VIDEO: Peter Carnabuci, of Maple Heights, recalls scenes of combat and concentration camps during World War II that have troubled him in recent years.
They thought they had locked up the memories and thrown away the key.
Talking meant remembering, so many veterans of World War II didn't speak about the scenes of carnage and combat they saw more than 60 years ago. Not even to their wives or children.
Suck it up, lock it away.
Problem was, there was more than one key.
Decades later those visions of horror have seeped to the surface in nightmares, flashbacks, anxiety and emotional numbness -- symptoms of post-traumatic stress disorder.
PTSD, more commonly associated with the war in Vietnam and the current conflicts in Iraq and Afghanistan, is showing up in veterans whose fighting days may be long gone but are far from forgotten.
The Department of Veterans Affairs' National Center for PTSD estimated that 1 in 20 of the nation's 2.5 million surviving World War II vets suffers from the disorder.
That figure may be low, according to Dr. Edgardo Padin-Rivera, chief of psychology at the Louis Stokes Veterans Affairs Medical Center in Brecksville, who said more than 30 percent of World War II combat veterans might be affected.
Dr. Helen Kales, principal investigator and director of the geriatric psychiatry section at the University of Michigan, said researchers there were surprised at the high prevalence of PTSD in older veterans.
"There has been a lot of emphasis on PTSD in returning vets," she wrote, "but it looks as though perhaps this older generation of service members has been left behind."
A 2007-08 study at the university that looked at 78 veterans, age 60 and older, being treated for depression found that 38 percent of them had significant PTSD symptoms.
PTSD affects about 30 percent of Vietnam veterans, 10 percent of Desert Storm vets, upwards of 20 percent of those who served in Iraq and 11 percent of Afghanistan combatants, according to the national PTSD center.
Kales said World War II veterans come from a generation "in which expressing psychological symptoms or distress was pretty stigmatized. So these cases may have gone untreated as the vets did not seek treatment and were able to somehow suppress their symptoms and function."
Until now.
In looking back on his wartime experiences as a forward artillery observer with the Army's 71st Infantry Division, there are moments when Peter Carnabuci, 83, of Maple Heights, can go no further. Words and thoughts are swallowed, reburied in silence.
His most vivid memories include the horrific aftermath of a German convoy blasted by American fighter planes and an enemy barrage that tore through his own convoy, blowing off his lieutenant's head.
Veterans affected
Number of veterans by war receiving PTSD compensation from the Veterans Benefits Administration for end of fiscal 2008
World War II: 24,145
Korean Conflict: 12,381
Vietnam War: 229,682
Iraq/Afghanistan: 55,000
Worst of all was discovery of the Gunskirchen Lager death camp in Austria, where skeletal prisoners, weakened by starvation, crawled to their liberators, hugging and kissing the GIs' boots, dying in their arms. And later, a visit to the Dachau concentration camp, where more than 43,000 people were killed.
After the war, "I never said anything to anybody," Carnabuci said. "It was so horrible that people wouldn't believe it."
But in recent years he has had problems sleeping more than two or three hours a day. Nor can he stop remembering, particularly the Holocaust camps.
"Why? Because of all those people killed like that, who could have been living like me, enjoying life, raising a family," Carnabuci said.
He said he decided earlier this year, on the advice of his doctor, to seek psychiatric help at the VA medical center in Brecksville and file a claim with the VA for disability compensation due to PTSD.
Of the 3,400 vets receiving PTSD care at the Brecksville center, Vietnam veterans represent about 65 percent. The center sees 30 to 40 World War II vets for PTSD a year.
Padin-Rivera said all vets seeking help at the center are now screened for PTSD.
Nationally, PTSD has affected 23 percent (92,998) of Iraq and Afghanistan vets seeking care at the VA from 2002 to 2008.
Both Kales and Padin-Rivera cite several possible reasons World War II vets have been experiencing PTSD symptoms, including difficulties concentrating, sleep disturbances and flashbacks.
They said later-life "triggers" of these symptoms can include the death of a spouse or fellow members of veterans' groups who previously provided support; ample time in retirement for reviewing the past; or medical problems that could reduce a prior ability to cope with PTSD.
PTSD information
What is post-traumatic stress disorder, or PTSD?
PTSD is an anxiety disorder that can occur after one has been through a traumatic event, such as exposure to combat, terrorist attacks, sexual or physical assault, serious accidents such as a car wreck, or natural disasters, such as a fire, tornado or flood.
What are the symptoms of PTSD?
Symptoms can occur at any time and are considered signs of PTSD if they persist longer than a month, cause great distress or interfere with your life or work. Symptoms include reliving an event through bad memories, nightmares, flashbacks and feelings of fear and horror. Possible triggers can be certain sounds, smells and news reports of a similar event. Feelings of numbness, jitteriness, an intense awareness of potential danger, sudden anger or irritability and difficulty sleeping or concentrating can occur.
Where to go for help?
Resources for information include:
The National Center for PTSD, www.ncptsd.va.gov, 1-802-296-6300.
The National Institute of Mental Health, www.nimh.nih.gov, 1-866-615-6464.
Anxiety Disorders Association of America, www.adaa.org, 1-240-485-1001.
SOURCE: U.S. Department of Veterans Affairs' National Center for PTSD
"We find many individuals who have functioned well, for the most part, and worked out ways to develop defenses. But as they get older those defenses don't work quite as well," Padin-Rivera said.
He said these soldiers come out of a generation that didn't always seek mental health. "They were told to get a job, raise a family and forget what happened -- just move on. So many vets thought that if they didn't think about it, didn't talk about it, in time they'd get over it. A lot of what we get from them is that they've been suffering in silence over 60 years."
He cited one example of a man who had been jammed into a cattle car with other POWs during the war and spent more than a week trapped inside with people screaming and dying around him.
The man had lapsed into a coma and later could not remember the ordeal until he was recently put into an MRI scanner for medical treatment and suddenly panicked as the old cattle-car memories returned.
Padin-Rivera also noted that the onset of dementia can dim short-term memories but sharpen long-term memories to the same degree of vividness originally experienced.
"The dementia folks seem to have more flashbacks, more instances where they really feel they're back in the war," he said. "It can be very scary."
Talking, particularly in groups, can be a good way to help World War II veterans deal with PTSD, according to Padin-Rivera.
The group setting can overcome any stigma associated with seeking aid and "help break the isolation that a lot of them believe they're the only ones suffering this way," he said.
He noted that in addition to medication, other therapy can include work on stress management, relaxation techniques and reduction of sleep disturbances.
In a sense, these World War II vets haven't stopped serving their country, even while grappling with PTSD in their later years.
"The World War II vets are giving us an immense amount of data and knowledge for working with the Vietnam vets who are now hitting their 60s," Padin-Rivera said. "I suspect we'll see a lot more Vietnam vets with the same symptoms as what we're seeing with the World War II vets as the dementia and fragility sets in, and their support groups die away."
But the past, at present, is what concerns Carnabuci the most, and he hopes the VA can help. He said he's been told the specialists there can't cure PTSD but they can help him accept it.
"Well, I do accept it. I have to accept it," he said. "These are my memories. They'll never take that away from me."