In the months after checking out of Walter Reed Army Medical Center, he found himself easily frustrated and, his wife said, perpetually angry. Envisioning threats in grocery stores and shopping malls, he stopped leaving his house and started drinking heavily. His marriage was near collapse when, in a fit of alcohol-fueled despair, he drove his car into a brick wall, emerging so dazed that he thought he was back in Iraq.

“with a physical injury — three months, six months, whatever — your cuts will heal,” he said. but post-traumatic stress “is more difficult because people don’t see it.”

Like Mr. Pennington, many veterans injured in combat are finding that their invisible psychological and neurological wounds are proving more debilitating than their obvious physical ones.

About 1,700 American service members have lost limbs in Iraq and Afghanistan, most in roadside bombings that seared skin, shattered bones and damaged internal organs as well. Most of those troops also came home with traumatic brain injuries and post-traumatic stress disorder, which in many cases were not recognized for months.

While advances in prosthetics have made it possible for many lower-limb amputees to regain full mobility, the track record for overcoming brain injuries and chronic P.T.S.D. — both capable of altering personality and hampering mental functioning — is more spotty, experts acknowledge.

“I think the limiting factor for these people going back to their lives is not having lost a limb,” said Dr. Douglas Cooper, a neuropsychologist at Brooke Army Medical Center in San Antonio. “The P.T.S.D. symptoms and post-concussive symptoms are the ones that seem to get in the way.”

For Mr. Pennington, medications seemed to worsen his depression and therapy did not ease his anxiety. He seemed headed for divorce, isolation and perhaps alcoholism. And there his story might have ended, a case study on the intransigence of war’s psychological scars. but it did not end there.

In 2009, an unexpected opportunity landed in his e-mail inbox: a casting call, forwarded by a friend in Nashville, from an undergraduate filmmaker looking for someone to play a combat veteran who had lost a leg, had post-traumatic stress disorder and lived in Maine.

This is my life, Mr. Pennington thought.

So on a lark, Mr. Pennington — whose last appearance on stage was in middle school and who had become nervous in crowds and, indeed, avoided most human contact — decided that fixing his life depended on performing before a camera.

“I thought acting would be so out of the normal that it would force me to deal with things,” he recalled. “I wanted my life back.”

The struggle by wounded veterans like Mr. Pennington to reclaim their lives is the unfolding next chapter in America’s wars in Iraq and Afghanistan. Since 2001, 46,000 American service members have been injured in combat, perhaps a third or more seriously. Those veterans now face years of rehabilitation at a cost of billions of dollars annually.

In the coming weeks, The New York Times will profile a few of those veterans. Their cases say much about the critical importance of high-quality health care and loving families. but as with Mr. Pennington, they also underscore the individuality of recovery, where the most effective therapies are often discovered by the veterans themselves.

Mr. Pennington, 28, grew up in central Maine and Fort Worth, Tex., toggling across the continent between divorced parents. He was a talkative boy who loved the outdoors and was good in school, but bad at keeping the jobs that helped support him after he said he had problems with his alcoholic father. When he turned 17, he joined the Army.

He fell in love with the life immediately. His first deployment to Afghanistan in 2002 with the XVIII Airborne Corps was uneventful, so he volunteered to go to Iraq almost as soon as he returned home. He lost a dear friend during that tour, but it did little to sour him on the adventure of war. He raised his hand a third time.

On that third deployment, to Iraq in 2006, he was driving the lead Humvee in a convoy through the insurgent-friendly city of Samarra when a powerful bomb exploded beneath the engine. Through fire and thick smoke, he managed to maneuver the vehicle out of danger with a push from a truck behind.

But when he went to slam on the brakes, he realized his left foot was gone, taken off by shrapnel that had penetrated the bottom of the truck.

His rehabilitation at Walter Reed Army Medical Center in Washington went relatively smoothly, fueled by his hatred of wheelchairs. He was discharged from the Army and returned to Maine in just a year. And there his problems really began.

Perhaps it was leaving the secure cocoon of Walter Reed. perhaps it was living in a rural town, far from Army buddies. perhaps it was his battles with the Veterans Affairs bureaucracy over benefits. perhaps it was the long menu of medications his doctors prescribed: narcotics to ease his pain, antipsychotics to control his moods, sleep aids to tame his nightmares.

Whatever the cause, he grew more irritable, anxious and depressed, symptoms of post-traumatic stress disorder. After he crashed his car into the wall, he told his wife, Marjorie, “I can’t do it anymore.”

With the help of a nonprofit group, the couple moved to Houston in 2008, where he found the care at the veterans health center more to his liking. Doctors there got him off most of his medications, started treating him for traumatic brain injury for the first time and expanded his P.T.S.D. therapy. He felt he was getting better.

But in 2009, Ms. Pennington’s brother committed suicide and the couple returned to Maine to help care for her nephew. Mr. Pennington again fell into a deep funk. He imagined people everywhere judging him, for having killed Iraqis, for being a “crazy veteran.” He spent more of each day in front of the television, afraid to leave home.

Around that time, Nicholas Brennan was looking for actors for his senior project at New York University, a film about a wounded veteran struggling with the transition to civilian life. a casting call sent across a veterans’ e-mail network got about a dozen responses, mainly from soldiers who had lost legs or from out-of-work actors. but the last one, from Mr. Pennington, seemed the most poignant.

“I was injured in 2006,” Mr. Pennington wrote. “it resulted in a personality change for the far worse.”

Mr. Brennan, who was also from Maine, visited Mr. Pennington and was struck by the similarities between the real soldier and his lead character, a Marine named Connor. both had worked in boat repair shops, both loved to fish, both struggled with life in small-town Maine.

“it was pretty clear from the first few minutes I met him,” Mr. Brennan recalled, “that he would be a perfect partner on this project.”

At first, Mr. Pennington simply hoped that acting would force him out of his shell. but as he inhabited the role, he found himself not just identifying with Connor, but also realizing things about his P.T.S.D.

In the final scene of the 15-minute film, titled “a Marine’s Guide to Fishing,” Connor sits on a pier at sunset, his prosthetic by his side, decompressing after a violent flashback in front of his co-workers. His boss, a Vietnam veteran, counsels him to take his time, but leaves with a gentle warning: “You stay out here too long, you’ll never get back.”

“that rang right home to me,” Mr. Pennington said in his Texas twang. “I said, ‘well, dang, that’s what I’m doing.’ ”

After the film was finished last spring, Mr. Brennan and Mr. Pennington showed it publicly for the first time in Portland. Mr. Pennington says he was terrified about speaking before an audience, but afterward people came up looking for advice about relatives struggling with P.T.S.D. His ability to help them was deeply satisfying.

The two men decided to create a Web site to distribute the film and offer their services as speakers. they have done about a dozen such engagements, including one at the Veterans Affairs Health Care Center in Augusta, where Mr. Pennington receives his care and has, at times, clashed with bureaucrats and doctors.

For Mr. Pennington, the public engagements have been a form of exposure therapy, pushing him to articulate bad memories and buried feelings that he had avoided before. The experience has also motivated him to return to therapy himself, making him realize, he said, that “this P.T.S.D. is really getting the best of me.”

Experts say that public speaking alone is not a solution for the symptoms of P.T.S.D. but it can be therapeutic, helping people articulate their emotions and give meaning to their experiences.

“it gives people some authority over what happened to them,” said Dr. Matthew J. Friedman, director of the Veterans Affairs National Center for P.T.S.D. in New Hampshire.

Recently, the Penningtons, who live with their five dogs in a bungalow on a grassy knoll overlooking Dexter, renewed their wedding vows. He spends his days chain-smoking Marlboros, riding a mountain bike for exercise and studying books on acting. He is considering joining a local theater group and doing stints as a regular guest on a radio station owned by the author Stephen King.

He still wakes each morning hating his carbon-fiber leg, which gives him cysts under the skin of his stump. but it is a part of him now. His relationship with P.T.S.D. is more complicated.

He is learning, he says, to talk about his darker memories of war, including the time he nearly killed an Iraqi family that had driven through a checkpoint. The family lived, he says, only because his gun jammed, and the event has haunted him since.

He is also learning how to talk about killing. it has not been easy, he says, because he still feels ashamed when acquaintances blithely ask how many Iraqis he killed. His solution has been to answer bluntly and without explanation: 18.

But the best thing, he says, is that he has become more confident about offering advice to other veterans.

During a recent trip to Augusta for a checkup, Mr. Pennington was approached by an older veteran, who pushed himself in a small cart. a former submariner with a bushy white beard, the man had diabetes, and doctors wanted to remove one of his legs. He nervously asked about what lay ahead.

Balancing gracefully on his good leg, Mr. Pennington removed his prosthetic and described the various annoyances the silicone sleeve could cause. then he put it back on and smiled.

“It’s not so bad,” he said. “if this was my only problem, I’d be doing great.”

Depression, the emotional disease which is often characterized by continuous durations associated with unhappiness along with sadness, professionals in the area associated with psychiatry say.

But simply because one person is actually moping about and just generally disliking the planet close to him or her, does not imply that it’s by now despression symptoms, but when this kind of habits, the sensation of emptiness, loss in self-worth as well as simply no hope for happiness merely proceeds and on, next, of course, see your face is incredibly a lot, without a doubt, stressed out.

Nevertheless, there are various forms of depressive disorders, via Manic or perhaps The illness depressive disorder * characterized by unexpected as well as excessive adjustments to one’s feeling wherein 1 minute they are in an improved state associated with euphoria even though the following second (evening or perhaps 7 days) he or she is sensation to stay in an individual hell, Postpartum depressive disorders : seen as an a prolonged despair plus a feeling of avoid by way of a brand new new mother in which actual strain through giving birth, a great unclear sense regarding responsibility for the fresh born child could be just some of your achievable reasons why newer and more effective new mother move through this, Dysthimia : characterized by a slight similarity along with depression, even though this occasion, it is often proven to be a lot less severe, in reality using any kind of circumstance, should be dealt with quickly, Cyclothemia — seen as an hook likeness together with Manic or even Bipolar depressive disorders when the individual suffering from this particular emotional disease might at times suffer from severe adjustments to a person’s emotions, In season Affective Condition * seen as slipping in the mentality only in the course of specific seasons (my partner and i.e. Wintertime, Springtime, Summer time as well as Drop) scientific studies nevertheless, confirm more and more people in fact fall right ditch more throughout the Wintertime and Slide seasons not only that, Moodiness, when a person’s disposition may shift through happy to unhappy for you to furious in a short period of time.

Clinical depression nonetheless, or perhaps as a few may call up while ‘major’ depressive disorder, is definitely the health-related phrase for despression symptoms. truly clinical depression is a lot more of an disorder rather than a sickness mainly because it essentially addresses the few who are suffering through signs or symptoms associated with depressive disorder. Clinical depression is the place doctors typically talk about “depression” while giving a new identify with their patient. It is basically just the health-related term.

However, in spite of as an true problem, Clinical depression may be dealt with. Doctors are in fact very positive that their sufferers that suffer via Specialized medical problem will likely be effectively on their way in direction of very good mental wellbeing providing that they handled after they’ve been identified as having Clinical depression. People who have been seeking for therapies for Clinical depression are actually rather productive inside their mission, considering the fact that 80 % of genuine Clinical depression individuals are actually treated and has to some degree observed relief from their problem.

For individuals who might be searching for a few responses for their Clinical depression associated concerns, the particular depression portion of the wellness heart is extremely suggested, and also textbooks about psychiatry and also the internet – which can provide a lot of tips with regards to Depression although self-medication/treatment is especially disapproved of. Clinical depression may not create as much as a danger since the other forms of despression symptoms, but it’s best to allow the particular fingers associated with professionals who can without danger deal with and also treat this particular dysfunction.

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When one of my most charming patients  -  a glamorous divorcee aged 70 whom I will call Jane  -  came to see me with a recurrent eye infection which we couldn’t seem to eradicate, I was convinced she was suffering from a type of ‘dry eye’, the sort of condition from which many older people suffer.

Yet when, in despair at my failure to pinpoint the cause of the problem, I took a swab sample and sent it away for testing, the result shocked me.

The microbiologist who had examined the sample discovered that Jane was suffering from chlamydia, a bacterial sexually transmitted disease (STD). 

Jack Nicholson’s character in Something’s Gotta Give (above with Diane Keaton) is told that – after a heart attack – he can’t make love until he is fit enough to climb a flight of stairs without getting breathless

‘Are you sexually active?’ I enquired gently at our next appointment?

‘Oh yes,’ came the reply. ‘My boyfriend is in his 40s.’

Jane didn’t seem remotely bothered or embarrassed by the diagnosis. she simply accepted the antibiotics I prescribed and headed for the pharmacy next door.

Perhaps it was her sang-froid that stunned me but I shouldn’t really have been surprised. according to Government figures, men and women over 60 are now the fastest-growing sector of the population who are contracting STDs, chlamydia in particular.

Since 2002, syphilis has tripled in the over-65s and doubled in the 35-64 age group; chlamydia has risen by 51 per cent in the 35-64 age group, with a 37 per cent rise in the over-65s.

Last week, figures were released showing HIV infections among over-50s have gone up by 60 per cent in England and Wales since 2003.

Unlike their fortysomething children  -  who grew up in the shadow of AIDS  -  the Baby Boomers are quite cheerfully promiscuous, with no interest in condoms for protection, as they never learnt to fear sexual diseases.

Another of my patients is a 64-year-old man I’ll call Jeffrey. after his wife died four years ago, Jeffrey decided he didn’t want another long-term partner.

In my consulting room, we learnt he had contracted genital warts while abroad.

Jeffrey was unflappable. had he been in his 20s, I imagine he would have been horribly embarrassed and worried about the future implications. after all, warts are treatable but never curable. Any future partner would have to know.

But Jeffrey had no intention of finding a second wife.

So as long as I could ease the symptoms (itchiness and rash; pain on urination), he was happy. And being older, he was used to the twinges of old age already  -  a few extra aches and pains really didn’t bother him, as long as they weren’t life-threatening.

When I asked why he hadn’t used a condom, Jeffrey told me: ‘I’ve never used one before. why should I start now?’

The Baby Boomers’ laid-back attitude is no doubt also due to being young in the Sixties and Seventies, when they were the first generation to enjoy the freedom of the Pill.

Now many of them are on to second marriages, or merely a string of relationships post-bereavement or divorce, and they have simply reverted to that relaxed mindset.

If you add in the lack of need to worry about contraception, plus the improved sexual drive caused by hormone replacement therapy (both oestrogen for women and testosterone for men), and the help of drugs such as Viagra and Cialis in cases of erectile dysfunction, the older generation have never felt more able to have a confident, enjoyable, second sex life.

Given that they are also among the most enthusiastic users of the internet, allowing them to find and change partners with ease, is it any wonder that the over-60s are so promiscuous? (A 2008 survey by the over-50s magazine Saga found that two-thirds of men and women aged 60-64 said they were still sexually active, with almost half of those getting between the sheets at least once a week.)

Or that GPs now see so many of them with diseases ranging from warts and chlamydia to herpes, syphilis and gonorrhoea?

While there is no doubt that the fact they are having sex is in itself good news  -  it’s great physical activity and it’s mentally healthy to be in a relationship, whether new or old  -  I would prefer that they weren’t collecting and spreading so many diseases.

So how do you get the message through to a 70-year-old who is in a fabulous relationship with a man 30 years her junior? or to my 64-year-old gentleman?

For women, I tend to point out that as you age, sex can become less comfortable, as the body is less lubricated and skin finer and more delicate. I suggest that using a condom can make sex more pleasant.

For the men, it’s simpler. I remind them that they may not be planning on becoming a father again, but a younger partner could still conceive, and do they really want an 18-year-old turning up on their doorstep in the future?

The only other concern is  -  are they fit for sex, particularly if they are post-heart attack?

Who could forget Jack Nicholson’s character in Something’s Gotta Give being famously told that  -  after a heart attack  -  he couldn’t make love until he was fit enough to climb a flight of stairs without getting breathless?

The doctor had a good point. you should have a basic level of fitness. you don’t want to have another heart attack in flagrante.

First I ask patients: how far can you walk comfortably?  More than 100 yards and you pass.

Can you lift two bags of shopping? Tick, and you pass. Lastly, can you  -  like Jack did in the end, before starting a relationship with Diane Keaton  -  climb those stairs?

If you can make it up a flight of 21 steps without serious discomfort, then go ahead. You’ll be fine. And those tests apply at any age, by the way.

My oldest sexually active patient is 98. his girlfriend is in her 50s. he appreciates that time is not on his side. who can berate him for sowing a few last wild oats while he can?