Living With a Person With PTSD
Living with a person with PTSD
Living with and being supportive of a person with PTSD can be one of the most difficult things you will ever experience. My ex-girlfriend can attest to that. I suffer combat-related, delayed-onset PTSD based on my 1989 experiences as a photographer in a war zone. As my girlfriend and I part ways at the end of our lease in a few days, I decided to write this article to help others navigate the shoals of PTSD relationships with insight that can only be gained with experience, intense introspection and a lot of checking against sources on the Internet and my own therapist.
The worst heartbreak about breaking up is that both of us are still very much in love with each other and the decision that we both needed time alone to heal was only one possible outcome out of many. We both agreed in hindsight that this could have been avoided if only some past decisions and actions on both sides had been made differently. The decision to break up was a good and healthy one for both of us, but it was only one possible outcome of three years of making decisions.
This article is about what could have been done differently by both of us: PTSD properly managed earlier, my being able to give more support to a girlfriend that didn't sign up for my illness, her learning more about how to handle a person with PTSD and protecting her own self against what was essentially emotional abuse, etc.
This article is for the person that lives with a person that suffers (or, thinks they suffer) PTSD.
Understanding PTSD and your situation
Information and understanding are your only way through the maze of a relationship with a person with PTSD. The problem is that the Internet is full of misleading facts and articles and PTSD, itself, isn't like schizophrenia or a broken bone with a clear diagnosis. The fact is, there are a lot of people running around thinking they have PTSD when they don't.
Here are some facts about PTSD:
- Only a tiny percentage of people that suffer severe trauma will also suffer from PTSD. Trauma can cause a lot of issues that need to be dealt with and may have long-term effects, but PTSD is a separate animal and the two terms are not interchangeable.
- Although I encourage research on the Internet to understand PTSD more, it is absolutely impossible to diagnose PTSD without seeing an experienced professional therapist and/or psychiatrist over several sessions and not just one. A person can literally exhibit every single 'symptom' of PTSD listed in DSM and STILL not have PTSD.
- PTSD is not curable: PTSD involves the physical creation of neural connections in the brain and once those connections are made, they can't be unmade any more than we can uncook an egg. That said, the symptoms of PTSD can be managed to the point where they simply don't come up even from triggers and in the event that PTSD does rear its ugly head, the sufferer has a vast toolbox of skills to get through it.
- Therapy is absolutely needed for the sufferer and also for you. That said, brace yourself for the fact that therapy, especially for the first several months, is going to bring a lot of things up to the surface, which is going to make the symptoms seem a lot worse and even seem to create new ones. That was something my girlfriend and I were not prepared for.
- Match the behavior to the symptoms, but also understand when a banana is just a banana. This is a two-part issue that becomes a bit of a balancing act. One one hand, for example, it's easy to read that 'paranoia' is one of the symptoms of PTSD, but it's another thing to experience your mate insisting that they think you're having an affair and questioning everything you're doing and forcing you to 'report to them' about every detail of your day as if you were in an interrogation. It's easy to get caught up in it and angry and defensive without being able to step back and say, "ok, that's paranoia and I know how to deal with that."
On the other hand, "anger" is also a symptom of PTSD, but sometimes a person that suffers PTSD has a legitimate reason for feeling angry with you: Dismissing their anger as a PTSD issue is rightfully going to piss them off and it's unfair to use their PTSD to avoid painful communication. As Freud famously remarked about his cigar and oral fixations: Sometimes a banana is just a banana.
- The PTSD sufferer has to learn a set of skills for dealing with the PTSD. You also have to learn a set of skills to deal with the PTSD sufferer and also to protect yourself and keep yourself in an healthy place. It takes work and commitment and discipline. It takes emotional maturity.
Self-Evaluation and Therapists
Whether or not the PTSD Sufferer is seeing a therapist, you need to see one that you feel comfortable with. You need to get yourself in a mental and emotional place where you're able to deal with your loved one without getting sucked into the trap of always dealing with their symptoms. For that, you need a trusted, trained, experienced outside perspective.
When we're confronted with a situation with a person, a lifetime of learning and growing have trained us to react to the situation at hand without thinking: We think of the person and the action as one and the same. You'll be learning new skills that teach you how to see the action for what it is and the person as the person you love. Therapy will give you the set of skills on how to react in certain situations and will help you get through a tangle of anger and bitterness that you're definitely going to feel from time to time.
The most important thing is becoming emotionally mature in a way that you may not have had to be, before. Consider it a growth opportunity: As much as the PTSD sufferer is going to have to learn skills to cope with PTSD, you also need to be self-evaluating your own emotions, thoughts, reactions and behaviors to make sure you aren't silently slipping into abuse, unhappiness and your own lack of growth.
Whatever you may feel against seeing a therapist, get over it. If it's a financial issue that keeps you from seeing one, there are a lot of options available to you that are a Google Search away. If there's a stigma issue involved (police and military are traditionally adverse to seeing a therapist because they believe it will end up on their record, for example) do what you have to do to find a private therapist out of town and establish your privacy concerns.
You will NOT get through this relationship without your own therapist. If the PTSD sufferer is against you seeing a therapist and you feel safe, assert yourself: "My choice is to be healthy with you, healthy without you, or unhealthy." Don't argue the point, don't fall for any arguments they come up with, don't try to avoid them getting angry. Just repeat that and ask them which you should choose. If they choose one of the other choices, just repeat their choice back to them: "So, you want me to be unhealthy." Nothing else. Do not be emotional about it no matter what you feel.
Work with your therapist to get your loved one to see a therapist.
This requires patience, understanding, and sometimes a lot of time. It requires strategy and compassion and a lot of time. It requires strength, maturity, going through a lot of incidences and frustration and anger and a lot of time.
It may, depending on the situation, mean having the strength to present an ultimatum and having the strength and preparation to stick to it. In any case, I mentioned that if you didn't get help, your relationship was already dead in the water. If the PTSD sufferer doesn't get help with a therapist AND psychiatrist/Nurse Practitioner as a team, then your relationship is still dead in the water. Thankfully, you have a therapist to help you gain what you need for yourself to survive this milestone.
Once you and your loved one is in therapy, the real work begins. If anything I write in this article after this contradicts your therapist, bring it up to them, but always side with them and trust them and discard anything I write that your therapist doesn't agree with: I'm not a therapist, I'm speaking generally based on my experiences and facts I learned, I'm still learning.
Safety and Emotional Health
In the best of circumstances, you both are emotionally mature, you realize that one person is sick, but getting better, you're not in physical danger from the PTSD sufferer and you both are committed to getting through a long and difficult time and getting out the other side with professional help.
In most circumstances, however, both of you are in different emotional places on a long process of healing -- and hurt -- and with very different issues that you have to deal with. Depending on your situation and the symptoms of the PTSD sufferer, you have to protect yourself, first, on two levels: Physical and Emotional.
I can say that one of my own symptoms is irrational anger and even rage. That said, (thank god) I've never struck or threatened to strike my loved one even in the worse cases of flooding or irrational anger. I have, however, been startled awake by an ignorant homeless shelter staff member that shook people awake every morning, even those of us in 'clinic beds.' She ignored protocol and I had her on the ground in a wrestling lock with my hand around her throat before I was even awake. It was only the intervention of another staff member that kept me from being kicked out of the shelter and/or arrested.
If you are physically hit, punched, grabbed in anger, pushed, have something thrown at you or in your direction, verbally threatened, etc., you are in physical danger. You need to get you and any children out of that situation at the first opportunity. This doesn't necessarily mean you're permanently leaving this person, but you absolutely need physical space to deal with them without getting yourself seriously hurt or killed... by accident.
If you think you're safe because you're a big guy and the PTSD sufferer is a woman, think again.
In this very worst case scenario, you need someone else to help you mediate any further conversation so that you can tell the person you are still with them, but there are conditions and a lot of work before you'll feel safe coming back. Trust me: It's a pretty good bargaining chip to convince them they need help and to commit to whatever they have to do.
Emotional health is a little bit more difficult to evaluate and the damage to yours may be a long and invisible process that you won't recognize by yourself. A bunch of friends and a girls/boys night out with unconditional support is not the help you need: Your friends and family have themselves in the equation of any 'therapy' support they can offer you and almost none of them have experience and training to deal with both you and the PTSD situation. Everyone will have advice, though...
The danger with emotional health is that the relationship between two people becomes more and more about the 'PTSD sufferer' and 'PTSD' and how tomorrow will be better for you, but (like my girlfriend discovered) tomorrow never comes.
PTSD is a mental illness and it's suffered by a person feels that needs you to be there, no matter what they do because of their illness. They believe that every bad thing they do is just PTSD and not really them so they don't feel culpable for their actions: They didn't do 'that.' PTSD did.
They're also probably smart, both consciously and sub-consciously. They're going to do and say whatever they have to -- up to a point -- to get you to comply with whatever they think they need you to do when they need that.... whatever 'that' might happen to be. They are either going to be very convincing, or try to wear you down into complying, or both.
Emotional health involves seeing things for what they are and seeing the tactics and the needs and motivations and acting to support them, but first to protect yourself. Again, you need help with this. I cannot stress this, enough.
Extend your support base and encourage the PTSD Sufferer to extend theirs
PTSD and the PTSD Relationship can be very alienating. My girlfriend and I were already natural introverts, so that made things even worse for us: We already didn't bother with making 'friends' of even the loosest sort even before we met, we didn't join groups, we felt uncomfortable letting too many people too deeply into our lives.
Both of us learned the mistake of this and we're scrambling now to correct it.
I've been able to alienate nearly every person that ever called me their friend in the past three years of my PTSD. I've literally been banned by my own family because they got sick of me being myself one day, and a monster, the next. My girlfriend is finally having to make the tough and heartbreaking decision to leave for her own health despite being still in love with me.
Her experience is that a lot of long-time friends don't talk with her and she's too embarrassed to talk with them. She's just now, in the past few months, discovering that her own family is much stronger and more loving than mine and have always been there for her: They're going to help her move out, go back to college, etc. They've always loved her, they just needed her to turn to them, first. Same with her old friends.
You need to bring people in and learn to be a joiner and get out to do things with people on your own. You need to do this even if the PTSD sufferer objects. Whether you're an introvert, or extrovert, the fact of people around you diffuses any fear you may have of separating with your PTSD loved one.
The reason this is important is because sometimes you have to confront the person with PTSD no matter what their threats might be and your fear of the Ace they may have: They will leave you. You have to be ready to call the bluff to get that option off the table for them.
Another reason that you need to extend your support base of people is so that there's no single voice telling you what to do and giving you advice: You'll find yourself in emotional places where any single, reasonable-sounding voice will seem to be giving you good advice no matter how unprofessional, ignorant and ultimately ill-conceived.
Go to groups. Find MeetUp groups in your city by simply searching "CityName" and the word MeetUp and searching for interests that match groups that are there. Reach out to friends that you think have abandoned you by doing a simple "Hey!" on Facebook chat: You may find that they missed you and thought you were abandoning them. Look up school mates. Start hanging out once in a while with co-workers. Some people are spiritual, so churches, synagogues and mosque communities are an option outside of regular services.
Simply put, the more people you have in your corner, the stronger you are about making decisions even if it means making ultimatums. This is true whether you're an introvert with a couple of friends, or an extrovert with a lot of friends.
Whatever you decide to do, fight hard against isolating yourself.
I self-medicated with alcohol -- the cheapest, nastiest beer I could find -- to forget painful, intrusive memories, to cut the edge of my rage and paranoia and grief. My trigger was any heavy helicopter that would fly by (the small ones didn't bother me) so when I figured out that helicopters tended to fly by every week-day at between noon and 2 pm, I started drinking around 10 am so that it wouldn't disable me and I could keep working after being triggered.
It didn't work, but I kept fooling myself into thinking it was better than nothing. It eventually got to the point where I was 2 - 4 80z Natural Ice per day and wasn't even feeling a buzz... and found it very hard to summon up the courage to stop.
The reason I gave you this personal testimonial is because I know for a fact that my self-medication attempts made every single symptom worse and not better. Worse, it made my symptoms worse for my girlfriend.
If I was paranoid, I became obsessively paranoid and ignored any facts that didn't fit my paranoia. If I was angry, I'd become enraged or endlessly argumentative without really knowing what I was angry about and without being able to make a point in my arguments. If I was trying to get in a single day's work despite the helicopter trigger, I became worse than useless and unable to concentrate.
Drinking also kept me from being able to make use of skills such as Grounding and Breathing exercises without a great deal of effort.
It would have been a huge help if my girlfriend refused to accept my rationality that alcohol helped my PTSD and refused to support it. If she had forced me to go to AA meetings the same way she forced me to see a therapist for the first time, things might have been very different. That said, the responsibility was ultimately mine to get help and I failed her by fooling myself with Self Medication.
My advice to you is not to bully them or badger them or argue with them or threaten them into quitting whatever self-medication method they use. Especially don't blame self-medicating when they are in the middle of an episode. You will never be able to have a rational conversation with a PTSD sufferer when they are in an episode in the first place and if they are self-medicating, the whole situation becomes even more irrational and, for you, self-defeating.
Disengage from the situation with the promise that you're willing to talk about it the next day at a particular time in the morning. You may have to repeat this several times because the PTSD sufferer will not want to stop at first: They have a point to make and they want you to agree with it.... they just don't know what it is.
Try to get them to agree to stop talking until that particular time, tomorrow. Morning is important because most PTSD sufferers are 'reset' and at their freshest in the morning if there haven't been any nightmares.
The next morning, simply tell them that you want them to try to tell you why they were angry and what they wanted you to do about it. Let them talk and, except for nodding your head and the occasional "ok" do not say anything until they are done talking and there is at least 30 seconds of silence. If it's 29 seconds and they start talking, again, keep silent. If they leave, let them and when they want to talk again, ask the original question, again.
If they manage to come up with a reason for their anger and are able to last 30 seconds without talking and without leaving, ask them the following question: "Was your anger and the way you acted proportionate to the problem you had with me?"
Next, simply make the following statement: "Your self medication isn't working for me. Find another way that doesn't involve self-medication. Prescription medication from a psychiatrist is ok. Anything else isn't."
Then stop. No matter what they say, your answer is, "Your self-medication isn't working for me."
Don't threaten them. Don't argue. Don't defend your statement. Don't get emotional, no matter what they say (and they'll go through a range of arguments involving pleading, rationalizing, anger, threats, appeals to guilt and how you don't understand and don't care about them).
Stay strong and be firm on this one truth: "The self medication isn't working for YOU."
Don't fall in the trap of saying that self medication isn't working for 'them" or even that "it doesn't work." It's a trap and you'll never get out of it.
Stay strong and firm ... and patient.
Time, Commitment and Patience: Know and agree to your limits.
If you think that getting through this is going to take a day, a week, a month, a single year... you're fooling yourself. The question -- this is deadly serious -- is how much time and commitment and patience you're willing to devote to this person and the fact that they are always going to have PTSD. They will some day be able to manage their symptoms if they work hard and YOU work hard at it and on yourself.
If you tell the PTSD sufferer that you'll always be there with them, no matter what, and then leave a couple years down the road because it just becomes too hard and you believe life for yourself would be better without their problems, you seriously hurt two people. It's unrealistic to promise that you'll be there, no matter what.
If the person with PTSD refuses to get help, continues to self-medicate, drives away all your friends and family, isolates you, keeps you from growing, makes you feel badly about yourself, etc. ... you're going to either hate them, or leave them, or both.
You have to be honest with your loved one about what you can deal with and for how long you're willing to put up with things if they aren't working to improve. Before you can be honest with your loved one, though, you have to be honest with yourself. If you're not really willing to go down the long road of their recovery with them, then don't bother going a short distance of making your own guilt feel better by helping them 'a little bit' until they're on their feet... only to leave them, then with clean hands.
This isn't a decision you can make in a day or a week and I highly recommend talking to your therapist about it. In the end, though, you need to one day sit down with the PTSD Sufferer and spell it out what you're willing to do, for how long and what THEY need to do for themselves if they want you to stick around.
The reason I make this point is because you are the main support structure that the PTSD sufferer depends on for their mental health. If they think you're going to be there and you suddenly withdraw your support, you've essentially pulled the rug out from under them in every possible way. You will essentially have taken every effort and improvement they've made and thrown it in their face.
It's dangerous for them. If you aren't willing to commit, then be honest, swallow whatever guilt you feel, and do them the favor of not letting them depend on quicksand.
With a straight, honest talk, however, and an agreement that you'll be there IF they do certain things in a reasonable amount of time (or are at least making a visible effort to accomplish those things), you'll agree to stay... if they don't keep to it and work hard and you leave, then it's on them. Not you.
I hope this helps
I hope this helps. I welcome any advice on how to improve this article.