Monday, June 22, 2015

Caring for a wounded warrior takes an emotional toll on their caregivers.

RAND’s “Hidden Heroes: America’s Military Caregivers’ Report” reported on the statistical data of mental illness among military caregivers. However, there is no report which specifically focuses on the darker side of military caregiving — suicidal thoughts, self-harm and in the worst cases, suicide itself.

According to RAND, 38 percent of post-9/11 military caregivers, and 19 percent of pre-9/11 military caregivers have Major Depressive Disorder (MDD). Many of the post-9/11 caregivers who suffer from MDD are female, younger, of lower-education and income levels, and usually have at least one minor child.

I’ve seen this depression on the faces of my military caregiver friends, and I have felt it. When the service member or veteran is in need of medical care, the caregiver ignores their own well-being — sometimes depression, sometimes to the brink of death and sometimes martyrdom.

How can a military caregiver slip into depression? From what I’ve witnessed, it does not happen overnight, instead it is a slow buildup of multiple factors from geographic location to lack of community support.

Constant and increasingly difficult news of their service member or veteran’s health is a contributor. For example, many injuries, such as a Traumatic Brain Injury, become progressively worse over time. With the possibility of having residuals such as migraines or even early on-set dementia. Missing limbs cannot grow back, some physical wounds refuse to heal. Veterans who were exposed to toxins such as Agent Orange battle new and old symptoms. It can feel like for every positive medical gain there is an equal or greater side-effect or loss.

If there are children involved, the caregiver has the additional burden of ensuring the child’s welfare – sometimes becoming the sole adult parenting in the house. As the children struggle to understand the injuries of the veteran, they may act out, placing an additional burden on their primary caregiver.

Guilt. Guilt over the fact that their service member or veteran survived when a friend’s did not. Guilt that they’re failing their children by not providing a “normal” life with two, healthy parents. Or that they did not realize the undiagnosed injuries of their veteran until the symptoms were too strong to ignore. If not addressed, this guilt has the ability to eat away at the caregiver’s self-worth.

If a spouse is caring for the wounded warrior, intimacy and sex may be incredibly difficult or non-existent. Some wounded warriors suffer from genital injuries, while others, due to medication, are unable to have sex as they had pre-injury. Some wounded warriors are able to physically have sex, but lack the cognitive abilities to be emotionally intimate with their partner. Others, such as military caregivers who are caring for a non-spouse (a parent or sibling, for instance), struggle with the idea that their wounded warrior may never have the ability to have a normal, intimate relationship. Recently, the Bob Woodruff Foundation released a report, “Impact after Injury,” which explores the “therapeutic advances to alleviate the devastating impact of war injury on fertility and on physical and emotional injury” and has been a leading force in addressing the issues of intimacy post-injury.

Another contributing factor is grief. I myself have mourned our “pre-injury” life. The plan we had established, our careers, educational goals, our child-rearing goals. Gone. As caregivers, we’ve had to learn to re-adjust and re-define our lives. This can also include the loss of friends and family, who, for one reason or another, distance themselves. One of the times I experienced this was when a friend’s wife told me that it was too hard for her spouse to see my husband the way he is now. I have never told my husband about this. Similar events, which happen to many military caregivers, are constant reminders that their life has changed.

The unknown data of exactly how many military caregivers attempt or commit suicide is alarming. This is one of the reason I urge Congress to pass the Military and Veterans Caregiver Services Improvement Act. To open up the Veteran Affair’s caregiver program, which includes medical training and therapy to military caregivers of all eras. Depression, mental health and suicide are not just a post-9/11 military caregiver issue, and all military caregivers need the mental health support.

Where can a military caregiver go when they’re feeling depressed? Non-profits such as Give an Hour  the Department of Veterans Affairs caregiver program offer free counseling for post-9/11 military caregivers. Tragedy Assistance Program for Survivors (TAPS), which has recently launched an online Military Veteran Caregiver Network, for all eras of military caregivers, can also be reached at (800)959-TAPS (8277), and it offers trained peer-support mentors and list resources, among other services.

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