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When Someone You Love Suffers from Posttraumatic Stress
What to Expect and What You Can Do
By Claudia Zayfert, Jason C. DeViva
The Guilford Press Copyright © 2011 The Guilford Press
All rights reserved.
What It Feels Like to Live with a Trauma Survivor
Lucy was reaching the end of her willpower. It had been almost 6 months since Ed got back from his deployment to Afghanistan. He had been part of an engineering crew, and his reports back from Afghanistan had been generally okay. She knew he had been afraid the whole time, and knew that there were three or four events that really shook him up. But 6 months? When he first got back, he seemed relieved to be home, but then he started pulling away from her and the kids. He told her that his superiors in the National Guard had recommended they take about 30 days to transition back to civilian life, but he kept asking for more time. It didn't seem like he was trying to get a job or get out and be more active, and she was starting to lose her patience. How much more would she have to put up with?
Maggie and Ian were concerned about their daughter, Tess, but didn't know what to do. Tess had been sexually assaulted by three men while she was away at college. Maggie and Ian had watched their usually outgoing and happy girl slowly recede into a shell, and it didn't seem like there was anything they could do to help. She had returned to school, but her grades had dropped and she didn't seem to be taking care of herself. They tried to visit as often as they could, but she didn't seem interested in spending time with anyone. They had even tried calling the college's health center on their own, but the person on the phone told them there was nothing the college could do if Tess didn't come in on her own. Maggie and Ian wanted to take care of their daughter but they felt helpless.
Juan was tired all day but couldn't sleep at night. It didn't help that most nights Estelle either was tossing and turning or she was not in the bed at all. But even when the bedroom was quiet, he would lie awake at night and worry. Would their marriage always be like this? Could it ever go back to the way it was? Worst of all, he couldn't stop blaming himself for all of it. He was supposed to protect his wife; if he had been there, she wouldn't have been attacked. And he should know what to do now to help her. But everything he said or did seemed to backfire and just make Estelle either angrier or sadder.
When your loved one is traumatized, the experience and your loved one's reactions to it can affect your life and your relationship—your lives together—in many ways. You probably have a lot of unanswered questions and may feel confused, frustrated, even frightened by what the future might hold. Can you identify with any of the following responses that we often see in the loved ones of survivors?
"IT DOESN'T MAKE SENSE."
Loved ones often feel a sense of confusion about the trauma survivor's response to the situation. As noted earlier, Joe couldn't understand why Tom was so affected by the car crash. It didn't make sense to him that Tom could be that bothered by a crash he had walked away from. Joe thought he should have been relieved to come home. Maureen felt similar confusion when her husband, Ralph, returned from a deployment to Bosnia in 1997. She could understand how he might have been bothered by the terrible things he saw, but it made no sense to her that he didn't just get over it and move on with his life. And why wouldn't he talk about what happened when he was there? She could take it. After all, she had grown up in a big city, with all sorts of bad things happening all the time.
Friends and family of trauma survivors often cannot understand why their loved one can't seem to "get over" an incident from the past, even one that was traumatic. They may have little understanding of what actually happened because the survivor is not willing to talk about the trauma. They may not understand why his difficulties won't go away and might even get worse over time.
"I NEVER KNOW WHO WILL SHOW UP."
Friends and loved ones of survivors of trauma often report that they can never predict what sort of mood the survivor will be in from one minute to the next. Susan, whose husband, Jerry, had served in the Gulf War, said that his mood changed almost from minute to minute. She had no way to know what would affect him: "Sometimes when we are out with friends, Jerry is talkative and sociable. Other times, he stays in a corner or outside and asks me to leave after just a few minutes. I never know who will show up." She used go along with whatever he was up for, but after a while she became frustrated at not seeing their friends, so she would drive him home and then return to the gathering by herself. This meant they spent less time together, and she was not sharing good times with him. Susan was feeling more and more distant from Jerry.
At times there may be clear causes, or "triggers," of the trauma survivor's angry, irritable, or isolating mood. For example, Susan knew that if Jerry saw a movie about war he would probably be in a bad mood for the rest of the day. Similarly, Jenny knew that no matter what sort of mood Marcus was in when they got to a family function, if someone asked him about his time in Iraq he would suddenly become quiet and sad. At other times, there may be no clear trigger for the irritability or isolation. It seemed to Juan that sometimes Estelle would wake up in a bad mood. She would start the day angry or unresponsive, before anything had even happened. If the trauma survivor in your life seems to get upset out of the blue, for no clear reason that you can see, you may feel that you can't predict what sort of mood he will be in from one minute to the next.
"I'M WALKING ON EGGSHELLS."
Trauma survivors often show extreme emotional sensitivity, so that even little things can upset them. As a result, family members often find themselves "tiptoeing around" in an effort to cause the survivor as little distress as possible. To avoid upsetting the survivor, they try not to burden her with requests, chores, or phone calls. They also may try to be very careful about what they say and how they say it because they don't want to suffer the consequences of having made their loved one angry. One man described this as "walking on eggshells" because he had to be so careful around his wife. Marion quickly learned that talking about the economy, the news, or her hopes and dreams about college upset her father, Marcus. So she learned to focus their conversations on sports and to choose her words carefully.
Perhaps the most unfortunate consequence of "walking on eggshells" is that the family member takes over most of the household chores and duties. Jeff, whose wife, Emily, had been in a bad car accident, realized in the months after the crash that paying the bills got Emily agitated for what seemed like days. So he gradually started paying all of the bills in addition to his other chores. When 6 months had passed since the crash, Jeff also was cleaning everything in the house and maintaining the cars. As much as he cared for Emily and wanted her to feel better, he started to resent the fact that he was carrying the entire burden of running the house.
"HE GETS ANGRY AT THE DROP OF A HAT. I CAN'T TAKE IT ANYMORE."
Loved ones can find it challenging to cope with the moodiness and anger that some trauma survivors display on a daily basis. They often talk about the frustration and powerlessness they feel. Instead of withdrawing and walking on eggshells around the trauma survivor, some family and friends may do just the opposite and interact with the survivor in aggressive ways. You may have noticed that the trauma survivor in your life can get angry very quickly. If the survivor feels trapped and does not think she has any other way to maintain a sense of control in her life, aggression may be the only way she can feel powerful. It is difficult to stay calm when someone is yelling at you, so you may have fallen into a similar pattern of aggression when responding to the survivor. Wanda's husband, Nadim, had been mugged and beaten one summer night. By winter he had become sullen and withdrawn. To Wanda, he seemed to communicate only by yelling at her. Eventually, she had had enough and started yelling back. On two separate occasions, neighbors had called the police after hearing shouting and crashing sounds from their apartment.
"WHAT POSSIBLY COULD HAVE HAPPENED?"
You might not know exactly what happened to the trauma survivor in your life, and that might make it really hard to understand how she is being affected by the trauma. When the trauma survivor does not confide in you, you may feel distrusted, hurt, and frustrated. For example, Sean knew that his sister, Kate, had been working at the factory when one of the massive steam-heaters blew and a lot of people were burned. But the news reports had been vague as to how badly they were hurt. Kate had been on the other side of the factory at the time but somehow ended up with minor burns. When Sean called to ask her what had happened, she only stammered, "I tried to help" and then hung up the phone. In the two months since then, she had not been back to work and had hardly spoken to anyone. Sean couldn't make sense of what she was going through; he kept asking himself, "What possibly could have happened?"
You may be wondering the same thing. Trauma survivors often are reluctant to talk about what they experienced. The people who care about them are left wondering what they went through and why it bothers them so much. You may even have directly asked the survivor to tell you what happened, only to have him refuse to talk about it. This may have left you not only confused about the trauma but also struggling to understand why he wouldn't trust you enough to share what happened. This can be a frustrating process. You want to help and to understand, but the survivor seems totally unwilling to open up and you feel left in the dark.
"I DON'T WANT TO KNOW!"
Loved ones often feel horrified by the events the survivor experienced. When Marcus communicated with Jenny while he was in Iraq, he updated her on the kinds of things his unit was doing. They were involved in some combat operations but often worked with civilians. One of the things Marcus told Jenny he enjoyed most was interacting with local families, especially the children. They made him think of his own family, and he felt more connected to the Iraqis. But then Marcus seemed to stop talking about civilians. He mentioned at one point that there had been a blast in a marketplace but didn't give a lot of detail. His sudden reluctance to share his experiences with Jenny confused her. She wanted to ask him what had happened in that explosion, but she realized that she was scared to hear the answer. What if children had been hurt or killed? She couldn't bear the idea of young people being involved in a war. She had a hard time imagining her husband, with two beautiful kids of his own, seeing children injured or killed. She found herself dreading calls from Marcus and hoping he wouldn't talk about what was happening over there because she was not sure she could handle it. Whenever he did talk about specific events, she would think to herself, "I don't want to know! Don't tell me!"
You may want desperately to help the trauma survivor in your life, but you also may want to remain in the dark about what he went through. Hearing about very distressing events, especially when they happened to someone you care about, can cause you to think more about those events than you otherwise might have. You also might struggle with anger, sadness, and helplessness when you think about exactly what happened to your loved one. You might find yourself, as Jenny had, thinking that you really don't want to know what happened to the person you care about. You may hope that she doesn't try to tell you. Juan knew from her bruises that Estelle had been physically attacked during the assault. Images of two men grabbing and punching her came into his mind when he least expected it, and he found them very upsetting. He felt horrible when he thought about his wife, who would never hurt a fly, suffering at the hands of complete strangers. When the police came to ask Estelle some follow-up questions, Juan wanted to stay with her for support. But he found it too hard and realized he didn't want to hear the details about what happened that night.
"WHAT AM I DOING WRONG?"
When the loved ones of trauma survivors do not know about the effects of trauma, they may blame themselves for the survivor's behavior. This can lead to feelings of guilt. When her boyfriend Charlie came back from Afghanistan, Meagan knew from what she saw on TV that he would probably have nightmares and flashbacks. But no one told her that survivors of trauma often avoid other people and have difficulty experiencing feelings like love or happiness. As Charlie withdrew and seemed to have no emotional response to her, she started to wonder why. This didn't seem related to his flashbacks so she started to wonder whether she was doing or saying something to drive him away. As much as she tried to draw him closer, he never seemed to respond to her with the love he showed her before his deployment. She asked herself over and over, "What am I doing wrong?"
Not knowing the extent of trauma's effects, Meagan did what many loved ones of trauma survivors do. She assumed Charlie's behavior was the result of something she was doing, so she tried to fix it. This often led to her feeling frustrated and hopeless; no matter what she changed or tried, Meagan couldn't get Charlie to act the way he had before he was deployed. After a few months, Meagan left Charlie, less because of how he treated her than because of how she thought he felt about her. You may feel so confused about changes in the trauma survivor that you blame yourself for the problems that he is having now. Unfortunately, blaming yourself not only leads to feeling guilty for something you did not do but also makes you think it is your responsibility to change the survivor, which places an almost impossible burden on you.
"WE'RE NOT AS CLOSE AS WE USED TO BE."
Trauma survivors often isolate themselves from their loved ones. As a result, even their closest family and friends feel as though they have grown worlds apart from the survivor. This loss of intimacy can be devastating for loved ones. Despite the fact that he spent most of his free time at his brother's house, Joe didn't feel close to Tom. It seemed like they barely talked even when they were together. Tom didn't seem comfortable opening up anymore. This was hard for Joe to take. As brothers, they had always been each other's best friend, and had always told each other everything. It felt weird that Tom never came up to visit him, even though Joe was willing to drive to see Tom at a moment's notice. Joe felt like the relationship had become a one-way street.
Even if the trauma survivor doesn't completely isolate herself from her loved ones, her intimate relationships may suffer. A spouse may become more distant, a son may interact less with his father, or, as in the case of Joe and Tom, one brother may no longer trust in and open up to the other. Many trauma survivors say they can feel alone even in a room full of people. Loved ones and family are often aware of the trauma survivor's detachment, and they may even feel the same way themselves. Even if you see the trauma survivor often or live with her, you may feel as though the two of you have lost the intimacy you once had.
"WE DON'T SEE ANYONE ANYMORE."
The isolation of trauma survivors can gradually shrink the worlds of those who care about them. This is especially the case for family members who live with trauma survivors or spend a lot of time with them. When the two brothers were invited to family events, Tom would call Joe and ask him to come spend the day at his house. Joe would be put in the position of either not visiting with family or refusing to see his brother. He started to feel like whatever he did would be wrong. Similarly, Marion knew her father got very uncomfortable when people asked him about Iraq. She felt terrible when Marcus left family gatherings alone, so she started going home with him so he would have company. She was spending much less time with her cousins and grandparents than she would like in order to make sure her father wasn't alone.
In the case of couples such as Juan and Estelle, the isolation of the survivor can result in isolation of the partner. The survivor avoids activities that the couple usually did together, and the partner, unaccustomed to doing those things alone, also stops participating in those activities. Juan realized that they saw fewer and fewer of their friends as a result of Estelle's desire to avoid social gatherings. Juan was concerned about Estelle and did not like leaving her home alone. As a result, he soon lost contact with most of his friends. When he complained to Estelle, "We don't see anyone anymore," she seemed completely unconcerned.
"I'M NOT GETTING MY SLEEP."
Loved ones of trauma survivors may suffer from sleep disruption. If you share a bed with a trauma survivor, chances are you have noticed that he doesn't sleep well. This may be affecting your sleep, too. You may wake up during the night when your loved one tosses and turns. If the trauma survivor has nightmares, you may wake up when she moves around or makes noise. Jenny was startled out of a sound sleep when Marcus cried out next to her. She asked him what was wrong, but he just kept yelling. When she couldn't understand what he was saying and he didn't respond to her, she realized he was asleep and having a bad dream. The next morning he didn't remember dreaming at all.
Excerpted from When Someone You Love Suffers from Posttraumatic Stress by Claudia Zayfert, Jason C. DeViva. Copyright © 2011 The Guilford Press. Excerpted by permission of The Guilford Press.
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