Hundreds of local veterans returning from Afghanistan and Iraq are receiving treatment for post-traumatic stress disorder. But many more remain untreated and undiagnosed, because they don't want to appear weak or unfit for military service, say local military health officials and veterans.

The stigma attached to mental health treatment may have played a role in Monday's deadly shooting at a U.S. military base in Baghdad. Army Sgt. John M. Russell, accused of killing five fellow troops, may have become nervous that the Army was setting him up for discharge after he was ordered to undergo counseling, his father said.

"If a guy actually goes to the clinic and asks for help, they think of him as a wimp, and he's got something wrong with him and try to get rid of him," Wilburn Russell said from his home in Sherman, where his son, a 44-year-old Army veteran, planned to retire.

Two years ago, the Dallas VA Medical Center set up a Mental Health Trauma Services clinic to treat military personnel for post-traumatic stress disorder, or PTSD.

Such clinics are located at VA medical centers across the country and are part of an array of services offered by military and veterans organizations in recognition that the lengthy wars and repeated combat rotations have caused widespread mental health problems within the military's ranks.

Veterans treated for PTSD at the Dallas VA Mental Health Services clinic receive treatment that includes counseling, medication and other strategies aimed at helping patients face their fears, said Dr. Lei Thomas, a psychiatrist and co-team leader of the PTSD program.

Ten thousand veterans from North Texas have served in one or both wars, according to local VA records.

This year, the Dallas clinic is seeing about 900 veterans per month, she said.

About 20 to 30 percent of combat veterans develop PTSD, studies show. But many don't seek treatment, she said.

One reason is a macho military culture that inhibits soldiers from revealing any sign of weakness or vulnerability - exhibited by a "John Wayne" attitude, which Thomas described this way: "I'm a soldier, I'm trained to do hand-to-hand combat, I'm not supposed to be talking and feeling this way."

There is also a fear within the ranks that seeking psychological help could hurt one's career or affect one's security clearance, she said.

In response to that perception, the Defense Department has revised a section on a security questionnaire to make it clear that military personnel can obtain mental health treatment without fear of hurting their careers in the long run.

Terry Lee, 37, a retired Army master sergeant and Iraqi war veteran who lives in Dallas, said he is being treated for PTSD at the Dallas VA. A career reservist, Lee was activated in 2004 and sent to Iraq, where he served as a patrol leader on convoys. His rotation coincided with an uprising by Iraqi insurgents and a spike in American combat casualties.

"When you go out on a convoy, there's always the threat of combat," Lee said. "You've got to worry about getting shot at" and being wounded or killed by improvised explosive devices.

"We never experienced nothing like that before - bodies all over the road," he said. "When you come home from Iraq and sit back, all that comes back over you."

After Lee returned from Iraq, his wife urged him to get treatment because he was having nightmares and had trouble sleeping. Lee said the Army initially glossed over his problems and kept him on active duty. He went to the Dallas VA, where he was diagnosed with PTSD. The Army eventually accepted the VA's diagnosis and, soon after, Lee retired.

Lee said he and other noncommissioned officers were taught to be tough and hard. "NCOs are not allowed to cry. They can't show emotion," he said. "But we're human. If you seek help, they will stigmatize you, and it could hurt your career. If they see that you're taking medication, you might not get promoted or they could take your troops away from you."

Lee was hit hard by the news of the killings at the Army stress clinic near Baghdad. He said it made him angry when he learned that the soldier charged in the killings was on his third tour in Iraq. He wondered whether the soldier had gotten any help earlier. "When you are coming back from Iraq, you need help," he said.

Several factors are considered for a PTSD diagnosis, Thomas said. Veterans must have been directly exposed to a traumatic event, have had fears of being killed or horribly maimed, and have experienced feelings of helplessness.

Clinic personnel attend health fairs and other community events for veterans, to reach those who haven't come in for treatment. "There are more people out there," she said.

Staff writer Lee Hancock and The New York Times contributed to this report.

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