Helping your PTSD spouse and yourself heal

Helping your PTSD spouse and yourself
by
Chaplain Kathie

When you read about PTSD symptoms, sometimes they just don't make sense and even when you do understand them, knowing what to do to counter them is a totally different story. Families are on the front lines of when a combat veteran comes home but all too often they are the last to be included in on the healing often ignored when it comes to the support they need as well.

The following is from the Mayo Clinic appearing in the center and what you need to know about each one so that you can be part of the healing as well as knowing what signs to look for.

PTSD Symptoms
Symptoms
By Mayo Clinic staff

Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not occur until years after the event.

Post-traumatic stress disorder symptoms are commonly grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:

Flashbacks, or reliving the traumatic event for minutes or even days at a time

During a flashback, you will see changes in them. They are not in the same room with you at that moment. They are back to where their lives were in danger, seeing, hearing, smelling and sensing danger. Every part of them is re-enacting the event. Their heart rate increases, their muscles tighten up, they sweat and if the event involved fire, they will feel the heat on their skin.

While you see them sitting in the same room or driving a car, they are not really there. On the road, they see something that reminds them of danger on the road in combat. Trash bags on the side of the street can cause a flashback and they begin to drive as if they were back in Vietnam, Iraq or Afghanistan or any other combat operation.
A car they feel threatened by can bring on a flashback. In the room they can be sitting in a chair but they are also back in combat once again full engaged in the event. This can be brought on by all kinds of things, like a news report, a smell in the house or even an anniversary date. While they may not be consciously aware of the anniversary date, in the back of their minds they know what happened on this date in their history.
You may notice them acting "off" or depressed a few days before the date and for days afterwards. They can't explain what is wrong because they may not be aware. If you have been with them for years, look back on when it seems really hard for them and you should notice certain times of the year are repeated as darker times for them.
Do not shout at them even if you are getting aggravated. Calmly say their name or pet name you have for them. Do not touch them or make any sudden movements toward them. Understand they are not doing this to you or ignoring you so that you do not take any of this personally and that should enable you to stay calm. If they do not respond to your voice, wait it out.
If they are driving, stay calm and talk them into pulling into a parking lot so that you can take over the wheel. Even if the flashback ends, they will be drained and it will be safer for you to drive until they are fully "back."
When it is a flashback, you can make it worse by the way you react to them or you can make it tolerable by the way you react with them. Many wives over the years have been attacked because they reacted without understanding and things got out of control because they did not understand.

Upsetting dreams about the traumatic event

As with flashbacks, they are not in the same room with you. They are right back in danger. All of their senses are fully engaged. With a nightmare, if you do not understand what it is doing to them or where they "are" in that moment, you may react with anger because they woke up the entire household again. PTSD nightmares are not the same as waking up a snoring spouse, snapping at them and ordering them to roll over. They will not dutifully gently respond. Many wives have been responded to with hands around their throat or fists to their eyes or nose. When they did not know why it happened, they assume they were just a victim of domestic violence instead of a PTSD spouse "defending" himself or herself against the enemy, because they were not really there responding to someone they love. They were fighting against someone trying to kill them.
First rule, do not touch them. Get yourself out of striking distance. Calmly say their name over and over again if you have to. If they are still not coming out of the nightmare, gently touch their foot while saying their name. Keep a calm voice even if you have to count to ten in order to stay calm keeping a gentle tone. When they wake up, they will not be fully back for a while, so respond to them in the state of mind they appear to be in. If they are crying, hold them. If they just roll over, let them. If they want to talk, listen. Don't try to "cure" them but be there to help them heal.

Symptoms of avoidance and emotional numbing may include:

Trying to avoid thinking or talking about the traumatic event

If they don't face it or talk about it, they can "get over it" they keep telling themselves. They stuff it into the back of their mind so they have to deal with it. They don't want to be reminded something followed them back from combat. What they want and what they need are two different things. If they do not face it to fight it, it wins.
Most veterans do not want to talk about war for this reason as well as the fact they think no one can understand. Don't force them to talk about it but open the door when they do mention a word or two to let them know you are ready to listen when they want to talk. When they do open up, don't try to fix them. Make sure you are able to hear what they have to say without responding to them with a shocked expression. Detach yourself from them emotionally at that moment and listen to them the same way you would listen to an actor reading a script in a movie. Most of the time they feel horrible about what they saw and what they had to do. They think of themselves as evil for having survived and you need to make sure they see themselves through your eyes again so they know they are not evil. They are loved.

Feeling emotionally numb

Feeling brings on pain. Being able to enjoy anything brings on guilt and opens the door to more pain getting in. They build a wall to defend their emotions so they don't end up feeling more pain than they are already carrying.

Avoiding activities you once enjoyed

If what they liked to do involved groups of people before, this could be the problem. On a bad day, the last thing they need is to be surrounded by other people they have to worry about. Don't force them to go. If you want to go, then go, always letting them know they are welcome to come but are not forced to do it. If you try to force them, no one will have a good time. First, ask yourself how important is it that they go with you. If you really want to go, then go without anger you are going alone. If it is really important they go with you then let them know why. Again, stay as calm as possible and forgive them if they just can't bring themselves to go with you. Don't take it personally.
For other things they used to like to do, like going to the movies, it may be impossible for them to do it after PTSD. A dark theater with a bunch of strangers and PTSD do not mix well. Going to a restaurant is a problem at times when they cannot sit in a booth or have their back against a wall. They need to be aware of everyone around them, so this is why they need their back secured. If you don't want to wait for a booth or the area they feel comfortable with, it becomes an unpleasant event and they will not want to try it again. Sometimes they do not want to attend church for this reason as well. They are exposed to a lot of strangers but because they are mostly families with children, they may be more able to attend. Again, let them sit where they are comfortable. You are not the one with PTSD but as they try to do what they used to do, you need to try to help them do it. Keep asking yourself, "How important is it?" that you sit where you want or force them to go?

One other thing when it comes to avoiding what they used to enjoy is if they are dealing with survival guilt. They feel as if they have no right to enjoy anything because someone died while they survived. Drinking while "enjoying" something is an excuse. They tell themselves they would not be enjoying anything but the booze is making them laugh and talk to other people. They can blame being alive again on the alcohol.

Hopelessness about the future

"I just want to be the way I was before!" This thought is behind almost everything they do and how they look at tomorrow. As time goes by and they still can't feel the way they did, they lose hope. They think they are doomed to remain hurting, that things in their lives will only get worse and most of the time, it is because there is turmoil in their homes. More often than not, it has to do with the way their families react to them with false expectations and most of the time, those expectations come from a lack of understanding.
They are frustrated with themselves, unable to get their families to understand and stop asking what is impossible for them to deliver at the stage they are in. Without getting the mental health help they need, you are dealing with not just the symptoms, but trying to get them to find hope enough to seek help. You can only try to get them to seek help if you know they need it and why they need it, so educate yourself as much as possible. If you get them to go for help you have nothing to lose but much to gain. When they do seek help, you will find hope restored as well that things will get better.
Know that they will never be the way they were before. No one ever comes out of any traumatic event unchanged. We heal from it and sometimes we are stronger after, but we are never the same. They can be more patient than before, more caring, more spiritual and yes, even more loving especially once they realize how much you contributed to their healing and rescued them from their darkest days.

Memory problems

Most of them have short term memory loss. They can remember something that happened twenty years ago but forget what you said ten minutes before. They get frustrated with themselves as you get frustrated with having to repeat things over and over again. Help them remember. Make sure they write notes about things they have to remember, like appointments or other important dates. When you talked about something they had to ask you about ten minutes later, help them to remember by patiently getting them to think about what was said. Use key words and wait for them to remember. If that fails, find another key word to use. This begins them thinking about what they are able to remember instead of believing they can't remember any of it.

Trouble concentrating

When they have all kinds of memories flooding into their thoughts, it is hard to concentrate on anything else. Memory loss is part of this. Help them to find memory tricks that work for them. Once they begin to remember, it makes concentrating a bit easier and then tricks help them to think more clearly. They have to pay closer attention and have to work harder to be fully engaged in anything. Once they know why this is, they are able to cope better with it instead of wanting to just give up. This is also one of the other reasons they give up on things they used to enjoy doing. If they cannot concentrate on it, they don't want anything to do with it. Work with them but don't force them.

Difficulty maintaining close relationships

With everything that comes with PTSD, it's hard to stay with them especially when you don't understand why they do what they do or act the way they do. One of the biggest decisions a spouse has to make is if they can unselfish enough to stay and help them heal. Until they start to heal, it has to be all about them and "you" get pushed back. You have to give up a lot helping them. You have to stop taking things personally as you give but they don't. As you pay attention to everything about them, they don't even notice you cut your hair or dyed it a different color. They don't notice things you did around the house as much as they notice what you did not do. You need to decide if you can live with a stranger until you get to know this person while the one you thought you married is buried under a lot of pain. He/she is still in there and everything you loved about them is still all there but you need to decide if you can invest the time and love to bring "them" out again. If you can stay and help them heal, you will have a very strong marriage after but it can be hell at times. It is especially hard if you have no understanding of why it is the way it is.

There is also the fact they may have had several unsuccessful relationships before you and they bring that pain along with what PTSD has done to them. You may not just be dealing with the ghosts of war but the ghosts of broken relationships as well.

Symptoms of anxiety and increased emotional arousal may include:

Irritability or anger

Anger was safe to feel in combat. Anger kept them alive. Anger also does not allow in more pain. As they heal the first thing that happens is they end up crying rivers. They think they are getting worse as the tears come but once they understand it's part of healing as the wall comes down, they find peace with it.

Overwhelming guilt or shame

This comes from combat and what happened there as much as it has to do with being back home and what is going on in their homes. Guilt for causing the problems at home as much as guilt from having survived when others did not. Shame because they cannot stop doing what they do any more than they could stop doing what they did. Guilt and shame can be overcome with help to understand themselves differently. They need to see the series of things that contributed to what they ended up with. They also need to be able to forgive themselves at the same time they seek forgiveness from others and God.

Self-destructive behavior, such as drinking too much

For the rest of these they have been addressed above.

Trouble sleeping

Being easily startled or frightened

Hearing or seeing things that aren't there

A family has to be part of the healing or they are part of the problem. You need to help your entire family understand this and that includes children. Depending on their age, you can help them to know why things are the way they are and that it has nothing to do with them. They are not to blame but they feel as if they are. Help them to understand at their level how they can help their parent heal. Let them know they cannot sneak up on Dad or Mom anymore. The way a parent reacts to the PTSD parent is taken in by the children. They will learn to help instead of feeling as if it is their fault and instead of hating their parent.

There can be peace in a PTSD house and you can find your own kind of normal living with it. Once you get past the worst times, the darkest days, you can find yourself being a better person as well. You can get there from here.