This month's "Shofar" covers the second of three parts dealing with Combat Trauma, commonly called "PTSD." While there is a lot of information out in reality and cyberspace on this subject, hardly anything is written about something that has shown to have merit and actually works and that is this axiomatic truth: The cause of combat PTSD is a moral issue and not a psychological one. Many Chaplains in the military have discovered this little known fact and are doing wonderful things as they counsel our fighting men and women in their personal journey to get back to a sense of normalcy. However, no one is sharing their experiences, so the general population does not know or understand about this aspect of treating PTSD.
As a result, Chaplain Libertay has articulated in this article a need and a plan which has already passed the test of research, time and effectiveness for our Sailor, Marine, Soldier and Airmen seeking help. So, enjoy the second of three articles for this month's "Shofar" magazine.
THE IMPORTANCE OF THE SPIRITUAL! by Chaplain Tim Libertay
By using the article “the” before the word “Spiritual,” I’m emphasizing there is an aspect to all of us which cannot be defined or articulated by modern science and the discipline of psychology. It is beyond the scope of the collection of data, observation and classification systems. Science deals with models based on observation. Honestly, how does one quantify such concepts as “love,” “art,” “beauty,” “evil,” and “good?” There are many more quantifying concepts, but few doubt these are real concepts nonetheless. These are hard to qualify and to empirically give measurements which express why person A loves Person B twice or even three times more than Person C loves Person B just simply cannot be done. In short, empirical and objective Science has its limits.
Furthermore,
Psychology, Science and philosophy only observe things and propose
methodologies to solve problems. This
discipline has no axiomatic truth claims, merely trends, probabilities and
analysis. This is why the answer must
lie somewhere else. To observe something
intrinsic (is that possible?) and then
put out a solution is pure supposition.
Furthermore, the solutions that are put out at that point reflect the
experiences, lack of experiences or even biases of the author. It’s as if one puts together a car engine with
only spark plugs and a cam shaft because that’s all the mechanic specializes
in. Common sense tells one that if a
person has a bias against something
piritual or in the realm of theology they will not look for
solutions in that field.
This is exactly what
happened a few centuries ago when a group of deists, atheists and agnostics exalted
reason above natural revelation. This
group of French Enlightenment writers called the “Philosophes” paved the way
for human excesses culminating in the French Revolution. They gave “rational” explanations towards
natural phenomena and because of their biases against God they postulated an
alternative reality based solely on human reason. To make matters worse, atheistic historians
and philosophers have taken the writings and works of believing scientists like
Newton, Keplar and DeCartes and stripped their Theistic context about our world
around us and only kept their methods and observations of our physical
world. In other words, while agreeing
with the science of believers, the philosophes did what they could to discredit
the ontological reason behind empirical science.
More importantly than
this though, is for one to understand what has happened in our academic circles
concerning spiritual truths. Essentially
in the past when ‘truth” discussions revolved around Theological and Biblical
concepts, agnostic concepts from less than honest intellectuals omitted certain
facts from academic pursuits. For
instance, how many of us in secular universities when we took basic philosophy
were told that Voltaire and Rousseau had shown natural philosophy (science) and
the Renaissance of the 18th century had triumphed over the
superstition of the Reformation? Who
among us as we sat in our seats in our first science or philosophy class heard
the professor say “The thunderstorm that terrified Martin Luther to start the
Reformation ended up being explained as electricity during the Enlightenment of
Benjamin Franklin” a few centuries later.
Truth be
told, both Voltaire and Rousseau believed in God, but hated the Roman Catholic
Church and organized religion. Both
lived terribly immoral lives and hated each other. In other words, their morality determined
their theology and so with their writings did away with a world view without a
personal god. Their lives are nothing
but exploits of men who live as practical atheists with no moral restraints. A sad commentary indeed on those who exalt
human reason in the theoretical world, but use their intellect as an excuse to
live in the depths of depravity and despair in the real one. Such is human reason or “moral injury”
without the context of theology behind it.
Here in America this
debate raged on in our seminaries and universities until finally the issue of
spirituality and Theology became a forbidden topic in our academic
culture. It is ironic that the same
historical religious academic system which propagated “Universals” (a moral belief system that God
is behind all truth) which eventually gave rise to the scientific method, resulted in totally doing away with any talk
or so called need of Theological truth. To wit: while the Christian educational
system gave rise to modern science, modern science has now declared the realm
of God and spirituality a forbidden or non-essential subject.
There is a
danger to this type of rationalism: the
possibility that one has by their very own biases left out a possible solution to a
problem. David Hackett Fischer writes:
“The fallacy of the negative proof is an attempt to sustain a factual position
merely by negative evidence.” It occurs
whenever a historian declares that “X is not the case,” and then proceeds to
affirm or assume that not-X is the case.”[1] In other words, that which we reject could
possibly be the answer to that which one seeks after. Such is the case with the “moral injury”
portion of those who suffer from PTSD.
A full
understanding of moral injury has already been developed and discussed over
almost two thousand years of Christianity.
To go down this road however is unacceptable for many who are clinicians
because they have been acclimated to a certain mindset without absolutes and
that is one of the things taught in Theology.
To this thought Fischer mentions another false logical premise and that
is “The counter fallacy of argument ad novitam which is the appeal to novelty
or modernity.”[2] Furthermore, much of clinicians’ natural
proclivities follow a bias against the Judean-Christian ethic and a belief of a
personal God and that God as described in the Holy Scriptures. In short: The Scriptures presuppose a
different view of who man is and how he came to be and that is an unacceptable
alternative for someone who is a psychologist, clinician or researcher.
It is this
view of man which tells us that the human race has a spiritual side and
presupposes a God with right and wrong presuppositions of good and evil. It is a totally different anthropology of who
we are as humans and how did we get there.
At this
juncture many may be uncomfortable with the content. However, keep in mind that 92 percent of all
Americans have some type of belief in God.
Of these, 82 percent have some type of Judeo-Christian view of
spirituality. So even if the person
reading this might not agree with the Theological concepts, the majority of the
people you are trying to help do believe these things. There is a Scripture
which states: Be wise as serpents, but harmless as doves.”[3] What that means in our context is for one to
essentially understand the situation, so one can help those who need help.
A century
later, a man who never traveled further than a few miles from where he was born
totally changed the paradigm on how we see life and the spiritual. His name was
Immanuel Kant. His contribution was we all have an innate
understanding of morality without God and we are taught certain things about
life and understanding of the supernatural by our culture. Kant still is the darling of social engineers
because if one does not like what is put into the minds of youth, then one can
change the input and create a different society. This is essentially the mission of many in
public education where the university professors have become the high priests
of a new social religion without a god and teachers have become their
missionaries.
A sample and
demonstration of this kind of thinking now permeates our societies’ mores and
customs that anything Christian automatically affects how we think as a
culture. Bishop John Paprocki of
Springfield Illinois said it perfectly:
So it is not a
question of the sacred and the secular, properly understood, being in
opposition to each other. The problem is an ideology of secularism laced with
profanity, not in the sense of “profanity” as commonly understood to refer to
foul language, but “profanity” as related to the “profane,” a word which comes
from the Latin, pro + fano, literally, “out in front of the temple.” The
“profane” is that which is excluded or excludes itself from God, from all that
is holy. Thus, our concern today is not
with the secular world, but with a profane secularism that seeks to exclude God
from the world outside the temple or church.[4]
Furthermore, if a
person of faith in Christianity even publically admits it, they are fair game
for humiliation and overt ridicule. In
an article on “Cultural Describing Christophobia,” Denver Broncos quarterback
Tim Tebow is vilified openly as he lives out his faith as a Christian:
Tim Tebow is a target
of irrational hatred, not because he’s an iffy quarterback at the NFL level, or
a creep personally, or an obnoxious in your face proselytizer. He draws hatred because he is an unabashed
Christian, whose calmness and decency in the face of his Christophobic detractor’s
drives them crazy… is a serious cultural problem in these United States.[5]
While this is an
example, it mirrors much of what society feels about Christians and
Christianity. The take away from this
type of thinking is that anything Christian has nothing to contribute to
anything and is totally unrelated to the real world. Unless of course it can be blamed for a
societies’ problems.
The logical
conclusion of a society bred on Voltaire, Rousseau and Kant gives rise to a
belief system that doesn’t need god or even spiritual truth. Hence, it is no surprise that much of what we
find in psychology and mental health is a follow on of this belief system. Again, one needs to be careful of this type
of paradigm because philosophically a man named Arthur Schopenhauer disproved
much of Kant’s assertions. Schopenhauer argued:
In every age much
good morality has been preached; but the explanation of its raison d’etre has
always been encompassed with difficulties.
On the whole we discern an endeavor to get at some objective truth, from
which the ethical injunctions could be logically deduced; and it has been found
to gravitate solely towards its own individual welfare, the idea of which in
its entirety is designed by the term “blissfulness;” and this striving after self-satisfaction
leads mankind by a path very different to the one morality would fain point
out. [6]
The
Basis of Morality essential proves by reason that the road traveled by Kant
and his progeny end up nowhere because there is no such thing as absolute truth
and one cannot make any judgments on moral issues. Worse yet, this type of thinking is based purely
on selfishness. The ultimate result is a
society based on chaos because there is no truth or standard. Hence, this is an empty and fruitless
endeavor.
A search for life without absolute spiritual
knowledge and truth can never answer the deep question of our existence. Without spiritual truth and the knowledge of
God’s grace and justice, humankind is left with a selfish desire to fend for
itself. From this perspective, we are
nothing, but animals and have no moral compass.
Evil is merely a concept and cannot exist and therefore is only in the
eye of the beholder and is purely subjective.
Since there is no god and absolute truths, both good and evil are simple
societal constructs which can be undone by ourselves.
Are the modern day
“Priests” and followers of this philosophy this blind? Of course evil exists! Does one’s ideology against the truths’ of
Theology prevent one from acknowledging the simple truths of the cause of PTSD? I submit an unequivocal “yes.” The horrors of combat prove the inhumanity of
man to man. Without Biblical truth
determining Spiritual and moral values, everything is relative and there is no
absolute truth. The alternative is a
world devoid of anything of moral truth and leads towards viewing life in
Communistic categories of social, economic and political only realities.
With this new found perspective, a solution
is still needed for the problems caused by combat trauma. Let us
now look at the work and research of others and put it into the proper
perspective. The results may be
helpful for many seeking relief.
In the early
90’s a new book came out that broke barriers of how one understood PTSD for
combat vets. In Jonathan Shay’s work
“Achilles in Viet Nam-the undoing of character,” he articulated how combat
changes people. By using the
illustration of Achilles in Homer’s “Iliad,” he showed by analogy how slowly a
person loses their humanity and compassion and then becomes a new person in
battle.[7] I also came across this truth when doing my
research with combat vets. I succinctly
remember one of my co-workers suffering from PTSD telling me “I could tell
slowly, but surely I was losing myself.”
When asked why he didn’t do anything about it, he replied “I didn’t want
to disappoint my friends who relied on me.”
One of the recurring themes of those in combat was the realization they
were changing their “inner” voice. [8]
Jonathan Shay is
considered the “Father of PTSD” for many military psychologists and is often a
guest in the military medical PTSD treatment circles. From there many of his ideas and solutions to
vet’s problems have given rise to many therapies and ideas of treatment… Some good and some bad. Before I say where I think this path is
wrong, I first of all want to give credit to where credit is due. Many military mental health professionals are
true professionals and have a compassion for our military members suffering
which has been translated into actual work.
Papers, workshops, books and the like have been published to address
this issue. From all of this things have
been discovered and have added positive things; however it is a slow
process. Progress is slow and still is inconclusive
at this juncture.
The amount of energy
from these folks has been impressive and the volume of literature in the last
ten years on this subject has mushroomed.
In contrast my own view of my colleagues in ministry in the military has
not been very positive. Some in Chaplain
leadership have passed the buck and just let Mental Health run with the
problem. My own frustration is magnified
when I talk to not only my Chaplain leadership but also those in my peer
range. Apathy is rampant and I feel a
real opportunity to help our military men and women have been lost. It’s like watching someone drown and just
passively sit back and watch them go under the water for the final count. I feel
for those of us in religious circles, this is our clarion call to step forward
and take charge.
The reason
being is found in a simple and profound truth:
PTSD is a spiritual problem, not a psychological one. To make matters worse, my colleagues are committing what I consider
spiritual neglect. Let me re-iterate: most
of the problems in PTSD are not physical or psychological. It is spiritual. As a result of this axiomatic truth, there is
a component in PTSD that everyone is afraid to address. It is known as the “moral quandary” or “moral
injury” part of the equation. As my
friend previous told me and I’ve verified it numerous times after in my
research interviews, there comes a “Moral” imperative that is strained,
stretched or even broken that combat brings up.
This is the key that often causes people to “snap” or “loose it” in
their lives.
This is where every clergy worth their
salt should be an expert in because this is the specialized area which all of Christendom
and even Judaism has dwelt in for the past 3400 years. In fact up until about
fifty years ago, this was a big part of philosophy which of course developed
into the discipline of psychology. The “Moral”
aspect of this question is obvious, but now we have a generation which does not
see the relationship with PTSD, morality and spirituality. In short, it is a knowledge that is no longer
considered a place at the table of science and the arts. It has been relegated to second class status
because it cannot be proven empirically or verified by charts, graphs and a
statistical delta. Therefore in the
minds of many, it does not exist and therefore, is not valid. It is a bias which maintains that anything
religious, especially from the Judeo-Christian ethic has no value.
In fact, Christianity
has been vilified to the point where the baby has been thrown out with the
bathwater. It is an institutional bias
so great that anything considered from this standpoint is automatically wrong
and like Copernicus from the scientific community of the past, is automatically discounted because of this
perspective. It is academic snobbery at
its worse. However, let’s go beyond bias
and personal attitudes. Let’s discuss
what has been called “Moral Injury” from a different paradigm which is found to
be useful.
MORAL INJURY
Moral injury
is a term that many in the psychological field do not like to use. First of all, in the field of psychology it
is difficult to define. Even in the
presentations of the 2011 COSC conference, there were 3 different definitions
by 3 different researchers. Some even
hate to use the term because they do not even think it exists because it cannot
be quantified like other scientific endeavors.
However, for some this is a
“Brave New World.” Unfortunately, this
is nothing new because this has already been addressed in numerous ways in numerous
times for the past two thousand years. Furthermore, some would argue that this
historical fact has no bearing in a scientific paper and is not related
whatsoever to the topic of PTSD. However,
since morality has been brought into this equation, one needs to go back to the
root of what is morality. To understand
this fundamental truth is essential.
Morality posits a
right and wrong. This begs the question
then as to who’s right or wrong. As I’ve
demonstrated there is indeed a spiritual component here which defies temporal
or empirical definition. While modernity
struggles with this “fuzzy” notion, it has already been solved via Theological
channels. To make a choice of right or
wrong posits a human response to a given situation. If that is true, then the thought process has
to have an origin. Theologically,
the most obvious of origins for humankind was found in the Garden of Eden as
recorded in the Scriptures. From there a
moral choice was made which affected not only the first humans, but how
humanity was to view reality after that.
The lesson from this
theological truth is this: morality is based on the character and nature of
God, not on what fallible humans think. Humanity
is at war with God’s principles and standards.
There are absolute spiritual truths and to go against them brings all
sorts of consequences which affect one’s outlook and ability to live a balanced
life. Guilt, depression and other
“internal” problems affect one’s health and well-being. There is a set of
epistemological truths which is Theocentric and not anthropologically centered
that yields answers. The next chapter
will deal with a new way of looking at this age old problem. My experience and research has shown this way
is the most effective in treating PTSD patients.
A CAVEAT
One must
remember that there is a difference between religion and spirituality. Some
have advocated spiritual healing, but have left out some important parts. For instance, Navy Chaplain Bill Cantrell in
a panel stated in his presentation “Moral Injury: A Spiritual Perspective,” “
the spiritual dimension can be seen as an aspect of life, but is better
understood as that which gives our lives their fullest meaning and their
greatest energy.” In his presentation he
builds a strong case to show a spiritual dimension of PTSD injury. He also advocates a strong affinity with a Center
for Mind/Body Medicine which combines modern medicine with inner healing. The
ability to deal with trauma by spiritual means is also a theme of Victor
Frankl, a Holocaust survivor. Another advocate for spiritual healing is the
Deputy Chief of Navy Chaplain Margaret Kibben.
During the 2011 COSC conference, she stated the following:
“Sometimes when a
Sailor or Marine steps on the yellow footprints and the command diminishes what
is important and replaces it with self, then the Sailor or Marine’s aperture
becomes smaller and they look only on themselves and not as a bigger aperture
of believing in something bigger than themselves. Without this, we lose hope
and become more in despair.”
After this
quote, she then went onto explain how “spiritual fitness” for the Sailor and
war fighter is important.
Unfortunately, while
most Navy Chaplains and clergy in their Christian traditions and denominations
talk in generic terms of how important it is to be “spiritual,” no one goes
into any details. The talk is usually
crouched in non-offensive terms which avoid words like “sin,” “Christ,”
“redemption” and “repentance.” In other
words, the things that are specific to Christianity are totally taken out. That is like fixing a car engine with bad spark
plugs and only using a screw driver. Both descriptions are true, but woefully
inadequate. Perhaps both Chaplain Kibben
and Cantrell didn’t address the specifics because they didn’t have the time,
however to not mention any specifics was unfortunate.
An Appeal to the Scriptures on the
Nature of Humankind
In the main premise
of Chapter 2, one finds that not everything can be quantified, objectified or
explained with empirical evidence. As a
result of this truth, this can explain why many of the current therapies and
theories are not very effective in explaining, curing and treating PTSD. It’s a lot like treating the symptoms of a
cold caused by a virus with antibiotics; it may take care of a secondary
infection, but doesn’t do anything about the root cause.
In order to properly
understand PTSD, one has to also understand human nature and how we are made or
wired. Treating symptoms (i.e. lack of
sleep, irritability, etc.) is the preferred method of many. For instance on a lecture concerning the
treatment of PTSD, Jonathan Shay made a case where those suffering from PTSD
lacked the ability to get a good night sleep.
He then extolled the virtues of the then new drug “Ambient.” After an hour session of discussing problems
and symptoms of PTSD, his conclusion was if those suffering from PTSD could get
a good night’s sleep using Ambient, then it would take care of the person’s problems.[9] In
short, drugs are the answer.
However, drug therapy
has now been shown not to work and is out of favor.[10] While sleep is important, it misses the
essential aspect of treatment. It treats
the symptom and does nothing with the root cause. What then is the most fundamental
aspect? It is nothing new nor is it
unique. Up until a few decades it was
considered THE cause and explanation for why we do what we do as people: Sin. Sin
is a moral term and hence needs a theological explanation. A proper understanding of this will bring to
light how we function, how we think and thus, how we are able to get to the
bottom of why people are so affected by personal trauma during combat. Unfortunately this word and its theology have
been simplified and vilified in all aspects of philosophy and science. It is a word that is thrown around, but
rarely understood in its true Biblical context.
Its understanding is paramount for understanding this problem however.
HAMARTOLOGY AND ANTHROPOLOGY
A simple
Bible lesson on Creation is in order. As
the story in Genesis 1-3 describes, God created man and women perfect. Of all created beings, God created Adam and
Eve (Humankind) with a special relationship.
They were created in God’s image (an autonomous personality having a
soul and spirit) with the ability to communicate spiritually and have
unhindered fellowship with God. Even
though man was a physical being, he also possessed a Spirit which is where the
fellowship occurred. As an autonomous
being, Man’s personality (mind, emotions and will) was demonstrated through His
soul (Greek: Psyche) as He communicated with God. It was a perfect relationship.
God in His perfect will gave Man (actually
Adam) tasks and prohibitions and it was Man’s duty to obey. This fellowship was maintained as long as Man
obeyed and it was broken once Man disobeyed God’s mandates. Once Man broke God’s law, then “sin” was
introduced into the world and it undid all of God’s perfection. With an introduction of sin into the world,
there were consequences of disobeying God.
God is Holy and because He is
Holy, cannot have any imperfection in His presence. Hence, there was a separation
between God and Man. In punishment, God
killed the ability to communicate with Man by making man’s spirit dead towards
Him. Even though Man maintained his life
giving spirit, he could no longer approach and freely interact with God because
of a sin nature. In short, disobedience
brought spiritual death and because the spirit and body are connected, it also
brought eventual physical death.
Even though there is this “deadness,” there
is still some semblance of God’s image in us.
As imperfect personal beings made in the image of God, we still have the
ability to communicate, think, feel, rationalize and understand internal truth
as given to us by God. It is this
internal testimony of the image of God which gives each person a “moral
compass.” In other words, these are
already written in the heart of each man, women and child born into this world,
something which yearns for completion. This
is something which knows good and evil and desires “inner peace” and
fulfillment.
Unfortunately, this inner knowledge does not
have a perfect guide like Adam and Eve did before the fall. They communicated perfectly in a perfect way
with a perfect God. After the fall or
disobedience, we are on our own as for making decisions. As a result, we as humans do things which we
think will bring us happiness and fulfillment because it satisfies the desires
of our flesh. We no longer seek after
spiritual truth, but substitute this truth with the thing we know best: our
fleshly desires. While sensual pleasures
may be great for a short time, it does not bring fulfillment in the long
run. As one substitute’s fulfillment in
sensual pursuits, the novelty wears off.
Some pursue after this type of fulfillment and never are content.
All of us have something internal which
tells what is good and evil because we are still made in the image of God, even
if it is somewhat marred by sin. If
something happens which goes against this “inner” conscience, then it
traumatizes the individual. The event
goes against everything that person knows inherently about God and His
world. The event causes a “searing” of
one’s conscience which takes away any joy and peace. While there may be no outside physical
problems, it wreaks havoc with one’s view of reality and life. No drugs, science or therapy can resolve this
conflict. It is something that is hard
wired within us by our Creator. It goes
straight to the essence of who we are as individuals and as humans.
This is where the bias of psychology comes
into play. The trauma from going against
something God has placed within us causes many internal problems in the
individual. The resulting feelings of
depression or guilt come from true moral injury of having our consciences go
through a “searing.” Unfortunately
modern psychology has convinced a willing public that morality is relative and
guilt is non-existent and caused by breaking of outside societal norms as opposed to those real
and natural feelings given to us by a personal God.
In
summing up this section, here are some theological truths about who we are as
people:
1.
We are a three part being: body, soul (psyche) which
comprises our mind emotions and will and a spirit.
2.
We are made in the image of God, but that was marred by
disobedience. As a result of this, we
have a sense of right and wrong, evil and goodness. This gives us an innate ability to understand
and know about spiritual issues.
3.
This innate ability can sense God’s truth, but because
of sin often cannot find its own way back to joy
Psychosomatic illness is not new stuff. In fact, this was realized 3,000 years ago in
the Psalms. The following passage
describes how a person suffers both physically and in their psyche (soul), but
knows how to seek after a solution.
Psalm 31:9-16 describes a person who is going through an emotional or
stressful situation and it has affected their
health:
Be gracious to me, O Lord, for I
am in distress. My eye is wasted away
from grief, my soul and body also,
for my life is spent with sorrow, and my
years
from sighing. My strength has failed
because of my iniquity, and my
body
has wasted away…Make Thy Face to shine upon thy servant and save me in your
lovingkindess
Part Three will be included in next Months "Shofar."
[2]
Ibid, 299.
[4] Speech
given by John Paprocki during a Red Mass on the topic of “Threats to Religious
Freedom: From Godless Communism to Profane Secularism,” Houston, TX., September
29, 2011.
[5]George
Weigel, “Tim Tebow and Christophobia,” The Southern Cross, October 2011,
Perspectives, p. 21.
[6]Arthur
Schopenhauer, The Basis of Morality, (Minneola,
NY: Dover Publications, 2005), p. 8.
[7] Jonathan
Shay, Achilles in Vietnam: Combat Trauma
and the Undoing of Character, (New York: Simon and Shuster, 1995), xiii-xxiii.
[8]Bob
Freiberg, “Spiritual Warfare with the United States Navy SEALs: Confronting
Them with Real World Missions of the Gospel of Jesus Christ” (D.Min
dissertation, Talbot University, 2003), 91. 17
[9] Jonathan
Shay, “Treating Those Who Suffer from
PTSD” (lecture presented at the Navy Chaplain’s School, Senior Leadership and
Management Course, Newport, R.I.), November 2004.
[10] Marcus
Charuvastra, “PTSD- Innovative Medical Solutions for Mental Health
Professionals” (Memo describing how pharmacologic therapies are not effective
for long term management of PTSD, Los Angeles, CA), Mar 22, 2012.
Is sin viewed as a specific action or just a disconnection from God and broken fellowship? Can't the only healing come from the supernatural work of the Holy Spirit? So isn't a key component to PTSD healing a conversion experience, redemption, and sanctification? I'm not discounting counseling, but it seems like counseling without meeting god and accepting him is an incomplete healing and that allows for continued sin and for some self inflicted death.
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