Hidden Battles on Unseen Fronts

by Patricia Driscoll

  “I don’t think I was in as bad shape as she says I was,” Duval says, “But she was a good listener, and I guess I needed to talk to someone more than I thought I did. I was very lonely.” The one time she came to see me I took her to the Kennedy Center to see Aretha Franklin and Robert Goulet. I was so happy to be able to do that for her.” He also reached out to other soldiers on the wards of Walter Reed. “A lot of them never left their rooms. They were on medication and drinking at the same time. There was a young kid, a Mexican-American from Texas who talked to no one and no one paid any attention to him. Finally I went into his room and said,’ You gotta come out, man. I know where you are. You’re living in your head.’ After a while he trusted me. We became friends. It helped us both.”

  It also helped to have Mercedes to talk to. Duval and Mercedes, a family practice lawyer living in Peru, had been communicating by email and phone since 2003 when a mutual friend convinced both of them that they had a lot in common. By April 2005, when Duval was recovering from his spinal surgery, they were talking daily. In July, at the first opportunity to get leave, Duval flew to Peru. Two weeks later, on July 16th, they were married at the US Embassy in Lima. When Duval was discharged from Walter Reed in February 2006, Mercedes was there to take him to their first home together, an apartment in Silver Spring, Maryland. But his living arrangements had not always been so pleasant.

  At the end of 2005 a doctor presented him with a letter assigning him to Building 18, a dormitory for long-term patients. Everyone knew its reputation. “There was mold and cockroaches. Rats. The paint was peeling off the walls. It was like public housing. We all understood the area was dangerous. About the time they wanted me to move over there a chaplain had just been mugged on his way out the door. One soldier was beaten up with his own leg. There were two suicides. But what choice did I have? I went over and tried it, but my mattress was a half an inch thick, so I went back to the doctor and said,’ I can’t live there. I have a back problem.’ And the doctor said,’ But I’ve already written the letter and you have to sign it.’ And I said,’ I’m not going.’” Ultimately Duval prevailed and was assigned to Building 11, which had previously housed medical students. “It was luxurious compared to 18, but that’s not saying so much, you know?”

  Duval was discharged with 80 percent disability from the Veterans Administration because of his spinal injury and sinus condition. He was refused disability for his PTSD and TBI, although he’d been seeing a psychiatrist at Walter Reed for both for over a year. He left the hospital armed with medications for depression and sleeplessness. “He is not the man I used to talk on the phone to before going to combat,” Mercedes says. “It’s not easy living with him. He doesn’t sleep so I don’t sleep. It’s hard to be close to each other physically or mentally because he is so messed up.” “Sometimes she wakes me up because I’m hitting her,” Duval says, “I’m having a nightmare and I think she’s the enemy.” Mercedes says, “I’ve learned to be patient and not take it personally when he broods and won’t talk to me. It’s like having a child again who demands all my attention and all my love but has trouble giving it back to me.”

  Duval admits he’s not easy. “I can hear myself acting like a kid. I have trouble making decisions. I’ll change my mind ten times about something stupid like what shirt to put on or whether or not to go to a movie.” The word, “leave” has become a loaded weapon. “When we argue, I’ll say ‘I’ve got to leave this house.’ What I mean is I just need a break.” But Mercedes interprets the word differently. “When he says ‘leave’ I’m afraid he’s going to walk away and never come back. Alarm bells go off for me.” But she remains committed to their marriage. “All I can hope is that he’ll change with time; that we will be affectionate with each other again. I love him, I just don’t understand him.”

  Duval doesn’t see himself as that much changed. “I am the same Duval I always was, but what I personally, went through has made me more jumpy and irritable, I know that. It has also made me more human. I love Mercedes. I love my sister and I love Yestania, my daughter. She just graduated from college. I will get through this. It’s going to be okay.”

  Duval has enrolled in French 101 and 102 at Montgomery Junior College in Rockville, Maryland. “I’ve always liked languages. Ideally I’d like to study Arabic, but I’ve heard it’s very hard to learn, so I’m starting out with something easier. Once we save a little money, I’d like to send Mercedes to MJC full time.” The Armed Forces Foundation assisted Duval and Mercedes with a number of unpaid bills.

  MEDALS

  Army Achievement Medal, National Defense Services Medal, Global War on Terrorist Service Medal, Afghanistan Medal Army Service Ribbon, Armed Force Reserve Medal, Unit Citation.

  “Being resilient does not mean that a person doesn’t experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.”

  —American Psychological Association, “The Road To Resilience—What is Resilience?”

  36

  THE BATTLE FOR LOVE

  By Mitchell S. Tepper, PhD, MPH

  US Marine Corps Corporal William Berger talks about how his TBI soured the relationship with his girlfriend. 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 Landstuhl 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 along 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, and for many of the tens of thousands of those who are experiencing symptoms related to deployment and combat related stress, PTSD, Traumatic Brain Injury 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.

  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 dep
ression, 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 on the battlefield. In the vernacular, to be caught “with your pants down” means to be caught unprepared, thus vulnerable to a negative outcome; so too in sexual intimacy. To bare 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 emotionally intimate relationships, require a sense of security and trust, commodities that are often hard to come by 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. This 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 afterward.

  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 lessen 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, the non-profit organization that connects veterans with conditions such as PTSD with professional mental health care providers, 55-year-old George Alexander, the civilian son of a Marine Corps sniper during World War II. 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 Newman, “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 stand by 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 such as communication skills; conflict management; sexual enrich
ment 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); effects of disability and chronic conditions on sexual response and expression; and access to couples counseling. Ideally, the DoVA will develop retreats for veterans battling for love just 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 forever. 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.