AMEDDC&S HRCOE Department of Pastoral Ministry Training. Moral Injury, PTSD, & PTG. CH (MAJ) Mark Lee, DMin, PhD

Transcription

1 AMEDDC&S HRCOE Department of Pastoral Ministry Training Moral Injury, PTSD, & PTG CH (MAJ) Mark Lee, DMin, PhD

2 Purpose Understand the foundations of, similarities, and differences between Moral Injury and PTSD, recognizing the potential Posttraumatic Growth, and the role of the UMT to lead combat veterans into such growth.

3 Understand PTSD s basic symptomology Define Moral Injury Objectives Differentiate Moral Injury and PTSD Understand basics of PTG Explore ways of engendering PTG

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5 PTSD Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:! Directly experiencing the traumatic event(s).! Witnessing, in person, the event(s) as it occurred to others.

6 PTSD! Traumatic event(s) occurred to a close family member or close friend. Event must have been violent or accidental.! Experiencing repeated or extreme exposure traumatic event(s) (Example: first responders collecting human remains)

7 Key Symptoms of PTSD Irritable behavior Reckless or self-destructive behavior Hypervigilence Exaggerated startle response Problems with concentration Sleep disturbance

8 Key Symptoms of PTSD Disturbance lasts more than one month. Disturbance causes significant distress or impairment in life functioning. Disturbance is not attributable to physiological effects of a substance (e.g. medication, alcohol) Two or more symptoms

9 PTSD s Shortcomings: PTSD created in 1980s by APA to acknowledge Vietnam Veterans and their sociological, psychological, and behavioral issues. (Schaller). At no time, that is, have psychiatrists agreed on one uniform set of diagnoses, much less a uniform definition of mental disorder, and structured clinical practice accordingly. Psychiatric diagnostic systems arose, rather, to meet the needs of (and also to discipline) clinical practice. (Kinghorn). Controversial diagnosis: even psychiatrists and psychologists don t agree. Some think the diagnosis is too readily and easily handed out. ( t-exist-sayspsychiatrist.html) Western ideas regarding medicine and mental health not necessarily shared with other cultures, especially with mental health. (Watters). About 20% of Soldiers returning from OIF and OEF shown to have bona fide PTSD; significantly higher than civilian (3%-4%). (Meichenbaum).

10 PTSD s Shortcomings: NOT minimizing legitimacy of PTSD for many who truly have it Acknowledging PTSD is controversial and not the catch all diagnosis for all combat related problems faced by veterans Aftermath of combat is more complicated than series of diagnosis and symptoms

11 PTSD - disorder Moral Injury injury PTSD and Moral Injury Combat trauma may be manifested symptomatically as PTSD, but the injury to the psyche is much more than just symptoms of a disorder, reparable through medication and therapy combat veterans PTSD symptoms need to address the moral aspects of the combat experience. (Kinghorn, Combat Trauma and Moral Fragmentation: A Theological Account of Moral Injury, Journal of the Society of Christian Ethics 32, no. 2 (2012)).

12 YOUR 90% SOLUTION RULE OF THUMB Is your Soldier fearful of something? Is there physical reaction? Yes PTSD Does your Soldier feel guilt or shame over something? Yes Moral Injury Your Soldier Can Feel Both/Suffer from Both at the Same Time

13 ASPECTS OF MORAL INJURY Has a complex feeling cluster, involving one or more of the following: anger, shame, remorse, betrayal, guilt, contrition, sorrow, depression, isolation, despair, loss of will to live.

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15 An ancient wound of war that can emerge at any point,... even years later. Moral Injury is recognized by the VA Moral Injury is different from PTSD Moral Injury is not diagnosable Moral Injury is:

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17 Moral Injury Moral Injury results when soldiers violate their core moral beliefs, and in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human beings. Soul Repair, 2012.

18 Moral Injury I went to war but did not get my Band of Brothers ~SGT, US Army Infantry~ Why did the family not stop their car why did they make me kill them? ~SFC, US Army Infantry~ Why did we go to war if we are just going to let ISIS take it? ~LTC, US Army Armor~

19 Moral Injury We never rolled out without some drop guns in case we shot the wrong guy. ~SGT, US Army Cav Scout~ The wrong guy died. SPC X was perfect and he got blown up by the IED but the dirtbag right next to him wasn t even scratched. ~SSG, US Army Infantry~

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22 Moral Injury Feels as though he/she has violated what he/she believes is good (guilt, shame). Traumatic shattered worldviews and previous beliefs (sanctity of life, safety, love).

23 Really an existential question! Why God would allow bad things to take place.! Questions of redemptive value of self Could exhibit some PTSD symptoms! Anger! Depression Moral Injury

24 Seeks: Forgiveness Healing rituals 1. Native Americans 2. Japanese Samurai 3. African tribes Moral Injury

25 WHY HAS IT TAKEN [BEHAVIORAL HEALTH] SO LONG TO GET SERIOUS ABOUT MORAL INJURY? Have not asked the right questions Fear-based models of care Shame and guilt not targeted in CBT Shame may prevent disclosure Clinicians may feel helpless or unprepared Clinicians may be too frightened of their own reactions Clinicians may be judgmental Brett Litz National Center for PTSD VA Boston Healthcare System Boston University

26 Moving to Posttraumatic Growth A lot has been spoken and written about PTSD. It s time to move ahead and look at an alternative, PTG, for surely the path of growth leads to a healthier destination than a path of disorder. (Cicilia Chettiar, Trauma and Growth, Indian Journal of Mental Health 1, no.1 (2014): 3).

27 Moving to Posttraumatic Growth Post-Traumatic Growth (PTG) is real and possible Calhoun & Tedeschi found that people actually grew in many aspects of life after trauma Post-Traumatic Growth Inventory (PTGI) Greater appreciation of life and changed sense of priorities Warmer, more intimate relationships with others A greater sense of personal strength Recognition of new possibilities or paths for one s life and spiritual development

28 Moving to Posttraumatic Growth Post-Traumatic Growth (PTG) is real and possible Person is more mature, wiser, stronger (emotionally and spiritually), and more benevolent, etc. Individual has struggled, re-evaluated previously held worldviews, adapted them and reinterpreted them, and creates new perspectives that are healthy and helpful NOT the same as being resilient (bouncing back to original state vs growing)

29 Why vs. For What Incarnational Ministry For both Healing and Growth Closure Moving toward PTG Cause (Meaning & Purpose) Community of Compassion Hope-filled Counseling (Andrew Lester)

30 The Role of the Caregiver SIT with the sufferer (i.e. Job s friends in the beginning) Practice pastoral care (Dietrich Bonhoeffer, Spiritual Care) " It must be made clear to them that the church comes to the sick without ulterior motives simply to be with them and to help wherever help is desired. Through simple presence we show that God is with the sick and that sickness may be interpreted as a sign of God s nearness. " Our love for the other consists first of all in listening in silence.

31 The Role of the Caregiver Pace the sufferer (i.e. Elizabeth Kübler-Ross, Stages of Grief) Denial Anger Bargaining Depression Acceptance NO pat answers just pray through it or read more Bible Acknowledge the pain of the dark night of the soul (St. John of the Cross)

32 The Role of the Caregiver Lead the sufferer into healing ritual and/or prayers as appropriate Facilitate finding meaning and purpose, with hope For surely I know the plans I have for you, says the LORD, plans for your welfare and not for harm, to give you a future with hope. (Jer. 29:11) Connect the sufferer to the faith community Provide safe space and people to share

33 Questions?