It started with the nightmares — middle-of-the-night eruptions when her fiancé would jolt her awake with his screams, his body drenched in sweat.

Renee Paxton watched as the outgoing, quick-witted man she loved and would later marry slowly came undone.

A load master in the Air Force Reserve with 240 combat missions into Afghanistan and Iraq, Rick Paxton stopped eating, stopped seeing friends. Loud noises spooked him; the American flag flying on a building stopped him dead in his tracks. He hardly left the house.

The 49-year-old became combative at the very suggestion that Renee Paxton get them help, worried that revealing his troubles would jeopardize his chances to advance after 25 years of service.

"He said, 'We don't talk about this,' " she recalled. "Military people push that stuff to a different part of their brain."

But the fear that is keeping soldiers from seeking help for their mental wounds is also tying the hands of those closest to them — the silence like a fence around the family.

"Often they are living in fear, silently, like women in domestic violence," said Jennifer Ferguson, a licensed marriage and family therapist who worked for a year in a post-traumatic stress disorder (PTSD) program at Madigan Army Medical Center south of Tacoma.

One in five U.S. soldiers coming back from war in Iraq and Afghanistan have signs of PTSD or other mental distress, studies show.

Several recent high-profile acts of violence allegedly involving active or former soldiers at Joint Base Lewis-McChord (JBLM) are focusing increased attention on what can go wrong for soldiers both in the war zone and after they come home.

Among the cases are a growing number of suicides, the murder in January of a ranger at Mount Rainier National Park, the murder-suicide last April involving a combat medic who led police on a high-speed chase down Interstate 5 and, a week ago Sunday, the slaughter of 16 unarmed civilians in Afghanistan, allegedly at the hands of JBLM Staff Sgt. Robert Bales, who was on his fourth tour of duty.

While a full mental-health evaluation of Bales will be undertaken in coming days or weeks, his defense team has brought in a forensic psychiatrist specializing in PTSD.

And Bales' wife, in a statement Monday expressing condolences to the families of the victims, spoke of her own family's trauma "as we try to make sense of something that makes no sense at all."

Career concerns

When a soldier suffers from PTSD, families, particularly spouses such as Paxton, are on the front line of it, among the first to notice the shift in behavior — anxiety, mood swings, what counselors call the night terrors.

But, Ferguson said, "a lot of times the soldiers don't want them to seek help. If they are on active duty they worry their careers will be destroyed."

So some families and spouses slog through this minefield on their own, or depend on close relatives and friends.

While there are outside support groups and programs that can help while protecting the identity of service members, some families say what they really need is to change the military mindset about getting treatment.

Patricia Bailey, who worked part time in a behavioral-health program at Lewis-McChord in the mid-2000s, has been circulating a petition urging the military to adopt a policy to ensure that service members' careers won't be jeopardized if they seek mental-health help.

She believes her ex-husband was reluctant to get the help he needed for his anger and anxiety after deployments to Asia and the Middle East because he was worried it would affect his career.

The Pentagon has said that soldiers won't be penalized for seeking help, but Bailey believes that in the absence of a specific policy, service members who need treatment won't seek it.

One veteran who now provides private counseling for families of service members suffering from PTSD said in the decades since he retired, "the military has changed a little bit, but not that much."

He recalled how an Army general who came to Lewis-McChord during the 2000s and talked about his own battle with PTSD changed the tenor of the conversation around the disorder.

"Prior to that," said the counselor, who asked that his name not be used to ensure confidentiality for his clients, "the military considered it a personal issue; get over it. During my time in the service, if I went to a mental-health person, that would be enough to end my career."

Now, he said, "that person is more likely to get help. Still, people are not looked at the same way once they do."

And from top brass to the lowest-ranked soldier, "no one wants to talk about it."

"No instant solution"

At Lewis-McChord, families can access a range of programs that help with marital and relationship problems, that offer services for children and adolescents and that provide counseling.

But there are no programs specifically tailored to help the families of soldiers suffering from PTSD.

The vet and counselor pointed out that each case is unique. "There's no protocol to deal with all the different aspects of what families will go through," he said.

It's possible to reduce and manage symptoms with proper therapy, along with support from loved ones, he said. He knows this not just professionally but personally, too, having suffered through them himself.

"I know they can come back from it," he said. "You don't do it with pills; there's no instant solution. It takes time. ... Just know that the person is going to be changed."

In the end some couples struggling under the nightmarish symptoms don't make it, especially younger ones. Unable to cope with a spouse who bears little resemblance to the person they married, they often give up and walk way.

Debbi Fisher, co-founder of Rainier Therapeutic Riding in Yelm, which provides a riding program as therapy for PTSD-diagnosed servicemen and women, said 75 to 80 percent of married clients in the program are going through divorce.

"It's hard for me to see the younger wives give up on their men or the other way around," she said.

But Renee Paxton, 44, whose husband has seen some positive results from participating in Fisher's horse-riding program, said she never considered giving up on him even as his behavior continued to confound her.

His missions into combat zones often involved bringing out the flag-draped caskets, and injured and dying comrades. Paxton first began noticing changes in him about two years ago — in early 2010 — when they were still engaged. He lost interest in most things, grew solemn and irritable. The sight of raw meat so unnerved him, she'd have to cover it if it was defrosting on the counter. She came to recognize his symptoms as similar to those of her father, who had served in Vietnam.

In September 2010, he stuck a gun in his mouth but didn't pull the trigger because he later told her he didn't want her to discover him that way.

She learned about that incident only after a Vietnam veteran friend of a friend came to talk to him, eventually convincing him to seek help.

The Vietnam vet told him, "You'll lose everything; it's your wings or your life."

Rick Paxton was admitted to Madigan and spent eight days in a psychiatric ward. He was released after eight days and declared "fit to fly."

But he never again did.

A year later he was diagnosed with PTSD, depression and other mental disorders.

In December 2010, at a small, intimate ceremony attended by close family and friends, Renee and Rick kept their promise to each other and were married.

After all they'd been through together, Renee Paxton said she was not about to give up on him.

"I love him," she said, "and I'm fighting for him."

Lornet Turnbull: 206-464-2420 or lturnbull@seattletimes.com.

On Twitter @turnbullL