Category Archives: trauma

War-related moral injury: what is it? What helps? 


I’m reading David Wood’s What Have We Done: The Moral Injury of Our Longest Wars (2016, Little, Brown and Company). David is a journalist and has experiences embedded in military operations in Iraq and Afghanistan. PTSD is well-known and discussed, especially in the context of war. If you have listened to the news, you know that many veterans struggle with it and struggle with return to civilian life. Suicide rates of current and former military members should grab your attention and tell you that we have a serious problem on our hands. If you have read further, you probably have heard about treatments such as Prolonged Exposure and Cognitive Processing Therapy being used by VA mental health practitioners. 

This book, however, introduces readers to the concept of moral injury, a cousin to PTSD. While the features may look similar to PTSD, moral injury may better account for some of the experiences, especially where terror (the emotion, not behaviors) may not have been the main experience. 

The book opens with a story of a Nik, a Marine whose position came under fire from a small boy with an assault rifle. 

“According to the military’s exacting legal principles and rules, it was a justifiable kill, even laudable, an action taken against an enemy combatant in defense of Nik himself and his fellow marines. But now Nik is back home in civilian life, where killing a child violates the bedrock moral ideals we all hold. His action that day, righteous in combat, nonetheless is a bruise on his soul, a painful violation of the simple understanding of right and wrong that he and all of us carry subconsciously through life. 

… At home strangers thank him for his service, and politicians celebrate him and other combat veterans as heroes. And Nik carries on his conscience a child’s death.” (8)

The author goes on to argue with illustration after illustration that to go to war is to suffer moral injury, to suffer the disconnect between deeply held values and the experiences during war. While it is easy to see moral injury in the forced choice to kill a child vs. save one’s own life, moral injury can also result from being sent on a fool’s errand–political reasons sent to war vs. need to protect or defend freedoms. 

PTSD v. Moral Injury? 

Post-traumatic stress disorder is biology. It is the body’s involuntary physical reaction as we relive the intense fear of a life-threatening event and the scalding emotional responses that follow: terror and a debilitating sense of helplessness. (15)

He goes on for paragraphs to depict the experience of PTSD and its cascade of symptoms–“fear-circuitry dysregulation.” But then listen to how he talks about Nik

…Nik doesn’t have PTSD. What Nik struggles with is not the involuntary recurrence of fear. He’s okay with the crowds at Walmart. He doesn’t startle at loud noises. In contrast with veterans who’ve experienced PTSD, Nik didn’t feel the pain of his moral injury at the moment of the incident…. [But] he is bothered by the memory of that Afghan boy and with questions about what he did that day. Like all of us, Nik had always thought of himself as a good person. But does a good person kill a child? …No, a good person doesn’t kill a child, therefore I must be a bad person. …The symptoms can be similar to those of PTSD: anxiety, depression, sleeplessness, anger. But sorrow, remorse, grief, shame, bitterness, and moral confusion–what is right?–signal moral injury while flashbacks, loss of memory, fear, and startle complex seem to characterize PTSD. (17)

PTSD has little to do with sin. It is a psychological wound caused by something done to you. Someone with PTSD is a victim. A moral injury is a self-accusation, prompted by something you did, something you failed to do, as well as something done to you. (18)

Guilt and shame are key characteristics. Not being able to save a buddy, making a quick decision that also included losses of civilian life, betrayal by leaders but being forced to carry out orders, or not being protected by buddies–all can create a moral injury. Add a mega dose of grief/loss from death and loss of companionship after the unit breaks up and you have a serious problem. (Don’t forget once home and safe, the loss of adrenaline, the loss of status, the replacement of dullness and the rebuilding of old relationships without your friends and without purpose will enhance all painful feelings including nagging guilt and shame.)

Definition offered

The lasting psychological, biological, spiritual, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. (250)

Spiritual community interventions? 

Despite their attractiveness, short-term interventions like CISD aren’t effective (chapter 6 details this). In addition, straight up attempts to challenge distorted thoughts are likely to fail. So, what might work? The book details some listening and validating activities by chaplains, including the burning of cards listing their “sins” as they leave the battlefront symbolizing their remorse and reception of God’s forgiveness. Talking about guilt, confessing failures and shame seem central. Note that confessing and validating do not necessarily mean that others agree that sins have been committed or that perceptions of self are accurate. They merely acknowledge the burden the veteran carries. Even the secular therapy models validate feelings of guilt while finding acceptance and forgiveness. Saying, “don’t blame yourself, you couldn’t help it” to Nik aren’t helpful. Finding a path that doesn’t blame or excuse (237) allows for a different path between all or nothing shame responses. 

It seems that what spiritual mentors and Christian practitioners have to offer in light of these themes are central to recovery from moral injury. 

The reality, says the author, our current therapies are only marginally helpful and sometimes harmful. Near the end of the book he concludes with this conviction,

True healing of veterans with war-related moral injuries will only come from community, however we and they define community–peers, neighborhoods, faith congregations, service organizations, individuals. That means it is up to us. (260)

And thus, YOU have a job to do

Listen. I highly recommend you read his last chapter (“Listen” begins on page 261). He will tell you how to engage a conversation in order to learn. No matter your personal beliefs about war, this is something you can do. Don’t look for the government to do the job, be the one to listen and learn yourself. Be the one to bear witness, as silently as you can. Your presence (more than your words) will convey compassion, understanding, and God’s presence.

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Filed under christian psychology, Good Books, Post-Traumatic Stress Disorder, trauma

Is it trauma or is it intensity/identity loss?


The current definition of PTSD requires an exposure to an intensely distressing event or events (either witnessed or told about in great detail) resulting in a pattern of intrusive re-experiencing, attempts to avoid such experiences and an ongoing negative cognitive/mood pattern. Such a diagnosis might be made after domestic and sexual violence, accidents, natural disasters, war, betrayal traumas, and even after hearing repeated stories of traumatic experiences to others (called secondary trauma).

Someone experiencing PTSD after life-threatening events might feel disconnected from family/friends, find it difficult to sleep, experience repeated nightmares, have difficulty not thinking about events during and after the traumatic experience, choose unhealthy coping patterns like alcohol abuse, or place themselves in situations where they re-enact parts of their trauma story.

But not everyone who has intrusive thoughts about a challenging situation, feels disconnected from their community (and previous self), drinks too much, or impulsively jumps back into danger have PTSD. Some of these same behaviors and experiences also show up in those who have left dangerous and all-consuming experiences and now do not know how to re-engage in regular life.

Consider these words of Dr. Steven Hatch, who spent time in Ebola clinics in Liberia at the height of the 2014 pandemic crisis in West Africa. He describes his experience after returning to his job at the University of Massachusetts.

To match the outside weather, my mood willingly turned dark. I withdrew from people, wandered about in a daze, and avoided public gatherings. When I did venture out, I carried myself in a completely different manner than I had before in my life.


The simple explanation was that I had post-traumatic stress disorder, and a few people, including some whose job it is to make such diagnoses, thought this to be true. (p. 239, Inferno)

He goes on to dispute his experience fighting Ebola as trauma. While difficult, he did not think it rose to the level of trauma experienced in war or even other more overwhelming Ebola clinics.

I could, however, recall the event [death of a toddler] in my mind without being emotionally overwhelmed, but also just as importantly I was able to still experience emotions about it, feeling appropriately somber. I just didn’t feel traumatized. (p 240)

So, what was his problem?

What I did share with many other volunteers was a sense that I didn’t belong in the States, for the work in West Africa was far from over. I desperately wanted to return, and almost within days of coming home I was trying to figure out how I could get back to an ETU [crisis Ebola center]. What I missed was the profound sense of purpose that such work had provided, and I slowly realized why people talked of “missing the war,” a phrase that always seemed discordant to my ears. You miss being in the midst of senseless butchery? Great. But I belatedly realized it was that purposefulness, the sense that you were doing something that was deeply and truly meaningful, that drove people back to such unstable situations. (p. 240-41)

There you have it. The seeming loss of crystal clarity or purpose in life can be very painful. When you are in an intense helping situation as Dr. Hatch was, every movement leads towards life or death. At the end of a day, you can count who lived and who died. No ambiguity. In addition, you are doing it with a team of people all committed to the same thing. You share the same vision, goal, and daily experience. You do not have to explain anything. And in these intense situations, you can have the kinds of intimacy not often experienced even in your immediate family. Also subtract mundane activities (grocery shopping, cleaning, taking care of children, etc.) that may not need to be done.

This is a recipe for distress upon return.

Return to regular life where you are expected to do these seemingly inconsequential activities AND where you have no one around to save AND no one who was present with your toughest experience…and you have a recipe for trouble. You may find it difficult to find joy in light of intrusive thoughts of recent emotionally intense experiences. You may long for a return to that sense of purpose and value. Because others do not understand and aren’t part of your “tribe” you may withdraw or find other ways to numb the pain.

Loss of identity and intensity may mimic trauma symptoms. They may be significant to need treatment. Military ending tours of duty, missionaries returning from field, humanitarians returning from doing crisis work, church planters leaving high stakes urban church plants, and trauma healing trainers returning from intense experiences may be at risk.

What can be done to prevent this distress?

  1. Probably nothing will take care of the problem. One could not go do intense work. Or one could become a crisis junkie. Neither are good options.
  2. But developing re-acclimation plans can help. Yes, training done before entering the intense experience will set the stage for healthy returns but post-tour of duty re-entry work is more important. The Army has develop protocols for re-entry by beginning the process even before leaving the “theatre.” Creating space for coming off the “high” giving time to process and following-up in the early days back can help. Involving family in the re-entry planning and building activities that can elevate family intimacy upon return will help immensely.
  3. Encouraging time and space to lament and process in group settings. This is where a therapist can help. Group process helps to put words to experiences and acknowledges impact on identity. This can also help re-connect with meaningful activities and experiences at home. One has to re-learn that meaning is not solely connected to intensity.

I have some very small personal experience with this. I’ve had intense experiences in international settings. When I have returned, I have sometimes found it hard to be at home when my head was still overseas. Being able to share with Kim and others helped. Practicing lament helped. Learning to be mindful of the present also helped me remember what has meaning and value in everyday life.

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Filed under Post-Traumatic Stress Disorder, Psychology, trauma, Uncategorized

Complex Trauma: Going Deeper, By Diane Langberg


As part of our staff meeting today we watched this video by Diane Langberg. It reviews the 3 stages of typical trauma recovery process plus focuses on the impact of the work on the counselor. Self-care is a common conversation these days. However, a few lines stuck out to me:

Unless we take care of ourselves, we will not be able to bear witness…. Vicarious trauma is not something done to us but a consequence of having empathy…. Evil and suffering also provide an opportunity to expose the weak places in [the counselor]…. Seek out the antidotes to the poison that you sit with…[these antidotes] are not just good coping mechanisms but part and parcel to living the life obedient to God.

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Reading the bible through the lens of trauma?


What if you read the bible through the lens of trauma? Some are quite obvious–catastrophes are all throughout the bible. But are these stories of trauma in the bible merely keeping a record of it or attempts to deal with the trauma, to put the world back proper perspective after chaos?

Consider this 2015 video by Rev. Dr. Robert Schreiter entitled: Trauma in The Biblical Record. He gives some background about this newer way to read the bible through this lens and then ends with 3 examples. I’ve just ordered this book on the subject, but those wanting to jump ahead may wish to know about it as well.

 

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Filed under Abuse, American Bible Society, counseling, Doctrine/Theology, Post-Traumatic Stress Disorder, Psychology, ptsd, trauma

Diane Langberg: Living with ongoing trauma


A few years ago, Dr. Diane Langberg gave a talk about ongoing trauma experiences, when there is no “post” in the posttraumatic stress disorder. When there is no after trauma yet (e.g., ongoing domestic violence, living in a war zone, etc.), what kinds of help and hope might a survivor hold on to? Is there anything that can be done?

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Filed under Abuse, continuing education, counseling, counseling skills, Post-Traumatic Stress Disorder, trauma

Diane Langberg on Shame


A few years ago, Dr. Diane Langberg presented on the topic of shame at the 2014 Community of Practice hosted by the American Bible Society. She describes the toxicity of shame as a distinct part of trauma, especially betrayal trauma. You will learn about the cognitive phase of shame, kinds of shame experienced and how the response to shame takes one of 4 common forms (i.e., withdraw, avoid, attack self, attack others).

Make sure you watch to the end as she shares some insights to how God understands and responds to our problem of shame. See how Jesus enters in to our shame.

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Filed under Abuse, Post-Traumatic Stress Disorder, sexual abuse, trauma, Uncategorized

Two announcements: A transition and an upcoming trauma healing facilitator training in PHL


Yesterday I posted information about summerbts_0314_l_bts_cnslngtxt_red courses at BTS. I’m really excited about Heather Drew’s course that explores therapeutic activities beyond talking about our struggles. Do check that out! Today, I’m posting about an upcoming trauma healing facilitator training (initial and advanced equipping) being held here in Philadelphia May 1-4, 2017. More on that in a minute.

But first, a change…

For the last 17 years I have been teaching in and leading Biblical Seminary’s counseling programs (now housed in our Graduate School of Counseling). I know I’m very biased, but I think our programs deliver training that transforms—mature counselors who learn how to listen and walk with others through difficult times. Over the years we have been able to develop licensure and ministry-oriented counseling programs as well as the Global Trauma Recovery Institute. This last certificate program enables participants to enter into cultures and communities and support trauma recovery without causing harm.

I’ve enjoyed every minute of it, due in no small part to supportive administration, excellent students, and fantastic staff who every day make BTS look great! But, after months of thinking and praying, I have decided to step away from the leadership of the program and full-time employment at BTS.  Beginning July 1 I will assume the position of Director of Training and logo-thiMentoring with the American Bible Society’s Mission: Trauma Healing. I have been partnering with the Bible Society since 2010 as the Co-Chair of the Advisory Council for ABS trauma healing programs. In this new venture I hope to have a closer role in supporting best practices in their train-the-trainer model of addressing trauma around the world.

If you are wondering why a psychologist would want to work as a trainer of lay and pastoral leaders in a Scripture-engagement trauma healing program, read this: 4 Reasons Why I Promote Scripture-Based Trauma Healing. Short answer? We can’t solve the world’s trauma if we don’t change the culture of conversation about trauma and faith. This program can do that.

Want to join me in equipping others?

May 1-4 ABS will run a local training for both initial and advanced equipping sessions designed to teach you how to lead healing groups and/or run equipping sessions to train others to lead healing groups. I will not be doing most of the training but I do hope to put in an appearance. This document will give you a bit of an overview. This one tells you about the role of the facilitator. And if you are already sold on the material and the mental-health informed training program, here’s where you sign up. Can’t attend now? Check thi.americanbible.org for dates of upcoming trainings here and in other parts of the world.

What is not changing about my role at BTS?

As the Thomas V. Taylor Visiting Professor of Counseling & Psychology, I will continue to teach gtc-logothe Global Trauma Recovery Institute’s curriculum with Dr. Diane Langberg. If you are looking for continuing education and specialization in trauma recovery, this mostly online curriculum may be right for you. In addition, I will provide additional support and teaching for BTS as they need it. However, under the leadership of Bonnie Steich, LPC, NCC, ACS, the existing faculty and staff will continue to deliver an exceptional curriculum.

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Filed under "phil monroe", American Bible Society, Biblical Seminary, Post-Traumatic Stress Disorder, ptsd, teaching counseling, trauma

Trauma and the Church presentation this Friday night


This weekend, Foundations Christian Counseling is hosting a 2 day conference, Counsel From the Cross at Spruce Lake Retreat. I will be speaking Friday night (8 pm) on “The Cross, the Church, and Trauma: Making the Church a Safe Place for Victims of Trauma.” Use the 2nd link above to register for the day or the weekend.

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Filed under "phil monroe", Abuse, Christianity, counseling, Counselors, Post-Traumatic Stress Disorder, ptsd, trauma, Uncategorized

Watch live stream presentations on power that harms or heals


Starting Tuesday, The Mission: Trauma Healing ministry of the American Bible Society will livestream its 2017 Community of Practice. You can link up here. Conference begins at 8:30AM EDT.

Here are a few of the notable plenaries

  • Tuesday 11 AM: The Good, Bad, and Ugly of Trauma, By Diane Langberg, with Phil Monroe
  • Wednesday 9 AM: The Exploitation of Power in Cultures, By Sherwood and Judith Lingenfelter
  • Wednesday 3:30 PM: Your Power as Facilitator, By Phil Monroe with Diane Langberg
  • Thursday, 9 AM: How to Empower People who have Lost Their Power, By Michael Lyles, MD
  • Thursday, 11 AM Power in Trauma and Healing in Rwanda, By Baraka Paulette

There are other presentations but these are some of the key presentations on the topic of power. Hope you can make it online.

 

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Filed under Abuse, Post-Traumatic Stress Disorder, Training, trauma, Uncategorized

Free Screening of Unchained: a documentary about generational trauma and healing in African American families


unchained-private-screening

Come early if you want a seat. Local church leaders are featured in the documentary.

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March 4, 2017 · 11:04 am