Depression is common; blast victims often experience damage to their brain's frontal lobe, making them "more susceptible to depression - a lifetime risk," said McNamee.
For others, damage is less visible and not well understood. Some 40 percent of troops returning from Afghanistan have experienced at least one IED blast at close range, according to a survey by the U.S. Army Mental Health Advisory Team.
Living under daily threat of IED blast takes a toll as well, said Dr. Sonja V. Batten, a clinical psychologist and senior mental health expert at the VA in Silver Spring. Two-thirds of the troops serving in Afghanistan work in areas where IEDs have exploded; 40 percent said an IED had exploded near them, according to a U.S. Army mental health report.
Troops exposed to IEDs over a typical 12-month deployment are more likely to have "significant long-term adjustment problems than people exposed to one or two IED blasts," Batten said in an interview.
But she stressed: "The science is very new; there is still a lot more we need to learn" about the mechanisms of mental injury and how to treat it.
For Bartlett, 35, psychological therapy included plunging into the world of veterans' self-help, working with groups like Healing Waters, a national, nonprofit organization that takes wounded veterans fly fishing.
"Guy said to me the other day, 'How can I stand in a river? I got no legs!' He's a quadriplegic. He can move his arms a bit. He goes out there and fishes. We got a blind guy, he fishes."
"It's important that we look after one another. Nobody knows our pain more than each other," Bartlett said.
"My first steps out into the world with half a face, I was drooling, my jaw was wired shut, I couldn't talk. People couldn't help but stare, and I couldn't give them a smile back. How do you focus on the positive?
"Being able to walk again, talk again," he answered. "You count your blessings every step you take."
