An excerpt from the book “What Have We Done” by David Wood. Copyright © 2016 by David Wood. Reprinted with permission of Little, Brown and Co. Some changes were made to reflect Stars and Stripes style and policy.

Darren Doss had just come back from a morning patrol on the outskirts of Marjah, Afghanistan, when his best friend, Kruger, got shot. It was a blazing hot day, June 1, 2010, and Americans and Taliban fighters were locked in a desperate fight along Marjah’s narrow, shadowed streets and back alleys and across its outlying poppy fields and irrigation canals.

The White House and the Pentagon had vowed to wrest Marjah from Taliban control and create a prosperous, safe, democratically run city as a model for the new Afghanistan. Doss and Marine Cpl. Zachary Kruger and the Marines of One-Six, along with thousands of other American troops, had been struggling since January to make this happen. The Taliban were dug in and determined to stay. The fighting was continuous and deadly.

Darren Doss is a slender man with dense black hair, a prominent nose, and soulful brown eyes that often reflect unvoiced pain and sorrow. Like the combat Marines I know, Doss is outwardly tough; he’s endured extremes of discomfort, deprivation, and grueling physical and emotional stress that most of us will never know. During his two combat tours as an infantryman in Afghanistan he was an aggressive fighter, not one to hang back. And yet Doss seems the most sensitive among the Marines of One-Six, more vulnerable to emotional bruising. To this group of men hardened by the violence of war, it felt as if Doss was the youngest, everyone’s little brother. In Marjah, he was about to turn 22.

That morning, Doss was the last man in a line of Marines heading back to their outpost after a routine patrol. Climbing a low wall, he heard AK-47 rounds impacting around him and realized that someone was trying to shoot him in the back. He scrambled quickly over the wall, cursing loudly, and made it back okay, but he barely had time to catch his breath before guys came running, yelling “Marine down! Marine down!” and grabbing their body armor and helmets and weapons. Doss raced out with them, and as they sprinted across an open field he could hear on another Marine’s radio that there was a firefight under way, it was bad, and the casualty was Kruger.

“I was tight with Kruger,” Doss said. “My heart just sank.” With reason: death was a constant in their lives. Two Marines had been killed within days of their arrival in January. Others followed, including Cpl. Jonathan Porto, who drowned when his armored vehicle tipped over into an irrigation canal and he was trapped inside. That May, the Marines of One-Six had been shaken by the death of a popular leader, 1st Lt. Brandon Barrett, who was shot by a sniper. In the following three weeks, Joshua DesForges, Nicolas Parada-Rodriguez, and Philip Clark were killed. On Monday, May 31, Anthony Dilisio was killed. Now, on Tuesday, Kruger was down.

The Marines leaped into the gully where Kruger’s squad was hunkered down in a firefight so intense that the barrel of one marine’s SAW was glowing red. Doss fell to his knees beside Kruger, who had been shot in the thigh and was bleeding heavily. They got a tourniquet on; a medevac helicopter had been called. Doss grabbed Kruger’s hand and squeezed, making jokes, trying to keep Kruger conscious. An Army chopper landed a distance away, and a crewman came sprinting through gunfire across an open field and flung himself down. He hadn’t brought a stretcher. As the Marines returned fire to cover him, the medic ran back to the chopper and returned with a stretcher. Doss and another Marine grabbed Kruger’s arms and dragged him up and out of the gully and got him on the stretcher. Then they ran.

The field they had to cross had recently been plowed, leaving foot-high ridges, making it difficult to run without turning an ankle. The larger danger was the Taliban gunfire raking the field. All hell was breaking loose, Doss thought. He could hear rounds impacting the dirt. By chance a New York Times photographer was riding on the chopper; one of his images shows Doss, his right hand gripping the stretcher handle, helping to shove Kruger into the chopper. Doss waited as it lifted off in a blizzard of pebbles and grit and tilted away. Then he ran back through sporadic gunfire. Within a few minutes the firefight died away, leaving an enormous emptiness, and the Marines trudged home. Kruger survived. The army medic received a medal for bravery. No medals were awarded to the Marines, who resumed their work without pause.

The shock and grief of seeing his best buddy grievously wounded, in pain, and at risk of dying clearly were an emotional blow to Darren Doss. But in the continuing maelstrom of Marjah, there was no opportunity to quietly absorb what would be a shattering experience for any human being. Here, it became just another emotional injury to a young man already wounded by loss.

“Over there, you don’t really talk about it,” Doss once told me. “You don’t have time to sit there and cry about (expletive). You got (expletive) to do, go on patrol. You don’t dwell on it.”

Darren Doss told me the story about Kruger over lunch recently at the Blue Ribbon Diner in Schenectady, New York. I had picked him up that morning at the VA medical center in nearby Albany, where Doss was an outpatient in the mental health clinic. He is diagnosed with PTSD, but his moral injuries have cut more broadly and deeper. He carries wounds of the soul that are eating away at him. Five years after Marjah, Doss was able to name six separate prescription drugs he is currently taking for anxiety, depression, pain, and insomnia. All for his experiences at war. At lunch his head drooped, his eyelids sagged, and occasionally he appeared to doze off. When we were done, he stepped outside to smoke a Newport. He stood alone in the parking lot, gazing out into the distance.

The politicians and policy makers and generals who rushed the United States into war in 2001 and again two years later never thought to prepare for the length and intensity of those conflicts and the psychological wounds the troops would bring home. Thousands of military professionals and intelligence analysts work briskly in offices along the Pentagon’s 17 miles of fluorescent-lit corridors, but when the United States went to war in Afghanistan in the autumn of 2001, few of them foresaw that cleaning out the ragtag bands of Taliban would last much beyond the spring of 2002.

Attention had quickly turned to Iraq, which the Pentagon and the White House gave assurances would be a short campaign. After all, the most recent war in the experience of many officers, Operation Desert Storm in 1991, took only three weeks of airstrikes and a four-day ground war to achieve victory over Iraq’s military, and psychological injuries seemed to be minimal. By the time American troops poured over the border into Iraq in March 2003, the invincibility of the U.S. war machine was a bedrock conviction within military and political circles.

On May 1, six weeks after U.S. troops invaded in the spring of 2003, President George W. Bush declared that “major combat operations have ended.” That was something of a surprise to the grunts of the Second Armored Cavalry Regiment with whom I was embedded as they conducted patrols and weapons searches that summer in east Baghdad. The small-scale skirmishes and bombings then breaking out were modest compared with what was coming. But Washington held to its belief that the war in Iraq was winding down. By October, despite the battle losses of 225 Americans dead, the Pentagon was making plans to recall 30,000 troops from Iraq as not needed.

GIs were assumed to be bedrock strong as well. A report prepared for VA clinicians in 2004 acknowledged “insufficient” understanding of the impact of severe war-zone stress. But judging from how quickly people seemed to recover from car crashes, the report said, “it is safe to assume that although acute stress reactions are very common after exposure to severe trauma in war, the majority of soldiers who initially display distress will naturally adapt and recover normal functioning during the coming months.”

There had been early signs that Afghanistan and Iraq would be different, more challenging for the troops, and at a higher human cost. In July 2003, the army surgeon general, Lt. Gen. James B. Peake, sent a team of mental health specialists to Iraq. It was an act of courage and foresight not appreciated within Washington’s ruling circles at the time.

But Peake knew combat stress and its effects on troops. As a young enlisted soldier, he’d been selected for West Point, was commissioned an officer, and [received] a Silver Star for combat valor in Vietnam before becoming a physician. He was aware of the lingering physical and mental health problems that followed the troops’ return from previous wars. When the invasion of Iraq was launched, he told me recently, “we recognized that the quicker we got on this, the quicker we would understand what the realities were of the current war, the better prepared we’d be to deal with it.”

Peake’s team found what he suspected. That December the Army’s Mental Health Advisory Team (MHAT) reported that 15 percent of the troops then serving in Iraq, or roughly 20,000 soldiers, screened positive for “traumatic stress.” A larger group was tagged with depression, anxiety, or traumatic stress. But fewer than one in four of them had gotten any help, because they were afraid of the stigma of seeking help or because no help was available. The military’s overriding culture, by necessity, was one of stoic acceptance of pain and discomfort. Not complaining.

But the cost was becoming evident: The surgeon general’s report noted the rising suicide rate among troops in Iraq — 15.6 suicides per 100,000 — was already dramatically higher that the Army’s peacetime average rate of 11.6. The numbers might be an aberration, the mental health team concluded, adding somewhat hopefully that the data “did not signify an escalating rate of suicide.” But the flood of military mental health injuries was under way. In 2005, the VA began frantically hiring some 7,500 additional mental health professionals to care for the rising tide of returning troops in need of psychological care. It wouldn’t be enough.

By 2006, the year Stephen Canty was itching to join the Marines, fighting in Iraq had increased in intensity and savagery. That year, 823 Americans were killed in combat there; 6,412 were wounded. About 1,500 miles away, the war in Afghanistan was bogging down in its fourth year of bloody slogging; American combat deaths had doubled since 2002. And back home, a majority of Americans for the first time agreed that the war in Iraq was a mistake and that President Bush had no plan to end it. John Murtha, a retired Marine and a conservative senior congressman, declared that the war was “flawed policy wrapped in illusion.” Regardless, voters kept returning to office politicians who were determined to press ahead with the wars.

The Army surgeon general’s Mental Health Advisory Team returned to Iraq that summer of 2006, where it again conducted surveys and focus groups among soldiers and Marines and found significant psychological trauma. Two-thirds of Marines then serving in Iraq had seen the severe wounding or death of a buddy. In individual interviews, one soldier told the Army researchers he had witnessed “my sergeant’s leg getting blown off.” Another had seen “friends burned to death.” Others reported, “I had to police up my friends off the ground because they got blown up,” “A friend was liquified [sic] in the driver’s position on a tank, and I saw everything,” and “A huge (expletive) bomb blew my friend’s head off like 50m from me.”

Like Darren Doss, most of the Americans we sent to war seemed capable of toughing their way through even this level of emotional stress, at least temporarily. But the survey team documented high levels of anxiety and depression: 20 percent of soldiers, just over 28,000, screened positive for depression or anxiety, and some were diagnosed with PTSD. More significant, the detailed surveys also turned up strong evidence of damaging moral injury: The personal and military moral codes that young Americans took with them to war were being corroded by their experiences in battle. Despite what they’d been taught about honor and dignity, for instance, almost two-thirds of the Marines surveyed told the MHAT researchers they would not report a buddy for injuring or killing an innocent noncombatant. Fewer than half of soldiers and Marines believed that Iraqi civilians should be treated with dignity and respect, the MHAT found.

Equally distressing, the military suicide rate kept rising, by the end of 2006 reaching 16.1 per 100,000. Over the next six years the rate for active-duty soldiers would double, rising to a shocking 29.6 suicides per 100,000. The survey team, reporting back to Washington, strongly urged that the Defense Department develop “battlefield ethics training so soldiers and Marines know exactly what is expected of them.”

In other words, train soldiers to recognize the key to preventing moral injury: helping them see and act on “what is right.” But it was already too late.

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