Lost in Las Vegas

The Army has recently developed a course called “Battlemind Training,” intended to help soldiers make the psychological transition back into civilian society. “In combat, the enemy is the target,” the course material says. “Back home, there are no enemies.”

This can be a difficult lesson to learn. Many soldiers and marines find themselves at war with their spouses, their children, their fellow service members, the world at large and ultimately themselves when they come home.

“Based on my experience, most of these veterans feel just terrible that they’ve caused this senseless harm,” Dr. Shay said. “Most veterans don’t want to hurt other people.”

Matthew Sepi withdrew into himself on his return from Iraq.

A Navajo Indian who saw his hometown of Winslow, Ariz., as a dead end, Mr. Sepi joined the Army at 16, with a permission slip from his mother.

For a teenager without much life experience, the war in Iraq was mind-bending, and Mr. Sepi saw intense action. When his infantry company arrived in April 2003, it was charged with tackling resistant Republican Guard strongholds north of Baghdad.

“The war was supposedly over, except it wasn’t,” Mr. Sepi said. “I was a ground troop, with a grenade launcher attached to my M-16. Me and my buddies were the ones that assaulted the places. We went in the buildings and cleared the buildings. We shot and got shot at.”

After a year of combat, Mr. Sepi returned to Fort Carson, Colo., where life seemed dull and regimented. The soldiers did not discuss their war experiences or their postwar emotions. Instead, they partied, Mr. Sepi said, and the drinking got him and others in trouble. Arrested for under-age driving under the influence, he was ordered to complete drug and alcohol education and counseling. Shortly after that, he decided to leave the Army.

Feeling lost after his discharge “with a few little medals,” he ended up moving to Las Vegas, a city that he did not know, with the friend of a friend. Broke, Mr. Sepi settled in the Naked City, which is named for the showgirls who used to sunbathe topless there. After renting a roach-infested hole in the wall with an actual hole in the wall, he found jobs doing roadwork and making plastic juice bottles in a factory. Alone and lonely, he started feeling the effects of his combat experiences.

In Las Vegas, Mr. Sepi’s alcohol counselor took him under his wing, recognizing war-related PTSD in his extreme jumpiness, adrenaline rushes, nightmares and need to drink himself into unconsciousness.

The counselor directed him to seek specialized help from a Veterans Affairs hospital. Mr. Sepi said he called the V.A. and was told to report in person. But working 12-hour shifts at a bottling plant, he failed to do so.

In July 2005, when Mr. Sepi was arrested, he identified himself as an Iraq veteran. But, Detective Andersen said, “He didn’t act like a combat veteran. He acted like a scared kid.”

Soon afterward, Nancy Lemcke, Mr. Sepi’s public defender, visited him in jail. “I asked him about PTSD,” Ms. Lemcke said. “And he starts telling me about Iraq and all of a sudden, his eyes well up with tears, and he cries out: ‘We had the wrong house! We had the wrong house!’ And he’s practically hysterical.”

As part of an operation to break down the resistance in and around Balad, Mr. Sepi and his unit had been given a nightly list of targets for capture. Camouflaged, the American soldiers crept through towns after midnight, working their way down the lists, setting off C-4 plastic explosives at each address to stun the residents into submission.

“This particular night, it was December 2003, there was, I’d say, more than 100 targets,” Mr. Sepi said. “Each little team had a list. And at this one house, we blow the gate and find out that there’s this guy sitting in his car just inside that gate. We move in, and he, like, stumbles out of his car, and he’s on fire, and he’s, like, stumbling around in circles in his front yard. So we all kind of don’t know what to do, and he collapses, and we go inside the house and search it and find out it’s the wrong house.”

Although Mr. Sepi said that he felt bad at the time, he also knew that he had done nothing but follow orders and that the Army had paid the man’s family a settlement. He did not imagine that the image of the flaming, stumbling Iraqi civilian would linger like a specter in his psyche.

Listening to Mr. Sepi recount the story of a death that he regretted in Iraq while grappling with a death that he regretted in Las Vegas, his lawyer grew determined to get him help. “It was just so shocking, and his emotions were so raw, and he was so messed up,” Ms. Lemcke said.