U.S. Marine Corporal William Berger talks about how his TBI soured the relationship with his girl friend. He describes how he was childish, irritable, withdrawn and unable to be intimate. His mood swings and reactions to medications became so extreme that she finally called it quits.
Chief Warrant Officer Richard Gutteridge describes how, during his struggle with severe PTSD after two deployments to Iraq, he became withdrawn from his wife and two sons,. His dependence on alcohol combined with depression and insomnia drive him to the brink of suicide. His wife appears with his packed suitcase when he leaves the Army base to check himself in to the psychiatric ward at Landstule Medical Center in Germany.
After recovering from his spinal injury Army Specialist 1st Class Duval Diaz left Walter Reed Medical Center armed with medications for depression and sleeplessness. He’d been seeing a psychiatrist at Walter Reed for PTSD and TBI for over a year. His wife, Mercedes describes him as not the man she knew before going into combat. She finds him withdrawn and extremely childish and demanding. His nightmares are so severe that he sometimes hits and kicks her in his sleep. She says she loves him but just doesn’t understand.
The trauma of war often results in wounded bodies and wounded psyches – both of which can dramatically impair a person’s capacity for intimacy. For some, returning from combat and transitioning back into an intimate relationship is not a big problem. Reuniting after a long separation in combination with an overwhelming feeling of gratefulness may even fuel desire and strengthen bonds. However, for Corporal William Berger, for Chief Warrant Officer Richard Gutteridge, for Army Specialist 1st Class Duval Diaz and his wife, Mercedes, and for many of the tens of thousands of those who are experiencing symptoms related to deployment and combat related stress, PTSD, mild traumatic brain injury (TBI) and major depression, being emotionally and physically intimate can present a real challenge.
The RAND report Families Under Stress: An Assessment of Data, Theory and Research on Marriage and Divorce in the Military (2007) suggests that people who return from deployment with a serious physical or mental injury bear a disproportionate burden of marital stress and divorce than their non-disabled counterparts. In addition to divorce and strain on relationships, the RAND report Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (2008) found that failed intimate relationships contribute significantly to suicide, intimate partner violence, child abuse, reduced quality of life, homelessness, and substance abuse (Tanielian & Jaycox, 2008).
The relationship between combat related trauma, risk and resilience factors, including guilt, shame, and anger and the resultant impact on the capacity for intimacy is poorly understood. However, in light of just the few excerpts of stories repeated here, it is not difficult to picture how a mental trauma like PTSD and depression, or a physical wound like TBI can create significant barriers to establishing and/or maintaining intimate relationships.
The symptoms of deployment and combat related stress, PTSD, depression, and TBI can erode the foundation of intimate relationships. Intimate relationships are founded on things such as communication, trust, a sense of safety, the ability to accurately perceive and tend to another’s emotional needs, impulse control, vulnerability and love. The constellation of problems distilled from the collection of stories in these pages including nightmares, night sweats, sleeplessness, loss of concentration, irritability, anger dyscontrol, hypervigilance, forgetfulness, short-term memory loss, depression, denial, migraines, seizures, emotional numbing, avoidance of sex, social withdrawal and loneliness plague both the person wounded and their intimate partners.
Overwhelmingly, the partners of these returning veterans were unprepared for what they faced. It was difficult for them to understand their loved ones’ radical changes in mood, behavior, and reactions. Many a partner has experienced what Mercedes expressed so candidly, “It’s like having a child again who demands all my attention and all my love but has trouble giving it back to me.” The combination of not understanding, the feeling of being in a relationship with a child, and the experience of being the target of anger, frustration, and blame makes maintaining emotional and sexual intimacy difficult.
Sexual intimacy at its core requires vulnerability on the part of both partners, and vulnerability is inconsistent with survival in the battlefield. In the vernacular, to be caught “with your pants down” means to be caught unprepared, to be vulnerable to a negative outcome; so to in sexual intimacy. To bear oneself literally, as in to get naked in front of a new lover, or figuratively, as in to share a personal fear or insecurity leaves one vulnerable. Hence, intimate sexual relationships, like emotional intimate relationships, require a sense of security and trust, commodities that are often hard to come on the battlefield.
Some partners like Mercedes stick around and hope their partner will change with time and that they will be affectionate with each other again, while others who cannot or do not want to cope with the changes leave. Partners who stick around may experience a heavy caregiver burden that can result in cumulative physical and emotional stress over time or even a phenomenon called secondary traumatization. Secondary traumatization is a situation in which the intimate partners of trauma survivors themselves begin to experience symptoms of trauma, a major factor contributing to the breakup of William Berger and his fiancé. While patience and hope are two important factors that can contribute to resilience, these too can be elusive and are not sufficient on their own to alleviate suffering.
The battle for love does not take place within a vacuum. Research shows that people with pre-existing vulnerabilities - like less education, less supportive extended families, lower socioeconomic status, or a history of adjustment problems - may experience worse family outcomes than individuals without these vulnerabilities. Also, in the case of marriage, the quality of a marriage before the trauma is predictive of the resilience or adjustment afterwards.
Our service members get some of our nation’s best medical care and physical rehabilitation services but access to mental health services is both limited and often ineffectual, as it is in the civilian healthcare arena. We need to work more aggressively to identify and get into treatment those struggling with depression, combat related stress, PTSD, mild brain injury, and spiritual issues. And we have to do more to educate and support their partners emotionally, and to lesson the burden of caregiving on them by providing adequate personal care or support services for the wounded partner.
The stories in this anthology talk of relationships that have either ended or been damaged by the veteran’s wartime experiences. Overall the picture painted for intimate relationships is not a rosy one. At the moment we need to look beyond the stories of OEF/OIF veterans in this anthology and outside of the limited research literature on intimate relationship adjustment after combat and then conduct research and develop evidence-based interventions.
We can start with the first person story of a mental health care volunteer for Give An Hour, 55 year-old George Alexander, the civilian son of a Marine Corps sniper during WWII. George tells this story as part of his counseling to veterans coping with PTSD. George’s father “came home from the war a damaged man and turned to drinking to relieve the demons that haunted him.” George describes a pattern of abuse he experienced when his father would get drunk and take out his anger on him and the secondary traumatization he developed by age six, complete with nightmares of combat, insomnia and other symptoms indicative of PTSD. George’s parents divorced when he was ten.
George’s early life experiences translated into a series of fights, substance abuse, risky sex, dropping out of school and violence. By the age of 19 - having already been married and divorced once – he took on a new identity and life under the witness protection program. George’s new life, however, was haunted by his past traumatic experiences. After 35 years of failed relationships (including three divorces and two broken engagements) and a painful medical condition that led him to the brink of suicide, he checked himself into a psychiatric ward. There he was diagnosed with Complex PTSD and received treatment. George is now in a stable marriage, works as a veterans’ advocate in honor of his father and volunteers providing counseling to veterans.
George often shares some of his insights after reflecting on his intimate life and relationships. “I had built a wall around me to protect myself, which ultimately wound up preventing anyone from getting close enough to love me.” He describes himself as withdrawn, emotionally numb, unable to trust anyone and always afraid of being rejected if a woman were to find out who he really was inside. He says he’s reminded of the famous line from Cool Hand Luke where Strother Martin says to Paul Neuman, “What we have here is a failure to communicate” since communication was a main problem. In his own words he describes, “being unable to let my shield down long enough to connect, to open up to another human being for the love I so desperately wanted.” He says that as a child he was never taught the skills necessary to have a successful relationship or to manage conflict, so as an adult he would just recoil and withdraw like an 8 year-old. George thought he was doomed to spend the rest of his life alone and unloved. He says, “I was depressed most of the time and frequently turned to substance abuse to get me through the lonely nights spent trying to figure out why I couldn’t maintain a loving, committed relationship with someone, which is what I wanted more than anything in the world. Then, totally by accident, I would meet the woman who would teach me what to be in a loving, committed and enduring relationship really meant, and we have now been together for the last 10 years. She also taught me the difference between love, sex and intimacy. I learned that intimacy meant sharing our feelings, our values, our thoughts and most importantly, our love. It was the love for this woman, who is his fourth wife, and their child that gave him the will to live and get help when he was in his deepest moments of physical and emotional pain.”
I know of other anecdotes of individuals who have ended up in happy marriages after several tries and much heartache, and even couples who have weathered the storm together. However when we see case after case of relationships disintegrating between returning veterans and their partners, we cannot standby and just let things happen “totally by accident”. Formal research needs to be done to understand what factors contributed to successful relationships and what type of therapeutic interventions can foster success in intimate relationships before, during and after going to war.
In addition to access to Chaplain counseling, anger management, stress management, and substance abuse treatments offered through the Department of Veteran’s Affairs’ system, we need to add classes on topics like: communication skills; conflict management; sexual enrichment strategies; adapting to changed bodies, changed minds, and changed relationships; adapting to changed roles within relationships (e.g., partner as caregiver, patient instead of provider), and; effects of disability and chronic conditions on sexual response and expression, and; access to couples counseling. Ideally, the VA will develop retreats for veterans battling for love as the Department of Defense does for active duty personnel via the Army Strong Bonds program.
We can also help people explore and understand the nature of love in their relationships, specifically who does it serve and what needs does it meet. Sometimes, as in the case of Duval and Mercedes and George and his new wife, love is the critical glue that holds relationships together. Other times, feelings of isolation and withdrawal can lead to suicidal thoughts as experienced by Richard. It is said that unselfish or compassionate love lasts for ever. Compassionate love serves the other and meets the needs of the other; archetypal examples are the love of God toward man, the love of a mother toward her new baby, and the love that Jonathan and David shared in the bible. Conversely, self-centered love is seen as conditional. If the condition is met, I feel love; when that condition is no longer present, the feeling of love is lost.
The battle for love on the home front requires a new type of bravery, a new type of hero. If we accept the notion that a hero acts in the face of fears, then we can say a hero rises above his or her nature. It is human nature to focus on what you had and what you lost and to want to hide in shame when you are feeling vulnerable. It takes a small act of heroism to move forward into the unknown, armed only with what you have at the moment. Now our heroes - both those who were deployed and put themselves in harms way to protect the greater good and those who stayed at home and held down the ship - are fighting for their lovers and their families. This virtuous fight requires the ability to see the good, to not let evil prevail, and to not let the spirit be broken.
While we cannot expect every relationship to survive, we owe it to our wounded troops and partners to give them the support they need to have a fighting chance to avoid unnecessary dissolution of marriages and committed relationships. A lack of healthy intimacy can significantly impair recovery and contribute to ongoing mental health problems. Healthy intimate relationships add meaning to life in the face of substantial loss and can contribute to a person’s recovery from physical and mental trauma. Those who have sacrificed for our country deserve our full support in their battle for love.
Tepper, M. “The Battle for Love.” Hidden Battles on Unseen Fronts, Stories of American Service Members with Traumatic Brain Injury and PTSD. Edited by Celia Straus. Drexel Hill, PA: Casemate Publishing, 2009.
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