Healing the psychological wounds of war

By Andrew J. Weaver
21 Feb 2008

What must [hu]mankind be, before such a thing as war could ever be known or thought of upon earth? How shocking, how inconceivable a want must there have been of common understanding, as well as common humanity, before any two Governors, or any two nations in the universe, could once think of such a method of decision? If, then, all nations, Pagan, Mahometan [sic], and Christian, do, in fact, make this their last resort, what farther proof do we need of the utter degeneracy of all nations from the plainest principles of reason and virtue? (Doctrine of Original Sin, John Wesley, 1757).

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Imagine that you are driving home after church one Sunday. On the way, you witness a terrible train crash involving hundreds of victims. Bodies litter the field, blood and gore are everywhere, and you instinctively stop to help. You apply your Red Cross training and attempt to stop the bleeding. There is moaning, dying, screaming, moments out of hell. Mercifully, it ends. You get back in your car and drive home as though nothing unusual occurred. You do not talk about what happened because everyone wants to forget that it occurred. That is analogous to the experience of many Iraq combat veterans who are returning home.

As of 10 February 2008, there have been 174 British and 3,952 American soldiers killed in Iraq with an additional 29,092 Americans wounded. Whatever we think of the wars they have fought and the policies of the government that has fought them (like many church people, I have been a critic, and I have been actively opposing a Bush library at Southern Methodist University), the duty of deep pastoral and psychological concern remains.

The saying, "war is hell," only begins to describe how horrible it has been for tens of thousands in the military. War is a life-threatening experience that involves witnessing and sometimes engaging in terrifying and gruesome acts of violence. It also is, for most service personnel, a patriotic response to protect and defend their country, loved ones, values, and way of life. War is a shocking confrontation with death, devastation, and violence. It is normal for human beings to react to war's psychic trauma with profound feelings of fear, anger, grief, repulsion, helplessness, and horror, as well as with emotional numbness and disbelief.

Many soldiers are psychologically unable to leave behind the trauma of war when they return home. They struggle with a variety of severe problems that neither they nor their families, friends, or communities know how to address or understand. Even experienced military personnel may never become fully desensitized to exposure to violent death, and they remain particularly vulnerable when victims include children.

Because many veterans have not been taught how surviving trauma can affect persons, they may have trouble understanding what is happening to them. They may think it is their fault that the trauma occurred, that they are going crazy, or that there is something wrong with them, since others who were at the same place do not seem to have the same problems. They may use drugs or alcohol to escape from their feelings. They may turn away from friends and family who seem not to understand. Because thinking about a trauma and feeling endangered is upsetting, people who have experienced combat generally want to avoid all reminders. Sometimes survivors are aware of this and avoid such triggers intentionally, but many do so without realizing it. Survivors may not know what to do to get better.

Psychological problems after being in war were described as "shell shock" in World War I, and "combat fatigue" in World War II. After the Second World War, mental health professionals began to recognize that these difficulties were not hereditarily-predisposed mental illnesses like schizophrenia or manic depressive illness, but a different type of psychological problem resulting from the experience of extreme stress in a war zone. As one might expect, the most important risk factor for post-traumatic stress disorder (PTSD) among veterans is the level of exposure to traumatic events during war.

Participation in hazardous duty can result in significant and enduring stress reactions. There are times when the experience is so extreme and unanticipated (such as seeing and smelling decaying bodies) that everyone involved is at risk for psychological trauma. Stress reactions can create sleep disturbances, irritability, intrusive painful re-experiencing of events, restricted emotional capacity, and impairments of memory and problem-solving capabilities. Long-term stress reactions may include depression, chronic anxiety, and the symptoms of PTSD, which include re-experiencing the events (such as nightmares, intrusive thoughts), avoidance (such as staying away from situations that remind the veteran of what happened), restriction in the capacity to experience and express feelings, and a variety of indications of hyperarousal (sleep disturbance, an exaggerated startle response, irritability).

A common response is to self-medicate with alcohol or drugs to counter distressing feelings and thoughts, as well as guilt over having survived when others died. Perhaps the most perplexing symptom for relatives and friends to understand is psychological numbness: a withdrawal of affection and avoidance of close emotional ties with family members, friends, and colleagues. These responses can cause or exacerbate marital, vocational, or substance abuse problems.

Unfortunately many soldiers returning from the war in Iraq are not getting the mental health treatment they need. In July of 2004, the respected New England Journal of Medical published a study by researchers at Walter Reed Medical Center in Washington. They found that up to 17 percent of the combat veterans returning from Iraq had PTSD, but only 4 in 10 of them sought mental health care. Stigma associated with seeking mental health treatment was the greatest single barrier to obtaining the help needed. If these PTSD suffers do not obtain appropriate help, many will become unnecessarily and tragically addicted to drugs or alcohol and commit suicide. Unfortunately, recent data published in the Canadian Medical Association Journal reports that suicide claimed more British Falkland veterans than combat did. One in 5 Falkland veterans had PTSD five years after the war ended.

Clergy and churches are in a valuable position to help with these problems. In psychological trauma, an individual's sense of order and continuity of life is shattered and questions of meaning and purpose abound. Studies have shown that religious faith is a primary coping strategy for many people, including recovering combat veterans suffering from psychological trauma. In addition to offering the natural social support of community, faith can provide a suffering person with a framework for finding meaning and perspective through a source greater than self, and it can give a sense of control over feelings of helplessness. Research has found that nurturing, non-punitive faith can enhance well-being and facilitate faster emotional recovery for many traumatized individuals.

Clergy are called upon to play a variety of roles as they help trauma survivors move through the healing process. Pastors are accessible and trusted, and through wise counsel they can aid in taking the sigma out of mental health care. Clergy are often in long-term relationships with individuals and their families, providing ongoing contacts in which they can observe changes in behavior that can assist in the assessment and treatment of veterans with PTSD. Pastors are also in a position in which they can refer veterans to mental health professionals and other support systems available through their faith communities.

The word "trauma" is derived from the Greek word meaning "wound." Just as a physical wound from combat can cause suffering in the body, a psychological trauma can cause suffering in the mind and soul. The church is in a critical position to help heal these wounds of war.

Further reading:

* Counseling Survivors of Traumatic Events: A Handbook for Pastors and Other Helping Professionals (Andrew Weaver, Laura Flannelly, and John Preston, Nashville, TN: Abingdon, 2003).

* Post Traumatic Stress Disorder: The Latest Assessment and Treatment Strategies (Marvin Friedman, Kansas City, MO: Compact Clinicians, 2000).

* The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms (Mary Beth Williams and Soili Poijula, Oakland, CA: New Harbinger, 2002).

* Trauma and Recovery (Judith Herman, New York: Basic Books, 1997).

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(c) Rev Dr Andrew J. Weaver is a United Methodist pastor and a research psychologist living in New York City, USA. He has co-authored 14 books including Reflections on Marriage and the Spiritual Journey (Abingdon, 2003), Counseling Survivors of Traumatic Events (Abingdon, 2003), Reflections on Grief and the Spiritual Journey (Abingdon, 2005) and Counseling on Sexual Issues (Pilgrim, 2005).

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