This article is part of The Unremembered, a Globe and Mail investigation into soldiers and veterans who died by suicide after deployment during the Afghanistan mission.
A growing body of research shows treating post-traumatic stress is more effective for patients in committed relationships when their partners are deeply involved in the care – the opposite of the usual experience in 22 soldier and veteran suicides examined by The Globe and Mail.
Couples psychotherapy for stress disorders improved all symptoms and showed results comparable to the best-known treatments, according to an academic study published earlier this year by PTSD experts in Canada and the United States.
The paper published in the Journal of Family Psychology builds on 10 years of research pioneered at Ryerson University showing that "conjoint cognitive behavioural therapy" – short-term intensive couples' psychotherapy that concentrates on problem solving to change attitudes and behaviour – reduced flashbacks, nightmares and emotional numbness. The treatment also kept more couples together and helped reverse the social isolation that is one of the disastrous consequences of stress disorders.
The Globe and Mail conducted its own in-depth interviews with family and friends of 31 soldiers who took their own lives after returning from serving in Afghanistan. Twenty-two were in committed relationships before they fell seriously ill. In 15 of the 22 cases, the relationships had recently collapsed or were in the midst of breaking down just before the suicide. In at least two cases The Globe studied, the military's own boards of inquiry recommended more family involvement in treatment.
In almost every case, spouses and exes reported they were left out of the treatment process leading up to the breakup and suicide; sometimes they were excluded by their partners but also, they felt, by a system that saw the couple and partner support as secondary matters to be dealt with later.
"I needed to understand and they were pushing me away," said Sylvie Duchesne, the wife of retired Sergeant Claude Emond, who took his life in 2014, just after she warned him she could no longer live with his growing paranoia. "At every step, I was told the process was confidential. And my husband didn't want me involved in his treatment steps."
Retired Sergeant Raynald Côté followed several therapy programs before his death in 2015, but his former partner Marie-Claude Deschênes said they never got to the stage of couples therapy.
"It's complex. The couple has to take charge from the earliest signs of PTSD, but it's not easy to know when to start on counselling. Raynald pursued several specialized therapies. Couples therapy was supposed to come later," Ms. Deschênes said.
Anne Wagner, a psychology professor at Ryerson University and a member of the research team, said that experience is typical. "Conventional wisdom is … the most pressing concern – that gets dealt with first," she said. "It makes logical sense but what we're seeing in our approach is you're not leaving the family behind; you're bringing them along."
Dr. Wagner said one of the benefits of couples therapy is that soldiers with PTSD – mostly men – are more willing to attend therapy if the main objectives include helping their partners and preserving marriages. It reduces some of the focus on their own illness, which they may be trying to minimize.
"Our team's perspective is very much that PTSD and the impact of trauma is not just an individual disorder," Dr. Wagner said. "By treating the patient, the partner and the relationship at the same time, you're getting a three-for-one, basically, for things that facilitate getting well."
Colonel Rakesh Jetly, the chief psychiatrist of the Canadian Armed Forces, said the military has made efforts to include spouses in treatment but the main obstacle is privacy concerns and the co-operation of the service member. Far from wanting to exclude spouses, he said, treatment teams are anxious to get them involved. "Some are most successful cases are when the spouse is integral to the treatment," Col. Jetly said. "There's not a single Canadian Forces member in for treatment who doesn't get asked, 'Can we meet your spouse?'"
Relationship breakdown is a major issue for stress-disorder patients so mental health professionals are anxious to talk to spouses, Col. Jetly said. Educating spouses can be key to effective treatment. Besides, "spouses are really good bullshit detectors," he said. "If someone is minimizing their symptoms, they know it."
Military boards of inquiry have also called for more spousal involvement.
Sergeant Paul Martin was a veteran infantry soldier, based at CFB Gagetown. The married father of two was diagnosed with PTSD after deploying four times to the former Yugoslavia and once to Afghanistan. A military board of inquiry examining his 2011 suicide recommended partners be involved in a soldier's mental-health treatment, "not only to gain an understanding of the treatment techniques, but also to identify if there are any unreported concerns."
In response to this recommendation, a commanding officer wrote in 2014 that family participation is already encouraged.
A military board of inquiry in Captain Brad Elms's suicide also stressed the importance of involving family members in a soldier's care. Capt. Elms had been diagnosed with depression after his Bosnia tour, but his family believes he was also struggling with PTSD. His wife and teenaged children noticed dramatic changes in his mental health after he returned from Afghanistan in 2009 and they pleaded with him to get help. But the well-respected infantry officer was worried that doing so would scuttle his career.
Capt. Elms took his life in November, 2014. The inquiry examining his death recommended that military health staff consider collecting information from family members and close co-workers during a soldier's post-deployment health screening.
A commander wrote in response in June, 2015, that he concurred, but noted that consent from the soldier was required before health staff could talk with family members.
With reporting from Renata D'Aliesio and Allan Maki
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