Contemporary Issue
The Woes of Waiting Wives: Psychosocial Battle at Homefront Lt Col Jyoti Prakash*, Wg Cdr RD Bavdekar+, Col SB Joshi' Abstract Few studies on stress have been carried out in soldiers and otber paramilitary forces deployed in operational situations because of tbe security concerns, practical difficulties of conducting combat psycbiatric studies and various other reasons. Studies on their families, who safeguard the family interests, during the period of absence of soldiers, have been even fewer. Significant contributions of researchers in this field were reviewed and suitubly interpreted. Analysis revealed various types of stress and tbe multiple coping methods being practiced. It also highlighted various preventive and remedial measures being undertaken by waiting wives and tbeir children. There is a need to understand and address tbe psychosocial issues of these families.
MJAFI2011; 67: 58~ Key Words: Waiting wives; Coping; Androgyny
Introduction eparation from the family due to the call of military duty has been a necessary evil of soldier's life. These prolonged and frequent separations not only impact a soldier's life significantly but also affect their wives and children, who are manning the homefront in a varied manner. In Indian mythology while Laxman goes with Lord Ram to fight one of the largest crusades ever fought, later to be known as Rarnayana, the contribution of Urmila who bore the distress of enforced separation with utmost sincerity stand out as the epitome of sacrifice by the military family. This article takes inspiration from these "heroes at home" and attempts to review all relevant literatore and discuss the woes of waiting wives. Our review brings out most of the relevant researches and literatures even to include important milestones like Second World War or Vietnam era. It will try to highlight the natore of stress affecting the families during various phases of separation, coping strategies being practiced by these waiting wives, predictors of good psychosocial adjustment and preventive strategies being practiced. Though this review attempts to cover the entire gamut of military family separation, it might lack the cultural colouring due to lack of any existing Indian studies in this direction.
inunense strain on the bond the of holy contractual agreement called marriage. The impact varies in natore and severity depending on the stage of the stressors being tackled, practices involved in the family and the coping mechanism of watchful expectants. Ashanka (Pre-separation): Extraordinary stressors are associated during the period of pre-separation, beginning with notification and terminating with separation of the family following movement of soldiers to the area of deployment. This period is characterized by general anxiety and tension within and between the family members. Nice reported significantly higher depressive affect scores in wives of naval sailors who were deployed as against wives of those not deployed. These effects began just before deployment. Interaction patterns between family members during the period of pre-separation were found to be the most important factors associated with these stressors, and supportive communication was found to be most critical in clear understanding of the changes associated with deployment
Stressors affecting waiting wives Separation enforced by the call of duty, induces
1. Disruptions of life patterns and routines.
S
[1].
Vll'aha (Separation): While the deployed soldier is surviving the adversities and war, the families at home are surviving a myriad of stressors, which are varied [2-7]. Stressors, which affect families generally, include the following [8-11]: 2. Assumption of new tasks and functions which
'Reader, Department of Psychiatry, AFMC, Pune-40. + Classified Specialist (Surgery & Plastic Surgery), 5 AFH, C/o 99 APO. 'Commanding Officer, 4014 Field Hospital, C/o 56 APO. Received: 30.04.2007; Accepted: 07.06.2010
E-mail:
[email protected]
The Woes of Waiting Wives: Psychosocial Battle at Homefront
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includes unilateral decision-making.
e. Jealousy regarding potential or real extra-marital affairs.
3. Lower standard of living.
f.
4. Assumption of new roles associated with helping family members and friends to cope during the deployment. 5. Inability to plan for the future. 6. Uncertainty about the soldier's welfare. 7. Deprivation of the soldier's support, especially in terms of the children's welfare. 8. Media reports associated with length, outcome and appropriateness of the war! deployment. 9. Anticipated loss in terms of long term effects of war! deployment on family members [12], and the anticipated! fantasized post war life. Punarmilan (Reunion): Dealing with the process of integration following return of the solider is equally or more stressful than periods during the war! deployment [13,14]. The joy or relief of reunion is short lasting and is soon masked by the distress caused due to adapting or modifying changes brought about by war [2,13,15,16]. The challenges are associated with the strains of reviewing what has happened to them during the separation and attempting to reorganize their lives as quickly as possible. These fundamental stressors can be grouped as follows: 1. Changes in the society: Many changes occur during the period of separation in the society and at home. Schuetz [17] aptly said, "The home to which he returns is by no means the home he left or the home which he recalled and longed for during his absence". 2. Changes in the family: Forced to reorganize, family members acquire new responsibilities like handling finances, making household decisions etc. Children may be burdened with additional tasks because of the father's absence, which require them to forego typical household activities and pleasures and adopt adult like responsibilities. The most frequent stressors associated with changes in the family are the following [3]: a. Family conflict over what is done at home, how and by whom. b. Criticism over maintaiuing contact involving evaluation over the frequency or quality of letters, calls and other communications from the soldier during her! his absence. c. Family rearrangement (Reorganization of family roles, routines and rules). d.
Shifts in social support network. (Soldiers may disapprove of continuing contact with these individuals).
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Disappointment over each person's homecoming fantasies. (Competition among the soldier and family members about activities to do when, where, and with whom).
3. Pressure to return to normal: Cuber [18] first documented the soldier's desire to escape from obligations of father and husband at least during the homecoming period whereas the spouse expects the returning soldier to make up for the lost time and devote more time to family matters [13]. Goonj (Echoes: long term post war stressors): Soon after the delayed! prolonged second honeymoons and vacations, families settle down to face the issues unresolved at the time of deployment which would have been exaggerated (e.g. marital conflicts, career decisions, major purchases etc.) and additional stressors brought out of physical separation and hardships of war. These include the following: 1. Struggling to return to normalcy. 2. Making decisions about careers and household quickly. 3. Confronting long-term resentments of family members. 4. Re-establishing personal relationship with family members. 5. Physical and medical disabilities: Dependency relationship, lowered self esteem. Stress reactions Psychological residues of war: Adjustment reactions and post traumatic stress disorder (PTSD) are the common forms of stress reaction. Other not so uncommon problems are fear of NBC poisons, lingering guilt about moral turpitude, if any and depression [19]. Secondary traumatisation: Numerous studies have confirmed the existence of this phenomenon amongst the spouses and children of war veterans [20-22]. People in contact with traumatized person may experience considerable emotional upset and may, over a period of time, become indirect victims of the traumatic events experiencing secondary traumatization [23]. In comparison to soldiers without PTSD, those with PTSDhad:
1. 2. 3. 4.
Higher estimates of PTSD in their partuers. Higher readjustment problem index scores. Lower life functiouing in general. Higher marital problem scores.
5. Higher family violence scores.
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6. Higher behaviour problem scores for their children. 7. Lower subjective well being for the spouse. 8. Higher spouse nervous breakdown index scores. Figley [24] suggested that secondary traumatic stress is an important frontier for scholars concerned with accurately accounting for the long-term effects of traumatic events. Given the evidence, he suggested that the secondary traumatization syndrome should be included in the discussion of PTSD in subsequent classification.
Coping patterns Effective coping patterns: A few researchers have worked on the various ways of coping in military wives and described the six following patterns [25-31]: 1. Seeking resolution and expression of feelings: Wives beyond the childbearing stage, who viewed their marriages and military life with satisfaction generally practiced this pattern. 2. Maintenance of family integrity: Seen in wives, who along with their husbands had fewer years of education and fewer educational achievements but were basically committed to military ways oflife. 3. Establishment of independence and maintenance of family ties: Seen in wives who had greater educational achievements, had more employable skills, felt less satisfaction with life in military and experienced legal problems (like power of attorney, purchase or sale of property, tax problems etc.) during separation. Legal complications appear to be both a result and a predictor to this pattern. There is a continued involvement with relatives, in-laws and parents and emphasizes the wives' autonomy through employment outside the home. 4. Reduction of anxiety: Wives who revealed little satisfaction with their marriages before and during the separation, and indicated a greater number of symptoms of tension and emotional strain, were more likely to emphasize the value of anxiety reducing behaviour. Symptoms of tension and strain are both predictors as well as residuals of this coping behaviour. 5. Establishment of independence through self development: Seen in wives who along with their husbands had fewer education and educational achievements, were basically committed to the military way of life but perceived weaknesses in the family system (health, finances, maturity) and financial instability as suggested by lower income. 6. Maintaining the past and dependence upon religion:
Wives who had limited experience with life in the military and experienced role adjustment difficulties (performing mother-father role, making decisions etc.) tended to emphasize the value of this pattern.
Models of coping These described patterns of coping in military wives can be analyzed conceptua1ly on the basis of Lazarus [32] cognitive theory of coping behaviour. His conceptual framework laid reliance on three major coping patterns (Direct action tendencies, defensive reappraisal and anxiety reaction). Four of the patterns mentioned (Resolution and expression of feelings, maintaining family integrity, establishing autonomy while maintaining family ties and establishing independence through self development) are all "direct action" highly functional patterns which aimed at strengthening the individual's resources to combat or adapt to stress and to protect against harm. Reducing anxiety is compatible with Lazarus anxiety reaction pattern; the threat of permanent loss of a husband, the ambiguity of the prolonged separation, the wife's past and present wives perceptions of an unsatisfactory marriage contribute to her feeling of estrangement and her questiouing of the future. Lazarus formulations also suggest that maintenance of the past, deuial of fear and dependence on religion are varied forms of psychological defenses, which are basically dysfunctional. These coping patterns and their predictors when considered together corroborate Hills [2] theory that a family's crisis and its response to that crisis are a funcrion of:
1. The wife's perception of the stress. (the probability of the return, husband's reason for deployment). 2. The hardships endured during the separation. (legal problems, role adjustment problems, symptoms of tension and strain). 3. The resources the family brings to the situation. (quality of the marriage, family strengths, education, previous experience with separation as a child, stage in the family life cycle, preparation for separation).
Patterns of coping Hill [2], in his classic study of families of servicemen separated by the demands of World War II, found a relatively predictable roller coaster type pattern of adjustments which involved initial disorgauization, followed by recovery and eventual disorganization. Not many studies have come to the forefront ever since to have a re-look at this fact.
Functional coping methods Limited empirical research in this field suggests that MIMI, W,l. 67, No. I, 2011
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The Woes of Waiting Wives: Psychosocial Battle at Homefront
war families cope with various war related stressors more effectively by following methods:
I. Increased social support by increasing contact with others, especially others in similar situation. This would include joining support groups, seeking help from qualified professionals or just talking to others. 2. Avoid unproductive worrying by channeliug energy into doing somethiug to help others and the troops (like forming a non-government body instrumental in reinforcement of military related welfare and benevolent measures). 3. Decrease unrealistic perceptions about the soldier's safety by maintaining contact with the soldier. These included writing letters to the soldier and others to express feeliugs. 4. Maintain physical health by focussing on healthy habits and appropriate exercise resulting in reduction in stress and boredom. 5. Increase the quality and quantity of family communication, which involved more one to one and group family discussions as a means of clarifying impressions and expectations and also rumour control. 6. Increase flexibility withiu the family with regards to roles, responsibilities and duties. Dysfunctional coping methods These methods of coping not ouly fail to effectively manage the stress related to deployment or war, they tend to create additional source of stress themselves [33].
I. Making radical changes like changing or selling homes. 2. Social withdrawal to avoid contact with those who may ask about the missing family member.
qualities that allowed women to act both instrumentally and expressively collectively termed "androgyny" [34] positively correlated to the degree of wife or family functioning. Management: These psychosocial issues in family of serving soldiers deployed in war! operations need to be addressed more aggressively. Prevention Cumulative literature has revealed several factors associated with lower levels of family stress and more effective family coping patterns. I. Comprehensive preparation of both the soldier and his! her family members for all aspects of deployment, separation, notification of injury! death, reunion and reintegration. Educational materials or hriefmgs can do these. 2. Frequent and early contact with other families coping with similar circumstances (Support groups, family welfare organizations). 3. Educational programs that would result in support and encouragement from the community, friends and extended family members. 4. Accurate, timely and available iufonnation regarding the circumstances (health, safety, schedule of return) of the soldier. 5. Provision of a single office or contact point for many families who do not live at or near a military installation to ensure adequate health and human service. Interventions The following steps are the elements of the most effective intervention programs:
4. Avoiding decisions until the missing family member can make them.
I. Adopting a family system orientation. View family as a unit of interconnected personal relationship. 2. Empowerment orientation-to build strength of families and provide interventions that are consistent with the needs as well sensitive to their social contexts.
5. Denying the absence of missing family member.
3. Brief and solution focussed orientation.
Psychological father presence: This theory was proposed by Boss [34]. Seen in a family with a physically absent father, a high degree of psychological father presence relates to the wife's dysfunction. A family with a physically absent father should reorganize itself into the one parent system so that it can cope more functionally with membership loss. Development of independence without the husband is functional, atleast until the husband returns to the family system. Parson et al [35] traditionally deliueated women to expressive behaviour and men to instrumental behaviour. Personal
4. Awareness of the immediate and long term consequences of traumatic events in family members and their relationships.
3. Abuse of substances: A significant correlation has been found between substance abuse and PTSD.
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5. Education of family about positive and negative consequences in a way that normalizes their existence and extermination. 6. Enabling each member of the family to adopt a positive view of the war related separation and anxieties. To have a family view of the crisis caused by the war and how to cope it.
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Prakash, Bavdekar and Joshi
7. Enabling the family member to be more prepared for future challenges by applying the lessons learnt from the current one. S. Involvement of defence services wives welfare association, NGOs, Red Cross etc. 9. Early detection and timely referral of family members with psychological and psychiatric problems.
References 1. Amen DO; Jellen L, Merves E, Lee RE. Minimizing the impact of deployment separation on military children: stages, current prevention efforts and systems recommendations. Military Medicine 1988; 153: 441-6. 2. Hill R. Family under stress. New York: Harper and Row 1949. 3. Hunter EJ. Families under the flag: A review of military family literature. New York: Praeger 1983. 4.
Solomon Z, Mikulincer M, Fried B, Wosner Y. Family characteristics and PfSD- a follow up of Israeli combat stress casualties. Family Process 1987; 26: 383-94.
Following interventions have been found useful during various operations and wars:
5.
1. Professionals working with military families affected by the crisis.
Solomon Z, Waysman M, Mikuliucer M, Benbenishty R, Florian V, BleichA. From frontline to hornefront: A study of secondary traumatization. Family Process 1992; 31: 289-302.
6.
Verbosky SJ, Ryan DA. Female partners of Vietnarn veterans: Stress by proximity. Issues in Mental Health Nursing 1988; 9: 95-104.
Commnnity interventions
2. Free education, consultation and counseling to local families in need. 3. Toll free phone lines to professionals qualified to help. 4. Formation of support groups and training. 5. Media liaison, information and networking. 6. Involvement of a professional body like Psychiatric! Psychological Society. 7. Installation of free security hardware and extra surveillance for homes of military personnel. In conclusion, the authors here have attempted to draw attention to the woes of these waiting wives, critically analyze their coping skills and understand the predictors for dysfunction in family to formulate appropriate preventive measures and remedial intervention for the "Urmilas of today" in addressing these psychosocial issues of waiting wives. We would like to give an analogy of relatives waiting for their kith and kin at an international airport. The ambience of waiting area is comfortable, there are appropriate authorities to inform the time of arrival and adequate facilities exist for recreation and diversion. There are frequent announcements and display of time of arrival of aircraft. The airport authorities take responsibility for the appropriate dissemination of information as regards arrival and delay of the arrival of aircraft. People are confident of the fact that in case of inadvertent delay or postponement! change of schedule of flight the passengers would be suitably looked after. Finally, the expectation materializes into reality at a distant horizon and slowly paces down to smoother airfield. After the arrival the baggage is rolled onto your footstep. In case of misplacement of baggage, the same would be relocated or compensated for. Conflicts ofinterest None identified
7. Williams eM. The ''Veteran System" with a focus on women
partners: Theoretical considerations, problems, and treatment strategies. In T. Williams (Ed.), Post traumatic disorders of
Vietnam veterans. Cincinnati OR: DisabledAmerican Veterans 1980; 73-124. 8. Figley CR. Critical services for the veterans of the gulf war. In Department of Veteran Affairs, VA Persian Gulf Returnees Working Group, War zone stress among returning Persian Gulf troops: A pre1imiuary report 1991: West Haven, CT: National Center for PTSD. 9. Figley CR. Strengthening military families: Mobilizing National resources (Proceedings of a conference held on October 4, 1990, Washington DC). 1991 Tallahassee: Florida State University, Marriage and Family Therapy Center. 10. Figley CR. Intervention with the family and children of the troops: War related secondary traumatic stress. In LA Levitt, NA Fox (Eds). Psychological effects of war and violence on Children. Hillsdale, NJ: Lawrence Erlbaum 1993; 184-96. II. Hobfoll SE, Speilberger CD, Breznitz S, Figley C, Folkman S, Leper-Green B et al. War related stress: Addressing the stress of the war and other traumatic events. American Psychologist 1991; 46: 848-55. 12. McCubbins HI, Dahl BB, Hunter EJ. Families in the military system. Beverly Hill, CA: Sage 1976. 13. Hogencarnp VE, Figley CR. War: Bringing the battle home. In Figley CR, McCubbin HI (Eds.), Stress and Family: Vol. II. Coping with Catastrophe, New York: BrunnerlMazel 1983; 148-65. 14. Stanton MD, Figley CR. Treating Vietnam veteran within the family system. In: Figley CR (Ed.), Trauma and its wake: The study and treatrnentofPfSD, New York: BrunuerlMaze11978; 281-90.
15. Hunter EJ. Long term effects of parental war time captivity on children: Children of POW and MIA servicemen. Jourua1 of Contemporary Psychotherapy 1988; 18: 312-28. 16. Wolfe 1. Preliminary reports on reunion survey on desert storm returnees. In the Department of Veteran Affairs, VA Persian Gulf Returnees Working Group, War zone stress among retuming Persian Gu1ftroops: A preliminary report. WestHaven, CT: National Centre for PfSD 1991. 17. Schuetz W. The Homecomer. American Jonrnal of Sociology MIMI, W,l. 67, No.1, 2011
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