You are usually the first one to know. Long before a doctor writes anything down, you are the one tracking which days are safe to ask about the bills, which seat at the restaurant keeps the evening calm, which anniversary in the spring turns into two bad weeks. You learned to read the front door: whether the keys land softly on the counter or hard, and what the rest of the night will probably look like either way.
That kind of attention is its own job, and most people carrying it have never said so to anyone. This page is for you, and it is mostly about one thing: what a first real conversation can look like, and how to give it a decent chance.
What you are probably noticing
Partners tend to report the same handful of changes, in this rough order. Sleep goes first, either late nights that avoid bed or a few hours broken by something neither of you talks about in the morning. Then the temper arrives earlier than it used to, over nothing, over a dropped cup. Then the withdrawal: still in the house, still technically present, somewhere else. Drinking creeps up a can or two at a time. The friends thin out. The phrase you hear most is that he is fine, or she is fine, and the subject changes.
None of that makes you the clinician in the relationship, and you are not responsible for producing a diagnosis. What you have is a set of observations nobody else in the world has, which is genuinely useful information if it ever reaches the right room.
Picking the moment
Timing does more work here than wording. Not inside a fight, because nothing said then is heard as concern. Not right off a shift, when the adrenaline has not settled. Not at a family gathering, where an audience turns a conversation into a cornering. Side by side tends to beat face to face, which is why so many of these talks happen in a truck, in a garage, or on a walk with the dog. No eye contact required, and an easy exit if it gets to be too much.
Keep the first attempt short. Five minutes is a success. You are not trying to settle anything, you are putting one sentence on the table and letting it sit there.
What to say, and what to leave out
Lead with what you have seen, not with a label. Words like PTSD and depression tend to land as an accusation, and the argument shifts to whether the word applies instead of whether anything is wrong. Something closer to this does better: you have been up most nights this month, and you have not wanted to go anywhere since March, and I miss you. Then stop talking. The silence after it is where the real answer usually comes from.
Leave out comparisons to other people's spouses. Leave out anything that sounds like a deadline, and leave out the ultimatum unless you truly mean it and are ready to follow through. Do not open with a list of treatments. A partner who feels diagnosed and scheduled inside of two minutes will be done with the conversation before it starts.
It helps to have one small next step in your pocket, something smaller than committing to therapy. A physical, since sleep and alcohol and pain are medical conversations as much as anything. A call to the department peer support contact. Or a page to read alone, which costs nothing and commits to nothing: if service history is part of it, a clinic page written for veterans and first responders explains what an intake visit involves, and some people will read that weeks before they will say a word out loud.
If the answer is no
Most first conversations end in some version of no. That is not a failed attempt, it is the first of several. You moved the subject from unspeakable to spoken, and that holds even when the reply is that you are overreacting.
What you can do from there is keep a short record, privately and without drama. Dates of the hard nights, the rough hours of sleep, the number of drinks, anything said about not wanting to be here. Two months of that is worth more in an exam room than anyone's recollection, and if there is ever a medical visit you are invited to, bring it.
Draw the line clearly at one place. If there is talk of suicide, or a gun and a bad night turning up in the same sentence, that stops being a conversation to schedule for later. The Veterans Crisis Line answers at 988, then press 1, and by text at 838255, and it takes calls from family members, not only from the veteran. You do not need permission to use it.
Your own load counts
Spouses in this position often describe a flat, worn out feeling they are reluctant to call anything, on the theory that the injury belongs to the other person. It does, and the cost of managing it around the clock is still yours. A therapist of your own is not disloyalty and does not require your partner's participation. If your spouse is enrolled with the VA, the Caregiver Support Line at 1-855-260-3274 can point you toward support built for family members, including local coordinators. Sleep, a standing appointment with a friend, one hour a week that nobody else can claim: these are small and they are not optional.
One more thing, said plainly. You cannot do this on someone's behalf. You can make the door easy to find, say the true thing out loud, and keep your own footing while they decide. That is the whole of the job, and it is a great deal more than nothing.