“It’s the children that I can’t forget.”

Time and time again, in my psychiatrist’s office at a military clinic, a soldier would tell me this. Strong, young, crisply uniformed, he or she would shake, sigh, stare blankly, or cry, recounting variations of this statement. The most painful traumas—be it seeing your best friends blown into body parts, losing limbs, brutally shot—was also seeing injured civilians, particularly, the children.

I heard stories about soldiers carrying a little girl who was severely burnt to the hospital, begging for her to be treated by the military providers even though they didn’t always have the resources to treat civilians. I heard about someone having to shoot a boy, out of fear he was rigged with a bomb trigger.

In Michael Hastings’ June 2012 Rolling Stone profile of Sgt. Bowe Bergdahl, the author notes that perhaps the turning point in Bergdahl’s fateful disappearance was his witnessing a child being run over by an MRAP (Mine-Resistant Ambush Protected vehicle). Bergdahl wrote about the incident in a bitter final email to his father, shortly before his capture by the Taliban.

The death of a child ranks highest in our set of moral taboos and violations. Ivan in Dostoyevsky’s The Brothers Karamazov famously remarked that God’s salvation “is not worth the tears of that one tortured child,” one of the most powerful critiques of religion ever written. And for Bergdahl and other soldiers, the death of children casts any possible idealism or meaning behind their war mission into serious moral crisis. Are the deaths of the most innocent worth the devastation of the battlefield?

This crisis adds to the core of war trauma, and the possibility of ensuing post-traumatic stress disorder (PTSD). When confronted with brutal, agonizing tragedy, soldiers who have been raised on a steady diet of single-minded military zeal are prime fodder for emotional and moral disillusionment and even disintegration.

PTSD is a complex condition that straddles both psychological and physiological symptoms triggered by trauma. On the physiological side, exposure to danger activates our primal evolutionary fight-or-flight responses, leading to heightened senses, rapid heartbeat, constant edginess, and irritability. When our neuro-physiological system is working properly, we are able to calm back down after a threat dissipates and return to a state of everyday normalcy and rest. But when some people are constantly exposed to threat, day in and day out, as in war zones or repeated abuse, the fight-or-flight physiological state becomes the new normal; their neuro-hormonal systems are essentially stuck on overdrive. Their minds are unable to shut off repeated images and memories of dangerous events, and they cannot fall asleep or are prone to restless vivid nightmares.

This physical misery combines with the psychological horror of emotional loss and pain. The content of the danger often involves violence, cruelty, death, and destruction to people who are trained to become closer than brothers and sisters in battle—people who you love, as vividly described by Sebastian Junger in his brilliant book War. These things also happen to people who you know are helpless, like random people caught in the crossfire. Like children.

With such losses, people with PTSD often enter states of emotional numbing or dissociation, where they are, in a sense, zombified—detached from their feelings, even as their body functions and moods remain jittery and edgy, and their internal lava remains roiling and untamed. This toxic combination leads to feelings of intense guilt, anger, isolation, and trouble interpersonally relating to others, including military bosses, everyday civilians, or family members who “just don’t understand.” The ongoing stigma, misperceptions, even indifference to what soldiers go through in war zones, from both their military colleagues who perpetuate a culture of “suck it up,” and then from civilians who remain sheltered and apathetic, only contribute to that dangerous loneliness. The cost of this loneliness has led to epidemic rates of suicide amongst military service members in the last decade.

Through my work, I learned to develop a deep respect for the soldiers I treated—for their honesty, their commitment, their sacrifice. It was heartbreaking for me to hear their sufferings secondhand, because I knew by and large they were good, straightforward people, joining the military oftentimes for pure-hearted, patriotic reasons. More than a few joined after witnessing 9/11, and some had even experienced it firsthand in Manhattan or DC. They simply followed orders and were sent into hell. It also struck me as painful that often the youngest ones, fresh out of high school and potentially the most emotionally vulnerable, were sent to the front lines.

Bergdahl, according to various reports, grew up in rural Idaho and was home-schooled on a diet of books of religious, intellectual, and spiritual inquiry. He showed signs of a restless, wandering soul, someone searching for meaning around him. He was probably a perfect young candidate for moral alienation when confronted with the reality of war.

It is not for me to judge or comment on his possible desertion, what that entailed, and the other ethical dilemmas that ensued afterwards: of his capture and hostage ordeal, of the resources and precious lives lost looking for him, or of the controversial deal that was brokered for his freedom. I imagine that he, like other victims of kidnapping or hostage situations, has suffered immensely, and is going through a delicate reintegration process at his military hospital and base. He has reportedly not yet contacted his family, who it seems he was close to right before his capture, and who agonized over his loss the past few years. I do know that reintegration has to be done slowly and carefully.

Like Sgt. Brody in the acclaimed show Homeland, a POW undergoes the additional trauma of becoming a hostage, stripped of one’s free will and individual identity, all under constant threat of torture and death. The breakdown of self, melded with the urge to survive, sometimes renders hostages vulnerable to Stockholm Syndrome (as it did with Brody). In other cases, it increases a person’s ego stamina and resilience, as in the case of the Hanoi Hilton prisoners, or the inspiring defiance of Michelle Knight. It all depends on the individual circumstances and degree of trauma, and pre-existing traits such as level of education, family background, pre-existing trauma and mental health conditions, and more.

Our military follows an official 3-phase reintegration protocol for POWs and also offers it to civilian hostages (like the American civilian contractors released from a terrorist group in Colombia in 2008). Phase 1 involves a full medical and psychiatric examination to check and treat any acute injuries or imminently life-threatening conditions. Phase 2 involves “decompression” where subacute care begins, such as nutritional and dental care, and psychological counseling to debrief and discuss events in a protected setting. The idea is to restore a sense of routine and normality gradually, which takes anywhere from a few days to weeks depending on the individual. Phase 3 is the move to return to outside life, with ongoing support from a multidisciplinary treatment team, where one returns to live with family and/or returns to work, and transitions back to everyday independent living. This phase can take months or more. Per recent reports of his return to work and moving into quarters at his base, it seems Sgt. Bergdahl has moved into Phase 3.

Without taking gradual steps, an individual is at increased risk of protracted PTSD and depression. Without help, there may be no opportunity to process at a comfortable rate the new barrage of stimuli from the outside world, including the sudden re-intimacy of family and friends (as portrayed by the awkward homecoming of Brody with his wife and suddenly grown children in Homeland or in the moving 1946 Oscar classic The Best Years of Our Lives), and the past flood of flashbacks and tragic memories from trauma exposure, carried alone as a heavy burden in the POW’s mind for so long. Deeper alienation and isolation can follow along with heightened chances of suicide and substance abuse.

The moral murkiness of the desertion controversy will probably complicate Bergdahl’s recovery and prognosis. His unusual situation will likely lead to the additional stress of judgment and condemnation by many, including his military peers as well as the general public.

From the standpoint of a medical practitioner or therapist though, it would not be my place to judge, but to heal a broken person as best as I can. In general, we all need to remain informed and compassionate about mental health issues and the stressors our military service members face, to advocate for easier access to mental health care, and to encourage our colleagues and loved ones to seek help for their issues instead of ignoring or blaming them. For aside from those who have also been in combat, who are we to judge what each of us would do when faced with the unspeakable day in and day out?