Two Case Studies of Positive Post-Deployment Coping in Military Families
Erin Finley, Ph.D., MPH, Health Research Scientist, University of Texas Health Science Center
Mary Jo V. Pugh, Ph.D., RN, Research scientist, assistant professor, South Texas Veterans Healthcare System/UTHSCSA
Matthew Jeffreys, M.D., Medical Director and Assistant Professor, Post Traumatic Stress Disorders Clinical Team, South Texas Veterans Healthcare System
American military families face one set of challenges when the service member goes off to serve in a war zone, and another when the member returns home to face the task of re-establishing relationships that may have been changed or damaged by long separations. Examining two case studies collected as part of a larger mixed-methods study conducted among veterans and their families in San Antonio, Texas, this paper examines coping strategies used by military couples working to manage health and relationship problems in the wake of recent deployments to Iraq.
This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System.The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
- Deployment Stresses
- Post-Deployment Challenges
- Case Couples
- Unshared Experience
- Changes in Self and Family Roles
- Coping Strategies
- Careful Disclosure
- Acknowledging the Other's Experience
- Relying on Network
- Providing Support
- Reaffirming Commitment and Obligation
- Viewing Readjustment as an Active, Ongoing Process
Combat deployments pose multiple challenges for American military families, not least because of the strain caused by long and often repeated separations. Over the now eight years since 9/11, such separations have become par for the course for much of the U.S. military.1By 2008, more than 1.6 million Americans had deployed to Iraq or Afghanistan; one third of American troops had served at least two tours in a combat zone, and 70,000 individuals had deployed at least 3 times.2 Nor are deployments without their dangers. Some 40,000 Americans have been killed or wounded in action, and another 75,000 have come home to be diagnosed with what is sometimes called an "invisible wound of war," the deployment-related psychological injury of Post-Traumatic Stress Disorder (PTSD).3
Although American military families living in a time of war must manage the anxiety and separation of combat deployments, they face yet another set of challenges when the service member returns home. This article draws upon a research study conducted among veterans of Iraq and Afghanistan and their families to provide a qualitative perspective on coping with key post-deployment challenges - namely, problems of unshared time and experience; changes in self and role within the family; and the special difficulties created by physical or psychological injuries sustained by service members during deployment.4
The potentially debilitating effects of long deployments on service members and their families has been well-documented over the past sixty years.5 Published research has reported increases in divorce rates among enlisted personnel,6 as well as an increase in child abuse and neglect among the children of those deployed.7 McLeland et al. found that active duty service members are more likely to report low marital satisfaction in the months immediately prior to and following a deployment.8
Oftentimes, these negative outcomes reflect an accumulation of stressors upon not only the deployed service member but his or her family members as well. In one study conducted during the First Gulf War, researchers classified three categories of stressors for the family members of deployed personnel: emotional, including missing the absent family member and fears for his or her safety (what Peebles-Kleiger and Kleiger call the "anticipation of trauma"); deployment-related, which includes legal and financial difficulties related to the service member's absence, such as increased child care costs and negotiating Powers of Attorney; and general life events, such as births, family illness, moving, and so forth.9 The cumulative power of these stresses can take a profound toll on all involved, particularly when resulting in relationship rupture. The U.S. Army has identified failed relationships with spouses and other partners as a key risk factor for suicide among deployed service members.10
While it is essential to acknowledge the very real financial and logistical strains that deployment can place upon families, there are other, more subtle stressors that also require attention. In a recent qualitative study conducted among Reservist families, Anthony Faber and colleagues relied upon Boss' description of "ambiguous loss" to examine how military families adjust to the absence of deployed family members; they noted that families must maintain a sense of the service member's psychological place within the family while also reassigning their duties while they are gone.11 These adaptations may be extremely successful during deployment, but Faber's study found that upon the return of the service member, military families often struggle to reassess these boundaries and responsibilities. Having adapted to deployment, they may find themselves forced to renegtiate post-deployment role expectations and standards for communication.
The question of how individuals engage in coping has gained increasing notice over the past decade.12 Problem-solving coping has recently been identified as a moderator of adjustment among Vietnam veterans and Americans exposed to the terrorist attacks on September 11th, 2001.13 The years since the current conflicts began have also seen greater recognition that coping is often a social process, a realization accompanied by a significant push to include spouses and other family members in therapy for post-deployment mental health concerns.14 However, no studies of which we are aware have explicitly addressed the question of coping among military families dealing with post-deployment readjustment and/or a service members' deployment-related disability. This paper provides a preliminary response to this gap in the literature by focusing in depth on two couples who have been largely successful in navigating these challenges. We then consider positive coping strategies they have used to move their relationships forward despite truly daunting obstacles.
The larger study from which these case studies were drawn involved 50 male veterans of Iraq and Afghanistan and 16 family members who had lived through the recent deployment of a spouse, partner, parent or child, during 20 months of fieldwork in San Antonio, Texas, in 2007-2008. After obtaining institutional review board approval, we recruited participants receiving outpatient care at a VA clinic and conducted interviews inquiring about life history, psychological distress, and deployment and post-deployment experiences. Among the Iraq/Afghanistan veterans and family members who participated in the San Antonio study were nine couples for whom both partners provided interviews on their experiences. Two couples are discussed here as case studies for considering positive coping strategies among military families, with the goal of providing a more intimate look at how individuals and couples enact particular kinds of communication and coping in their efforts at managing the stresses of deployment and readjustment. These couples were selected because they were judged by the authors to be coping well overall, and because the husband had in each case sustained a significant injury that was having a demonstrable impact upon the couple's life and relationship, thus making their experiences more comparable and their successes more remarkable. One-time audio-recorded interviews were conducted with each couple following informed consent, each lasting approximately three hours. Transcripts were reviewed for references to key problems and to attitudes or behaviors that participants had undertaken in the effort to manage those problems. These references were then analyzed for underlying themes, and themes were examined for their relation to constructs previously identified in the literature.15
Derek and Laticia
Now a disabled veteran and college student, Derek was a communications specialist in the Army before he was wounded in Iraq, leading to the amputation of his leg and an early discharge. Both he and his wife, Laticia, are African-American. They have two sons, both Laticia's by a previous marriage.
Josh and Laurie
Josh is a former Marine who was also wounded in Iraq, suffering a traumatic brain injury. Like Derek, he is now attending college and working towards his degree. Josh and Laurie have an infant son, and they are both Euro-American.
All four participants are in their mid- to late-twenties,16 and were living in San Antonio at the time of the interview.
In prefacing the issue of post-deployment challenges, it should be noted that the amount of communication between family members during deployments varied a great deal among those in the San Antonio study. Those who deployed early in the conflicts often had to make do with sparse email or telephone contact, since communications infrastructure was slow to develop in post-invasion Iraq and Afghanistan. In contrast, service members who deployed later on were sometimes able to manage daily or weekly phone calls, although many found that this accessibility did not lessen the sense of distance. Several veterans reported incidents in which loved ones were upset by hearing mortar rounds exploding in the background over the phone line; such contacts could do as much to emphasize the separation as to narrow it.
Invariably, no matter how frequent the contact, those deployed and those at home were leading very different lives. Derek and Laticia exemplify this. On her end, Laticia dealt with Derek's deployment by taking an intimidating courseload so that she could complete her college degree by the time he came home. While Derek was going out on patrol every day, Laticia was watching their two kids and studying for tests; because Derek had not been entirely honest with her (an issue we discuss in more detail below), she went through the days imagining him in a basement somewhere, orchestrating communications from the safety of an underground bunker. This vision of his life over the eight months of their separation was shattered the night she heard from a heavily sedated Derek, calling to tell her that his leg had been amputated following a rocket propelled grenade attack on his vehicle. Their lives during these months could hardly have been more different; even her imagined view of his life in Iraq proved heartbreakingly wrong.
Josh articulated the challenge of reconciling such a chasm of unshared experiences when he said of his post-deployment relationship with Laurie that, "It's hard to live with another person again after a [deployment], because you've had six months of different experiences. After being away for so long, each person has their own expectations of what the other is going to be like."17 During those months of separation, both partners have lived as Faber et al. described, "physically absent but psychologically present".18 Such absences may seem particularly acute during periods of extreme stress. Josh had lived through sustained combat while he was away, but Laurie, too, had struggled, suffering a miscarriage that left her disheartened and grieving.
In the wake of such experiences, neither partner could fully know the other's memories. Josh says, "[Laurie] tells me she was up all night watching CNN because she was scared to death, but I wasn't there for it, so it's not real." Laurie can describe worrying about him, staring helpless and frightened at the news and wondering where he was, just as Josh can tell her what it was like working on a bomb squad day after day, but these memories are not shared. Josh said it was like "meeting a friend after a year. Familiar, but strange."
Changes in Self and Family Roles
From Josh's perspective, then, coming home to his wife felt like returning to something recognizable, but for Laurie, the alterations in him were dramatic enough to reshape their relationship entirely. It is common for family members to find their service member has been changed by his or her experience of deployment. Laurie said that after the first of two deployments, Josh was, "Just different. Different personality. He was such a smart, well, he still is smart. He was so nice. He was the person who'd always calm me down because I was always - 'Ah! We've got to get this done!' - and he would always calm me down. The perfect balance for me. And then when he got back, he just always wanted to sleep. Didn't want to go out. Wouldn't do anything anymore. And he was getting frustrated himself because he couldn't calm me down anymore." She felt that Josh had become more impatient, less diplomatic, less easy-going. Because of the changes in him, there were changes in the dynamics of their relationship as well. As Laurie says, "We almost switched roles at that point."
Josh and Laurie's experience of changing self and roles was not unusual; both the personal changes wrought by combat deployment and the necessity for family members of functioning without the service member can create a situation in which it is necessary to reconsider pre-deployment patterns of behavior and responsibility. Prior to his first deployment, it had been Josh's role to calm Laurie down when she became anxious over worries or household tasks. Now they reversed roles. They found themselves, as Josh described, in a period of "getting to know each other again," sorting through each partner's "expectations of what the other is going to be like."
Laurie says that she was able to deal with this process because it was, in part, expected. Towards the end of Josh's second deployment, she had been invited to a meeting where wives were briefed on what to expect from their husbands coming home. They were told, "It's very important that we don't have to understand what they're feeling, but realize that they are going to be different and they do have some issues with what happened out there, and they've seen some awful things. They told us that they were going to be different. And they were."
But knowing there were likely to be differences did not always make it easier to deal with them. Laurie witnessed Josh's difficulty in transitioning from his role as a Marine sergeant to that of husband and father. The second time Josh returned, she says, "He would treat me like one of his Marines. He would just almost boss me around in a way. Even though - it's kind of funny to say, but usually the woman's the boss of the house. I usually boss him around, tell him what to do.... But he would boss me around. Tell me what to do. He would use a certain tone that did not go well with me. I did not like that. So, a lot of tension with that."
In the early days after Derek's leg was amputated and he was medically evacuated to the U.S., his and Laticia's greatest challenge was getting his physical health squared away. After an initial round of surgeries intended to prepare his leg for a prosthesis, they spent four months living in outpatient housing on base, where they were given a hotel room to share with Laticia's two young sons. Derek had never lived with Laticia and the boys. Previously engaged, the couple was hastily married after his injury, and he was faced with the task of learning to be a husband and step-father at the same time he was learning to live without his leg.
Through a long hot summer in a crowded room, Derek says of Laticia that, "Her biggest complaint was [that] ... for a long time I was extra clingy. I wanted her by my side at all times. I had missed her for eight months. I had gone through being blown up three times in one day, any day can be the last one. So I was already mentally trying to figure out that I might never see her again. And then being in an explosion and getting injured myself, and seeing that I was still here and feeling like it was on borrowed time...and it drove her nuts."
Laticia agrees. "You don't want to say - 'Oh my god, he's right there.' But it was like that, 'Oh my god he's right there!' If we had been sewn at the hip, that would have been great for him. But you know that left me no extra time or personal time or kid time. It was me and him. That's how it was. He was very clingy. Very clingy." The man who had been independent and self-sufficient now needed Laticia's help in such basic tasks as bathing and using the toilet. They went from long-distance fiancés to new spouses facing disability and shared parenting.
For Josh and Laurie, the challenges they faced after the first deployment became much worse after the second, when Josh was caught in an explosion and sustained a significant Traumatic Brain Injury (TBI). More than a year after his injury, Josh continues to struggle with its consequences. "Long-term memory is dicey. Speech is dicey. There are times, especially if I get emotional, that I have to search for words. I hesitate. I stumble. Hearing's screwed up. I can technically hear perfectly, but there's something where it gets jumbled in my brain and I can't figure it out, or I just don't hear it. Other problems like balance." He is unable to drive at night because he has a hard time judging distances and lacks concentration. He cannot pay bills because he forgets them. He says, with some bitterness, "The most I can do is to play with my son, and that's about it."
Laurie must now take on the responsibilities that Josh is unable to carry, on top of overseeing his frequent medical appointments and the paperwork associated with his veterans' disability claims, trying to supplement his disability compensation with a part-time job, watching out for him - with his impaired balance, everything from taking a shower to walking down stairs requires supervision - and caring for their infant son. She says she is unable to get enough sleep, is "very stressed," and gets "frustrated very easily." The worst, she says, is that Josh has lost much of his expressiveness due to his injury. "With him I never know if he's angry or happy. His facial expressions, his tone of voice - it's very difficult for me to tell the difference."
Laurie says that the second time Josh returned, after his injury, all the changes she had noticed before were just "multiplied by a thousand. He'd sleep nonstop, or try to sleep nonstop. He doesn't fall asleep at night really. But once he does fall asleep, he just wants to sleep all the time. He wants to eat all the time, play video games. Very much of a loner. He's always been a bookworm but not really a loner like that." She admitted, "It kind of bugs me. I don't like being a couch potato like that. I like to go out and do things." Even now, she worries about letting him drive alone, because he is easily disoriented and gets lost even in their neighborhood. She notes that she doesn't want him to become overly dependent, that she wants him to remain as independent as possible; she sounds for a moment more like a concerned mother than a wife.
Enlarge this imageWith so many changes, things were rough for a while, and Laurie threatened to walk out on Josh more than once. Still, they have worked it out, adjusting their lives to the new baby and to the challenges created by Josh's injury and what would later be diagnosed as his PTSD. When Josh was asked how they got through, his answer was succinct: "Talking. Love. Time."
In the remainder of this paper, we consider how what Josh insightfully summarized as 'talking,' 'love,' and 'time' were actively operationalized by these two couples, identifying a series of six coping strategies that emerged in their narratives of responding to the trials of injury and post-deployment life.
At the time of fieldwork in 2007-2008, a great deal of conversation was ongoing in the military around the question of how much communication between troops and family members was best during deployment. In truth, both of these couples described making very careful decisions about what information to share, both during deployment and afterwards. For example, Laurie made a point of communicating to Josh during his second deployment that she was spending time with a number of male and female friends. Living on base, her movements were subject to some scrutiny, and she was worried by rumors accusing her of infidelity (a common and devastating concern for many of the study's participants). Laurie called Josh and said, "Look, this is what's going on. People are spreading rumors around and don't be surprised if you hear anything. But you don't have anything to worry about. I'm always here for you." Because she dealt with the concern up-front, Josh was not caught off guard by the accusations, and the issue never became a problem.
Disclosure, however, was not always the default choice. As noted above, Derek never revealed to Laticia that he had been assigned to a frontline unit and was going out on patrol nearly every day while he was in Iraq. When I asked him why, he said that, knowing how much responsibility she had on her hands while he was gone, "I couldn't feed her worrying about me, because I knew she was going to be worried enough." The truth did not emerge until one evening after his injury, when he was still in the hospital and on a heavy dose of painkillers. Amidst the narcotic blur, stories of Iraq came tumbling out. When asked about her reaction to learning that he had lied, Laticia said, "I was just glad he was home, safe, alive, and I don't think I really had a reaction. I really didn't have a strong reaction, like, 'why did you lie to me?'" Instead, she said that she was relieved to finally understand some undercurrent in his emails and phone calls from Iraq, particularly those in which he would say very little, wanting only to feel her presence on the other end of the line. "I understand now what was going on those calls. I'm just glad that I was able to be there for him. Even without knowing, I was just glad I was able to be there." Perhaps seeing the reality of his injury enabled her to focus on her relief rather than anger or a sense of betrayal, but the omission that might have damaged trust in another relationship seemed to have no ill effects on theirs.
Later on, however, Derek made the decision to be more intentionally open about his experiences. A year or so after his injury, Derek was diagnosed with PTSD and began a type of cognitive behavioral therapy known as Prolonged Exposure, which requires describing traumatic events in detail under the close supervision of a mental health care provider. These descriptions are taped, and Derek was expected to listen to them repeatedly as part of his therapy. One night, he allowed Laticia to listen to one of his tapes.
Laticia nodded as she described her response. "The floodgates in my eyes must have opened up to full gauge....Just hearing some of the things that he went through was like a real eye-opener for me. I think if the wives would listen to that - I think it helps. But it helped me - not understand, but at least be able to look at the picture to help me understand. I think I listened to about half, for about 30 minutes? And cried like a newborn baby. It was emotional. And then just to know that was just a couple of incidents of what he went through over there. It was an eye-opener."
Both of these couples found that careful disclosure (which also included strategic non-disclosure, as in Derek's decision not to worry Laticia with the details of his mission in Iraq) could help to reduce their partner's anxiety during deployment. In the wake of deployment, careful disclosure could help in reaching across the gap of unshared experience, bridging some of the ground lost.
Acknowledging the Other's Experience
Careful disclosure also opened the way to another coping strategy described by both couples, which involved engaging in respectful acknowledgment of each other's deployment experiences.
As an example, although Laticia found the months after her marriage to Derek to be a challenging transition, going from a single mother to caring full-time for a husband who wanted her present every minute of the day, she got through it by reminding herself of his experiences in combat, and reflecting on how they had shaped him. She acknowledged the suffering he had gone through in Iraq, and identified it as something like what is often called post-traumatic growth, saying that she found him to be more compassionate and loving than he had been before he deployed. She recognized that, "he has gone through those experiences and the life that he sees is completely different from how I see life," and concluded that, "My thing is not to let it push us apart. Not let it - he's constantly right there - and not let that put me in a way where he's annoying me or something. Because I will never have the same outlook on life and love and people that you care about that he does." Although Derek frequently caused her frustration, by acknowledging his experiences with deployment and placing his worldview and behavior in that context, she found it easier to be patient and understanding.
Relying on Network
Social support is a widely recognized component of mental and physical well-being, so it comes as no surprise that both of these couples described the essential support role played by their networks of family and friends. 19 Derek spoke glowingly of the other wounded soldiers with whom he has gone through rehabilitation and recovery, and of the good example they have provided in helping him see that his amputation need not be a disability. Laurie pointed out that she talks with her mother almost every day by phone, and has relied on her friends among the Marines, in particular, because they can understand her experience. Laticia, when asked to provide advice for other wives struggling with a husband's injury, suggested finding a "network" of people going through something similar. "Stay strong," she said, "seek out people that are going through the same thing, and through that network you'll be okay. "
Similarly, the support provided within these partnerships played an important role in shaping each spouse's experience of post-deployment and post-injury adjustment. This support was both emotional and instrumental. As Derek described, "[Laticia] was my counselor, my financial advisor. She managed everything while I was too doped up to do anything. She was there to hold me when I couldn't pee standing up. There's just the support, and the comfort to know she was there."
Beyond traditional gender differences in the way that American husbands and wives support one another,20these couples faced the added challenge of one partner requiring care and the other providing it, an imbalance in instrumental support that at times proved disheartening to both Josh and Derek. Josh admitted that he was frustrated by his own inability to do much around the house besides "play with my son." Derek voiced a similar concern when he followed his praise of Laticia's support by saying that, "There were many days when I came home and felt [like] a huge burden. If there was anything that made me depressed it was that - look at all she's doing for me and I can't give back. I can't give enough back to her to make up for it." Because of this imbalance and the discomfort it caused him, the manner in which the support was provided mattered greatly. As Derek said, "[Laticia] never once said, 'Look what I've done for you,' or 'You're lazy, why can't you do it?' And that helped a lot."
Reaffirming Commitment and Obligation
In talking of the challenges they had encountered, both Laticia and Laurie also made a point of reaffirming their commitments to marriage and family, and indicating that their efforts in support of their husbands were a necessary part of that commitment. Laurie reflected that "most - probably 80% of couples give up because of these issues. We have friends who got divorced twice in those two deployments." She conceded that, "It is so easy to just walk away from a relationship when all these things are going on." Even so, she said, "you just can't give up. You have to be very strong."
Drawing on her own view of marriage, Laticia says of the care she provided for Derek that, "I didn't feel like I was doing anything that - that's my husband. That's my husband. That says something." She grew up in a family where those who got married stayed together, even through the tough times. As a result, she says, "There was never a thought of, why did my fiancé have to have this happen? That never crossed my mind. It was me taking care of my family. It was me as a wife doing what a wife needs to do to take care of her husband through the sick and the health and the rich and the poor. Period. That's just what you need to do. You get it done."
Derek, too, remained focused on his obligations, and found this to be a spur towards action and recovery. "It's not just me. I have a family to take care of and support, so I can't sit there and feel sorry for myself. I never had the chance to just sit there and 'why did this happen to me?' It happened. You can't go back and change it, now we just figure out how do we take the best care of everyone. And that was just the process."
Although no systematic information on attitudes toward marriage was collected during the larger study, these two couples stand out for their espousal of an idea of marriage that emphasizes mutual care and commitment rather than, for example, the satisfaction of each partner's individual needs. Couples who described greater difficulty in coping post-deployment were also more likely to describe aspects of the marriage or partnership that they found personally unsatisfying, and to leave such descriptions unaccompanied by the kind of reaffirmations made by Laurie and Laticia above.
Viewing Readjustment as an Active, Ongoing Process
The final coping strategy these couples described was a recognition of the ever-changing nature of life challenges and an active orientation towards communication, flexibility, and problem-solving over time. Laurie, for example, spoke of how useful she and Josh had found a post-deployment marital seminar they attended on base before Josh separated from the military. She explained that many problems in a marriage can be prevented by open communication, by talking out issues and concerns before they "explode." In addition, she spoke of how she has continued to use the lessons of the seminar in resolving problems as they arise: "Sometimes I go through the workbook and go, 'what can I do?'
For Laurie and Josh, this process of ongoing coping and adjustment has also relied upon the willingness of both partners to compromise. When Josh first came home and began treating her "like one of his Marines", Laurie says, "I finally told him, if you keep doing that, I'm walking out. I will always be there for you and your injury, but I will not take that from you. That's where he turned and realized, 'Oh my gosh, yes I am doing something wrong.' So we sort of have that straightened out." She also encouraged him to seek treatment for his PTSD, and although he has had difficulty with therapy because of his problems with memory, he is now taking an anti-depressant that has improved his mood and helped him to be more patient and less short-tempered.
Derek, too, has been diagnosed with PTSD. When asked about his illness, Laticia points to how much progress he has made in his recovery, while acknowledging that, "It's still a presence there that affects some of the things he does." She expects his relationship to the illness will change over time, and that he will respond accordingly. "I figure it's probably always going to be a presence in some sort of way, because it's something that he has to live with and deal with and constantly make an effort to overcome and change."
Enlarge this imageIn both cases, Laurie and Laticia identified post-deployment challenges they expect to ebb and flow, and proposed an active and evolving response.
These case studies provide an intimate glimpse into the strategies used by two military couples in responding to the challenges of deployment-related health and relationship problems. Each of the couples described their own perspective on these problems, including the months of separation and the resulting burden of often intense memories and experiences they did not share, deployment-related changes that had occurred in each other and in their roles and relationships, and the difficulties created by Josh and Derek's injuries.
Among the most challenging of the problems they identify may be the necessity of renegotiating the distribution of both emotional and concrete tasks within the family. Following Josh's injury, Laurie took on not only what had previously been his role as the calm and centered partner, but also the majority of his household responsibilities as well. This remained an ongoing source of frustration - both for him, perhaps because it represented much of the competence and ability he had lost with his injury, and for her, because she felt unable to find time for herself or to keep up with the demands placed upon her. Although the shifts in role and responsibility described by these two couples are probably unique and specific only to themselves, Bowling and Sherman have recently argued that all military couples are likely to face some renegotiation of relationship and household roles post-deployment; consistent with our findings, they advocate flexibility and communication as adaptive strategies for managing this challenge.21
In revealing such coping strategies, the narratives of these two couples contribute to a major gap in the evidence base around reintegration and coping among military families. Although a number of studies have pointed to the difficulties of post-deployment readjustment - noting, for example, emotional cycles of deployment (including reunion), levels of distress and marital satisfaction during and after deployment, and major tasks of reintegration - few studies have actually documented how military families work to adapt to post-deployment life.22 As a result, these case studies provide an important glimpse into a problem of great concern for those providing treatment and other services to military families.23
Nevertheless, the strategies described here are roughly consistent with the literature on healthy marriage, resilience, and positive coping, suggesting that wisdom garnered from among couples facing non-deployment life challenges may also be relevant and informative. For example, Laurie and Laticia provide emotional and instrumental support to their injured husbands and rely on extended networks of family and friends as a source of support themselves, thus falling back on classic strategies of positive coping for caregivers.24 Both wives described taking active and ongoing steps to adjust to health and relationship problems as they arise, an approach found to be associated with healthy marital relationships,25 and one fully in accordance with descriptions of coping as a dynamic process "of continuous appraisal and reappraisal". 26 The couples' descriptions of acknowledging their partners' experiences correspond well with the concept of partner empathy, long-recognized for its importance in sustaining well-functioning relationships over time.27 Similarly, reaffirming personal commitment to marriage and family is often cited as an important practice for keeping relationships healthy.28 Aspects of coping observed in these couples particularly emphasized two of Gottman and Silver's (2002) principles of successful marriages: maintaining awareness of the partner's world and turning toward instead of away from one's partner.29 These strategies of coping, then, are not uniquely valuable to military families, but military families facing multiple challenges may be required to pull together a constellation of such strategies in order to achieve positive family well-being and functioning.
Military families may also find that certain strategies take on greater importance when the service member has sustained an injury. In contrast to the relative dearth of studies on coping post-deployment, there is a growing wealth of literature on coping with disability.30 One frequent finding of this literature has been that problem-focused rather than avoidance coping is a strong predictor of positive psychosocial adjustment.31 Disability research, however, has focused primarily on coping at the level of the individual rather than within relationships or families, despite the acknowledged positive impact of social support on both physical and psychological outcomes (some of which are relevant to service members injured in the current conflicts, such as depression, anxiety, and phantom limb pain among amputees).32 There are more specific insights to be drawn from the literature on traumatic brain injury, which has focused directly on issues of coping and caregiver burden among spouses. 33 Blais and Boisvert, for example, have found that positive appraisal of a partner's communication skills predicts marital satisfaction in couples dealing with TBI, while Katz and associates have found that, among wives who have been dealing with a husband's TBI for a longer duration, low coping flexibility predicts a greater sense of caregiver burden.34 As in the case studies presented here, these findings suggest that active, compassionate communication and the ongoing willingness to be flexible play an important role in determining how successfully couples will manage disability over time.
The question of how the additional burden of combat injury impacts the couples in these two cases is an interesting one, as it may, in certain ways, allow these individuals to side-step challenges identified among non-injured veterans in the larger study. Although it was common among all of the wives interviewed to describe some frustration with their husbands in the wake of deployment, this frustration seemed more potent when the husband's offending actions were understood to indicate poorly controlled behavior rather than, for example, evidence of deployment-related stress or a mental illness like PTSD. In contrast, while both Laticia and Laurie expressed impatience with some aspects of their husbands' behavior - Laticia with Derek's clinginess, and Laurie with Josh's bossiness and short temper - they both pointed to a combat-related injury as a source for the offending behavior rather than simply chalking it up to weakness, immaturity, etc. It is widely accepted that visible injuries are associated with less stigma than are the psychological wounds of war, and although Josh's injury was not visible, it may be that his having had a physical wound made it easier for Laurie to accept that his deficits were the result of events beyond his control.35 On the other hand, it may be that both wives maintained an overall positive view of their husbands precisely because they focused on their injuries and war-related suffering rather than on behaviors they found troubling or irritating. This mode of acknowledging their husbands' experiences, in other words, may also function as a coping strategy unto itself, replacing negative feeling with compassion and respect.
It is worth noting, however, that both of the above examples of unsatisfactory behavior - clinginess and bossiness - can also be read as indicating some problem with the husband's performance of masculinity. American men, and particularly military personnel, are generally rewarded for demonstrating toughness and tight emotional control.36 Although the behaviors and attitudes expressed by men within their intimate relationships should not be assumed to conform over-rigidly to such cultural guidelines, given that the performance of gender is individual, contextual, and often co-created within relationships,37 both of these cases suggest the influence of culturally normative gender role expectations, as well as the importance of successfully negotiating these expectations within the unique dynamic of a couple's relationship. For example, the fact that both Laticia and Derek point to Derek's clinginess as unusual may suggest some ongoing renegotiation of his masculinity as a newly disabled person.38 Similarly, Laurie's expectation that "usually the woman's the boss of the house" sparked conflict upon encountering Josh's "bossy" performance of masculine military authority; although her comments indicate she judged his way of speaking to be appropriate in dealing with "one of his Marines" , she found his conduct inappropriate to the context of their home and relationship.
Among the six positive coping strategies identified in these two case studies, careful disclosure may have particular importance for families facing or reuniting after deployment. It was not uncommon for service members in the San Antonio study, Derek included, to describe feeling reluctant to tell spouses and family members about many of the more difficult things they witnessed or participated in while in Iraq. One veteran described not wanting to "burden" his wife with the "horror" of what he had seen, and certain nondisclosures can represent a deliberate attempt to protect loved ones from memories or experiences that might prove upsetting. Nonetheless, disclosures, if made thoughtfully, can aid during deployment in reducing spouses' worry, as when Laurie warned Josh that he might be confronted with rumors regarding her fidelity. Post-deployment disclosure, as when Derek shared his therapy tapes with Laticia, can help to diminish the gap of unshared experience that many spouses find so distancing, thus facilitating greater closeness and partner empathy.
These case studies reassert a vision of marriage as the outcome of continuous, creative action on the part of both partners,39 and point towards strategies of positive coping that play an important role in moving military families through the challenges of post-deployment, particularly for those facing the additional challenges of injury and mental illness. Although no generalizations can be extended to all military families based upon case studies alone, such in-depth analysis can be productive in identifying practices and strategies for future investigation, and has the added benefit of illustrating how such efforts are brought to bear within the ever-changing circumstances of family life. Future research will be required to assess the most effective communicative and coping strategies for use among military couples during and after deployment, as well as to continue the process of developing evidence-based guidelines for incorporating these strategies into educational and therapeutic offerings in military and veterans' care settings.40
- 1. The length of deployments differs by specialization and branch of service. Marines are typically deployed for 6-7 months. Soldiers have been at some points deployable for as long as 15 months, although the current maximum is 12 months.
- 2. Terri Tanielian and Lisa H. Jaycox, "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery," (San Diego, California: RAND:Corporation, 2008), Shannon J. Johnson et al., "The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report." (APA Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, 2007).
- 3. U.S. Department of Defense, "Operational Iraq Freedom and Operation Enduring Freedom U.S. Casualty Status Report, October 7, 2009," (2009), "Analysis of Va Health Care Utilization among U.S. Global War on Terrorism (Gwot) Veterans," (VHA Office of Public Health and Environmental Hazards, 2008).
- 4. Funding for this study was provided by National Science Foundation Doctoral Dissertation Improvement Grant #0650437 and by the Emory Center for Myth and Ritual in American Life, a Sloan Foundation Center for Working Families. Additional support was provided by the Institute for the Integration of Medicine and Science at the University of Texas Health Sciences Center, San Antonio. The study protocol was reviewed and approved by the Institutional Review Boards of Emory University and the University of Texas Health Sciences Center, San Antonio, as well as the South Texas Veterans Health Care System Research and Development Committee.
- 5. Lincoln, Alan, Erika Swift, and Mia Shorteno-Fraser. "Psychological Adjustment and Treatment of Children and Families with Parents Deployed in Military Combat." Journal of Clinical Psychology In Session 64, (2008): 984-92. McFarlane, Alexander C. "Military Deployment: The Impact on Children and Family Adjustment and the Need for Care." Current Opinion in Psychiatry 22, (2009): 369-73. Moreau, Donna. Waiting Wives: The Story of Schilling Manor, Home Front to the Vietnam War. New York: Atria Books, 2005. SteelFisher, Gillian K., Alan M. Zaslavsky, and Robert J. Blendon. "Health-Related Impact of Deployment Extensions on Spouses of Active Duty Army Personnel." Military Medicine 173, no. 3 (2008): 221-29. Tollefson, Thora T. "Supporting Spouses During a Military Deployment." Family and Community Health 31, no. 4 (2008): 281-86.
- 6. Gregg Zoroya, "Divorce Rates Rise for Soldiers, Marines," Army Times 2008.
- 7. Deborah A. Gibbs et al., "Child Maltreatment in Enlisted Soldiers' Families During Combat-Related Deployments," JAMA 298 (2007).
- 8. Kelly C. McLeland, Geoffrey W. Sutton, and Walter R. Schumm, "Marital Satisfaction before and after Deployments Associated with the Global War on Terror," Psychological Reports 103 (2008).
- 9. L.N. Rosen, D.B. Durand, and J.A. Martin, "Wartime Stress and Family Adaptation," in The Military Family: A Practice Guide for Human Service Providers, ed. J.A. Martin, L.N. Rosen, and L.R. Sparacino (Westport, CT: Praeger, 2000). Mary Jo Peebles-Kleiger and James H. Kleiger, "Re-Integration Stress for Desert Storm Families: Wartime Deployments and Family Trauma," Journal of Traumatic Stress 7, no. 2 (1994).
- 10. "Mental Health Advisory Team (Mhat) V," (Office of the Surgeon, Multi-National Force-Iraq Office of the Command Surgeon Office of the Surgeon General, U.S. Army Medical Command, 2008).
- 11. Anthony J. Faber et al., "Ambiguous Absence, Ambiguous Presence: A Qualitative Study of Military Reserve Families in Wartime," Journal of Family Psychology 22, no. 2 (2008), P. Boss, Family Stress Management (Newbury Park, CA: Sage Publications, 2002).
- 12. Regina Yiven, Eva Bjorck-Akesson, and Mats Granlund, "Literature Review of Positive Functioning in Families with Children with a Disability," Journal of Policy and Practice in Intellectual Disabilities 3, no. 4 (2006).
- 13. Erin Martz, Tim Bodner, and Hanoch Livneh, "Coping as a Moderator of Disability and Psychological Adaptation among Vietnam Theater Veterans," Journal of Clinical Psychology 65, no. 1 (2008). Crystal L. Park et al., "Pathways to Posttraumatic Growth Versus Posttraumatic Stress: Coping and Emotional Reactions Following the September 11, 2001 Terrorist Attacks " American Journal of Orthopsychiatry 78, no. 3 (2008).
- 14. Candace M. Monson, Steffany J. Fredman, and Kathryn C. Adair, "Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder: Application to Operation Enduring and Iraqi Freedom Veterans," Journal of Clinical Psychology In Session 64, no. 8 (2008), Serena M. Lambert and Michael M. Morgan, "Supporting Veterans and Their Families: A Case Study and Practice Review," Family Journal: Counseling and Therapy for Couples and Families 17, no. 3 (2009).
- 15. Amanda Coffey and Paul Atkinson, Making Sense of Qualitative Data: Complementary Research Strategies (Thousand Oaks, CA: Sage Publications, 1996).
- 16. 52% of Iraq and Afghanistan veterans are between the ages of 20-29. National Center for Veterans' Analysis and Statistics, February 2009.
- 17. All text in double-quotes is taken directly from the transcripts of recorded interviews. All study participants completed informed consent and were then asked whether or not they would mind if the interviews were audio-recorded; most had no problem with this and these interviews were recorded. Quotes were edited primarily for length; brackets indicate edits made for the purpose of removing identifying names or facts, or where it was necessary to include additional information for the purposes of clarifying a quote.
- 18. Faber et al., "Ambiguous Absence, Ambiguous Presence: A Qualitative Study of Military Reserve Families in Wartime.": 223
- 19. A. Abbey, D.J. Abramis, and R.D. Caplan, "Effects of Different Sources of Social Support and Social Conflict on Emotional Well-Being," Basic and Applied Social Psychology 6 (1985), Linda K. George, "Stress, Social Support, and Depression over the Life Course," in Aging, Stress, Social Support, and Health, ed. K. Markides and C. Cooper (London: Wiley, 1989).
- 20. e.g. Arlie Russell Hochschild and Anne Machung, The Second Shift (Avon Books, 1990).
- 21. Ursula B. Bowling and Michelle D. Sherman, "Welcoming Them Home: Supporting Service Members and Their Families in Navigating the Tasks of Reintegration," Professional Psychology: Research and Practice 39, no. 4 (2008).
- 22. S.H. Pincus et al., "The Emotional Cycle of Deployment: A Military Family Perspective," Journal of the Army Medical Department April-June (2004), McLeland, Sutton, and Schumm, "Marital Satisfaction before and after Deployments Associated with the Global War on Terror."
- 23. Stephen J. Cozza, Ryo S. Chun, and James A. Polo, "Military Families and Children During Operation Iraqi Freedom," Psychiatric Quarterly 76, no. 4 (2005), Alan Lincoln, Erika Swift, and Mia Shorteno-Fraser, "Psychological Adjustment and Treatment of Children and Families with Parents Deployed in Military Combat," Journal of Clinical Psychology In Session 64 (2008), Alexander C. McFarlane, "Military Deployment: The Impact on Children and Family Adjustment and the Need for Care," Current Opinion in Psychiatry 22 (2009). Bowling and Sherman, "Welcoming Them Home: Supporting Service Members and Their Families in Navigating the Tasks of Reintegration.", Families and Service Members American Psychological Association Presidential Task Force on Military Deployment Services for Youth, "The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report," (2007).
- 24. Yiven, Bjorck-Akesson, and Granlund, "Literature Review of Positive Functioning in Families with Children with a Disability."
- 25. R.G. Steele and M.I. Fitch, "Coping Strategies of Family Caregivers of Home Hospice Patients with Cancer.," Oncology Nursing Forum 23 (1996). John M. Gottman and Nan Silver, The Seven Principles for Making Marriage Work. New York: Three Rivers Press, 2002.
- 26. Yiven, Bjorck-Akesson, and Granlund, "Literature Review of Positive Functioning in Families with Children with a Disability.": 265
- 27. Edgar C. J. Long et al., "Understanding the One You Love: A Longitudinal Assessment of an Empathy Training Program for Couples in Romantic Relationships," Family Relations 48, no. 3 (1999). Gottman and Silver, The Seven Principles for Making Marriage Work.
- 28. L.P. Sheras and P.R. Koch-Sheras, Couple Power Therapy: Building Commitment, Cooperation, Communication, and Community in Relationships (Washington, D.C.: American Psychological Association, 2006).
- 29. Gottman and Silver, The Seven Principles for Making Marriage Work.
- 30. Cite Martz and Livneh 2007 (in Martx 2009)
- 31. Deirdre M. Desmond and Malcolm LacLachlan, "Coping Strategies as Predictors of Psychosocial Adaptation in a Sample of Elderly Veterans with Acquired Lower Limb Amputations," Social Science & Medicine 62 (2006).
- 32. Olga Horgan and Malcolm MacLachlan, "Psychosocial Adjustment to Lower-Limb Amputation: A Review," Disability and Rehabilitation 26, no. 14/15 (2004).
- 33. Marie Claude Blais and Jean-Marie Boisvert, "Psychological and Marital Adjustment in Couples Following a Traumatic Brain Injury (Tbi): A Critical Review," Brain Injury 19, no. 14 (2005).
- 34. ---, "Psychological Adjustment and Marital Satisfaction Following Head Injury. Which Critical Personal Characteristics Should Both Partners Develop?," Brain Injury 21, no. 4 (2007), Shlomo Katz, Shlomo Kravetz, and Fabian Grynbaum, "Wives' Coping Flexibility, Time since Husbands' Injury and the Perceived Burden of Wives of Men with Traumatic Brain Injury," Brain Injury 19, no. 1 (2005).
- 35. Tanielian and Jaycox, "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.", Matthew Jakupcak et al., "Implications of Masculine Gender Role Stress in Male Veterans with Posttraumatic Stress Disorder," Psychology of Men & Masculinity 7, no. 4 (2006), Michael E. Addis and James R. Mahalik, "Men, Masculinity, and the Contexts of Help Seeking," American Psychologist 58, no. 1 (2003).
- 36. Donald J. Mrozek, "The Habit of Victory: The American Military and the Cult of Manliness," in Manliness and Morality: Middle-Class Masculinity in Britain and America, 1800-1940, ed. J.A. Mangan and James Walvin (New York: St. Martin's Press, 1987).
- 37. Matthew Gutmann, "Trafficking in Men: The Anthropology of Masculinity," Annual Review of Anthropology 26 (1997), ---, "The Ethnographic (G)Ambit: Women and the Negotiation of Masculinity in Mexico City," American Ethnologist 24, no. 4 (1997).
- 38. The literature on disability frequently notes that disabled men may experience their illness or injury as a challenge to their masculinity, particularly if it interferes with independence or sexuality Barbara E. Gibson et al., "Men on the Margin: A Boudieusian Examination of Living into Adulthood with Muscular Dystrophy," Social Science & Medicine 65 (2007), R. Noam Ostrander, "Meditations on a Bullet: Violently Injured Young Men Discuss Masculinity, Disability, and Blame," Child and Adolescent Social Work Journal 25 (2008), Thomas J. Gershick and Adam Stephen Miller, "Coming to Terms: Masculinity and Physical Disability," in Men's Lives, Sixth Edition, ed. Michael Kimmel and Michael A. Messner (Boston: Pearson, 2004)..
- 39. Sheras and Koch-Sheras, Couple Power Therapy: Building Commitment, Cooperation, Communication, and Community in Relationships.
- 40. Scott M. Stanley et al., "Dissemination and Evaluation of Marriage Education in the Army," Family Process 44 (2005). This article provides an example of one such program and its evaluation.