Eric and Melissa Bourgeois with their three children at the Fort Campbell Army base. Courtesy Melissa Bourgeois
How the US military is failing partners with secondary trauma
Army wife Melissa Bourgeois hit her breaking point five years ago when she was living at a U.S. military base in Vicenza, Italy, with her husband, Eric, an infantryman. Eric was just back from a harrowing second deployment to Afghanistan marked by frequent firefights. Filled with an uncontrollable rage, he spent his nights self-medicating at bars with his war buddies.
Eric's anger toward his family had become explosive, and he regularly punched doors, furniture and even a concrete wall that left his hand injured. Melissa, 25 at the time, with their two small children, felt isolated in a new country where she barely spoke the language. She needed to talk to someone about her situation, but she said each time she sought mental-health care on the base, she was given Valium and sent away.
In October 2008, Eric backed Melissa into a corner and started shouting at her in front of the children, the smell of alcohol heavy on his breath. "I was hysterical, screaming," she said. Desperate, she called a friend, who reported him to the military police for domestic abuse. The commanding officer of Eric's company held him in the barracks for 72 hours before releasing him. When Melissa went to her husband's platoon sergeant for help, he told her that if she was so unhappy, maybe he should just send her back home. Soon after that, Eric said, the platoon sergeant told him, "Keep your wife in line."
In a U.S. military psychologically ravaged by 12 years of continuous war, troops' family members, like Melissa, are the victims of a hidden mental-health crisis, missing from the public calculus of the social costs of combat and systematically denied by the institution that placed their partners — and them — in harm's way. Interviews with military doctors, psychologists, social workers and counselors and with service members and spouses suggest that this problem is ubiquitous yet invisible.
"The military just doesn't want to deal with wives," Melissa said.
'You replay it over and over'
Combat post-traumatic stress disorder (PTSD) takes a severe toll on spouses. A New England Journal of Medicine study that analyzed medical records of more than 250,000 spouses of U.S. active duty soldiers from 2003 to 2006 found that the multiple and prolonged deployments typical in Iraq and Afghanistan led to greater risk of "depressive, anxiety, sleep, and acute stress reaction and adjustment disorders" among spouses — among the anxious and depressive symptoms referred to by mental-health providers as secondary traumatic stress.
While the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the bible of psychiatric diagnoses — does not include secondary traumatic stress, it does recognize that PTSD can arise in family members of those exposed to violent trauma. According to peer-reviewed studies on the Vietnam War and the war in Croatia in the 1990s, prolonged caring for and exposure to a partner with PTSD is a strong predictor of developing PTSD symptoms as well.
"When something terrible happens to someone you love, it is going to affect you," explains clinical psychologist Dr. Laurie Pearlman, who played a lead role in identifying the effects of secondary trauma. "The person comes back and your life is completely altered. You live according to their trauma. You imagine what your loved one is going through, and you replay it over and over."
Military data show rising suicide rates and deteriorating mental health in the ranks — which is tied to a growing epidemic of domestic violence.
In the midst of an eight-hour firefight, your only link to survival is the adrenaline that keeps your body moving forward and keeps you fighting for your life … It's not like you're wondering how she's doing back home.
Eric Bourgeois
Yet the military does not aggregate data on the mental health of spouses, despite the documented high risk of this population. "We do not track PTSD in spouses. We track PTSD in soldiers," explained Army media-relations specialist Maria Tolleson via email. Catherine Wilkinson, a spokeswoman for the Department of Defense, confirmed that even the numbers of spousal suicides are not collected by the military. "We are not tracking data about spouse death by suicide in the same way that we do for service members," she said.
The Army's attitude to spouses' mental-health struggles is perhaps best captured in the "New Military Spouse Handbook" distributed at family-support centers at the sprawling Fort Campbell Army base on the Kentucky-Tennessee border. The purple pamphlet, with an illustration of a bride and a uniformed groom on the cover, instructs spouses not to get upset about their partners' anger, exhaustion, mood swings or deployments. The handbook offers instructions on how to dress for formal Army functions and write thank-you cards but provides scant information on mental-health problems that families might face or resources that can address these issues. "We are super spouses," the pamphlet reads. "No matter (what) the world throws at us, we can be OK."
EXCERPT: New Military Spouse Handbook
Tips from a handbook that is being distributed at family centers at the Fort Campbell Army base on the Kentucky-Tennessee border.
Dining out
The Spouses will enjoy the opportunity to dress in their most formal dinner gowns or tuxedoes and spend a fun evening with their Soldiers.
Thank you
A handwritten thank you is appropriate for any occasion, whether it be a meal, a gift received or simply a kind deed. When writing a note to a couple, address it to the Spouse and send it within 5 days.
Tips for the Army family
Super Spouses: We learn when our Soldiers are gone that we can make it ... We are super Spouses. No matter the world throws at us, we can be OK. Have fun. Do not get so wrapped in making plans that you cannot stop and smell the roses. Let it go, be silly. Just being together is enough. Enjoy, Chill out, Smile, Laugh, Love is a gift — give it, share it.
Read more excerpts here.
A terrible toll on families
Sitting in their Fort Campbell home in a small subdivision of identical houses not far from the barracks, with their toddler daughter playing on the floor, Melissa and Eric Bourgeois describe the toll that his condition has taken on the family. Eric, who comes across as polite and direct, was diagnosed with severe PTSD in 2008. He said combat filled him with overwhelming rage. "When you are over there, the only emotion that keeps itself alive is anger," he said, gesturing with his right hand, his left one in a sling because of a shoulder injury he sustained in Afghanistan. "In the midst of an eight-hour firefight, your only link to survival is the adrenaline that keeps your body moving forward and keeps you fighting for your life … It's not like you're wondering how she's doing back home."
During his second deployment, he would call home in the middle of the night, and if Melissa didn't answer, he would blow up at her the next time they spoke, screaming on the phone.
Eric returned to a wife whose feelings he had learned to disregard and children he no longer seemed to know and who shied from their father's touch. He was unable to turn off his anger; he got blackout drunk just to be able to sleep.
Melissa said her husband's constant explosions and withdrawal and the burden of raising her family practically alone took a profound toll on the family's mental health. The two boys began to mimic their father's behavior. "(The oldest) started acting up when his father was gone. He flooded the house two times, broke eggs on the floor and took off running out the front door," she said. As for herself, "it is like I have absorbed some of his symptoms." Small things upset her, and she started to yell more at the children. She had panic attacks driving on the highway and crying bouts in the bathroom, which she would lock herself in for hours. "I used to be bubbly, a social butterfly," said Melissa, who has an energetic affect and a quick smile. "But with PTSD, you are always waiting for something to set it off."
The Department of Defense said it provides mental-health care to military spouses and families, tasking Tricare with providing "medical services and support to members of the Armed Forces (and) their dependents," which it said includes mental-health care. Eligible spouses (unmarried partners do not qualify) can, ostensibly, access this care directly from military-run facilities on bases, as well as from private providers off-post that are part of the Tricare network.
According to Stacy Rzepka, a public-affairs spokeswoman at Fort Campbell's Blanchfield Army Community Hospital, "Spouses who endure stressors in their role as caregivers to service members ... are entitled to the full range of behavioral health services available in their Tricare medical coverage, whether at an Army medical facility or with one of our network providers off-post."
I used to be bubbly, a social butterfly. But with PTSD, you are always waiting for something to set it off.
Melissa Bourgeois
Yet families who ask for help say they face a mental-health system that is grossly inadequate and inaccessible to them. Even the Department of Defense's own Mental Health Task Force of 2007 acknowledged in a report that it "must expand its capabilities to support the psychological health of its service members and their families" and that the current system is overwhelmed by need and impeded by shortages. Jodi McCullah, whose nonprofit group offers free counseling to service members, veterans and families in the Fort Campbell area, agreed, saying, "We have been at war for 12 years ... There are a lot of people struggling here."
When asked if the military provides adequate mental-health care to families, Dr. Joe Wise, chief of behavioral health at Blanchfield, defended the system, saying, "Dependents have Tricare health insurance, and there are plenty of providers across the country who take Tricare."
But a former Army therapist and psychiatric nurse practitioner and current Tricare mental-health provider who wishes to remain anonymous said that, given the shortage of providers, service members take precedence. "It is kind of harsh, but the family members are not as important as the active-duty members ... because that is what the mission is — to keep the fighting force healthy," he said.
But even troops face long waits for appointments. After Melissa and Eric relocated to Fort Campbell in 2009, Eric was able to see someone only once every six weeks despite being diagnosed with severe PTSD.
His condition escalated last year, with the first of several suicide attempts. Melissa said that since Eric's diagnosis five years ago, it has been nearly impossible for him to get consistent care, with long waits between appointments leaving him and his family vulnerable. "The Army says they care so much about preventing suicide among soldiers, but this is the perfect example of how they don’t really care," she said.
Alan: The rest of this article can be accessed at http://america.aljazeera.com/articles/2013/11/13/the-military-s-hiddenhealthcrisis.html
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