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My dad had this really bad when he first came back I guess.depends on the situation
if it's a 'kill or be killed' as our current ROEs basically require, the situation likely isn't as traumatic
IMO, from my personal experiences in war, it's not so much killing others that messes people up as seeing your boys killed, aka Survivor's Guilt
They were due to ship back home in like a week and got shelled. My dad and like 4 others made it out unscathed and a couple others got wounded and he had to see a shell fall ON the foxhole of a friend of his who had a child born while he was away from home the way Lutz saw his friends die as potrayed in Band of Brothers.
Asked him if he talked to any of his friends from his time in and his response scared me when I was younger but I get it now:
"After my first tour I stopped making friends... you make friends it hurts more when they leave"