The American Legion National Chaplain s Conference September 27, 2008 Indianapolis, IN

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1 The American Legion National Chaplain s Conference September 27, 2008 Indianapolis, IN Chaplain, Lt Col, William T. Yates Wing Chaplain 181 st Intelligence Wing (IN ANG) Terre Haute, Indiana

2 Introduction Overview Insights into Military Culture Phases of Deployment Critical Issues Physical Psychological, Emotional & Relational Spiritual Role of Chaplains and Churches Q & A

3 God s Promise in Times of Crisis I waited patiently for the LORD; he turned to me and heard my cry. He lifted me out of the slimy pit, out of the mud and mire; he set my feet on a rock and gave me a firm place to stand. He put a new song in my mouth, a hymn of praise to our God. Many will see and fear and put their trust in the LORD. ~ Psalm 40:1-3

4 Insights into Military Culture Young population, still maturing High Ops Tempo + multiple deployments (12-18 months) Harsh & Dangerous Conditions in 60+ AORs worldwide Wing Man & Buddy System ingrained in units There: Adrenaline Rush vs. Here: Boredom & Routine Rules of Engagement (military) Rules of Disengagement (personal) Indiana: 4 th largest state for combat deployments in USA Pride in service

5 Five Stages Phases of Deployment 1. Pre-Deployment: Alerted about leaving 2. Deployment: Leave home 3. Sustainment: Troops gone/families at home 4. Redeployment: Troops prepare to return 5. Post-Deployment: Return & Reunion Note: More problems are surfacing today at the return from war than at the time of separation from family

6 Critical Issues 1 Physical PDHA (Post-Deployment Health Assessment) Most Commonly Reported Problems (Office of SecDef) - muscular-skeletal injuries (neck, back, legs) - hearing loss and tinnitus - fatigue (related to other stresses and injuries) TBI (Traumatic Brain Injury) 320K cases (Rand Corp 2008) The emerging generation of disabled veterans - number has jumped 25% since 2001 Transporting the Combat Wounded

7 Traumatic Brain Injury (TBI) Signature Wound of the War (American Legion Magazine, May 2008)

8 What is TBI? Traumatic brain injury (TBI) happens when: The head is jolted, hit or penetrated and the brain moves or is seriously harmed within the skull Leading causes in combat: Blasts ( IEDs, mortars, RPGs) Falls Motor vehicle crashes Note: TBI can occur without any outward signs of injury to the head and often includes polytrauma

9 How Many are Affected by TBI? Rand Corporation Study (2008) 19.5% reported probable mild TBI 18.5% met criteria for either PTSD or depression 37.4% of those with mtbi also had either PTSD or depression VA Study (2007) 42% of OIF/OEF veterans with a history of mtbi also had PTSD symptoms (Lew et al., 2007; JRRD, 44; )

10 Transporting the Combat Wounded

11 Down Range

12 Entrance to 332 nd Air Force CASF, Balad, Iraq Contingency Aeromedical Staging Facility

13 CCATTs (Critical Care Air Transport Teams)

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15 Landstuhl Regional Medical Center Wounded Warrior Ministry Center Germany

16 Arrival at Landstuhl

17 Chaplains Greet every Wounded Warrior Arrival 24/7

18 Rapid Stabilization & Normalization (3-12 Day Care Plans)

19 Critical Issues 2 Psychological, Emotional & Relational Traumatic Stress (PTS/D, COSR) 300K cases (Rand Corp 2008) Depression (MDD) Suicide (Army: highest level since records first kept in 1980) Separation from the Combat Team - loss of bonding and fit - intensity of life outside the wire - social network of military friends who get it Substance Abuse, Risky Behaviors, Divorce Difficulties talking about experiences & asking for help

20 Divorce in the Military Divorce rate among military personnel doubled from 2001 to 2004 Women in the military are more likely to divorce than men The longer an individual is deployed, the less likely he or she is to divorce Source: Rand Corp Study 2007

21 Post-Traumatic Stress (PTS/D) Combat Operational Stress Response (COSR)

22 What is PTS(D)? [Dr. Frank Ochberg, MD, Dept. of Psychiatry, Michigan State University] Three clusters of experiences that continue 30+ days after event(s): 1. Trauma memory (re-experiencing) 2. Numb feelings ( I m not the person I was ) Easily confused with and misdiagnosed as depression 3. Nervousness and Agitation A Diagnosis of PTSD must include clinically significant distress or impairment in social, occupational, or other important areas of functioning.

23 Defining Trauma Memory Person has been exposed to a traumatic event in which both of the following were present: (1) The person experienced, witnessed, or was confronted with an event(s) that involved actual or threatened death or serious injury, or a threat to the physical integrity of one s self or others; (2) And, the person s response involved intense fear, helplessness, or horror. DSM-IV-TR

24 Context of PTS(D) Reactions Afghanistan Iraq Being attacked or ambushed 58% 89% Receiving incoming artillery, rocket or mortar fire 84% 86% Being shot at or receiving small arms fire 66% 93% Shooting or directing fire at the enemy 27% 77% Being responsible for death of an enemy combatant 12% 48% Being responsible for the death of a noncombatant 1% 14% Seeing dead bodies or human remains 39% 95% Seeing dead or seriously injured Americans 30% 65% Knowing someone seriously injured or killed 43% 86% Seeing ill or injured women or children whom you were unable to help 46% 69% Being wounded or injured 5% 14% Having a buddy who was near you shot or hit -- 22% Clearing or searching homes or buildings 57% 80% Engaging in hand-to-hand combat 3% 22% Saved the life of a soldier or civilian 6% 21% ~Hoge, et al. (2004) in Current Psychiatry, January 2006

25 Who Has PTS/D? About 20% of troops who return from combat deployments meet criteria for PTSD, depression, or anxiety (vs 3% of general population) About 17% who served in Iraq and 6% who served in Afghanistan had PTSD symptoms 3-12 months after their deployments ~Kaplan, Psychiatric Times, Jan 2006 About 300K walking wounded at home and in our churches Only about half of all troops are reporting and seeking help ( self-id )

26 Who Has PTS/D? Percent Pre-OIF 3 months Post OIF 12 months Post OIF Depression Anxiety PTSD ANYPSY

27 Impact on Marriages I have a good marriage My relationship with my spouse makes me happy My relationship with my spouse is very stable I really feel like a part of a team with my spouse Percent Agree or Strongly Agree Pre-OIF 12 months Post OIF

28 Critical Issues 3 Spiritual Wounds Ruptured Worldview Rage and anger Guilt and Shame (especially Survivor s Guilt) Forgiveness vs. revenge Hope vs. Cynicism Grief and loss Crisis of Self-Concept & Identity ( omnia mea mecum porto ) Moral Conflicts Importance of Grace and Absolution

29 5 Core Human Beliefs or Worldview Assumptions Belief in a fair and just world Results of Psychological Trauma A violated sense of fairness or justice The need to trust others Feelings of treachery or betrayal A positive self-identity The need for safety Personal faith or religion that brings meaning even to the most complex and ambiguous events A violations of one's sense of self A catastrophic revelation of mortality or vulnerability The violation or contradiction of one's core religious or faith-based belief system [Everly & Lating, 2002]

30 Cries of the Spiritually Wounded Where is God in all this? Can I find God in the midst of suffering? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. (Psalm 39:8) Why did I make it and my buddies didn t? - flying cover for your buddies culture (feeling responsible) - survivor guilt (real/imagined) Will I be accepted despite my wounds and problems?

31 Helping the Spiritually Wounded In suffering, we can t say what God IS doing but we can know what he is NOT doing - Not seeking to harm us, abandon us, or increase our suffering The journey home is longer than the flight back - I m home now, but a part of my soul is back there (veteran) Ask: Are you resolved with what happened? to determine status, needs, and next steps in care

32 Role of Chaplains & Churches Situational Awareness: troops and families Provide Spiritual Care - hopeful ambassadors for God - authenticity in dealing with the human condition Importance of Listening & Absolution Rites of Sending & Welcoming Home Practical Care of Everyday needs Use Professional Relationships - VA, Military Chaplains, etc.

33 Resources & Links MilitaryOnesource.com IN National Guard Family Programs - Military Child ( National Military Family Association (

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35 Questions & Discussion