Add these four local men to the military's list of casualties.
Matthew A. Proulx.
Andrew L. Norlund.
Justin C. Reyes.
Gary M. Underhill.
They didn't die in combat.
They didn't die from friendly fire.
They died by their own hands.
No comprehensive studies are available on the reasons for suicides connected to the ongoing military actions, but Army officials say the suicide rate among its personnel is now the highest it has been since the first Gulf War.
Ninety-nine soldiers killed themselves last year. A third of those deaths involved individuals who had served in Iraq or Afghanistan, according to the Army.
The rate of suicide since the Iraq War began in 2003 has increased from 12.4 per 100,000 soldiers to 17.3 per 100,000 last year, and that does not include veterans who served in the two war zones and later returned to civilian life.
With the four Erie County men, it would be difficult to argue that the war did not affect their mental conditions before they killed themselves.
One died after returning home from Iraq with post-traumatic stress disorder. Another returned from Iraq with post-traumatic stress disorder and began drinking heavily.
A third Iraq veteran knew he needed help but would not seek it. The fourth was in mental anguish and headed to Iraq.
Their families and friends say they are as much casualties of war as the soldiers who die on the battlefield.
"Men and women who serve in a war zone have a unique experience with violence and death. They bring this experience home with them, and for these individuals suicidal thoughts can be especially lethal," said Houston Crum, a Veterans Affairs counselor who works with returning veterans and their families in the Buffalo Niagara region.
Military officials blame the increased number of suicides on problems that often involve love and marriage. Family members of the dead say it goes way beyond failing relationships.
In addition to the flashbacks and nightmares of post-traumatic stress disorder, relatives and soldier advocates cite extended combat deployments and redeployments, combat stress -- once known as shell shock -- and shortened periods of leave as reasons for the higher number of suicides.
"It's always handy to blame the spouse in these things, but I think it really comes down to extended fear, situations where the fear doesn't go away," said Roger Proulx, commenting on the daily anxiety his son Matthew faced escorting truck convoys in Iraq. "You may be in a compound, but you have to go outside, and you don't know where the danger lurks."
>Wouldn't seek help
Sgt. Matthew A. Proulx, 40, carried out his final mission in life with military precision.
The National Guardsman had been wounded twice in the Iraq War and awarded the Purple Heart.
Proulx also suffered from a third injury -- mental illness brought on by the war. But he decided to handle the matter in his own way. To seek outside help would make him a marked man, and he did not want to be seen as a weakling in the military's warrior culture.
Just before he killed himself April 4, Proulx made one quick phone call to the Buffalo Police Department's 911 operator.
"I'm going to commit suicide. I have a gun. I want you to come right now because I don't want anyone else to get this gun."
He ended his cell phone call inside his parked car, put the muzzle of his military assault rifle to his mouth and "blew his brains away," his family said.
Police rushed to Proulx's home next to Schiller Park and found him dead in his 2007 Honda Civic.
Nancy Proulx said her son's concern that no one else get hold of his high-powered rifle was right in line with his soldierly ways.
"Being a soldier right to the last minute. He was taking care of business. He called the police and told them about the gun," his mother said.
Proulx had given up a promising photography career in New York City to join the military after his first wife, an employee in the World Trade Center, narrowly escaped death Sept. 11, 2001, because she had arrived late to work.
He told his mother he felt helpless and needed to do something. Two weeks later, Proulx joined the state's Army National Guard.
After his deployment in 2004-05, Proulx moved here with his second wife, Colleen Grzelewski, a fellow Guard member from Buffalo who also had served in Iraq.
Proulx had not seen the last of death. He was assigned full time to a color guard at military funeral services.
It was a job he loved, according to Grzelewski. But as for his inner turmoil, the widow said, he had no interest in seeking help.
"To ask for help within the military system, the Army, is to admit weakness and failure, and then you're screwed," she said. "That is the truth. Soldiers will run around with a broken ankle, and it's the same with a mental problem.
"You're taught in the military to be strong. The whole military culture creates this problem," Grzelewski said.
Grzelewski's description is eerily accurate in the case of Justin Reyes, who, despite two damaged ankles, continued fighting in Iraq. When he did return home, he required extensive reconstructive surgery and rehabilitation, a family member said.
In addition to worries about reaching out for help, seeking assistance for a mental health issue raises fears about what peers and supervisors in the military will think.
Airman 1st Class Andrew L. Norlund, 23, of Elma, ended his life with a shotgun, fed up with ridicule he had endured from fellow members of the Air Force, according to entries in his journal.
In one of the more disturbing entries, he wrote:
"My superior does not respect me, he makes fun of me as do most of the people I work with on mid-shift. Now everyone sees what's been going on in my head because I wear it on my face.
"Now they are asking me if I am OK, and I say 'Sure man, I'm cool.' Because if I tell them what is going on my career will be over because suicidal people eventually get discharged, get no respect if they are kept in, and treated differently, and some of that is because you can't go to war/deploy if you are suicidal.
"And even though they don't respect me, I have to respect them because they have more stripes on their arm."
At the same time, Norlund's personal life was falling apart. His marriage, little more than two months old, appeared to be unraveling.
Even if he wanted to try to save the relationship, Norlund knew he was scheduled to leave soon for Iraq.
So with no apparent way to solve his dilemma, the young airman left Seymour Johnson Air Force Base in North Carolina on July 6, 2004, and purchased a 12-gauge shotgun.
Before loading the weapon, he drank heavily, then put the barrel of the gun in his mouth and pulled the trigger.
"He probably felt as though he was trapped in a life situation that he did not want to be a part of," said Dr. John D. Norlund, the airman's father. "He knew he was going to be sent to Iraq and put in harm's way. That knowledge certainly contributed to the angst."
Norlund's journey to the Air Force began after he gave up a promising academic future at Rochester Institute of Technology, where he had been awarded a major scholarship.
The Air Force offered him a chance to change course. Growing up, he had suffered from attention deficit hyperactivity disorder but that did not prove an obstacle to entering the service.
He progressed quickly as a munitions system specialist and was well regarded for his attention to detail and work ethic. Those glowing assessments, in fact, were written about him in a memorial program the Air Force prepared and distributed at a chapel service after he had killed himself.
Yet, his journal reveals frustration and anger toward those with whom he worked in the Air Force. Something was out of whack. His father learned that he was planning to seek help but never made an appointment.
The doctor says he does not blame the military for his son's demise. The Air Force, he points out, has a program that works with suicidal airmen. But some individuals in the military, he says, lack a sense of awareness and skills to help distressed service members.
"To say there is something wrong with the institution is a misallocation," said Norlund, a radiation oncologist.
Other families and friends of service members who have committed suicide are not as philosophical as the doctor.
They contend that the well-documented experiences of Vietnam veterans should have made the government better prepared to deal with mental health issues.
>Trying to catch up?
Congress has just passed a bill to try to curtail suicides among veterans, and the military says it is working on several fronts that include:
Efforts to eliminate long-held opinions that lead to denigrating emotional and mental problems among members of the armed forces.
Education on the symptoms of post-traumatic stress disorder so that family members and friends of returning war veterans can get help for their loved ones.
A campaign to raise overall awareness that suicide is a public health issue, much like heart disease, and needs to be handled openly.
No direct correlation has been found between deployments and suicides, says Col. Elspeth C. Ritchie, a top Army psychiatrist, but she acknowledges frequent deployments lead to problems.
"We know that those factors put a strain on relationships," Ritchie said. "Other related studies have found that longer and more frequent deployments have increased the rate of post-traumatic stress disorder, anxiety and depression."
The mental health of Army Staff Sgt. Justin C. Reyes, 26, of East Amherst, after returning home from a tour of duty in Iraq, included some of the symptoms Ritchie cited.
Reyes left the Army last May after he was diagnosed with post-traumatic stress disorder. About a month later, he hanged himself.
Those who were close to the 1998 Williamsville East High School graduate say the military's inability to provide adequate treatment for returning combat veterans represents a national tragedy.
Like Airman Norlund, Reyes was having difficulties in a relationship. When his girlfriend left him shortly after they moved to Kansas, Reyes called her and threatened to harm himself if she did not return, according to authorities.
On June 21, 12 days after his desperate phone call, police checked his Wichita apartment because friends had been unable to reach him. In a bedroom, they found him hanging from an orange extension cord slung over a door.
A relative told investigators that Reyes had been drinking heavily and was having troubles since returning from Iraq.
In Iraq, Reyes proved himself a leader and was promoted to staff sergeant. He also earned a number of medals and commendations for his service, which -- at least in part -- cost him his mental well-being.
"I was frozen. I was in complete shock," Mark Bonanno said of his longtime friend's suicide. "I would never have expected this. That's why it was so shocking."
The military, Bonanno said, "is responsible" for combat veterans and owes them improved treatment to prevent these types of tragedies.
To honor their son, the Reyes family has asked for contributions to the Medina Memorial Hospital Foundation at 200 Ohio St., Medina, NY, 14103.
>Underhill loved Army
Reyes' story, in some ways, matches that of Army Sgt. Gary M. Underhill and his experiences upon returning from the war.
Underhill, 21, of Lancaster, had done one tour in Iraq and had been scheduled to return for a second deployment in September.
But he died July 30 from a self-inflicted gunshot wound in Watertown, near Fort Drum, where he was stationed with the 10th Mountain Division, authorities said.
Underhill's family said he had sought counseling after returning in July 2006 from a year in Iraq. He attended one session, but because of long hours training soldiers for deployment, he kept missing follow-up sessions.
Nicki Underhill, the sergeant's widow, refused to say the stress of war played a part in her husband's death. She said he loved the military and loved training the members of his infantry squad.
Although she will not blame his death on war experiences, she says her husband changed gradually after his return from Iraq, refusing to let down his guard and experiencing nightmares, anxiety and depression -- signs of post-traumatic stress disorder.
His death, like that of Reyes, brought similar reactions toward the military and the need to do a better job addressing mental health issues.
"People are going to come back damaged. You can't forget them when they come home," said Jessica Pitingolo, a friend of Reyes and fellow 2003 Lancaster High School graduate.
The Department of Veterans Affairs says it is trying hard to work with troubled soldiers.
>Attempting to change
Veterans should not consider reaching out for help as a sign of weakness, according to Joan M. Chipps, the suicide prevention coordinator at Veterans Affairs Medical Center in Buffalo.
"We have a poster that says 'It takes the courage and strength of a soldier to ask for help,' " she said of the effort to change attitudes.
The mother of Matthew Proulx, the National Guard sergeant, says that, while too late for her son, other distressed combat veterans need to seek treatment to save themselves and spare their families untold grief.
"I don't think Matthew felt he could reach out for help. That's just what I think," she said. "He had told me that it was considered a weakness in the military, and he was not a weak person."
Soldiers who seek help, she said, are not weaklings.
She says she hopes the other soldiers serving in Iraq and Afghanistan will come to believe that before making the long journey home.