Families can be a key support for any veteran, especially those facing mental health challenges.
But relatives and spouses often don't know what they don't know about life in the military.
Illinois will soon provide a family preparation course about the emotional cycle of returning from deployment, as required under a new law that takes effect Jan. 1. Until then, here are tips that experts say veterans' relatives should know.
Military life comes with structure, routine, chains of command. The lifestyle changes veterans, and they notice it when they return.
"You're facing the world, where they don't operate on the same kind of principles or standard operating procedures that you're used to in the military. That's like a real culture shock," said Henry Tyler, veteran peer specialist for National Alliance on Mental Illness in DuPage County.
Always offer to listen
Veterans might not be ready to talk about their combat experiences, but they appreciate a willing ear and a show of empathy.
"Ask if they want to talk about what the experience was. Pay attention. Don't be afraid to say 'I've noticed you're staying in bed a lot, you're not going out. Are you OK?'" says Bill "Fallout" Atkinson, a Navy veteran who served in Vietnam.
PTSD signs, triggers
Combat veterans woke up every day of deployment knowing they could die. Imagine the stress that would cause, then imagine trying to deal with it. Welcome to post-traumatic stress disorder, or PTSD.
"I don't think a lot of people fully understand how trauma can affect a person and how they make decisions; their stress level. If they haven't dealt with any of it, the whole 'fight or flight' never shuts down ... We all have difficulty sometimes shutting off the hypervigilance," said James Spencer, an Army veteran whose brother, a Navy veteran, died by suicide; vice president of the Aurora University chapter of Student Veterans of America.
The four key signs of PTSD are hypervigilance; reexperiencing traumatic events; avoiding trigger situations; and changes in thinking and mood.
"Some of their survival responses that functioned well in context while they were deployed aren't going to go away right off the bat. Try to be patient," is the advice for families from Michael Brennan, psychologist and clinical director of the Road Home Program for Veterans and their Families at Rush University Medical Center in Chicago.
Moral injury is real
Actions required in war can contradict a veteran's sense of right and wrong. Conducting or witnessing these actions can lead to guilt and shame, which some veterans suppress instead of addressing through counseling or peer support.
"Moral injury is an internalized situation where the person feels they participated in such bad stuff that nobody can love them ... Forgiveness is a huge part of the healing process as well as rebuilding a lost sense of self-worth," said Jim Mukoyama, founder of Military Outreach USA.
Exiting the military means veterans lose a group of people with whom they shared their lives and on whom they depended for safety. The loss leaves a void.
"I always encourage them to make a community ... It binds people to recovery and their lives," said Robert Adams, retired founder of the Midwest Shelter for Homeless Veterans in Wheaton, a Vietnam veteran and PTSD therapist.
Veterans often relate best to other veterans, especially when seeking therapy or counseling.
"More veterans helping veterans would be incredibly welcomed ... You need a person that you don't need to explain yourself to," said Jonathan Birkey, an Army veteran who served in Afghanistan and president of the Aurora University chapter of Student Veterans of America.