B0038M1ADS EBOK (48 page)

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Authors: Charles W. Hoge M.D.

BOOK: B0038M1ADS EBOK
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Spouses, partners, children, and close family members feel the passage of time as they wait to hear from their warrior; as they wait for the
safe return of their warrior; as they witness the devastation of the war on
other families in their unit or through the news; as they go through each
day filled with ordinary activities that make up life. It isn't only the burden of having to juggle all of the responsibilities when the warrior deploys
(finances, child care, work, education, etc.). It's also the burden of waiting, of having to hold fear somewhere deep inside (just as the warrior
does) to get through each day. The connection with their warrior is an
active living experience within the passage of time, which can be accompanied by intense loneliness and isolation.

For modern warriors and their families, the availability of rapid communication between the war zone and home by e-mail, phone, and web cam has helped tremendously to keep relationships strong, to maintain
the commitment, and to provide ongoing reassurance that the warrior is
safe and their loved ones at home are doing okay. This reassurance is vital
for everyone. However, the advances in communication don't reach all
areas of the operational theater, and many warriors experience sporadic
or no contact with home for long periods of time, just as in past wars.
If there are extended operations or casualties, communication ceases,
and loved ones may panic at the sudden gap in contact. In addition, even
during communication "blackouts," some information trickles through,
and loved ones may learn of casualties before official notification, or hear
rumors that increase their worries and fears.

Although rapid communication provides mutual support and may
be beneficial in solving problems at home, neither the warrior nor their
spouse/partner want to burden each other in the time they have to communicate. The warrior doesn't want to share the details of their combat experiences for fear that it will unnerve their partner; their partner
doesn't want to burden the warrior even if there are severe stresses at
home, because they don't want the warrior to be distracted by these issues
and lose focus in the war zone. What this means is that neither person can
rely on each other for support on a day-to-day basis and have to grow as
individuals. Warriors get most of their support from unit peers, which is
essential in the operational environment; spouses get support from other
spouses, friends, and family. This may create distance and lead to challenges upon reunion. Partners/significant others who are not married to
the warrior can have a particularly difficult time finding support because
they aren't able to easily tap into the military community.

The other by-product of easy communication is that strains in the relationship can rapidly become evident. Warriors might hear rumors of their
spouse or significant other hanging out with other people and become
suspicious or jealous (rightly or wrongly). The relationship could unravel
and end during deployment, leaving the warrior feeling bereft, angry,
helpless to do anything, and unable to concentrate or focus on the mission. The anger can be compounded by financial strain if the warrior's
bank accounts with hard-earned combat pay are drained or credit cards maxed out during a breakup. Unit leaders are often not very receptive to a
warrior's request to take unscheduled leave to go home and try to resolve
a relationship crisis in the middle of deployment.

Everyone grows, matures, and changes during the absence. Spouses
and partners become much more independent. Children may reach major
milestones (e.g., walking, talking). Young children may not remember the
warrior, or may have difficulty adjusting to new routines, shared custody,
or a move when the warrior returns. Role changes in the household can be
challenging. Warriors may have a hard time transferring responsibilities to
their spouse/partner, and then on return unrealistically expect that the
roles should go back to the way they were before deployment.

Family structure has changed considerably over the years, and the
current wars bring unique challenges. In particular, the large number
of single parents and dual military families with children has led to significant child-care burdens falling for extended periods on grandparents
and other relatives or friends. This expands the impact of the current
wars to many people outside of the immediate military family. Child custody issues can be particularly challenging due to military and deployment stresses.

Women have for the first time been involved in direct combat operations in large numbers. Nearly 40 percent of military women serving
during the Iraq and Afghanistan wars have children. Women have faced
deployments within a year after delivery. The first four years of an infant's
life, and, in particular, the first year, are critical in the child's development.
Separation during this period can result in the infant forming bonds with
another caregiver-perhaps a grandparent-which can lead to difficulties when the mother attempts to reunite after deployment. There are
concerns that this could increase the risk of long-term developmental or
interpersonal problems for the child. All of this adds to the complexity of
readjustment on the return home.

One of the greatest challenges in the current wars in Iraq and Afghanistan has been multiple deployments. Warriors who remain in service (and
their families) are expected to "reset" rapidly after return and be ready for
another deployment. Even the time at home is interrupted by extended absences for military training, and it can be challenging to nurture a
strong relationship or resolve issues related to the previous deployment.
Both the warrior and their loved ones may immediately start bracing for
the next deployment, and as a result, keep buried their reactions from the
previous deployment.

Lingering Postwar Effects

No matter how long ago the warrior returned from deployment, spouses,
partners, and family members can be impacted by how the warrior was
affected by their experiences. Sometimes there is a sense that the warrior
is a different person. Family members often feel that they have to "walk
on eggshells" due to the level of rage. Household sleep patterns can get
disrupted when the warrior repeatedly leaves the bed in the middle of
the night. There might be arguments and conflict over roles and responsibilities, the amount of time the warrior wants to spend with unit peers,
the amount the warrior is drinking, or the spouse moving something that
belongs to the warrior. In extreme cases family members can experience
"secondary traumatization" and start to exhibit PTSD symptoms related to
the warrior's behavior. One of the most difficult things to cope with is the
emotional detachment and withdrawal.

Loved ones may recognize that the warrior needs help for war-related
problems, but be frustrated in attempts to convince the warrior to follow
through. They may also need help themselves but not have an opportunity to receive it, because they feel like they have to remain "strong" or
because they find themselves still managing the household by themselves
even after the warrior returns.

Both the warrior and their spouse/partner want a break when the warrior returns home, but the reality is that they might have a difficult time
adjusting and finding an equilibrium that's mutually supportive. This can
be influenced by how much each individual has changed, where they got
support from during the deployment, and the various life stresses related
to employment, finances, moves, family strain, or transitions to civilian
life. Life back home is very complicated, and warriors sometimes yearn to
return to the "simplicity" of the operational environment.

When there are serious war-related reactions, such as PTSD, depression, rage, alcohol abuse, or effects of traumatic brain injury, one of the
most common emotions that spouses, partners, and close family members
experience is a sense of helplessness. They feel powerless to be able to
do anything to help their warrior, and fearful of the warrior's response
should they try. They might also continue to fill roles that the warrior usually assumes rather than confronting the behavior and attempting to work
out an equitable solution. Hopefully, the knowledge gained from reading
this book puts some of this in perspective and offers hope that there are
things both the warrior and their loved ones can do during the transition
period.

The following considerations are directed primarily to spouses, partners, or significant others of warriors. Ask your warrior to read any sections
that you think would benefit both of you.

YOUR STRENGTH AND INDEPENDENCE

Your most important strength is your individuality and ability to live a fulfilling and meaningful life independently from your warrior. The more
comfortable you are with your independence, the happier you'll be, and
the more there will be for you to share with your warrior. Your independence allows you to effectively take over roles and responsibilities when
your warrior is deployed, and there's no reason to stop doing this when
your warrior returns. Independence doesn't mean being on your own. You
can be intimately connected with each other and independent at the same
time. In fact, that's ideal. There is great joy in two people sharing with each
other and appreciating the many qualities that make each other unique
individuals. If you have your own interests, dreams, and friends that motivate and inspire you, then you have things that give meaning to your life
when your warrior is away, as well as when you're together. They add to
your sense of confidence, self-worth, accomplishment, and connection to
others. When warriors encourage and value their spouse's independence,
this adds to the health of the relationship.

TAPPING INTO YOUR RESOURCES

In addition to your own strength and independence, as a spouse or significant other of a warrior, you likely have a great many resources available to
you, particularly support from family and friends. Although the exercises
in this book are geared for warriors, they can be just as useful to you.
Being aware of your feelings and reactions, ensuring good sleep, physical exercise, noticing your breathing, meditation, eliminating "shoulds,"
acceptance, letting go, coping with the emotions of loss or grief, dealing
with anger, and many of the other skills presented in this book are worth
learning. There is also tremendous value in narrating and sharing your
story with whomever you're comfortable with.

You may need support from a mental health professional yourself at some
point. In one survey of Army spouses, nearly 20 percent had significant symptoms of depression or anxiety, and 8 percent reported that mental health
symptoms were seriously affecting their relationships or ability to function at
work. If you're experiencing depression, isolation, difficulty sleeping, rage,
increased alcohol use, loss of interest in things you used to enjoy, or severe
worry or anxiety on an ongoing basis, then you should consider getting help.
Suicidal or homicidal thinking are definitely reasons to seek help.

One of the challenges for you, which may be less of an issue for service
members or veterans, is navigating the civilian health-care system, such as
TRICARE. This can be difficult and frustrating at times, and requires a lot
of patience. One of the easiest ways to get started is to see your primary
care provider and ask for a referral, or contact Military OneSource at www
.militaryonesource.com or 1-800-342-9647. If there is suicidal thinking,
homicidal thinking, or verbal or physical abuse going on in your household, then contact one of the crisis lines, where there are counselors available twenty-four hours a day: the National Suicide Prevention Lifeline at
1-800-273-TALK (8255) and the National Domestic Violence Hotline at
1-800-799-SAFE (7233) or 1-800-787-3224 (TTY). Both of these hotlines
are connected with crisis centers where you can get immediate assistance.
See chapter 8 on navigating the mental health care system for more information on how to get help.

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