The dangers of war can never be underestimated, and they affect all veterans in a variety of ways. While an unfortunate number of combat vets return home with physical injuries, it is the mental ones which remain unseen that can cut the deepest.

We have perhaps become used to the sight of veterans who have lost limbs or been disfigured by their war experience, so a person with no visible scars or wounds can read as one who has been untouched by that terrible trauma. Combat vets have corroborated this, agreeing that being visibly wounded means that they feel less judgement about having post-traumatic stress, as opposed to one who suffers only from mental injuries.

This is of course the result of an unfortunate misconception. Mental wounds can disfigure and persist longer than many physical afflictions. While our society has made great strides in recognizing this fact in recent decades, there still exists a painful stigma that holds back recovery for our men and women who remain mentally scarred after they’ve completed their service.

The stigma of living with Post Traumatic Stress Disorder (PTSD) is compounded by the presumption that a soldier is someone who can take on all challenges without hesitation. While considerable valor is shown by our fighting men and women, the truth is that not every problem can be faced with a warlike demeanor. The attitude that helps them to survive in a war zone can be incredibly destructive when turned inward. After spending years in a combat mindset where the slightest hesitation or weakness can be deadly, facing personal issues on the home front can be a supremely difficult adjustment.

PTSD can manifest itself in several ways. The symptoms include severe anxiety and flashbacks, but also personality adjustments and situational avoidance to prevent triggers. Individual severity and response does vary, but a number of veterans have reported symptoms that interfere tremendously with what we would consider a normal routine.

This disruption often penetrates deeply into all facets of the lives of those stricken with this condition. Veterans of Iraq and Afghanistan with PTSD are more likely to be homeless than in previous generations. They’ve also been found to be at an elevated risk of suicide and self-harm. Higher rates of unemployment and domestic violence are reported in the lives of PTSD sufferers.

Their plight can also seriously affect those closest to them, leading to what’s been given the name “secondary PTSD,” suffered by the spouses and family members who must deal with the fallout of this disease on a daily basis without suffering the primary symptoms. Because of such stresses, marriages of veterans with PTSD end in divorce at an elevated rate, and those afflicted are more likely to have had multiple failed marriages.

A problem this wide-ranging, with such disparate manifestations, has unsurprisingly inspired a number of varied treatments. The options run the gamut from medical marijuana to meditation to unique, unorthodox purpose-designed therapies for soldiers. A condition like this has no simple cure, and what works for one sufferer can be ineffective for the next. This is part of what makes PTSD such a persistent issue for our veteran community and the country at large.

One often-overlooked aspect of the issue is its cultural context. The PTSD phenomenon seems to have made more of an impact in the United States as opposed to other countries where war is just as much a part of the culture, if not more. Hypotheses about the reason for this vary, and a recent book by Colorado academics Sarah Hautzinger and Jean Scandlyn explores the idea that PTSD has become the predominant “idiom of distress” for our soldiers. In effect, this means that the way we discuss trauma has turned PTSD into a catch-all term for the suffering brought by fighting in war, which can appear in many ways, from hallucinations to chronic anxiety.

The book, called Beyond Post-Traumatic Stress: Homefront Struggles with the Wars on Terror,” observes that the affliction is diagnosed far less in the United Kingdom, whose soldiers have fought alongside ours in Iraq and Afghanistan. Going further, studies of Lebanese soldiers and victims of war, for whom violence is often a daily occurrence, find that their trauma is expressed much differently than that found in our veterans.

PTSD, while not a completely American phenomenon, has taken root in this country’s fighting force in a way unseen in most other combatants. Hypothesis for why this is the case do abound, like the relative youth of our fighting force, or the length of U.S. deployments as opposed to U.K. ones.

No matter the origins, the fact is that PTSD has made a dangerously negative impact on our veteran population, necessitating a wide range of solutions. Mental health professionals continue to fight the problem, but for the many veterans who live with the disease (estimates reach up to 800,000), a remedy can seem far from reach.

There are steps the average person can take in order to help. Empathy and understanding must form the foundation of any effort, whether individual or from a group, to help rehabilitate those who suffer from this disease. Concerned civilians should consider volunteering to help with veterans’ charities. Forging open-minded connections is a great way for the average person to help bring sufferers out of their internal anguish and find positive channels for their energy.

Awareness of PTSD is certainly growing, but the popular image of a mentally imbalanced, dangerous veteran capable of lashing out in the wrong situation is an exaggerated image still yet to be overcome. Dangerous behaviors related to PTSD do happen, but the reality is that the vast majority of sufferers never act out violently. For helpful progress to be made, education of the symptoms and triggers as well as the realities of living with the disease can bridge the gap between its sufferers and the public at large.

Our brave service members have given so much to our nation, often at a terrible price. As those who enjoy the benefits of their sacrifice, we owe to them our deepest gratitude and a sympathetic understanding of the ways that they may have been affected by their experience. Yes, they have shown great bravery, but that doesn’t preclude them from residual pain. They’ve performed their duty admirably. While it may be impossible to completely repay them, it’s our imperative to do all we can.