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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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FAQ 1 | FAQ 2 | FAQ 3

Relationships: Caregivers/Partners with PTSD.

FAQ 1:

Q: Dear Frank, A man asked me this question in reference to his girlfriend. How do you tell someone close to you about PTSD if they've never heard about it and how do you encourage someone to look into getting help. He listened to your Sage Advice for Trauma Survivors and Caregivers Audio CD. I guess it's difficult for a loved one to figure out how to start off the conversation.

A: Dear Joyce, Thank you for sending me this question. As you know, I've written a few pieces for GFW (Partners with PTSD) and made a DVD (Living with PTSD) for partners of people with PTSD. My messages informed about PTSD, encouraged partners to become as knowledgeable as they possibly could be, and to recognize that loved ones might prefer to keep painful memories to themselves--protecting their loved ones, but risking loss of trust and intimacy.

In this answer I'll try to focus on the assumption you raise, "I guess it's difficult for a loved one to figure out how to start off the conversation." That is often very true. People with PTSD have symptoms and suffer and withdraw. Hiding from help is actually part of the diagnosis. PTSD includes retreating from social situations, self-isolation, loss of hope for a full and rewarding future, and irritability. Sometimes that irritability is angry and violent, pushing away the family and friends who care most.

So I will not say, "Just go ahead and talk to your loved one." It pays to show that you respect a person's desire for privacy and dignity. It is often a good idea to wait for a sign that your partner is ready to talk. Even as a therapist, paid to help a client, I often say, "We needn't get into painful parts until you are sure you are ready."

PTSD is a set of symptoms but it is also a memory of something real. Your partner may want help with symptoms, like insomnia and irritability, but may not want to recall details of a rape or
violent death that was witnessed. So when you sense that your loved one is as open as he or she will ever be, you might say, "I think your insomnia (pick a symptom that is least embarrassing) may be part of PTSD and PTSD can be treated. Could we talk about treatment?"

Instead of, "Could we talk about treatment?," you might be more assertive and say, "I'd like to get you an appointment with an expert for treatment." Or, "Let's get help together, because I'm hurting, too."

I never know exactly what someone else should say, but I do often work with partners and try a few ideas, sometimes using role-play in which I play the spouse who wants to help and the spouse plays the loved-one with PTSD.

So I might say, "I've been reading about PTSD and I think that could be the cause of your insomnia. Could I look into an appointment for you with a PTSD expert?" And the wife, playing the role of her angry husband, might say, "I don't want you to bug me." That's not a good sign. I'd then say, "OK. I don't want to fight about this."

In those cases, I usually advise waiting for another chance and trying again, cautiously and politely. Sometimes the caregiving spouse goes for treatment and eventually the person with PTSD overcomes his or her resistance. That is like going to Al-Anon when you really want your partner to go to AA.

But far more often the role-play works out and so does the application in real life.

For example, I say that line above about insomnia and wanting to set up an appointment, and the partner, in role-play says, "I guess that would be OK." They often add, I never thought of saying it just like that. Some actually want to write the line down and practice it.

I'm not suggesting that the words make the difference. The anxiety that both partners come to share gets in the way of progress. There is discomfort and embarrassment on both sides.

So talk with a friend, or actually see a therapist. Overcome your awkwardness. You certainly are not alone. It may not work the first time, but it is worth a few tries. Try and try again.
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Relationships: Caregivers/Partners with PTSD.

FAQ 2:

Q: Dear Frank:

I just received a compelling and complicated request from a GFW website reader. Could you offer us some reflection on these issues?

I came across your website and have a very strange/interesting situation that I desperately need advice on. I have PTSD from childhood abuse and am currently in a serious relationship with someone who has war related PTSD. The problem that we have is that I am very emotional and want him to know about my past and the things that I've gone through- because I feel like it's an important component of what makes me who I am. Every time I try to talk to him about anything he blocks me and I feel completely unsupported. I also try to talk to about his past, but he cannot because most of it is classified... That said, he can't get therapy because it's classified and because it would effect his future job prospects (if he went to a high ranking military therapist with a clearance). He explains to me that he is really emotionally numb and can't feel most of the time. He has also had flashbacks (he has never been violent or anything) and is very hyper vigilant.

To complicate the situation more, he is taking a job that further puts him in harms way- this is terrifying to me, but he doesn't care that it hurts me... And I fear that it could worsen his PTSD if he makes it out alive. I ask him why he does this and he responds "because it's my career" and that's that. In order for him to take this job we have to move across the country where I have no support network. I think he may feel I am blocking his career path because I am pretty anti-war, but in reality I am just scared he will be hurt. However, he won't let me communicate this to him because he refuses to talk about anything.

I am willing to stay with him even if he takes this job because he is my life partner... But I don't know how to have a conversation with him about my past, and have him be receptive and understand the risks of moving very far without a support network. How do we meet both of our needs, where he insists on emotional space and I need proximity? Further, why is he so terrified about having me open up to him and how should I initiate a conversation?

Your advice would be incredibly appreciated.

A: Dear Joyce:

This is difficult, indeed. Our web readers may not face challenges exactly like this, but they may have related issues and concerns. First, let's consider the survivor of childhood abuse with PTSD who craves understanding from a reluctant spouse. The spouse's reluctance can stem from any of several legitimate reasons. (I'll refer to the spouse as "he" although genders could be reversed and partners could be of the same gender). He could have his own demons and want to keep them at bay. That appears to be the case here. He could have rage at his partner's abuser, and find it difficult to control. He could have an idealized image of his wife (or loved one) and find it humiliating to imagine her violated. This is an unfortunate norm in certain cultures where the extreme result is a so-called "honor killing." Far more common is the situation where the man lacks the emotional maturity to tolerate his partner's feelings. He hasn't learned to listen without needing to fix things.

And fixing the consequences of incest or abuse is way above his pay grade. But there are many husbands and male partners who can learn to listen, and can be coached in the "ministry of presence." Skilled couples counselors, chaplains, family docs, peer supporters and mental health professionals all have the ability to model the "ministry of presence." So if you are reading this and you are a survivor of childhood abuse and you need your partner to tolerate your truthful story of persistent anguish, you might let him know that you do not need him to fix anything. You want him to learn to stand by you as you recover some painful memories. You might even say, I'm just going to let a memory in without saying a word. But I want to know that your are there. (In a way, that's what I do when I use the Counting Method: ). If he is willing to go with you to a therapist (or any of the helpers mentioned above) you could make it clear that you do not want him to be put on the spot or to feel as though he has a problem. You want to work toward a better relationship in which he feels his strength while you feel your pain. Admittedly, this is not an easy journey and having a skilled, experienced guide can make a big difference. The GFW community could share good news and not-so-good news about couple counseling for just this problem.

Now let's turn to the man (or woman, although it is more likely a male) who has a security clearance and a mental challenge related to trauma. I had a clearance when I was deployed with the US Secret Service to identify and help agents (and top management) deal with these issues. I had colleagues in other agencies where the issues were as delicate or more so. In some circumstances, a person with a high security clearance was not allowed to see a psychiatrist who was not similarly vetted. In some circumstances, a psychiatric visit was mandated. In many situations, a known visit to someone like me would interfere with advancement. So I can confirm the fact that an agent with PTSD may risk a loss of security clearance by seeking proper treatment. There are ways to improve PTSD symptoms without creating a paper trail of psychiatric treatment. There is self-help. There is spiritual help. There is confidential peer support. There may also be a way to have conversations with psychiatrists that are off-the record and more informational than clinical. The "old boys" network can assist. "Old boys" exist in the CIA, FBI, and the military. Sometimes they are called, "rabbis." They have been around a long time. They do not seek managerial positions, but they may have advanced in rank. They are discrete, wise and trustworthy. They give good advice. If you are the husband of a wife who is suffering from PTSD, but you don't want to trigger your own PTSD, get as much help as you can for your own PTSD.

PTSD is real. It will hurt you on the job and in your marriage if you can't cut it down to size. Treatment is like the oxygen mask on an airplane. Put your own mask on first before assisting others.

So, in sum, there are partnerships where PTSD complicates life for husband, wife and the marriage itself. In most cases, the issues can be brought to one or two therapists who offer guidance, support and treatment. The condition improves. But in some situations, the stigma of PTSD and the prejudice against therapy is real. It takes careful, diplomatic efforts to find the way. The way may be "off the books" and available through informal contacts. But the agents who most need to find the way are also expert at this sort of covert discovery. They do it for a living. I encourage them to search for help, to minimize their own PTSD, and to become better able to serve their missions and their marriages.
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Relationships: Caregivers/Partners with PTSD.

FAQ 3:

Q: Dear Frank, I recently received this question:

"PTSD is obviously a huge part of my life. Try as I might to keep my symptoms hidden, they sometimes surface. After many years in a relationship that soon may become binding or legal do you feel that I should reconsider if the person involved is unable to accept that I cannot get over the past. I know that I have to make my own decisions but I would like hearing the insights from you as well as from others in the GFW family. I constantly feel I have to act okay when I am desperately stressed. My way is of coping is more and more self medicating to hide my pain. (Ativan and wine) I am getting down on myself for my inability to heal. I do have a therapist but we seem to be at a standstill in our therapy. It took me forever to find this therapist. Knowing her she would say be patient. My fiancé doesn't believe in therapy. What are your thoughts on this situation?"

A: Dear Joyce, My answer:

The fact that you ask this question leads me to believe that you doubt the wisdom of marrying a man who does not accept you as you are. And because you have serious doubts, so do I. Obviously, I am in no position to know what is really best for you. There must be very strong assets that this man brings you, or you wouldn't even consider a life commitment. But hear yourself:

" symptoms...surface"

" ...the person involved is unable to accept that I cannot get over the past"

"I feel I have to act hide my pain"

It appears that you have to be false to yourself and false to him to make a marriage work.

Furthermore you are at a standstill in therapy and your fiancé doesn't believe in therapy.

An ideal life partner would believe in you. He might have doubts about this therapist, if you are getting nowhere. But he would support your choices. He might help you feel confident about the future, which is necessary if you are trying to let go of the past.

Might it be that this man is being honest with you? That he believes you can make some significant psychological changes, and succeed in living your life with him, rather than living his life with him? Or is he incapable of appreciating and respecting your interests, your priorities, and your desire to escape traumatic memories?

I do hope you can win this long struggle to step out from the shadow cast by past trauma. Good partners and true friends do not say, "Get over it." They may wish you will get over it. But they join you for the long haul and they become sources of hope, comfort and validation.

If he is none of those - comforting, validating, and inspiring - I'd really wonder why he remains in your life. But if he is merely aggravated that your demons continue to plague you and he loves you despite your burdens, I'd think twice about saying , "Sayonara." Many men are angry at PTSD, while they care deeply for the one who suffers from it.

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