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Sunday, March 31, 2013

VETERAN CHAPLAIN OBSERVATIONS ON COMBAT STRESS

WELCOME to the AGC "Shofar" journal.  This month's feature is the beginning of a three part series focusing on Combat Stress.  With the war on terrorism winding down and less deployments, many of those Sailors, Marines, Soldiers and Airmen who saw combat or were in a war zone will have more time to adjust from a high optempo to one of standing down.  With the change of pace, also comes time for one to reflect and ask "What the heck just happened the last few years?" 
  While America was at the Mall, our military was at war.  Our brave Soldiers, Marines, Sailors and Airmen were still engaged in numerous operations with real people against real enemies and unfortunately, real deaths.  We are at the beginning of something significant because many in our military who went through combat will now need to put their experience into perspective.  This is important because how one deals with this will determine one's quality of life and life with one's family, friends and work. 
  The official DOD position is to approach this as a mental health issue.  However, those of us in the "Chaplain" trenches have observed it is more of a spiritual condition.  Chaplain Timothy Libertay has written an article addressing many of these issues.  This is the first of a three part series addressing how combat stress affects a person and how it should be confronted.  With that in mind, read and enjoy the first of three part article dealing with "Combat Stress." 

THOUGHTS ON COMBAT STRESS AND ITS TREATMENT
by Chaplain Timothy Libertay

            It has been ten years since I finished my dissertation on “Ministry with the Navy SEALs.”  Little did I know and understand that one of the minor correlated parts of my research would come back time after time to help me minister to Veterans returning from Iraq and Afghanistan.  At the time of my research over ten years ago, little had been done in this field of PTSD to help those coming back from war.  Back then, as stated from one of the guys I interviewed, problems were viewed as a character flaw or weakness of the individual and one was expected to “get over it.” 
            This view thankfully has changed due to many societal and culturally changes acknowledging our collective responsibly to help those who serve our country.  I still remember in the early part of the Iraqi war listening in on a Marine General’s meeting.  His emphasis was to get the word out to His Marines that if anyone was having difficulties adjusting or suffering from Post-Traumatic Stress Disorder (PTSD), they could come in for help and not have it affect their career.  This was indeed a cultural shift from a warrior’s perspective.
            In the early parts of the war with Marines and Sailors, military Chaplains were the traditional people to go to for counseling and help.  Chaplains had been at the forefront of every major conflict in America since 1775.  As care providers, Chaplains unlike any other staff officers lived, ate and slept with the Soldiers and Sailors on the front lines. This unique relationship gave Chaplains the credibility to do the briefs on “Combat Stress,” Pre and Post Deployment Stress” and family counseling related to the unique problems of the war fighter’s war experience.  As one who had numerous oversea tours on ships, shore and finally operational Marine units in war zones, this was my experience and world.   However, in the 7 years I was gone, I noticed a not-too-subtle change once I came back to the States.  It was a brave new world where the Chaplain was relegated towards only doing “religious stuff” and had little say in the world of PTSD and care for our war fighters.   I noticed a very distinct change over how the warfighter was taken care of as they returned.  It was one that I had a lot of concern over. Not only because it was a huge paradigm shift on how PTSD was handled, but it was going down a wrong path. 
            The concern was that something that was originally a spiritual and moral question had been redefined and packaged as a “psychological” issue.  To their credit, the Mental Health Professionals of the Navy and armed services stepped up to the plate and filled the vacuum that was left from the inactivity of Senior Chaplain Leadership.  Mental Health Professionals are to be commended for their tireless and compassionate efforts to help those with acute hurts.  However, like Patroklous masquerading as Achilles in the Iliad, it was a venture that had serious problems with its epistemology and hence, will never completely consummate the intended desire.

 History and Problems

            The intention of this paper is to help our Sailors, Marines, Soldiers and Airmen who serve this great country get over an affliction that paralyses their life: PTSD.  Post Traumatic Stress Disorder is a real phenomenon which sucks hope out of the soul of a sufferer.  Having experience in treating both civilian and war time tragedies, I submit the results of PTSD can be the same to an individual.  However in the military, there is a distinct difference which confuses the symptoms of PTSD with that of re-adjustment problems in coming back from a war-time environment.  It is a subtle difference that the uninitiated without military service or combat deployment do not understand.  For the purpose of this paper however, this difference will be discussed briefly because the main focus is on military PTSD.  Likewise, I will not address Traumatic Brain Injury (TBI), as that field has different variables for diagnosis and treatment.

Effects of PTSD

            PTSD has been around ever since antiquity.  In fact, Herodotus mentions it in his writings in the battle of Marathon between the Athenians and Persians:

Epizelus, the son of Cuphagoras, an Athenian, was in the thick of the fray, and behaving himself as a brave man should, when suddenly he was stricken with blindness, without blow of sword or dart; and this blindness continued thenceforth during the whole of his afterlife.[1]

  In more recent times, Karl Meninger of the Meninger Clinic researched PTSD (even though it wasn’t called that at the time) right after WW2 and concluded : “Out of every five men who died, one never came back to live a normal life due to psychological problems.  They were institutionalized and needed care for the rest of their lives.”[2]  Karl’s biggest contribution at the time was his research demonstrating the most effective way to prevent and overcome PTSD was work with the individual on the front. David Grossman conversely mentions in his work “On Killing,” that most people suffered PTSD after Vietnam due to not having societal support once they had left the battlefield.[3] More recently PTSD has gained a lot of media attention and used by politicians to give the impression they actually cared about our service members (my opinion of course).  As a result, Congress passed a massive bill to fund PTSD research and development for those psychologically affected by the war in Iraq and Afghanistan. 
            First of all one might ask: What is PTSD and what are its effects?  While there are many different definitions found in research, it is something that is described better by its symptoms than anything else.   Those suffering from this affliction have: lack of sleep, nightmares, daymares, and difficulty in concentrating on anything, loss of appetite and/or motivation, argumentativeness, depression and sometimes lack of self-control which can lead to violent outbursts.  Some sufferers may have multiple symptoms or perhaps just one.  The bottom line is that the individual undergoes some type of change from the inside out due to their wartime experiences.
            In response to many coming back from combat and having suffered one or many of these symptoms, funding was given from the Department of Defense (DOD) to help those suffering to relieve the effects of this malady.  In response and to their credit, the Mental Health professionals of the military came up with some good models to help our brave men and women.  COSC (Combat Operational Stress Control), OSC (Operational Stress Control) and Battle Mind/Resiliency have arisen as a response to this need.  Along with this, numerous studies and research methodologies from many foundations and schools of Psychiatry and Psychology are also a part of this movement.  In a few short years, a lot of research, debates, conferences and seminars have filled the coffers and enhanced the reputations of many.  Academia has exploded on the scene as various models, therapies and studies jockey for position as being THE answer to cure for PTSD.  Trouble is, one can describe the symptoms, but the cure is still an enigma. 
 As the dust settles down on this adventure, one thing is certain.  In spite of all the invested money, time and research there is absolutely no proof that any of this stuff actually works!  While perusing and studying most of the data and research in the last few years, my experience has shown that there is no definitive mode of “curing” this malady.  Every research paper on the study has been inconclusive and is only preliminary and has limited success.  Thinking my discovery on this specific topic inconclusive, I sought out at the major Military experts and in conversations with them, they admitted what I discovered too.   There are many reasons for this, but the fact remains that in spite of our best efforts, something is still missing.  It is in this milieu, I propose a new solution.  It is in fact a new way to look at an old perspective.  It has already offered solutions in times past, but no one has been asking the right questions.  At least up until now.
            I call it the “Emperor has no clothes Syndrome.”  It is a based on a different world view where someone removed from the heat of the battle can honestly sit back and give a reasonable analysis of what is happening.  Like the little girl who noticed the important man did not have any clothes on while everyone complimented the King, no one has stepped in and questioned the effectiveness of what is being done for our troops.  Unfortunately, this is where ego’s, money, funding issues and turf wars intersect. 
  To date there has been no mechanisms set up to measure the effectiveness of these projects and programs.  All evidence is suppositional, anecdotal and fuzzy.  It is a lot like the story of the blind men and the elephant where each blind man takes a piece of the total story and comes to a different conclusion based on their incomplete facts.  That is all right because some things just cannot be measured empirically (see the next chapter for this discipline).  However, some Mental Health professionals are now acknowledging something that was missing from their discipline and this something is the key to unlocking this whole strategy of treatment.  This is the realization that not everything has an empirical or objective solution.  
            One of the main discoveries as psychotherapists delve into the depths of men and women’s hearts is they are uncovering an axiomatic truth:  “Moral Injury.”   This is the phenomena where a person has done something they believe is wrong and has affected their whole belief system and world view resulting in some type of PTSD.  It is a part of Psychology which is a new field of study and has gathered much debate and research.  Simply put, this is the “Holy Grail” of what causes PTSD and since one now has the cause, one can also work on the cure.  At least this is the thought process of those steeped in Kantian philosophy typical of clinicians, one learns morality, so therefore one can undo it and then after cognitive “manipulations” can “cure” the sufferer.  
            In reality however, this is not the case.  Let me illustrate a short analogy, which is something cogent and real, yet is never, ever discussed in “academic and science” circles because many believe in a dualistic world where the objective and subjective never meet namely something called “Spiritual Truth.”  The analogy of the clinician’s world to spiritual truth is equivalent to where the common belief for centuries was the sun revolved around the earth.  Scientific absolutism via the writings of Ptolomy had defined planetary motion in three books and was the standard for almost 2 millennia.  NO one ever questioned it.   However when a Roman Catholic priest named Nicoli Copernicus wrote that the earth revolved around the sun this new, but simple concept turned the world upside down. Taking this premise, a young Lutheran seminary student named Johannes Keplar (via the research of Tycho Brahe) took this idea and came up with 3 simple laws of planetary motion. 
A simple idea coming from a different a priori assumption explained the same phenomena.  The solution had been there all along, but the phenomena were just misread and misinterpreted.  Of course, there was a social, academic and even a religious antipathy to the new interpretation.   So ferocious was the outcry against both Copernicus and Keplar because they went against conventional thinking that they both had to endure professional and personal ridicule and even death threats.  So much for the analogy. 
I propose something which is quite simply put, simple.  We are spiritual creatures living in a physical world.  We are not only subject to the laws of physics, but also to spiritual and moral laws.  It not only is a marriage of science and the spiritual, but the complete solution to an age old problem.  While others have pontificated and searched for connections between “science” and theology, I propose a true melding of the two disciplines which actually works and can be proven both empirically and subjectively.  The application is for the two disciplines, However, I propose something that can and will help both Mental Health professionals and Navy Chaplains.  It’s a marriage of what seems like two complete opposite classes of studies, but historically have been one.
            To sum up, while the Mental Health has a done a wonderful job taking care of our military people suffering from PTSD, they suffer from a fundamental or foundational false premise: a false anthropology of what makes up a person.  The answers however have been around for centuries and that is we are spiritual creatures.  Even though Ptolomy was brilliant and a master of observation, he never fully explained planetary motion.  It was only when Copernicus posited a different reality that the world benefitted from true science.  Much is the same with us today and the disciplines of Psychology and Theology and what exactly makes us human. 
 For some this is a huge stretch and it makes them uncomfortable because it posits a god and that is supposedly out of bounds for science.  It also means there are some things one just doesn’t understand and that runs counter to the arrogant belief that we as humans possess the capacity to know all knowledge.  As a result, I submit the following as another means of answering the same questions that Psychology is trying to resolve.  Even if one disagrees with the following ideas, at the very least therapists can use these concepts in their tool box as they deal with Soldiers, Sailors, Marines and the like in their sessions because many of those suffering from PTSD have some sort of faith background, be it tacit or active. For those with an active faith, it is merely a re-iteration of their belief in a personal God who rules and reigns this world and the next. 
 
TO BE CONTINUED...  PART TWO NEXT MONTH

  [1]Herodotus. The Histories. VI. 117.
 
  [2]Karl Meninger, “Military Suicide” (reference to Dr. Meninger’s work during a workshop covering the causes of suicide from returning combat veterans at the Meninger Clinic, Topeka, KS,  Fall 1998).
                                           
  [3] David Grossman,  On Killing, (New York: Little Brown and Company, 2009), 290-293


 

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