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There is a loaded semiautomatic pistol on Kyle Dubay’s night stand in his tiny one-bedroom apartment just outside Phoenix, and a rifle under the bed.

But it’s not the guns that help him sleep – it’s the prescription pills.

Mr. Dubay, 28, was an infantry medic for three tours in Iraq. The nightmares started on his second tour. “You saw everybody having them,” he said. “People would wake up in the middle of the night screaming, swinging their fists.”

He received a diagnosis of post-traumatic stress disorder between his second and third tours. “I had a lot of anger,” he said, “a lot of things I just didn’t understand.”

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Back home after his final deployment, the binge drinking and bar fights started. There was a bottom to the hole Mr. Dubay had fallen into. When he finally hit it, he was blacked out with a belly full of Jack Daniel’s and Percocets.

Deciding to get help, as Mr. Dubay did, meant asking for it, and there’s a stigma around that. “You’re not as much of a man,” he said. “You’re not as much of a soldier.” He paid no mind to all of that and started seeing a therapist. “It helped clarify things. It helped put things in order. But I was never really able to get that energy out.”

So he started fighting again, but this time it was different.

He walked into the Spartan Academy gym in Mesa for the first time because of a brochure he picked up at Arizona State University, where he is working toward two degrees – one in kinesiology, one in biology. He had watched mixed martial arts on television. He was already a fan of what is popularly known as ultimate fighting, and he figured his hand-to-hand combat training would be an asset.

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By his own admission, he was “terrible” at first. I asked him what terrible looks like. He says it’s a lack of efficiency in movement and lack of a game plan; it’s frustrated movements and “flopping around all over the place.”

Then I asked him what experience looks like in mixed martial arts. “You learn when to struggle and when to relax,” he said. “You use a lot less energy. It just looks better. It really does.”

There are now 10 young veterans training with him at the gym and finding similar relief. The kind of fighting they do is called American Pankration. The goal is to get your opponent in a stranglehold until they “pass out or tap out.” Two taps is how a fighter submits. Mr. Dubay admitted that it was strange that the fighting seemed to be helping – “strangely comfortable” was how he described it.

I was suspicious, but after watching him at the gym, I got it. Most of his time at the gym is training, not fighting. There is something almost gentle about the training ritual. There is an engagement with a training partner, a drop to the mat and then often a quiet pause until one fighter says: “You all right? Let’s try that again.” Maybe the most important thing is that no matter how rough it gets, there are no actual enemies in that gym. That person who has you in a stranglehold doesn’t actually want to kill you. It’s a distinction the brain sometimes can’t make reliably after repeated combat exposure.

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When he started at the gym, Mr. Dubay said, “I felt alive again.”

“When you’re in Iraq and you get into firefights, it’s the most alive and alert you’ll ever be in your life,” he said. “When I started fighting, I got a taste of that again. You’re alert. Your adrenaline is running. It’s you versus one other person, and there’s only one winner.”

Outside the gym, he started to notice that situations that used to make him angry or cause flashbacks didn’t faze him – at least not as much. Anxiety lost its stranglehold. Before the deployments, he said, his soft voice cracking: “I was always the person that loved everybody. Everybody loved me. I was so happy.” He’s training at the gym a few nights a week, and he’s even started to feel happiness again.

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He’s been injured more than a few times at the gym. It’s hard on his body. But a medic knows how to perform triage. “Every medical issue I have is its own entity,” he said. “There might be some adverse effects on one issue while I work on another. It’s a balance game.”

For now, as long as he’s on that mat a few times a week, something he calls “the ball of fire” is under control and life after war seems manageable.

He felt the ball of fire in his chest first. Then it started to grow. “The bigger it gets,” he says, “the more it pushes down into your stomach. It can make it hard to breathe. You feel it just spreading into your limbs, going down through your arms and into your fingers. Everything is so tense and so angry. You just want to scream to get rid of it.”

Every guy he knew had a different threshold for the terrible stuff of war, and that was vexing to Mr. Dubay at first. It’s one of the things he says he has some clarity on now. “Everybody has a different size cup. Once it’s full, it’s full.”

The cup and the ball of fire are not the same thing, he explained: “The cup is the memories. The ball is the anger and frustration you have for those memories.”

As we talked, the names of the fallen and how they died spilled out from his cup in a sort of shorthand.

“Walker. … I had just talked to him.”

“Locklear and Kincaid. … They hit a massive I.E.D.”

“Shank. … Nothing to do.”

Mr. Dubay still hears from those who survived. He calls them “my guys.” They learned to lean on him in Iraq – whether he was working feverishly to save a life, or handing out Power Ranger Band-Aids to the luckier, barely wounded warriors.

They are leaning still. They come to him now with medical issues, just to talk, or with questions about filing a disability claim with the Department of Veterans Affairs. (He, however, is going through the claims process by himself.) Nationwide, the department’s backlog for processing disability claims is more than 800,000.

His guys don’t have words for it as he does, but, he says, “In essence I think they feel the same energy inside of them.”

A recent study by the Department of Veterans Affairs found that close to 30 percent of 834,463 Iraq and Afghanistan veterans seen at a department hospital or clinic were treated or evaluated for post-traumatic stress disorder.

There are conversations in the mental health field about whether it should be called PTSD at all – some suggest removing “disorder” and replacing it with “injury.” There is no shame in a combat injury, the argument goes, and a person who has shrapnel in his shoulder doesn’t stumble around drunk until it falls out. When you have an injury, you see a doctor – you get help.

The help Mr. Dubay has received has nudged him toward an understanding of what happened in Iraq. “Maybe not why it happened,” he says, “but that there’s nothing that could ever be done, so I have to accept it.”

The therapy has given him clarity. The fighting has given him a release. But Mr. Dubay’s story doesn’t have a happy ending – or a sad one. If anything, just three years after his final exit from Iraq, his story has only a beginning.

Jeff Severns Guntzel is Senior Reporter for American Public Media’s Public Insight Network, which offers a confidential way for people to share their personal experience with journalists around the country.

