Is PTSD Contagious?
It's rampant among returning vets—and now their spouses and kids are starting to show the same symptoms.
Brannan Vines has never been to war. But she's got a warrior's skills: hyperawareness, hypervigilance, adrenaline-sharp quick-scanning for danger, for triggers. Super stimuli-sensitive. Skills on the battlefield, crazy-person behavior in a drug store, where she was recently standing behind a sweet old lady counting out change when she suddenly became so furious her ears literally started ringing. Being too cognizant of every sound—every coin dropping an echo—she explodes inwardly, fury flash-incinerating any normal tolerance for a fellow patron with a couple of dollars in quarters and dimes. Her nose starts running she's so pissed, and there she is standing in a CVS, snotty and deaf with rage, like some kind of maniac, because a tiny elderly woman needs an extra minute to pay for her dish soap or whatever.
Brannan Vines has never been to war, but her husband, Caleb, was sent to Iraq twice, where he served in the infantry as a designated marksman. He's one of 103,200, or 228,875, or 336,000 Americans who served in Iraq or Afghanistan and came back with PTSD, depending on whom you ask, and one of 115,000 to 456,000 with traumatic brain injury. It's hard to say, with the lack of definitive tests for the former, undertesting for the latter, underreporting, under or over-misdiagnosing of both. And as slippery as all that is, even less understood is the collateral damage, to families, to schools, to society—emotional and fiscal costs borne long after the war is over.
Like Brannan's symptoms. Hypervigilance sounds innocuous, but it is in fact exhaustingly distressing, a conditioned response to life-threatening situations. Imagine there's a murderer in your house. And it is dark outside, and the electricity is out. Imagine your nervous system spiking, readying you as you feel your way along the walls, the sensitivity of your hearing, the tautness in your muscles, the alertness shooting around inside your skull. And then imagine feeling like that all the time.
Caleb has been home since 2006, way more than enough time for Brannan to catch his symptoms. The house, in a subdivision a little removed from one of many shopping centers in a small town in the southwest corner of Alabama, is often quiet as a morgue. You can hear the cat padding around. The air conditioner whooshes, a clock ticks. When a sound erupts—Caleb screaming at Brannan because she's just woken him up from a nightmare, after making sure she's at least an arm's length away in case he wakes up swinging—the ensuing silence seems even denser. Even when everyone's in the family room watching TV, it's only connected to Netflix and not to cable, since news is often a trigger. Brannan and Caleb can be tense with their own agitation, and tense about each other's. Their German shepherd, a service dog trained to help veterans with PTSD, is ready to alert Caleb to triggers by barking, or to calm him by jumping onto his chest. This PTSD picture is worse than some, but much better, Brannan knows, than those that have devolved into drug addiction and rehab stints and relapses. She has not, unlike military wives she advises, ever been beat up. Nor jumped out of her own bed when she got touched in the middle of the night for fear of being raped, again. Still.
"Sometimes I can't do the laundry," Brannan explains, reclining on her couch. "And it's not like, 'Oh, I'm too tired to do the laundry,' it's like, 'Um, I don't understand how to turn the washing machine on.' I am looking at a washing machine and a pile of laundry and my brain is literally overwhelmed by trying to figure out how to reconcile them." She sounds like she might start crying, not because she is, but because that's how she always sounds, like she's talking from the top of a clenched throat, tonally shaky and thin. She looks relaxed for the moment, though, the sun shining through the windows onto her face in this lovely leafy suburb. We raise the blinds in the afternoons, but only if we are alone. When we hear Caleb pulling back in the driveway, we jump up and grab their strings, plunging the living room back into its usual necessary darkness.
The Vineses' wedding album is gorgeous, leather-bound, older and dustier than you might expect given their youth. Brannan is 32 now, but in her portraits with the big white dress and lacy veil she's not even old enough to drink. There were 500 people at the ceremony. Even the mayor was there. And there's Caleb, slim, in a tux, three years older than Brannan at 22, in every single picture just about the smilingest motherfucker you've ever seen, in a shy kind of way.
Now, he's rounder, heavier, bearded, and long-haired, obviously tough even if he weren't prone to wearing a COMBAT INFANTRYMAN cap, but still not the guy you picture when you see his "Disabled Veteran" license plates. Not the old 'Nam guy with a limp, or maybe the young legless Iraq survivor, that you'd expect.
It's kind of hard to understand Caleb's injuries. Even doctors can't say for sure exactly why he has flashbacks, why he could be standing in a bookstore when all of a sudden he's sure he's in Ramadi, the pictures in his brain disorienting him among the stacks, which could turn from stacks to rows of rooftops that need to be scanned for snipers. Sometimes he starts yelling, and often he doesn't remember anything about it later. They don't know exactly why it comes to him in dreams, and why especially that time he picked up the pieces of Baghdad bombing victims and that lady who appeared to have thrown herself on top of her child to save him only to find the child dead underneath torments him when he's sleeping, and sometimes awake. They don't know why some other guys in his unit who did and saw the same stuff that Caleb did and saw are fine but Caleb is so sensitive to light, why he can't just watch the news like a regular person without feeling as if he might catch fire. Some hypotheses for why PTSD only tortures some trauma victims blame it on unhappily coded proteins, or a misbehaving amygdala. Family history, or maybe previous trauma.
Whatever is happening to Caleb, it's as old as war itself. The ancient historian Herodotus told of Greeks being honorably dismissed for being "out of heart" and "unwilling to encounter danger." Civil War doctors, who couldn't think of any other thing that might be unpleasant about fighting the Civil War but homesickness, diagnosed thousands with "nostalgia." Later, it was deemed "irritable heart." In World War I it was called "shell shock." In World War II, "battle fatigue." It wasn't an official diagnosis until 1980, when Post Traumatic Stress Disorder made its debut in psychiatry's Diagnostic and Statistical Manual of Mental Disorders, uniting a flood of Vietnam vets suffering persistent psych issues with traumatized civilians—previously assigned labels like "accident neurosis" and "post-rape syndrome"—onto the same page of the DSM-III.
But whatever people have called it, they haven't been likely to grasp or respect it. In 1943, when Lt. General George S. Patton met an American soldier at an Italian hospital recovering from "nerves," Patton slapped him and called him a coward. In 2006, the British Ministry of Defence pardoned some 300 soldiers who had been executed for cowardice and desertion during World War I, having concluded that many were probably just crippled by PTSD.
Granted, diagnosing PTSD is a tricky thing. The result of a malfunctioning nervous system that fails to normalize after trauma and instead perpetrates memories and misfires life-or-death stress for no practical reason, it comes in a couple of varieties, various complexities, has causes ranging from one lightning-fast event to drawn-out terrors or patterns of abuse—in soldiers, the incidence of PTSD goes up with the number of tours and amount of combat experienced. As with most psychiatric diagnoses, there are no measurable objective biological characteristics to identify it. Doctors have to go on hunches and symptomology rather than definitive evidence. And the fact that the science hasn't fully caught up with the suffering, that Caleb can't point to something provably, biologically ruining his life, just makes him feel worse. It's invalidating. Even if something is certainly wrong—even if a couple of times he has inadvisably downed his medication with a lot of booze, admitting to Brannan that he doesn't care if he dies; even if he once came closer to striking her than she ever, ever, ever could have imagined before he went to war—Caleb knows that a person whose problem is essentially that he can't adapt to peacetime Alabama sounds, to many, like a pussy.
"Somebody at the VA told me, 'Kids in Congo and Uganda don't have PTSD,'" Caleb tells me angrily one day.
You can't see Caleb's other wound, either. It's called traumatic brain injury, or TBI, from multiple concussions. In two tours, he was in at least 20 explosions—IEDs, vehicle-borne IEDs, RPGs. In one of them, when a mortar or grenade hit just behind him, he was thrown headfirst through a metal gate and into a courtyard. His buddies dragged him into a corner, where he was in and out of consciousness while the firefight continued, for hours. When it was over, they gave him an IV and some Motrin, and within hours, he was back on patrol. The Army has rules about that sort of thing now. Now if you're knocked unconscious, or have double vision, or exhibit other signs of a brain injury, you have to rest for a certain period of time, but that rule didn't go into effect in theater until 2010, after Caleb was already out of the service. He wasn't diagnosed for years after he got back, despite Brannan's frantic phone calls to the VA begging for tests, since her husband, formerly a high-scoring civil-engineering major at Auburn University, was asking her to help him do simple division. When Caleb was finally screened for the severity of his TBI, Brannan says he got the second-worst score in the whole 18-county Gulf Coast VA system, which serves more than 50,000 veterans. But there's still a lot about brain damage that doctors, much less civilians, don't understand.
"I guess we're just used to dealing with people with more severe injuries," a VA nurse once told Brannan upon seeing Caleb.
Unlike PTSD, secondary traumatic stress doesn't have its own entry in the DSM, though the manual does take note of it, as do many peer-reviewed studies and the Department of Veterans Affairs. Symptoms start at depression and alienation, including the "compassion fatigue" suffered by social workers and trauma counselors. But some spouses and loved ones suffer symptoms that are, as one medical journal puts it, "almost identical to PTSD except that indirect exposure to the traumatic event through close contact with the primary victim of trauma" is the catalyst. Basically your spouse's behavior becomes the "T" in your own PTSD. If sympathy for Caleb is a little lacking, you can imagine what little understanding exists for Brannan.
Secondary traumatic stress has been documented in the spouses of veterans with PTSD from Vietnam. And the spouses of Israeli veterans with PTSD, and Dutch veterans with PTSD. In one study, the incidence of secondary trauma in wives of Croatian war vets with PTSD was 30 percent. In another study there, it was 39 percent. "Trauma is really not something that happens to an individual," says Robert Motta, a clinical psychologist and psychology professor at Hofstra University who wrote a few of the many medical-journal articles about secondary trauma in Vietnam vets' families. "Trauma is a contagious disease; it affects everyone that has close contact with a traumatized person" in some form or another, to varying degrees and for different lengths of time. "Everyone" includes children. Which is something Brannan and Caleb lose not a little sleep over, since they've got a six-year-old in the house.
Katie* Vines, the first time I meet her, is in trouble. Not that you'd know it to look at her, bounding up to the car, blondish bob flying as she sprints from her kindergarten class, nice round face like her daddy's. No one's the wiser until she cheerfully hands her mother a folder from the backseat she's hopped into. It contains notes about the day from her teacher.
"It says here," Brannan says, her eyes narrowing incredulously, "that you spit on somebody today."
"Yes ma'am," Katie admits, lowering her voice and her eyes guiltily.
"Katie Vines." Brannan was born here in Alabama, so that's drawled. "Wah did you do that?"
Her schoolmate said something mean. Maybe. Katie doesn't sound sure, or like she remembers exactly. One thing she's positive of: "She just made me…so. MAD." Brannan asks Katie to name some of the alternatives. "Walk away, get the teacher, yes ma'am, no ma'am," Katie dutifully responds to the prompts. She looks disappointed in herself. Her eyebrows are heavily creased when she shakes her head and says quietly again, "I was so mad."
Brannan and Katie's teacher have conferenced about Katie's behavior many times. Brannan's not surprised she's picked up overreacting and yelling—you don't have to be at the Vines residence for too long to hear Caleb hollering from his room, where he sometimes hides for 18, 20 hours at a time, and certainly not if you're there during his nightmares, which Katie is. "She mirrors…she just mirrors" her dad's behavior, Brannan says. She can't get Katie to stop picking at the sores on her legs, sores she digs into her own skin with anxious little fingers. She is not, according to Brannan, "a normal, carefree six-year-old."
Different studies of the children of American World War II, Korea, and Vietnam vets with PTSD have turned up different results: "45 percent" of kids in one small study "reported significant PTSD signs"; "83 percent reported elevated hostility scores." Other studies have found a "higher rate of psychiatric treatment"; "more dysfunctional social and emotional behavior"; "difficulties in establishing and maintaining friendships." The symptoms were similar to what those researchers had seen before, in perhaps the most analyzed and important population in the field of secondary traumatization: the children of Holocaust survivors.
But then in 2003, a team of Dutch and Israeli researchers meta-analyzed 31 of the papers on Holocaust survivors' families, and concluded—to the fury of some clinicians—that when more rigorous controls were applied, there was no evidence for the intergenerational transmission of trauma.
I asked the lead scientist, Marinus van IJzendoorn of Leiden University, what might account for other studies' finding of secondary trauma in vets' spouses or kids. He said he's never analyzed those studies, and wonders if the results would hold up to a meta-analysis. But: "Suppose that there is a second-generation effect in veterans, there are a few differences that are quite significant" from children of Holocaust survivors that "might account for difference in coping mechanisms and resources." Holocaust survivors "had more resources and networks, wider family members and community to support them to adapt to their new circumstances after a war." They were not, in other words, expected to man up and get over it.
We await the results of the 20-year, 10,000-family-strong study of impacts on Iraq and Afghanistan veterans' kin, the largest of its kind ever conducted, that just got under way. Meanwhile, René Robichaux, social-work programs manager for US Army Medical Command, concedes that "in a family system, every member of that system is going to be impacted, most often in a negative way, by mental-health issues." That was the impetus for the Marriage and Family Therapy Program, which since 2005 has added 70 therapists to military installations around the country. Mostly what the program provides is couples' counseling. Children are "usually not" treated, but when necessary referred to child psychiatrists—of which the Army has 31. Meanwhile, the Child, Adolescent and Family Behavioral Health Office has trained hundreds of counselors in schools with Army children in and around bases to try to identify and treat coping and behavioral problems early on. "We're better than we were," Robichaux says. "But we still have a ways to go."
Of course, the Army only helps families of active-duty personnel. It's the Department of Veterans Affairs that's charged with treating the problems that can persist long past discharge. But "if you asked the VA to treat your kids, they would think it was nonsense," says Hofstra's Motta.
When I asked the VA if the organization would treat kids for secondary trauma, its spokespeople stressed that it has made great strides in family services in recent years, rolling out its own program for couples' counseling and parenting training. "Our goal is to make the parents the strongest parents they can be," says Susan McCutcheon, national director for Family Services, Women's Mental Health, and Military Sexual Trauma at the VA; according to Shirley Glynn, a VA clinical research psychologist who was also on the call, "for the vast majority of people with the secondary traumatization model, the most important way to help the family deal with things is to ensure that the veteran gets effective treatment." In cases where children themselves need treatment, these VA officials recommended that parents find psychologists themselves, though they note "this is a good time [for the VA] to make partners with the community so we can make good referrals." Or basically: "You're on your own," says Brannan.
Brannan sent Katie to the school therapist, once. She hasn't seen any other therapist, or a therapist trained to deal with PTSD—Brannan knows what a difference that makes, since the volunteer therapist she tried briefly herself spent more time asking her to explain a "bad PTSD day" than how Caleb's symptoms were affecting the family. When I visited, Katie was not covered by the VA under Caleb's disability; actually, she wasn't covered by any insurance at all half the time, since the Vineses aren't poor enough for subsidized health care and the Blue Cross gap insurance maxes out at six months a year. She's never been diagnosed with anything, and Brannan prefers it that way. "I'm not for taking her somewhere and getting her labeled. I'd rather work on it in softer ways," like lots of talks about coping skills, and an art class where she can express her feelings, "until we have to. And I'm hoping we won't have to." Certainly she seems better than some other PTSD vets' kids Brannan knows, who scream and sob and rock back and forth at the sound of a single loud noise, or who try to commit suicide even before they're out of middle school. Caleb spends enough time worrying that he's messing up his kid without a doctor saying so.
Brannan is a force of keeping her family together. She sleeps a maximum of five hours a night, keeps herself going with fast food and energy drinks, gets Katie to and from school and to tap dance and art, where Katie produces some startlingly impressive canvases, bright swirling shapes bisected by and intersected with other swaths of color, bold, intricate. That's typical parent stuff, but Brannan also keeps Caleb on his regimen of 12 pills—antidepressants, anti-anxiety, sleep aids, pain meds, nerve meds, stomach meds—plus weekly therapy, and sometimes weekly physical therapy for a cartilage-lacking knee and the several disintegrating disks in his spine, products of the degenerative joint disease lots of guys are coming back with maybe from enduring all the bomb blasts, and speech therapy for the TBI, and continuing tests for a cyst in his chest and his 48-percent-functional lungs. She used the skills she learned as an assistant to a state Supreme Court justice and running a small newspaper to navigate Caleb's maze of paperwork with the VA, and the paperwork for the bankruptcy they had to declare while they were waiting years for his disability benefits to come through. She also works for the VA now, essentially, having been—after a good deal more complicated paperwork, visits, and assessments—enrolled in its new caregiver program, which can pay spouses or other family members of disabled vets who have to take care of them full time, in Brannan's case $400 a week.
At home after school, she makes Katie a pancake snack and then, while Katie shows me the website for a summer camp that teaches military spy skills, Brannan gets back to work. Because she also helps thousands of other people—measured by website and social-media interactions—through Family of a Vet, a nonprofit created "to help you find your way, find the information you need, and find a way not only to cope with life after combat…but to survive and thrive!" Brannan founded the organization in 2007, after panicked Googling led her to the website of Vietnam Veteran Wives (VVW) when Caleb returned from his second tour. Life after the first tour had been pretty normal. "Things were a little…off," Caleb was edgy, distant, but he did not forget entire conversations minutes later, did not have to wait for a stable mental-health day and good moment between medication doses to be intimate with his wife, and then when he finally tried, pray to Christ for one of the times when it's good sex, not one of the times when a car door slams outside and triggers him, or the emotion becomes so unbearable that he freezes, gets up, and walks wordlessly out the door.