Steve and Marilyn* are a gorgeous couple. Steve is tall, broad-shouldered, blue-eyed and sandy-haired, in perfect contrast to Marilyn's dark-eyed, olive-skinned petiteness. They are the sort of couple you envy, until you hear their story.
Ten years ago Steve was a decorated police officer till the day he "knew I couldn't go back, couldn't do it". After 18 years in the force, images of what each shift might bring ran through his head: a SIDS baby? A body off The Gap; someone's submerged, bloated son?
Unaware of what was going on inside his mind, Marilyn had a different perspective: "All of a sudden he quit his job and would spend the whole day at the beach," she says. "We had a toddler at the time who never slept, but Steve wouldn't ... couldn't ... help."
Being unemployed impacted on Steve's self-esteem to the point "he would put me down to make himself feel better", she says. Marilyn took a second job "just to stay away from him". Confused, resentful and depressed, she remembers, "I used to cry a lot. Some days I used to struggle to go to work myself."
Post-traumatic stress disorder (PTSD) may affect as many as five per cent of Australians at some time in their lives. And not all will be diagnosed. For men, particularly those in the emergency services or military, it's often work-related, but the greatest fallout is at home. Many have partners and young children, and all bear the brunt. To cope with trauma, sufferers shut down and put emotions aside to keep functioning. This may be an asset in the field, but not in family life. Some will eventually be able to share their struggles and reconnect emotionally, but many families will never know what haunts their men.
Steve and Marilyn are luckier than many. Now they can talk about it: his PTSD diagnosis, the derision of colleagues, the impact on their lives. I ask Steve what it was like to do his job when he became a father. "I knew I couldn't do it," he says. Suddenly Marilyn faces him. "You said that! That's one of the first things you said to me after the baby, that you 'couldn't do it'. I thought you were talking about our relationship!" "No," Steve says, shaking his head. "The job."
Matt and Kara had three young children when he returned from army service in East Timor. Kara first noticed something wrong when Matt "just had no reaction", she says. "To anything. He was like a robot. He shut himself off, never wanted to go out, even to family functions." At first Kara was frustrated, but that changed overnight when she suffered an ectopic pregnancy. "It burst, I was rushed to surgery and given hours to live. Matt went home and played computer games and told no one what had happened. Not even my family."
Distraught, Kara insisted he see a doctor and the PTSD diagnosis brought relief, but Kara "made the mistake of thinking it could just be 'fixed' ", she says. Matt was struggling with what wasn't an obvious physical injury. "He comes from a family of 'real men' who don't understand. It was hard for him," she says. But it also proved very hard for her.
Kara could deal with the PTSD, but their relationship came to an abrupt, devastating end when Matt and his counsellor had an affair. Kara had a breakdown - she was 10 weeks pregnant at the time. "I don't know how I managed to hang on to that baby. I had to take five tablets a day to do it. I literally threw up at the thought of it all." She doesn't blame Matt, but says it's PTSD that "destroys lives and destroys families".
PTSD has mental, emotional and physical effects: three clusters of symptoms include hyper-arousal (being anxious, irritable and easily startled), intrusion (sudden flashbacks, nightmares and re-enactments of the trauma) and avoidance (blocking emotions, withdrawal and disconnection from people and life). Many sufferers feel as if they are going crazy, as symptoms can be delayed, then triggered again and again for years, seemingly unrelated to the events that caused them.
When PTSD isn't diagnosed (and even sometimes when it is), many sufferers self-medicate with drugs or alcohol to numb symptoms, only to create new problems.
Rachel's family is another casualty. After nine months of "always waiting for the death knock, you don't take a full breath until they're back in the country", she was shocked when husband Paul returned from army service in Afghanistan and didn't even kiss her at the airport. "He just said, 'Right, okay, what are we doing?' No emotion, nothing." Rachel put it down to exhaustion.
But things didn't improve. The plans that had sustained her while Paul was away, finishing their home and travelling to Europe (with London ballet tickets booked), were dashed when it became clear Paul wasn't up to any of it. Instead he "went to bed exhausted and pretty much slept for the next two weeks. I kept making excuses for him: of course he's fatigued, maybe another cup of coffee."
But then it got bizarre. On walks, "Paul would be checking for threats in the bushes. Sometimes he'd hit the ground in the prone position. It was surreal." There were other changes, too. "He never used to swear but he would have uncontrollable road rage, every second word f... or c.... Then one day he was standing in the bedroom, just staring at the floor and saying, 'I can't get my shit together, I'm f...ed, I don't know what's wrong with me.' He just wasn't able to function." She was alarmed and confused but what was even more baffling was that Paul had received the all-clear in psychological screening before leaving Afghanistan.
Rachel desperately tried to get help but ran into closed doors. "Paul didn't want to open up to the in-house psychs because it ends up on record. He held it together for appointments, meaning I wasn't believed, and then he would be out of control for days afterwards from the effort of acting fine."
Annoyance and frustration soon turned into powerlessness and despair. Paul's PTSD was destroying their family, but Rachel wasn't eligible for counselling services. At the same time she felt the pressure of being the only person her husband believed could save him. "The most traumatic thing in my life was he didn't realise how sick he was and I couldn't get any support. I had to watch him get sicker and sicker, and I couldn't help him and I couldn't get him help."
Eventually, their 10-year marriage broke up six weeks before Paul was due to be screened again, when "the kindest, most gentle, warm-hearted man, the type that dogs and children gravitate towards" became violent towards her.
Now in treatment, Paul is recovering. But, says Rachel, "the impact of PTSD blew our family apart. He is well in himself, but our relationship was collateral damage."
Treatment for PTSD typically involves identifying symptoms, understanding the condition and reprocessing the traumatic experiences to minimise triggers. Then the work is to rebuild damaged lives. Partners and families also need help to grieve for the person who went to work and came home changed. Like any loss, this involves the tumultuous recycling of shock and denial, bargaining, anger, sadness and finally, hopefully, acceptance. It is at this point they can best support the sufferer. But this final salvation can be denied if sufficient help is not forthcoming.
It's a situation with which Debora is all too familiar. When her air force husband, Warren, returned from Somalia in 1994, they had two children, aged two and seven. "We'd just built our home and Warren was saying things like, 'I feel so materialistic. Five minutes ago I was living among people with garbage bags for roofs. Why do we need all this stuff?' " she says. "Before he was very social, but he became distant, to the point of me wondering if I'd done something wrong."
With a mounting sense of dread, she tried to make sense of why he'd changed: "Is he unhappy? Has he met someone over there? I would raise it and he would fob me off, but it felt like he could walk out the door any minute."
Later Warren started having panic attacks when he went out and would have to ring Debora to collect him. Eventually, they found help through a veterans' counselling service. Warren's diagnosis "was a relief", says Debora, but then she got angry: "Where is the husband I had?"
Warren improved, until the events of September 11, 2001, "triggered something ... he got worse, told me he was going to commit suicide", she says, struggling. "I remember the neighbours had a barbecue and he turned to me and said, "Deb, do you know what burning bodies smell like?" She was horrified. Warren was eventually hospitalised for 10 weeks, "which was hard for all of us. We missed him so much". One day, they smuggled the dog into hospital.
Finally Warren disclosed the PTSD to his employer and did not return to work. To add insult to injury, "most people wiped us", Debora says. "They didn't know how to deal with it and we lost a lot of friends."
In psychological terms, this is known as the "second injury". Trauma is compounded when trust is broken by people you think you can count on - when employers, family, friends and professionals not only let you down, but cause further distress.
Debora now runs a Facebook page called PTSD Support and Awareness. Her advice for partners of sufferers is: "Educate yourself because you are going to have to educate your kids, family, in-laws, everyone. The more you understand, the better you are going to be. Don't hide it from the kids. Join a support group, seek counselling and look after yourself so you can be supportive."
Debora has found some acceptance. "It's still a roller-coaster. But he's a good man, a good father and we've persevered. Some days we would say, 'It's not a good time to talk to Dad; he's not good today.' Looking back, my kids missed out on things like Warren not attending school events because he felt vulnerable in public. But he walked my daughter down the aisle. I know how stressful that was for him, but he was determined to do it."
Despite all that has happened, Kara is still hopeful for her family. "Our three eldest grew up with a dad, a decorated soldier, all muscle, big as a house. He used to run in their sports days. Now they see a different man. Every day is a battle for him. My greatest wish is that one day I will see the glint in their eyes like I used to, that they will be proud to say, 'Hey, that's my dad.' "
* All names have been changed.
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