Returning to civilian life from active duty is notoriously difficult for soldiers suffering from posttraumatic stress disorder, or PTSD. But in some cases, those difficulties are compounded when traumatised veterans become violent or emotionally abusive towards their family.

David Forbes, the director of Phoenix Australia – Centre for Posttraumatic Mental Health, says it is estimated that one-in-five Australian veterans suffering from posttraumatic stress disorder may be at risk of committing acts of physical or emotional violence against their family.

He says the figure is based on reports from clinicians and academic research, mainly from the US. 

“The small amount of research does suggest that there is a link,” said Professor Forbes. “It’s obviously not as though everybody with PTSD necessarily engages in domestic violence or partner violence, but it does increase the risk.” 

That risk increases further for those who sustained PTSD through military service.  

According to the Department of Veterans’ Affairs, around five-to-20 per cent of veterans will experience PTSD at some point after they have completed their service. 

In some cases, PTSD symptoms may not be exhibited until a number of years after the traumatic event, with many sufferers resorting to self-medication, in particular alcohol, as a means of alleviating their pain. 

A variety of symptoms are associated with PTSD, but it is hyper-arousal and hyper-vigilance that are most likely to result in violent or aggressive behaviour.

“The small amount of research does suggest that there is a link. It’s obviously not as though everybody with PTSD necessarily engages in domestic violence or partner violence, but it does increase the risk.” — David Forbes, director of Phoenix Australia – Centre for Posttraumatic Mental Health

“Part of PTSD is this sense of feeling keyed up and on edge,” Professor Forbes added. “The person’s already primed up and ready for action, particularly in military populations where they’re primed for threat detection.

“The risk in interpersonal and family contexts is that situations are quickly perceived as threats and as attacks, even at the social level rather than the physical level, and it is responded to quite quickly. It precedes thought; it precedes consideration and the response is occurring almost automatically.” 

Because most of the research into the link between domestic violence and PTSD in veteran populations has been conducted in the US, Professor Forbes said that caution was necessary when generalising and applying the results of that research to the Australian context.

However, a DVA spokesperson confirmed that a major joint study was under way to collect data specific to Australian veterans. The research, which is part of the department’s Transition and Wellbeing Research Program, is focusing on the mental health of personnel who ended their full-time service between 2010 and 2014. The University of Adelaide is conducting research into military personnel, while the Australian Institute of Family Studies is looking into the family sphere. 

Even if Professor Forbes’ one-in-five estimate of PTSD sufferers at risk of committing acts of family violence turns out to be inexact, Karen Willis, the executive officer of Rape and Domestic Violence Services Australia, says the estimate is unsurprising. Like Professor Forbes, she is quick to emphasise that PTSD and similar mental illnesses alone do not make people violent. PTSD, she adds, is an “enabling factor” rather than an explanation for violence.  

Mrs Willis argues that the primary cause of domestic violence is gender inequality. If gender inequality wasn’t the primary cause, she says we would expect to see domestic violence being committed at roughly similar rates by both men and women. However, family violence is overwhelmingly committed by men against women.  

“The risk factors for men experiencing violence and then using violence in their relationship is exponentially higher than for women,” Mrs Willis said, adding that women who sustain PTSD through their military service are at a greater risk of self-harm.

After more than 30 years working with victims of family violence, Mrs Willis is well acquainted with the complex social, cultural and psychological roots of domestic violence. Her own experiences and the best available research suggest to her that it is assumptions about masculinity and sex-role stereotypes that are particularly responsible for domestic violence. Men who believe that women should be passive and submissive, or who are motivated by similar concepts of gender inequity, are more likely to commit acts of violence.

The combination of gender inequality and PTSD can be explosive: “you put them together and all hell is absolutely going to break loose,” she added.

“The risk factors for men experiencing violence and then using violence in their relationship is exponentially higher than for women,” said Karen Willis, the executive officer of Rape and Domestic Violence Services Australia, adding that women who sustain PTSD through their military service are at a greater risk of self-harm. 

But like Professor Forbes, Mrs Willis is quick to return to a point that is repeatedly emphasised: men who are not motivated by the sexist assumptions that she describes will not suddenly become violent towards their wives because of PTSD.

Part of the problem in understanding the correlation is that PTSD has not always been well understood, especially by the general public. 

Although it did not emerge as a specific diagnosis until after the Vietnam War, battle trauma is not a new phenomenon. Swiss physicians in the 17th century described symptoms exhibited by soldiers similar to PTSD, which they called “nostalgia”. 

During the First World War, traumatised soldiers were said to suffer from neurasthenia or “shell shock”. The return of traumatised Australian soldiers from that war could also herald suffering for their family members.

Elizabeth Nelson, the author of ‘Homefront Hostilities: The First World War and Domestic Violence’, examined domestic violence in Victoria immediately after the war ended and believes her research has implications for how the link between PTSD and domestic violence should be understood today.

While she is confident that the historical record shows that there is a link between war trauma and domestic violence, Dr Nelson cautions against always attributing acts of violence by returned soldiers to PTSD. Like Mrs Willis, she believes doing so may obscure causes that are more deeply rooted in social conditioning. 

“Given violence was prevalent before the war, how do we know if it was the war that made them violent?” she said. “I can’t just assume it’s the war, so it was useful to look at their repatriation files. In some cases there seemed to be a correlation between some kind of psychological disturbance and violence towards their wives.”

But in other instances battle trauma could be used as a pretext. In one case that Dr Nelson examined, a soldier facing criminal charges for attacking his wife received a lenient sentence because he was described as a returned soldier despite having never seen combat.

Some cases she studied did demonstrate how shell shock could profoundly change veterans. In the course of her research, she would uncover poignant testimony of wives who suffered at the hands of traumatised husbands. In one court proceeding, a woman described how the abuse she suffered could be both physical and emotional.

“In 1914 he went to the war and returned in 1918,” a transcript reads. “Since he came back I have noticed a marked change in him. He has been cruel to me. He has kicked and punched me. My body is all bruised. He has endeavoured to misuse me. When I refused, he threatened to take my life. In my company in the street, he used vile language.” 

War trauma was not well understood in 1918. Despite pioneering efforts in clinical psychology, shell-shocked soldiers would often receive poor treatment or were neglected altogether. Even today, veterans of Vietnam, Iraq and Afghanistan often say they feel neglected by mental health services. It is clear that this neglect can also have consequences for the families of veterans. 

Jeff Jackson, a reserve officer and Vietnam War veteran, who works for the RSL helping veterans with PTSD adjust to civilian life, is blunt about the impact of PTSD.

“There would only be a handful of us who don’t have PTSD,” he said. “I don’t know why. We were all exposed to the same things. It comes down to the individual. Some people say ‘Well, you’re a hardass’. Well, maybe that’s what it is. You just block it out and get on with it. I don’t know.” 

Despite the many problems that still face returning veterans, Mr Jackson believes that the situation has improved greatly since the Vietnam era.

“Over the years, [the Department of Veterans’ Affairs, DVA] have learnt and currently with the younger vets there is quite a bit of help available to them,” he said.

Now, when a compensation claim is lodged with the DVA by a veteran suffering PTSD, a social worker will call to check on that veteran’s welfare. Mr Jackson says this sort of care was not available to Vietnam War veterans. 

“The [department has] changed a lot,” he continued. “They’ve realised you can’t be adversarial all the time because they’re dealing with people who are like a hand grenade about to go off.”

While Mr Jackson is happy to praise the DVA’s willingness to modify its practices and the way it treats veterans, he says this gradual process has been marked by tragedies. 

“I remember, probably nine years ago now, a bloke had just come up from Geelong,” he said. “He went up to their information office on the 11th floor, stood at the counter, pulled out a revolver and shot himself in the head. He’d had enough of them. A Vietnam vet. He’d been put through the hoops one too many times.” 

Major General David McLachlan, the president of the Victorian RSL, says that the treatment offered to returning veterans continues to improve. In fact, veteran’s organisations such as the RSL may be among the few interest groups satisfied with measures taken in last year’s Federal Budget.

“There would only be a handful of us who don’t have PTSD . . .  It comes down to the individual. Some people say ‘Well, you’re a hardass’. Well, maybe that’s what it is. You just block it out and get on with it. I don’t know.” — Vietnam War veteran Jeff Jackson

Mr McLachlan says the government delivered on the RSL’s requests.

“There have been a lot of steps taken by DVA and the Department of Defence, the latter in counselling and providing the opportunity for people who are still serving and returning to be able to be assessed in terms of their mental health.” 

He also believes that mental health resources are improving.

“The point that also needs to be recognised is that the government has placed no cap on the resources directed towards those areas that affect mental health, and a Prime Ministerial advisory council has been established for younger veterans,” he said.

Professor Forbes is also optimistic about the future of PTSD treatment, as well the ability to protect families from violence at the hands of trauma sufferers. 

“Where we are now compared to where we were 20 years ago is a long way down the track,” he said. “We have treatments that work.”

Clinicians will make sure that in cases where domestic violence is a risk, it will be treated as a problem in its own right and not just as a symptom of PTSD, he added. “Clinicians are now clear that domestic violence must be the first point of intervention. Intervention targeting the PTSD will follow on from that.”

Currently, the Federal Government spends around $179 million a year to help fund the DVA’s mental health services. This includes funding for online mental health information and support, GP services, psychologist and social work services, specialist psychiatric services, pharmaceuticals, posttraumatic stress disorder programs, and in-patient and out-patient hospital treatment.

► If you or someone you know is impacted by sexual assault, domestic or family violence, call 1800RESPECT on 1800 737 732 or visit 1800RESPECT.org.au. In an emergency, call 000. For practical information and confidential support visit I-DECIDE, an online interactive tool for women in unhealthy or unsafe relationships.