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More women are coming back from Iraq with post-traumatic stress disorder. When scientists study the psychiatric injuries of war, they usually study it in men. Now some question whether the military and veterans' hospitals are ready for these women. In our Span of War series, NPR's Joseph Shapiro reports on one woman in Madison, Wisconsin.

JOSEPH SHAPIRO reporting:

Abbie Pickett curls up in a chair with her algebra book. A soft breeze pushes through the open living room windows. She's barefoot and her blonde hair is pinned on top of her head. It's midnight and her final exam is just hours away. She's trying to study, but her mind wanders.

Ms. ABBIE PICKETT (War Veteran): It's harder for me to remember things. I don't sleep well at night. Granted, it's finals, but I'm still wide awake, as you can see, and...

SHAPIRO: Doctors at the veterans' hospital diagnosed post-traumatic stress disorder. It's a psychiatric condition that can result from experiencing a great danger.

Ms. PICKETT: I think sometimes I just feel really sad, and I don't know what to pinpoint that to. I mean, sometimes you just feel emotions that overcome you and you can't explain them.

SHAPIRO: Pickett's 22. She came home from Iraq and signed up for classes to become a physician's assistant. But that dream seems to be slipping away. She's dropped all of her courses this semester except algebra. There's a lot riding on this one test tomorrow.

(Soundbite of traffic)

SHAPIRO: It's 8:30 the next morning...

Ms. PICKETT: Hi, there.

SHAPIRO: ...when Abbie Pickett walks up the steps into the Madison Area Technical College, on four hours of sleep...

Ms. PICKETT: I had to stop and get some caffeine.

SHAPIRO: ...with a cup of coffee in her hand.

(Soundbite of door slamming)

Ms. PICKETT: I'm just freaking out, you know. I think it's normal final freak-out, so--tons of formulas and, you know, trying to keep everything straight in your head.

SHAPIRO: Where those formulas compete with thoughts of her year in Iraq with a combat support unit of the Wisconsin Army National Guard.

(Soundbite of door shutting; bell dinging)

SHAPIRO: It's time for her algebra test.

Ms. PICKETT: Hi. I'm Abbie Pickett. I'm here to take my final exam.

Unidentified Woman #1: Hi, Abbie. I haven't met you before, so I wasn't sure...

SHAPIRO: Because of her PTSD, she gets extra time and she gets to pick a quiet room.

Ms. PICKETT: How about this one?

Unidentified Woman #1: OK. You let me know if there's anything you need.

(Soundbite of paper rustling; door shutting)

SHAPIRO: She needs quiet because noise will break her concentration, especially a sudden, loud noise. It will take her thoughts right back to Iraq.

(Soundbite of clock ticking)

SHAPIRO: That can happen anytime, like last New Year's Eve in Madison.

Ms. PICKETT: I was at the ATM machine. I went to put my card in and I hear `bam, bam, bam,' and I went down. And you know, the sky's being lit up, just like it would in an attack.

SHAPIRO: It was a display of fireworks for the new year.

Ms. PICKETT: I had a friend on each side, and I had my hands up on my ears, and they were walking me through, you know, all these people, and illumination on faces and all that. I ended up in a doorway of some building and just huddled there and crying, for, you know, 45 minutes. I couldn't stop crying.

SHAPIRO: Today, Abbie Pickett tries to wrap her mind around everything that happened to her in Iraq and how it changed her. She says she actually misses Iraq, the deep bonds she made with other soldiers, the way she fixed up a school. But there was danger and lots of stress. Pickett drove a truck carrying 2,300 gallons of explosive fuel. Once, another fuel truck driver came to her.

Ms. PICKETT: One of my friends, another fueler, sat me down and said, you know, `Me and the other fuelers were talking and we want to know, if it came down to it, would you be able to kill a kid?'

SHAPIRO: Because sometimes the enemy might use a child as a decoy.

Ms. PICKETT: They told us the biggest threat was a child stepping out in front of your truck and stopping your convoy so that you could be ambushed. And what they told you to do is keep driving. No matter what, you keep driving.

SHAPIRO: Abbie Pickett never did see a child with a gun. Still, it jolts her to think she was once ready to kill a child to save her own life and the lives of her friends. That's something she says the rest of us can't understand, not unless you've been at war or had mortars rain down on your base in the middle of the night.

Ms. PICKETT: We heard the first one and you just knew it was close and you could feel it rattle inside you, and everybody hit the ground and three people ran in front of the doorway, and you know, I grabbed onto their shirt and I said, you know, `Find the bunker, find the bunker.'

SHAPIRO: The next rocket hit less than 25 feet away. Pickett remembers a woman's screams and how in the dark she tied her shirt around another soldier's arm to try to stop the blood that spurted from his opened artery.

Ms. PICKETT: And I held some guy's life in my hands and for days after--well, months after, I thought he lost his arm. And that was what was traumatic to me, was that, you know, some guy that I treated lost his arm.

SHAPIRO: She found out later the man's arm was saved. Still, right after that bombing, her sleep problems and anxiety began. Today, Pickett gets treatment at the VA medical center in Madison.

(Soundbite of voices)

Unidentified Woman #2: ...about some patients here...

SHAPIRO: Susan Knoedel's a therapist there. She runs the Women's Stress Disorders Treatment Program. She says post-traumatic stress disorder shows up in women pretty much the same as in men--trouble sleeping and concentrating, being quick to anger, always on alert for physical danger. But researchers are finding one thing that seems more pronounced among women: They fear they can no longer connect to other people.

Ms. SUSAN KNOEDEL (Therapist): They may feel damaged. They either witnessed something or had to do something or experienced something that is humiliating or shameful. But also there is a way with any kind of trauma like this that once you've seen this, you can't not know that this can happen in the world.

SHAPIRO: A lot of what we know about women and PTSD has come from scientists funded by the Department of Veterans' Affairs. They found that women who join the military are more likely, when compared to women in the civilian world, to have been sexually abused as children, and in the service they may deal with sexual violence again. Seventy-one percent of women who ask for VA disability benefits for PTSD say they've been sexually assaulted while in the military. That's important, because sexual violence is a cause of PTSD, and if you've been traumatized once, you're more at risk if you face trauma in war.

Knoedel says she sense there's something different about many women with post-traumatic stress disorder coming back from this war.

Ms. KNOEDEL: Early on in my career here, there was a lot of shame and focus on the stigma, and `I never told anybody this.' And more and more often what I hear now from women is, `Well, I went and reported it to my commanding officer,' and I will perhaps compliment them on just the courage it took to do that. And they say, `Well, I was mad.'

SHAPIRO: When she was 19, Abbie Pickett says she was sexually assaulted by an older soldier. She regrets that she didn't report it, so in Iraq, she spoke out when she saw things that didn't seem right. Sometimes that got her in trouble. Now that may be the spirit that helps her deal with her own PTSD. She's spending the summer with a veterans' advocacy group to push for more mental health care at the VA. She goes to the Madison VA to get medications and for counseling but only on and off, because at the VA, she says she sees what she's afraid she might become.

Ms. PICKETT: When I talk to, you know, the older vets, that's one of the questions. I'm like, `Do you still think about, you know, being over there?' And I had a World War II vet that said, `Every day.' And I started to get teary-eyed and I said, `I was just hoping that you would tell me it'd get better with time.' And I still think about it every day.

SHAPIRO: Pickett knows that PTSD symptoms can be mild and go away after several months. They can be severe and last a lifetime. She's been home a year now. She's worried because she thought her post-traumatic stress disorder would ease up by now.

(Soundbite of door opening)

SHAPIRO: Back at the college, Pickett comes out of the testing room after three and a half hours.

Ms. PICKETT: My brain feels melted. There are a couple problems that I'm unsure of, but all in all, I think it went OK, knock on wood.

(Soundbite of knocking on wood)

SHAPIRO: The school semester is over. When Abbie Pickett got back her grade for algebra class, she got a B.

Joseph Shapiro, NPR News.

MONTAGNE: Other Span of War stories are at npr.org.

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