Psychology
2013. Vol.4, No.3, 189-195
Published Online March 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.43029
Conscripted without Induction Order:
Wives of Former Combat Veterans
with PTSD Speak
Shaul Kimhi1*, Hadas Doron2
1Department of Psycho l o g y, Tel Hai College, Upper G a l i l e e , Israel
2Department of Social Wor k, Tel Hai College, Upper Galilee, Israel
Received January 2nd, 2013; rev ised February 2nd, 2013; accepted February 27th, 2013
This study examines the lives of wives who are living with former combat soldiers with chronic PTSD,
from the subjective perspective of the wives themselves. Structured interviews with 20 wives indicated
the following main results: 1) About 2/3 of the wives reported that, for a long time, they did not know
what the problem with their husband was and had no idea that it was connected to his military experience.
2) All of the wives described many negative effects of their husband’s situation on daily family function-
ing. In most cases, the wives described their husbands as handicapped individuals who could do very few
things that are usually associated with normal family functioning. 3) Most wives described their husbands
as “absent-present”: The husband was present physically but would often detach himself from everyone
around him. 4) Most wives reported suffering from anxieties of all kinds and other symptoms, which also
characterized their husbands. Study results are discussed in light of relevant theories.
Keywords: PTSD; Trauma as a Result of Combat Reaction; Family Coping; Husbands PTSD Effects on
Family; Secondary Traumatization; Present-Absent Relationship
Over the past 25 years, about half of all countries in the
world have been affected by wars (Marshall & Cole, 2009).
War is one of the most potent traumatic experiences known to
man. It often results in short-term combat stress reaction (CSR,
e.g., Umbrasas, 2010) or acute stress disorder (ASD), and
long-term psychopathology, most notably posttraumatic stress
disorder (PTSD, American Psychiatric Association, DSM-
IV-TR, 2000; Magruder & Yeager, 2009; Renshaw & Camp-
bell, 2011). According to researches, a substantial number of
soldiers as well as their families show a wide range of symp-
toms long after the waris over (e.g., Everson & Figley, 2011;
Solomon, Horesh, & Ein-Dor, 2009).
The aim of the current st udy is to examine several aspects of
negative long-term effects of war: the lives of wives who are
living with former combat soldiers suffering from chronic
PTSD, from the subjective perspective of the wives themselves.
Most studies that have examined the effects of PTSD have fo-
cused on the lives of the soldiers and were based on quantita-
tive methods. Some studies have focused on the effects of this
situation on families (e.g., Gold et al., 2007) and fewer studies
have examined the issue from the veterans’ or their wives’ per-
spectives (e.g., Ray & Vansone, 2009). The current phenome-
nological study is based on in-depth interviews with twenty
women married to former combat veterans who have been af-
fected by PTSD for many years. The purpose of this study is to
give us a glance into how life looks when one’s husband has
chronic PTSD. The majority of relevant research has focused
on wives’ stress symptoms, while other issues have been stud-
ied to a much less er ext ent.
Combat Stress Reaction and Posttraumatic
Stress Disorder
Soldiers who have been exposed to combat operations un-
dergo massive stress. This experience can lead to immediate or
delayed stress reactions that may harm psychological wellbeing,
physical health and functioning in the short and the long term
(Benyamini, Ein-Dor, Ginzburg & Solomon, 2009). War-in-
duced psychic trauma is most often expressed in either or both
of two related mental disorders (Waysman et al., 1993).
The first is combat stress reaction (CSR), which is a military
diagnosis but not an official DSM diagnosis. CSR refers to a
breakdown on the battlefield, characterized by a wide range of
acute psychological and somatic manifestations, (e.g., anxiety,
withdrawal, running amok) that signify that the individual has
ceased to function as a combatant (Benyamini & Solomon,
2005). When these symptoms continue to exist for at least a
month and meet the DSM criteria, a diagnosis of PTSD is ap-
plied (e.g., Cardena & Carlson, 2011).
The second is posttraumatic stress disorder (PTSD), an offi-
cial DSM IV-TR diagnosis (American Psychiatric Association,
2000). It refers to a psychiatric syndrome characterized by sev-
eral symptoms that continue for at least one month: 1) recurrent
re-experiencing of the traumatic event through nightmares or
intrusive memories. 2) Avoidance of stimuli associated with the
trauma, and emotional numbness. 3) Increased arousal includ-
ing symptoms such as insomnia, inability to tolerate noise, and
excessive response when startled. If most criterion are met but
the time passed since the traumatic event is less than a month, a
diagnosis of Acute Stress Disorder is given (Butcher, Mineka,
& Hooley, 2010). One should keep in mind that in many cases
*Corresponding author.

S. KIMHI, H. DORON
PTSD may be delayed and may develop long time after the
traumatic experience took place (e.g., Andrews, Brewin, Stew-
art, Philpott, & Hejdenberg, 2009; McFarlane, 2010; Smid,
Mooren, van der Mast, Gersons, & Kleber, 2009).
The current study focuses on wives of former combat veter-
ans who were officially diagnosed as suffering from PTSD,
either a short or a long time after their combat experiences.
Inter alia, our study focuses on one important aspect that has
been studied very little: the wives' experience, beginning from
their husband’s traumatic involvement until they recognized
their husband’s problem and the husband’s official diagnosis.
Negative Effects of the Combat Veteran
Husband on Spouse and Family
The negative effects of the husbands’ traumatic experience
have been studied with regard to: the entire family (Galovski &
Lyons, 2004; Gold et al., 2007; Ray & Vanstone, 2009;
Wezelman, 2011), spouses and children (Ben Arzi, Solomon, &
Dekel, 2000; Bramsen, Van der Ploeg, & Twisk, 2002; Dekel et
al., 2005; Dirkzwager, Bramsen, Ader, & Van der Ploge, 2005;
Ein-Dor, Doron, Mikulincer, Solomon, & Shaver, 2010;
Waysman, Mikulincer, Solomon, & Weisenberg, 1993); wives
of Israeli POWs (Dekel, 2007; Dekel & Solomon, 2006); mari-
tal relationships (Solomon et al., 2011) and parenting (Cohen,
Zerach, & Solomon, 2011). These studies have indicated many
negative effects of the PTSD afflicted former combat soldiers
on their entire own family. The current study explores how the
husband's chronic PTSD affect various aspects of family life,
such as daily functioning, economic situation, social life, lei-
sure time and couple relations over the years, from the wives
point of view.
One of the negative effects of the husbands’ chronic PTSD
on the families which were researched more extensively is
“secondary traumatization”. This term has been used to indicate
that people who come into close contact with a trauma victim
may experience considerable emotional upset and may, over
time, become indirect victims of the trauma themselves (Figley,
1983). Overall, studies have supported the concept of secondary
traumatization among wives of former combat soldiers (e.g.,
Ben Arzi, Solomon, & Dekel, 2000; Bramsen, van der Ploeg, &
Twisk, 2002). Yet, Renshaw et al. (2011) have demonstrated
that most wives of service members/veterans with PTSD in
their study experienced generic psychological distress that is
not conceptually consistent with secondary traumatic stress but
which reflects general psychological distress. The current study
examines how the wives of former combat soldiers describe
their own signs of distress or secondary traumatization.
Family Coping
In addition to distress symptoms, the current study examines
wives’ successful coping. Many factors affect both of these
aspects (e.g., Bonanno, 2004). Studies have indicated that the
family is one of the most important resources, affecting both
resilient and healthy development, as well as vulnerability as a
reaction to potential traumatic events (e.g., Bronfenbrenner,
2005; Hobfoll, 2001). McCubbin and his colleagues (McCub-
bin, Boss, Wilson, & Lester, 1980; McCubbin & Patterson,
1982; McCubbin et al., 1998) as well as other researchers
(Berger & Weiss, 2009; Wadsworth, 2010), when explaining
variability in military families’ responses to the crises of war,
observed that many families moved from crises to successful
adaptation and resiliency. Family resilience implies the capacity
of a family to successfully manage challenging life circum-
stances—now or in the future (Walsh, 1998). Most scholars
writing about family resiliency have focused on the relational
processes within families as the primary basis for considering
thei r r esiliency (e.g., Black & Lobo, 2008; Becvar, 2013; Wal sh,
2011). In order to better understand some of these factors, the
current study asked the wives what had helped them to cope
with this difficult situation, through the years.
Research Q uestions
The current study examines four main issues regarding the
effects of the husband’s PTSD on his wife and family. However,
beyond the general assumption that our subjects would report
many difficulties in living for years with a husband suffering
from PTSD, the inquiry in this study was not based on specific
hypotheses. The main questions were chosen mainly due to the
limited number of studies and especially the lack of phenome-
nological perspective on these issues. The four main questions
are:
1) What was the process that wives experienced beginning
from their husband’s potentially traumatic experience until they
recognized their husband’s problem?
2) How did the husband’s chronic PTSD affect various as-
pects of family life over the years: daily functioning, economic
situation, social life, leisure time, couple relation s?
3) What are the characteristics of the wives’ secondary trau-
matization?
4) What helped the wives to cope with hardships though the
years?
Method
Sample
As a first step, the authors asked a woman whom they knew
as participating in meetings of a support group of wives who
are living with former combat soldiers with chronic PTSD to
request that these women agree to be interviewed for our study.
Four wives (out of ten) agreed and then, a “snowball” sam-
plingwas used: Each interviewed wife was asked to refer to
other women she knew who were in a similar situation. Wives
were instructed to call the other woman and get her permission
to give the authors her phone number. This was an obligatory
precondition for the authors to call the next subject and ask her
to participate in the study and to be interv iewed.
Five wives refused to take part in the study. The final sample
consisted of 20 wives of former combat soldiers with chronic
PTSD. Ages of participants ranged from 35 to 61 (M = 48, SD
= 7.6). The husbands’ traumatic events were from the following
wars: Two from the Six Day War (1967), nine from the Yom
Kippur War (1973), two from the First Lebanon War (1982),
two from the Second Lebanon War (2006), and the five others
during reserve duty (one in southern Lebanon in 1987). Some
of the wives reported that their husband’s syndrome had started
immediately after the traumatic events (eight wives, 40%) and
the others (60%) reported that there was a process of deteriora-
tion (between a few months to several years after the original
traumatic event). The wives have two to four children each.
Ages of children ranged from 3 to 33 (M = 16, SD = 8.3).
Eleven of the wives (55%) have had a high school education,
190

S. KIMHI, H. DORON
five have had an academic education (25%) and four did not
report on their education. According to the wives, the official
percentage of disability of their husbands range from 70 to 15
(M = 44.2, SD = 15.8). However, five of the wives reported that
their case is still pending, and two of the wives did not report
this data. Ten of the husbands are unemployed and the others
either work part time or work for temporary periods inter-
spersed with unemployment.
The Interview and Analysis
The research tool was a structured interview constructed in
three steps: First, based on research literature regarding secon-
dary traumatization and wives of former combat veterans with
chronic PTSD, a first draft of the interview prepared. Second,
three wives living with partners who were former combat sol-
diers with chronic PTSD were interviewed for their comments
(they were not included in the final sample). Following this, we
changed questions according to their comments. Third, the last
step was repeated with another two wives (included in the final
sample). At the end of this step, the final version was con-
structed as follows: Each domain started with a general open
question, followed by specific questions (only if the informa-
tion in reply to the general open question was not sufficient). In
this way, every interviewee was allowed to respond in her own
way, with a minimum of guidance from the interviewers. Ex-
amples of the open questions: 1) When did you first realize that
your husband was suffering from combat stress reaction? How
di d y o u di sc ov er t his? What did y ou do with this understanding?
2) Please describe your functioning and that of your family in
general during the last year. 3) Tell us about your husband’s
and your social life during the last three years? 4) Describe the
relationship with your husband today? Have these relationships
changed during the years since your husband's official diagno-
sis?
Content analysis of interviews was done by attributing texts
to content categories (e.g., Krippendorf, 1980; Jones et al.,
2010). The process of building content categories was first
based on the interview’s predetermined four general open ques-
tions, which served as main categories. Each main category was
divided into subcategories. The process of building content
categories was first based on the interview with predetermined
four general open questions.
The process of attributing text to sub-categories (within each
of the main four categories) was conducted as follows: The
main researcher and two assistant researchers read the texts and
attributed them independently to content categories. Compari-
son of content categories among the three researchers revealed
high agreement of 84%. All texts which indicated no agree-
ments regarding their attribution to categories were brought up
for further discussion, and only if no agreement was reached
(less than 4%) another independent researcher was asked to
decide. Based on content analysis, the main categories and
sub-categories analyzed in this study were as follows: 1) Real-
izing the problem: Discovery of the problem, the understanding
process after the discovery. 2) Family functioning: daily func-
tioning, economic situation, couple’s social life, leisure time,
couple’s relations. 3) Characteristics of the wives’ stress symp-
toms. 4) Coping with hardships though the years.
The interviews took place at the interviewee’s home, after
receiving their personal permission to be interviewed. At the
beginning of each interview, the researcher clarified that the
purpose of this study was to explore the personal experiences of
being married to a former combat veteran with PTSD. In addi-
tion, complete anonymity was assured. It is important to note
that most of the interviewees displayed special interest in the
research and were happy to cooperate. All interviews were
recorded and transcribed word for word, excluding any possibly
identifying details. The length of each interview was between
one to two hours. The total number of interviews took about
two years to complet e.
Analysis
The Process of Realizing the Problem
About 2/3 of the wives reported that for a long time (in a few
cases up to several years) they did not know what the problem
was with their husbands and had no idea that it was connected
to his military experience. Those few wives, who knew from
the beginning, got the information from an official institution
like the hospital where their husbands had been hospitalized.
What made the process longer and more complicated was the
fact that more than half of the husbands suffered from delayed
combat reaction that later turned into PTSD. In other words, the
disorder did not appear in proximity to an identified experience
(e.g., such as participating in a war) but months or even years
after the husband’s traumatic experience occurred. Sometimes
the disorder started directly after an identified experience (e.g.,
reserve duty) and at other times, it developed gradually. These
conditions make it very difficult for most wives to understand
the causes and nature of their husbands’ problems. The follow-
ing are examples of the wives’ reaction to the general question
“how did you learn about your husband’s problem?”.
“My husband fought in the 1973 war as a platoon com-
mander ··· The outbreak started in 1988 ··· He was on reserve
duty and they had a simulation of war with casualties and how
to bury soldiers ··· Then he came home and tried to stay next to
me all the time ··· Later he started to cry and told me that on the
way home he did not remember the way and did not understand
where he was ··· Then he asked me to take him to a psychia-
trist”.
“I learned that my husband has combat reaction only after
our first son was born ··· I understood that something was
wrong ··· He had many outbursts of anger”.
It seems that not only had most of the wives lived with their
PTSD husbands for a long time before they were officially
diagnosed, but even when the diagnosis was made, wives re-
ceivedal most no information about the problem and got little if
any information from the relevant authorities. In some cases,
this process took up to ten years. Some of the wives described
how little they understood about their husband’s problem. Lack
of information and/or understanding of the problem are more
salient among wives whose husbands’ combat reaction started
after the 1973 war. The following are examples of the long
process of recognition:
“Since 1974 I have known that he has combat reaction, but I
did not know that combat reaction means nightmares and not
sleeping well at night. No one approached me ··· the doctor
asked me not to push him by asking for sexual relations ··· That
was the only thing (the doctor told me)”.
One wife related that her husband had kept his experience
and many of his symptoms a secret for many years and she
never thought that his problems had anything to do with trau-

S. KIMHI, H. DORON
matic combat experie nce:
“It was about seven years ago, I had a serious operation and
he was afraid that he was going to lose me and only then he
told us everything. He kept it inside for many years ··· I don’t
know how he had so much strength (to keep it as a secret) for
such a long time ···”.
Some of the wives reported temporary relief after their hus-
bands were officially diagnosed as suffering from PTSD. For
the first time they received some understanding of his strange
behavior and problems. For those wives it was some kind of an
official affirmation that their husband was sick and should not
be blamed for his behavior:
“I felt relief that there was a name for the problem. I felt like
I was breaking down from something. Maybe I was not neces-
sary, I don’t know ··· Instead of being happy, I cried”.
Overall, it seems that, for most wives, realizing and under-
standing that their husband had a PTSD syndrome took long
time. Moreover, in most cases, the wives hoped and expected
that things would get better sometime in the future. It took them
many years to accept and internalize that their husband’s case
was chronic, with ups and downs which they had to live with in
the long run. In most cases, it was a very difficult and painful
process and in some cases continues in the present.
Effects of th e Husba nd’s PTSD o n Fa m i ly Life
Daily functioning. Beyond the differences between the
families, all of the wives described many negative effects of
their husband's situation on daily family functioning. In most
cases, the wives described their husband as handicapped and as
unable to carry out small tasks that are usually associated with
normal family functioning: cleaning, taking care of the children,
shopping, and the like. All of the wives were very frustrated,
yet they were aware of their husbands’ low ability to take part
in daily family life. None of the wives blamed her husband for
his situation but all of them sounded desperately pessimistic for
any possible future change of the situation. For example:
“I think that my husband did not meet the children’s teachers.
I sent them to school, I did everything ··· I am the only one who
cleans ··· Most times I cook even though he is a great cook ···”.
There seems to be great similarity among the wives when
describing their husbands’ low level of daily family functioning
and lack of or little initiative: The husband waits for instruc-
tions about what to do. The main theme raised by the wives is
the fact that almost all of the responsibility for daily family life
rests on their shoulders.
Economic situation. About eight wives described economic
deterioration due to their husband’s situation. In some of the
cases, their standard of living decreased dramatically when the
family had to live on pensions from national insurance only.
For example:
“When he stopped working, our economic situation deterio-
rated and I had to work full time in one place and at another
half time job in another place ··· There were times when we
really had nothing to eat; simply there was nothing to eat at
home.”
“We were in an excellent [financial] situation and all of a
sudden boom! When my parents understood that we didn’t have
money they brought us food, took the girls shopping and this is
what saved me.”
In some cases the husbands’ PTSD, whether it had started at
once, or through a long process, caused him to quit his job (or
to be fired) while at the same time, the family had great ex-
penses for doctors, lawyers and medicine. As a result, most
families became financially hard-pressed and this made the
already complicated situation much worse. Some of the wives
said that without the children to care for, they would not have
had the ability or motivation to continue the struggle.
The Couple-Hood Realm
The “present-absent” husband. One of the most prominent
findings in the women's stories relates to couple-hood and a
familial reality in which the husband is “absent-present”. Physi-
cally the husband lives and is present in family life, although
not actively. His figure exists. However, sometimes his emo-
tional state causes him to detach himself from reality, as if he
does not feel or respond to those around him and/or his envi-
ronment. This gives rise to the impossible disparity between his
apparent and visible figure, seemingly alive, and his conduct,
lacking depth and content, the image of someone who is dying.
The language and the words these women choose to depict
this condition, as well as their tones of voice, varied among
wives and sharpened the differences in the way in which each
woman tells her story. Nevertheless, the experiences and feel-
ings are common and appear to express the same emotions. For
example:
“He is living-dead. Sometimes he says things like that he
would rather be dead, at least he would not suffer and would
not be a burden upon his family. Of course, this is the last thing
I would want to happen, and I'm most happy that he’s with us,
but I wouldn’t lie if I said that there were a few times, during
severe crises, that I thought that, in any case, he is like dead,
like some ghost in the house. Then ··· maybe it would be better
to know that he is dead and that’s it, and not to cope with this
gap between having him physically, and nothing inside.”
Social life and leisure time. Most wives reported that due to
their husband’s condition they have a very limited social life. It
seems that the wives’ limited social life takes place without the
husband and includes friends and their close family. Further-
more, they report very limited family leisure time due to the
husband’s difficulties in going away from home and enjoying
almost any leisure activity. For example:
“There is no social life at all. Since it happened, we have
done nothing, no vacation. Once we went to a hotel a minute
from home. He came because his psychiatrist asked him to get
out of the house, for me ··· I have gone out by myself in the last
four years. Before that, I was very afraid to leave him alone at
home ··· I go out with friends ··· I go abroad as a tourist with
friends.”
Couple intimacy. Most wives reported very limited intimate
relations and the majority of them said that they had often con-
sidered leaving their husbands and starting a new life. The main
reason for staying with the husband was the fear that he would
not survive the separation. It seems clear that the husbands’
PTSD affects the couple’s intimate relations significantly and
negatively. For example:
“We haven’t been intimate for the last couple of years. We
have not had sex for many years. When I asked him why he
replied that my body disgusts him. He says that I disturb his
sleep ···”.
Wives’ Secondary Traumatization
The most common reports regarding secondary traumatiza-
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S. KIMHI, H. DORON
tion are anxieties of all kinds and other symptoms also charac-
terizing the husbands’: general anxiety, phobias, sleep problems
and bad dreams, guilt feelings and hyper-arousal. In addition, it
is possible to identify fear of the future, possibly due to fear
stemming from the realization that reality is not going to
change, as well as the actual fear of the trauma being transmit-
ted to the children. Their stories reveal that the trauma experi-
ences sometimes cause them to dysfunction, to freeze, to disso-
ciate from reality and to “get stuck”. For example:
“I don’t have nightmares, I have guilt feelings and pain as
though it is me who went through the experience. Maybe it is
because I identify with him ···”
“I have anxieties. The re are times that I wake up with anxiety
and feel that I am choking ··· I could not get to sleep, I had real
anxiety.”
Overall, it seems that the wives did not talk much about their
secondary traumatization symptoms. When asked directly, they
described these briefly, as though this was not a central matter
compared to issues such as their family life. Furthermore, al-
most none of the wives mentioned feeling depressed and some
of them explained that they do not let these feeling gain con-
trols.
Coping with Difficulties along the Years
Most of the women mention three prominent domains as as-
sisting them to cope with hardships through the years. The first
is the emotional relations that preceded the traumatic event, as
fortifying their commitment to their partners: the love that was
and still exists and the sense that this is what marriage was
designated for—the difficult times the couple has to undergo
and when needed to help each other. For example:
“We have very great love and a true friendship. When you
see the closest person in the world suffering and falling apart,
you only want to help him. At least for me it’s like that. I will
fight for my family with all of my strength ··· There are so many
things to cope with ···”
The second domain is the partners’ reactions—the recogni-
tion, the embrace and the gratitude all constitute the oil that
maintains the fire of devotion, bound in sacrifice. This domain
also includes the women’s spiritual beliefs.
“··· so what helped me is myself. You realize that there are
things that you have to do in the universe, that you have a duty.
I'm not talking about raising the kids; there’s something that my
soul has to cope with and this will lead me to a better place.”
The third domain refers to the children. The interviewees
mention that the children are the fruit of marriage. More than
any other familial frame work, they are a strengthening factor
and provide compensating qualities like humor, optimism, and
a positive sense of future.
“What are the sources of strength? I don’t know ··· Look, I
say to myself, ok I’m carrying this, I’m a strong person. I have
my daughter which is this wish to carry on and not to fall and
not to crash and to give her, at least on my part, a happy place
in which to grow up, an optimistic and good place, good ex-
periences ···”
Discussion
The main goal of the current study was to learn from wives
of former combat veterans with chronic PTSD about their fam-
ily life. The following questions guided the current study: what
was the process of learning about the husband post trauma; how
the husbands’ situation affects different aspects of family life;
what secondary traumatization symptoms characterized the
wives, and what helps them to cope with this long-term chal-
lenging situation.
In most cases, the wives in this study indicated that for a long
time they did not understand the changes in their husband’s
behavior and had no idea that these were somehow related to
his army experience. Most studies that examine veterans with
PTSD and the effects on the family (e.g., Ein-Dor et al., 2010;
Gold et al., 2007) have not examined this period of disillu-
sionment, or recognition. Our study suggest that this stage,
which might take many months (sometime even years) is char-
acterized by lack of understanding and information, confusions,
shame and efforts to hide the husband’s situation from close
family members. Some of the wives describe this stage retro-
spectively as the worse period, since their husband experienced
the traumatic event. The most common response regarding this
stage was total misunderstanding of what the causes of their
husbands' unusual behavior were and how to explain their dete-
riorating condition.
The wives describe this first stage as characterized by lack of
communication and feelings of gradually detaching from their
husband. This description is compatible with former studies
(Solomon et al., 1987; Waysman & Mikukulincer, 1990) indi-
cating low levels of expressiveness and cohesion, as well as
high levels of conflict in veterans’ families, associated with
PTSD diagnosis among CSR veterans. However, since few
studies have explored the period from the potential traumatic
event until the formal diagnosis of PTSD, further studies are
required to widen our understanding regarding this stage. This
could grant practitioners and professionals adequate knowledge
about transmitting information about the PTSD diagnosis to
families.
The main issue explored in our study was the effects of the
husband’s situation on his wife and family. Our results suggest
highly negative effects on family life. The wives describe in
detail the tremendous negative effects on the following aspects
of their lives: daily functioning, economic difficulties, lack of
couple intimacy, poor parenthood and very little social life and
leisure time. These results corroborate other studies, indicating
the negative effects of the husbands’ traumaon the entire family
(Ben Arzi, Solomon, & Dekel, 2000; Bramsen, Van der Ploeg,
& Twisk, 2002; Galovski & Lyons, 2004; Ein-Dor, Doron,
Mikulincer, Solomon, & Shaver, 2010; Ray & Nanstone, 2009;
Renshaw et al., 2011; Solomon et al., 2011). However, these
studies mainly focused on levels of various symptoms com-
pared to control groups. Unlike these studies, the current study
focused on the subjective perspective of the wives describing
processes within their family life.
The authors think that the most important and genuine issue
revealed in this study is the “present-absent” husband phe-
nomenon. The wives described their husbands as physically
present, yet many times dissociated from family life. Some of
the wives used metaphors to name this situation such as “living
dead”. These “present-absent” situations leave the wife alone,
man y t ime s n ot on ly lac ki ng of su pport and someone to lean on,
but also with a constant demand to take care of and worry about
the helpless husband. In the worst case, they even talked about
constant worries when leaving home that their husband might
harm himself. It seems to us that this ongoing situation is one of
the most difficult for the wives in our study, and this is consis-

S. KIMHI, H. DORON
tent with former researchers who point to the numbness/
avoidance symptoms of PTSD as the most harmful to the fam-
ily (Evans et al., 2003; Hendrix, Erdmann, & Briggs, 1998;
Riggs et al., 1998; Taft, Schumm, Panuzio, & Proctor, 2008).
Furthermore, the ambiguity and disorganization in the
women’s lives is enhanced by the discrepancy between the
husband’s mental state and his physical condition. This dis-
crepancy finds expression in dissociation and detachment from
reality, which certainly bring about a disrupted perception of
reality. This notion is compatible with Pennebaker and Seagal’s
(1999) assertion that trauma, by definition, breaks the sense of
continuity, of flow and consecutiveness which is the basis for a
sense of meaning. Thus, it disrupts the perception of reality.
Overall, it seems that the use of metaphors and expressions
such as “dead-live”, “present-absent”, “empty within”, “wall”
and the like, assist the women in describing the intensity of
their feelings and emotions in the presence of such a discrep-
ancy.
Finally, all the wives we interviewed for the current study
stayed with their husbands regardless of the very difficult life
they have experienced, demonstrating rather high levels of
commitment to the relationship. This finding is compatible with
reports by Dekel et al. (2005) and Dekel (2007) that wives of
combat stress reaction veterans displayed moral and conscien-
tious commitment to their partners. It is plausible that the feel-
ings of commitment, devotion and care for the children together
with the idea that the husband might not survive separation has
served as the main bond holding the couple together and has
helped the wives to carry on. Moreover, the women in Dekel et
al.’s (2005) research reported some positive aspects of their
marital relationship, addressing the partners as “empowering”
in some way, which may also account for the effect of staying
in the relationship. To the best of our knowledge, this issue has
hardly been studied.
Limitations of the Study
The present research has some limitations, as follows: 1) The
small number of interviewees requires caution in generalizing
our findings to the general population of Israeli wives of veter-
ans with PTSD. However, one should keep in mind that quali-
tative research, like ours; aims to gather an in-depth under-
standing regarding a wife's life with a former combat veteran
husband who suffers from chronic PTSD. 2) It is difficult to
compare the current study with other studies regarding wives of
veterans with PTSD, which used mainly quantitative method-
ology. 3) Caution should be applied due to the fact that wives
of veterans with PTSD who have recovered to a considerable
degree were not part of the current study, yet their stories merit
inquiry and comparison to the current study group.
Conclusions and Suggestions for Future Studies
The main conclusion seems to be the tremendous aversive
effects of the veterans with chronic PTSD on their families for
many years, or even for their entire lives, since the husband’s
injury. The family lives of these people can be described as a
constant struggle for survival on the one hand, yet on the other
hand, the studied wives display high levels of commitment to
their “wounded” husbands. The women who participated in the
current study offer a rare and genuine glimpse into their narra-
tives. The women are diverse in their degree of clarity, con-
solidation and organization they grant to their stories; never-
theless, they reveal common themes of coping with their long-
term difficult situation.
Overall, a practical conclusion seems to be that wives of
former combat veterans with PTSD might well benefit from
early family consultation (preferably given by specialized psy-
chologists) to accompany, guide and support these families in
their long-term tough struggle to keep t h e ir heads above wate r.
It is highly recommend that further studies based on inter-
views with wives of veterans with PTSD should take place in
other cultures and include wives whose husband have recovered
considerably from their trauma.
REFERENCES
American Psychiatric Association (2000). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington DC: American
Psychiatric Association.
Andrews, B., Brewin, C. R., Stewart, L., Philpott, R., & Hejdenberg, J.
(2009). Comparison of immediate-onset and delayed-onse post-
traumatic stress disorder in military veterans. Journal of Abnomal
Psychology, 1118, 767-777. doi:10.1037/a0017203
Becvar, D. (2013). Handbook of family resilience. New York: Springer
Science + Business Media. doi:10.1007/978-1-4614-3917-2
Ben Arzi, N., Solomon, Z., & Dekel, R. (2000). Secondary traumatiza-
tion among wives of PTSD and post-concussion casualties: Distress,
caregiver burden and psychological separation. Brain Injury, 14,
725-736. doi:10.1080/026990500413759
Benyamini, Y., Ein-Dor, T., Ginzburg, K., & Solomon, Z. (2009).
Trajectories of self-rated health among veterans: A latent growth
curve analysis of the impact of posttraumatic symptoms. Psychoso-
matic Medicine, 71, 345- 352. doi:10.1097/PSY.0b013e31819ccd10
Benyamini, Y., & Solomon, Z. (2005). Combat stress reaction, post-
traumatic stress disorder, cumulative life stress, and physical heath
among Israeli veterans twenty years after exposure to combat. Social
Science & Medicine, 61, 1267-1277.
doi:10.1016/j.socscimed.2005.01.023
Berger, R., & Weiss, T. (2009). The posttraumatic growth model: An
expansion to the family system. Traumatology, 15, 63-74.
doi:10.1177/1534765608323499
Black, K., & Lobo, M. (2008).A conceptual review of family resilience
factors. Journal of Family Nursi ng, 14, 33-55.
doi:10.1177/1074840707312237
Bonanno, G. A. (2004). Loss, trauma, and human resiliece: Have we
underestimated the human capacity to thrive after extremely aversive
events? American Psychologist, 59, 20-28.
doi:10.1037/0003-066X.59.1.20
Bramsen, I., Van der Ploeg, H. M., & Twisk, J. W. R (2002). Secon-
dary traumatization in Dutch couples of World War II Survivors.
Journal of Counseling and Clinical Psychology, 70, 241-245.
doi:10.1037/0022-006X.70.1.241
Bronfenbrenner, U. (2005). Child care in the Anglo-Saxon mode. In U.
Bronfenbrenner (Ed.), Makinghuman being human: Bioecological
perspectives on human development. (pp. 274-282). Thousand Oaks,
CA: Sage.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal psychol-
ogy (14 ed.). New York: Al lyn & Bacon.
Cardena, E., & Carlson, E. (2011). Acute stress disorder revisited. An-
nual Review of Clinical Psychology , 7, 245-267.
doi:10.1146/annurev-clinpsy-032210-104502
Cohen, E., Zerach, G., & Solomon, Z. (2011).The implication of com-
bat-induced stress reaction, PTSD, and attachment in parenting
among war veter ans. Journal of Family Psycho lo gy , 25, 688-698.
doi:10.1037/a0024065
Dekel, R. (2007). Posttraumatic distress and growth among wives of
prisoners of war: The contribution of husbands’ posttraumatic stress
disorder and wives’ own attachment. American Journal of Or-
thopsychiatry, 77, 419-42 6. doi:10.1037/0002-9432.77.3.419
194

S. KIMHI, H. DORON
Dekel, R., Goldblatt, H., Keidar, M., Solomon, Z., & Polliack, M.
(2005). Being a wife of a veteran with posttraumatic stress disorder.
Family Reltions, 54, 24-36. doi:10.1111/j.0197-6664.2005.00003.x
Dekel, R., & Solomon, Z. (2006). Secondary traumatization among
wives of Israeli POWs: The role of POWs’ distress. Social Psychia-
try & Psychiatric Epidemiology, 41, 27-33.
doi:10.1007/s00127-005-0002-6
Dirkzwager, A. J. E., Bramsen, I., Ader, H., & van der Ploge, H. M.
(2005). Secondary traumatization in partners and parents of Dutch
peacekeeping soldiers. Journal of family Psycho lo gy , 19, 217-226.
doi:10.1037/0893-3200.19.2.217
Ein-Dor, T., Doron, G., Mikulincer, M., Solomon, Z., & Shaver, P. R.
(2010). Together in pain: Attachment-related dyadic processes and
posttraumatic stress disorder. Journal of Counseling Psychology, 57,
317-327. doi:10.1037/a0019500
Evans, L., McHugh, T., Hopwood, M., & Watt, C. (2003). Chronic
posttraumatic stress disorder and family functioning of Vietnam vet-
erans and their partners. Australian and New Zealand Journal of
Psychiatry, 37, 765-772. doi:10.1080/j.1440-1614.2003.01267.x
Everson, R. B., & Figley, C. R. (2011). The long way home: The after-
math of war for service members and their families. In R. B. Everson,
& C. R. Figley. Families under fire: Systemic therapy with military
families (pp. 277-286). New York: Routledge/Taylor & Francis
Group.
Figley, C. R. (1983). Catastrophes: An overview of family reactions. In
C. R. Figley & H. I. McCubbin (Eds.), Stress and the Family, Vol. II:
Coping with catastrophe ( pp. 3-20). New York: Brunner/Mazel.
Galovski, T., & Lyons, J. A. (2004). Psychological sequelae of combat
violence: A review of the impact of PTSD on the veteran’s family
and possible interventions. Aggression and Violent Behavior, 9, 477-
501. doi:10.1016/S1359-1789(03)00045-4
Gold, J. I., Taft, C. T., Keehn, M. G., King, D. W., King, L. A., &
Samper, R. E. (2007). PTSD symptom severity and family adjust-
ment among female Vietnam veterans. Military Psychology, 19, 71-
81. doi:10.1080/08995600701323368
Hendrix, C. C., Erdmann, M. A., & Briggs, K. (1998). Impact of Viet-
nam veterans’ arousal and avoidance on spouses’ perceptions of
family life. American Journal of Family T he rap y, 26, 115-128.
doi:10.1080/01926189808251092
Hobfoll, S. E. (2001). The influence of culture, community, and the
nested-self in the stress process: Advancing conservation of re-
sources theory. Applied Psychology: An International Review, 50,
337-421. doi:10.1111/1464-0597.00062
Jones, D. K., Evenson, K. R., Rodriguez, D. A., & Aytur, S. A. (2010).
Addressing pedestrian safety: A content analysis of pedestrian master
plans in North Carolina. Traffic Injury Prevention, 11, 57-65.
doi:10.1080/15389580903434199
Krippendorf, K. (1980). Content analysis: An introduction to its meth-
odology. Beverly Hills, CA: Sage.
Magruder, K. M., & Yeager, D. E. (2009).The prevalence of PTSD
across war eras and the effect of deployment on PTSD: A systematic
review and meta-analysis. Psychiatric Annals, 39, 778-788.
doi:10.3928/00485713-20090728-04
Marshall, M. G., & Cole, B. R. (2009). Global report 2009: Conflict,
governance, and state fragility. Fairfax, VA: George Mason Univer-
sity, Center for Systemic Peace and Center for Global Policy.
McCubbin, H. I., Boss, P., Wilson, L., & Lester, G. (1980). Developing
family invulnerability to stress: Coping patterns and strategies wives
employ in managing family separations. In J. Trost (Ed.), The family
in change (pp. 379-40 5). Visteras: International L ibrary.
McCubbin, H. I., & Patterson, J. (1982). Self Reliance Index (SRI). In
H. I. McCubbin, A. I. Thompson, & M. A. McCubbin, Family as-
sessment: Resiliency coping and Adaptation-Inventories for research
and practice (pp. 625-637). Madison: University of Wisconsin Sys-
tem.
McCubbin, H. I., Thompson, E. A., Thompson, A. I., & Fromer, J. E.
(1998). Stress, coping, and health in families: Sense of coherence
and resiliency. Thou s a n d O a k s , CA: Sage Publications.
McFarlane, A. C. (2010). The long-term costs of traumatic stress: In-
tertwined physical and psychological consequences. World Psychia-
try, 9, 3-10.
Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health
benefits of narra t ive. Journal of Clinical Psychology, 55, 1243-1254.
doi:10.1002/(SICI)1097-4679(199910)55:10<1243::AID-JCLP6>3.0
.CO;2-N
Ray, S., & Nanstone, M. (2009). The impact of PTSD on veterans’
family relationships: An interpretative phenomenological inquiry.
International Journal of N ur si ng Studies, 46, 838- 847.
doi:10.1016/j.ijnurstu.2009.01.002
Renshaw, K. D., & Campbell, S. B. (2011).Combat veterans’ symptoms
of PTSD and partners’ distress: The role of partners’ perceptions of
veterans’ deployment experiences. Journal of Family Psychology, 10,
953-962. doi:10.1037/a0025871
Renshaw, K. D., Blais, R. K., & Caska, C. M. (2011). Distress in
spouses of combat veterans: The importance of interpersonally based
cognitions and behaviors. In S. MacDermid Wadsworth, & D. Riggs
(Eds.), Risk and resilience in US military families (pp. 69-84). New
York: Springer. doi:10.1007/978-1-4419-7064-0_4
Renshaw, K. D., Rhoades, G. K., Allen, E. S., Blais, R. K., Markman,
H. J., & Stanley, S. M., (2011). Distress in spouses of service mem-
bers with symptoms of combat-related PTSD: Secondary traumatic
stress or general psychological distress. Journal of Family Psychol-
ogy, 25, 461-469. doi:10.1037/a0023994
Riggs, D. S., Byrne, C. A., Weathers, F. W., & Litz, B. T. (1998). The
quality of the intimate relationships of male Vietnam veterans: Prob-
lems associated with posttraumatic stress disorder. Journal of Trau-
matic Stress, 11, 87-101. doi:10.1023/A:1024409200155
Smid, G. E., Mooren, T. T., van der Mast, R. C., Gersons, B. P., &
Kleber, R. (2009). Delayed posttraumatic stress disorder: Systematic
review, meta-analysis, and met-regressions analysis of prospective
studies. The Journal of C l i ni c al Psychiatry, 70, 1572-1582.
doi:10.4088/JCP.08r04484
Solomon, Z., Debby-Aharon, S., Zerach, G., & Horesh, D. (2011).
Marital adjustment, parental functioning, and emotional shring in
war veterans. Journal of Family Issues, 32, 127-147.
doi:10.1177/0192513X10379203
Solomon, Z., Horesh, D., & Ein-Dor, T. (2009). The longitudinal
course of posttraumatic stress disorder symptom clusters among war
veterans. Journal o f C l i n i ca l Psychiatry, 70, 837-840.
doi:10.4088/JCP.08m04347
Taft, C. T., Schumm, J. A., Panuzio, J., & Proctor, S. P. (2008). An
examination of family adjustment among operation desert storm vet-
erans. Journal of Consulting and Clinical Psychology, 76, 648-656.
doi:10.1037/a0012576
Umbrasas, K. (2010). Keeping the diagnostic lens polished: Psycho-
logical reactions to stress. Annals of the American Psychotherapy
Assn, 13, 68-69.
Wadsworth, S. M. (2010). Family risk and resilience in the context of
war and terrorism. Journal of Marriage and Family, 72, 537-556.
doi:10.1111/j.1741-3737.2010.00717.x
Walsh, F. (2011). Family resilience: A collaborative approach in re-
sponse to stressful life events. In S. M. Southwick , D. Charney , & M.
J. Friedman (Eds.). Resilience and mental health: Challenges across
the lifespan (pp. 149-161). Cambridge: Cambridge University Press.
Waysman, M., Mikulincer, M., Solomon, Z., & Weisenberg, M. (1993).
Secondary traumatization among wives of posttraumatic combat vet-
eran: A family typology. Journal of Family P syc ho lo gy, 7, 104-118.
doi:10.1037/0893-3200.7.1.104
Wizelman, L. (2011). When the war never ends: The voices of military
members with PTSD and their families. Lanham, MD: Rowman &
Littlefield Publisher.