En español | "I feel like I'm sleeping next to my brother.”
The soldier's wife answered my “How are you doing?” question with a mixture of sorrow and shame. Her husband had returned from Afghanistan with a traumatic brain injury and a missing limb.
In an unguarded moment, she was mourning the loss of the emotional and physical connection they once enjoyed. Her achingly honest answer was a reminder of an aspect of war, injury and caregiving that no one really wants to talk about: emotional and physical intimacy — or lack thereof.
When roles change and one person finds themselves as a caregiver, the balance in the relationship can shift in subtle but essential ways that often go unnoticed in the midst of exhaustion, medications, new routines and other emotional ups and downs. It follows that connectivity and intimacy would undergo a change as well.
And these changes can affect our mood and emotional well-being.
One caregiving daughter, on the front lines with her aging parents, spoke of gradually losing connection with her boyfriend when she'd return home physically and emotionally depleted.
“It was a similar feeling to the exhaustion of new motherhood, that sense I had of being completely ‘touched’ out,” she said.
The big shameful secret about caregiving — the thing that most of us don't want to talk about — is what does or doesn't happen when the bedroom door closes. That part of the relationship between a couple is a private and often taboo subject in our society.
Find a new normal
When my journalist husband Bob was critically injured in Iraq in 2006, it took a full year before I let my breath out.
I was pulled in so many directions as a wife, mother and with work, that sleep was my only constant craving. The concept of physical intimacy felt like summiting Everest.
In those early days, I was almost afraid to touch him, horrified by the metal staples in his head and the trauma of life interrupted by near death as he lay in a coma for five weeks. For months afterward, maybe years, I viewed him as more fragile, unable to “un-see” all that we had been through.
Every ache and pain he had brought me immediate fear.
Caregiving a spouse is about as sexy as crepe-soled nursing shoes. The yin and yang we enjoyed so effortlessly as a couple had veered wildly off course with his injury.
Every day I wondered if we'd ever be the same again or if trauma had damaged and rearranged us permanently.
We had many points to connect us. We were older. We shared four children.
As time passed, we worked our way back to intimacy and found a new rhythm together, the way that I imagine every couple does as time moves forward and years roll on. Intimacy is an ever changing landscape, never static and always evolving.
Part of this lay in accepting the “new us."
Realize mental health affects sexual health
Many of the injured veteran couples I'd met in our work at the Bob Woodruff Foundation were in the early parts of their marriages and relationships.
Many hadn't yet started families. For them, the road ahead without vast resources, or sometimes supportive families, was enough to break any bond. And too often, the legacy of injury and war is post-traumatic stress disorder (PTSD).
Not surprisingly, a large percentage of these relationships did not survive.
Mental health issues can be the wet blanket thrown over a healthy libido. According to the 2015 study “The Elephant in the Bedroom: Sexual Functioning in Military Populations,” young male military personnel with a psychological injury may be 30 times more likely to report experiencing ED symptoms than those without a psychological injury.
Yet only 12 percent of those with sexual functioning problems sought treatment.
Sexual health is a huge contributor to overall mental health, but this is still an often overlooked and uncomfortable subject. VA physicians aren't required to include questions about relationships and sexuality in their checkups with injured patients although I know that some have begun doing so.
In the civilian world, broaching that topic may depend completely on the physician and how much time he or she has. For many couples, starting that conversation without an entry point from a doctor is impossible, laden with the shame of failure.
Share feelings, concerns
Like any difficult subject, talking about intimacy and sharing stories is often the key to finding solutions.
Ohio resident Barbara King Fairbanks became a caregiver to her husband shortly after their marriage when an accident left him paralyzed. In their early 30s at the time, life looked completely different from how they had envisioned it.
“Our physical relationship ended, but our relationship as spouses is still strong,” Fairbanks wrote. “Our common purpose unites us as does a great sense of humor. We laugh a lot.”
Intimacy takes on many different forms. For couples who are unable to resume a physical relationship, focusing on the other shared joys or interests in life are often the way back to feeling close and connected.
There is no one prescription for every couple travelling along the caregiver road, no magic bullet, just as there is no one universal truth about all relationships. Each one is unique.
When Bob was recovering, some of the most intimate acts to me were simply to hold his hand, touch his face or lay my head in the crook of his shoulder. The power of touch was a potent substitute for the life we had once enjoyed.
At the end of the day, intimacy is about sharing, whether that's feelings or a sense of humor or an experience.
The more we can articulate what we need, what we miss and what we wish for, the closer we feel to one another. There can be no greater gift than to unburden, no greater reward than to connect to another human being.
Caregiver Annette L. Hicks from Landaff, New Hampshire, said it best on the AARP Family Caregivers Discussion Group on Facebook: “A relationship can survive without physical intimacy. A relationship can survive without emotional intimacy. It cannot survive without either.”
Katy Dondanville, associate professor of research at UT Health Science Center in San Antonio, has three tips to help increase the connection and intimacy between a caregiver and loved one:
1. Physical touch that occurs in the process of caregiving can sometimes begin to feel clinical.
Reintroduce physical touch in a personal way by doing something as simple as holding hands, hugging or sitting close to your partner. Note: Individuals with PTSD tend to stay on guard against danger; be mindful not to come from behind to initiate touch.
2. Words of praise, kindness and affection can go a long way to restore intimacy.
Try to catch your partner doing something nice and express gratitude with an “I” statement. For example, “I appreciate it when you put your coffee cup in the dishwasher."
3. Memories connect us to our partners and also bring up good feelings and tender emotions. Pull out photo albums, videos or simply talk about past pleasant memories to find greater connection.
Keep in mind that increasing the connection and intimacy with your partner can take time, especially when it has been dwindling or nonexistent for a while.
Stick with your renewed actions for at least two weeks. Consistency is key to increasing intimacy between a couple.
How have you found intimacy with loved ones during the process of caregiving? Can you share some ways you connect or stories you have about making your relationship stronger despite the demands of caregiving a loved one?