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MICHELE NORRIS, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Michele Norris.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

All week, we've been talking about women and war. There are currently more American women deployed to war zones than in any other time in history, but not without a cost. Women are coming home with both combat-related stress and what the Department of Veterans Affairs refers to as military sexual trauma. And that can make women more vulnerable to post-traumatic stress disorder. A VA report from 2003 found that 28 percent of female veterans surveyed were victims of rape during military service.

Reporter Gloria Hillard visited a VA residential program for women dealing with what experts are calling the double whammy.

GLORIA HILLARD: The eight women gathered in a circle of chairs, notebooks resting on their laps, each has her own style from soft blouses to hooded sweatshirts. I tried to picture them in uniform.

Unidentified Woman #1: Can you kind of think of what's hard about (unintelligible)?

Unidentified Woman #2: Just to be able to identify the feeling I'm actually feeling.

HILLARD: For some of the female veterans in the room, this is the last stop in what has been a decades-long and difficult journey. For the younger women, the sound of roadside bombs is not so distant. This is the VA Women's Trauma Recovery Program in Menlo Park, California. For the next two to three months, this will be home to these women.

To be admitted to this intensive program, they must be referred by other mental health officials with a diagnosis of post-traumatic stress disorder, the result of combat or sexual assault by a fellow soldier.

SANDRA (U.S. Army Veteran): Prior to me coming here, I just didn't know if I was going to live another day. Sometimes I wanted to go to sleep and not wake up.

HILLARD: Sandra is a petite, small-boned woman in a crocheted hat and scarf. Three years ago, the 31-year-old Army reservist wore a helmet and body armor on the streets of Baghdad. Her primary job was rebuilding schools, she says. One day, a truck she was driving was hit by a roadside bomb.

SANDRA: There were other things, like firefights and doing - going in and doing raids, you know, either in the daytime or nighttime.

HILLARD: The violence she witnessed is the source of nightmares and flashbacks. But when she speaks of the trauma, it is a singular event, a very personal one. She takes a deep breath, but can't continue.

SANDRA: It just brings back too many emotions. And I guess fear sometimes.

Unidentified Woman #1: Of?

SANDRA: Fear of how I might react because I kind of blocked it out for so long. I just don't want to touch it. Yeah.

HILLARD: Sandra is among a growing number of young women who have experienced both combat and sexual assault, or what psychologists from the field refer to as the double whammy.

Ms. SANDRA: I guess the simplest way to say this is - the effects of that are just - are devastating.

HILLARD: Dr. Darrah Westrup is the director of the Menlo Park program. Military sexual trauma, Westrup says, contributes to the severity of PTSD symptoms, from feelings of extreme isolation and self-blame to thoughts of suicide.

Dr. DARRAH WESTRUP (Director, Women's Trauma Recovery Program): You've got that piece of feeling unsafe and not being able to do the things you normally were able to do and being on guard at all the times, which is exhausting, combined with this personal shame. The world is malevolent, and you are fundamentally not okay.

HILLARD: Westrup says she's seen an increasing number of women from Iraq with both combat trauma and reported sexual assault. Ketora is one of them, a shy, young woman, who, on this day, looks more like the college student she was prior to joining the Marines after 9/11. She was deployed to Iraq in 2003.

KETORA (Iraq War Veteran): I tell myself that - something, I knew something was wrong with me, but I just thought that - I just try to act normal. I tell myself in my mind that it didn't happen. Nothing happened. I just - I'm okay.

HILLARD: But she wasn't okay. After returning home, she suffered severe depression and couldn't leave her house. Today, her eyes begin to tear. And she takes off her glasses and begins to talk about her experiences in Iraq.

KETORA: Everywhere we went, we were always being attacked. And after a while, I just became numb. I didn't - I couldn't feel it. I just, I don't know, I wasn't myself. And I realized that, but I had to be whatever it is that I was in order to survive from the enemies and from my own platoon members.

HILLARD: Her own platoon members. It began with sexual harassment. And then, she says, things got worse.

KETORA: It's humiliating. It's degrading. Who's going to believe you? In my rank, I was only a lance corporal. And he's the guy, the one that everybody hoorahs and gives a pat on the back. Everybody loves him. He could never do anything wrong.

HILLARD: She didn't think anyone would believe she had been raped. It was a story echoed by women nearly twice her age. There was a phrase that would always punctuate their stories, acknowledged by others with a nod of the head, rape by rank. Two years ago, the Department of Defense introduced restricted reporting, which allows the victim of a sexual assault to bypass chain of command and make a confidential report.

Dr. Kaye Whitley is the director of the DOD's Sexual Assault Prevention and Response Program.

Dr. KAYE WHITLEY (Director, Sexual Assault Prevention and Response Program): We offered restrictive reporting, so they can come forward, get medical help and get counseling and get assistance. And that way - if there choose restricted, their command will not be notified and there will not be an investigation.

HILLARD: Within a year of instituting the program, the reports of alleged sexual assault rose close to 30 percent. But does restricted reporting impede the investigation into and the prosecution of sexual crimes?

Dr. WHITLEY: Well, certainly we - as much as everybody else, we want to get the offender. But I think we have to look at the balance, where we have to balance victim care with offender accountability.

HILLARD: Whitley says after receiving medical help and counseling, the victim has the option to change their reporting status and pursue an investigation.

(Soundbite of women laughing)

HILLARD: For the women at Menlo Park, it may be too early to talk about their lives after they leave here and whether they'll ever fully recover. Recent government reports have criticized the VA on the grounds that it hasn't done enough studies to make sure that its treatment programs are really helping vets with PTSD and other mental health conditions.

Dr. Westrup counters, in the absence of numerous studies and statistics, there are the women themselves. The Women's Trauma Recovery Program, she says, asks them to face the nightmares they've been fleeing. And that, she says, can have a powerful effect.

Dr. WESTRUP: And you can just see it in how they carry themselves, and how they speak, and the way they look.

HILLARD: It's just after dinner. The women gather in a circle again this time trying to keep a beach ball of the world in the air.

Unidentified Woman #3: It was coming right towards you.

Unidentified Woman #4: One, two, three…

HILLARD: The metaphor is not lost on them. Each is trying to find meaning in their world again.

Unidentified Group: Fifty-seven, 58, 59, 60.

(Soundbite of women shouting)

HILLARD: They've been at it for nearly an hour. But with a soldier's resolve, they gave it one more try.

Unidentified Woman #5: One, two, three…

HILLARD: For NPR News, I'm Gloria Hillard.

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