1. Making sense of the trauma and ensuing consequences.

Participants appeared both to strive and struggle to understand the traumatic event, PTSD and other ensuing consequences.

Striving and struggling to understand. All participants described aspects of their striving and struggling to understand the trauma and their partners’ response to it. It was not just the PTSD that participants had to deal with but a wide range of consequences including depression, litigation, threats to their housing situation and financial strain.

For most participants, receiving the diagnosis of PTSD seemed to be a relief: a helpful experience that facilitated understanding. For some, it offered justification for their partners’ difficulties. Diagnosis offered hope of progressing forward:

Ah! It’s got a name, so I can deal with that! But if it hasn’t got a name, then you’re stuffed aren’t you? (Sally)

Participants described how family, friends and the public failed to understand their partners’ PTSD. It seemed to be the hidden nature of mental health difficulties that made understanding and empathising difficult for themselves and others, which both Laura and Kerry related to stigma. Some participants compared their partners’ psychological injuries with a physical injury, intimating how much easier they thought life would be if the injury was physical:

I thank my lucky stars that Matt’s in one piece and alive, but to be honest if he was missing a leg, this would probably be a hell of a lot easier to deal with…If he was missing a leg, people can see that he’s been injured in combat, but the fact that he can’t walk down the street without being like a terrified little, you know, terrified child, people just don’t have time for it, you know, they don’t get it. (Laura)

Information regarding psychological and physical trauma represented in the media served as points of reference for participants’ understanding. For some, the struggle to understand PTSD seemed impeded rather than facilitated by the media, because they thought that PTSD occurred only in military contexts. Some participants had read multiple books on PTSD, enhancing their understanding on an intellectual level, but many reflected that they were still unable to understand fully and empathise with their partners.

Entering a new perceived reality. The trauma and PTSD appeared to signify major changes in participants’ lives, including changes in their quality of life, physical health and relationships. Most participants described this reality as harder to live with or unwished for. There was a sense of the PTSD being omnipotent, often in control of the relationship and causing conflict.

For some participants, there was a strong sense that the emergence of trauma and PTSD shattered their expectations surrounding their life course and put life on hold. Laura externalised the PTSD, comparing it to a “big black cloud” and later an “evil witch” who arrived just as she was starting to think her dreams would materialise:

The PTSD has interfered in our life. It’s like some big, nasty, evil witch or something that’s come in and destroyed everything, all our hopes and dreams basically. Just when I finally thought, “This is it, the rest of my life, wahay, finally! We can look forward to a nice, long, happy rest of life together”. It’s just been trodden on and squashed and thrown out of the window.

Most participants reported arguing more with their partners following the trauma. Some seemed to have largely overcome this, whilst others described conflict as an ongoing, significant element in the relationship. Participants also described the PTSD as having a detrimental effect on their social lives, whereby they socialised less frequently and plans were thwarted. In this way, participants had entered a social reality controlled by the PTSD:

It stopped us socialising really …She wouldn’t go out anywhere…I couldn’t meet up with all the old friends …She would never go to a pub again …So our social life went downhill. (Roy)

Looking backwards: Reflecting and reminiscing. Participants compared and contrasted life at present with life pre-trauma and post-trauma. All participants reported significant changes, but they varied hugely in terms of how they viewed these changes. A range of losses or threatened losses were highlighted, including the loss of their partner, relationship and career, and there was often a strong sense of sadness or mourning over these losses:

I miss him desperately. It’s like I’m grieving, it’s like I’m in mourning, but he’s still alive. It’s difficult to grieve for somebody when you see them day in, day out. And it’s hard to reconcile that in your head that I’m in mourning for a loss, but he’s still there. (Laura)

In looking backwards, all participants commented upon changes in the emotional connection with their partner. A negative impact upon intimacy and the sexual dimension of relationships was described. Some said that the PTSD had affected their partners’ ability to communicate with them, resulting in participants feeling angry, upset, unsympathetic or more distant from their partner.

Whilst most participants described various difficulties the trauma had generated in their relationships, two described how their relationship had strengthened over time, despite these strains. In particular, Duncan perceived the trauma and PTSD as having primarily positive consequences and likened his relationship to a journey, which was reset “in the right direction” through increased quality time and communication with his wife:

We try to go for a walk practically every day round the park…which actually has brought us closer together, just that time to walk together and perhaps sit on the bench for a while and talk things through. So that’s actually been very, very positive.

Looking forwards: Hope versus uncertainty. Participants contemplated their future lives and relationship with hope, as well as uncertainty, fear and at times hopelessness. Visions of the future varied from envisaging the relationship becoming stronger and the future being an ideal time of their lives financially and socially, to hope for greater equality in the future relationship, to simply hoping for life to return to how it was previously. Sally wanted her future to involve doing “normal mundane things” again, such as seeing friends together, whilst Duncan appeared particularly hopeful about the future.

Participants’ uncertainty about the future often concerned whether PTSD was too large an obstacle to conquer. Several participants seemed to experience a dialectic of holding hope, yet fearing “this is it”. A few participants feared their partner might commit suicide; two had previously attempted suicide. The following extract demonstrates how Laura swung between feeling hopeful and fearful about whether she would regain her partner, whom she viewed as lost, or whether PTSD would win the battle:

I can’t help but feel [the PTSD] is a temporary thing and that it will be dealt with and he will be treated and that he will get over it and he’ll get better…But equally, I can’t help but worry that that’s a bit optimistic and that he won’t ever be back to his old self and that this is how it is.

For all participants, there was a sense of commitment to their partners and embarking upon the future together. However, a more complex narrative emerged in some interviews, with a strong sense of commitment struggling to coincide alongside uncertainty about whether or not the relationship could continue.

2. Shifting identities.

Alongside the endeavour to make sense of everything, there was a strong sense of the identities and concomitant roles of participants and their partners evolving as a result of the trauma. This occurred as participants strived to cope with new positions in their relationships, as well as the emotional impact of their experiences.

Adapting to new responsibilities and roles.

Participants reported a range of new responsibilities that they adopted at the time or in the aftermath of the trauma, primarily in order to care for their partner due to the PTSD and, in some cases, physical difficulties arising from the trauma. Although not all participants labelled themselves as a “carer”, they all described new caring responsibilities and most said that they did the majority of household chores nowadays. Several participants reported taking responsibility for trying to manage their partners’ PTSD symptoms. For some, such new responsibilities were so marked that they characterised shifts in roles within the relationship. Three participants likened this to becoming a mother caring for a child:

I just wanna pick him, just wanna like wrap my arms around him and soothe him and say “Oh, shhh, you’ll be okay”, you know, like you would with a child …That’s what the bulk of my life is like with him now. It’s just wanting to take care of him, wanting to shield him and wanting to protect him from the big, bad, nasty outside world that makes him jump. (Laura)

Participants who described a shift in roles depicted it as being largely unwanted, with Kerry and Laura expressing particularly strong aversion for their new caring roles and worry that they could maintain them for a limited time only. The following extract demonstrates how Kerry adapted her parenting style in order to compensate for her husband’s loss of skills. By adopting more traditional fatherly responsibilities, she was left feeling that she had surrendered motherhood:

I was the one who would march in and say “Right! What’s this? Do your homework! Do that!” …I felt I’d given my right up to motherhood really. It felt I’d become a father.

There was a sense that participants bore the brunt of the PTSD and that this was a stressful, exhausting and arduous position that they were compelled to assume. It was particularly anger and irritability that participants tolerated, which increased their own stress levels. For participants with children, the whole household bore the brunt of the PTSD. Several participants described being at the end of their tether at times and portrayed a sense that their coping resources were limited:

Nicola’s right you see, I haven’t got any sympathy at the minute [laughs], not that she needs sympathy all the time, she doesn’t. But I don’t think Nicola likes to tell me when she’s feeling particularly bad, because I go “Oh for god’s sake” …Sometimes I’m just up to here [gestures]. (Sally)

Subordinated in the relationship. A sense of feeling subordinated in the relationship emerged from the data, as though participants’ positions had become less important as their partners’ needs had increased. Narratives recounted how equality was lost and the relationship became one-way as the focus was placed wholly upon the partner. Sally described how she instinctively adapted when her partner returned from hospital, although she had not recognised this shift in the relationship until the interview:

It’s all about her …I hadn’t thought that it had affected me, put it that way, but I think talking to you, probably you know it’s affected me more than I thought …Every human adapts, don’t they, to what they’ve got? And since she’s come home from hospital, I think I’ve just adapted and I just, eurgh, slot where I feel I should be and do what I feel I should do.

As part of this subordinated, undervalued position, some participants reported no longer being able to access emotional support from their partners. There was a sense that participants’ emotional needs were neglected within the relationship, because their needs were considered less important:

You think “Yeah okay I’ve listened to that long enough, I want to talk about me now, ‘cause I’ve got a problem at work” [laughs]. And you don’t get the chance to, because …his issues were bigger and so …tend to take precedence. (Eve)

Subsequently, many participants perceived themselves as having lost personal qualities, such as their sense of humour. Laura described how the metaphorical loss of her partner had resulted in her being unable to talk about her feelings anymore and deemed this change so intense, she considered her personality had altered:

The one person that I want to talk to is him and I can’t. And he said to me the other day “I wish you’d talk to me Laura, I wish you’d talk to me more”. And I said to him “How can I?”…It’s changed me; it’s changed my personality, because I’ve always been somebody who will talk.

The emotional journey. Participants described a vast array of emotions that they experienced at the time of the trauma and beyond, including disbelief, horror, distress, fear, worry, anger, self-blame, disappointment, resentment, pity and compassion. Guilt was a prevalent emotion that all participants reported or suggested experiencing. The following extract demonstrates how Laura made sense of her guilt, relating it to feeling selfish for experiencing her own suffering when she thought the focus should be on her partner:

I feel that there’s nothing mentally wrong with me, so I should be able to cope and I feel guilty when I’m having a bad day and for feeling bad ‘cause I think “Well whatever he’s going through is a million times worse than anything I’m feeling” …I feel selfish for wanting it to go away for my sake rather than for his sake.

For a couple of participants whose partners suffered significant physical injuries, there was a strong sense of the trauma being traumatic for them too:

Seeing him in the hospital, it was just, I mean he was grotesque …He just looked horrific. (Eve)

There were many instances whereby participants described emotions that seemed to mirror their partners’ emotions and PTSD symptoms. Some participants reported emotional and physiological responses (e.g. anxiety, sleeplessness) as a result of their own stress and shock. Others reported emotions such as irritation, low mood and happiness arising in response to their partner experiencing the same emotion. A couple of participants reported experiencing avoidance and hypervigilance in relation to their partners’ PTSD triggers, because they were attempting to control the PTSD:

I’m hypervigilant, I’m looking out for blooming dogs and I’m doing this and I’m trying to take the stress out of his life. (Kerry)

Finding ways to survive the experience. Participants described a range of coping strategies employed in an attempt to survive their experiences. Many talked about how work and a life outside the house, away from their partner and the PTSD, were important in managing their own emotional response:

I can remember thinking “Thank God I’m here”, because you just get absorbed in work…Getting out of the house was my saving [laughs] grace, you know, from a selfish point of view. (Eve)

Engaging in enjoyable activities and distraction techniques were utilised by many participants:

I can get through it by doing other things, you know, taking the car and go for a ride. (Roy)

A couple of participants resorted to unhelpful or unhealthy methods of coping, for example drinking alcohol excessively. At times, coping involved avoiding or disregarding their thoughts and feelings. At others, it involved acceptance of the situation. Despite using numerous methods to try and survive their experiences, the situation sometimes seemed too intense and participants’ coping methods inadequate. Some acknowledged that they might appear to be coping outwardly, but were not coping internally. In this way, the image of coping was like a facade to the outside world, which was unaware of the trauma’s true impact.

3. Accessing and experiencing outside resources.

This theme is about participants’ perceptions and experiences of support available to them, which ranged from being very helpful to very unhelpful. Support from outside the relationship was particularly pertinent, as many participants considered they had lost their partners’ support within it. Accessing resources was complicated by factors such as stigma, ambivalence and desire for privacy.

Support from others. Experiences of emotional and practical support varied hugely both within and between participants. Many described how talking to friends, family and work colleagues was helpful. Eve described how the process of venting, receiving sympathy and obtaining new perspectives from friends and family was helpful for her, particularly because inside the home the focus was wholly on her husband:

Being able to get it off your chest and say to somebody, “This is happening” …Also to get somebody else’s perspective, you know, ‘cause sometimes they would say: “Yes, but X, Y and Z, he has done this, this and that” and maybe that makes you step back and you think “Yeah, I could be a bit more understanding”. Or other times, just to be sympathetic to me, because I suppose it was all very much about him at home.

The relationship with support was complex, with most participants expressing how they needed or valued support, but certain factors prevented some from accessing it. For example, Sally’s partner seemed ashamed of the stigma associated with PTSD and did not want their experiences discussed with others. Despite varied experiences of outside support, participants often reported feeling like they were coping alone.

Kerry found practical support from friends helpful at the time of the trauma (e.g. taking care of the children), but felt more ambivalent about accessing emotional support. She disliked discussing her problems and although people knew about her partner’s difficulties, unlike Sally, they did not understand the full extent of them. She talked about the process of having and losing support:

We were regular church goers …After Harry’s injury, there was [laughs], they were almost offended that they couldn’t heal him [laughs], so that aspect of our life went as well…and with that went a certain section of your friends or so-called friends [laughs] …It’s a dangerous mix, you know, people thinking they can heal people and make people feel better and whatever and then writing them off. It just added to the hurt really.

Professional support. Participants’ opinions of professional support varied greatly with some aspects being much appreciated and others perceived as unhelpful or inappropriate. These included mental health and other services, for example physical health services, the Ministry of Defence and the police service. Participants identified ways in which professional support could have made the journey easier, particularly through increased awareness, greater communication and identifying and meeting their needs more effectively.

The need for increased awareness about PTSD in services that treat people with physical and psychological trauma was expressed, and for services to communicate how trauma can affect people. Kerry described how an information leaflet might help, akin to those used in physical healthcare:

A bit like a head injury sheet you get, you know: “If you hear noises in your ears, get blood from your nose, go back”. You almost need, you know: “You’ve suffered a traumatic event, if this, this and this happens, please refer back to your GP”. I think would help so many people.

Participants described ways that services could improve support offered to their partners, which in turn would impact upon themselves. These included a need for earlier intervention, greater attempts at engagement and further support out-of-hours. Several participants described stigma as creating ambivalence in their partners, preventing them from seeking support, and articulated the need to dispel the shame and stigma associated with mental health difficulties:

If he hadn’t have felt the stigma with [PTSD], he may well have made the connection sooner and said to them, “Well it might have been, it’s been since I got back from [the warzone], maybe it’s something to do with that”. But because he was so in denial …He didn’t want it to be that, that was the last thing on earth he’d wanted it to be. (Laura)

Participants reported having little or no involvement in their partners’ mental health care. A wish for services to communicate with them more throughout their partners’ treatment was expressed by some.

No participants reported having been offered any direct support themselves from NHS services. Some displayed ambivalence about professional support, considering its value as limited, or thinking that the practicalities of attending would increase their stress levels. Others emphasised the importance of professionals offering support and some thought that group support would be helpful, for example through normalising and validating their emotional responses:

It would be helpful just to talk to other people that are in my situation …see how they cope, be reassured that my feelings of guilt and feelings of being selfish aren’t unique and that I’m not selfish and I shouldn’t feel guilty. (Laura)