I once knew a man who had served in Viet Nam who believed that he deserved to suffer for the things he did there.  He refused all pain medication to treat his terminal cancer.  I believe he suffered more from the guilt over what happened there than he did the disease he was currently experiencing.  It was painful to watch, knowing his pain could be eased, but that he wouldn’t allow it.

As a society, we teach our children that violence is wrong, killing someone is abhorrent, and that we have an obligation to step forward to prevent others from causing injury.  And then we send them off to war where they have to resort to the very behaviors they’ve had a lifetime of learning not to do.  It’s no wonder they come back with PTSD!

When we are forced to engage in behaviors that cause a conflict of interest, such as believing in the sanctity of life and then having to kill another person in combat, we violate our moral code.  At least in some instances, this is part of the basis of PTSD.  We don’t even have to be the instrument of death itself; we may witness others, and by not stopping their actions feel we are responsible.

Once someone experiences moral injury, s/he may become overwhelmed by shame, guilt, and anxiety over the possible consequences or anger over feeling betrayed.  Moral injury is tied to PTSD.  More research is needed to learn why some people develop PTSD while others go through similar circumstances without the same response.  Perhaps if treatment focused more on responding to the moral issues involved, it would prevent the development of PTSD, at least in some individuals.



In a national study of those who provided caregiver services to veterans, the following statistics were gathered. This information is from a study published in 2010.

Caregivers were asked what health condition the veteran to whom they provide care had. The response:

  • Mental illness was reported by 70%.3
  • Post-traumatic stress disorder (PTSD) (60%)
  • Traumatic brain injury (TBI) (29%)
  • Diabetes (28%)
  • Injuries to bones, joints, or limbs (24%)

The presence of diabetes or cancer is increasingly reported by caregivers of older veterans and those serving in Vietnam or earlier. [Depression/anxiety, PTSD, and spinal cord injuries are more common among younger veterans, particularly those who served in Vietnam or later).

Most caregivers say the veteran they care for is their spouse or partner (70%)

Only 16%, say they are caring for a parent or parent‑in‑law

About one in ten indicate that they are caring for their son or daughter (9%) (These relationships differ from caregivers in general; nationally, only 6% of caregivers are providing care to a spouse or partner).  Of note, not all family caregivers of veterans are actual family members; they may be friends, neighbors, or other non‑relatives.

Only 29% of caregivers of veterans feel they had a choice in taking on the responsibility of caring for their loved one. By comparison, nationally 57% of caregivers do.

Caregivers of veterans who feel, for whatever reason, they did not have a choice in becoming a caregiver are more likely to report impacts on their lives in terms of emotional stress, isolation, physical strain, financial hardship, children’s emotional problems, and work impacts. They are also far less likely to say the experience is fulfilling for them or that the knowledge and skills they are gaining give them a sense of reward. These effects are evident even though their burden of care appears to be equivalent to those who feel they did have a choice.

Most caregivers of veterans (69%) report typically spending at least 21 hours per week helping the veteran.  This includes 43% who spend more than 40 hours per week—three times the share of caregivers nationally who do (12%). 

Caregivers whose veteran has paralysis or diabetes are nearly twice as likely as their counterparts to spend more than 80 hours per week providing care.

Those providing care to a spouse/partner are in the most time‑intensive situations—half (50%) spend more than 40 hours per week, compared to 32% of those providing care to their child and 24% of those who have some other relationship to the veteran.

The long-term nature of the care being provided creates a situation where caregivers are at great risk of burnout.  The importance of providing support for the caregivers of veterans is evident.


Although many Veterans may not show any signs of intending to harm themselves prior to attempting suicide, some Veterans in crisis may exhibit behaviors that indicate they are thinking of harming themselves.

Veterans who are considering suicide often show signs of depression, anxiety, low self-esteem, and/or hopelessness, such as:

  • Appearing sad or depressed most of the time
  • Clinical depression: deep sadness, loss of interest, trouble sleeping and eating—that doesn’t go away or continues to get worse
  • Feeling anxious, agitated, or unable to sleep
  • Neglecting personal welfare, deteriorating physical appearance
  • Withdrawing from friends, family, and society, or sleeping all the time
  • Losing interest in hobbies, work, school, or other things one used to care about
  • Frequent and dramatic mood changes
  • Expressing feelings of excessive guilt or shame
  • Feelings of failure or decreased performance
  • Feeling that life is not worth living, having no sense of purpose in life
  • Talk about feeling trapped—like there is no way out of a situation
  • Having feelings of desperation, and saying that there’s no solution to their problems

Their behavior may be dramatically different from their normal behavior, or they may appear to be actively contemplating or preparing for a suicidal act through behaviors such as:

  • Performing poorly at work or school
  • Acting recklessly or engaging in risky activities—seemingly without thinking
  • Showing violent behavior such as punching holes in walls, getting into fights or self-destructive violence; feeling rage or uncontrolled anger or seeking revenge
  • Looking as though one has a “death wish,” tempting fate by taking risks that could lead to death, such as driving fast or running red lights
  • Giving away prized possessions
  • Putting affairs in order, tying up loose ends, and/or making out a will
  • Seeking access to firearms, pills, or other means of harming oneself

If you are a Veteran or know a Veteran who is showing any of the above warning signs, please call the Veterans Crisis Line today: 1-800-273-8255.



Emotional numbing is something those of us with PTSD must often contend with on a daily basis.   The problem isn’t that we don’t feel; the problem is that at a subconscious level we feel too much and to counteract that turmoil of emotion, we block everything out and we don’t share how we’re feeling.  It’s difficult though to maintain a relationship with our spouse, significant other, or children when they don’t know what we’re feeling or thinking.

When we clam up and don’t talk to those we care about, they unfortunately tend to think they’ve done something wrong, even when they haven’t.  Because we don’t want to face our emotions, we don’t talk about what we’re thinking and they take that to mean they were right in believing we are angry at them.  The truth is, whatever we are thinking about may have absolutely nothing to do with them.  It’s just that what we are thinking about causes us enough emotional grief that we tune everything out.  That’s a recipe for disaster as far as our relationships are concerned.

So, you might ask “How does one stop feeling emotionally numb?”  The answer is that we have to stop running from our feelings and face them.  We have to allow ourselves to experience those feelings in order to process and let go of them.

And, don’t kid yourself: it’s something that takes a lot of effort to achieve.  Although it may not be easy, you may want to at least try to assure those you care about that they aren’t the source of your silence.  Children especially tend to think they are responsible for how you feel.

Don’t let PTSD take your family and loved ones from you too.  The cost is too great.  They are worth fighting for; don’t let the silence of PTSD rule you and destroy your loved ones.