Soldier Finds Comfort at Dark Journey's End

They talked about the calls to prayer they had heard every day and the voices of the muezzins. One sounded as if he had just woken up, the Marine said. He tried to imitate him.

"Allah Akbar!" he shouted, his voice echoing on the linoleum.

"Allah Akbar!" she shouted, laughing and swinging her arms in the air. "Allah Akbar!"

Outside the door, a patient paced the 39 steps, her threadbare hospital gown flowing like an Arab robe over her dirty gym clothes.

In her first few days on the ward, Blackwood told her story to five different psychologists. None of them offered therapy or relief. Instead, the medical students wanted to "present her" to the staff as an interesting case. She declined. VA officials say that in-depth therapy is not the goal of acute psychiatric care in a ward such as 3D East but that the focus is instead on stabilizing patients, assessing their condition and creating a safe environment.

Jon Bowersox, a good friend of Blackwood's who is a military and VA surgeon, was shocked on his visit to see a staff so unfamiliar with post-traumatic stress disorder, given the hospital's proximity to several military posts. "We've got to get you out of here," Bowersox told her.

With her influential friends, including Bowersox, a lawyer and a diplomat, Blackwood was better connected than most VA patients. That week, they formed a tag team to spring her from the bleak world of 3D East. When they got her out, they moved her first to New York and then to the Fort Thomas residential women's clinic in Kentucky, one of six in the huge VA system. Blackwood was admitted so quickly because Bowersox knows the director. When he called, there happened to be a vacancy.

"I don't know whether I could do this without my friends helping me," Blackwood said.

Fort Thomas offers intense, highly personalized care, and its program has proved to be one of the most effective in the country, the other side of the spectrum from what Blackwood experienced in Washington. The grounds hug the Ohio River and are surrounded by hiking trails. Only 10 patients are admitted every seven weeks. They attend 25 hours of group sessions and two to four hours of individual therapy each week. The program's director, Kathleen Chard, is considered to be in the vanguard of PTSD treatment and will be training mental-health clinicians across the country for VA over the next 15 months.

In her individual therapy sessions, Blackwood was asked to relive her Iraq experience, in detail, until she could understand her fears and her instinctual reactions to them. This is called exposure therapy. She learned to recognize that when she heard a loud noise, it didn't mean that a bomb was exploding. Her reaction was based on memory, not reality. In another form of therapy, cognitive processing, she learned to discard the irrational thoughts imprinted on her brain by her traumatic experience in Iraq.

Looking back, Blackwood credits Ward 3D East, even in its bleakness, with giving her safety, and a place to scream, cry and express her pain for the first time. Chard's clinic taught her to leave the war in Iraq and allowed her to live without paralyzing fear. "It saved my life," she said.

A few days ago she walked under an umbrella in a heavy storm. When the thunder pounded, she didn't flinch.