There are ways to help the PTSD sufferer go through the physical and emotional pain, but you also have to take care of yourself during the process.
By Mary Tendall
Last June, over coffee, Helen,* a member of a wives-of-vets support group I attend, told me she had been going through some very rough times. Her husband Greg, a Vietnam veteran who had been treated for severe PTSD, decided to stop taking the prescribed dose of methadone he had been using for the past 13 years to help him cope with the pain of severe spinal stenosis. Although the medication did alleviate much of his discomfort, the relief came with unwanted side effects.
Nausea was a daily experience, and three or four times a year, for some unexplained reason, the medication would cause hours of uncontrolled vomiting and dehydration that often sent him in the emergency room of the local hospital. During Greg’s latest visit to the hospital, the emergency-room physician suggested he consider going off the medication. Being a take-charge kind of guy, Helen’s husband simply stopped taking the medication without first talking to his primary-care physician.
It is a well-documented fact that methadone is a highly addictive opiate, and patients who want to stop taking the medication need to do so very gradually, under the supervision of a physician. Otherwise, they will experience severe withdrawal symptoms. While Greg made it through the agitation, anxiety, muscle aches, increased tearing, insomnia, runny nose, sweating, and cramping that are typical of the initial withdrawal phase, a month later he fell into debilitating depression and psychosis.
Incapable of making sound decisions and unable to take on even the simplest tasks, he spent hours crying and apologizing to Helen and to his grown children for every insult and injury he believed he had ever caused.
Prior to going off methadone, Greg, like many Vietnam veterans who have been diagnosed with PTSD, suffered from bouts of depression that he usually managed by watching lots of television or spending hours tirelessly digging in the garden, but the depression and delusion resulting from the methadone withdrawal took sadness, detachment, and disconnection to a new level. In a matter of days, Helen’s vigilant, combat-ready husband – the man who was previously always in control – lost interest in everything he enjoyed. Incapable of making sound decisions and unable to take on even the simplest tasks, he spent hours crying and apologizing to Helen and to his grown children for every insult and injury he believed he had ever caused.
Coffee cup in hand, Helen told me, “Living with someone who has severe PTSD is difficult at times – especially before they are diagnosed. But Greg’s past transgressions – if not forgotten – were forgiven years ago.”
She went on to explain what a psychiatric nurse had helped her understand. “Methadone masks both physical and emotional pain. By taking off the mask, my husband not only opened up old physical wounds in his back, but also exposed emotional pain that had been suppressed for years.
“The only way he was going to heal it was to experience the emotions, which by now are mostly sadness and grief. The nurse told me that what my husband needed most was love, support, and the time required for his brain to heal itself.”
With tear-filled eyes, Helen said that living with a severely depressed spouse was even more difficult than living with the symptoms of PTSD. It had been years since any of the flashbacks, nightmares, angry outbursts, or extreme hypervigilance had disrupted her family’s life, but during his methadone withdrawal, communication, social interaction, and their general well-being was affected once again. Helping her husband, without losing her balance, became a top priority.
As Greg went through what can only be described as the “dark night of the soul,” Helen, like many members of our support group, had age and experience on her side. With a little help from her friends, she devised a plan that would carry her through this difficult period in her life.
First, Helen learned everything she could about the issue. While her husband was going through withdrawal, she searched the Internet, found a toll-free number for a methadone-withdrawal hot line, and spent hours talking to a knowledgeable counselor who assured her that her husband would eventually get through the initial wave of discomfort.
The counselor also recommended vitamin and mineral supplements and a proper diet, emphasizing whole, unprocessed foods and minimizing sugar. Speaking with a knowledgeable expert relieved Helen’s fears, and gave her hope. When her husband’s depression peaked, she began reading everything she could about depression and kept the number of the 24-hour suicide-prevention hotline by the phone. When his despair was too much for her to deal with, she called the hotline and handed Greg the receiver.
I knew from our support-group meetings that Helen’s husband was a very private person who would never encourage her discussion of family business. However, when he started talking about ending his life, Helen took action. She made an appointment for him to see his VA physician. She called a friend who had recently taken suicide-prevention training, and asked for guidance. She enlisted the help of a local therapist who was accustomed to working with veterans and their families, and she researched inpatient recovery center options – just in case. During her husband’s darkest time, Helen never left home unless a friend or family member was around to keep an eye on him.
Maintain a positive attitude
Helen knew that her husband’s depression, just like his PTSD, had nothing to do with her, and she made sure to keep this fact in mind. Regardless of how low her husband was, Helen maintained a positive, cheerful attitude. She believed they would get through this difficult time, and she reassured him of this whenever possible.
Quitting his medication so quickly had affected Greg’s brain, and Helen often reminded him that, in time, his brain would heal. Helen confided, “There were times when I wanted to scream, but whenever I was around my husband, I contained my feelings and put his well-being in front of my frustrations.” No matter how bad Greg felt, Helen understood that his behavior was not about, or because of, her. Choosing not to take anything personally gave Helen the distance she needed to be supportive and effective.
Visualize the ideal outcome
While her husband was suffering from his intense withdrawal symptoms, Helen believed he would eventually recover, and she often visualized and talked about a time in the future when they would resume their normal activities. “Although maintaining the yard and garden was always Greg’s domain, in spite of having a black thumb, I stepped in. I pulled what I hoped were weeds, over-watered the vegetables, and imagined that one day Greg would notice my incompetence and resume his work. I believed that whatever help he needed to recover would come – and sure enough, it did.”
Take care of yourself
When faced with a stressful situation, experts advise us to take care of ourselves – physically, emotionally, socially, and spiritually. It’s very challenging to be around a depressed spouse, as it is easy to become drained by a partner’s dark mood. What did Helen do to maintain her balance during this stressful time? She walked her dog every day, lifted weights three times a week at the gym, ate healthy meals, put on her headphones and listened to her favorite music, and wrote down her negative feelings in her private journal.
It didn’t take long for Helen to realize that curing Greg’s deep depression was way beyond her abilities.
Helen told me, “I make an effort to keep my negative thoughts and feelings to myself, but sometimes I just have to let it out. That’s when I turn to my journal – actually, it’s just a spiral notebook that I use to vent. I write about whatever is bothering me, then tear out the pages, crumple them up, and toss them into the fireplace where I watch them burn.”
Resist the urge to fix
It didn’t take long for Helen to realize that curing Greg’s deep depression was way beyond her abilities. “In the past, when Greg was feeling a little down or having a bad day, I’d try to fix the situation – find some way to distract him or make him laugh – but it didn’t take me long to realize that his condition was beyond my understanding. Once I saw that I was over my head, I deferred to the experts.”
Greg’s healing and recovery included regular visits to his VA physician, a 48-hour stay at a VA hospital where he was prescribed an antidepressant, a week-long stay at a non-VA psychiatric facility, weekly outpatient visits with a local therapist who had years of experience treating veterans, several meetings with a VA social worker, and monthly meetings with a VA psychiatrist.
Today, Greg is doing much better. With Helen’s gentle prodding, he has resumed interest in his usual activities. In the past month he has traveled to visit a distant friend, planned to take a short trip with his son, and has even ventured back into the garden to prune the fruit trees.
*Names and some situations in this article have been changed. Some photos may include models who have no real-life relationship to the story or any PTSD issues.
Mary Tendall, MA LMFT, has worked for over 20 years with combat veterans and their families, as a licensed psychotherapist, specializing in combat-related PTSD. She has consulted for the Gulf War Resource Center, National Public Radio, and Newsweek. She continues to work with combat veterans and their families, and is affiliated with several national non-profits whose goal is to help veterans, such as VietNow, Soldier’s Heart, Train Down, and America’s Heroes First. She can be reached by e-mail at firstname.lastname@example.org.