Spirituality & the MilitarySpirituality & the Military Familyarizonacoalition.org/ACMF Symposium-Spiritual Care for Families.pdf · Spirituality & the MilitarySpirituality & the Military

Spirituality & the MilitarySpirituality & the Military FamilyFamily

The Spiritual Journey of Recovery and Reintegration After War

Rev. Dr. John P. Oliver, BCCACPE Supervisor, Chief of Chaplain Service, Durham VA Medical Center, Durham, NC

Objectives j

Identify re-adjustment challengesIdentify re adjustment challenges veterans and their families face post-deployment.

Identify psychological and spiritual effects of war trauma on survivors and their families.

Explore resources available to Military Service Members, Veterans and their families.

Explore the “Support Team” Model in working with Military Service Members, Veterans and their families.

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Military Service - Basic Overviewy

Military produces highly trained men and women.

These individuals had HUGE responsibilities while deployed and return to no jobs orwhile deployed and return to no jobs or relatively trivial responsibilities in comparison.

Service members are our family members, neighbors, friends, co-workers, patients. Thousands upon thousands have served in the military. y

All who have served come home changed. For a few individuals these changes can be debilitating and life altering

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debilitating and life-altering.

Family - Basic Overviewy

Military has high expectations of families both A ti d t d R tActive duty and Reserve components.

Family members are left with all responsibilities while loved ones are deployedresponsibilities while loved ones are deployed.

Family members, are our neighbors, friends, co-workers and patients.

All families are changed as a result of a deployment. For a some family systems, these changes can be debilitating and lifethese changes can be debilitating and life-altering.

LONG Term Effects (Alberta Martin, 2004).

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O G e ec s ( be a a , 00 )

Challenges in Returning Homeg g

Returning home is disorienting and can represent a g g psignificant change of and perhaps an absence of social community, structure, order, mission, purpose and predictability for the returning service member.

The enormity of the war experience can shatter one’s basic sense of safety and their understanding of the meaning of life as they knew itmeaning of life as they knew it.

Re-adjustment and “re-setting” after the crisis of trauma j gcan be complicated and difficult.

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Home is Different . . .

Homecoming is disorienting and can represent a g g psignificant change for a family. They have learned to live without their military member.

N ith th t i i b th i f il dNeither the returning service member nor their family and friends are the same as they were before deployment to war.

Families and friends must re-adjust and “re-set” upon re-integration.

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A Soldier’s Heart

PBS F tliPBS FrontlineAired March 1, 200560 minutes

A Soldier’s Heart tells the stories of soldiers who have come home haunted by their experiences and asks whether the government is doing enough to help.

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Typical Crisis Cycleyp y

Crisis

A typical crisis has a beginning where stress builds, a highwhere stress builds, a high

point of stress and then a slow tapering of anxiety and fear that

leads to recovery.

Typical Resting Point for those unaffected by trauma

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Over time, anxiety typically builds then dissipates

Abbreviated Crisis Cycle After Traumay

Crisis

Typical Resting Point for those affected by trauma is much closer to Crisis Mode at ALLcloser to Crisis Mode at ALL

Times

Individuals who have been affected by trauma are often at a constant high state of readiness.

Hyper vigilance

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Crisis Cycle After Multiple Deployments

CrisisCrisis

Crisis

Over time, resources for managing crisis are eroded.

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Over time, resources for managing crisis are eroded. Crisis comes earlier.

Re-setting for Civilian Lifeg

Upon returning from war individuals mustUpon returning from war, individuals must “re-set” themselves for civilian life.

Re-setting includes: Grief and transition processing, p g Un-learning (or re-learning) basic skills such

as defensive driving rather than offensive driving

Re-developing community support systems

See www.battlemind.org .

War Comes Home

When service members comes home, they , ybring the war with them.

Family Re-setting includes:Family Re setting includes: Re-establishing relationships (all types) Processing grief and transition Processing grief and transition Relearning basic family skills, roles and

Re developing community support systems Re-developing community support systems

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Objectives j

Identify re-adjustment challenges veterans and y j gtheir families face post-deployment.

Identify psychological and spiritual y p y g peffects of war trauma on survivors and their families.

Explore resources available to Military Service Members, Veterans and their families.

Explore the “Support Team” Model in working with Military Service Members, Veterans and their families.

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Four Causes of Stress InjuryFour Causes of Stress InjuryFour Causes of Stress InjuryFour Causes of Stress Injury

INTENSE OR PROLONGED STRESSINTENSE OR PROLONGED STRESSINTENSE OR PROLONGED STRESSINTENSE OR PROLONGED STRESS

Life threatLife

threatWear & Wear &

teartear LossLoss Inner Inner conflictconflict

Events that provoke terror

Events that provoke terror

Death or injury of others who are

Death or injury of others who are

Accumulation of stress from all

Accumulation of stress from all

Events that contradict

Events that contradict

threatthreat teartear conflictconflict

provoke terror, horror, or helplessness

provoke terror, horror, or helplessness

others who are loved and with whom one identifies

others who are loved and with whom one identifies

stress from all sources over timestress from all sources over time

contradict deeply held moral values and beliefs

contradict deeply held moral values and beliefs

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Family StressorsFamily Stressors

PhysicalPhysicalPhysicalPhysical Negative Negative C iC i

Negative Negative C iC iFi i lFi i lFi i lFi i l PhysicalPhysicalPhysicalPhysical Coping Coping Coping Coping FinancialFinancialFinancialFinancial

Spiritual and Emotional StressorsSpiritual and Emotional Stressors

RelationshipsRelationshipsRelationshipsRelationshipspppp

Secondary Secondary TraumaTrauma LossLoss

SpiritualSpiritual

TraumaTrauma

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Reactions to Traumatic Events

Psychological Physical

Cognitive Emotional

Behavioral InterpersonalBehavioral Interpersonal

Spiritual20

Spiritual

Trauma Definitions

Trauma: Injury whether emotionally or physically j y y p y yinflicted. An experience that is emotionally painful, distressful or shocking and which may result in lasting mental and physical effectsmental and physical effects.

Psychiatric trauma is essentially a normal response to anPsychiatric trauma is essentially a normal response to an extreme event.

Trauma reactions upon returning from war are NORMALreactions to the abnormal circumstances of war.

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Secondary Trauma y

Trauma also affects those who Trauma also affects those who experience it indirectly.

Secondary or vicarious trauma refers to Secondary, or vicarious trauma, refers to those people who care for, or are involved with those who have beeninvolved with, those who have been directly traumatized.S t t l i il t th t f Symptomatology very similar to that of PTSD.

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PTSD - Exploredp

Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to one or moredisorder that can develop after exposure to one or more terrifying events that threatened or caused grave physical harm (to self or other).

This is a specific psychiatric disorder in which a cluster of symptoms occurs beyond one month after someone experiences a traumatic eventexperiences a traumatic event.

Non-mental health care providers (pastors included) should never assume this medical diagnosis or proffer it tonever assume this medical diagnosis or proffer it to individuals as stigmatization, distancing and inappropriate over-identification can occur.

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PTSD Symptoms Overviewy p

Symptoms of PTSD, present for at least oneSymptoms of PTSD, present for at least one month, and are divided into three symptom clusters:

reexperiencing of the traumatic event,

avoidance of trauma-relevant stimuli and numbing of general responsiveness, and

heightened physiological arousal.

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PTSD Symptom Overview (cont)y p

Symptoms of PTSD are distinguished fromSymptoms of PTSD are distinguished from “normal” (non-pathological) remembering of stressful events by their persistentof stressful events by their persistent nature, evocation of emotional distress, and disruption of functioning in daily lifeand disruption of functioning in daily life.

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Psychological Reactions to Trauma

Traumatic events are often re-experienced.

Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

Recurrent distressing dreams of the event.

A i f li if h i Acting or feeling as if the traumatic event were recurring.

I t h l i l di t t t i t l Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

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Psychological Reactions (cont.)

Physiological reactivity on exposure to internal or t l th t b li bl texternal cues that symbolize or resemble an aspect

of the traumatic event

Hyper-vigilance, jumpiness, an extreme sense of being "on guard“ overreactions, including sudden unprovoked anger

General anxiety

I i Insomnia

Obsessions with death

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Spiritual Reactions to Traumap

1. Confusion about God2. Loss of community3. Altered sense of meaning in/of life4 Loss of previously sustained beliefs4. Loss of previously sustained beliefs 5. Confusion about core ethical beliefs6. Confusion about morality7 Grief/loss of relationship with God and others7. Grief/loss of relationship with God and others8. Questions of Theodicy9. Feeling dirty and unworthy10. Feeling permanently damaged 11. Feeling angry at self – blaming self12. Feelings of guilt.

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12. Feelings of guilt.

Spirituality & Rebuilding Lifep y g Spirituality is that which gives a person meaning and purpose.

It is found in relationships with self, others, ideas, nature, and, possibly, a higher power.

These many relationships are prioritized according to an organizing y p p g g gprinciple and form an intra-, inter-, and trans-relational web that houses a person's sense of meaning and purpose.

Spiritual distress arises when one of these relationships that provide p p pmeaning is threatened or broken. The more significant a particular relationship is, the greater the severity of spiritual distress if that relationship is threatened or broken.

Spiritual wholeness is restored when that which threatens or breaks the patient's relational web of meaning is removed, transformed, integrated, or transcended.

Mark LaRocca-Pitts Ph D

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Mark LaRocca Pitts, Ph.D. .

Effects of War on Faith

Depending on where individuals are in their faithDepending on where individuals are in their faith development, Trauma can destroy the potential help religious resources might offer.

Un-integrated religious experience can appear to be insignificant in the wake of extreme trauma gand the abyss. Integrated, well developed spirituality that is not tied to external belief systems, but is a part of one’s identity can be y , p ypowerful in aiding recovery from trauma.

Marion ThullberyMarion Thullbery

Effects of War on Faith

Veterans' warzone experiences (killing, losing friend)Veterans warzone experiences (killing, losing friend) weakened their religious faith, both directly and as mediated by feelings of guilt.

Weakened religious faith and guilt each contributedWeakened religious faith and guilt each contributed independently to more extensive current use of VA mental health services.

Fontana A & Rosenheck R (2004)Fontana, A., & Rosenheck, R. (2004).

Within PTSD group a lack of forgiveness was associated g p gwith worse PTSD severity, and worse depression. Negative religious coping associated with worse depression.

Drescher Ramirez Romesser Rosen FoyDrescher, Ramirez, Romesser, Rosen, Foy .

Objectives j

Identify re-adjustment challenges veterans and y j gtheir families face post-deployment.

Identify psychological and spiritual effects of i d h i f iliwar trauma on survivors and their families.

Explore resources available to Military S i M b V d h iService Members, Veterans and their families.

Explore the “Support Team” Model in working with Military Service Members, Veterans and their Families.

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Veteran’s Use of Clergygy

Research shows that 4 of 10 individuals with mental h lth h ll k li f lhealth challenges seek counseling from clergy.

Individuals are 5 times more likely to reach out to a minister than all other mental health providersminister than all other mental health providers combined.

Veterans often feel more comfortable approaching their pastor than the do a mental health professionaltheir pastor than they do a mental health professional.

Negative reasons Magical thinking avoiding truth Negative reasons. . . Magical thinking, avoiding truth of diagnosis, etc.

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The Pastor’s Challengeg

Actualizing Hope and Resilience Actualizing Hope and Resilience Providing an honest, caring relationship

T thf l i i ti f th f t Truthful imagination of the future Resource review – what was lost - what

was gained? Acceptance of humanity p yMoving toward pardon of self and others Inspiring collaboration & community Inspiring collaboration & community

Role of the VA Chaplainp

Provide an honest and engaged presence with Veterans, their f ili d th t ff i i it l f h lifamilies and the team offering spiritual resources for healing, and wholeness .

Engage as a contributing member of interdisciplinary care Engage as a contributing member of interdisciplinary care teams.

Serve as resident expert for spiritual assessment of Veterans Serve as resident expert for spiritual assessment of Veterans highlighting spiritual sequelae of war.

Educate local Clergy regarding Veteran’s struggles. PartnerEducate local Clergy regarding Veteran s struggles. Partner with Military Chaplains.

Serve as liaison for Veterans and local congregations and g gwith Military Chaplains.

Various Resources

VA Medical Centers VA Medical Centers Vet Centers

N ti l C t f PTSD National Center for PTSD Suicide Help Line 1-800-273-TALK (8255)Military One Source Tri Care Resources Tri Care Resources Child Crisis Centers and others locally

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Pastoral Care Approachespp

Providing a Safe HavenProviding a Safe Haven

ListeningListening

GroundingGrounding

AcceptingAccepting

Referring

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g

What NOT to do as a Pastor

Ask if they killed anyone or push for details regarding the d l tdeployment

Try to fix problems Prematurely assuage feelings of guilt Prematurely assuage feelings of guilt Diagnose PTSD, assume PTSD or label PTSD Assume the service member is “unsaved” or does not have

f ith ja faith journey. Push to get service member involved in church ministries Treat as “heroes” or “show them off”Treat as heroes or show them off Try to be the therapist or to manage patient outside

appropriate support systemsA id ti b t l d i it l i j Avoid conversations about moral and spiritual injury

Faith-based Community Best Practices

Providing childcare at all functions. Providing childcare at all functions. Providing support and during holidays and

special occasions.p Adopting a Veteran, Service Member and/or

their family. y Providing ministry outlets that are congruent

with this population. Staying connected with and serving as a

pastoral resource during and after deployment

Objectives j

Identify re-adjustment challenges veterans and y j gtheir families face post-deployment.

Identify psychological and spiritual effects of i d h i f iliwar trauma on survivors and their families.

Explore resources available to Military Service M b V t d th i f iliMembers, Veterans and their families.

Explore the “Support Team” Model in ki ith Milit S iworking with Military Service

Members, Veterans and their Families.

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Influx of OEF/OIF VeteransInflux of OEF/OIF Veterans

1 8 million have served so far in OEF/OIF1.8 million have served so far in OEF/OIF

800,000 OEF/OIF Vets are now VA Eligible, g

300,000 OEF/OIF Vets have enrolled (16% of those who have served)

96% of OEF/OIF seen in outpatient96% of OEF/OIF seen in outpatient

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Need for a Community Responsey

No one system can provide all the services No one system can provide all the services needed.

S ti th f il ill t th Supporting the family will support the individual.

78% of survivors receive 100% of their support from family members.

Survivors and caregivers needs are different.

Concentric Circles of Care

Veteran

Care Providers

Spouse / Family

Community

Support at any level ripples back to veteran. and throughout the community.

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Community-based Support Teamsy

A community-based support team is –A community-based support team is – a group of volunteers organized to provide practical emotional & organized to provide practical, emotional &

spiritual support

Team Philosophy Do what you can when you can Do what you can, when you can In a coordinated way With a built-in support system

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With a built in support system

Value for Veteran and Familyy

Hope p Decreased isolation Increased quality of life Increased quality of life Decreased stigmatization Early intervention Adherence to treatment regimeng Peer-to-Peer support

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Value for Team Members

Altruistic experiencesp Decreased social isolation Increased awareness of problems Increased awareness of problems

experiencedG tit d Gratitude

Mission and Purpose

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Project CompassionProject Compassion

Project Compassion180 PROVIDENCE RD STE 1 C180 PROVIDENCE RD STE 1-CCHAPEL HILL, NC 27514(919) 402-1844

www.project-compassion.org

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Bibliographic Resourcesg pCantrell, Bridget and Chuck Dean, Down Range to Iraq and Back, 2005.Drescher Kent D National Center for PTSD – Menlo ParkDrescher, Kent D., National Center for PTSD – Menlo Park.Figley, Charles, Strangers at Home: Comment on Dirkzwager, Bramsen,

Adèr, and van der Ploeg, Journal of Family Psychology, 2005.Fowler James, Stages of Faith: The Psychology of Human Development andFowler James, Stages of Faith: The Psychology of Human Development and

the Quest for Meaning. Harper & Row; San Francisco 1981.Frankl, Viktor, Man's Search for Meaning: An Introduction to Logotherapy

Boston:Groopman, Jerome, The Anatomy of Hope: How Patients Prevail in the face

of Illness. Random House, 2003.Hasty, Cathy and Mona Shattell, Putting Feet to What We Pray About.

Journal of Hospice & Palliative Nursing, 2005p g,Jaffe, Jaelline, Jeanne Segal, Lisa Flores Dumke, Fontana, A., & Rosenheck,

R. Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. Journal of Nervous Mental Disorders. 2004

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Mental Disorders. 2004

Bibliographic Resourcesg pLaRocca-Pitts, Mark, Walking the Wards as a Spiritual Specialist. Harvard

Divinity Bulletin, 2004.Lester, Andrew D: Hope in Pastoral Care and Counseling, Westminster John

Knox Press, 1995. Lynch, William F., Images of Hope: Imagination as Healer of the Hopeless.

Notre Dame Press 1974Notre Dame Press, 1974.Paynter, Emily, Ph.D. Compassionate Care, Meditations and Insights. (2006)Shumann, Joel, Keith Meador: Heal Thyself: Spirituality, Medicine and the

Distortion of Christianity Oxford Press 2003Distortion of Christianity. Oxford Press, 2003.Titus, Craig Steven: Resilience and the Virtue of Fortitude: Aquinas in

Dialogue with the Psychosocial Sciences, The Catholic University of America Press, 2006.

Weaver, Andrew, Laura Flannely & John Preston: Counseling Survivors of Traumatic Events, 2003.

Wolski Conn, Joann (ed.), Women’s Spirituality: Resources for Christian Development. Paulist Press, 1986.

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Development. Paulist Press, 1986.