Publisher Health

To hear more audio stories from publications like The New York Times, download Audm for iPhone or Android.

The night our world changed, I was in a copper baron’s palatial Adirondack home, writing about the history of the poorhouse. That afternoon, with the stained-glass reflections of autumn colors blazing through my window, I pored over an 1832 vendue contract auctioning the care of three female paupers to the lowest bidder in Sandown, N.H.

I had taken a year’s unpaid leave from teaching at the State University of New York at Albany to write a book about technology and poverty. It was the first book I’d written for a popular press, the first written as a journalist rather than a scholar. I knew I had chosen risk: insecure income, shifting health insurance, a left turn from my career path that might not pay off.

During my monthlong writing residency, I had no cell service, so I struck up an epistolary romance with Jason, my partner of 11 years. He told me about his dreams: a tiny U.F.O. banging against his shins, failing to abduct him; a nightmare about killing someone and fleeing the law. I confessed my discomfort with the retreat: I was writing about the 19th-century exploitation of the poor, the very people ground into mortar to build the storied estate where I was staying.

On Oct. 8, 2015, I stepped out onto the veranda, in a vest and scarf against the cold. The fiery colors of the near-peak leaves had vanished, giving way to the night sky. I threw my head back in hopes of glimpsing a meteor shower. But the clouds obscured the Draconids, so at about 10 p.m., I went to the basement computers to check my email.

From: “Jason Martin”

Subject: Re: Yup!

Date: October 8, 2015 at 6:14:34 PM EDT

To: “Virginia Eubanks”

Virginia!

bad nwews. I just got outta the ER where ive been for almost 24 hours. i jot jumped late last night by the deli. nobody I recognized. They kicked and punched me on the groupnd for a long time apparently. But the wierdestpart is how it passed so quickly and intensely I iddnt even have a reaction. I may have lost conciousess for a moment or two. cause next memory is sitting on chair in deli with cops asking questions. … oh wow so tired and so messed up right now. despite the good prognosis. . its takng all my energy to write this, so sorry for brevity and inabiity ti make it a more readable piee

xoxoxoxoxox

jason

My ears buzzed and my breath caught. I staggered to the residents’ phone booth. Rubbing my fingers nervously over the graffiti scratched by decades of artists into 100-year-old planks, I dialed Jason’s cell number, and his father answered. They were together. Jason was stable. But his jaw was broken in three places. A cheekbone broken. An eye socket.

I was ready to jump into my ancient pickup and rattle home, but Jason’s dad deterred me. As much as I wanted to rush to his side, there was nothing I could do before morning but watch him sleep. If my truck broke down along the Northway, I would be stranded.

I left the woods as the sun was rising the next day and arrived home to learn the details. Several men had beaten Jason unconscious less than two blocks from our home in Troy, the small city in upstate New York where we live. He was walking back from the corner store with Zebra Cakes and Camel Lights, and someone asked for a cigarette. When he turned to respond, he was hit the first time. He thinks there were four or five guys, all or mostly white, probably in their 20s and 30s. But he can’t be sure. He remembers just flashes: shoes in a circle around his head, waking up in the folding chair, a jagged moment of light and sound during the ambulance ride.

It was good that he didn’t remember more. The damage to his face and skull required six and a half hours of plastic surgery to repair.

That attack marked the beginning of our struggle to navigate a relationship transformed by trauma. Since then, I think I’ve read just about everything that has been written about how to support a loved one healing from post-traumatic stress. Among other things, I’ve discovered how devastating caregiving can be for those of us partnering someone with PTSD. While Jason’s diagnosis wouldn’t arrive for a few more months, and while my own clinical troubles would take years to emerge, that attack is an incandescent dividing line. Everything else — falling in love, building a life and our unknown future — now arranges itself in relationship to that moment, arrayed before or after what we call the Catastrophe.

When Jason and I got together in 2004, I was going through a numbing divorce from a man who left town with his best friend’s wife 10 days before I defended my Ph.D. dissertation. That I stayed in the relationship as long as I did left me feeling like a chump. “He was just your grad-school husband,” my friend Rachel consoled me over the phone. “Your self-esteem is so low in grad school.”

Jason had been a friend for years. I was newly single, playing the field. Considering my options, I spied him in a crowded barroom and thought: Jason Martin — that would be fun. And I tipped my cowboy hat so it covered both our faces and kissed him. Jason resisted my attempts to get him into my bed, his slowly unfolding woo suggesting a longing for durability, for depth. I resisted his resistance, herding him toward shallow intimacies like a Border collie.

Jason asked, “What are your three superpowers?” When I couldn’t identify any, his face drew together in mock concern. “Oooohh,” he said, shaking his head, “I can’t go out with you again until you know your superpowers.” Something in him sensed that my confidence was at a low ebb, and he wanted me undiminished, undimmed. The next time he called, I had a list: I can make anything taste good. I have a magic ray that makes everyone feel sexy. I see people as they really are.

A musician and artist, Jason was a local celebrity in the Capital region. He lived in Schenectady in his early 20s and helped community members make TV shows for the local public-access cable station, creating operatically bizarre video art to play in late-night schedule slots. After a failed bid for City Council on the Green Party ticket, he moved to nearby Troy and opened a music studio and performance space. He created Power Animal System, a genderqueer art troupe, and performed all over the region, decked out in 1980s-era ladies’ business suits, wigs and wolf masks. When the independent newsweekly tired of trying to categorize his creative output — as poet, musician, producer, video and performance artist — it named him the region’s “Best Jason Martin” three years in a row.

Where Jason went, community flourished. His superpowers were legion. He was at home anywhere. His mind was brilliantly unconstrained. He brought out people’s creativity, dragging them onto open-mic stages, shoving instruments into laughingly resistant hands. “Now you’re a musician,” he would say. “Play!”

We feasted, profligate with our health and extravagant in our desire for each other. After roast pork shoulder and dark chocolate, we would smoke cigarettes in my apartment with greasy fingers, dancing to Captain Beefheart records and Ethiopian pop. We had what I took to calling “Lie Detector Sex.” Because I grew up in a household shaped by the secrets and separations of alcoholism, Jason’s emotional openness and physical fearlessness were both provocation and revelation.

We faced struggles like any couple: I was more wounded by my divorce than I’d hoped; his boundary-pushing could shade into carelessness with my feelings. A few years after we started dating, he was diagnosed with bipolar disorder. His case was relatively mild and well controlled, with few of the symptoms that wreak so much havoc on relationships: no suicidal ideation, no sexual or financial shenanigans. He saw a psychiatrist regularly and adjusted medications when necessary. We saw a couples’ counselor when our relationship needed mending.

I bought a house in South Troy in 2009, and we moved there together, filling it with talismans of our devotion. We sheetrocked a cartoon he drew of the two of us inside a first-floor wall. In the backyard, we planted a Montmorency cherry tree, known for its jewel-toned, half-sweet, half-sour fruit. We buried beneath it a tiny bundle — rose petals for romance, cinnamon for spice, our initials intertwined. We cemented a block print of the tarot card for strength — a woman holding open the jaws of a lion — under our threshold. Written on its back: “Protect this house, those who pass through it and the love that makes it a home.”

The attack happened, by my count, 127 steps away from our front door.

After Jason had plastic surgery on Oct. 23, 2015, the hospital didn’t keep him overnight for observation. Instead, they gave me a small set of wire clippers and told me that if the anesthesia or the pain made him sick, I should cut the wires holding his jaws together so that he wouldn’t aspirate on his own vomit. I curled myself into a tiny ball on the corner of the bed and watched him, terrified, holding the wire cutters, until I fell into a restless sleep near dawn.

The next morning, I went to the drugstore to pick up his painkillers. The pharmacist informed me that the prescription had been canceled. The system showed we did not have health insurance.

In a panic, I called our insurance provider. The customer-service rep assured me that it was a technical glitch and reinstated our prescription coverage so I could pick up Jason’s pills. But when I looked up our account on the company’s website, it showed that all our claims for the plastic surgery had been denied. We owed $38,962.47.

That night, I moved into the small in-law apartment on the first floor of our house. I was listening to the internal voice that whispered I would need my sleep to get through what was to come. But also sharing a bed with Jason would be like sleeping with a fitful nuclear bomb. He radiated heat, sweated through the sheets, his arms flailed and his feet pedaled. Nightmares shocked him awake dozens of times a night.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma is an event involving “actual or threatened death, serious injury, or sexual violence” intense enough that it overwhelms a person’s ability to cope.

Our bodies respond to trauma before we can apprehend the experience in our thoughts or feelings. Senses are heightened, adrenaline is released and the emotional and rational parts of the brain cede control to the autonomic nervous system, responsible for regulating primal bodily functions such as heart rate, digestion and respiration.

The three most well-known responses to trauma are fight, flight and freeze. The fight response prepares the body for battle. A blinding rage gives you energy and tunnel vision, and you lash out at perceived attackers. The flight response prepares the body to run, compressing you into an unpredictable spring of kinetic energy. The freeze response shuts everything down and prepares you to survive a brutal onslaught.

Fight, flight and freeze are all common, adaptive mechanisms for surviving assault, rape, battle or natural disaster. You have little conscious choice about which path you take when threatened with existential harm.

A 2016 study estimated that more than 82 percent of Americans will experience at least one traumatic event during their lifetime. But according to national surveys, a much smaller number, about 4 percent of men and 10 percent of women, will develop post-traumatic stress disorder.

I came to see the canonical symptoms of PTSD as mirrors of trauma responses. The intrusive thoughts, nightmares and flashbacks that psychiatrists call “re-experiencing” echo fight responses. Re-experiencing occurs when a sensory stimulus such as a sound, image, smell or even an invention of your dreaming mind — a trigger — pulls you back into the moment of trauma as if you are living through it again. Pathological vigilance, irritability and jumpiness, known as reactivity, feel like flight responses that have outlived their purpose. Avoiding people, places and activities that might trigger a trauma response recalls the body’s protective shutdown during freeze. Taken to its extreme, any of these symptoms can worsen into dissociation, essentially the mind splitting off into an altered state, resulting in blackouts and lost time. There is also another set of PTSD symptoms laid out in the DSM-5: negative thoughts and feelings that began or worsened after the trauma. This always seemed to me self-evident. Existential trauma is a stone-cold bummer.

Many people who endure a traumatic event will experience nightmares, jumpiness and emotional numbing in its wake. A PTSD diagnosis, however, requires that symptoms last at least a month. PTSD is a disease of persistence.

People who are bipolar, like Jason, are more likely to develop PTSD after a traumatic event than the rest of the population, though the etiology and symptoms of the two illnesses are entirely different. Bipolar didn’t change Jason’s fundamental character. When his depression was particularly acute, he retreated to rest and recover, but he remained a kind, open, creative and generous man, the partner I knew. PTSD was different.

Fighting through the aftermath of the attack was exhausting. But it was also very simple, all action and no feeling. I experienced a state some partners of the chronically ill call survival euphoria. I picked the closest lion, and I wrestled it down.

I fought to get Jason, in pain and frustrated, gasping and seething through metal and gauze, into his rusted 2008 Hyundai Accent after the plastic surgery that rebuilt his face and skull. I fought — in the end, successfully — to get our medical insurance reinstated and our medical debt cleared. I fought to manage the extraordinary generosity of our community. A fund-raiser to support Jason’s healing made the local news, and 200 people showed up. I had laryngitis, but I attended anyway. Wearing a long scarf, I didn’t say a word the entire evening, gesturing to my throat and shaking my head again and again.

On Halloween, I blended fun-size Butterfingers in milk so Jason could drink them through his extra-wide smoothie straw. On Thanksgiving, I blended turkey, stuffing and chicken stock. I managed Jason’s medications, giving him his oxycodone and then hiding the bottle when he bellowed for more, like a drug-seeking bear, an hour later.

Then, in December, Jason was leaving his first performance after the attack when a drunken homophobe perceived him as queer and tried to attack him in the street. While friends prevented the irate man from landing any punches, Jason endured verbal abuse, death threats and was chased through the street while his jaw was still wired from the surgery.

After the second attack, he disappeared for three days, a stretch of time that he still doesn’t remember. By January 2016, a clinical psychologist had diagnosed him with PTSD.

From the outside, our life looked normal. We hired a wonderful aide with the money from the fund-raiser, and with her help, Jason managed to keep his job as an adjunct instructor of video art at a local college. Jason attended weekly therapy sessions with a clinical psychologist specializing in trauma. He even managed to play a few gigs at house parties.

But our private world was harrowing. Jason hid weapons behind doors and under beds. He had a special system for defending himself against imagined intruders: a brick to throw, then a bat to swing if they persisted and then, finally, a knife for up-close combat. He put plywood over the windows. Junk-food wrappers and dirty clothes piled up. Agoraphobia meant that the garbage didn’t always make it out of the house for pickup. A few dirty dishes were overwhelming, and they quickly morphed into impregnable piles.

I stayed downstairs in my tidy bubble, mounting emergency cleaning expeditions to the second floor every few weeks. Even so, we endured a series of infestations: moths, ants and, finally, mice.

I became hypervigilant about Jason’s hypervigilance, constantly scanning the horizon for threats. I worried that the laughter and trash talk of neighborhood kids would be too loud; that fresh baked bread would be too soft and he would tear it trying to butter it; that his keys would be misplaced or the car wouldn’t start on the first try; that it would be too hot or too cold, or too sunny or too rainy, that he wouldn’t have a warm jacket or sunglasses or a working umbrella at hand.

Any one of these things transformed a normal morning into a tsunami of explosive rage followed by shuddering withdrawal. Blue skies, then the meteor, then the ice age.

Leading lights in PTSD research — Janina Fisher, Bessel van der Kolk, Pat Ogden, Dan Siegel and others — like to talk about the crucial role “interpersonal neurobiology” plays in treating trauma. The theory is this: As social creatures, human beings learn from birth to regulate our emotions by interacting with others. Optimally, caregivers will respond to an infant’s hysterical cries with caring gestures: calm rocking, shushing. They will identify needs — Is the baby hungry? Wet? — and do their best to meet them. Good-enough caregiving, the theory goes, leads to secure attachment, and in that safe space a child learns to regulate his own emotions, meet her own needs. In other words, interpersonal neurobiology suggests that our ability to regulate our emotions doesn’t just arrive as we hit developmental milestones; it evolves in relationship with people around us.

When we are hijacked into reliving a trauma or become withdrawn and shut down — what psychologists call dysregulated — we regain emotional balance as we once learned it: communally. Ruth Buczynski, president of the National Institute for the Clinical Application of Behavioral Medicine, suggests that “relationship is paramount” to healing trauma.

Healthy relationships are both vaccine against PTSD and potential cure. Meta-analyses of existing studies in 2000 and 2003 found that poor relationship quality was among the strongest factors in developing PTSD after a traumatic event. A 2010 study found that good social support leads to increased improvement in patients seeking therapy for chronic PTSD.

You need strong relationships to survive the kind of psychic wound Jason suffered during the attacks. The paradox is that trauma’s lingering impacts can enfeeble human connection, weakening even the strongest of social bonds. PTSD takes from us the very thing we need to heal from it.

I tried to maintain some semblance of my former life: I worked on the book, started a new research project, was offered a job and briefly considered moving us both to Philadelphia. When I wasn’t working, I made appointments and returned calls: therapists, doctors, human resources, insurance companies, co-workers, family and friends. Jason kept going to therapy every week as the scars faded from his face. But he was dogged by insomnia — nightmares and hypervigilance kept him awake at night, and he spent most of his daylight hours watching TV and drifting in and out of sleep on the living-room couch. I scheduled meal deliveries and dropped off laundry at the fluff-and-fold. I looked for blackout curtains and white-noise machines on Amazon. I fought and fought.

Then, I fled.

On the first anniversary of the beating, I was in Los Angeles on a reporting trip. For the second anniversary, I was on the road, working on the new research project.

When I was away, I desperately tried to feel something — anything — for myself. In Helsinki, Finland, to speak at a conference of Nordic social workers, I sat in a 190-degree smoke sauna and then padded outside, barefoot and mostly naked, to plunge into a hole in the ice in the Baltic Sea, over my head in the black near-freezing water, once, twice, three times.

In 2016, I was on the road 147 days. In 2017, I was gone 97 days.

We needed the money I earned through speaking engagements and research grants. But to claim that all my travel was materially necessary would be disingenuous. I wanted space and time away from the maelstrom of PTSD. I wanted to leave as much as I needed to leave.

In December 2017, we decided to experiment with traveling together. Before the attacks, we were partners in adventure — we drove hundreds of miles of Route 20, visiting 1930s-era attractions: sifting through a museum of petrified creatures, spelunking in Howe Caverns, trying to choose a favorite roadside cheeseburger. We tramped the Adirondacks and floated in the Sacandaga reservoir. He ducked under security fencing to photograph crumbling 19th-century hotels while I kept lookout from the car.

We wanted to try to recapture that feeling. We used all my Amtrak points to buy two round-trip tickets in a sleeper car for a seven-day trip to Montana for my mom’s 75th birthday. In theory, it was perfect: a tiny fishbowl of our own, traveling across the country at a leisurely pace. I imagined we would read, play cards. I bought a tiny electric kettle so we could make tea while the world passed outside the windows.

In practice, it was a nightmare: a tiny fishbowl in which we were trapped together. Jason didn’t sleep. He was easily triggered and emotionally volatile. He snapped at me, other passengers, the conductor. I seethed and withdrew, thinking how much fun I would be having if I were alone.

One night in January 2018, shortly after my father died, I came upstairs to share dinner with Jason, sad and exhausted and seeking comfort. “I’m feeling super vulnerable today,” I said. “So please let me know if you can’t be nice.”

I’m not sure why that request precipitated the worst fight of our relationship. Perhaps it was the veiled suggestion that Jason had changed so much that he might hurt me when I was vulnerable, the insinuation that he was no longer the man he used to be.

I remember that a look crossed his face, the look our cat gets when he has spotted a mouse — ears perked and gaze sharpened. I felt a malevolent part of Jason — a part I hadn’t imagined existed — turn its attention to me. I can’t remember much about the fight, but I know I felt like prey. I cried on the kitchen floor. Jason watched television nearby, silent and checked out as I sobbed. It felt as if I were living with an angry, cruel, terrified stranger who wore Jason’s face.

The dark joke among PTSD caregivers is that your partner becomes the “T” in your own PTSD. PTSD researchers point out that during trauma, prey automatically orients to the predator, giving the threat all its attention. Jason oriented to people yelling outside the house, strangers on the street, angry white men on TV.

I oriented to Jason.

In August 2019, Jason and I shared two packs of American Spirits. We’d both quit smoking by then, but we decided that any time you get rejected by a mental hospital, you get to buy a pack of cigarettes.

I’d just returned from a monthlong reporting trip in Iowa and Illinois for a story about government debt collection. Jason was in awful shape — the thousand-yard stare I knew meant dissociation, and under the surface of this blank, numb gone-ness, the simmering of unpredictable rage. I asked when he had last eaten. He said he didn’t know. I asked when he had last showered or changed his clothes. He didn’t know. I asked when he had last taken his medication. No idea.

I called our couples’ therapist, and she suggested that I take him to the hospital, arguing that he needed inpatient treatment. “He’s not doing any of the things that are necessary to keep living,” she said, and coached me through what I should say when I tried to check Jason into a behavioral-health crisis center. Use the phrase “decreasing function,” she said. Use the phrase “passive annihilation.”

We hoped for a three-day admission that might stabilize his medications and his mood, offer new possible treatments, and give us both a moment of rest. We waited in the E.R. for five hours, Jason sitting beside me wearing a ball cap pulled down over his eyes, sunglasses blocking his peripheral vision, hovering like a rabbit about to bolt. The unit was full, and as long as he was not suicidal or homicidal, the nurses finally told us, his care was a low priority. We were welcome to wait, they said, but it might be all night. The sounds of the hospital were triggering Jason’s PTSD, and he deteriorated as I watched. About half an hour after he curled up, fetal, on the floor of the E.R., I gave up and took him home.

It had been almost four years since the attacks, and we had weathered it all with white-knuckled grippings onto our old life. Like a liturgy, we had assured ourselves time and time again that we were making real progress, that we were on the road back to normal. “We’re halfway through,” we had promised each other, six weeks after the attacks. “Halfway there,” we said at six months. And again at the one-year mark, and at the two-year mark: “Halfway,” we repeated with increasing desperation. “Halfway.”

The failed attempt to get Jason into inpatient treatment wasn’t a simple setback. It was the moment we started to wake up to our new reality. There would be no back to normal.

Jason’s PTSD was proving resilient, but not remarkably so: A 2018 study found that 50 percent of cases globally last more than two years, and 23 percent last more than 10. I read more clinical studies, trauma theory, memoirs and self-help books to understand, to interrogate, to find a way forward. Seeking fellow travelers, I pored over websites and online support groups.

One author, assuming everyone with PTSD was a veteran, asked: “Is he more controlling since returning from war?” The book advised me to respond to attempts to restrict my activities and police my actions by “maintaining a sense of humor.”

A website argued that because people with PTSD may fear abandonment, any suggestion that I might leave the relationship could “intensify their symptoms and make conflict worse.”

Another book offered pointers on adjusting my communication style: I should drop everything I was doing and give Jason all my attention any time he spoke. I should maintain eye contact at all times. I should ask for permission to interrupt before I speak.

“If at any point he looks bored or agitated, or starts shutting down or questioning your motives,” the book advised, “quickly summarize your reflections and stop.” The more I looked for help, the angrier I got.

Most people with PTSD in the United States never served in the military, but much of the research on the subject in this country is funded by the Department of Veterans Affairs. So while there is little data on post-traumatic caregiving in nonmilitary families, research shows that the partners of veterans with PTSD “have a greater likelihood of developing their own mental-health problems.” Studies of Vietnam vets have shown that partners of those with PTSD report “lower levels of happiness, markedly reduced satisfaction in their lives and more demoralization” compared with partners of returning soldiers without PTSD. Caregivers also report stress, unmet needs and instances of physical and emotional violence in their relationships.

The V.A. recognizes this and has tried to address it. As of June 2022, about 37,000 families were enrolled in the V.A.’s Program of Comprehensive Assistance for Family Caregivers. The program, established in 2010, provides training, health care and a small stipend for family members of seriously wounded veterans. A 2019 analysis by Katherine E.M. Miller and her colleagues found that caregivers in the program who received a modest stipend — $600 to $2,300 monthly — were able to work substantially less at their day jobs.

There is no Program of Comprehensive Assistance for Family Caregivers of victims of community violence or rape.

Researchers and psychologists call partners like me “supportive others.” The RAND Corporation calls caregivers of veterans with PTSD “hidden heroes.” Everyone seems to agree that we are crucial to healing. And yet, we are asked to paper over the cracks in institutional support systems with strips torn from our own skin. Without adequate assistance, we are offered two equally unthinkable choices: Martyr yourself or leave.

The night we failed to get Jason into the mental hospital, I tucked him under a blanket on the couch, made him a hot cocoa and left him watching Netflix. I sat on the back porch, smoking a cigarette, making a hard decision: I had to stop traveling. I said no to dozens of invitations, slowly clearing my calendar, but I still had that article about government debt to finish. I was scheduled to do another monthlong writers’ retreat, so half a dozen of our most extraordinary friends stepped in to help.

Each of them claimed a day to stop by, check that Jason had eaten, make sure he was taking his meds. They brought guitars, doughnuts, YouTube recommendations, gossip. Occasionally one of them would have to take Jason by the hand, lead him into the kitchen and ask him gently to eat something, spoonful by spoonful. It was an all-amateur, all-volunteer psych ward.

Despite the evidence amassing in my journal, I had trouble admitting that I was exhibiting my own signs of PTSD: panic attacks, hypervigilance, emotional numbing, nightmares.

Each week, I took a 14-hour round-trip train ride from Montauk to Albany to check in and make phone calls: hospital, therapist, insurance, repeat. The most stubborn obstacle was finding a psychiatrist to adjust Jason’s medications. It took five weeks to schedule a session. When I explained our situation through tears, begging for an emergency appointment, a receptionist responded, “They’re all emergency appointments.”

While we waited, Jason was unable to teach his class. After finally getting a new prescription, he had to wait for the new meds to start working, and the rest of the semester slipped away. We were crushed when we received a letter from the university informing us his teaching contract would not be renewed. He was now officially out of work. I prepared to hunker down and accompany Jason through the maze of the unemployment and disability systems. Our income dwindled. My responsibilities doubled.

Researchers sometimes talk about the communicability of PTSD as if it were a form of dark magic, the miasma of mental health, like the bad air once thought to cause plague. They suggest that caregivers suffer from vicarious trauma, that we catch secondhand symptoms from overempathizing, from simply imagining the assaults on our loved ones. Or that caregivers develop compassion fatigue because we fail to focus on our own well-being.

In December 2019, I started to keep a journal. In it, I described almost comically transparent nightmares: dreams about broken pipes spewing water overhead, dreams of drowning. Though I’d made sure that Jason had a social network, my own relationships were strained. In the first year or so after the Catastrophe, we received such an outpouring of support that it was easy to feel grateful, surrounded by love. But after four years, my friends got on with their lives — had babies, moved, took new jobs — while part of me was still stuck in 2015. I had taken so much water out of the well of my friendships; I felt guilty sending the bucket down again. I was exhausted, and in my limited free time, all I wanted to do was go to the woods, sit in silence and do nothing. To revel in being responsible only for myself.

In 2020, trying to dispute a medical bill that had gone into collections, I got stuck for most of an hour in a hellish labyrinth of broken voice prompts and singularly unhelpful call-center workers. After I hung up, billing error still unresolved, I began to pace, stalking back and forth in the cramped in-law apartment, mind racing, until my legs gave out underneath me. I cried so hard that one of my eyelids turned inside out, and then climbed into the hottest shower I could stand. I started taking deep breaths to calm down, but I was so out of control that I began to hyperventilate.

Despite the evidence amassing in my journal, I had trouble admitting that I was exhibiting my own signs of PTSD: panic attacks, hypervigilance, emotional numbing, nightmares. Finally, I asked the psychologist I was seeing regularly to give me the Clinician-Administered PTSD Scale for DSM-5. I ranked up a symptom severity score of 33 out of 80, placing me in the “moderate” category.

My PTSD diagnosis was possible because the DSM-5 designates that a “qualifying exposure” to trauma can occur in any of four ways: direct personal experience, witnessing trauma to others, repeated exposure to gruesome details of traumatic events or indirect experience through a family member. According to the DSM-5, my trauma originated in learning about Jason’s trauma; it arose in that moment when I stepped off the veranda beside that sylvan lake and checked my email.

But I disagree.

I believe my PTSD was caused not by empathy, or by referred suffering or burnout but by living with someone with PTSD and an avalanche of daily, direct “small-t” traumas: impossible paperwork, the broken health care system, mounting debt, a constant exhaustion that fed isolation from family and community. My traumatic exposures were the fruit of institutional failures: Every time Jason was denied resources he needed to heal, I was left to pick up the slack.

The pandemic trapped Jason and me in the house together, for better and worse. Things deteriorated enough that we separated in July 2020, Jason moving into an Airbnb despite our Covid fears. He came back when we ran out of money, three weeks later. After hearing about Jason’s continued difficulty with focus and emotional control, our couples’ counselor suggested he might also be suffering from a traumatic brain injury. “Count backward from 100 by sevens,” she instructed him. “Spell ‘world’ backward.” Jason was laughing, but he couldn’t do it.

It took us six months to schedule an appointment with a neuropsychologist. After performing a comprehensive series of tests, she reported that he most likely had a moderate traumatic brain injury, which worsened his psychiatric symptoms and resulted in cognitive deficits, based on his description of losing consciousness during the attack, his slowed mental processing, trouble with memory and problem-solving and — most troubling for a musician — diminished fine motor control.

A neurologist might be able to give us more answers, offer new resources. It took us nine months to make that appointment, but we went to one together in October 2021. The neurologist didn’t see any evidence of a traumatic brain injury on Jason’s M.R.I. or electroencephalography, but he was deeply concerned about cardiac events that could result from his persistent insomnia.

“Less than four hours of sleep a night will kill you,” we both remember the doctor saying. His clarity startled us into action. Jason moved off the living-room couch, where he slept most nights, and back into the upstairs bedroom. He shut off screens two hours before bedtime, established a sleep routine. Finally, he began to get real rest.

Jason settled into a combination of Eye Movement Desensitization and Reprocessing (E.M.D.R.), sensorimotor and talk therapies. I relied on a cognitive behaviorist and a genius bodyworker who combines massage with internal family systems therapy. Jason meditated and arranged visits from friends; I guarded my time alone and hiked until my legs felt rubbery. And slowly, things started to improve.

We reclaimed our house. We threw out what I had taken to calling “the depression couch.” We repainted the bedroom and rearranged the furniture. We put up a wall of pictures reminding us of better times.

We were both done fighting and fleeing. We’d taken the relationship out of deep freeze and allowed it to thaw. We finally had the energy to look with an honest eye at what remained.

What I saw was fear. Fear that he stays with me because I’m a good nurse. Fear that I stay because I’ve let my loyalty to him overwhelm my responsibility to myself.

We’ve had sex only once in six years.

“Let’s try to ease into intimacy,” my psychologist suggested. “Start by sitting back-to-back for a few minutes every day — you don’t even have to look at each other. Do some deep breathing. Observe your reactions.”

So, most nights around sundown, Jason and I meet and sit on the living-room floor, back-to-back, for a few minutes. I look straight ahead. I resist my body’s urge to pull away. I examine my feelings.

I would love to report that in these moments, I realize that PTSD has brought us closer, made us appreciate the small stuff, deepened our gratitude. But that’s not true. And yet, dozens of conversations about this essay have rekindled our commitment. We’ve stretched ourselves — sometimes painfully — to imagine the narrative from each other’s point of view. PTSD didn’t bring us together, but unraveling our story has begun to re-establish trust.

We are different people now. Jason used to be able to talk to anyone: politicians, punks, professors, psychiatrists, psychics, plumbers. Now when he leaves the house, it is with hat pulled down over his eyes and keys bristling from his fist. He avoids grocery stores, the library, walking downtown.

My superpowers have changed, too. While the kitchen is still full of grits and black-eyed peas, pickled beets and potpies, I haven’t dusted off the sex ray in years. And I’m not entirely sure I can see others — even Jason — as they really are anymore.

But we persist. We play gin rummy together by candlelight after dinner. We borrow DVDs from the public library — “Spaceballs,” “The Thin Man,” “Booksmart” — movies with no punching to trigger Jason, and no sex, which just makes me too sad. Sometimes I put my foot on his thigh under a shared blanket.

We’ve survived a catastrophe, barely, and maybe that’s enough. For now, we are aware of where we are and where we are not. We approach each other tenderly. We wound each other. We stumble and slide and try again.

Virginia Eubanks is a journalist and teaches at University at Albany, State University of New York. She is working on a memoir about community violence, PTSD and caregiving.