These days, Lance Cpl. James Blake Miller spends much of his time sitting on the floor of the run-down trailer he keeps as a residence behind his father's house in the tiny coal-mining town of Jonancy, Kentucky (population 297). This is his favorite spot in the trailer, where he reclines against an easy chair whose upholstery has turned a dingy nicotine brown. From here, Miller can anticipate any possible threat, keep an eye on all avenues of approach an enemy might take. As cigarette butts overflow in the ashtray and empty beer bottles collect around him, he silently cycles through procedures the Marine Corps drilled into his head: defend, reinforce, attack, withdraw, delay.
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Since returning home from Iraq three years ago, Miller rarely sleeps more than once every few days. When he can get some sleep, he makes sure he's got a gun under his pillow. His entire life has been thrown into a strange and purposeless blend of chaos and inertia; though he doesn't do much these days besides smoke, drink beer and ride his Harley, he seems to teeter perpetually on the brink of a meltdown. Occasionally, and without provocation, Miller becomes so overwhelmed by blind rage that he imagines shooting a stranger in the kneecaps or beating a fellow bar patron to a bloody pulp. "I can be drinking a beer and get pissed off and think, 'I'm gonna break this bottle and cut that guy's throat over there,'" he says.
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Miller's nightmares, insomnia, heightened alertness, self-imposed isolation and persistent recollections of his seven months in Iraq are all classic symptoms of PTSD, an anxiety disorder that results from exposure to an event so psychically frightening that the aftershocks continue for months or even years. Studies estimate that as many as 500,000 troops serving in Iraq and Afghanistan will suffer from some form of psychological injury, with PTSD being the most common.

Like many disabled vets, Miller feels betrayed by the military, neglected by the VA and misunderstood by pretty much everyone else. "People hear 'PTSD' and they think that means you're crazy," he says. "My aunt tells her kids, 'Don't go around Blake. He might flip out and shoot you.'"
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Wherever he finds himself, though, Miller counts his time in days. "I don't worry about tomorrow unless I wake up," he tells me one night in his trailer. "I have no goals, long-term or short-term. I don't worry about paying the bills. I don't worry if I'm gonna have money to eat tomorrow. I don't worry about #in' nothin'. As long as I keep telling myself I wasn't there — if I can believe that for thirty minutes out of the day just by telling myself over and over and over, 'I wasn't there. It didn't happen' — that thirty minutes is worth it."
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Once he decided to enlist, no one could talk him out of it. He was only seventeen, sitting in his doctor's office for his annual athletics physical on September 11, 2001, when he heard that terrorists had crashed a pair of airplanes into the World Trade Center. The next day he insisted his father sign him up — or else he would quit high school.
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"It was the only way I knew to travel and see the world. I just happened to pick a weird time to go. I got to travel, and it was a life-altering experience, that's for sure."

The town of Jonancy, nestled deep in the Appalachian Mountains, is the kind of place that inspires thoughts of escape. Unemployment in the area is thirty-five percent higher than the national average, the median household income is less than $24,000 and only ten percent of county residents earn college diplomas.

The fighting began in the dark of night and continued over the next twenty-four brutal hours, during which Miller's squad endured nonstop bombardment by rocket-propelled grenades and machine-gun fire. Sinco, the photojournalist embedded with Miller's company, was shocked by the ferocity of the battle. "I was scared sh#less," he recalls. "We came under heavy fire, and I remember running across the street with bullets flying everywhere. We encountered three insurgents who were horribly, horribly dead. One had half his head blown off, and another guy was half-alive, speaking in Arabic. You could tell he was saying 'Help me, help me, help me.' The brutality was so extreme and so relentless."

The unit sought shelter in a house and made the roof its command post. "I was standing near Miller, and an RPG came flying right at us," Sinco says. Miller radioed for tanks to bring support fire. Soon a massive explosion shook the structure so hard it seemed it would collapse. Sinco saw a building nearby, smoldering. "I thought it was over. I slumped down against a wall with my camera, and for some reason Miller slumped down across from me and lit a cigarette. He told me later that he thought he'd never see another sunrise." Sinco snapped the photo of Miller that was soon reproduced all over the world.
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It wasn't until Miller returned home to Jonancy in February 2005 that he realized how big a deal Sinco's photo had become — and how much pressure there would be for him to live up to its symbolism. "I get home, and there's news vans and motherf#kers all over here," he recalls, the anger putting gravel in his voice. "There were people offering me all kinds of deals, like, 'Hey, this guy wants to make pillowcases and T-shirts with your picture on it,' and 'This guy wants to make a rifle after you.' " The Marine Corps attempted to license the photo and asked Miller to become a recruiter — an offer he declined.

Miller was in the galley of the USS Iwo Jima when a petty officer made a whistling noise that sounded exactly like a rocket-propelled grenade. Something in Miller snapped, and he blacked out. When he came to a few hours later, he was lying in the ship's clinic, surrounded by a doctor and a shrink. Though Miller has no recollection of the incident, he was told that he slammed the petty officer from one wall to the other, threw him down and started beating him.

"I flipped out because I done this and I don't remember," Miller says. "I was like, 'What the hell is wrong with me?' It's been like that ever since."
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Dr. Laurie Harkness, who worked with Miller at a VA-affiliated center in Connecticut, says that most PTSD cases are treatable with intensive counseling and the right combination of meds. But there is a heavy institutional stigma about mental-health issues in the armed forces, and since the military doesn't conduct mandatory post-deployment psych evaluations in person, vets like Miller are left to make their own health-care decisions.
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With the number of suicides among returning veterans climbing, it's hard not to worry about Miller. Though he believes that taking one's own life is morally wrong, his thoughts often take a dark turn. One night, sitting in his trailer, he says something that makes me fear he will end up another war casualty, dead and buried long after leaving Iraq. "I have a blatant disregard for life," he says. "Every day that I wake up, it's like, 'Why do you keep giving me more?' The Bible says the big man don't put no more on you than what you can stand. . . ."