A Journey Toward Healing the Wounded Soul

Good day.  I am excited that you have opened this presentation on the soul care initiative, a journey toward healing the wounded soul of our veterans and their families.  From my experience as an Army Chaplain for 30 years and my 9 deployments, I have a passion for the care of our returning veterans and their families.  Our veterans and their families face numerous challenges after re-deployment and demobilization. I pray that you will decide to journey with us and our veterans as we partner together on caring for the soul.

Before we begin, it is important to understand several factors.  

First, there is much more to our veterans than Post Traumatic Stress Disorder (PTSD).  The politicians, press, and advocacy groups tend to focus on our veterans who return from war wounded, having a difficult time adjusting to their new civilian life. And it seems our returning veterans are placed into two different categories, either they are heroes or they are broken. There is much more to our veterans than either of these two characteristics.  

Second, fewer than 1% of Americans have served or participated in our latest wars.  If you add the direct family members it still is only 5% of the population.  With so few Americans having a direct link to a veteran, often most Americans do not understand most of our veterans are not wounded and many have successfully navigated the transition to civilian life.  Even those who have been diagnosed with PTSD make an enormous contribution in their communities. 

Third and last, since 9/11, the Department of Defense and the Veterans Administration have made progress in veteran care under the rubrics of their physical, emotional, social, and psychological well-being.  Recently, the Washington Post described alternative therapies that the VA has explored as part of a treatment regimen; to include equine therapy, alpha stimulation, guided imagery, yoga, hypnosis, aqua therapy and even Botox.  However, I have discovered an underserved component of our veteran well-being; the spiritual.  Our returning veterans face a deep spiritual crisis, not generally in public view.  Sufficient resources have not been committed to help our returning veterans recover from the spiritual trauma of war.  

Why is this important?  The battlefield became a test of the soul for our warriors as they confronted the horrors of war.  Some veterans have been physically wounded.  Others experienced the invisible wounds of mind and spirit.  I hope that as we review the literature and research on the role of spirituality in healing, describe the realities of spiritual trauma for the combat warrior, and explore the strategies and resources for soul care, that we begin to reflect on the importance of soul care as a part of our veteran journey toward healing.  Soul care becomes just one aspect of wholeness.

• Develop an awareness of military culture and family dynamics

• Discuss post-deployment transition challenges including the affects of trauma

• Describe the aspects of spiritual recovery

• Explore the resources available to the faith community for the care of the veteran and family

Objectives

These are the objectives for this presentation:

• Develop an awareness of military culture and family dynamics

• Discuss post-deployment transition challenges including the affects of trauma on the combat warrior, family and community

• Describe the aspects of spiritual recovery

• Explore the resources available to the faith community for the care of returned and returning veterans

• Soul Repair: Recovering from Moral Injury after War Rita Nakashima Brock & Gabriella Lettini

• War and the Soul: Healing our nation’s veterans from Post-traumatic Stress Disorder Edward Tick

• Silent Wounds: The hidden cost of war James Daniels, Emily Howden & Richard Kuhlbars

• The Post-traumatic Stress Disorder sourcebook, a guide to healing recovery and growthGlenn Schiraldi

• Those Who Have Borne the Battle, James Wright

Literature

Here are some of the seminal documents that were used as foundational material in designing and implementing the Soul Care Initiative. They give us a clue of the importance regarding spirituality considered in the well-being of our returning veterans. All of these books provide the reader a glimpse into the importance of the whole person with regards to healing and growth.

• The great malady of the 20th century, implicated in all our troubles and affecting us individually and socially, is the “loss of the soul.” Moore (1992)

• Association with increased tolerance of pain, and higher quality of life Kaczorowski (1989)

• Association with recovery from mental illness and substance abuse George (1992); Koenig, George & Peterson (1998)

Research on Religion

Spirituality as a consideration does not have substantial historic scientific inquiry.  Despite relative neglect by social and behavioral scientists, people frequently report that their spiritual beliefs and practices are a major source of personal strength.  This may be a reason why spirituality is beginning to receive scientific attention, especially within the medical community.  However, exploring spirituality is demanding in part because researchers find it difficult to measure spirituality separate from religion.   Virtually all research is based on measures of religion rather than spirituality.  However, this base research omits a segment of our population that describes themselves as spiritual but not religious.

• High intrinsic religiousness, an inward involvement in religion predicts more rapid remission from depression…Koenig, McCullough, Larson (2000)

• Association with health, energy, and vitality Frankel & Hewitt (1994); Shuler, Gelberg, & Brown (1994)

• Abundant evidence reveals robust relationships between religiousness and healthGeorge, Larson, Koenig, and McCullough (2000)

Research on Religion (Cont.)

Research suggests that one of the foundations for positive health effects of religion is the affiliation with organized religion.  This affiliation reduces health risk behaviors such as smoking, alcohol abuse and sexual promiscuity.  However, studies have suggested there are negative effects of religious or spiritual involvement.  Some individuals express guilt over their illness; “if my relationship was right with God I would not have gotten sick.”  Or, “I wonder why I had bad karma?”   Clinicians remind their clients that pain and illness has always been with us. Good health and long life are not guaranteed, no matter how spiritually enlightened or religious a person is. With that said, research has suggested that there is a robust relationship between religiousness and health.

• Social Support

• Liturgy - repentance, forgiveness, reconciliation and healing

• Search for justice that restores and heals

• Sacred story - seek theological, spiritual meaning of shared story for the veteran

Faith Community Assets

The church, synagogue, temple, or mosque are faith communities open to hospitality.  The faith community becomes a resource in which the veteran and family can be a part of a social network, a family.  Also, churches, mosques, temples, and synagogues can offer the use of their buildings as a simple way to extend their hospitality to a veterans group in need for a place to meet.  Veterans support groups usually provide their own facilitators.  But faith communities that have professional counselors might also make these resources available.  Also, a spouses and parents support group may be beneficial.  By providing space and child care for such a group will open doors to possible opportunities for healing and restoration.  So the faith community becomes a social support for the veteran and his/her family.  

The faith community can provide rituals throughout the year.  Congregational spiritual practices, activities, and rituals create a climate of healing and communicate a sense of care to the veteran and his/her family.  Whether a retreat, study of holy writings, special healing services, recognition service, or in the Christian tradition the use of the church calendar in developing liturgy such as a Good Friday Service, contain powerful resources for hope and restoration.  

Walking with veterans and their families on healing journeys is means of justice and what faith communities are about in ministry.  In the Christian tradition the church recognizes that Christ died a torturous death because of human brokenness that is graphically symbolized in the images of war and its desolation.  “He descended into hell” a phrase Christians confess, reminds them of the Good News that even the hell of war is not beyond the grasp of God’s redeeming love through Jesus Christ.  The crucified Lord returned with forgiveness, healing, hope, and the requirement for all to do likewise.  As the church lives the liturgy throughout the church year they experience anew the powerful reassurance of God’s grace and presence in the lives of that faith community.  As the church lives out these words, they learn to trust others, to bind the wounds of those hurting, and to grow in grace.  

Lastly, members of the faith community can be a great resource because of the power of story. An important note, the veterans’ story is sacred as is the faith community story.  By understanding the veteran’s story in the context of the spiritual meaning within a particular faith community context, the listener can relate to the person not the war.  This is the most important step toward developing a relationship of trust with the veteran and their family.

• Structured

• Standardized

• Authoritarian

• Esprit de Corps

• Mission focused

• Discipline (Care for Our Returning Veterans, Evangelical Lutheran Church in America)

• Warrior Ethos

• Constant transition

Military Culture

Before we begin any discussion on what the faith community can do to be a part of the healing journey with our veterans and their families, we must have a basic knowledge of a few critical aspects of the community we are trying to serve.  The military and veteran community are microcosms of American society, but they have unique components and histories that impact those who serve and have served; such as military culture, family dynamics, and the context of war.    

Let us look a bit deeper into these three aspects.  First, the military is a unique culture on to itself.  Only service members are asked to give up certain rights for the benefit of the nation; like freedom of speech.  As we begin to assist our veterans and their families it would be wise to understand the military culture that guides their life.

STRUCTURED – The military is structured into different branches of service (Army, Navy, Marines, Air Force, and Coast Guard) each with different components (Active Duty, Reserve, and/or National Guard). Each service has its own history, traditions, rank, organization, vocabulary and acronyms; such as PX, CPX, NBC. This is a maze that can be daunting to even Active Duty family members.

STANDARDIZED – The military is also standardized in terms of procedures, processes, and regulations.  From the uniforms worn to the forms that need to be completed, all have a standardized purpose.

AUTHORITARIAN – The military is also highly authoritarian with clearly delineated ranks and responsibilities. Generally the decision makers are the Commander  and the Senior NCO (Non-Commissioned Officer) which can be called by any number of names from Top Sergeant, First Sergeant, Sergeant Major, to COB (Chief of the Boat). The services also have a strict class system that regulates professional and personal relationships between officers, non-commissioned, and enlisted personnel.  The military is very hierarchical.  Everyone knows immediately his or her position in relation to others.  Veterans often have difficulty  understanding how civilian communities work,  “Who is in charge here?”

ESPRIT DE CORPS – Regardless of these distinction there exists what is know as Esprit de Corp, or a unique bond between service members. This bond is often forged and made stronger through the experience of combat. It is also reflected in the customs and traditions of the military and its branches. It is virtually liturgical. The pastor may say the “the Lord be with you” and the congregation response with “and also with you”. In the military, a lower ranking member salutes a higher ranking individual in greeting and respect and the higher ranking

• Transition is a way of life

• Self-contained community

• While they are away

• After they come home

• Military Brat

• Resources and services available

Understanding Military Family Dynamics

The second aspect of understanding the military community is that of the family dynamics.  Remember what we just discussed regarding military culture, constant transition.  Perhaps this is the most important thing to remember in ministry to military families.  They are in constant transition.  Military families face frequent moves, often without the financial help provided by corporate moves.  Frequent moves become a sacrifice.  The military family readily build new friendships.  For some in the civilian world, this may appear pushy.  But realize, connections are extremely important.  Connections need to be made prior to deployment, be maintained through the deployment, and sustained after the deployment if ministry is to have any lasting impact.

Military communities are closed societies with loose boundaries between work and social life.  For the active duty military member, many live on a post or base, where they live, work, and play in a self contained community.  The military community has a great diversity of faith groups, races and regional cultures unknown in other communities.  Therefore, the importance of esprit de corps for the family is just as important as it is to the warrior.  They understand the unique challenges they must face with the changing of doctors, finding new employment, finding a trusted child care provider, locating a hair fashion specialist.  Therefore the support the family receives from like minded and situationed persons becomes valuable especially during deployments.  But this isolation from the civilian community can also be detrimental.  

While the warrior is deployed, the family attempts to keep everything as normal as possible.  The spouse and children attend school functions, church/mosque/synagogue/temple, continue playing soccer, baseball, cheer, visit the grandparents, go shopping.  Normalcy is paramount for the family.  Also, the spouse may find it difficult to navigate the military systems in order to better integrate into the community or to find resources.    

Upon return there are several dynamics that affect the family.  The returning warrior has changed, and so has the spouse and children.  The spouse functioned alone as well as the children.  The warrior denied his/her own needs in order to serve their comrades, and the spouse denied her/his needs for their children.  The warrior followed rules and regulations and the spouse navigated the bureaucracy of military agencies. At times, neither the warrior or spouse understand or accept these changes. All of these could affect the reintegration of the couple and family.

I am sure you have heard the term, military brat.  They are part of a unique group of individuals.  They have lived in foreign countries.  They may change elementary schools 4 times.  They

• Korea

• Viet Nam

• Operation Desert Storm

• Operation Enduring Freedom

• Operation Iraqi Freedom

The Context of War

The last several slides we have reviewed the aspects of military culture and defined some of the dynamics of the military family.  The next step in our journey is to put into context our combat warriors and the wars they fought, beginning with the Korean War, and updating our discussion to the most current wars in Afghanistan and Iraq.  All wars can be described in terms of their length, costs, and casualties.  But each war had its unique aspects that pose challenges to the care system and to each veteran.

America’s wars prior to Korea were in direct response to an attack or provocation.  There is a line that follows from Korea to Viet Nam to Afghanistan to Iraq.  Korea was the first of 4 sustained, multi-year wars that responded to presumed or implicit threats.  Although each began with some clear political objectives, only in the case of the Gulf War of 1991 were the objectives clear and only in that case did withdrawal follow the meeting of the objectives.  These wars had no formal declaration of war.  All were marked with political constraints on the use of military force.  All of the extended military objectives have been marked by imprecise and changing objectives.  Each extended war has witnessed a fundamental shift in public enthusiasm and support.  Understanding of the mission and support for the troops depended on some ambiguous premise and soft assumptions.  

(*Note, most of the material used for the context of war slides was taken from Those who have Borne the Battle, Wright.)

Some other considerations of our two most current wars.  First, there are no front lines so to speak.  There are no safe areas. This has significance for our women service members.  When they depart the Forward Operating Base on a convoy they are at the same risk as the men.  Therefore women return with the same war wounds as the men, to include PTSD.  Second, our researchers have made great strides in designing protective gear that our service men and women survive their combat wounds.  In fact, a warrior had a 99% success rate of survival if reaching the medical facility in less than 30 minutes from the time of injury. This means we have many returning veterans who are physically wounded, as well as the silent wounds of mind and spirit.

• The “Forgotten War”

• In order to avoid a Declaration of war, President Truman described the war as a “police action”

• 1.8 million served; 37,000 killed; 100,000 wounded

• “no one wants to die for a tie”

• Pentagon initiated a rotation system

• Since the Korean War a shift began in public enthusiasm and support(Those Who Have Borne the Battle, Wright)

Korean War

The Korean War in the U.S. was initially described by President Harry S. Truman as a "police action" as it was an undeclared military action, conducted under the auspices of the United Nations.  It has been referred to as the "The Forgotten War" or "The Unknown War" because of the lack of public attention it received both during and after the war, and in relation to the global scale of World War II, which preceded it. Nearly 37,000 warriors would die in Korea and over 100,000 wounded.  Families at home would morn, but the country at large failed to recognize the scale and cost of the war.  In the first weeks of the war, a Gallup poll suggested that 81% of Americans supports the war.  There was little criticism.  This mood of confidence quickly eroded due to set backs in the conduct of the war.  US politicians began debating the conduct of the war and its aims.  In a year, a stalemate seemed accepted by the public.  Not surprisingly, the debate at home influenced the attitudes of the warriors.  With the strategic goals shifting to negotiating a truce along the same lines as when the war began a comment like, “No one want to die for a tie” became prevalent.  Lastly, the Pentagon initiated a rotation system.  This became a critical component.  It did provide a clear limit of service, but it had a negative effect on unit cohesion reducing combat effectiveness and led to individuals calculating how to amass points and reduce risk.  Attachments to units and their battle buddy was degraded.  Since Korea, each extended war has witnessed a fundamental shift in public enthusiasm and support for the engagement.  Each war was marked by early support that subsequently declined.

• Part of the “containment strategy”

• Disillusionment following the Tet Offensive

• Most veterans were draftees

• 58,220 killed in action and 303,644 wounded

• Anti-war movement part of counterculture

• US direct involvement ended August 1973(Those who have Borne the Battle, Wright)

Viet Nam

All of the later controversy about the Viet Nam War needs to be understood in the backdrop of the late 1950’s and early 1960’s.  Very few policy makers questioned the basic Cold War assumptions that led the US into the war.  These assumptions were projected unto the service members who executed the policy in combat.  The Cold War philosophy centered around the containment of communism.  From Cuba to Berlin to South East Asia communism threatened the free world.  

Political ambivalence at home, poor foreign policy decisions, poor military tacticians and leadership not understanding or adjusting to guerilla warfare, and domestic politics contributed to the American public confidence waning.  Then came the Tet Offensive.  This provided a shock to the American public as it turned most assumptions upside down.  North Viet Nam orchestrated a major assault on several major South Viet Nam cities.  Although the US and South Vietnamese forces turned them back, the strategic impact was quite negative.  Yes the US was able to win battles, however the fact that the North Vietnamese were able to undertake the offensive was a setback.  The absence of a strategic mission became pronounced following Tet.  

Early in the war, there were few draftees.  Early units had trained together and were led by officers and Non-commissioned officers who trained them.  President Johnson refused to call up the reserves and guard because he desired to minimize the political fallout.  So it was necessary to increase the draft calls.  The politics of the draft became a political issue; deferments, demographics of those serving, and standards.  

Those who fought in Vietnam sacrificed much, over 58,000 warriors were killed in action and over 300,000 wounded.  However, the toll continues even to today.  Recently, the Veterans Affairs released statistics stating that more Vietnam veterans have committed suicide than who died in the war.  Those who survived the war in southeast Asia continued to fight the war at home.

Lastly, the counterculture of the 60’s shaped the dialogue back home.  The music was largely anti-military and rejected patriotic support.  The assassinations of Robert Kennedy and Dr. King seemed to suggest a political system in disarray.  By 1967 the protests against the war became more vocal and consequential.  The My Lai massacre fitted readily into a growing narrative of the war and the conduct of the troops there, that all “good boys” were at least potentially murderers tainted by war.  Allegations of baby killers seldom were aimed at specific troops, ended up including all troops.  

• Operation Desert Storm - 17 January 1991

• US forces suffered 148 battle deaths, 35 due to friendly fire

• Introduced live news broadcasts from front lines of battle - instantaneous coverage

• Proclamation, the Vietnam syndrome indented in the sands of Kuwait (Those Who Have Borne the Battle, Wright)

Gulf War

When Saddam Hussein invaded Kuwait, President Bush began a major buildup in Saudi Arabia.  Warnings to Iraq were not effective.  Generals Powell and Schwarzkopf controlled the war plans.  They rejected any incrementalism in favor of total and overwhelming military force at the outset.  The war had clear objectives and once these objectives were reached, the US disengaged forces from Kuwait.  

The outcome was a rapid victory, 100 hours.  The US and its coalition defeated the Iraqi forces with few casualties.  The tragedy was the large number of friendly fire deaths.  

A rather new entity within warfare took on an important role, live news broadcasts from the battlefield.  Instantaneous news was on most Americans television sets for days.  News pools captured the realities of war.  Even though the war was in every American home, public opinion remained high.  

President George H. W. Bush declared, “By God, we’ve licked the Vietnam syndrome once and for all.”  Operation Dessert Storm was a rapid success.  However, this was not the case as we will see later

• Operation Enduring Freedom combat operations began 7 October 2001 as a result from the terrorists attacks in the US, Iraq not so clear

• “We don’t want any more Vietnams.”

• At first, US led coalition largely supported by US citizens

• Current wars not so simple

• Dissimilarities

• Even though public support has decreased, the support remains high for the troops (Those Who Have Borne the Battle, Wright)

9/11

The terror attacks on 9/11 made a tremendous impact on the first decade of the 21st century.  Few blinked when President Bush and other leaders responded to these acts of terrorism claiming a “war” or terror.  Within a week of 9/11 there were reports that members of the Bush administration were drawing up war plans for Iraq as well as Afghanistan.  This was to be the next phase of the war on terror, the ouster of Saddam Hussein.  In the 17 months that followed the commencement of military action in Afghanistan, attention shifted to Iraq.  Allegations about Saddam’s weapons of mass destruction mounted.  March 20, 2003 US lead troops pushed into Iraq.  However, as effective as the coalition forces were, unforeseeable and uncontrollable events would intrude.  

As the wars in Iraq and Afghanistan wound ahead through the decade, as the number of US deaths climbed above 6,200, and as multiple deployments and shifting missions marked these wars, they became controversial.  The lessons of Vietnam would not stay out of the controversy.  It was not that the importance of learning about how to engage in guerilla war or counterinsurgency operations was missed, rather it was the resolution not to go to such wars.

The war on terror is not like previous wars where there were decisive battles between nations.  The current war is not so simple and their engagements are seldom resolute as conflicts of the past.  

Several dissimilarities exist in the current war; overwhelming support of the US populous toward the troops, the number of women who find themselves involved in combat because there are not front lines, and the number of wounded who survive their initial wounds due to better equipment and modern battlefield medicine.  However, modern body armor and headgear have not protected troops from the loss of limbs, burns, or from head injuries.  

The public appreciates that the military is an all volunteer force who have served professionally and proudly.  This has remained constant.

• Casualties - over 6,200

• Serious wounds - over 50,000 of which 1600 limb amputations

• Traumatic Brain Injury - over 43,000

• Over 4,000 new cases of PTSD each month

• Most of the injured are young and will require decades of care

• Estimated health care costs could reach half a trillion over the next two decades (Iraq, Afghanistan War Wounded Pass 50,000, David Wood, Huffingtonpost, 25 October 2012)

• 1.1 million caregivers providing 24/7 care to wounded veteran

• Statistics do not reflect soul wounds

Long Term Affects of Post 9/11 War

The wars of the 21st century will have long term affects for decades.  U.S. Troop Casualties – over 6,200 killed in Afghanistan and Iraq combined.  Of these troops; 98% male. 91% non-officers; 82% active duty, 11% National Guard; 74% Caucasian, 9% African-American, 11% Latino. 19% killed by non-hostile causes. 54% of US casualties were under 25 years old. 72% were from the US Army.  Of the over 50,000 serious wounds, a large percentage are brain or spinal injuries.   The total excludes psychological injuries.  US Troops with Serious Mental Health Problems - 30% of US troops develop serious mental health problems within 3 to 4 months of returning home.  *There are over 460,000 post 9-11 veterans with Post Traumatic Stress Disorder (PTSD).  Over 50% of those with PTSD do not seek treatment.  Some just refuse to be on medication, other believe they will be shunned by society or employers, or even have their civil rights or guns taken away.  59% feel no improvement or worse after therapy.  30% drop out of treatment.  A sizable proportion have tried over 10 different medications to no avail.   * (National PTSD Center, VA American Legion)  

*There are nearly 50,000 homeless veterans or in a federal program aimed at keeping them off the streets during 2013.  2/3rds of them were diagnosed with PTSD.  The average for homeless veterans is 6 years on the streets. *HUD, National Coalition for Homeless

Our wounded warriors will require health care for decades due to the young age of our troopers.  Recently the Rand Corporation under the auspices of the Dole Foundation conducted a survey. They discovered there are over 5.5 million caregivers (1.1 million from post 9/11 war) who provide 24/7, 365 days a year care for their wounded loved one. This also takes a toll on the family systems.

The one aspect that these statistics do not reflect,  those who experienced the wounding of the soul.  There is no data on those warriors who have experienced spiritual or soul wounds.

Transition ChallengesCombat Veterans

• Change in roles

• Feeling disconnected

• Battlefield to bedroom

• Fantasy versus reality

Spouse

• Joy, relief, unexplained anger

• Feeling a loss of independence or hand it all back

Children

• Change; older, taller, matured

• May experience disappointment (Returning home: What we know about the reintegration of deployed service members into their families and communities, Marek, Hollingsworth, D’Aniello, O’Rourke, Brock, Moore, Butler VI, Zhang, Miles)

Beyond the most telling statistics on our wounded warriors , the transition home from combat to home provides numerous challenges as well.  

Reintegration is characterized by the veteran’s returning to his or her daily life as experienced prior to deployment.  Despite much literature suggesting that the reintegration stage lasts several months, this stage can actually persist for months to years depending on the individual veterans, his or her family, and the fuller context of the service member’s life.  Reintegration can be a turbulent time for the family, as members must re-form into a functioning system. Some studies suggest that relationship stress and negative family function may reach a peak between 4 to 9 months after the service member’s return. One of the greatest challenges for these families appears to be renegotiating family roles as the veteran encounters the often-unexpected difficulty of fitting into a home routine that has likely changed a great deal since his or her departure. Typically, over the course of one or more deployments, the at-home parent and children assume new responsibilities. While the veteran was deployed the spouse took on many of the roles the service member accomplished prior, such as paying bills, disciplining the children, repairing the car.  Now that the veteran has returned, the veteran may desire to back the responsibilities.  This can cause conflict.  Let’s look at some of the challenges each family entity may experience.

For the returning veteran; 1.Feeling like they no longer fit into their families due to the family changes that occurred in their absence.  Often the spouse feels an increased competence of the spouse because they have taken over many of the tasks and roles that were previously completed by the service member. 2. The transition from a war zone to home can be disconcerting in itself.  Imagine being on a forward operating base in Afghanistan where the threat of rocket or mortar fire is prevalent, and the next day arriving home.  There may be a sense of joy and relief being home, but the danger may still be a part of the veteran’s experience.  Often difficulties occur due to low frustration tolerance, poor anger management, difficulties in coping and self-regulation, hypervigilance, and social withdrawal. Many of these could be characterized as post-traumatic stress symptoms and may also include increased alcohol use and heightened symptoms of depression and anxiety. 3.  Most returning veterans begin to think of home on the plane as they leave the danger behind.  Often they have unrealistic expectations, a fantasy of what the reunion will be like.

For the spouse; 1. Of course there will be feelings of joy and relief, to finally have his or her spouse home after a deployment into a combat zone.  But there may be some unexplained anger.  This could

• Psychological

• Emotional

• Cognitive

• Physical

• Behavioral

• Spiritual

Whole Person Perspective Reactions to Trauma

Our veterans who experienced trauma face the most difficult challenges.   As we review the impact of trauma on the warrior, we will look at this from a whole person perspective.  Additionally, as we review the realities of how trauma affects the veteran, keep in mind that as the veteran exhibits the residue affects of trauma, so does the family and community.

Reactions to trauma affect the whole person.  Most medical professionals readily recognize the psychological, emotional, cognitive, physical, behavioral reactions to trauma.   However, as stated earlier, the underserved component in understanding the reactions to trauma is in the spiritual realm.  All too often the spiritual and the soul are relegated to the purview of the religious counselors and religious leaders.  Combat trauma has not been treated traditionally as a spiritual or moral injury.

Psychological

It is important to note, trauma changes the person.  It is not that they are worse, but different.  Each person who returns from war will be different.  War changes all who have stepped unto the battlefield.  Post traumatic  stress is a normal reaction of normal people to extreme and life threatening events. It is part of the human survival response.

It is marked by differing symptoms that occur in three different domains: Intrusive memories, hypersensitivity, and dissociation.  Most people recover on their own. It is only when people become stuck that the condition we know as Post Traumatic Stress Disorder or better know as PTSD occurs.  It should be noted that the symptoms described must exist for more than 30 days for a formal diagnosis to be made.  When one exhibits the symptoms of PTSD, the hallmark of anxiety is avoidance.

Emotional

This slide may bring a laugh.  The symptoms of anxiety are merely an exaggerated stress response.  The emotional responses of irritation, moodiness, anger, can be easily observed, most likely you will be on the receiving end of the outburst.  However, there are several not so easily observed, fear and loss of confidence.  Important to remember, the warrior will not be him or herself, rather they will have very exaggerated emotions.

Mental

Some common cognitive responses might be:

Distortions of orientation/confusion – Trauma victims often experience distortions of time, narrowing fields of vision, and other spatial and temporal relationships. For example a small gun is remembered as being the size of a cannon.

Presence of cause and effect thinking – Certain aspects of the trauma become universalized like all people with olive complexions are terrorists or believing all planes are weapons and panicking when one flies by.

Difficulty concentrating – The warrior will have a difficult time focusing and concentrating.  This is also accompanied by difficulty in making decisions.

Physical

The physical symptoms of trauma are similar to reactions to stress, tension, fatigue, trembling, panic attacks. Again, it is when these symptoms remain for an extended period of time, that the warrior may be experiencing a combat related anxiety.

Behavioral

SLEEP DISTURBANCE – At night the warrior will have trouble sleeping and often will experience nightmares. During the time when the warrior is awake, them may experience vivid flashbacks of the event. At times these are triggered by something like a smell or sound.

HYPER-VIGILANCE – On constant alert to possible threats.

NEED TO DO CERTAIN THINGS OVER AND OVER – This reaction is in response to create order out of the chaos of the traumatic experience and create a sense of being in control.

DOING STRANGE OR RISKY THINGS – This reaction is usually an attempt to create the rush and excitement that are part of the survival reaction.

SELF-MEDICATION – A common way of avoiding painful memories of the horrors of combat.

EATING PROBLEMS – Lose of appetite is often associated with the down side of the trauma curve, but sharp increases in appetite can also occur as the body seeks to replenish its energy reserves.

DEPRESSION – Reflective of the overwhelming power and shock of traumatic events leads the warrior down a path of depression.

KEEPING TO YOURSELF – Withdrawal is common as senses are overwhelmed and there may be fear and confusion associated with the traumatic stress reaction.

LACK OF MOTIVATION – Nothing excites the warrior, does not have the same sense of joy with self, family, job, friends, and activities.

AGITATION – Trauma victims often exhibit nervousness, irritability, and can be prone to bouts of anger.

SPIRITUALDiscouragement

Hopelessness

Despair (The Post-Traumatic Stress Disorder Sourcebook Schiraldi, G. 2000)

Fear

Guilt

Moral Injury

Confusion about God

Each of us hold basic assumptions that give order to our world and can make stress bearable.  After one experiences trauma, these assumptions are shattered.   Trauma disrupts one’s view of the world, even their spiritual understanding, as suggested by Dr. Schiraldi in his book, The Post Traumatic Stress Disorder Sourcebook.  

War’s violence press questions of faith into the lives of those who fight them.  When a warrior steps onto the battlefield he or she immediately is confronted by the kinds of horror and hardships that has moved humanity through the centuries to reach for the spiritual.  

Spirituality characterizes a person that has assurance, confidence, anticipation, hope, and joy.  Following trauma that same person experiences a loss of these qualities.  They now exhibit discouragement, hopelessness, and despair. It may feel that God is feeding them to the sharks.

But the wounding of the soul goes much deeper.  Even people of great faith are changed by trauma.  There are numerous stories of chaplains who were so wounded by trauma of war that they lost their faith or adopted destructive behavior as an escape of war.

Consider Spiritual IssuesHow to define?

Let’s take an in-depth look at the spiritual issues affecting our combat veterans. The spiritual domain is not a common field for the medical and mental health models for treating the symptoms of combat trauma.  The Department of Defense and the Veterans Administration have made progress in combat veteran care under the rubrics of the physical, emotional, behavioral, psychological, and mental.  The area that has been underserved is the spiritual.  All too often the spiritual and the soul are relegated to the purview of the religious counselors and religious leaders.  Combat trauma has not been treated traditionally as a spiritual or moral injury.  

Spirituality is a complex subject.  Spirituality challenges researchers when they attempt to frame it in scientific terms. One reason is that there's no widely accepted definition of spirituality. Some people associate spirituality strictly with religious beliefs, while others associate it with nature, art, meditation or inner peace or harmony.  Yet, some researchers think that measuring spirituality with questions about peacefulness, harmony and well-being is meaningless since it results in spirituality being simply defined as good mental health, so they instead prefer to define spirituality in terms of religious practices and beliefs.

As one researcher puts it, "Spirituality is an important, multidimensional aspect of the human experience that is difficult to fully understand or measure using the scientific method, yet convincing evidence in the medical literature supports its beneficial role in the practice of medicine." The Association of American Medical Colleges defines spirituality broadly: "Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individual's search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism, and the arts."

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

• After WW2 spirituality and religion disconnected

• Distinction between the two became common with the rise of secularism

• Modern spirituality is centered on the values and meanings by which people live

• Person well-being, both physical and psychological, is an important aspect of modern spirituality

• Some discoveries suggest other possible links between spirituality and mental health

• Important note: 18-35 year olds largely view themselves as spiritual not religious

Spiritual Not Religious

SpiritualityReligionReligion

&Spirituality

Spirituality is not the same thing as religion.  This is an important distinction to understand.  While religion may be one way in which persons express or experience spirituality, it is not the same as spirituality itself.  Religion can be thought of as the organization of belief which is common to a group of people, that has been ritualized, institutionalized, and codified.  It becomes a communal experience, rather than individual.  Consider for a moment, spirituality is the dance and religion is the steps.  

Many people use the terms religion and spirituality interchangeably, but they are two separate concepts that often overlap. Simply put, religion is a belief system that adheres to a doctrine or doctrines, while spirituality is a personal belief, which may or may not include a belief in God. Why is all of this important for us to understand?  A large demographic of our veterans are 18-35 year olds.  Their world view is through a lens from the eyes of spirituality rather than religion.    

Spirituality acts as a filter through which a person sees and interacts with the world. Think of it like this: Spirituality usually influences how a person lives, how he or she reacts to stressful situations, and how well and how quickly a person recovers from emotional strain.

Do you recall, from our initial slides specifying the research on the importance of spirituality, religion, or faith in the healing process, spirituality as a consideration does not have substantial historic scientific inquiry.  It has only be recent that there has been empirical science on soul  care and its impact on health.  There have been numerous publications on the impact of spirituality on health care and medicine in medical journals. Within modern American psychology William James and Abraham Maslow emphasized the study of healthy vibrant persons  with an attention on spirituality.  (Moss, 2002) With this said, psychology has lagged behind in attending to spirituality in research and clinical practice.

People with a spiritual orientation may view a variety of life’s areas as "sacred" and thus seek help when they feel their physical and emotional well-being is threatened. They believe there is an ultimate purpose for them, and they glean hope from that belief even in the most tragic and distressing of circumstances.

But again, documented research often fails to distinguish between religion and spirituality and in doing so suggests that a spiritual or religious orientation is associated with better mental health. The results of either suggest that it can help increase self-esteem, find meaning in life, improve family and special relationships, and decrease drug and alcohol abuse. Both provide a moral compass to help navigate life.

Spirituality and Meaning“He who has a why to live can bear almost any how.” (Nietzsche)

“The deeply personal search for meaning can bring a person to inner peace even in the presence of adverse circumstances.” (White Paper)

“We also become spiritual when we become moved by values such as beauty, love or creativity that seem to reveal a meaning or power beyond

our visible world.” (Richard Fuller)

“The kind of spirituality I value is one in which you get great joy out of contributing to life…” (Marshall Rosenberg)

Trauma can shake one’s faith.  As we consider the spiritual issues that affect the veteran’s soul, a place to begin is how spirituality provides meaning in life.  The flip side, as healing occurs trauma survivors might discover the potential for a greater faith.

Constructing meaning from life’s events –is an essential human characteristic, a critical element of psychological well-being (Fetzer Institute, 1999). Pursuing the purpose of one’s life takes on significance especially after experiencing trauma.  Some researchers have suggested that traumatic events frequently challenge one's core beliefs about safety, self worth, and the meaning of life. For individuals whose core values are spiritually grounded, traumatic events may give rise to questions about the fundamental nature of the relationship between God and humankind. Survivors may question their belief in a loving, all-powerful God when the innocent are subjected to traumatic victimization. In this way, traumatic experiences may become a starting point for discussion of the many ways in which survivors define what it is to have "faith."  Spirituality can be the center

Recovery of meaning in life may be achieved through changed ways of thinking, involvement in meaningful activities, or through rituals experienced as part of worship service or some other spiritual involvement.  Human beings have long looked to faith for strength and support, particularly in difficult times. .  Life meaning is an inherent part of faith and the spiritual journey.

• Spirituality helps give meaning to people’s suffering.

• Spirituality helps people find hope in the midst of despair.

• It is through spirituality that people can become unstuck from despair. (Christina M. Puchalski)

Spirituality and Suffering“Man is not destroyed by suffering, he is destroyed by suffering without meaning”

Viktor Frankl

Sometimes under the stress of living and at times suffering, it is easy for us to lose sight of the meaning and purpose that steadies us and sees us through the difficult times.  Again, meaning and purpose are critical components especially in the midst of suffering.  

Victor Frankl wrote that "Man is not destroyed by suffering; he is destroyed by suffering without meaning.“  He noted when writing about concentration camp victims, that survival itself depended on seeking and finding meaning. People cope with their suffering by finding meaning in their suffering. This is where spirituality plays such a critical role. It is the relationship with God that gives meaning and purpose to people's lives, to their joys, and to their sufferings.  St. John of the Cross helps us understand suffering as a way of growth: “There is another reason why the soul walks securely in these darknesses: it advances by suffering. Suffering is a surer and even more advantageous road than that of joy and action. First, in suffering God gives strength to the soul...second, in suffering, virtues are practiced and acquired and the soul is purified....”

Spirituality is the dimension of human beings that seeks healing. Often spirituality is expressed as religion: For many people religion forms a basis of meaning and purpose in life. The profoundly disturbing effects of trauma can call into question a person's purpose in life and work.  Healing, the restoration of wholeness (as opposed to merely technical healing) requires answers to these questions.  

In the medical field, it is apparent that the care of the ill person involves more than just attention to the physical. A person's mind and spirit are often affected by and may contribute to the manifestation of physical symptoms. In healing, all dimensions of a person are involved: physical, emotional, and spiritual. People may look to science to alleviate their suffering. When science fails to do so, they begin to look toward spirituality for meaning, purpose, and understanding.

• Expressed through feelings of anger, doubt, grief, fear, hopelessness, guilt, and a sense that life is meaningless

• Some who had a faith prior to combat may have lost their faith as a result of their experience

• Feelings of un-forgiveness

• Anger directed toward God

• God has directed anger toward the warrior; “God is punishing me!”

Spiritual Struggle

Spiritual beliefs may influence the trauma survivor's ability to begin a journey of healing following the trauma experience.  Several studies have indicated that negative thoughts or attributions about God, such as "God has abandoned me," and "God is punishing me," or, being angry at God are associated with a number of poor clinical outcomes.  One study of Veterans being treated for PTSD found that negative religious coping and lack of forgiveness were both associated with worse PTSD and depression symptoms. (Witvliet, C. V. O., Phillips, K. A., Feldman, M. E., & Beckham, J. C. (2004). Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. Journal of Traumatic Stress, 17 (3), 269-273)

Spiritual injuries include anger, doubt, grief, fear, hopelessness, depression and loneliness.  These can lead to feelings of abandonment and loss of faith in God.  For many veterans it is the feeling of being un-forgivable, because of what they have done or saw while in combat.  These effects may change as time passes and a person moves further away from the acute phase of trauma recovery. Trauma can be associated with loss of faith, diminished participation in religious or spiritual activities, changes in belief, feelings of being abandoned or punished by God, and loss of meaning and purpose for living.

• It is not PTSD

• Emerges after PTSD symptoms are relieved

• Comes from a violation of a core moral belief

• Comes from a feeling betrayed due to another person’s violation

• Changes one’s views of expectations about human capacity to behave in a just or ethical manner

Moral Injury

After the veteran returns from war, for many, the threats of combat linger. People grow up in families or faith communities with a given moral code of conduct. Moral codes come into conflict in war.  What we were taught is, “Thou shalt not kill.”  What we experienced in combat was, “I killed another human being.”  What we were taught, “Love thy neighbor as thyself.”  What we experienced in combat was, “I have injured another.”  What we were taught was, “The name of the Lord is a strong tower; the righteous runneth into it and is safe.”  What we experience in combat was, “My friend died.”  What we were taught is that God is love.  What we experienced in combat is, “I have faced evil and have been lessened by it.”  

Warriors are required to do things including the taking of a human life, motivated by a direct command, survival and fear that may be in direct contrast with a moral code they lived with previously. Or, the injury is brought about by bearing witness to perceived or real immoral acts, especially those that are inhumane, cruel, depraved, or violent that brings about pain, suffering or death to others. This sets the stage for moral injury, a painful spiritual wound.  Moral injury manifests itself usually as one experiences a relief of the symptoms of PTSD.

Source: Soul Repair, Nakashima, Brock, Lettini

• Resolving Guilt

✓ Repentance and forgiveness

✓ Remembrance and mourning

✓ Mourning and lamenting

• Serving Others

Transforming Spiritual Trauma

War has been regarded as a gross consequence of human failure.  In theological language, sin.  The conduct of war often descends into brutality.  Even when the outcome may bring peace, the broken and shattered lives along the way become a reminder to those who were engaged of war’s harsh realities.  A sense of brokenness and alienation from God, self and others is a consequence.  Many warriors have experienced grievous wounds to their souls.    

How can the returning veteran journey toward transformation and healing of the soul?  They begin a long spiritual quest that may include repentance, forgiveness, mourning, lamenting, and reconciliation. Also, by serving others the veteran can begin to look beyond their soul wounds into the needs of others. This has a deep healing power.  

The faith community is no stranger to such quests.  When warrior has a soul wound, the community of faith can live out a critical role in the warriors’ journey.  After wars of the past, clergy and laity have played a key role in helping veterans find healing of the soul.  Clergy and laity have offered through their actions hope, love, patience, forgiveness, trust, and comfort.  Each have offered words of assurance from scripture.  Both actions and words living out the Gospel provide remarkable healing power.

There are important factors that clergy, lay leadership and congregations must be aware.  Forgiveness from war related trauma can be complicated and elusive.  Some veterans do not like the person they have become and they become mired in shame.  Some carry deep rage and anger thinking they can never forgive or be forgiven.  Some do not realize they need forgiveness until years later.  Some compartmentalize what happened and suffer in silence.   However, the faith community has many traditional practices that could be offered to the veteran as part of their healing journey.

Faith Community Response

The next several slides suggest the numerous responses available to the faith community. The community of faith offers hope, new life, love and compassion. These center around several core responses.  The faith community is uniquely positioned to respond.  

Although returning veterans are among the demographic least likely to attend church, many have loved ones who attend regularly.  With awareness, training, coaching and support, caregivers (clergy, parish nurses, congregation members, loved ones and friends) can be empowered to render an invaluable service to the returning veterans and their families.  Cultivating an awareness within the congregation can be central to develop a caring an effective mission or ministry. Begin to discover who the veterans are in your community. Stop by the American Legion or VFW and meet the local commander. Know the community resources available to our veterans.  It may be helpful to have a table in entrance to the sanctuary, or fellowship hall with materials from the VA and other veteran services; such as VFW, American Legion and Veteran Centers.

Faith Community Response

Second, provide support.  The community of faith has so many resources in liturgy and faith traditions that can be used to bring healing of the soul and begin a process of developing spiritual resilience.   Congregational spiritual practices, activities, and rituals create a climate of healing and communicate a sense of care to the warrior and their family.  Whether a retreat, study of sacred texts, special healing service, and recognition service; or in the Christian traditions, a Good Friday service, or use of liturgy and the church calendar, all contain powerful resources of hope and healing.  Explore resources from other faith traditions, such as Native Americans.  There is a richness across faith traditions that offer restoration and healing.

Connect with the community resources available to the veteran, such as counseling, job training, education.  Call the local VA Hospital Chaplain and discuss ways to collaborate on soul care.  Clergy and congregational care offer numerous tools to the veteran, such as counseling, visitation and hospitality. Visiting with families prior to deployments to find ways to support them during the absence of the military member can be accomplished by clergy and laity alike. Establishing connection early in the deployment cycle, caring and supporting their family during the deployment, and showing patience and understanding upon return are the best way of developing and nurturing trust.  Trust will assure the veteran that he or she can reach out during other challenging times.  Also, rituals of sending and blessing can be included within the worship service (with the families permission) to express support for the departing military member and their family.  Clergy and congregational care offer numerous tools to the veteran, such as counseling, visitation and hospitality.

Faith Community Response

Third, seek  a restorative path. Walking with veterans and their families on healing journeys is a means of justice and central to the ministry in a community of faith.  Sometimes that journey includes an awareness of trauma, as well as the space for trauma healing.  For Christians recognize that Christ died a torturous death because of our brokenness and this is graphically symbolized in the images of war and its desolation.  “He descended into hell” a phrase Christians reminds them of the Good News that even the hell of war is not beyond the grasp of God’s redeeming love through Jesus Christ the Lord.  The crucified Lord returned with forgiveness, healing, hope and the requirement is for us to do likewise.  Churches provide a sacred story for seeking the theological and spiritual meanings of suffering through actions of compassion, grace, patience, understanding, and forgiveness.  As the church lives out the liturgy throughout the church year Christians experience anew the powerful reassurance of God’s grace and presence in their lives.  As the church does so, each congregant learns to trust others, to bind the wounds of those hurting, and find restoration into the community.

In Hebrew the word for Justice is “mishpat”, it means caring for those most in need within a society. This is an important component of understanding justice in faith communities. It is about caring for those in need as a way to restore relationships and support reconciliation.  Seeking justice alongside veterans and their families can be a way for communities of faith to more deeply understand the needs of individuals, families, and communities.

Conflict is a normal part of human relationships, and provides a unique opportunity for communities of faith to respond in a transformational way.

Faith Community Response

Fourth, create space.  Faith communities extend hospitality. Social support becomes a critical component in veteran care. The community of faith can open their facilities for various veteran group meetings, such as peer support groups. Peer support groups have provided combat veterans a great source of comfort and care. The groups comprise of combat veterans who regularly meet to share in their story, struggles, challenges, as well as offer encouragement. Peer support groups provide their own facilitators. But if a particular faith community has professional counselors they might make them available. Also, a spiritual mentoring program can be beneficial as well, where a combat veteran with spiritual maturity who has been on a journey toward healing can be a mentor to a more inexperienced veteran. Additionally, family members largely care for their wounded loved one. The faith community can provide needed support through group meetings, and various ministries that reach out in support.  The community of faith can be a safe haven for the returning warrior and family. By opening their doors and developing “spaces of grace” where the warrior and family feel safe to share their feelings and needs, is an important step in the healing journey.  

The warrior’s story is “sacred.”  The faith community is about sacred things. Also, the faith community has a sacred story as well. Members of the faith community can be a great resource because of the power of story. Please understand the importance of this critical point, members of the faith community CAN BE a great resource. They that are committed to a ministry to veterans should prayerfully contemplate the experiences of the veteran returning from war.  The stakes are high and the costs of war are very personal.  Therefore, attentive and non-judgmental listening will help the warrior in his or her spiritual struggle.  For a veteran, telling even a small snippet of one’s story and feeling heard and accepted may be the first important step toward healing.  Just a few things to consider – A warrior may sometimes make politically incorrect (at least from the listener perspective) comments.  If you react negatively, the warrior may conclude you do not have the capacity to bear the brunt of their trauma story. Sometimes when listening we reply, “I understand how you feel.”  A veteran rightfully believes that unless you have been in combat yourself, you can’t fully understand. Often when telling a war story, the warrior may use a string of 4 letter words.  Important not to interrupt and correct.   You are to listen to their sacred story. A veteran may appear angry.  The veteran’s anger is not directed toward you. Don’t change the story.  It sends the wrong signal, you are not interested. 6.   And do not try to fix the veteran.  They do not want fixed, they want heard.

Above all, remember, this is their story.  By understanding their story in the context of spiritual meaning, we then can relate to the person not the war.  This is the most important step

Faith Community Response

Lastly, make meaning. By providing the veteran opportunities for service gives them a connection beyond themselves, an opportunity to serve others. Invite veterans to participate in service projects, or volunteer in interests groups within the church, will prove beneficial as they begin to see the needs of other beyond themselves.

• Faith based organizations have initiated programs supporting warriors and their families

• Partner with VFW, AMVETS, American Legion, Wounded Veterans of America, Disabled Veterans of America, etc.

• Get to know the VA and its resources

• Locate a Veterans Center

Network with Community Resources

Across the country numerous faith based organizations have initiated programs to support our veterans and their families.  If you google the topic, you will see the plethora of links.  Secondly, most communities have an American Legion, Veterans for Foreign Wars, AMVETS, and a Disabled Veterans of American chapter.  They all provide services for our warriors.  Also, it is best to become familiar with your closest VA Hospital and the chaplaincy, also find the closest Vet Center.  They provide counseling services for the warrior and family, free of charge.  The only stipulation is that the warrior be a combat veteran.

Questions or Comments?

I hope you discovered this presentation helpful in your particular setting. As you process the information contained in the presentation and you have questions, or you begin having a conversation with your faith community leaders about starting a mission or ministry to veterans and their families and you desire more information, please feel free to contact me. My contact info is dsmith@justpeaceumc.org. I look forward to our journey together in caring for our veterans and their families.