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  1. 1. Resiliency and Hope Engaging Spiritual Resources Post trauma Rev. John P. Oliver, D.Min., BCC, ACPE Supervisor Chief of Chaplain Service, Durham VA Medical Center
  2. 2. Overwhelming Task Having looked into the abyss of evil, death & destruction our veterans return with the one thousand-yard stare. We, the care providers, see the coming storm and, in parallel process feel overwhelmed.
  3. 3. Where we are today. . . As of June 26, 2008 4,633 USA - Fatalities (OEF/OIF) 17,627 WIA – Returned to duty within 72 hrs 14,782 WIA – Not returned to duty within 72 hrs OVER 1.6 Million service members are involved in the Global war on terror (GWOT). http://www.defenselink.mil/news/casualty.pdf 9
  4. 4. Challenges in Returning Home . . . . Trauma reactions upon returning from war are NORMAL reactions to abnormal circumstances. Resetting - Difficulty of coming home and ―turning off‖ combat skills. 10
  5. 5. Typical Crisis Cycle Crisis A typical crisis has a beginning where stress builds, a high point of stress and then a slow tapering of anxiety and fear that leads to recovery. 12
  6. 6. Re-setting for Civilian Life Crisis Individuals post-trauma are at a constant state of readiness. Easily triggered. Hypervigilance 14
  7. 7. Re-setting after multiple deployments Crisis Crisis Crisis Over time, resources for managing crisis are eroded. Crisis comes earlier. 16
  8. 8. Reactions to Traumatic Events Psychological Physical Cognitive Emotional Behavioral Interpersonal Spiritual 17
  9. 9. Spiritual Reactions to Trauma  Confusion about God  Altered sense of meaning in/of life  Loss of previously sustained beliefs  Confusion about core ethical beliefs.  Grief around loss of relationship with God  Questions of Theodicy  Feeling dirty and unworthy  Feeling permanently damaged  Feeling guilty 19
  10. 10. Spiritual Consequence of War Difficulty reconciling beliefs with traumatic warzone events Agree Neutral Disagree I abandoned my religious faith during the war. 0% 20% 40% 60% 80% 100% Agree Neutral Disagree 0% 20% 40% 60% 80% 100% 20
  11. 11. Weakened Faith Research showed that a Veterans' war zone experiences (killing, losing friend, etc.) weakened their religious faith, both directly and as mediated by feelings of guilt. Weakened religious faith and guilt each contributed independently to more extensive current use of VA mental health services. Fontana, A., & Rosenheck, R. (2004). Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. J Nerv Ment Dis, 192(9), 579-584. 21
  12. 12. Spirituality & Rebuilding a Life  Spirituality is that which gives a person meaning and purpose.  It is found in relationships with self, others, ideas, nature, and, possibly, a higher power.  These many relationships are prioritized according to an organizing principle and form an intra-, inter-, and trans-relational web that houses a person's sense of meaning and purpose.  Spiritual distress arises when one of these relationships that provide meaning is threatened or broken. The more significant a particular relationship is, the greater the severity of spiritual distress if that relationship is threatened or broken.  Spiritual wholeness is restored when that which threatens or breaks the patient's relational web of meaning is removed, transformed, integrated, or transcended. Mark LaRocca-Pitts, Ph.D. . 22
  13. 13. Resilience Defined  Doing well in adversity  Theability to overcome setbacks and obstacles; maintain positive thoughts during times of adversity.  The capacity to cope effectively with the internal and external stresses.
  14. 14. Resilience is Not  Invulnerability . . .  The idea that everyone can succeed in fame and wealth when faced with difficulty.  A replacement for erred public policy nor is it a reason to avoid social change.  Resilience comes at a cost. Psychological scars often, if not always accompany the resilience that individuals attain in the most difficult situations Titus, Craig Steven: Resilience and the Virtue of Fortitude: Aquinas in Dialogue with the Psychosocial Sciences, 2006.
  15. 15. Facets of Resilience  Resilience helps us cope with hardship (endures, minimizes or overcomes hardships);  It helps us resist the destructive pressures on our physiological, psychological and spiritual self (maintains capacity);  Resilience moves us to achieve a new proficiency out of the unfavorable experience.
  16. 16. Resilience Research  Genetic approach  looking at genetic codes for resilience  Personality approach  looking at how positive and negative outcomes can be attributed to temperamental traits and developed characters.  Cognitive approach  seeing emotions as the result of the meaning a person attributes to particular events and experiences  Developmental approach  identifying adaptive reactions to developmental challenges of the life span  Social Relationship approach  exploring how changes in family, religious and other social relationships contribute to the challenges we face or help us overcome them.
  17. 17. Spiritual Resources for Resilience Faith  Explore questions of meaning and purpose in life. ―There is a meaning . . . I will find it.‖  Reframing the meaning of the event.  Forgive and be forgiven.  Trusting God for protection / guidance.
  18. 18. Spiritual Resources for Resilience Community  Sense of belonging to and being loved by God. God as a supportive partner.  Attachment to God and others. (Bowlby’s attachment theory suggests When we feel secure, well attached, we are not fearful.)  Subject – rather than Object (I and Thou)  Purpose within the community  Reduced ―risky‖ behaviors.  Rituals – establish belonging and patterns of behavior
  19. 19. Spiritual Challenges for Resilience Negative Prayers  Prayer study shows deleterious effects of ―negative prayers‖ for removal of problems rather than ―positive prayers‖ for support through the problems. Problems arise when:  One views traumatic events as punishment from God.  One views God as angry, unfair and punitive.  There are unclear boundaries within congregation  Pastoral and congregational responses do not engage the person at their point of need.
  20. 20. Resilience as a Choice Viktor Frankl  described those prisoners who comforted others and shared their scarce rations as "sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms--to choose one's attitude in any given set of circumstances, to choose one's own way."
  21. 21. Resilience and Moving Ahead Harold Kushner  suggests that when bad things happen, "All we can do is try to rise beyond the question `why did it happen?' and begin to ask the question `what do I do now that it has happened?" Helen age 10  Bad things can turn into good things. Joseph  ―You meant it for evil, but God meant it for good‖
  22. 22. Cost of Resiliency  Psychological scars often, if not always accompany the resilience that individuals attain in the most difficult situations  Giving up precious relationships, ideas and self-understandings  Forgiveness – Pardon  Change of life goals / mission / purpose.
  23. 23. Hope
  24. 24. Hope Defined  Hope is a belief in a positive outcome related to events and circumstances in one's life.  Hope implies a certain amount of despair, wanting, wishing, suffering or perseverance — i.e., believing that a better or positive outcome is possible even when there is some evidence to the contrary Wikipedia
  25. 25. Hoping Defined  Hoping is a realistic and adaptive response to extreme stress or crisis in which the person acquires a patient and confident surrender to uncontrollable, transcendent forces.  Hoping contrasts with wishing, which implies more urgent ego claims and controls aimed at particular objects and goals.  Similarly, despair may be regarded as a more objectless and profound state of being than, for example, grief, which attaches to specific loss. Dictionary of Pastoral Care and Counseling
  26. 26. Hope and what is Possible  Hope is a sense of what might be possible.  Imagining that what we really need is possible, though difficult.  Hopelessness means being ruled by the sense of the impossible.  Hope is an arduous search for a future good of some kind that is realistically possible but not yet visible. Lynch, William F., Images of Hope: Imagination as Healer of the Hopeless, 1974
  27. 27. Hope and Imagination  Hope is tied to the life of the imagination  The nature of hope is to imagine what has not yet come to pass but is still possible.  Hope imagines and refuses to stop imagining (or hypothesizing)  Hope imagines With – it is a collaborative venture Lynch, William F., Images of Hope: Imagination as Healer of the Hopeless, 1974
  28. 28. True Hope  Hope is not initiated and sustained by erasing emotions like fear and anxiety, it integrates the genuine threats and dangers that exist into the proposed strategies to subsume them.  Hope takes into account the real threats that exist and seeks to navigate the best path around them.  Hope brings reality into sharp focus. Hope incorporates fear into the process of rational deliberation and tempers it so we can think and choose without panic. Groopman, Jerome The Anatomy of Hope
  29. 29. Actualizing Hope and Resilience  Honest, caring relationship  Truthful imagination of the future  Resource review – what was lost? What was gained?  Acceptance of humanity  Pardon  Collaboration / Community
  30. 30. Need for a Community Response  No one system can provide all the services needed.  Supporting the family will support the individual.  78% of survivors receive 100% of their support from family members.  Survivors and caregivers needs are different.
  31. 31. Veteran’s Use of Clergy  Veterans feel more comfortable approaching their pastor than they do a mental health professional.  Individuals seek council from ministers more than all other mental health providers combined. In minority populations this is even more true.  Often seeing a member of the clergy is less threatening and has less stigma attached. Is viewed as engaging a known community resource.  Negative reasons. . . Magical thinking, avoiding truth of diagnosis, etc. 42
  32. 32. Community-based Support Teams A community-based support team is –  a group of volunteers  organized to provide practical, emotional & spiritual support Team Philosophy  Do what you can, when you can  In a coordinated way  With a built-in support system 43
  33. 33. Value of Teams for Clients  Hope  Decreased isolation  Increased quality of life  Decreased stigmatization  Early intervention  Adherence to treatment regimen  Peer-to-Peer support 44
  34. 34. Value for Team Members  Altruistic experiences  Decreased social isolation  Increased awareness of problems experienced  Gratitude  Mission and Purpose 45
  35. 35. Concentric Circles of Care Veteran Spouse / Family Care Providers Community Support at any level ripples back in a positive way to the veteran. 46
  36. 36. Support Team Philosophy  Do what you can, when you can  In a coordinated way  With a built-in support system 47
  37. 37. Support system  Members support one another by  setting personal and team boundaries,  sharing the care,  inviting new persons to join the team.  The support system encourages  mutual, respectful relationships  appropriate educational and emotional support and supervision. 48
  38. 38. Resources Project Compassion 180 PROVIDENCE RD STE 1-C CHAPEL HILL, NC 27514 (919) 402-1844 www.project-compassion.org 49
  39. 39. Bibliographic Resources Cantrell, Bridget and Chuck Dean, Down Range to Iraq and Back, 2005. Drescher, Kent D., National Center for PTSD – Menlo Park. Figley, Charles, Strangers at Home: Comment on Dirkzwager, Bramsen, Adèr, and van der Ploeg, Journal of Family Psychology, 2005. Fowler James, Stages of Faith: The Psychology of Human Development and the Quest for Meaning. Harper & Row; San Francisco 1981. Frankl, Viktor, Man's Search for Meaning: An Introduction to Logotherapy Boston: Groopman, Jerome, The Anatomy of Hope: How Patients Prevail in the face of Illness. Random House, 2003. Hasty, Cathy and Mona Shattell, Putting Feet to What We Pray About. Journal of Hospice & Palliative Nursing, 2005 Jaffe, Jaelline, Jeanne Segal, Lisa Flores Dumke, Fontana, A., & Rosenheck, R. Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. Journal of Nervous Mental Disorders. 2004 51
  40. 40. Bibliographic Resources LaRocca-Pitts, Mark, Walking the Wards as a Spiritual Specialist. Harvard Divinity Bulletin, 2004. Lester, Andrew D: Hope in Pastoral Care and Counseling, Westminster John Knox Press, 1995. Lynch, William F., Images of Hope: Imagination as Healer of the Hopeless. Notre Dame Press, 1974. Paynter, Emily, Ph.D. Compassionate Care, Meditations and Insights. (2006) Shumann, Joel, Keith Meador: Heal Thyself: Spirituality, Medicine and the Distortion of Christianity. Oxford Press, 2003. Titus, Craig Steven: Resilience and the Virtue of Fortitude: Aquinas in Dialogue with the Psychosocial Sciences, The Catholic University of America Press, 2006. Weaver, Andrew, Laura Flannely & John Preston: Counseling Survivors of Traumatic Events, 2003. Wolski Conn, Joann (ed.), Women’s Spirituality: Resources for Christian Development. Paulist Press, 1986. 52
  41. 41. Other Resources 1. http://www.helpguide.org/mental/emotional_psychological_trauma.htm 2. http://www.hooah4health.com/mind/combatstress/default.htm 3. www.ncptsd.va.gov Rev. John P. Oliver, D.Min. Chief, Chaplain Service Durham, NC 27712 (919) 286-6867 john.oliver@va.gov 53