There is a child in my life who thinks I am a hero, a point which is certainly debatable. He was simply happy that I returned home in one piece—at least he thought I was in one piece—and ready to start our lives over from the point at which we left off. However, it fast became apparent to him that I am not the same person he knew before I left, and he is confused by that. He wants the "old me" back and so do I. It is painful and disappointing for both of us.
An Army Reservist who returned from Iraq and Kuwait. From her blog “Citizen Soldier Sojack in OIF.”
Service members return home to various types of support systems that may include parents, spouses, children, and significant others. These support systems are critical to the well-being of the veteran with PTSD and TBI. However, they are particularly at risk because family members often do not have access to psychological and informational support services. Providing these services is particularly important for several reasons:
- Family members are often the first to identify that the veteran is having difficulty, and are often instrumental in motivating the veteran to seek professional services. In addition, family members provide critical social and emotional support for the veteran, and may relieve some stress by taking care of many of the veteran’s day-to-day responsibilities (US DoD Task Force on Mental Health 2007, Hirsel 2007).
- PTSD can create a circular momentum where the service member’s PTSD increases the stress in the spouse, which puts stress on the relationship, which then intensifies the PTSD symptoms in the soldier.
- The veteran's PTSD impacts the psychological health of other family members and caretakers. This has important implications for the well-being of these individuals, as well as for their ability to support the service member (Galovski and Lyons 2004).
1. Effect of PTSD/TBI on the Family
More than 60 percent of service members are married, and almost 50 percent have children.
For some, returning from deployment is a joyous experience. For others, reintegrating back into the family is difficult. It is not uncommon that at the beginning both the spouse and service member have unrealistic expectations of a rapid return to “normal.” Both partners soon realize that the service member is not the same as when that service member left and that the family also has changed—spouses have become more independent and developed new routines, and children have gotten older. New family roles and routines must be negotiated (American Psychological Association 2007).
This situation is more challenging for service members who return home with PTSD or depression. The natural tension is exacerbated by the service member’s emotional numbness, their apparent disinterest, their reduced ability to solve problems, and their often violent temper. Studies have shown that veterans with psychological injuries are less sure about their role in the household, and are more likely than others to report feeling like a guest in their own home. Those with PTSD are more likely to report that their children acted afraid, or did not act warmly to them (Sayers 2008).
In some cases parents, spouses, and children display symptoms of PTSD because they are upset by the service member’s symptoms—a phenomenon known as secondary traumatization.
Children are at risk for intergenerational transmission of trauma and addressing the concern can be delicate. For example, research shows the following (Ochberg and Peabody 2008):
- When a family silences a child, or teaches him/her to avoid discussions of events, situations, thoughts, or emotions, the child's anxiety tends to increase. He or she may start to worry about provoking the parent's symptoms. Without understanding the reasons for their parent's symptoms, children may create their own ideas about what the parent experienced, which can be even more horrifying than what actually occurred.
- Overdisclosure can be just as problematic. When children are exposed to graphic details about their parent's traumatic experiences, they can start to experience their own set of PTSD symptoms in response to the horrific images generated.
- Children who live with a traumatized parent may start to identify with the parent and begin to share in his or her symptoms as a way to connect with the parent.
- Children may also be pulled to reenact some aspect of the traumatic experience because the traumatized parent has difficulty separating past experiences from present.
2. Services for Family Members
Despite the challenges that families face, they often have difficulty obtaining mental health services. VA provides support for families only through the Vet Centers described in Section 5. These centers provide some psychological health services and support groups. However, the availability of services varies among the different centers. The VA mental health care system may incorporate marital/family interventions when they are focused on improving relationships and reducing veterans' symptoms, but does not offer services targeted at improving the psychological well being of the spouse and children. Marital counseling or family counseling is not readily accessible at many VA facilities.
DoD provides psychological support for families throughout the deployment cycle through MTFs, TRICARE, and several nonmedical programs. However, access to on-base services is limited. Many mental health professionals and chaplains are deployed at the same time that family members need their services. As a result, family members are often referred to the TRICARE network where it may be difficult to find a therapist who is accepting new patients or who has an available appointment time that is not too far in the future. The Army Task Force on Mental Health found that children had particularly constrained access to clinical treatment services, especially adolescents with substance abuse problems (US Army Surgeon General 2008).
Military bases also have nonmedical support services. The armed services vary in what services they offer and how they overlap and coordinate with on base mental health services. Each unit has a Family Readiness Group (FRG), made up of family members, volunteers, and soldiers, that offers family members access to information and social support.
Military OneSource offers confidential resource and referral services that can be accessed 24-hours per day via telephone, the Internet, and e-mail. OneSource provides confidential family and personal counseling services in local communities across the country, at no cost, for up to six sessions per person per problem.
Paradoxically, although the on-base capacity to support psychological health is reduced during deployment in an effort to devote resources to supporting the health of deployed service members, this reduction contributes to the distress of deployed service members who worry about family members at home who cannot obtain needed assistance. Only 21 percent of soldiers serving in Iraq are satisfied with the type of support the military is providing to their families, and only 22 percent think the Family Readiness Group has helped their family. (US Army Surgeon General 2008).