READING, Pa. — To this day, when he first hears a siren in the distance, Andrew Barrow's mind instantly takes him back to Iraq, where he heard the same sound and took cover.
An incoming rocket makes a high-pitched whine similar to a far-off siren, Barrow said.
One time when Barrow heard it, he and other soldiers turned to see an Iraqi policeman directing traffic in an intersection 100 feet away.
They yelled and waved their arms at him to tell him to take cover.
Just as the officer swiveled to look at them, six explosions destroyed the intersection, killing the Iraqi policeman and several other people.
It's an image ingrained in Barrow's mind.
Yet as a policeman himself in Muhlenberg Township, Barrow said he has frequent occasion to hear a siren in the distance.
There are other sights, sounds and smells that cause him to flash back to his days as a major in the Army National Guard.
"For a tenth of a second, you're taken right back to that moment," said Barrow, 44, a patrolman for 16 years who lives in West Brunswick Township, Schuylkill County. "I don't know if you can ever shake that."
Other local police who are military veterans said they experience the same type of momentary flashbacks.
Amity Township Patrolman John Coe often was a white-knuckle driver expecting trouble around every corner after he returned from Iraq in April 2007 following eight months there as a Marine Corps sergeant.
Coe, 31, of Exeter Township would drive in the middle of Berks County roads to avoid imagined improvised explosive devices.
"I'm getting back to accepting that a bag of trash on the side of the road is just a bag of trash," Coe said.
In the service, Coe was part of an effort to integrate U.S. and coalition forces with the Iraqi army. The very nature of the assignment was a mental challenge.
"There was always a fear of them turning on you," Coe said. "You always wonder whether they are playing both sides of the fence or whether they are fully invested in the effort or if they are just bad guys. But you have to set that aside and establish trust."
During his tour, Coe was involved in at least two-dozen hostile engagements.
"We saw a lot of action," Coe said.
He and his wife, Georgiana, 32, have a 17-month-old and a 4-year-old.
His driving was a big pet peeve of Georgiana's after he returned, but he's improved at it a lot, said Georgiana, a 9-1-1 dispatcher.
Coe also doesn't particularly enjoy fireworks anymore, but he has young kids and so do relatives and friends.
"So he has to kind of grin and bear it," Georgiana said.
Lingering issues include being jumpy.
"He can be startled very easily, especially when he's sleeping," she said.
And he had a common but unhealthy coping method when he first returned.
"He stayed in the house a lot," Georgiana said. "Family and friends pretty much had to drag him out."
It's all part of adjusting to civilian life after serving, local veterans said.
Some veterans adjust more easily than others.
The Department of Veterans Affairs estimates 15 to 20 percent of returning veterans suffer from post-traumatic stress disorder.
PTSD is just one of many effects of trauma that veterans might experience, the department said.
After returning to the U.S., Coe and other troops were forced to undergo a month of debriefing and counseling in California when all they wanted to do was go home.
"Guys haven't seen home for months and some for two years," Coe said. "They see green grass for the first time in a long time. The idea (of counseling) is good, but it's not executed appropriately."
Barrow and Coe agreed a debriefing would be more useful after soldiers get to return home first.
That way they can more easily see what adjustments might be problems, and they can identify other issues they might have, Barrow said.
For instance, it wasn't until after Barrow was home for a while that he began to come to terms with how close he had been to getting killed.
Coe said he thinks counseling would be more beneficial and service members would be more receptive if it were given six months after returning home.
Though he said he's not dealing with PTSD, Coe said he knows veterans who are.
Coe said he's found it helpful that the Wounded Warrior Project contacts him every few weeks to make sure he's still doing fine.
The organization reached out to Coe because he suffered a back injury in an explosion that killed a comrade who was sitting directly behind Coe in a Humvee.
"Everybody in the vehicle was hurt," Coe said. "When I regained consciousness, the guy behind me was dead."
He doesn't attempt to forget or repress that memory.
"Ignoring it isn't healthy," Coe said. "I just don't broadcast it if I think about it."
He thinks about the explosion on its anniversary, March 24, which is the day after Coe's birthday.
"It might linger for a day and I'll think about how the others who were in the vehicle are doing," Coe said.
Due to his injury, Coe received a Purple Heart medal.
Reactions may differ
Joe Taimanglo, an officer with Central Berks Regional police for two years, said people wanted to know if he suffered from PTSD after he returned from serving in Afghanistan as an Army specialist in 2004.
Taimanglo, 30, said he didn't.
The Muhlenberg Township resident, who with his wife, Stephanie, has a 3-month-old and an 8-year-old, was in only one major firefight during his deployment.
The rest of the time, insurgents took potshots at soldiers in his unit, but there weren't any casualties.
Taimanglo thinks some people might be predisposed to PTSD while others are better at coping.
"I don't know if people let their feelings get the best of them over there," Taimanglo said. "Maybe they replay it too much in their heads. But I never had to hold my buddy in my arms while he's dying, so it's hard for me to say."
He did have one military colleague who battled alcoholism but who is also fine now.
He said he's sure PTSD is a real phenomenon but that it doesn't affect him.
'Anyone is vulnerable'
Misconceptions about the condition mean many soldiers don't know they suffer from it or are in denial about it, said Dr. Joanne Cohen Hamilton, an associate professor and a therapy program coordinator in Kutztown University's Department of Counseling and Human Services.
"People think it's a 24-7 experience, but it's not," she said. "That might be why some say PTSD doesn't bother them."
Another stereotype about PTSD, which prevents some from seeking help, is the myth that only weak people get mental illnesses, Hamilton said.
"But on the front lines, anyone is vulnerable," she said.
Symptoms of PTSD can mimic those of other conditions, such as anxiety, panic, depression and bipolar disorder; some personality disorders; insomnia, and conduct and oppositional defiance disorders in youth, she said.
Symptoms include hypervigilance, avoidance of day-to-day life, fears of threat and difficulty discriminating between what is trustworthy and what isn't, she said.
The goal of therapy is for a soldier to gain control of his or her memories instead of letting memories control the soldier, she said.
"The fullness of life is not appreciated if you think you've gotten over PTSD but actually haven't," she added.
Barrow, who has been deployed four times since 2002 with tours in Bosnia, Afghanistan and two in Iraq, said he thinks a driving force behind so many PTSD cases now is that soldiers can feel helpless because they are being targeted by explosives and other methods that soldiers can't easily combat.
"The rockets that come in. What are you going to do?" said Barrow, who said he does not suffer from PTSD. "You can't control it. You can't fight it."
During a 16-month tour in Iraq, Barrow was in charge of security in the Green Zone, the governmental center of Baghdad where international security was intense.
But there were nerve-wracking breaches of that security.
"In one month, 80 rockets landed within 300 meters of where I slept," he said.
When he heard the noise of incoming artillery while he was sleeping, he would roll over and pull body armor on top of himself in addition to the armor that he placed on an overhead bunk every night before going to bed.
He often thought of his family.
Barrow has two children, ages 8 and 13, with his wife, Kathy.
"I missed a lot of their growing up," Barrow said. "You'll never get that time back. I missed 41/2 years of my kids' lives, with 38 months of that in combat since 2002."
So why do it?
"If I don't do it, who's going to?" Barrow said.
Barrow recalled seeing young men acting tough in a bar after his return.
He couldn't stop himself from thinking: "Why do I have to do this, and what have you guys done for your country lately?"
Those kinds of thoughts feed a bitterness that can afflict some veterans, Barrow said.
Other adjustments for Barrow included going from commanding hundreds of security force members to taking orders as a patrolman.
He also had to force himself to hold back and stop trying to change his home life back to the way it was before he left on his tours.
"You're gone a long time, so naturally things at home aren't going to stay the same," he said. "I found myself wanting to change things back. But it's best for the first month to just do nothing like that and get reacquainted."