Little Relief on Ward 53

Calloway's physical metamorphosis was rapid. The burnished soldier turned soft and fat, gaining 20 pounds the first month from tranquilizers and microwaved Chef Boyardee. He lived at Mologne House, a hotel on the grounds of Walter Reed that was overtaken by wounded troops. His roommate was another soldier from Iraq with psych problems who kept the curtains drawn and played Saints Row video games all day until one day he vanished -- poof, AWOL, leaving nothing behind but empty bottles of lithium and Seroquel.

For the first time in almost a year, Calloway had a plush bed and a hot shower, but he was too angry to appreciate the simple comforts. On an early venture outside Walter Reed, he went to downtown Silver Spring and became enraged by young people laughing at Starbucks. "Don't they know there is a war going on?" he said.

Wearing a rock band T-shirt, Calloway looked like any other 20-year-old on the sidewalk, but an unspeakable compulsion tore through him. He said he wanted to hatchet someone in the back of the neck.

"I want to see people that I hate die," he said. "I want to blow their heads off. I wish I didn't, but I do." He made similar statements to his psychiatry team at Walter Reed.

Violence seeped into his life in a thousand ways. When he cut himself shaving, the iron smell of blood on his fingertips gave a slight euphoria. But it was the distinct horror of his sergeant's death that was encoded in his brain. The memory made him physically sick. He would sweat and shake as if having a seizure, and sometimes he felt as if he were back in the heat and sand of Iraq.

The recognized treatment for PTSD is cognitive behavioral therapy, in which patients are encouraged to face their feared memories or situations and to change their negative perceptions. A key technique is known as prolonged exposure therapy. It involves revisiting a traumatic memory in order to process it. The idea is not to erase the memory but to prevent it from being disabling. Highly structured, one-on-one sessions over a limited time period have proved most effective, according to Edna B. Foa, a professor of psychology in psychiatry at the University of Pennsylvania, who has been contracted by the Department of Veterans Affairs to train 250 therapists who treat PTSD.

But Calloway and a dozen other soldiers from Iraq and Afghanistan interviewed by The Post described a vague regimen at Walter Reed's outpatient psychiatric unit, Ward 53. They get a heavy dose of group sessions such as "Reflecting with Music," "Decisions," "Feelings Exploration" and "Art Expressions." Calloway reported to his "Reel Reflections" class one morning for a screening of "The Devil Wears Prada." Only two hours a week are devoted to a post-traumatic recovery group, according to a copy of their schedule.

These soldiers said they are over-medicated and treated with none of the urgency given the physically wounded. One desperate patient, a combat medic who broke down after her third tour in Iraq, said she begged her psychiatrist: "We are handicapped patients, too. Cut off both my legs, but give me my sanity. You can't get a prosthesis for that."

In an interview this month, Col. John C. Bradley, head of psychiatry at Walter Reed, said soldiers with combat-stress disorders receive the accepted psychotherapeutic treatment there. He said they are placed in a specially designed "trauma track" and are given at least an hour of individual therapy a week and a full range of classes to help them cope with their symptoms. Exposure therapy is as effective in group settings as in individual sessions, he maintained -- a belief that runs counter to the latest clinical research.

Bradley acknowledged staff shortages and said vacancies in his department go unfilled for as long as a year because of the Army pay scale and the high cost of living in the Washington area. He recently asked to increase his staff by 20 percent, and last month he brought on a reservist to help doctors with the time-consuming duties of preparing reports for the soldiers' medical evaluation board process. "We are constantly looking for innovative ways to provide service and outreach and support to soldiers," said Bradley, who deployed to Iraq last year with a combat-stress unit.

One of the country's best PTSD programs is located at Walter Reed, but because of a bureaucratic divide it is not accessible to most patients. The Deployment Health Clinical Center, run by the Department of Defense and separate from the Army's services, offers a three-week program of customized treatment. Individual exposure therapy and fewer medications are favored. Deployment Health can see only about 65 patients a year but is the envy of many in the Army. "They need to clone that program," said Col. Charles W. Hoge, chief of psychiatry and behavior services at the Walter Reed Army Institute of Research.

Instead, Deployment Health was forced to give up its newly renovated quarters in March and was placed in temporary space one-third the size to make room for a soldier and family assistance center. The move came after a series of articles in The Post detailed the neglect of wounded outpatients at Walter Reed. Therapy sessions are now being held in Building T-2, a rundown former computer center, until new space becomes available.