Posts tagged " soul wounds "

Soul Care Conversation (Spiritual Model for Healing from Moral Injury; Fifth Step – Making Amends)

June 19th, 2017 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community.

We continue our conversation on a proposed spiritual therapeutic model toward healing from moral injury. As a reminder, this six step model includes;

  1. Acknowledge (confession) – take an honest assessment of thoughts and behavior, then acknowledge guilt and shame, and anger
  2. Forgiveness – choose forgiveness of self in the trauma experience as well as others who may have had responsibility
  3. Self-acceptance – renounce self lies like; I’m no good, I’m nothing, I’m worthless, I can’t be loved, and accept the reality of being a child of God
  4. Renewal – begin to retrain mind
  5. Amends – restoration involves a direct way to repair what has been damaged or broken
  6. Accountability – be in a community that offers accountability and support

We have discussed the first four steps; confession, forgiveness,  self-acceptance, and renewal of the mind.  This month, we will discuss the fifth step, making amends.

BACKGROUND

Making amends is an integral component in any recovery program. Addiction, whether to alcohol, drugs, sex, or gambling creates moral wreckage. Broken relationships and a deep soul wound result.

In these situations an apology will not suffice. Alcoholics Anonymous (AA) calls for making amends.

Additionally, AA understands that making amends is a delicate process, therefore the guidance of a sponsor or counselor is required.

Making amends is a critical component toward recovery from addiction. This process also has importance to a veteran regarding restoration from doing or experiencing harm resulting in moral injury. The same components exist;

  • experiencing the reality of broken relationships and a deep soul wound
  • offering an apology is not enough
  • needing someone to be a confidant, listener, counselor or friend

We will look closely at these three factors in making amends as they relate to healing from moral injury.

 THEOLOGICAL IMPLICATIONS

Experiencing broken relationships and soul wounds – The conduct of war often descends into brutality. Even when the outcome may bring peace, broken and shattered lives along the way become a reminder to those who were engaged in war’s harsh realities. A sense of brokenness and alienation from God, others and self occurs and the consequences are grievous wounds to the soul. A soul wound goes deep because the battlefield strips away the veteran’s belief system. At the very core of the wound is the feeling or brokenness and hopelessness.

From the opening pages in the first book of the Torah, the Hebrew scripture tells us something has gone wrong; loving relationships have been broken, creation has been marred, humanity has been separated from God, all resulting in the need for God’s healing. Good news begins right here; God does not simply step in and by coercive force make things right. Rather, love shapes God’s activity; patient and persevering. Love becomes the “healing balm” that galvanizes God’s response to a broken world.

Offering an apology is not enough – The core ingredient to experience healing is restorative justice. Restorative justice becomes the central focus. One of the clearest and most holistic words for justice is the Hebrew shalom, which means both “justice” and “peace.” Shalom includes wholeness, or everything that makes for a person’s well-being, security, and the restoration of relationships that have been broken. Restorative justice is about repairing broken relationships with other people.

For a veteran who may have experienced a moral injury while in combat, it may be difficult to see how they can experience “wholeness” after what they may have done or seen. Yet, it may be in service to others that the veteran begins to see the positive connection with others, and see this as a way to make amends.

Shalom is not a passive concept, rather it is lived out in community. That is why justice always has to be social. So restorative justice, most simply, means putting things right again — fixing, repairing, and restoring broken relationships. And doing justice restores our relationship with God.

Needing someone to be a confidant, listener, counselor or friend. – The faith community is uniquely positioned to be a blessing to veterans who have experienced a soul wound. After wars of the past, the faith community has 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.  They have offered words of assurance from Holy texts. Both actions and words living out the sacred Love story provide remarkable healing power.

Also, other veterans can be a solace to one another. Through a like minded community, veterans can encourage and support each other.

Restoration will involve a lot of lists. In particular, the veteran should make a list of all the people he/she has hurt physically or emotionally. The memories may be painful, especially when listing family members. When attempting to make direct amends, there might be people unwilling to forgive. This is where the veteran should turn to a counselor or clergy to assist the veteran through the painful process.

BIBLICAL BASIS FOR “MAKING AMENDS” 

We are reminded of the scripture that states, “An eye for an eye.” However, there is much more to Biblical justice than this statement. In fact, the Hebrew and Christian texts call for justice is a much deeper and more involved approach. Rather than retribution, justice involves making amends.

The Biblical concept of making amends involves restoration:

  • restoration of self
  • restoration in community
  • restoration to God

Human failure is nothing new. In fact the Bible contains so many stories of people of faith who failed; Samson, Abraham, David, Solomon, Jonah, all of the Disciples, and the Apostle Paul. The evidence of failure is sobering.

But, equally overwhelming is the evidence that God restores those who have failed. There are passages from both the Hebrew and Christians texts that reveal God’s character as the One Who Restores! God reclaims and restores those who in a moment of weakness failed. This is God’s Love in action! Restoration involves;

  • acknowledging the wrong
  • making amends with those harmed
  • making peace with God

In the Hebrew texts, the Law of Moses specified the various circumstances and processes for restitution to one’s neighbor (the victim) and sacrifice to God (Leviticus 6:2-7). All are as important as the other.

In the Christian texts, there are numerous examples of restoration, one being the story of Zacchaeus (Luke 19). This story reiterates the importance of acknowledging the wrong, making amends to neighbor, and making peace with God. Zacchaeus shared before Jesus and his neighbors that “I will give half of my wealth to the poor, Lord, and if I overcharged people on their taxes, I will give back four times as much.” Jesus responded, “Salvation has come to this house today, for this man has shown himself to be a son of Abraham.”

Restoration is not only possible, it is hoped for and encouraged.

IMPLICATIONS FOR THE VETERAN

Let us briefly explore each of these three areas.

Acknowledging the wrong – “Acknowledge” is defined; to admit to be real or true, recognized the existence, truth, or fact of.  A synonym is confession. Confession is a written or oral statement acknowledging guilt.

Confession. The word stirs up memories. Whatever the memory, most likely it is not pleasant. In fact, for many confession connotes pain from failure and being weighed down with guilt. However, confession offers us healing through a face to face encounter with the grace, love, and forgiveness of God.

The first step toward restoration with God is to acknowledge our sin. Confession becomes a vital part of our fellowship with God as it provides an opportunity to be reconciled within the community.

Making amends with those harmed – An amend has to do with restoring justice as much as possible. The idea is to restore in a direct way that which we have broken or damaged – or to make restoration in a symbolic way if we cannot do it directly.

There are many ways for a veteran to make amends, however, amends may not be possible to the person(s) directly injured or wronged because danger remains where the harm occurred. There are indirect ways. Veterans can offer assistance to organizations assisting war refugees. Additionally, there are non-governmental organizations (many faith-based) serving in war torn countries that are in need of not only financial assistance, but volunteer service.

Sometimes it will be difficult to make amends even indirectly. Veterans have another option, to make “living” amends. This simply means that the veteran lives differently. Amends are about genuine change in our behavior instead of a simple apology. We take on a whole new way of living.

Making peace with God – In Christian traditions, the prayers of confession and great thanksgiving prior to communion can make peace with God. More powerfully, the communion service is not only a means to confess, repent, and hear words of assurance, but we also participate in the powerful act of receiving God’s grace through the bread and wine. Hope and new life not only become words, but experienced realities. Communion becomes an act of making peace with God.

BENEFITS TO MAKING AMENDS

If we have not made any effort to make amends to those we have harmed, we may then have a lot of people, places, and things to avoid. We tend to live in isolation. In fact, large areas of our lives become closed off to us. When we make amends, are lives are open to new possibilities. We will experience a new freedom and Shalom.

Lastly, we are reminded in Micah (6:6-8) that God does not require our words or acts in worship to make peace, but “to do what is right, to love mercy, and to walk humbly with your God.” To do this, we become restored people.

Next month we will discuss the last step, accountability. Until then, thank you for the conversation…

Soul Care Conversation (Faith Community Response, Make Meaning)

November 18th, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Last week as we honored our veterans, I shared a personal reflection on the sacrifice our veterans make while serving our nation. This week, we will discuss the fifth and last response of the faith community, make meaning.

BACKGROUND 

Meaning and purpose are central in human life, particularly when individuals confront highly stressful and traumatic life experiences. 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, and between God and self. 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.“

Trauma can shake one’s faith.  The veteran wants to understand why. Why did the traumatic event occur? Why did they survive? The journey to understand the why can be a long process for the veteran.

Trauma interferes with the practices that embody our systems of belief. The soul of veterans often demonstrate the ineffectiveness of their prayers, their worship, the value of scripture, and their faith. For many of our veterans, their traumatic experiences with which they struggle will affect their understanding of God and faith. The pain and terror of trauma can infuse such doubt in God and God’s faithfulness that the veteran reaches a point of denying God and their faith. The veteran can question God’s ability to intervene in the situation. The veteran can feel that God is punishing them and blame God for the loss.

For others, the presence of a meaning-making system, such as faith, serves as a protective factor when trauma strikes. Faith and spirituality can assist the veteran in developing a sense that love shapes God’s activity; patient, persevering, and long lasting. It is through love that God responds to a broken world.

Holocaust survivor Viktor Frankl writes in his 1946 book, Man’s Search for Meaning, that the primary motivation of a person is to discover meaning in life. Throughout this powerful book Frankl insists that meaning in life can be discovered under all circumstances, even in the most miserable experiences of tragedy and loss. Through his own experience Frankl shared that people can discover meaning through doing a deed, experiencing value, and even by experiencing suffering. Meaning making is a key component in trauma healing.

LIVING LESSONS

During my deployment to Iraq, 2003-2004, I experienced a wounding of the soul. The circumstances of these wounds I have shared in previous conversations. My symptoms of soul loss were the following;

  • shattered self esteem
  • finding it difficult to pray
  • no spirit of thankfulness
  • seeing no value in scripture
  • not interested in attending worship
  • deep self-doubt

These symptoms would ebb and flow for 8 years. At times I would find myself experiencing a sense of peace through the ritual of worship, or a sense of healing through a spiritual retreat, or a sense of community when with other combat veterans.

However, I noticed that many of my symptoms subsided when I began my tour in Afghanistan as the Command Chaplain for all US Forces. Possibly because the mission was so daunting that my focus was on the task at hand. But, I believe it was something much deeper.

It became clearer after my re-deployment. I was re-assigned into a new position where I experienced very little significance, meaning and purpose. I began to exhibit similar symptoms that I had following my Iraq deployment.

I finally recognized that I needed professional help to work through what I was feeling and experiencing. During the course of these last four years it has been the wise council of a therapist and the listening ears of fellow veterans in a support group that have assisted me on a healing journey. But I have discovered that at the center of all of this has been re-discovering meaning and purpose.

After my retirement from active duty, JustPeace hired me as staff to be the Coordinator for the Soul Care Initiative. Soul Care was a new emphasis for the United Methodist Church’s resource agency for Conflict Transformation and Mediation. My responsibilities have brought me great meaning and purpose.

But something else happened. I conducted my first workshop in a small college town in central Pennsylvania. As I look back on that first workshop experience, I believe I provided the participants a very sterile/clinical approach to trauma and trauma care. However, I began to include my personal story in my training presentation. This was not easy to do, but I thought it important to be authentic to those who trusted me to share such important information.

A year later I conducted a workshop in a community in close proximity to where my first workshop occurred. A person who attended my first workshop was in attendance. He commented that he was appreciative how I made myself vulnerable to the participants and wished I had done the same the year prior.

I then recognized that I was on my healing journey. Not that sharing the harsh realities of war is ever easy, but in revealing my journey with others proved to me that this was an important step. My healing journey took a big step when I discovered purpose and meaning for my life as I shared my story.

IMPLICATIONS FOR THE FAITH COMMUNITY 

The faith community can become a part of the veteran’s journey to find the answer to “why?” The faith community can engage veterans in their journey toward finding meaning and purpose by;

  1. Offering numerous interest groups – Research has suggested writing workshops and art therapy have value in spiritual healing. But there are numerous opportunities such as; rock climbing, bicycling, motor cycle riding, hiking, and other high adventure activities.
  2. Providing veterans opportunities for service – This gives them a connection beyond themselves and an opportunity to serve others. Invite veterans to participate in a Habitat for Humanity project, a Volunteer in Mission project, or some other work project that allows the veteran to give back. There are some groups whose focus are veterans; Team Rubicon, Volunteers of America, and Grace Under Fire, are some examples.

What examples can you offer, whether an interest group or volunteer opportunity, where you have seen success? Have you found other methods for veterans to find meaning and purpose?

This concludes our conversation on the faith community response. Next week we will begin to explore the various veteran support agencies that the faith community can collaborate with in veteran care. Until then, thank you for the conversation…

 

 

Soul Care Conversation (Faith Community Assets for Veteran Care, the Eucharist)

June 1st, 2016 Posted by Blog 2 comments

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Several weeks ago we began a conversation with a new focus, the faith community’s strengths and capacities for veteran care. The first topic we discussed was hospitality. Next we looked at the importance of ritual as a means of support for the veteran to transition from the battlefield to civilian society. This week, we will discuss how the Eucharist may be a means toward healing and well-being.

BACKGROUND

While in combat, a unit chaplain serves a large number of warriors who may be scattered on a number of forward operating bases (FOB) and combat out posts (COP). Chaplains often rotate their visits based upon transportation availability, personnel needs on a particular FOB or COP, mission requirements, enemy threat, and weather. Whatever day the chaplain visits a particular location, it is “Sunday.”

In Christian traditions, the Eucharist is central to the warrior worship experience, especially while serving in combat. Each time a chaplain visits a unit location, he or she offers an opportunity for the warrior to worship, and the Eucharist is offered. As the chaplain places the host in the hand of the warrior and looks into his or her eyes, words of grace, hope, and new life are offered. This simple and yet profound act has powerful implications for the warrior while deployed.

However, it is important to understand that within the Christian community, denominations categorize, name (Lord’s Supper, Communion), and practice the Eucharist differently. Also, there are theological differences. Chaplains and warriors adhere to their specific faith traditions. However, occasionally these differences and the theological substance of the elements are really not important to the warrior while in combat. If it had been a long time since any chaplain last visited a particular location, warriors would attend a service or mass no matter the faith tradition of the chaplain or style of worship service. What was important to the warrior were the words of comfort, fellowship with others, and the sense of the presence of the Holy. Communion would bring together these three elements for the warrior.

IMPORTANCE WHILE IN COMBAT

Participating in the Lord’s Supper while in combat is a soul-stirring experience because of the depth of its meaning. During each of my combat deployments, Communion took on a special meaning for me as a chaplain as I saw myself as a conduit of;

  • a means of offering God’s grace even in the midst of hell
  • recalling Jesus’ suffering for us through His broken body and spilled blood
  • the mystery of our redemption as we receive the fullness of Christ

Also, communion had special meaning for the warrior. As the warrior came forward to receive the elements, they would reach out with their dirty and battle scarred hands palms up. I would place the host in their open palms and I would look them in the eye and say, “The Body of Christ, broken for you.” Often the warrior would take the host with tears in his or her eyes, thanking God that they were still alive and that God has kept them safe for another day. The warrior would celebrate the Lord’s Supper accepting the host with;

  • heaviness of heart knowing of separation from loved ones back home
  • trying to understand the separation from the loss of a battle buddy killed or wounded
  • thankfulness knowing that Jesus had drawn near to us even in the midst of hell in combat

Participating in the Lord’s Supper while in combat is an integral part of our Christian worship. We receive comfort as we remember our Lord’s suffering, death and resurrection through prayers of confession and the Great Thanksgiving, but also through the meal itself. Additionally, the Lord’s Supper points to a hope as we look for His glorious return in the future.

MEANS TOWARD HEALING AND WELL-BEING AFTER THE VETERAN’S RETURN

This past January, my pastor asked me if I would be willing to take the worship service while he attended his doctoral studies. He reminded me that it was the first Sunday of the year and of the month which meant we would be celebrating the Eucharist. “Would that be OK?” Of course I was excited to be in the pulpit again and for having the opportunity to celebrate the Lord’s Supper. Little did I know the impact or effect being the celebrant would have on me.

As I stood behind the altar and reminded the congregation that “all were welcomed to the Lord’s table”, my heart flooded with emotions. As I placed in each persons’ palm a broken piece of bread from the common loaf, my eyes were filled with tears, for I recalled the warriors whom I placed the host in their hands and knew of the power and the mystery of that moment that while we were in combat we each received the good news of the forgiveness of sin and the hope of the resurrection. It reminded me of words of grace, hope, and new life. This simple and yet profound act has powerful implications for the veteran who now has returned.

The Eucharist is a means for the faith community to help the returning veteran work through the feelings of fear, shame and guilt, and pain and loss. For the Lord’s Supper provides opportunity for;

  • creating a safe place to reconnect to what the veteran feels
  • receiving social support as each person participates in the Peace and in the common meal
  • participating in the salvation story

Safe place – often, the only time a warrior felt safe while in combat was during the worship service. At the entrance to chapels in Iraq and Afghanistan were weapons racks where the warrior could safely place their weapon during the worship service and for a moment feel the safety of that place. In the chapel or even in the open spaces where many services occurred, the warrior could remove themselves from the stress and threat of the mission and draw strength from the prayers, the Word proclaimed, the fellowship with others, and the Lord’s Supper. For the returned veteran experiencing PTSD, he or she can re-connect to feelings of safety in their place of worship. More importantly than the safety of the physical space is the safety of being able to be themselves, honest with their emotions before God.

Social support – just as important to reconnect with feelings, it’s important to reconnect with others. Veterans often isolate themselves from others. During the communion service, the congregation can make an effort to invest in personal relationships. Important to note, as a civilian you may feel like you don’t understand what it’s like to be a warrior or to have seen the things they have seen. But people don’t have to go through the exact same experiences in order to offer support. What matters is that the person the veteran turns to cares about them and is a good listener. Being there for the veteran can be a source of strength and comfort. The communion service may be the beginning for the veteran to sense genuine concern from the congregation and then in turn reach out for support. For the veteran experiencing moral injury, Communion can be a time to reflect on their guilt and shame, and pain and loss. Through the words prayed in confession and the Great Thanksgiving, and the act of the Communion service, the veteran may begin to experience reconciliation and healing.

Participating in the salvation story – for the veteran who has experienced soul wounds, being able to process the painful elements of their experience in order to discover its meaning and motivations is vital. This assists the veteran to develop and reclaim a sense of self-worth. The soul wound may be so deep that the veteran cannot accept or experience God’s mercy. However, the prayer of Great Thanksgiving proclaims God’s mighty acts of salvation from creation, through the suffering and death of Jesus and His resurrection. As the veteran hears stories of other soldiers like Joshua, Gideon, David, and the Roman Centurion, it reminds them of the intersection of faith and military service in a time of war. Possibly they may begin to visualize how they can be a participant in the salvation story.

What was your experience of celebrating the Lord’s Supper while in combat? How may participating in the Eucharist now bring you hope and healing? What specific ways can your congregation incorporate in the liturgy and prayers words that include the veteran in the salvation story? We will end with these thoughts.

Next week, we will discuss how the search for justice can bring restoration and healing. Until then, thank you for the conversation…

 

 

Soul Care Conversation (Transforming Spiritual Trauma)

March 21st, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

For the last several weeks we have explored the various components of spirituality and how it effects our veterans by trying to understand spirituality and meaning, the “why”, and spirituality and suffering, “why me?” This week we will look at transforming spiritual trauma, “what now”.

BACKGROUND

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 in 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.

Violence and killing are timeless descriptions of war. However, it is in the act of war that three distinctive injuries can occur; PTSD, moral injury and soul wounds. All three have spiritual implications. For several months we discussed the impact and the symptoms of trauma on the warrior. We determined that there are numerous similarities within the symptoms of the psychological, emotional, cognitive, behavioral, and the spiritual impacts of trauma;

  • anger
  • rage
  • moodiness
  • isolation
  • hyper-vigilance
  • confusion
  • isolation
  • impaired memory
  • depression
  • inability to sleep

Some of the spiritual symptoms of trauma are;

  • doubt
  • grief
  • fear
  • hopelessness
  • loneliness

These can lead to feelings of abandonment and loss of faith in God. The spiritual symptoms of trauma 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.

At the very core of spiritual trauma, loss. While in combat the warrior will experience loss. The warrior’s battle buddy may die or be wounded. Or, the warrior experiences a loss in faith (faith in leaders, faith in execution of the war, faith in country, faith in God). Lastly the warrior may experience a loss of hope, hope for the future.

CONSIDERATIONS TOWARD HEALING

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 to forgiveness and religious coping in military veterans. (Journal of Traumatic Stress, 17 (3), 269-273)

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
  • reconciliation

The church is no stranger to such quests.  When a warrior has a soul wound, the faith community can live out a critical role in the warrior’s journey.

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 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. Additionally, there are Native American spiritual practices that would not be considered “traditional” in many faith communities, however they provide powerful resources that could be healing.

Providing the veteran opportunities for remembering and grieving becomes critical in their spiritual journey.  While in the war zone, survival comes first.  Remembrance and grief get put on hold.  Encourage the warrior to remember and mourn the loss of friends, or safety, or innocence, and possibly their faith.  Allow them to express their full force of feelings such as hatred, abject despair, loneliness, confusion, terror, rage.  Provide them with some examples of lamentations, such as David in the Psalms.  Share that lament is being totally honest with God.  This could be accomplished in numerous ways; pastoral counseling, during a special service for veterans, a retreat, or in a peer to peer support group.

As we have discovered earlier, meaning making or serving others is a big part of the spiritual journey.  Often, it is in service of others that the veteran begins to see the positive connection with others, and see this as a way to make amends.  This can be done by providing support to the family and buddy who was killed or wounded.  Or by connecting to an organization formed by veterans to make reparations or support refugees.  Opportunities such as these provide the veteran opportunities for meaning making.

We discussed several weeks ago that 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, requires an answer to the question, “what now”.

Our next conversation we will look at a theology of healing. Until then, thank you for the conversation…

Soul Care Conversation (Spirituality and Suffering)

February 22nd, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Last week we began to explore the various components of spirituality and how it effects our veterans by trying to understand spirituality and meaning, the “why”. This week we will discuss spirituality and suffering, “why me?”

BACKGROUND

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. C. S.. Lewis, who watched his wife die a horrible death because of bone cancer states, “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains.”

Everyone’s experience in the midst of suffering will be different. I did not experience a shout from God, but silence. During those moments of fear and loss I asked, where was God in my times of suffering? At times it seemed that during my deepest yearnings of the soul I felt that God not only slammed the door in my face, but seemed to have bolted the door from the inside, not wanting me to enter spaces of grace and peace.

Suffering is one of the greatest challenges to our faith and to our spiritual well-being. There are many different ways to look at suffering through spirituality;

  • suffering is a reason not to believe in a God who can allow pain, torment, and death, all too often experienced by the innocent
  • suffering suggests guilt and thus punishment of a wrathful or vengeful God
  • suffering is the work of God or the demonic
  • suffering happens as a result of bad karma
  • suffering is the result of a fallen and broken world, not caused by God

Of course, there are many other ways to look at suffering. In each situation suffering asks questions and may open doors for finding answers, whether through formal religious beliefs or in searching beyond our understanding of faith. There may be times when we ask questions and the door may remain closed and we will not find answers.

It does not matter which question suffering demands, there is the same question all people ask, “why me”? Most likely as we ask this question “why me”, we feel isolated because we either have turned away from God or we feel God has turned away from us. Where is God?

During the times in our attempts to find God we may search for hope through the scriptures, only to come across difficult texts to understand. The trials of Job may rekindle anger with God because we feel God plays games with our lives. Or, we come across Romans Chapter 5, “suffering produces endurance, and endurance produces character, and character produces hope,” and we feel that this seems unsympathetic to our suffering.

SUFFERING AND MEANING

The crux at understanding suffering is that it is not about finding an answer to “why me”. We find answers to suffering when we realize that it is in our emotional reaction to our physical difficulties, such as pain or loss. It is in how we react that we have the means to make meaning out of what may seem random and pointless. The experience of suffering is not uplifting, rather it is the ability to rise above the struggle.

In our conversation last week, we looked at the powerful testimony of Holocaust survivor Viktor Frankl. In his book, Man’s Search for Meaning, Frankl insists that meaning in life can be discovered under all circumstances, even in the most miserable experiences of tragedy and loss. He 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 the Holy 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….”

From the Christian point of view, discussions about God and suffering always lead to the cross where Jesus suffered. In the cross God demands no more for humanity than God demands from Self. Jesus suffered not to save us from suffering, but to teach us how to bear our own suffering. In this, our suffering draws us closer to God.

There is another way we can find meaning in our suffering. The letters of Saint Paul contain a number of references to suffering, such as the second letter to the Corinthians. Paul writes that God comforts and strengthens us in our hardships and trials. God does this in order for us to help others, so that we can be sympathetic and understanding. In doing so we can be of help and comfort to those who suffer.

CONSIDERATIONS TOWARD HEALING

Spirituality does the following;

  • seeks healing
  • seeks a connection to the Holy
  • influences how a person lives

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, requires an answer to the question, what is my purpose in life.

Spirituality links people to the Holy or to something beyond ourselves. Spirituality may provide ways to cope through suffering by;

  • either being healed
  • or a peace of mind if healing does not come

Spirituality and religion usually influence how a person lives, how he or she reacts to stressful situations and how well and how quickly a person recovers from emotional strain. A spiritual or religious orientation is associated with better mental health as understood by documented research. It can help increase self-esteem, find meaning in life, improve family and special relationships, and decrease drug and alcohol abuse.

We must consider another important factor, sin-based suffering is far more terrible that mere physical pain. Anxiety and depression result. Even when we do nothing wrong we are still haunted with guilt and shame. Just the perception of doing wrong can create intense guilt. Moral injury and soul wounds can have a deep effect on the warrior. Healing begins when we can forgive ourselves for perceived or actual events.

As this is true, so is the fact that humans are capable of doing the right thing. It says that out of suffering can come love. Love can become the balm that begins to heal the fear and pain. Spirituality provides a means for a veteran to find peace even in the midst of living in hell.

Our next conversation we will look at a theology of healing. Until then, thank you for the conversation…

 

 

Soul Care Conversation (Soul Wounds)

February 11th, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Three weeks ago we looked at three distinctive and yet similar war injuries that have spiritual implications; Post Traumatic Stress Disorder (PTSD), moral injury and soul wounds. We began our conversation on this triad first by focusing on PTSD. Last week we discussed moral injury. This week we will look at soul wounds.

WHAT ARE SOUL WOUNDS?

The injuries of war; PTSD, moral injury, and soul wounds, are a result of war’s violence. Warriors often experience intense fear and the confusion of moral ambiguity in war. Because of a warrior’s experience in war, the returning veteran’s assumptions about God, of the world, and of self are often shattered, resulting in a soul wound.

When the soul is wounded, it is an inner wound inflicted through the gateway of the mind, emotions, and experiences. Just like physical wounds constitute health difficulties to the body, inner wounds do more because the wound cannot be seen.

At the core of a person is their soul, that which gives a person meaning. When the soul is in anguish, this can become a spiritual scar. Soul wounds produce guilt, shame, and fear. However, a soul wound goes much deeper because the battlefield strips away the warrior’s belief system so that at the very core of the wound is the feeling of brokenness and hopelessness. In fact, the feeling to the warrior is that their soul has left them.

In a reply to my blog last week on moral injury, Larry offered an equation on the cause of soul wounding.

… the trauma of war violence begins the process that expresses as PTSD symptoms. “Normal” war trauma can produce stress symptoms proportional to severity, and exposure/duration. If this basic trauma scenario is overlaid or aggravated by moral issues that question the justness of the war or specific personal acts of a warrior, moral injury is likely to occur. The cumulative effect of trauma/PTSD and moral injury can be enough, in certain individuals and circumstances, to move the host area of the wound to the spiritual realm. In a simple equation, it might look like this; Traumatic stress (PTSD) + conscience violation (moral injury) = soul wound.

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 in war’s harsh realities.  A sense of brokenness and alienation from God, self and others is a consequence resulting in many warriors experiencing grievous wounds to their souls.

HOW TO IDENTIFY?

What may a wounded soul feel like? Soul wound symptoms reflect a diminishment of everything meaningful to the warrior. Countless warriors describe the dark side of their war experience with the word – hell.  “War is hell.”  “I lived through hell.”  Soul wounds feel like hell at the very core of the warrior’s being.

What may a wounded soul look like? Some common emotional and behavioral symptoms of a soul wound are;

  • inner rawness
  • irritability
  • little or no tolerance
  • feelings of anger, hate, resentment
  • lashing out
  • easily frustrated
  • irresponsible behavior
  • irrational expectation of others
  • isolationism
  • depression

These symptoms are very similar to PTSD and moral injury. However, it is through the spiritual symptoms that one can begin to distinguish a soul wound.

Some common spiritual symptoms;

  • difficult to forgive
  • hard to feel loved
  • confusion about God
  • self-hate
  • shattered self-esteem
  • feelings of hopelessness
  • hostility toward God, self and others
  • despair
  • finding it difficult to pray
  • no spirit of thankfulness
  • seeing no value in scripture
  • loneliness
  • doubt
  • fear
  • grief

For some, the circumstances of a soul wound may lead to the questioning of important and previously sustained beliefs. This can lead to a deep spiritual struggle. A key component in considering soul wounds is understanding how spirituality has been affected by trauma and or moral injury, and then, because of this, what role spirituality can now provide within the healing journey.

TREATMENTS

What can restore the wounded soul? 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), “Post traumatic mental and physical health correlates of forgiveness and religious coping in military veterans,” Journal of Traumatic Stress, 17 (3), 269-273)

We will briefly discuss several healing measures and strategies.

Healing measures include;

  • discover answers to the questions of meaning and purpose
  • work through feelings of guilt and shame
  • develop a thankful attitude
  • overcome fear

Spirituality is the dimension of human beings that seeks healing. For many people spirituality 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 journey toward restoration of wholeness, requires an answer to this question; what is my meaning and purpose.

Another critical component for inner healing is that the veteran will need to work through any feelings of guilt and shame. The veteran works through any feelings that God is somehow disappointed or angry with her/him. Knowing that God isn’t angry or disappointed creates an attitude of grace, acceptance, and trust. Also, when dealing with soul wounds, carrying around a mindset of guilt and shame makes the healing process much more difficult because it mentally separates us from the holistic approach that must include the spiritual component.

Developing a thankful attitude is another key to receiving healing for our wounded soul. Thankfulness leads to trust – if you are thankful for what God has given you, then you will find it easy to trust God in the areas of pain, loss, and grief. Additionally, an unthankful attitude can evoke a veteran to become unforgiving, unloving, resentful, and hateful. An unthankful attitude can become a poison to our emotional health and the ability to receive healing to our wounded soul.

Lastly, fear can easily overwhelm the veteran. Fear becomes a wall between the veteran and trusting in God. Breaking through this wall results in a tremendous amount of peace and healing can then take place.

There are several strategies toward healing;

  • individual work
  • connect with a spiritual mentor
  • personal counseling with a psychotherapist or pastoral counselor
  • done in community

Do you know of other strategies? How can the faith community be a partner with the veteran? Over the next several months, we will begin to explore these questions.

Thank you for the conversation, until next week…

 

 

 

Soul Care Conversation (Moral Injury)

February 4th, 2016 Posted by Blog 4 comments

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

We have determined in our conversation during these last several weeks that the effects of trauma on our bodies, our minds, and our spirits, are profound. Two weeks ago we looked at three distinctive and yet similar war injuries that have spiritual implications; Post Traumatic Stress Disorder (PTSD), moral injury and soul wounds. Last week we focused specifically on PTSD. This week we will look at moral injury.

SO WHAT IS MORAL INJURY?

In our conversations over these last several weeks we began to see some similarities within the symptoms of the psychological, physical, behavioral, and the spiritual impacts of trauma and moral injury. So, what is moral injury?

The term moral injury is fairly new, however the concept goes back to the Iliad and Odyssey. Recent attention has been given to moral injury as a reality for most combat warriors. Some experts describe moral injury as a psychological scar of war. However, it has not yet been codified as an injury.

Moral injury is unlike PTSD, which is based on fear from feeling one’s life threatened. Moral injury produces guilt and shame from something done or witnessed that goes against one’s values. Men and women have returned from war broken and their diagnosis is wrongly labeled PTSD because their wound was not recognized as a moral injury.

Our warriors grow up with a given moral code of conduct. Moral codes come into conflict during war.  What we were taught, “You shall not murder.”  What we experienced in combat, “I killed another human being.”  What we were taught, “Love your neighbor as yourself.”  What we experienced in combat, “I have injured another.”  What we were taught, “The name of the  Lord is a strong tower; the righteous run into it and are safe.”  What we experience in combat, “My friend died.”  What we were taught, “God is love.” What we experienced in combat, “I have faced evil and have been lessened by it.”

Warriors may take a human life motivated either by a direct command, or survival, or from fear. This may be in direct contrast with a moral code they lived with previously and now sets the stage for moral injury, a painful psychological and spiritual wound.  Or, the injury is brought about by bearing witness to perceived or a real immoral act that brings about pain, suffering or death to others. Or, the injury could be brought on by committing an error that resulted in the loss of life of a battle buddy or a non-combatant.

Thomas Gibbons-Neff, a combat veteran approaches moral injury from a warrior perspective in his article in the Washington Post, “Haunted by their decision in war.” He reflects on the challenge that the Veterans Administration (VA) and the returning warrior have in understanding the difference between PTSD and moral injury. He writes, “Moral injury…isn’t really a part of the ‘returning veteran’ lexicon; instead, veterans use PTSD as a convenient catchall…While in many cases they can overlap, differentiating the two allows the returning veteran to understand not only the trauma he or she experienced but also the damage left by the decisions made in war.”

As I engaged in conversations with medical and behavioral health professionals while in Iraq and Afghanistan, they stated that in order to understand moral injury and address its effects, we must first recognize that it exists.

TREATMENTS

The veteran community can provide a vital role in the journey toward healing.

Despair, this word that’s so hard to get our arms around, Ashley Gilbertson reflects in the Virginia Quarterly Review on his profile of Noah Pierce, an Iraq veteran who committed suicide in 2007. It’s despair that rips people apart [who] feel they’ve become irredeemable.

In his article, “Moving Beyond PTSD to ‘Moral Injury‘” Jeff Severns Guntzel reflects on this profound statement as he reviews a 2010 interview with Dr. Jonathan Shay by Public Broadcasting’s “Religion & Ethics Newsweekly.” Dr. Shay, a VA psychiatrist for over 20 years, states that “We’re turning our attention to this idea of moral injury and the limits of the PTSD diagnosis to explore what happens to a person who has experienced combat.” Dr. Shay continues by sharing, “It’s titanic pain that these men live with…in part because they feel they deserve it, and in part because they don’t feel people will understand it.”

It is interesting, Dr. Shay suggests that treating moral injury “happens not in the clinic, but community.”

Peers are the key to recovery — I can’t emphasize that enough. Credentialed mental health professionals like me have no place in center stage. It’s the veterans themselves, healing each other, that belong at center stage. We are stagehands — get the lights on, sweep out the gum wrappers, count the chairs, make sure it’s a safe and warm enough place…

Also, in an article, “Moral Injury in the context of war”, written for the National Center for PTSD, Department of VA, suggests that pilot testing is underway in evidence based treatments. These experiential strategies are associated with increased post-traumatic growth. The key element in each of these strategies, forgiveness.

SPIRITUAL COMPONENT

As we look at both of these treatment strategies, community and forgiveness, the faith community can provide a critical role.

Recall the description of Noah Pierce’s feeling of despair, about being irredeemable. The feeling of being irredeemable has powerful spiritual implications. Both the Hebrew and Christian scriptures share stories of men and women of faith who felt despair, shame, and dishonor because of something they had done. Each had to search their own soul and cry out to the One who brings forgiveness, wholeness, and restoration. Each discovered the importance of finding a companion to share their story, find encouragement, and at times hear the difficult realities of their soul.

As Dr. Shay suggests, treating moral injury happens in the community. The faith community can live out a critical part in this healing journey. The faith community offers the Sacred story that reveals to the “irredeemable” the One who loves them no matter what they have done or the state of their soul. The faith community also listens to the veteran’s sacred story. Deep listening is the beginning of the healing journey for our veterans.

What do you see as possible ways to be in partnership with our veterans who suffer from moral injury?

Next week we will discuss soul wounds…until then thank you for the conversation.

 

 

Soul Care Conversation (PTSD)

January 28th, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

We have been having a conversation for several weeks about the effects of trauma on the whole person. We have determined that the effects of trauma on our bodies, our minds, and our spirits, are profound. Last week, we looked at three distinctive and yet similar war injuries that have spiritual implications; PTSD, moral injury and soul wounds. This week we will focus specifically on PTSD.

PERCEPTIONS OF VETERANS?

It is important to note that there is much more to our veterans than 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.  In fact, I have heard our combat veterans labeled by the press or others as either heroes or broken. Often 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.

However, many of our veterans have experienced deep physical, psychological and spiritual wounds. Since 9/11, the Department of Defense (DoD) and the Veterans Administration (VA) made progress in the traditional treatments for veterans who have been wounded. Recently, the Washington Post described alternative therapies for veteran well-being that the VA has explored as part of a treatment regimen to include;

  • equine therapy
  • alpha stimulation
  • guided imagery
  • yoga
  • hypnosis
  • aqua therapy
  • Botox

War-related conditions simultaneously threaten the body, mind and spirit causing a full range of symptoms that effect the whole person. One of these symptoms is PTSD. David Wood in his article for the Huffington Post, “Iraq, Afghanistan War Wounded Pass 50,000”, 25 October 2012, states that there are over 4,000 new cases of PTSD each month. This is a significant statistic that demands our nation’s attention in providing long term care.

SO WHAT IS PTSD?

We have stated previously that trauma changes the person.  It is not that we are worse, but we are different.  Post-traumatic stress or deployment-related stress are normal reactions of normal people to extreme and life threatening events. It is part of the human survival response. Warriors often experience during a combat deployment intense fear, panic, confusion, helplessness and even horror.

During the American Civil War, soldiers experienced anxiety and depression. It was referred to as “soldier’s heart”. During World War I, veterans experienced “shell shock”. “Battle fatigue” or “war neurosis” were the terms used during World War II. It was not until after the Vietnam War that the American Psychiatric Association listed combat trauma as an official diagnosis. Additionally, after the studies on Vietnam veterans and now the in-depth studies on veterans of the Post 9/11 Wars; thousands of veterans who struggle with nightmares, insomnia, anger, isolation, and addictions, no longer are written off as failures, malingerers, or shirkers. Therefore, PTSD is an officially recognized mental illness.

For this conversation, we will not delve into the neuro-anatomy effects of PTSD on the brain except to say that when a person experiences trauma, there are three areas of the brain that are altered;

  • prefrontal cortex
  • amygdala
  • hippocampus

These brain functions affect the fear response, memory, and emotions of a person.

Also, we will not take a deep dive into the Diagnostic and Statistical Manual of Mental Disorders to investigate all of the formal diagnoses. What is important to understand is that a formal diagnosis of PTSD requires a warrior to experience symptoms in five different categories (as per the US Department of Veteran Affairs National Center for PTSD);

  • stressor (exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence)
  • intrusion symptoms (recurrent, involuntary, intrusive memories; traumatic nightmares; dissociative reactions; intense or prolonged distress; marked physiological re-activity after exposure to related stimuli)
  • avoidance (of trauma related thoughts or feelings, trauma related external reminders such as people, places, conversations, activities)
  • negative alterations in cognitions and mood (inability to recall features of traumatic event, persistent negative beliefs and expectations of self, persistent distorted blame, markedly diminished interest in significant activities, feeling alienated from others, persistent ability to experience positive emotions)
  • alterations in arousal and activity (irritable or aggressive behavior, self-destructive or reckless behavior, hyper-vigilance, exaggerated startle response, problems in concentration, sleep disturbance)

There are four additional criterion that further defines a diagnosis, but most important is the duration (persistence of symptoms longer than one month).

TREATMENTS

Many forms of psychotherapy have been used with our veterans diagnosed with PTSD. Those that have exhibited a track record of success include;

  • cognitive behavior therapy (CBT)
  • cognitive process therapy (CPT)
  • eye movement desensitization and reprocessing
  • exposure therapy

For one year, I was part of a trial program, PTSD Pathways, at Fort Belvoir. The program modules included psycho-education, CBT and CPT, relaxation techniques, relationships and coping, and post-traumatic growth. The program also included a weekly group process as well as one-on-one counseling with a therapist. The PTSD Pathways proved somewhat beneficial in my initial healing. More on this later.

The VA and DoD also have used additional therapies as reported by the Washington Post (see above). Also, our warriors have been treated with medication(s). Some of our veterans recover on their own. Some, even after therapy and medications, still linger in pain. Why?

SPIRITUAL COMPONENT 

From my personal observations and experiences a part of our veteran well-being that is under-served is the spiritual component. Why is this important? Our returning veterans face a deep spiritual crisis, not generally in public view.

The battlefield became a test of the soul for our warriors as they experienced life threatening events. After a near death experience, death haunts a veteran’s life. The ongoing realities of death linger deep in the soul. Trauma is suffering that will not go away. The aftermath of trauma challenges the veteran to overcome fear and to find meaning. These all have spiritual implications.

As trauma affects the body and mind, it also affects the spirit. Soul care should be an integral part of our veteran’s journey toward healing.

This concludes this week’s conversation on PTSD. Next week, we will discuss in some detail moral injury. Until next week, thank you for the conversation…

Soul Care Conversation (PTSD, Moral Injury, or Soul Wounds?)

January 21st, 2016 Posted by Blog 2 comments

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

We have been having a conversation for several weeks about the effects of trauma on the whole person. We have determined that the effects of trauma on our bodies, our minds, and our hearts, are profound. Additionally, last week we discussed that the impact of trauma on our spirits are as important. This week, we will look at three distinctive and yet similar war injuries that have spiritual implications; PTSD, moral injury and soul wounds.

PTSD OR MORAL INJURY OR SOUL WOUNDS?

Over these last several weeks we have discussed the impact and the symptoms of trauma on the warrior. You most likely began to see some similarities within the symptoms of the psychological, emotional, cognitive, behavioral, and the spiritual impacts of trauma. So, when a returning veteran exhibits anger, rage, moodiness, isolation, hyper-vigilance, depression…which injury does the veteran experience; PTSD, moral injury, or soul wounds? How can we differentiate between the three wounds? Why is it important to distinguish between the three?

Violence and killing are timeless descriptions of war. However, it is in the act of war that these three injuries can occur. An Army Special Operations Sergeant who beats an Afghan man in anger after he survived an Improvised Explosive Device but one of his team members did not survive. A Navy Corpsmen attempts valiantly to save the life of a comrade only to see her slip away in death. An Air Force Captain stands by frozen in shock unable to offer aid to a fellow Airmen whose legs were severed following a land mine explosion. Which injury may these warriors have experienced?

Each one of these warriors most likely will exhibit similar symptoms;

  • inability to sleep
  • confusion
  • hyper-alertness
  • depression
  • anger
  • isolation
  • impaired memory
  • lack of concentration
  • panic attacks
  • fatigue
  • guilt

There is an overlap in symptoms with these three injuries. Why is this? While PTSD, moral injury and soul wounds are specific conditions, each produces similar symptoms that affect the whole person. As we have discussed previously, deep physical, psychological, and spiritual wounds are a result of war. Whether a warrior experiences depression, or had a traumatic brain injury, or has deep grief, these are all health problems that affect the whole person and often exhibit similar symptoms.

Personally, I experienced a mild traumatic brain injury during my Iraq deployment in 2004. It was almost 8 years later that I was diagnosed with PTSD. Now nearly 12 years after my return from Iraq, my therapist shared that he thinks that I may have experienced a moral injury. And on top of all of this, I know from my own spiritual assessment after my return from Iraq in 2004, I suffered from a soul wound. The interesting part, the symptoms of each malady are similar, but, now I know the treatments require different approaches.

HOW TO DIFFERENTIATE?

Because the symptoms are similar, how can we differentiate between the three? Let’s look at each of these separately.

  1. PTSD – Most of the attention within the medical and behavioral health communities has been on the impact of life-threatening trauma that results in PTSD. PTSD is recognized as a mental disorder that can develop after a person is exposed to one or more traumatic events.  A formal diagnosis of PTSD requires that persons report symptoms in each of the following categories; disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyper-arousal. These symptoms continue for more than a month after the trauma. Important note, PTSD requires a diagnosis.
  2. Moral Injury – The term moral injury is fairly new, however the concept goes back to the Iliad and Odyssey. There has been much recent attention given to this as a reality of most combat warriors. Some experts describe moral injury as a psychological scar of war. It has not been accepted as a diagnosis as yet; however, I believe as more research points to this as a valid wound, we will see the Veterans Administration and the Department of Defense coding veterans with this injury. Unlike PTSD, which is based on fear from feeling one’s life threatened, moral injury produces guilt and shame from something done or witnessed that goes against one’s values.
  3. Soul Wounds – This term is largely used in the faith community. However, even warriors who are not persons of faith can also experience “soul wounds”. At the core of a person, is their soul, that which gives a person meaning. When the soul is in anguish, this can become a spiritual scar that can be identified as a “soul wound.” Similar to moral injury, soul wounds produce guilt and shame. However, a soul wound goes much deeper because the battlefield strips away the warrior’s belief system so that at the very core of the wound is the feeling of brokenness and hopelessness. In fact, the feeling to the warrior is that the spirit has left them. In addition, there is the lack of trust in the Holy to tend and transform their wounds.

WHY IS IT IMPORTANT TO DIFFERENTIATE?

As we have discussed previously, whether a warrior exhibits symptoms of depression, a traumatic brain injury, or deep grief, these are all health problems that affect the whole person. However, treatment of each requires different disciplines and diagnoses. Therefore, it is imperative that we can differentiate between the three injuries because the approach to healing and wholeness will be different. We do a disservice to our veterans if we fail to look at the whole person in treatment and if we do not treat the specifics for each injury.

While the idea of warriors feeling remorse over battlefield horrors is not new, moral injury has gained much attention since the Post 9/11 wars. After one year of intense mental health treatment for PTSD, I was not noticing improvement. In conversation with my therapist, we discussed that other mental health providers have seen veterans not improving with PTSD treatments.

Why? Wrong doing is not necessary for a PTSD diagnosis, nor does PTSD capture moral injury. And, PTSD and moral injury are not a soul wound. PTSD sufferers can find relief with medication and counseling that encourages reliving the trauma event to work through fear. But if the person considers what happened to be morally wrong, reliving it may only reaffirm that belief, and wound the soul further. Soul wounding is a very deep issue and I cannot say I have even grasped the depth of it myself. What I do understand is that whether it is PTSD, moral injury, or soul wound; healing takes time and will encompass a holistic approach.

Next week, we will begin to take a deep dive into these three spiritual issues, the first will be PTSD. Until next week, thank you for the conversation…

 

Soul Care Conversation (Spiritual Effects of Trauma)

January 13th, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversations is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

We have been having a conversation for several weeks about the effects of trauma on the whole person. Last week we discussed the impact of trauma on the warrior’s behavior. This week, we will discuss the spiritual impacts of trauma.

Because warriors often experience intense fear, panic, confusion, helplessness and even horror during war, how can one return from war feeling anything but changed? Warriors can experience physical and psychological wounds that can incapacitate them and that can affect their behavior. Additionally, the combat veteran also can exhibit spiritual symptoms.

SPIRITUALITY AND TRAUMA

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 have moved humanity through the centuries to reach for the Holy.

A spiritual person can be characterized having;

  • assurance
  • confidence
  • anticipation
  • hope
  • joy

Following trauma that same person experiences a loss of these qualities.  But the wounding of the soul goes much deeper. Soul wounded persons often exhibit;

  • discouragement
  • hopelessness
  • despair

For some, the circumstances of the trauma may lead to the questioning of important and previously sustained beliefs. This can lead to a deep spiritual struggle. A key component in considering soul wounds is understanding how spirituality has been affected by trauma, and then, what role spirituality can now provide within the healing journey. For the warrior, these are difficult questions to answer.

EFFECTS OF TRAUMA

The effects of trauma on the person’s spirituality;

  • can lead to confusion about God
  • a shattered faith in God, others, and self

Spiritual symptoms can include;

  • shattered self esteem
  • finding it difficult to pray
  • no spirit of thankfulness
  • seeing no value in the Scripture

SOUL WOUNDS

Soul wound symptoms reflect something deeper. Soul wounds can result in a diminishment of everything meaningful to the warrior. What may a wounded soul feel like? Countless warriors describe the dark side of their war experience with the word – hell.  “War is hell.”  “I lived through hell.”  Soul wounds feel like hell at the very core of the warrior’s being.

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 behaviors as an escape of war.  Many have lingering fear and guilt from their experiences.

Many warriors struggle with ethical and moral challenges that they faced.  Transgressions can be from individual acts of perpetrating violence on another or by witnessing the behavior of others committing violence. The moral injuries exhibit similar symptoms as to soul wounds.

I did not understand soul wounds until I read the book, War and the Soul, by Dr. Edward Tick.  Dr. Tick revealed to me the importance of healing the wounded soul after combat.  This all became real to me when in Afghanistan during my first visit to the Marines, the Command Chaplain for Region South West told me about the Concussion Restoration Care Center (CRCC), where wounded warriors had an opportunity to begin their healing following a trauma event.  At the CRCC the psychologist, psychiatrist, and behavioral health specialist realized after months of counseling that there were three spiritual issues they were not able to help the wounded warrior; why, guilt, and fear.  They decided to bring a chaplain on-board as part of the team.  The whole person concept in treating trauma included the spiritual component.

SPIRITUALITY DEFINED?

But why has spirituality not been institutionalized as a part of the whole person concept in healing? Possibly because 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.

Definitions include;

  • religious beliefs – a connection to that which transcends self
  • nature, art, and meditation
  • inner peace or harmony
  • sense of the sacredness of life
  • that which provides meaning and purpose

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.

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.

SPIRITUAL INJURIES

What do spiritual injuries look like? They may include;

  • anger
  • doubt
  • grief
  • fear
  • hopelessness
  • depression
  • loneliness

These symptoms may change as time passes and a person moves further away from the trauma event. 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. Suicide becomes a risk.

Next week we will discuss in more depth moral injury and the effects of wounding the soul. Until then, thanks for the conversation….