Caring for Those Heroes With Invisible Wounds

When a wounded warrior returns home, friends and family gather around the hero with the missing leg, the paralyzed spine or the badly burned and scarred face. But for those veterans with post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI), the wounds are invisible. As a society, we celebrate and honor our returning veterans, but there are heroes in the shadows -- the 10 million family caregivers of veterans, many of whom struggle to cope with the brain-related disability affecting their veteran that others don't see.

"When my husband returned from Iraq, he was diagnosed with PTSD," says Lisa*, the 36-year-old wife of an Army sergeant whose entire squad was lost in a suicide bomber attack that only he survived. "My neighbor, whose husband lost his leg, said to me, 'At least your husband returned in one piece.' She has no idea that the 'one piece' is a man with missing pieces in his brain -- he is in such tremendous pain in his head he can barely function every day."

Lisa's husband is often jumpy, and he has night sweats and horrific dreams where he wakes up screaming. He has found it hard to re-enter normal life. On a family trip to the grocery store with their two young children, someone dropped a cereal box in the aisle and her husband literally jumped at the sound and became agitated, sweating so badly they had to leave the market without their groceries.

And then there are terrifying moments for Lisa. "One night, I awoke with my husband standing over me with his pistol. He was sobbing and I was paralyzed with fear. I love my husband, but I am frightened every day he'll snap and hurt me or the kids, but I cannot leave him just because he has this problem. I cry a lot and feel like there is no one to talk to about it."

When it comes to brain-related disease or disorders -- whether it is Alzheimer's, autism, dementia or depression -- the person afflicted and their families are shrouded in stigma and isolation. Which is why this May, during National Mental Health Awareness Month and Military Appreciation Month, the Mental Health Association of New York City (MHA-NYC) is honoring those who support military mental health issues and who continue to raise awareness and provide education and support to veterans and their families.

"PTSD and TBI are indirect trauma for caregivers," says Kim Williams, director of The Center for Policy, Advocacy and Education for MHA-NYC. "Caregivers of veterans with mental health issues face tremendous challenges, which is why our mission is to educate and advocate for services and programs which can overcome the stigma of mental health problems and get military families the help they need."

According to the U.S. Department of Veterans Affairs (VA), PTSD affects 31 percent of Vietnam veterans, 10 percent of Desert Storm veterans, 11 percent of veterans from the war in Afghanistan and 20 percent of Iraqi war veterans. A 2008 Rand Study on military affected by mental health issues found 18.5 percent of military returning from Iraq and Afghanistan suffer from PTSD where symptoms often don't appear until months after the initial traumatic event. Rand also found TBI affects 19.5 percent of these soldiers and only about half of these veterans who need help actually seek it.

What isn't reported is the collateral damage of PTSD, TBI and depression is the caregivers helping loved ones cope as best they can in a society which has little understanding of brain-related illnesses and injuries.

One of the biggest issues facing the military and family caregivers of veterans is the increasing rate of veteran suicides. In a recent study conducted by Craig J. Bryan at the University of Utah published in the Journal of the American Medical Association (JAMA) Psychiatry, 1 in 5 patients who experienced more than one TBI in their lifetime reported preoccupation with suicide as opposed to those with no TBI who reported no thoughts of suicide. In addition, multiple TBIs created a higher risk for PTSD and depression.

"Many veterans are ashamed or feel weak when suffering from PTSD, TBI or depression," says Williams. "They hide their mental health problems, afraid of losing their careers and this attitude forces their caregivers -- whether a spouse, a parent or other family member -- to hide the problem as well." Williams advises this creates isolation and hopelessness for all involved. "By not getting the help they need, veterans sometimes turn to suicide and caregivers are at a lost as to what they could have done to prevent it," continues Williams.

In 2011, the Department of Defense reported 164 active-duty service members committed suicide. Yet, Pentagon data shows in recent years about half of service members who committed suicide never deployed to Iraq or Afghanistan and more than 80 percent had never been in combat. The misperception of tying trauma in war zones to suicide rates is not borne out by the reported statistics, yet problems with depression and suicide persist, especially as we age.

Williams reports baby boomers are more likely to report mental health problems over other age groups, a fact underscored by the recent CDC report indicating a 28 percent increase in suicide among boomers over the last 10 years. But on the flip side, Williams says baby boomers are also more likely to seek help.

While most veterans of any age group do not turn to dramatic measures such as suicide to address their mental health issues, the MHA-NYC has created programs and services to help those who feel hopeless or at a loss on how to deal with PTSD, TBI and depression. The MHA-NYC offers its National Veterans Crisis Line, (1-800-273-8255) a toll-free, 24/7 resource for veterans and their caregivers to get connected to the resources they need -- especially mental health support such as the National Suicide Prevention Line (1-800-273-TALK) or National VA Caregiver Support Line (1-855-260-3274). To date, more than 250,000 veterans and their caregivers have found help and hope through the National Veterans Crisis Line.

In addition to highlighting its support of veterans and caregivers at its annual gala event on June 6 in New York City, MHA-NYC will honor Kenneth Fisher, the founder of the Fisher House. This lodging program offers military families a home away from home while their veteran is receiving medical care and treatment, including mental health issues, at a major military hospital or a VA medical center. To date, 60 Fisher Houses across the U.S. have provided 130,000 families nationwide with more than 3 million nights of free lodging saving military families and the government more than $150 million in temporary housing and transportation costs.

"We can't allow those veterans with mental health issues and their caregivers to remain in the shadows," continues Williams. "It is up to all of us to create awareness and acceptance that mental health is like any other disease or disorder -- there are treatments and programs to help. Our message to military families is to not fight this battle alone."

*Name has been changed to protect privacy of the caregiver.

Sherri Snelling includes information about caregivers of veterans and mental health issues in her book, A Cast of Caregivers.