JONANCY, Ky. — Growing up in Jonancy Bottom, where coal trucks grind their gears as they rumble down from the ragged green hills, Blake Miller always believed there were only two paths for him: the coal mines or the Marine Corps. He chose the Marines, enlisting right out of high school.
The Marines sent him to Iraq, and then to Fallouja, where his life was forever altered. He survived a harrowing all-night firefight in November 2004, pinned down on a rooftop by insurgents firing from a nearby house. Filthy and exhausted, he had just lighted a Marlboro at dawn when an embedded photographer captured an image that transformed Blake into an icon of the Iraq war.
His detached expression in the photo seemed to signify different things to different people -- valor, despair, hope, futility, fear, courage, disillusionment. For Blake, the photograph represents a pivotal moment in his life: an instant when he feared he would never see another sunrise, and when his psychological foundation began to fracture.
Blake, whose only brush with celebrity was as a star quarterback in high school, became known as the Marlboro Man, a label he detests. That same notoriety has carried over into his post-Iraq life, where he is an icon of sorts for another consequence of the war -- post-traumatic stress disorder, or PTSD.
On Nov. 10, precisely one year after the photograph was flashed around the world, Lance Cpl. James Blake Miller was medically discharged from the Marine Corps, diagnosed with full-blown PTSD. Three years after leaving the Kentucky hills for a career in the Corps, he was back home. He feels adrift and tormented, dependent on his new bride, his family and his military psychiatrist to help him make sense of all that has befallen him.
He barely sleeps. On most mornings, Blake says, he has no good reason to get out of bed. Often, his stomach is so upset that he can't eat. He has nightmares and flashbacks. He admits that he's often grouchy and temperamental. He knows he drinks and smokes too much.
"He's not the same as before," said Blake's wife, Jessica, who has known him since grade school. "I'd never seen the anger, the irritability, the anxiety."
Blake says he feels guilty about taking money -- $2,528 in monthly military disability checks -- for doing nothing. Yet he's also frustrated that two careers made possible by his military training, police officer or U.S. marshal, are out of reach because law enforcement is reluctant to hire candidates with PTSD.
So he broods, feeling restless and out of options: "I'm only 21. I'm able-bodied as hell, yet I'm considered a liability. It's like I had all these doorways open to me, and suddenly they all closed on me. It's like my life is over."
At a local restaurant one night last month, Blake became enraged when he thought a man was staring at Jessica's rear end.
"I just wanted to grab his hair and smash his head against the table," he said later. "I was ready to kill him." But he restrained himself, he said.
Jessica's grandmother, Willa Fouts, whom Blake calls Mamaw, patted his arm outside the restaurant and told him: "You've had a few episodes like that, Blake, where you're just so quick to anger. You need to try to calm yourself."
Jessica, who graduates this spring from Pikeville College with a psychology degree, has persuaded her husband to undergo visualization techniques in which she helps him confront his demons.
"It's understandable that Blake has PTSD, after all he's been through," she said. "Ordinary people can't comprehend what it's like to be constantly shot at and have to kill other human beings. They need to know what it means to send people like Blake out to fight wars. You're going to have a lot of people breaking."
Five other members of his platoon of about three dozen have been diagnosed with PTSD, Blake said. A dozen men from his unit were killed in action. A Journal of the American Medical Assn. study published in March found that more than a third of troops who served in Iraq sought help for mental health problems within a year of returning home.
Sitting in the couple's spacious apartment above a furniture store outside Pikeville, Jessica squeezed Blake's hand and told him: "You've gone through so much, baby, that you just broke."
Blake was staring at the sunrise. He was on a rooftop in Fallouja, sucking on a Marlboro and wondering whether he would live to see Jessica and his father and brothers again.
Luis Sinco, a Times photographer, was crouched next to the corporal, taking cover behind a rooftop wall. There was a break in the all-night firefight after an Abrams tank, radioed in by Blake, destroyed a house filled with insurgents.
Sinco pressed the shutter.
He did not consider the image particularly special. It was the last shot he filed that day.