Everything in Ward 3D East is locked, even the windows. Located inside the District of Columbia VA Medical Center, only three miles from the Veterans Affairs headquarters where national health policies are made, the psychiatric ward is a refuge for mentally ill homeless veterans and those plagued by drug and alcohol addictions. This is where Lt. Sylvia Blackwood drove herself before the sun came up one April morning and stayed for seven grim days.
Blackwood, a reservist with the 356th Broadcast Operations Detachment, survived two tours in Iraq, first as a military journalist, then as a State Department spokeswoman. "The possibility of death was so ever-present and terrifying that you just couldn't think about it. Everyone was dying. It was a constant barrage," she said.
She saw a severed arm and a stabbing victim. She survived an attack from a makeshift bomb and a bombing near her quarters. But Blackwood is not a typical example of a soldier who flips out after witnessing one gruesome event.
"I don't have the gore," she said. "I don't have one event. I have a gazillion events. I have Iraqis pleading with me to get them out of the country. I have friends who turned up dead."
She made it out of Iraq unharmed physically, but as a psychological casualty who would not acknowledge it to herself. Even as she slipped deeper into paranoia, panic and mental paralysis, she tried to keep up her exuberant bearing. Her plan was to heal herself. She feared that any sign of weakness would harm her career.
"If I'm a second lieutenant and I admit I have a problem, maybe they'll take that away," Blackwood said she thought. "I'd say, 'No, I'm okay, I'm fine.' Meanwhile I'm circling the drain and getting worse and worse."
At the start of this year, Blackwood, 41, took on a new job as the chief of media relations for the Special Inspector General for Iraq Reconstruction, based in Crystal City. No one knew that loud noises would trigger a panic attack for her, that she was barely sleeping or eating, or that she was clawing her forearms so fiercely the blood sometimes soaked through her sleeves.
One day in April, she got lost on the Metro after work. She panicked and decided not to go to her job ever again. Her mind raced: "I'll be fired," she thought. "I won't be able to work again. I won't be able to support my son. Then I'll start screaming because I've let him down. I won't be able to stop. Maybe they will send me back to Iraq! How can I make this stop?"
When she finally got home, Blackwood went to her bedroom and took out her Leatherman knife. With almost clinical detachment, she debated how to slash her wrists. "If I cut this way, I'll survive and be embarrassed," she remembers thinking. "If I cut that way, there'll be a lot of blood. If I do it in the back yard, they might not find me for a couple of days. It will be icky. Maybe I'll have a blanket to cover up my body."
At 4 in the morning she was sitting on the floor with the knife, a piece of cardboard and a blanket. But an image suddenly stopped her. "I saw my son's face, and I couldn't leave him," she recalled. She rushed out of the house and walked around until dawn. By 7 a.m. she was walking into the VA Medical Center on Irving Street NW, crying so hard that her shoulders shook and mumbling to the guard about killing herself.
He pointed. "You go that way," he said.
The mental-health unit didn't open for an hour. In her suicidal state, Blackwood was told to wait.
When she at last got to see a counselor, they agreed that she should be admitted.
Blackwood shared Ward 3D East with 26 men and three other women; mixed-gender wards are common in VA psychiatric units. There was no exercise equipment. No outdoor courtyard. No treatment either, other than prescription medication. The linoleum corridor was 39 paces long, and Blackwood walked it many times a day.
"There's nothing to do all day. Nothing," Blackwood whispered to a visitor. "And there's no air."
Every day the patients met for announcements. At one meeting, a staff member scolded them: "Did you all take showers today? The smell on the floor is not good. Take a shower. Keep yourself clean."
Pacing the floor, a man sang: "It's not a va-ca-tion! It's med-i-ca-tion!"
Another patient lifted his pant leg to show Blackwood the knife he hid in his sock. One day she took a poll. Of the 17 patients in attendance, seven had been to war, 16 to jail. Everyone except her.
The Iraq war vets found one another quickly on Ward 3D East. An ashen young man in gray socks popped into the visitors room where Blackwood was sitting one evening. He told her that his best friend had died in Iraq. "He took the gun, put it in his mouth and fired," he said without emotion. "Blew his brains out." He held his friend's head until he was dead. He showed Blackwood how, cradling his hands just so.
The next day, a Marine veteran burst into the visitors room. He wore a red Marine Corps T-shirt. His tan combat boots flopped open, shoelaces removed. "I'm goin' crazy in here," he said, as he chomped furiously on nicotine gum.
Blackwood and the Marine bantered in abbreviations.
"One fifty-fives!" he laughed.
"Incoming!" she laughed back.
"Allah Akbar!" he shouted.
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.