Susan Evans, LICSW
The Journal of the American Medical Association reported in 2006 that 35 percent of Iraq war veterans sought treatment for mental health issues within a year of coming home. The Department of Defense now estimates that between 15 percent and 29 percent of veterans from the war in Iraq and Afghanistan will suffer from Post Traumatic Stress Disorder (PTSD). The caseload for mental health counselors in the Veterans Administration is six times higher than anticipated. By 2008 more than 400,000 troops could need mental health treatment if this trend continues. Who will help the spouses and families of these combat veterans?
Stepping up to help are women with vast experience dealing with combat veterans returning home from war. They are married to vets who have significant PTSD disabilities from previous wars, and the Iraq war, and they have jointly written this article as a way of offering support, encouragement and hope to the spouses and families of Iraq vets. They offer the following thoughts while recognizing that each war is unique and some of these suggestions may not be appropriate for the Iraq war experience. (We use “he/him” to refer to the vet for convenience only.)
Listen and Do Not Judge
War is a bad thing and terrible things happen. That doesn’t make your vet bad. Listen if he talks about the war. Don’t judge, and don’t try to stop or smooth over his emotions. When he tells you trauma stories, you might tell him he did the best he could under the circumstances, and wars are horrible. If the stories overwhelm you, it’s ok to say you need to take a break and you are working on listening. If he doesn’t talk about the war after a few months at home, you may want to suggest he see a counselor if he is showing symptoms of PTSD. If he does talk about the war, it’s not a good idea to ask for details because this may bring on a flashback. It’s not helpful to tell him you understand what he went through because you don’t and can’t. It’s probably not helpful to tell him he is a war hero as there may be things he did in the war that disturb him. Rather you can say he is your hero by making it home. If he cries, let him cry with you or alone, and don’t try to interrupt or stop this. It’s probably a sign of healing. Make sure you have someone safe to debrief with as well.
Make an effort to learn who his favorite comrades were during the war. Keeping in contact with these comrades can sometimes be helpful with reentry, and staying in touch with them may last forever, and help with coming to grips with the reality of the war they fought.
PTSD Symptoms
Know what to look for. Educate yourself about PTSD as much as you can. Here are a few of the symptoms:
- emotional/social isolation
- numbing
- sexual dysfunction
- sleep disturbance
- intrusive thoughts and memories (flashbacks)
- heightened anxiety and startle reaction
- inability to concentrate
- depression
- nightmares
- survivor guilt
- spacing out
- night sweats
- sudden anger (or repressed anger)
- inability to feel anything but anger
Symptoms may not surface for years. Tracy said “I remember when he talked Vietnamese in his sleep, and had terrible nightmares. Sometimes he still does”. Betsy said “he didn’t start having flashbacks until many years later when the Iraq war began”. If he has flashbacks, ask him what you can do that helps or if he does better handling them alone.
Accept Help
Be willing to accept help even if he doesn’t. Find resources (see below) or use your health insurance to see a professional of your own choosing. Some employers offer short term confidential counseling as an employee benefit. If your vet is willing, encourage him/her to get a good evaluation from someone experienced in PTSD treatment. Remember though that experts don’t agree on what really helps. Trust that what you observe is valid.
Protect Yourself and Your Family
Encourage him to set limits on what kinds of questions people ask him. Thoughtless questions can cause soldiers to relive trauma. It’s ok to say “that’s not an appropriate question”.
Criticism of the war should not be taken personally, and vets should be supported in leaving situations where military personnel are criticized for serving in the war. Most people support the troops even if they don’t support the war.
You may need to remind your vet that he is not the center of the universe, and he no longer needs to worry about his own survival. He is now part of a family where concern for other family members and their feelings and needs is important.
Get in a support group. It’s a relief to be with other people who understand. “It has saved my marriage and maybe my life”. Trudi. Our support group is funded by the Department of Veterans Affairs. In Washington State a unique program is offered where veterans and their significant others can receive counseling at no charge.
Children are affected by a parent’s PTSD. Symptoms can be passed from one generation to the next which is called intergenerational transmission of trauma. The ages of your children affects how this occurs. For instance small children may experience the numbness of PTSD as disinterest or not caring, while older children may act out. Sometimes children will take on some of the symptoms of PTSD. Your children need to know in an age appropriate and calming way that these symptoms are not their fault.
You cannot fix the PTSD symptoms. Those are his symptoms that he has to learn to manage or not. Make your own goals and keep them in your focus. These goals might be improving your own health with good nutrition, exercise, and rest, or spending time with friends, or doing special things for yourself.
Things to Remember
- Always be truthful with your vet. This builds trust. Tell him calmly when his behavior is not normal. If you don’t know if it’s normal, ask others, and observe others. Don’t walk on eggshells.
- He probably will not ever be totally the same. He is in many ways a different person now. Grieve for what is lost and move on. This is your life now even though it‘s not fair.
- Stay on top of medications. Try to notice the changes with new medications or when he stops taking meds and report this calmly to your vet. Suggest he call his medication prescriber if the side effects are problematic. Running out of meds can trigger depression and other problems.
- Anticipate drug and alcohol problems. Learn about resources for you, your kids and for your vet. Find out what to do. Discourage him from isolating and drinking or doing drugs.
- If he isolates himself, point this out and encourage involvement with family, sources of help. Don’t go with isolation for long periods of time. Short periods of withdrawal to help control anger make sense, but withdrawing from life into a “bunker” is not helpful.
- When you have conflict which is normal and to be expected, focus on the issue at hand and resist bringing up issues from the past. Stay focused on the issue, not the person and seek solutions, not who is to blame. If possible, set a time limit for hot topics of a few minutes, and take a time out with an agreement to discuss this issue later. Be sure to again discuss later.
- If you feel concerned about violence in your home, bring others into the situation: your minister, a trusted friend, a counseling professional and talk about your concerns calmly when things are not escalated. Don’t keep this concern secret. If necessary to protect yourself and your children, call the police.
- Sometimes war experiences cause a spiritual crisis, a loss of faith. If your vet’s not finding help with this you might encourage him to keep looking. There are spiritual advisors who understand combat and PTSD.
- Physical exercise helps everyone release anxiety and tension. Stay active and encourage your vet to do the same. Regular meals, good nutrition, plenty of rest and time for play help everyone cope with stress.
- Take care of yourself in many different ways. You matter just as much as your vet Handling traumatic stress in a loved one is very stressful for most partners. Learn and use stress reduction techniques.
Enjoy the good times. When bad times come, hang on! Good times will come again.
Conclusion
We are learning that many of the Iraq vets have traumatic brain injury as well as PTSD which brings new challenges, and often requires a spouse to remember things for their vet. We are learning that it is hard to tell how much someone can recover from a traumatic brain injury. We believe that drawing together in a community of support and encouragement is still the best way to face these unknowns, and we are grateful for the good company of one another.
