The Uncounted: The ‘perfect,’ troubled military spouse

What is war's true toll? Liz Snell wasn't the type to step out ahead of her Marine. A good military wife, she believed, fell in line and worked quietly in the background.

What is war's true toll? Liz Snell wasn't the type to step out ahead of her Marine. A good military wife, she believed, fell in line and worked quietly in the background.

Editor’s note: One tragic number is known: 22 veterans kill themselves every day. Another is not: How many military spouses, siblings and parents are killing themselves? What is war’s true toll? This is part of a CNN report by Ashley Fantz, The Uncounted.

(CNN) – More than a dozen medals lined a shelf in Liz Snell’s home. One was emblazoned with an eagle, another an anchor. Two bore the Red Cross insignia and were nested near a coin commemorating Operation Iraqi Freedom.

People assumed the medals belonged to her husband, Brian, a Marine staff sergeant who was barely drinking age when he deployed to Iraq for the first time in 2003.

His wife rarely spoke up to set the record straight: Those medals were hers.

Liz Snell wasn’t the type to step out ahead of her Marine. A good military wife, she believed, fell in line and worked quietly in the background. That’s why her volunteer resumé ran three pages long: She was a caseworker for families who needed financial advice. She coordinated job workshops for spouses who had to find new employment every time their warriors changed bases. She helped lead a volunteer program with the armed services branch of the Red Cross.

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Liz’s medals were tokens of gratitude, small ways of recognizing that she served her country, too — reminders that America’s longest-running wars required military spouses to be strong and brave.

A young, pretty mom with a voice so soft she often sounded like she was telling a secret, Liz weathered five deployments with her husband and knew how to calm other wives. When they were rattled by another deployment, another order to move, an argument with their Marine or some kind of broken heart, she’d say, “Stay on the positive side.” Or, “God doesn’t hand you something you can’t handle.”

In a hope chest at her home on Camp Pendleton in California, she kept a memento of her nomination as 2011’s Military Spouse of the Year. It was a huge honor in her world. “The nomination itself is an award for me,” she told a local news reporter at the time. “It takes qualities of strength and adaptability to thrive within the military spouse lifestyle.”

Liz Snell was very convincing. There was nothing she worked harder at than hiding the truth.

Deployment after deployment, all the pressure and fear and weight of obligation had worn her down. The urge to make it stop consumed her. One afternoon, she walked into her bedroom closet with a plan.

Six years later, she remembers it like a dream: Standing outside of herself, she watched her hands as they tied a rope into a noose and slipped it over her head.

Every day, 22 veterans commit suicide.

That number is sadly familiar. It has become a symbol of the cost of war that extends beyond the battlefield.

But no one is tracking war’s impact on another group: military spouses, siblings and parents.

Their suicides go uncounted.

The dozens of military family members I interviewed over the past year — many of whom have attempted suicide, contemplated it or had loved ones who killed themselves — said the cumulative trauma of 12 years of war has left them wrung out and desperate.

Some, like Liz Snell, said the strain of multiple deployments played a role in their despondency. The financial and emotional burden of caring for injured service members wore others down. Some were pushed to the edge in their grief over a death at war.

It’s an oversimplification, of course, to say deployments plus stress equals suicide. Most of the family members interviewed were quick to agree that war alone did not break them. Liz Snell said she struggled with depression long before she became a Marine wife.

“Suicide is complicated and complex,” said Jacqueline Garrick, who directs the government’s Defense Suicide Prevention Office. “The trajectory for suicide is as different as every human being is different.

“There are associated factors in relation to suicide, but there are no causal factors. It cannot be said that one thing — service, deployment — caused someone to commit suicide.”

Alarmed by the number of veterans and active warriors taking their own lives, the Pentagon opened the Defense Suicide Prevention Office in 2011. Garrick, a clinical social worker who has counseled suicidal troops, told me legal and logistical obstacles have prevented the military from tracking family members’ suicides.

HIPAA, the congressionally mandated health privacy act, prohibits medical professionals from sharing patients’ information. And death records are not consistent from state to state in reporting suicide. Also, collecting anecdotal information from xmedia reports would not paint a credible portrait because many news outlets have policies against reporting suicides.

But those reasons never satisfied scores of family members who, through organizations such as the National Military Family Association, relentlessly pressed Congress to act.

At lawmakers’ request, Garrick’s staff sent the House and Senate Armed Services committees a report in February outlining an idea for tracking some family member suicides: The Pentagon could buy death records from the Centers for Disease Control and Prevention and compare them with information the Defense Department already has on military dependents. It would take up to two years to launch the initiative at an initial cost of almost $700,000.

The chairs of the Senate and House Armed Services committees, Michigan Sen. Carl Levin and California Rep. Buck McKeon, said this week that they had no comment on the contents of the report.

Levin is still reviewing it, spokeswoman Tara Andringa said. McKeon is “gratified” that the report was done, said his spokesman, Claude Chafin. Military family member suicides will “likely come up” during an annual hearing on military suicide, Chafin said. That hearing has not been scheduled but Chafin said he expects it will convene this summer.

“That is a small amount of money in military terms,” said Kristina Kaufmann, a longtime military wife who has testified before Congress about the need to track these suicides. Kaufmann is the executive director of Code of Support, a national non-profit that advocates for military families. “It’s a drop in the bucket compared to what they’ve spent to deal with the problem they know they have with service members. It’s time they understood the full extent of the deaths happening.”

Four years ago, the spouse of the highest-ranking military officer in the country tried to call attention to the problem. Deborah Mullen, wife of Adm. Mike Mullen, then chairman of the Joint Chiefs of Staff, took the stage at a Defense Department health care summit and described what Army leaders told her when she asked how many family members had committed suicide. They knew nine relatives had killed themselves in 2009, they told her.

Mullen then asked how many family members had attempted.

“I was stunned when I was told that there were too many to track,” she told the crowd. “If that number is that large just in the Army, we really don’t have an idea of the scope of the problem.

“It’s our responsibility,” she implored. “These are our family members. We have got to find a way to track them.”

Mullen recently told me that some spouses she met described being so depressed they couldn’t get out of bed, prepare meals, leave the house or get their kids to school. They said they wanted mental health care but feared that seeking help would jeopardize their service member’s career.

Others had sought help but felt they didn’t get adequate treatment. Mullen knew two wives, each suicidal, who went to military physicians and were sent away with medications but no counseling or follow-up care.

Mullen did say there were positive signs toward the end of her husband’s time as chairman. In 2010, Mullen noticed that wives were more willing to speak up about their depression and seek help. She also told me that she is hopeful the Veterans Crisis Line has improved since its inception in 2007.

In 2009, Mullen called the line on behalf of a female veteran she met who had been unable to get treatment for post traumatic stress. Though the operator was polite and talked to Mullen for 15 minutes, she said, ultimately the operator did not provide helpful resources.

“They could provide nothing for this person,” Mullen told me. “I got off the phone thinking this wasn’t the right way to go.

“It really does matter who picks up the phone,” she said. “You could get someone on the line who’s helpful or someone who’s not.”

Mullen eventually found help for the veteran by making phone calls to contacts in the woman’s state.

In 2013, the suicide hotline fielded about 29,000 calls from people identifying themselves as family members or friends — about 11,000 more calls of this kind than the hotline received in 2012.

I asked the U.S. Department of Veterans Affairs for a breakdown of those numbers: how many were family members and what had they called about.

VA spokesman Mark Ballesteros explained that the hotline has that information in its database but has never aggregated it.

In other words, the VA could not provide data on how many of these callers were seeking help for their service member or how many were in trouble themselves.

“There’s a lot of anecdotal evidence out there,” Mullen stressed to me. “Military leaders realize that there is a problem with military family suicides and attempts.”

But until the military tracks those deaths, it’s impossible to know why they happened.

Why did Army wife Faye Vick take her life in 2006? The 36-year-old placed her baby and 2-year-old in the backseat of her car, the Raleigh News & Observer reported, and asphyxiated them all.

Could anything have helped Cassy Walton, wife of Iraq veteran Nils Andersson? He killed himself outside his Texas home in 2007. Just days later, she shot herself wearing her husband’s dog tags and fatigue jacket.

What made Monique Lingenfelter, the wife of a sergeant assigned to a special operations unit, barricade herself in her home near Fort Bragg, North Carolina, in 2009? Police tried for hours over a PA system to persuade the pregnant Army wife to come out. She killed herself, and her baby also died.

What was going through Sheena Griffin’s mind in April 2010? While her husband was stationed at Fort Hood preparing to deploy to Afghanistan, Griffin told him that she wanted to kill herself and their 8-and 9-year-old sons. He called authorities. When police arrived at the family home, they found it engulfed in flames, and the mother and boys shot dead.

The families of Iraq and Afghanistan veterans have lived through America’s two longest wars. They are a generation that has endured multiple deployments — as many as five — and the first to be bombarded by social media and 24-hour news cycles. They care for the more than 600,000 veterans with PTSD, traumatic brain injury or depression.

“We have sort of studied everything but the family members themselves,” said Melinda Moore, a University of Kentucky researcher who has worked with a Defense Department-funded group studying service member suicide.

“The service member is like a pebble dropped in a pool,” she said. “The pain that person carries affects everyone around them. Trauma ripples outward.”

In a photo taken just days before their wedding, Brian and Liz Snell look like little kids on a road trip. They are in the back of a car, their skinny shoulders pressed together, grinning wide, cheesing for the camera.

It was September 14, 2001, and Brian had graduated from Marine Corps boot camp in California that day. With planes still grounded because of the 9/11 terror attack, Brian’s mother was driving the teenagers home to Michigan. They had to make it back in time to say their vows in the backyard of Liz’s grandmother.

The couple’s life together had barely started, and war already was calling the shots.

Liz remembers her cream empire-waist dress, made by her mother, and how she swept up her red hair, tendrils framing her face. She was such a happy bride. She was marrying the boy who made her feel anchored.

Liz’s youth had been spent moving — whenever her mother remarried or changed jobs or when Liz went to live with her dad for awhile. As the new kid at Northwest High School in Rives Junction, Michigan, she noticed Brian right away: He was the star football player with a swagger and a soft spot for the underdog. He was always sticking up for kids who got picked on. It took Liz weeks to work up the nerve to approach him.

“Uh, do you have a dollar?” she asked.

He answered without hesitation. Sure, he did. And he’d give it to her — in exchange for a kiss.

They weren’t together long when Liz started to get a bad feeling. She called Brian, crying, telling him to come over. They needed to talk.

“I’m pregnant.”

The first time she said it, he fell off the couch and put his head in his hands.

She repeated herself. A couple minutes passed. Brian looked up at her.

“OK,” he told her, “I guess we’re gonna have a baby.”

They were scared and broke, but Brian promised they would make it.

He managed to finish football season and his senior year in high school while working part-time at an automotive plant. He found an apartment for them in a public housing complex. When he kept going out with his friends at night, she told herself it was understandable. He was still growing up.

One night he came home and said he wanted to take her to dinner at Chi-Chi’s. Halfway through, he pulled out a ring fashioned from a straw wrapper.

“I was just wondering if you wanted to get married?”

“Yeah, OK,” she said.

Major life decisions followed a similar script. Liz doesn’t remember Brian telling her he wanted to enlist. He just did it.

She imagined military life as a grand adventure. They would move around, see different places. Maybe he’d get stationed in Italy.

But soon the baby arrived. And then boot camp. Kaila Snell, born April 6, 2001, was barely 3 months old when her daddy left for basic training.

War came quickly to the Snells’ home. Brian spent much of 2002 away from his new wife and baby daughter, training for deployment. In 2003, he left for Iraq.

Liz’s first time at war felt like the cold tile of the bathroom floor in her parents’ house.

She would wait until Kaila was asleep, then get into the shower, turn on the water, slump down and cry.

One morning, Liz’s stepfather tried to comfort her.

“I can hear you crying in there,” he said. “You don’t have to hide.”

Be strong. Don’t complain. Never worry or distract your warrior when he’s on deployment. Defend the home.

Liz doesn’t remember anyone telling her how a good military spouse behaves. It was just understood.

The early days of the Iraq and Afghanistan wars were hard on military families. Many organizations set up to help them cope weren’t in place back then. Young spouses like Liz didn’t realize they needed to plan for how their children might react when one parent disappeared. No one asked Liz how she would handle finances or juggle the demands of being a single parent. Questions of the heart were not broached.

How would she stay close to Brian when he was going through an experience to which she could never relate? How would he reconnect with her or their baby after being gone for a year?

Liz recalls that her only contact with the military came during a predeployment meeting that family members were encouraged to attend. She stood in a crowd of people she did not know and who did not talk to each other.

It was strictly procedural. “They gave us a phone tree, I think, but I wasn’t really going to call someone I didn’t know and tell them that I was scared.”

Then the young couple found out Liz was pregnant again. This time, Brian wouldn’t be able to feel her belly as it grew. He wouldn’t be there for the birth.

Days before her husband left, Liz grappled with bad news from her doctors. She needed to have her cervix stitched closed because she had “cervical insufficiency,” a condition in which the weight of the pregnancy causes the cervix to open too early. She’d gone through the same surgery before Kaila was born and had hoped it wouldn’t be necessary again.

Not wanting to ruin her husband’s send-off, Liz didn’t tell Brian.

She kept her mouth shut about most things. He didn’t know she spent many nights awake, staring into the dark. She didn’t have a name for what she was feeling, but she’d experienced it before — when she was a teenager and had trouble shaking sadness.

Her husband gone, Liz drew inward as her pregnancy progressed, spending whole days watching television or sleeping. When her mother and grandmother called from Michigan, she told them she was fine.

When Briannah was born, Liz wanted to show her husband the thick dark hair she had, so different from her older sister’s auburn shade. But Brian didn’t have access to e-mail; Liz had to mail him a photo that he wouldn’t get for days.

She didn’t tell her husband that Briannah had a heart condition. Alone, the Marine wife made her way through more than a dozen doctor’s visits and a stack of confusing medical bills.

Each time Brian came home from a deployment, they danced the same choreography: a week or so of renewed romance, followed by awkward moments, little annoyances, stupid stuff that morphed into fights. The toys went over there. That’s the way she’d been doing it for months. The kids’ bedtime was 7. That’s the routine. He couldn’t just come back and mess everything up.

In the span of nine years, from 2002 to 2011, the family moved four times when Brian got orders to change bases. Even with a bachelor’s degree earned online and a few credits shy of an MBA, Liz struggled to find a job in each new city.

The nose-diving national economy didn’t help. When prospective employers called her for an interview, some said they couldn’t afford to hire someone tied to the military who might not be around for long. So Liz took part-time work as a house cleaner and baby sitter.

Brian knew it was hard; he told her he understood. When he was home, he put his arms around her and kissed her forehead. He had missed their first two wedding anniversaries because he was deployed. For their third, he surprised her by arranging day care and taking her to a cabin for the weekend. It was sweet. She loved him for doing that, and she did her best to show it. But truthfully, it only made her feel more obligated. On top of everything, now she had to be sexy, too.

She weighed telling Brian that she felt depressed, but guilt stopped her. What right did she have to complain? He was the one fighting a war. He never talked about what he saw, which made her scared to ask. If he opened up, she was sure she couldn’t help him navigate that pain. And then she would have really failed.

So for years, Liz kept doing what she’d always done — act the opposite of how she felt. She crammed her schedule with more volunteer jobs. She worked with a Marine family readiness group designed to help families cope with the emotional tumult of deployments, a job that required her to give lectures to other spouses. She told them it was perfectly OK to be unhappy. She wrote blogs about how much she enjoyed being a military wife.

Inside, a voice continually goaded her: You’re worthless. You’re not doing a very good job.

It was on an August morning in 2007, with Brian away at his job on a new base at Camp Lejeune, North Carolina, when Liz left her daughters to play in the living room and walked to the bedroom closet.

She stood on a stool, looped a rope over a rod and around her neck. She tugged, testing its strength. Then she heard her daughters wail.

Startled, she pulled the rope loose, stepped down and went to the living room. After drying tears and wiping noses, she curled up on the couch.

She closed her eyes, hard, and told no one what she’d done.

Liz Snell didn’t know Jessica Harp. But she’d heard the Army wife’s name — and her story. In 2011, Harp’s suicide note, posted on her blog, went viral among military spouses.

The note shocked Liz, but not for its content. She was stunned that a wife would have the bravery to be so public about her problems.

While Liz struggled to keep her secret, Harp’s became known to the world.

“If you are reading this, you should know that I am dead,” the 27-year-old wrote. “At least I hope I’m dead. It would be awful to fail at your own suicide.”

In nearly 4,000 words, Harp unpacked in aching detail the way her marriage disintegrated after her husband returned from a tour in Afghanistan. Her story of loneliness and depression mirrored Snell’s. Harp wrote that she repeatedly asked for help but never got what she needed. That was the experience of other military family members I interviewed.

In fact, they all have a name for their common enemy: The Deployment Monster.

This is the bastard, they say, who pulls up a seat at the kitchen table and mocks them before, during and after a deployment. It brings isolation, fear, chaos and uncertainty. It steals sleep and security.

The monster is a baby who never cried a lot before a deployment but now cries all the time, or a toddler who, months into a deployment, is found sleeping by the front door.

The monster is the warrior who returns changed, drinking all the time, blowing through money, suffering an unseen injury that causes him or her to feel constantly unsettled, distant, balled up angry and ready to fight.

A spouse, parent, sibling or a child tries to hang on as the monster spins a post-deployment ride faster. They don’t know how to make it stop, and they second-guess themselves about whether they can do anything at all.

Some confess to thinking, as Harp did: “If he had died, I would have been surrounded with so much support.”

Harp did not kill herself.

When I contacted her, she explained that she had preprogramed the note at a time when she was suicidal. When her note published, she was in a hospital. National media covered her story.

Her marriage ended, she said, and she found someone new. Therapy and medication helped her recover. She had started fresh. She is happy.

She declined to say anything more because she was concerned that doing so would disrupt her new life.

But she also sized up whether it would be worth it to again enter a media spotlight.

So many military family members need help, she said; they’re killing themselves, and they go unheard. She said she would talk again if she believed it would make a difference. She didn’t think it would.

What difference would it make to talk about the pain? To tell someone, anyone, that you were drowning? Better to pretend. Better to use work as a life raft.

Liz kept herself afloat by volunteering. The Marines had given Brian a new job as a recruiter and transferred him to Southgate, Michigan, near Dearborn, in 2009. He was away from home a lot, either on training missions or simply working.

But Liz was back in her home state. At least there, she had connections.

She threw herself into a major project with the armed forces branch of the Red Cross: the development of a database of national and local resources for military families. She had finally landed a paid position with the organization, managing some staff and a large group of volunteers. She joined the board of the Military Spouses of Michigan and helped write legislation aimed at aiding spouses in finding employment when their service members were reassigned to the state.

As the family neared the two-year mark of living in Michigan, Liz began to get comfortable. Brian had done four tours — more than his share, she assumed. She had made friends. Briannah was taking Taekwondo and playing softball. Kaila, a voracious reader, began writing her own short stories.

Brian and Liz felt connected again. Sometimes they sneaked away to a cabin in the woods where their cell phones wouldn’t work.

Depression occasionally climbed on her back, but she wrestled it off. She thought work helped, that it strengthened her with purpose.

It did win her attention: In January 2011, she was nominated for Military Spouse of the Year, a title decided by the vote of military families across the world. She was so happy about the recognition that when she lost, it felt alright.

It felt like a mean trick when Brian told her he’d gotten his fifth deployment order, this time to Afghanistan. The family would have to go back to Camp Pendleton in California.

Liz went numb.

Kaila, 10, screamed at her parents that she hated military life. “I’m never going to marry a military man!” she shouted.

Eight-year-old Briannah slammed the door to her room, threw things and cried. Brian tried to console them, explaining that what Daddy did was important, that he believed in it.

Liz would have to quit her jobs in Michigan and resign from the state’s board of Marine spouses. She would leave her family and friends and return to a place where the people she knew before were probably gone — reassigned somewhere else.

She felt like she’d been locked in a dark room and couldn’t find the door.

When Staff Sgt. Snell came home from Afghanistan in January 2013, his wife was more than depressed. She was gripped by violent fantasies.

When she closed her eyes, she envisioned walking to the closet where her husband kept his gun.

Terrified that she could not control herself, she went to see a doctor on Friday, March 1. The physician asked whether she was suicidal. She lied. How would it look to other military spouses if she went to a psychiatric ward? She’d never get a job then. People would talk. What would her husband think, her kids?

The physician referred her to a behavioral therapist who she could see Monday, March 4.

Liz spent the weekend in a ball on the couch, afraid to shut her eyes. When she did, that awful movie started in her head: Opening the closet, unlocking the gun cabinet, curling her finger over the trigger.

By Sunday the compulsion to kill herself was all consuming. In church, she tried to pray the thoughts away. If God was good, she kept thinking, why was she so bad? On the family’s drive home, Liz started crying hysterically. Brian pulled over.

She got out of the car, away from the kids’ earshot, and he followed.

“You have to promise me you won’t …” she choked, “Promise … just go home, go home and hide the keys to the gun closet.

“I don’t feel safe in the house. Keep me out of the house.”

Then, she told him about wanting to die.

They got back into the car and drove home, both silent. Liz had convinced Brian she could make it one more day, to her doctor’s appointment. He was quiet that night. He asked no questions, and she offered nothing more. He waited until she fell asleep to go to bed.

The next morning, Brian and Liz went to the hospital on Camp Pendleton.

For about eight hours, Brian sat with his wife in a room while several doctors came in to question Liz. She asked Brian to step out because she was afraid she wouldn’t be able to tell the full truth in front of him.

By dark, the Snells say, they were told that the facility had no designated spaces to treat psychiatrically troubled military family members. She was transferred to the Naval Medical Center San Diego, about 50 minutes away.

Liz laid back on a gurney and straps were fastened over her. As she was wheeled out to an ambulance, she craned her neck back and caught sight of her husband.

He was leaning against their car in the parking lot, his head buried in his hands.

At the Naval Medical Center San Diego, Liz was checked into a psychiatric department reserved for patients who are at high risk of hurting themselves or others.

She was given a hospital gown and pants and was asked to remove her bra so that she couldn’t use it to hurt herself.

That first night, she called Brian.

“I want to go home,” she told him, crying. “I’m sorry. I’m sorry. I’m weak.”

As Brian listened to his wife, he could only think to tell her something he’d never told her before.

“You are the strongest person I know.”

Liz had voluntarily checked herself in, and at that point, no doctor had examined her. She could have left, but her husband’s words made her want to try. Typical to her way of thinking, she believed she owed it not so much to herself as to her family.

Her roommates were both military spouses. One was married to a Vietnam vet. The other woman looked to be her age. She was surprised by how many military wives she saw come into the hospital. It made her feel less crazy and alone.

Every day, she met one-on-one with a Navy lieutenant and psychologist, Michael Epstein. She granted him permission to speak with me.

“Once she’d been taken out of her home life, she was very motivated to live,” he said. “With Elizabeth, there were a lot of stressors in her home — Brian being deployed, she was a single mother pulling a lot of weight and not having an independent life outside of being a mother.”

He made an analogy to the safety instructions given before an airline flight: “You put your mask on yourself before you put it on your kids. Elizabeth had been putting the oxygen on her kids and husband for years, and never on herself.”

Several times a day, Liz attended group therapy. Everyone had to name something they wanted to work on. By the end, the clinician had demonstrated that each person could offer something unique and valuable to someone else in the group. Liz thought about the jobs she’d had helping other military wives and felt her strength grow.

But she fell sometimes, too.

During shift changes, nurses asked patients if they felt they wanted to harm themselves or someone else. Once, Liz replied by staring at the phone and confessing she had an urge to wrap the cord around her neck.

But Liz made remarkable progress. On her third day in the hospital, her status was upgraded. She was allowed to wear her own clothes. She put on Brian’s USMC sweatshirt.

He visited her every day. He brought her food and met with Epstein.

“Here was this staff sergeant deployed five times, in charge of probably hundreds of 17-year-old and 19-year-olds in theater, and he was standing in a room with me feeling powerless about how to take care of his wife,” Epstein recalled. “He wanted to do anything that he could to help her. I saw absolute genuine concern for her, and he listened to everything I said.”

Brian encouraged his wife to keep a journal if that helped. She could blog it all if she wanted, he told her. People in the military could think whatever they wanted. It didn’t matter.

“Brian is clearly a person who puts family first, the Marines second,” Epstein said.

After 12 days, the psychologist and other doctors deemed Liz stable enough to go home. With a diagnosis of chronic depression and anxiety and a two-week supply of Zoloft and sleeping medication, Liz checked out on March 15.

The hospital, following procedures set by national standards for mental health care, arranged an appointment for Liz to come back within a week for a follow-up visit, Epstein said.

When service members are treated for mental health care and released from hospitalization, Epstein said, their commanding officer is notified.

Military spouses and other family members are largely on their own. After their initial follow-up appointment, the hospital provides them with a reference to a therapist. It is up to them to go.

After Liz got out of the hospital last March, the couple made an effort to spend evenings together with their daughters. When I visited them in September, Brian had just returned from training Marines on how to work amphibious assault vehicles. Briannah and Kaila were doing their homework on the couch.

Briannah is 10 now, an athlete. She has earned belts in Taekwondo and wants to play soccer. She’s shy and smart and after warming up to me, she demonstrated how to unlock cell phones.

Liz and Brian said they’d had to limit Kaila’s Kindle downloads to three books a month. The 12-year-old engaged me in a miniseminar on young adult literature and discussed character development like one of my editors might.

Over dinner, sitting at the kitchen table next to her parents, Kaila talked more about her favorite books, which all seemed to feature a strong girl fighting battles. Her parents became tickled at her passion. Kaila laughed with them. She said they like it when she talks.

“We talk about things now,” she said, looking at them before continuing. “We didn’t really do that before. It’s OK because we talk now.”

Liz went to a handful of sessions with a therapist after she got home. But those ended, she said, when the counselor shut down the practice, citing personal reasons. Liz did not ask the therapist to connect her with another mental health professional, and the therapist didn’t offer to do that, Liz said.

To refill her medications, Liz goes to a psychiatrist who asks how she’s feeling. At most, she said, their exchanges last 10 minutes.

Liz has not talked much to anyone about the most shattering event in her life since her hospitalization. In late September, after my visit, Brian was in a motorcycle crash. His injuries were severe. Liz and her mother both told me that Liz said aloud in the desperate hours after the crash that she didn’t want to live if Brian died.

In the short conversations I had with Brian before the accident — he didn’t want to be formally interviewed but was polite and eventually open with me — it became clear that he was the only person available to catch Liz if she fell. She has no family or friends she deeply trusts near her in California. Brian is her world.

He kept alarms in his phone to remind him when it was time for Liz to take her medication. When she shared details about her depression with me, a stranger, or he told me something about Iraq, their eyes locked. They looked out for each other. They were a team.

After months of therapy, Brian is now getting around in a wheelchair. He has suffered a brain injury, too, and often speaks in tangents because he struggles to stay focused on a single thought.

“It takes a lot of patience, and it makes me feel sad,” Liz told me. “I wanted him to come home, and he is home. But he’s not Brian, and I’m alone.”

Kaila and her sister struggle, too. Briannah won’t go on sleepovers because she doesn’t want to be away from her dad. Kaila acts angry. When she recently punched Briannah in the face a couple times, Liz asked her psychiatrist — a private provider covered by the military’s insurance-style program TRICARE — to recommend a counselor for her daughter. So far, Kaila has had one session; her mom sat in for the first half-hour.

Liz saw how much the session helped, so she set up appointments for herself.

She said she’d like to have someone to talk to. Brian is no longer available like before.

When Liz is not driving Brian to his therapy appointments, she is keeping busy with new responsibilities. She’s got a paid position as a volunteer coordinator with Blue Star Families. She created a website dedicated to encouraging depressed and suicidal military family members to get help. She blogs about her hospitalization, anonymously.

A military spouse assisting with the website nominated Liz for 2014 Military Spouse of the Year. Liz campaigned hard for it on social media. She told military relatives eligible to vote that she wanted to use the title to call attention to the problem of depression and suicide among military spouses.

She was disappointed when she didn’t make it through the first round of votes. But it was a step, she said. Stay on the positive side. Eventually, she believes, the people with power who can do something will.

They’ll pay attention, she just knows it, and people like her will finally be counted.

Need help?

For immediate help

Veterans Crisis Line — A 24/7 hotline open to family members and all armed forces, including veterans, active, Reserve and National Guard. 1-800-273-8255, press 1 http://veteranscrisisline.net/

For nonemergency help

TAPS — Not-for-profit Tragedy Assistance Program for Survivors offers help to anyone who has lost a military loved one regardless of the relationship to the deceased. It provides in-person and online peer-to-peer counseling and specializes in connecting family members — siblings with siblings, parents with parents, for example — who have lost loved ones under similar circumstances. 1-800-959-TAPS (8277) http://www.taps.org/

Give an Hour — Psychologist Dr. Barbara Van Dahlen founded the nonprofit in 2005 after recognizing a demand for mental health professionals to help Iraq and Afghanistan troops and their families. Give an Hour’s network of nearly 7,000 psychologists, social workers, psychiatrists, marriage and family therapists, drug and alcohol counselors and pastoral counselors offer help to individuals, couples, families, children and adolescents. http://www.giveanhour.org/

Military OneSource — Nonemergency 24/7 help for service members and their families to tackle all aspects of military life. OneSource provides counseling referrals and other assistance with mental health needs. 1-800-342-9647 http://www.militaryonesource.mil/

Military and Family Life Counselors — These certified counselors with master’s or doctorate degrees in mental health are embedded at installations and offer short-term, nonmedical counseling.http://www.militaryonesource.mil/12038/MOS/Booklets/MFLC_Program_Brochure.pdf

Courage Beyond — Courage Beyond provides confidential, no-cost or low-cost programs and services to military Americans and families facing post-traumatic stress disorder and other invisible wounds of military service. The group hosts several retreats a year for spouses and weekly anonymous online counseling sessions open to any family member. 1-888-497-0379https://couragebeyond.org/

By Ashley Fantz

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