Moral Injury: Spiritual Aspects of Struggles for Women ADSMs and Veterans

Transcription

1 Moral Injury: Spiritual Aspects of Struggles for Women ADSMs and Veterans National VA/DoD Women's Mental Health Mini-Residency August 2018 Arlington VA Presenter: SARAH A. SHIRLEY, Ch, Lt Col, FLANG

2 Disclosures The information in this presentation represents the opinions of the author and not those of the Florida Air National Guard, the State of Florida, the United States Air Force, the Department of Defense, or the United States Government. The author/presenter has no financial interests or relationships to disclose.

3 Workshop Outline Introductions Learning Objectives Terminology Contextual Issues Resources for Human Flourishing Case Discussions Review

4 Learning Objectives Identify one or more contextual issues that may contribute to spiritual struggle for women ADSMs and Veterans Distinguish among similar concepts: moral injury; spiritual distress; ethical dissonance Propose two or more non-clinical approaches to address spiritual struggle in women ADSMs and Veterans

5 Embracing squishy terms Moral Injury Spiritual Struggle Growth Sacred Authority Dissonance Flourishing Healing Religion Ritual Community Theology Hope Shame

6 A woman s place

7 (moral) Authority

8 (spiritual) Growth

9 (sacred) Spaces

10 Key Takeaways Ethical dissonance or moral tension are healthy responses to morally ambiguous or ethically conflicted situations Spiritual struggle is a sign of life Social, political, and economic biases against women create a context of ethical dissonance Truth-telling, rituals, and supportive spirituality (including religion) can help women ADSMs and Veterans live more whole-heartedly

11 Foundational Scholarship & Resources Brock, R. N. & Lettini, G. (2012). Soul repair: Recovering from moral injury after war. Boston, MA: Beacon Press. Caterson, J. E., Liesveld, C., & Pace, A. (2014). Engage your strengths 4.0. Washington, DC/New York, NY: Gallup/American Bible Society. Doehring, C. (2015). The practice of pastoral care: A postmodern approach (revised and expanded edition). Louisville, KY: Westminster John Knox Press. Fowler, J. (1981). Stages of faith: The psychology of human development and the quest for meaning. New York, NY: Harper Collins. Hufford, D. J., Fritts, M. J., & Rhodes, J.E. (2010). Spiritual fitness. Military Medicine, 175(8), James, J. W. & Friedman, R. (2009). The grief recovery handbook: The action program for moving beyond death, divorce, and other losses, including health, career, and faith. New York, NY: William Morrow, an imprint of HarperCollins Publishers. Koenig, H. G., King, D. E., and Carson, V. B. (2012). Handbook of religion and health (2 nd Ed.) New York, NY: Oxford University Press. Litz, B. T., Lebowitz, L, Gray, M. J., & Nash, W. P. (2015). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury. New York, NY: The Guilford Press. Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, Pearce, M. J., Koenig, H. G., Haynes, K.N., & Resick, P.A. (2016). Spiritually-oriented cognitive processing therapy: Veteran/military version therapist s manual. Durham, NC: Duke University Center for Spirituality, Theology and Health.

12 Foundational Scholarship & Resources, cont. Pargament, K.I. & Sweeney, P.J. (2011). Building spiritual fitness in the Army: An innovative approach to a vital aspect of human development. Journal of American Psychology, 66(1): DOI /a Roberts, S. B. (2012). Professional spiritual & pastoral care: A practical clergy and chaplain s handbook. Woodstock, VT: Skylight Paths Publishing. Sherman, N. (2015). Afterwar: Healing the moral wounds of our soldiers. New York, NY: Oxford University Press. Sweeney, P. J., Rhodes, J. E. & Boling, B. (2012). Spiritual fitness: A key component of total force fitness. Joint Force Quarterly, 66, Tick, E. (2014). Warrior s return: Restoring the soul after war. Louisville, CO: Sounds True, Inc. Werber, L., Derose, K. P., Rudnick, M., Harrell, M. C., & Naranjo, D. (2015). Faith-based organizations and veteran reintegration: Enriching the web of support. Santa Monica, CA: RAND Corporation. Retrieved from

13 References Gaudet, C. M., Sowers, K. M., Nugent, W. R. & Boriskin, J. A. (2016). A review of PTSD and shame in military veterans. Journal of Human Behavior in the Social Environment, 26(1), 56-68, DOI / Gilligan, C. (2014). Moral injury and the ethic of care: Reframing the conversation about differences. Journal of Social Philosophy, 45(1), Harris, J. I., Park, C. L., Currier, J. M., Usset, T. J., & Voecks, C. D. (2015). Moral injury and psycho-spiritual development: Considering the developmental context. Spirituality in Clinical Practice, 2, Harris, J. I., Usset, T., Voecks, C., Thuras, P., Currier, J. & Erbes, C. (2018). Spiritually integrated care for PTSD: A randomized controlled trial of Building Spiritual Strength. Psychiatry Research, 267, , Koss, S. E. & Holder, M. D. (2015). Toward a global understanding of spirituality and religiosity: Definitions, assessments, and benefits. In Spirituality: Global Practices, Societal Attitudes and Effects on Health. Hauppauge, NY: Nova Science Publishers. Krause, N., Emmons, R. A., & Ironson, G. (2015). Benevolent images of God, gratitude, and physical health status. Journal of Religion and Health, 54, Liebow, N. (2016). Internalized oppression and its varied moral harms: Self-perceptions of reduced agency and criminality. Hypatia, 31(4), Morgan, J. K., Hourani, L., Lane, M. E., & Tueller, S. (2016). Help-seeking behaviors among active-duty military personnel: Utilization of chaplains and other mental health services. Journal of Healthcare Chaplaincy, 22(3), doi: /

14 References, cont. Picket, K. L. & Gentry, R. H. (2017). Slut shaming in a school bullying case: Evaluators ignore level of harm when the victim self-presents as sexually available. Sex Roles, 76, DOI /s Rios, M. (2018). The glue is still drying. In R. E. Meagher & D. A. Pryer (Eds.), War and moral injury: A reader (83-94). Eugene, OR: Cascade Books. Shay, J. (2013). Trust within fighting forces: Its significance, its creation, maintenance and destruction. Colrain, MA: Unpublished draft manuscript. Shirley, S. A., Alders, E. A., Crosby, H. A., Charters, K. G., & Caterson, J. E. (2018). Faith-based programming for spiritual fitness. In K. H. Thomas & D. L. Albright (Eds.), Bulletproofing the psyche: Preventing mental health problems in our military and veterans ( ). Santa Barbara, CA: Praeger. Sonke Gender Justice, the Wits Centre for Diversity Studies, & Institute for Development Studies (2018). Faith, gender & sexuality: A toolkit. Institute for Development Studies: Brighton, England (United Kingdom).

15 Contact Sarah A. Shirley, Ch, Lt Col, FLANG DSN