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VII. ''It Just Kept Building Up and Building Up ... ''

The Women's Trauma Recovery Program is tucked into a small adobe-style building on one corner of a sprawling V.A. health-care campus in Menlo Park, Calif., about 20 miles south of San Francisco. Outside there is a sunny courtyard, where residents often gather to smoke and talk. Inside there are five dorm-style bedrooms, each with a pair of twin beds. The feeling is something less than homey but something more than institutional. Next door there is a larger and more established 45-bed program for male active-duty soldiers and veterans with PTSD.

When I arranged to visit the women's program for a couple of days last July, it was unclear whether any of the six female patients then in residence would speak to me. According to Darrah Westrup, the psychologist who leads the program, this group had only just begun its 60-to-90-day treatment program, which was devoted both to learning coping skills and to gradually doing exposure therapy for their traumas. For many of the patients, entry in the program - gained through a referral from a mental-health specialist and then a fairly intensive application process - felt like a last resort. Privacy, too, was paramount: some of these women had isolated themselves for years and, working with the program's therapists, were just beginning to rebuild some confidence, Westrup said.

So it came as a surprise when, one by one, each one surfaced at Westrup's office, ready to talk to me. (They requested that I protect their privacy by not using their full names.) Each asked too that Westrup be present for the interview, and I soon understood why: despite the fact that conversation revolved mostly around the impact of living with PTSD rather than the traumatic events that caused it, the danger of a flashback always lurked. ''Are you here?'' Westrup would ask gently when somebody appeared momentarily glazed or her speech slowed down. ''Do you feel your feet on the ground?''

Some of the women served in previous decades and were only now dealing fully with their PTSD. They recognized themselves as harbingers, as cautionary tales of how bad it could get for those of the current generation of female soldiers if they left their PTSD untreated. And they repeated that sentiment again and again. ''I'm only talking to you,'' one said, ''because I want other sisters to know they're not alone.''

I met six women, two of whom served in Operation Iraqi Freedom. Most hadn't seen combat, though three of them said they were raped by fellow soldiers during deployments in Germany, in Japan, in Qatar. The women - Johnnie, Kathy, Kathleen, Ann, Michelle and Sara - had served in the Army, the Navy or the Air Force. What ran through nearly every woman's story was a sense of things left unresolved. Nobody mentioned perpetrators being punished. Nearly everyone expressed having gone through relentless self-questioning: ''What if I hadn't accepted that ride?'' one wondered aloud. ''What if I hadn't drank so much?'' asked another.

According to Patricia Resick of the National Center for PTSD, being able to process trauma is the key to recovering from it. Those people who cannot make sense of what happened to them are more likely to continue reliving it through flashbacks and intrusive memories. ''It's like a record that keeps getting stuck,'' she said. ''They can't accept that it happened because of the implications of accepting it. It means that bad things - horrible things, really - can happen to good people.''

The women in Menlo Park described, vividly, the aftermath of living with unresolved military trauma: Kathy was arrested more than once for drunken driving. Michelle tried to kill herself three times. Sara was put into a military psychiatric hospital. Ann raised children and had a successful career, but said that inside her home in rural Northern California, she was often so paralyzed by fear that she hid in the closet any time the phone rang.

The program required that the women spend time writing down their thoughts and then analyzing them on paper, rooting out the ''distorted thinking'' - things like feeling unworthy or guilty - and then reinterpreting them in a more healthful way. While each woman acknowledged that the work was painful, there seemed to be a kind of summer-camp camaraderie growing among them. Yet there was always the notion looming that at some point they, and their symptoms, would need to return home.

One of the two vets of the Iraq war on the V.A. campus was Kathleen, a 37-year-old Army nurse with dark hair and fair skin. She arrived at Menlo Park courtesy of a program sponsored by the Department of Defense, in which active-duty soldiers with severe PTSD are granted leave and financing to pursue residential treatment through the V.A. This is part of a larger effort across the military to find and address soldiers' mental-health issues as quickly as possible. Kathleen was a first lieutenant and a registered nurse based at Fort Sill, Okla. She was medevacked out of Baghdad less than three months earlier.

Sitting in a chair in Westrup's office, dressed in a pastel T-shirt and jeans, Kathleen knit her fingers together anxiously. Despite appearing nervous, she seemed eager to talk. For better or worse, Kathleen's trauma was still fresh. She was also one of the few female veterans I spoke with who were suffering from PTSD who did not mention experiencing sexual harassment or assault in the military, though she did allude to ''a bad childhood.''

Speaking in a soft drawl, she described being stationed at a combat support hospital inside Baghdad's Green Zone, working 15-hour shifts in the intensive-care unit, often tending to burn patients who were helicoptered in from southern Iraq. ''I expected some death,'' she said. ''I was realistic. What I didn't expect was that we would be taking care of so many civilians, and those civilians would be children.'' She paused to add that she had five children of her own - all daughters, ages 9 to 18, who were back in Oklahoma with her husband, himself an Army man who'd been deployed to Iraq twice already.

In Baghdad, the stressors piled up quickly: helicopters kept arriving from the south, burn patients howled, children sometimes died. Lying in bed at night, Kathleen listened to mortars exploding and stray gunfire outside the Green Zone. ''It just builds up and wears down on you,'' she said. ''You're always in a heightened adrenaline rush.''

Her hands started to tremble then. She mentioned a young boy named Mohammed who died in the Green Zone hospital early on in her time in Iraq, saying only that she felt responsible for his death. ''I can't say more about that,'' she said, shaking her head. She then described caring for another young Iraqi who'd lost his legs because of complications from a gunshot wound. She started to understand that he might not survive outside the hospital. She described a creeping feeling of powerlessness. ''You get to a point when you can't take care of everybody,'' Kathleen said, her voice quavering. ''It's really tough.'' She knotted and unknotted her hands, appearing somewhat blank.

Westrup interjected softly, ''Kathleen, are you here?''

''I'm here,'' she said. Then she continued: ''It got to a point that I was having panic attacks all the time because we'd get a patient in, and I'd be thinking, Oh, my God, they're not going to survive, and how can I help them stop screaming and not be in pain? It just kept building up and building up. ...''

Then one day Kathleen's superiors barred her from visiting the young man who'd had his legs amputated, suggesting that she was becoming too emotional. Since the death of the boy named Mohammed, she had been taking Paxil for depression, and about the same time, she said, an Army doctor took her off the medication.

''I went crazy,'' she said plainly. ''I had a major panic attack. I felt like I couldn't get enough air.'' On the night it happened, she climbed the stairs to the hospital's rooftop, which overlooked the Green Zone. ''We sat up there millions of times, smoking our cigarettes or just shooting the breeze and watching the helicopters coming in and going out. It felt like a safe place.'' But when a hospital doctor turned up on the roof, startling her as she gasped for air, Kathleen began to cry. The doctor fetched the senior nurse on call. Believing that Kathleen was contemplating suicide, the nurse had her evacuated first from the roof, Kathleen said, and then from Baghdad altogether.

When I asked if she considered suicide during her deployment, Kathleen answered: ''Oh, several times, but I was able to contain those thoughts. What kept me going was the thought of my children, and them not being taken care of if I killed myself.'' She did, however, rehearse some thoughts about what would happen if she wandered outside of the Green Zone and deliberately into enemy fire. ''I was worried about how children of parents who commit suicide have a higher rate of suicide themselves. I have three teenagers, and I'm thinking, I can't do that. But if I died because of the enemy, then that would be acceptable. They would be sad, but they could hold their heads high and say, 'Yes, my mom served - she gave to this country.'''

Everything that happened to Kathleen - her feelings of compassion for her Iraqi patients, the powerlessness she felt in trying to save them, the depression, Paxil and ultimate breakdown - all very easily could have happened to one of her male colleagues. Indeed, she told me she was not the only soldier feeling great stress in the hospital: ''We were all facing these struggles,'' she said. ''There were people that were breaking down crying, nobody was sleeping well. There were a lot of nightmares.'' And yet it was Kathleen who was helicoptered out of the war on a stretcher on April 29 last year and returned to Oklahoma, to her three-acre property, her five girls and her husband.

Leaving Iraq and returning home to Oklahoma, Kathleen felt an instant change in her relationship with her daughters. ''It was very difficult for me to see them,'' she told me. ''I thought I would be excited and run to them and tell them I loved them, but instead I was scared. I was scared for them to hold me, to touch me. I don't know why, because I wanted to really bad. I was afraid for them to see me shake or stutter, not being able to communicate.'' She mentioned, with no small amount of heartbreak, that it was hard to reconnect with one particular daughter, who has dark hair and brown eyes, because ''she looks like she could be Iraqi.''

Two weeks after arriving in Menlo Park, she was still baffled by how excruciating family life had become. When her 9-year-old daughter had started shouting playfully while being chased by her 11-year-old in the yard outside, her mind flashed instantly to Iraq. Kathleen said: ''It just goes through me and brings me right back. I have a lot of flashbacks. And then I'd have nightmares, afraid that they'd hear me talk in my sleep or yell out, moaning.'' She added, ''Me and their dad have had nothing but conflict after conflict, because he wants me to be a certain way, and I can't.'' Her children, she said, had begun avoiding her in order not to upset her, asking their father to drive them places, speaking quietly in her presence.

Kathleen started seeing an Army psychologist daily, something she found to be extremely helpful. A social worker at Fort Sill introduced the idea that she might be further helped by the women's residential program in Menlo Park. Yet having already left her children for most of the last year, Kathleen was resistant to going.

And then came a turning point. One day, when her husband was not around to do the driving, she had the girls in the car on their way to somebody's team practice, when her 13-year-old daughter tried to offer some encouragement. ''She said, 'Mama, you can get through this; it's not like you killed anybody,''' Kathleen recalled. ''I started crying, and she goes, 'Oh, my God, you killed somebody!' I went into another panic attack right in front of my kids.'' She welled up at the memory, saying: ''That was enough for me. I was like, I'm ready to go. I'm getting through this.''

So far, however, treatment had been a mixed bag for Kathleen, mostly because she was homesick and afraid. She had, however, fostered a great deal of empathy and respect for the other women she'd met, understanding that some had lived with debilitating PTSD for 20 years.

''I came close to leaving here the other day,'' she told me. ''But the girls just surrounded me. They were like, 'Don't leave.''' The women then went on to describe how they lived before treatment - one with security cameras and a security fence at her house, another locked away in her apartment, several having lost their marriages and distanced themselves from their kids. ''They said: 'You don't want this life. I would give anything to go back to when my trauma was new and to get help with it,''' Kathleen recalled. ''And I could see myself 20 years down the road; I would be them. And I don't want that,'' she said. ''I love these girls, but I don't want that.''

VIII. What the Future Holds

Six weeks later, I flew back to California to attend the Women's Trauma Recovery Program graduation. It was held on a Thursday morning in a wide recreation room on the building's ground floor. Someone had moved the Ping-Pong table to one side and dragged a number of chairs into neat rows. A modest buffet lunch was laid out along the room's back wall.

The residents took their seats at the front of the room, having clearly primped for the occasion. They then read poems, held hands, made grateful speeches to the staff and, at the end, played some pensive music on a boombox and bowed their heads, many of them weeping. It was, of course, impossible to know what was in store for any of them. Clearly, they had benefited from the cohesiveness of the group, having met others who were wrestling with the same demons.