CHEYENNE -- Gulf War veteran Steven Bates suffered from flashbacks, panic attacks and uncontrollable outbursts of anger for years after he returned from the Middle East.

He was so anxious that he avoided crowds and formulated escape routes whenever he was inside an enclosed space.

Bates, 41, of Cheyenne eventually suffered a nervous breakdown, for which doctors prescribed antidepressant medications. The drugs didn't work.

"Not knowing why I was the way I was, I wanted to commit suicide a few times," said Bates, who recently was diagnosed with post-traumatic stress disorder and began receiving treatment at the Cheyenne Veterans Affairs Medical Center.

With all the attention paid lately to post-traumatic stress disorder -- also known as PTSD -- it's easy to forget that previous generations of service members, including Bates, didn't always receive proper help when they complained of PTSD symptoms.

Previously called shell shock, traumatic war neurosis and post-traumatic stress syndrome, PTSD was finally listed in medical diagnostic manuals in 1980. Before that, some medical professionals scoffed at the idea that the disorder was a legitimate diagnosis.

As a result, many veterans of previous conflicts -- notably the Vietnam War -- were diagnosed incorrectly and given unhelpful treatments.

"People weren't necessarily believing that this was a for-real diagnosis, and they thought it was something that just went away," said Dr. Hollis Hackman, who treats veterans with PTSD at the Sheridan VA Medical Center.

Of course, much has changed with regard to PTSD in recent years -- and some things have not.

In the VA medical community, Hackman said, you no longer find clinicians who think PTSD is an imaginary diagnosis. Veterans who seek help for PTSD are more likely to be diagnosed properly and receive well-established treatments than before.

"It's very different now. Very different," Hackman said. "If a veteran comes now for treatment with PTSD, we welcome them with open arms.

"We know a heck of a lot more than we did then, and there's a heck of a lot more available," Hackman added.

The VA expects the number of troops with PTSD to increase as the conflicts in Iraq and Afghanistan linger.

The U.S. Department of Defense has not released the number of troops diagnosed with mental problems. But a Rand Corp. study earlier this year estimated that 18.5 percent of service members with time in Iraq and Afghanistan are suffering from depression and PTSD.

The Department of Veterans Affairs, which cares for military members after they leave the service, earlier this year said roughly 60,000 veterans of the conflicts in Iraq and Afghanistan have been diagnosed with PTSD.

But only about 50 percent of service members with PTSD or depression sought help in the past 12 months, according to the Rand survey. Many may be keeping their illness a secret, military officials warn.

One reason for the reluctance to seek help is the stigma that PTSD and other mental illnesses carry inside and outside the military, officials said.

Some service members keep quiet about their PTSD symptoms because they fear it will hurt their chances of promotion or destroy their security clearance. Top military brass continue to insist that it will not be a factor in either.

Other veterans and service members are reluctant to seek help because of concern that they will be viewed as crazy or dangerous by their communities.

Several Wyoming veterans suffering from PTSD declined to be interviewed for these stories because they said they worried it could hurt their prospects at work or embarrass their families.

"Sometimes they need assistance, but they are not willing to see a mental health provider because of the stigma," said Dr. David Kilpatrick, director of the Cheyenne VA Medical Center.

Military mental health professionals insist that PTSD is nothing to be ashamed of.

In fact, everyone exposed to enough trauma will develop post-traumatic stress symptoms, Hackman said.

"PTSD is essentially a normal kind of reaction to abnormal events," Hackman said. "These are all normal kinds of protective mechanisms that we are all pretty much hard wired with."

Hackman oversees an inpatient program for veterans with PTSD at the Sheridan VA, where the disorder is treated with a combination of medication and therapy.

The six-week program teaches skills in stress management, relaxation, grief issues and anger management.

It also gives veterans a chance to build trust with others who have experienced war, and to work through their battle trauma.

"We can't erase memories, but we can help people make changes so they can respond to the memories in a more helpful fashion," Hackman said.

"We try to help them change their frame of reference and help them adjust away from a war-zone (thinking) process to a civilian process," he added.

Hackman said he predicts an increased demand for PTSD-related services, and he said Congress is responding with more funding.

That's good news for returning veterans -- and for veterans of previous conflicts who are increasingly coming forward for help.

Steven Bates said he lost four marriages and was institutionalized as a result of PTSD. He was also violent, and he wasn't always a good father.

But the hardest part, he said, was not knowing what was causing him to act that way.

"I wondered, am I a weak individual? What kind of man am I?" said Bates, adding that he is seeing improvements as a result of treatment at the Cheyenne VA.

Reach reporter Jared Miller at (307) 632-1244 or at jared.miller@trib.com.