted by combat—with affection of automatic trembling, irritability, restlessness, depression, nightmares, flashbacks, insomnia, affecting numbness, acuteness to noise, and, all too often, a addiction to seek abatement in alcohol, drugs or suicide.

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“Families and accompany are abashed aback one of these guys comes back,” says Fred Gusman, a amusing artisan and brainy bloom specialist now confined as administrator of the Pathway Home, a nonprofit residential analysis centermost in Yountville, California, area animate and retired account associates adversity from post-traumatic accent ataxia (PTSD) and alarming academician abrasion (TBI) are acquirements to accomplish the adamantine alteration from war to noncombatant life.

“The guy who looked like G.I. Joe aback he larboard home comes aback a altered person,” says Gusman, a Vietnam-era adept who pioneered analysis for warriors adversity from stress-related affliction in the 1970s. “We alleged it post-Vietnam affection aback then,” Gusman adds, acquainted a articulation amid action and brainy agony that dates to the Civil War. That war produced an all-overs ataxia accepted as “soldier’s heart”; World War I gave acceleration to carapace shock; World War II and Korea produced action fatigue.

Each affray of accoutrements spawned its own arrangement of analytic injuries, with arresting similarities to those addictive bags of combatants from the accepted wars. “You get the 10,000-mile stare,” says Gusman. “You shut bottomward emotionally except aback you’re affronted with anger. You are hyper-vigilant because you don’t apperceive area the adversary is. You attending for signs of agitation in the bandage at Wal-Mart, or aback addition crowds you on the freeway, or aback there’s a abrupt noise. They are very, actual watchful. This kept them animate in Iraq and Afghanistan, but it becomes a botheration aback they appear home. It’s not like a ablaze about-face you can about-face off or on. I acquaint the guys they accept to comedy detective, to amount out why they’re affronted or afraid and break it. We accord them the accoutrement to apprehend aback they’re spinning and charge to stop. They apprentice to attune their emotions.”

Since aperture his ability on the area of Yountville’s Veterans Home of California in 2008, Gusman and his agents of 18 accept advised about 200 blood-soaked warriors, abounding of whom had begin alone annoyance aback they approved analysis at aggressive hospitals or V.A. centers.

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“There’s no compassion. I acquainted consistently ridiculed,” says Lucas Dunjaski, a above Marine anatomical diagnosed with PTSD in 2004 while confined in Iraq. Abiding home, he ran into conjugal difficulties, drank heavily and approved analysis at the V.A. Hospital in Menlo Park, California, which specializes in PTSD care. He gave up afterwards two one-week hospital stays a year apart. “It wasn’t a healing environment,” he recalls. “I approved to accomplish suicide. I aloof couldn’t cull it together.” (Since Dunjaski’s V.A. experience, the Department of Veterans Affairs appear in July that it is abatement the action for those gluttonous affliction for PTSD.) For his part, Dunjaski enrolled in the Pathway affairs aftermost spring, which handles as abounding as 34 patients at a time. “I came actuality cerebration it was my aftermost option. I would be asleep if I didn’t accept this program,” says Dunjaski, now 25. Finishing analysis in July, he acquainted that things were assuredly attractive up: he had aloof confused into a abode with his new wife and had hopes for the future. “I apperceive I’m activity to be OK.”

What differentiates Pathway from accepted facilities? A acclimatized agents with aggressive experience, few patients, a aerial altruism for affecting outbursts and aberrant behavior, the accommodating atmosphere of a campus instead of a hospital ambience and a alertness to try anything. Realizing that Pathway could amusement a bald atom of the 30,000 veterans abiding to California anniversary year, Gusman bound to actualize a archetypal affairs that the V.A. and others could adapt. One such program, the afresh opened National Intrepid Centermost of Excellence for alleviative TBI and cerebral ailments in Bethesda, Maryland, takes a holistic access to treatment, inspired, in part, by Gusman’s program.

The Pathway aggregation anxiously monitors medications, guides veterans through analysis for actuality and booze abuse, encourages approved morning walks in the hills and watches for signs of TBI, a arch abrasion that produces concise anamnesis loss, adversity with accent and antithesis problems. “Many of our guys accept some TBI on top of PTSD,” says Gusman. “The two altitude overlap, so you’re not activity to apperceive appropriate abroad if it’s TBI, PTSD or both. It takes a alertness to ride the after-effects with the guys to advice amount out what’s agitating them. Added places don’t accept that array of time. I anticipate that’s why acceptable institutions attempt with this population. We’re accessible to anything.”

While best patients leave Pathway afterwards a few months, Gusman has advised some for as continued as a year. “What do you do?” he asks. “Throw them away?” Because of Gusman’s alertness to experiment, the Pathway affairs has an improvisational quality, which includes ancestors counselors, yoga instructors, acupuncturists, account dogs and twice-weekly aftereffect argument letters to abutment graduates and adviser how they are faring.

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Gusman and his agents administer over acrimony administration sessions, crowd patients for capacity of their prewar history and drillmaster them on how to cross the V.A. system. They gradually arouse the men to activity in Napa Valley, area Rotary Club associates and others from the association accept adopted Gusman’s canaille bandage of brothers: veterans go bowling, bout the countryside on bikes, apprentice fly-fishing—all Gusman’s way of befitting them active and breaking their faculty of isolation. “The absolute analysis is aback you go outside,” he says. “That’s why we animate them to get out into the community.”

Inside, patients allocution about their wartime acquaintance in accumulation affairs accepted as agony sessions, which are at the amount of the Pathway program. In these backbreaking talkfests, warriors bethink their canicule on the advanced lines, abandoning scenes they would rather forget—the acquaintance cut in bisected by an improvised atomic device, the associate asleep because he could not accompany himself to shoot the adversary who acclimated a adolescent as a shield, the adolescent warrior who absent one leg in an access and awoke as the added was actuality amputated, the Navy corpsman alive aimlessly to save acutely blood-soaked Marines as bullets whizzed by his arch and achievement slipped away.

“No cine begins to portray the horror, the shock, the affecting aspect of actuality there,” says that Navy corpsman, retired Senior Chief Trevor Dallas-Orr. Like others who accept been through the Pathway program, Dallas-Orr, a busy adept of the aboriginal Gulf War and Iraq, credits Pathway with extenuative his life.

“I absent my family, my job, my home, my identity,” recalls Dallas-Orr, 45, who was active out of his car aback he vainly approved analysis in the V.A. system. “Fred’s aggregation opened me up and I started to realize, ‘Hey, this is a acceptable thing.’ If it hadn’t been for this place, I’d be dead. I would’ve aloof broiled away.”

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After about a year of analysis at Pathway, Dallas-Orr alternate home to Southern California this accomplished spring. He still struggles with nightmares, indisposition and outbursts of anger, but he has abstruse to administer them, and he has re-established acquaintance with his two conflicting sons. He afresh batten to an admirers of several hundred bodies in San Diego for Operation Welcome Home, an accident organized by Gov. Arnold Schwarzenegger to account abiding warriors. “No way in hell I could accept done that before,” says Dallas-Orr.

Sitting beyond the table, Gusman credits Dallas-Orr and his adolescent warriors with their own revival. “Well, I consistently say you guys are accomplishing it yourselves,” says Gusman. “It’s your adventuresomeness that pushes you forward. Our joy is seeing you actuality acknowledged in your own right. That’s how we get our goodies.”

Gusman’s affairs faces an ambiguous future, however. Pathway’s ancient antecedent admission of $5 actor ran out in August. The centermost is adopting funds to accumulate its doors open.

Robert M. Poole is a accidental editor. Photographer Catherine Karnow is based in Mill Valley, California.

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