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U.S. Marine Corporal William Berger talks about how his TBI soured the relationship with his girl friend. He describes how he was childish, irritable, withdrawn and unable to be intimate.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Officer Richard Gutteridge describes how, during his struggle with severe PTSD after two deployments to Iraq, he became withdrawn from his wife and two sons,.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 Landstule 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 She finds him withdrawn and extremely childish and demanding.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 a long 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, Mercedes, and for many of the tens of thousands of those who are experiencing symptoms related to deployment and combat related stress, PTSD, mild traumatic brain injury (TBI) 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 (Tanielian & Jaycox, 2008).

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 depression, 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 in the battlefield. In the vernacular, to be caught “with your pants down” means to be caught unprepared, to be vulnerable to a negative outcome; so to in sexual intimacy. To bear 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 emotional intimate relationships, require a sense of security and trust, commodities that are often hard to come 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. Secondary traumatization 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 afterwards.
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 lesson 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, 55 year-old George Alexander, the civilian son of a Marine Corps sniper during WWII. 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.