Every trauma has a spiritual dimension that warrants spiritual intervention. —Dean Bonura
Addressing the trauma that results in PTSD requires an understanding of spirituality. Spirituality is an important concept, and people assign many different meanings to it. We’ll briefly consider some of these meanings but not attempt to provide an exhaustive explanation. Coming to some kind of understanding of spirituality is essential in order to grasp the fact that trauma has an inherent spiritual dimension that warrants spiritual intervention.
The concept of spirituality has to do with the seat of morality and represents the connection one has to the sacred or to the transcendent or to a living and personal God.[i] Spirituality relates to the soul, that which is unique to humanity, the thing that drives us, the essence of life. It contributes to our search for complete integration, balance, and meaning.[ii] Spirituality is an all-encompassing, existential concept affecting one’s emotions, thoughts, actions, and connections with others.
Everyone has spirituality, but it is manifested differently in each of us. According to Ronald Rolheiser, an authority on contemporary spirituality, it is represented by the concept of eros, or desire, and it is how a person channels that desire, either in healthy or unhealthy ways. Spirituality also leads to greater personal integration and connection or to greater disintegration in body, mind, and soul.[iii]
Spirituality gives people a way of understanding the world, how it works, how meaning is derived, and how they determine what matters. Spirituality informs a person’s assumptions about life; however, spirituality is not the same as religion. Religion is a component of spirituality or an expression of it. While religion may be defined in terms of an institutionalized dogma—a set of tenets, beliefs, or practices that involve traditions and rituals—spirituality is more generally defined, informal, relational, existential, and behavioral.[iv]
Trauma affects a victim’s spirituality, assumptions about life, and how meaning, purpose, and significance are derived beyond typical social or institutional structures.[v] When one’s spirituality is assaulted or disrupted, then those assumptions about life are shaken—or, in some cases, shattered. Ideas about what is good, meaningful, or worthwhile are questioned. This explains why sometimes trauma victims suffer from a crisis of faith: when they feel that God is responsible in some way for their trauma or when they blame him for it.
Often those who lose faith in God also lose faith with their religious communities or with their families and friends, and as a result become isolated. These soldiers feel abandoned by God, conclude that he is irrelevant, or, worse, assume that he betrayed them.
Spiritual trauma is the effect of trauma upon a person’s sense of meaning, concept of self, view of God, or understanding of the nature of evil and suffering. Like any aspect of trauma, the extent of spiritual trauma depends on how the traumatic event is viewed by the victim. What is spiritually damaging to one victim may not be damaging to another victim who has gone through the same traumatic experience. The more threatening and damaging the effects of the event on an individual’s core spiritual values, the greater the spiritual trauma.
Imagine the symptoms of trauma are like an iceberg, having visible and less visible symptoms. People understand the nature of icebergs: most of their mass is below the surface of the water. What the human eye sees is only the “tip of the iceberg” (fig. 2.1). The real danger is below the waterline.
Clinicians usually address the visible symptoms of post-traumatic stress. These symptoms may include anger, sleeplessness, intrusiveness, hyperalertness, emotional numbing, dissociation, depression, and nightmares.
But there are symptoms that exist below the waterline. These symptoms might be grief, guilt, shame, anger toward God, alienation from him, and many forms of loss, such as loss of faith, loss of identity, and loss of meaning. These symptoms are spiritual in nature and require spiritual remedies. Some symptoms exist both above and below the waterline, requiring both clinical and spiritual intervention.
The below-the-waterline symptoms (fig. 2.1) represent significant spiritual symptoms of trauma that are not often addressed by mental health professionals. They frequently involve theological questions and existential concerns that are typically beyond the expertise of most clinicians. It is in these instances that pastoral caregivers are most helpful, because they are usually qualified to address the spiritual symptoms of trauma.
Below-the-Waterline Issues of Trauma
As I stated earlier, trauma usually involves loss. Much of this loss relates to the spiritual, to matters of faith, or to a violation of what is held sacred. Some researchers on combat trauma talk about moral injuries, such as violations of what is right or betrayal of trust.[vi] These injuries may be viewed as spiritual in nature. A sense of hopelessness, loss of trust, and lack of positive spontaneity also characterize spiritual trauma.[vii]
Effects of wartime trauma have social and relational consequences. These consequences often involve the continuance of violence beyond the battlefield and the perpetration of abuse. Such consequences may lead to feelings of despair or hopelessness, and a deep sense of loneliness that may threaten the very stability of the soul.
The symptoms of spiritual trauma may manifest as conflicted belief systems and existential questioning. Deeply conflicted victims have lost their spiritual anchors and find themselves adrift, questioning basic assumptions about themselves, their values, and their beliefs.[viii] Spirituality is at the center of existential questioning. These questions may include “Where did I come from and where am I headed? Who am I, how should I live, or what is my purpose? Who or what am I connected to or how do I fit?”
Spirituality is at the center of existential questioning
Existential questioning is a normal reaction to the experience of trauma. The search for meaning, for instance, generates great anxiety. If meaning is not found, the result can be total despair and confusion—an emotional, spiritual, or mental condition that is sometimes referred to as “the dark night of the soul.”[ix]
Trauma generates other spiritual questions about the nature of God, the suffering of the innocent, and the relationship of God to his creation. Trauma disrupts our ideas about ourselves. A traumatic event creates inner turmoil for victims, which some describe as disassociation between the inner self and the outer environment.[x] Coming to a resolution of the turmoil involves reintegrating the trauma so that the inner self is able to find meaning and purpose. When people make sense of their trauma, they also find peace.
Figure 2.1. Symptoms of Trauma
Graphic designed by Michael D. Bonura. Used by permission.
Many soldiers act as if they are invulnerable, but that sense of invulnerability is shattered when they become traumatized.[xi]
Spiritual interventions must address the core issues of spiritual trauma. The use of biblical information about trauma to address these issues challenges traditional psychological interventions, which usually ignore the spiritual aspects of trauma. Addressing trauma in this way poses the possibility of new constructs for understanding trauma, and may mark the path for healing. Such new constructs radically alter victims’ understanding of their trauma and provide a way for finding healing and growth.[xii]
The Soldier and Spiritual Trauma
The spiritual effects of trauma are well documented among combat veterans. I’ve worked with service members with extensive combat experience, and some indicated a loss of faith in God. Their combat experiences were intense and affected the way they viewed the world, themselves, or how they related to people close to them. Some of these members not only questioned God but also manifested other symptoms, such as loss of innocence and loss of meaning and purpose, often accompanied by severe guilt and grief reactions.[xiii]
Other service members who were engaged in intensive combat told me how their experiences caused them to question their faith in God or their religious beliefs and practices. They appeared desperate and alone and often felt misunderstood. Their life stories were totally disrupted. They found it difficult to integrate their experiences with their beliefs and the way they wanted to live their lives. They were never at peace.
There is often a reduction in religious orientation among veterans diagnosed with PTSD. Though they had once been active in church, those manifesting severe symptoms were no longer active. They felt alone, powerless, and disenfranchised. In a study conducted by Wayne Chappelle, who served as an air force psychologist in Iraq, some soldiers withdrew from religious activities when they began to question their beliefs. This was especially the case after an attack and when a comrade was killed.[xiv] Veterans I’ve met and talked to found it difficult to reconnect to God or become spiritually active again after combat, despite strong belief in God or deep desire to practice their faith.
The extent to which spirituality exists in a veteran prior to combat affects the development of some trauma symptoms later. People who are more spiritually attuned, who are aware of themselves and God, and who possess an understanding of the world and the nature of evil are less likely to lose their faith as a consequence of trauma. Yet in instances of severe trauma, there is usually a decrease in faith or in spiritual growth regardless of spiritual maturity. There is also a greater likelihood of resentment toward God and prevalence of anger.
In cases of moderate trauma, soldiers tend to express a positive outlook toward God despite continuing struggles with understanding their traumatic experiences. While growth is not often reported, most veterans I surveyed indicated a belief in the potential for spiritual growth and a reliance on spirituality or religion as significant factors leading to resilience during combat.[xv]
Sometimes traumatized service members seek new sources of meaning because of their doubts.[xvi] Former systems of beliefs prove inadequate for these members, and they cast about, looking for new answers, feeling alienated and abandoned by God.[xvii]
Some veterans perceive God’s punishment in their traumatic symptoms and are unable to find forgiveness. Several studies report negative effects of religion among those with serious health problems.[xviii] Perceived punishment from God could imply blame or absence of forgiveness. Perceptions of an angry or unloving God foster fear, disillusionment, and distrust.
Spiritual Coping and Trauma
The experience of trauma may open the possibility for traumatized people to access their capacity for spiritual or religious coping. That is, they are capable of accessing spiritual resources that enable them to maintain their well-being despite adverse circumstances. Their values and beliefs help them withstand the negative effects of trauma so that they are able to bounce back quickly and resume normal functioning.
Some studies indicate that people find relief from the symptoms of their trauma through spiritual or religious coping.[xix] In one study, people who used religious coping, nurtured by deep-seated convictions, were able to rise above their challenges.[xx] In another study of 165 combat veterans with PTSD, which investigated the relationship between faith and quality of life, mental wellness was associated with positive spiritual coping.[xxi] The spiritual coping of these soldiers was not always religious in nature or specifically Christian; nonetheless, spirituality or religion played an important role in enabling these warriors to sustain themselves during and after combat. Generally, people fare better when they have faith as a resource for coping.
people who used religious coping, nurtured by deep-seated convictions, were able to rise above their challenges
Faith helps people accept what they cannot change and find peace despite the lack of definitive answers.[xxii] Religion is an important factor regardless of the context, whether it is trauma or some less severe circumstance. Religious content may even improve the effectiveness of psychotherapy. One study found that religious content improved the effectiveness of psychotherapy of the depressed, even when the therapist was not religious.[xxiii]
Soldiers who participate in religious activities experience a greater ability to cope with wartime adversity, a heightened sense of morale, and a positive sense of well-being. Chappelle observed an elevation of morale and a lowering of stress among soldiers who actively participated in religious activities while deployed to OIF.[xxiv] As a chaplain who conducted numerous worship services in combat, I noticed the calming and stabilizing effects religious services had upon soldiers who attended worship or participated in Bible studies or prayer groups. Chappelle further noted an inclination in service members to talk about their spiritual activities, which helped alleviate their suffering and pain.[xxv]
Spirituality—or religion, depending upon how one is inclined—contributes to resilience, and the ability to cope with the negative effects of stress and trauma. But spirituality may also produce negative effects.
Spiritual Coping and Negative Effects
Some forms of spiritual or religious coping may contribute to negative outcomes, such as increased psychological or physical impairments. In one study, those who questioned God’s love or perceived their situation as divine punishment or the work of the Devil experienced a significant increase in mortality.[xxvi] They were found to be at a significant risk of dying over a two-year period.[xxvii] Sometimes faith hinders coping or complicates recovery, especially in relation to anger, guilt, and shame.[xxviii]
Spiritually motivated people may become conflicted and traumatized when they are compelled to violate their own sense of spirituality.[xxix] For example, a soldier who kills a child to survive has much more trouble with the effects of his trauma than does a soldier who kills an enemy combatant, because his actions violate his spiritual ethics. Similarly, soldiers who have had to choose between saving a civilian or a comrade may suffer more from the effects of trauma.[xxx] These situations represent spiritual dilemmas that, if left unresolved, can lead to guilt.
Trauma, Benefits, and Spiritual Transformation
Trauma has the power to transform us and make us into more compassionate and caring individuals.[xxxi] In studies that examined the association between religious beliefs and trauma, the use of spirituality in therapeutic interventions proved beneficial for trauma victims.[xxxii] Trauma exposes the depths of the soul and may initiate a process of spiritual inquiry and soul-searching. Trauma may serve as a “dark grace,” leading one not to despair but to noble pursuits. For example, Saint Francis of Assisi used his wartime experience to propel him into a life of selfless service. Nelson Mandela turned his jail sentence into an opportunity to serve his country.[xxxiii]
Trauma brings to the forefront questions about the meaning of life, value in suffering, justice, forgiveness, and self-identity. These things become acute in the mind of the sufferer and must be answered. Deep issues that were hidden or on the periphery of consciousness are exposed by trauma. A traumatic event can break a person or create an opportunity to pursue a greater sense of meaning.[xxxiv]
Exploring spirituality and trauma raises the level of intervention to a transcendent plane that poses the possibility of new discoveries and new meanings.[xxxv] Several studies noted the role of spirituality in the recovery of mental illness. Such recovery has meant new hope for the sufferers and a reclaiming of one’s self, resulting in a renewed sense of meaning and purpose.[xxxvi] One study found that use of religious coping among the mentally ill contributed to their ongoing recovery. In a sample of 379 people, 81 percent reported the use of faith-based activities for coping, and 65 percent perceived the use of religious coping strategies to be effective.[xxxvii]
These studies point to the benefits of trauma when one is able to access religious or spiritual coping. While it is true that trauma sometimes produces a crisis of faith, it is equally true that trauma sometimes opens the door to faith and, combined with faith, contributes to the sufferer’s well-being and even transformation.
trauma sometimes opens the door to faith and, combined with faith, contributes to the sufferer’s well-being and even transformation
The role of chaplains, military and civilian, highlights the effective use of spiritual activities among those who are routinely stressed. I noted over my own career the effective use of spiritual activities among soldiers under stress, including combat stress and at other times of great loss and suffering.
Some studies suggest symptoms like despair and discontentment may precipitate religious conversions.[xxxviii] At times of extreme difficulty, people are vulnerable and receptive to spiritual themes. They are often open to change and disposed to the prompting of the Holy Spirit. In a national survey conducted in 1988, 66 percent of the 1,481 respondents indicated death in the family often or sometimes strengthened their faith in God.[xxxix] Many other studies, reports, and news stories highlight the power of faith in the lives of people who face severe trauma.
In a study of 154 Vietnam veterans that investigated the relationship of combat trauma to the presence of spirituality, certain beneficial aspects of spirituality (meaning and purpose, current worship attendance and prayer) correlated to long-term adjustment despite combat trauma. However, conflicts about faith and feelings of alienation from God correlated with more severe symptoms of PTSD.[xl] In the same study, the researcher found frequent worship attendance was important because it indicated the presence of social support and a connectedness to God, which have been shown to support resiliency and contribute to healing.[xli]
Spiritual well-being and the experience of trauma have a dynamic relationship. One study noted the causal relationship trauma has to well-being and to spirituality. The experience of trauma in a sample of respondents tended to decrease their well-being, which caused an increase in spirituality, which in turn helped restore well-being.[xlii]
So you can see from these studies, traumatic pain and suffering often have a positive impact on the development of one’s spirituality and faith. Spirituality sometimes enables one to cope with trauma. But while this is true, the opposite is sometimes the case.
The Value of Spirituality and Spirituality-Based Treatment
The value of spirituality in the treatment of mental illness is gaining recognition among clinicians and other mental health professionals.[xliii] Though spirituality was long regarded as an unrelated concept, more and more mental health professionals are advocating an understanding of spirituality and its inclusion in treatment. However, most mental health professionals do not have the training to make spiritual interventions.
The healing of the person’s spirit involves restoration to both life and community. Healing always involves transformation. Such transformation is not a return to conditions prior to the traumatic experience, but an acquisition of new and adaptive ways of thinking and responding because of the trauma.[xliv]
The spiritual effects of trauma shatter one’s sense of security and control. Spiritual intervention may account for that trauma and restore a sense of security and control. Many veterans report the importance and usefulness of spirituality in their lives. Veterans who have found Christ have seen their lives transformed. They’ve experienced God’s love and forgiveness and are invigorated with hope and a sense of purpose they have not experienced before. Their relationships have been restored, and they’ve found meaning in service to others.[xlv]
Spirituality-based approaches to the treatment of PTSD are effective. Research shows that leveraging spirituality-based approaches produces results. In some cases, clinicians indicated that they observed more results from spiritual interventions than from conventional behavioral health practices.[xlvi]
In addressing religious coping as a useful process, Kenneth Pargament, internationally known for his work on religious beliefs and health, and his colleagues concluded that the use of religious practices might be more responsive to the problem of human inadequacy than anything offered through conventional clinical interventions.[xlvii] Veterans have overcome negative effects such as guilt and anger, and learned to let go of their bitterness through forgiveness.[xlviii] These veterans found reconciliation with God and with others. They also gained courage and found hope.[xlix]
These observations are especially compelling given they are derived from research conducted by nonclerical caregivers. How much more effective might a clergyperson be who understands the spiritual nature of trauma and is able to apply spiritual remedies?
Some veterans suffer from alcoholism or drug abuse, and thus the shame that often goes with addiction. Many of these veterans report finding God and describe their experiences in terms of receiving God’s grace and strength.[l] These reports should not be news to clergy. As pastors and chaplains, we have seen the power of God at work in the lives of those who are in our care. We know how the gospel changes lives. We know the power of forgiveness. We have witnessed people set free, redeemed from the bondage of guilt and shame.
Guidelines for the Implementation of Spiritual Coping Skills
The following guidelines are useful for pastoral caregivers providing treatment for those suffering with the effects of trauma:
- Remain calm, composed, and in touch with your own feelings when interacting with anyone impacted by trauma.[li]
- Be aware of the profound theological questions post-trauma reflection produces.
- Be cognizant of your own beliefs and the limitations of those beliefs about suffering.
- Demonstrate an understanding of the levels of loss and the grieving process.
- Be aware of your professional limitations. While trauma is essentially a spiritual issue, it also presents many psychological complications, which are usually beyond the capability of the pastoral caregiver or Christian counselor. Consult with clinicians; do not hesitate to refer.
- Demonstrate sensitivity and respect for the veteran. Sensitivity and respect are especially critical because they help create a safe and secure environment that is essential for the treatment of PTSD. Never assume that you understand what a veteran has experienced.
- Use a client-centered approach that builds on trust and develops counselor-client rapport. Client-centered approaches focus on the needs and concerns of the client. The pastoral counselor who takes this approach begins where the client wants to begin and adjusts to the client’s agenda as much as is reasonable and appropriate. This approach empowers the client and grants necessary control over treatment.
- Be sensitive to the spiritual perspectives of clients. When working with groups, the caregiver will encounter a wide range of spiritual perspectives. Some research suggests pastoral caregivers should avoid proselytizing the trauma victim and cautions practitioners to remain within the arena of their professional expertise. Other research indicates clients who voluntarily participate in spirituality–based programs are open to discussions about faith. Regardless, issues of faith should never be forced. It is always helpful for pastoral caregivers to consider the client’s own sense of existence, beliefs, and practices and allow the client to open the door to more specific discussions about personal faith.[lii]
Additional Guidelines and Observations
Pastoral caregivers should be prepared to respond to challenging theological questions. Spirituality-based treatment, especially involving orthodox Christian approaches, often includes theological questions about the source of evil, the purpose of suffering, and divine punishment. Christian counselors should exercise care when counseling someone who may be blaming God or who may be construing the terrible trauma they face, like the loss of a child, as intended somehow for their spiritual development.[liii] Communicating or inferring these messages is not usually helpful and can be very damaging. We should not assume we know the mind of God. It is better to deal with the “what” and the “how” issues than the “why” concerns, at least in most cases.
Pastoral caregivers should avoid incorporating diverse spiritual teachings and methods into treatment. A practitioner may be tempted to experiment with different approaches, e.g., Native American or Eastern intervention techniques.[liv] Some practitioners advocate an eclectic approach; for example, they draw from Greek mythology, shamanism, and Buddhist rituals. I advise a more conservative approach, using practices and rituals familiar to the practitioner, and perhaps thereby avoiding retraumatizing the victim.
Pastoral caregivers should learn to assist the client in reconstructing spiritual beliefs in positive ways. How spiritual awareness develops depends upon the beliefs of the survivor. Undoubtedly, these beliefs will concern questions about the existence of God, the problem of evil, and the meaning and purpose of life.
Pastoral caregivers who are familiar with the concepts of spiritual direction may find these concepts useful in guiding a sufferer through the maze of suffering and in gaining a deeper understanding of the ways of God. Questions like “Where do you think God is in this?” or “What do you think God is saying to you through this experience?” may be helpful at appropriate times. We need to be sensitive to where our clients are and to what is happening to them. Good counselors know how to ask the right questions at the right time, and they are always sensitive to the needs of those who are in their care.
The Use of Spiritual Practices and Rituals
Prayer, meditation, and healing rituals are helpful in treating PTSD.[lv] In research I did with combat veterans, soldiers most often identified prayer as the preferred spiritual coping activity.[lvi] Other productive forms of treatment include music therapy and guided imagery.[lvii] I have used thematic music and videos as well as pictures that depict therapeutic concepts during group sessions, and soldiers have found them helpful.
Healing services have been developed and used successfully in promoting reconciliation.[lviii] Healing services are religious in nature and focus on confession, forgiveness, and reconciliation. They have been used to mark milestones in the treatment process or as celebratory events. They help soldiers in the way they communalize their trauma. Communalization happens when the community acknowledges its role in sending service members to war. It is the expression of the warrior’s experience within the larger, supportive community.
In a feasibility study conducted by several researchers, the daily practice of repeating a sacred word or phrase throughout the day moderated symptoms of PTSD among a small sample of veterans. They found a reduction of psychological stress, a reduction in symptoms, and an increase in quality of life.
In research conducted by Chaplain Steve Hokana, spirituality-based writing produced positive states among veterans suffering with PTSD, as opposed to writing that was not spiritually based.[lix]
Spiritual healing can be found through confession. Confession is the admission of guilt. For many Christians, confession is an act of contrition that involves the sacrament of penance, of making amends for wrongs committed; it leads to reconciliation and absolution of sin. Veterans who are able to make things right with God and with offended parties are able to live with themselves. Some feel guilty for things they have done, but without assigning the proportionate amount of guilt to others. They have carried a much too heavy and undeserved burden.
Limitations in Pastoral Care
War involves killing, atrocities, and the loss of friends. Pastors who have not experienced war cannot imagine what it is like to be a combat veteran. They can listen, they can sympathize, but they will never completely understand.
Soldiers do not expect civilians to understand. That’s okay.
It is helpful for pastoral caregivers to recognize their limitations and not assume too much. Veterans want your respect, not your pity. Honor the veteran for his or her sacrifice; it will greatly contribute to your rapport with them.
A pastor is a representative of God. This may be an obstacle for the veteran who has blamed God for the trauma. Patience, compassion, and humility lead to the development of a bond of trust between the pastor and soldier. Eventually, theological questions will surface, and it is important for the pastor to provide honest and sensitive responses.
The pastoral counselor serves as a spiritual guide, encouraging the veteran to accept responsibility for wartime actions and leading the soldier in confession and reconciliation with God. This is an enormous task, requiring spiritual companionship and commitment.[lx]
The Role of the Church in the Communalization of Trauma
The prevalence of PTSD in the community demands a response from the church. The church can play an effective role in addressing PTSD among its members and as an outreach to the community, especially in the role of communalizing trauma.
Communalization of trauma is the victim’s expression of trauma, its effects, and its personal impact within a larger and supportive community, such as a church. The church is a redemptive community in which soldiers suffering from PTSD find compassion, forgiveness, love, and reconciliation. As a faith community, the church offers numerous opportunities for victims to exchange their loneliness and isolation for restoration and reconnection.[lxi]
As a context for healing, the redemptive community provides soil for the cultivation of one’s wholeness. Members relate to one another without fear or recrimination. The church provides a network of support for the pastor and the survivor, and a context for the expression of unconditional love.
Within the church, God has placed people who minister with their gifts, offering the means to restoration and connectedness, and bridging the gap that exists between loneliness and belonging.[lxii] The church is a healing community, a community where people are loved and accepted, and a place where each person is affirmed and empowered.
Healing begins in the context of communalization, when survivors treat survivors, and the larger community gives its support. It occurs in the context of a community of trust, which fosters total, unconditional regard. Veterans feel comfortable telling their stories in a supportive community of like-minded veterans and in a larger supportive community of civilians.
It is the larger community that must take responsibility for sending service members to war. This community also has responsibility to support veterans upon their return from combat and help in the process of their healing.
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[iii] Ronald Rolheiser, The Holy Longing (New York: Doubleday, 1999); T. Plante, “What Do the Spiritual and Religious Traditions Offer the Practicing Psychologist?” Pastoral Psychology 56 (2008): 429–444; Kent Drescher, “Treatment of Moral and Spiritual Injuries Associated with PTSD” (seminar conducted at the Naval Medical Center, Portsmouth, VA, September 12, 2013).
[iv] Larry Decker, “Including Spirituality,” National Center for PTSD Clinical Quarterly 5, no. 1 (1995): 1; Plante, “What Do,” 430; Kenneth Pargament, The Psychology of Religion and Coping: Theory, Research, Practice (New York: Guilford Press, 1997), 36; Pargament et al., “The Sacred.”
[v] Grant, “Spirituality and Trauma,” 1; Mahoney et al., “Broken Vows.”
[vi] Shay, Achilles in Vietnam.
[vii] Daléne Fuller-Rogers, Pastoral Care for Post-traumatic Stress Disorder (New York: Haworth Pastoral Press, 2002); N. Duncan Sinclair, Horrific Traumata: A Pastoral Response to the Post-traumatic Stress Disorder (New York: Haworth Pastoral Press, 1993); Brené Brown, “Shame Resilience Theory: A Grounded Theory on Women and Shame,” Families in Society 87, no. 1, vol. 4 (2006): 3–52; Kent Drescher and David Foy, “Spirituality and Trauma Treatment: Suggestions for Including Spirituality as a Coping Resource,” National Center for PTSD Clinical Quarterly 5, no. 1 (1995): 4–5.
[viii] Sherry A. Falsetti, Patricia A. Resick, and Joanne L. Davis, “Changes in Religious Beliefs Following Trauma,” Journal of Traumatic Stress 16, no. 4 (2003): 392.
[ix] Daryl S. Paulson, “The Hard Issues of Life,” Pastoral Psychology 49, no. 5 (2001): 385–394. This phrase is attributed to St. John of the Cross (1542–1591), who was a Spanish mystic and Catholic priest, and used the phrase to describe his lack of Christian joy. The “dark night” is a time of spiritual dryness, spiritual shadows, and spiritual struggle; it is time when God appears withdrawn from the individual.
[x] Decker, “Including Spirituality.”
[xii] Raymond Finch, “Trauma and Forgiveness: A Spiritual Inquiry,” Journal of Spirituality in Mental Health 9, no. 2 (2006): 27–41.
[xiii] For an extensive discussion of these reactions, see Herman, Trauma and Recovery; Pargament et al., “The Sacred”; Margaret Nelson-Pechota, “Spirituality and PTSD in Vietnam Combat Veterans,” National Conference of Vietnam Veteran Ministers, accessed December 1, 2015, http://www.vietnamveteranministers.org/spirituality_intro.htm.
[xiv] Wayne Chappelle, “An Air Force Psychologist’s Collaboration With Clergy: Lessons Learned on the Battlefield of Iraq,” Journal of Psychology and Christianity 25, no. 3 (2006): 205–215.
[xv] Dean Bonura, “A Biblical Approach to the Problem of PTSD,” (DMin dissertation, Gordon-Conwell Theological Seminary, 2009).
[xvi] Pargament et al., “The Sacred”; Nelson-Pechota, “Spirituality and PTSD.”
[xvii] Nelson-Pechota, “Spirituality and PTSD.”
[xviii] See Pargament et al., “The Sacred” for the studies they cite.
[xix] Weaver et al., “A Systematic Review.”
[xx] As cited in M. Eberly, “Resiliency: Bouncing Back From Adversity,” Christian Counseling Today 14, no. 4 (2006): 36–39; see also S. Joseph and P. A. Linley, “Psychological Assessment of Growth Following Adversity: A Review” in Trauma, Recovery, and Growth, eds. Stephen Joseph and P. Alex Linley (Hoboken, NJ: Wiley, 2008), 21–36; Evelyn F. Bussema and Kenneth E. Bussema, “Gilead Revisited: Faith and Recovery,” Psychiatric Rehabilitation Journal 30, no. 4 (2007): 301–305.
[xxi] T. Rouss, “Religiousness/Spirituality and Quality of Life in Combat Veterans with Posttraumatic Stress Disorder,” (PhD dissertation, Pepperdine University, 2006); Bussema and Bussema, “Gilead Revisited.”
[xxii] Schiraldi, The Post-Traumatic Stress Disorder Source Book: A Guide to Healing, Recovery, and Growth.
[xxiv] Chappelle, “An Air Force Psychologist’s.”
[xxvi] As cited in Pargament et al., “The Sacred.”
[xxvii] Ibid., 677.
[xxviii] Bussema and Bussema, “Gilead Revisited,” 386.
[xxix] Matsakis, Post-traumatic.
[xxxi] Grant, “Spirituality and Trauma,” 1.
[xxxii] Falsetti et al., “Changes in Religious Beliefs,” 391–398. See also Weaver et al., “A Systematic Review.”
[xxxiii] Richard Scheinin, “Trauma May Open a Door to Spirituality,” The Gazette (1998–99), accessed December 10, 2015, http://www.ptsdsupport.net/gazette.html.
[xxxv] Finch, “Trauma and Forgiveness.”
[xxxvii] Bussema and Bussema, “Gilead Revisited.” See also Bonura, “A Biblical Approach,” who observed from a study of 30 OIF/OEF veterans, that most indicated they felt indebted to God in some way for preserving their lives or acknowledged that a Transcendent Being was with them in combat. Soldiers who were reporting PTSD symptoms did not blame God or express unbelief but frequently admitted they struggled with their faith, or conversely that their faith in God was the only anchor they had as they tried to live with their PTSD. Many soldiers reported some reliance on spirituality as a coping tool during combat. Many indicated prayer, attendance at worship services, and religious beliefs helped them cope.
[xxxviii] As cited in James E. Kennedy, Robert C. Davis, and Bruce G. Taylor, “Changes in Spirituality and Well-being Among Victims of Sexual Assault,” Journal for the Scientific Study of Religion 37, no. 2 (1998): 322–328.
[xl] Nelson-Pechota, “Spirituality and PTSD.”
[xlii] Kennedy et al., “Changes in Spirituality,” 326.
[xliii] Weaver et al., “A Systematic Review.”
[xliv] Sinclair, Horrific Traumata; C. Adsit, The Combat Trauma Healing Manual (Newport News, VA: Military Ministry Press, 2007); Margaret Hill, Harriet Hill, Richard Baggé, and Pat Miersma, Healing the Wounds of Trauma: How the Church Can Help (Nairobi: Paulines Publications Africa, 2004).
[xlv] Dewey, War and Redemption.
[xlvii] Pargament et al., “The Sacred.”
[xlviii] Dewey, War and Redemption.
[li] Fuller-Rogers, Pastoral Care; Drescher and Foy, “Spirituality and Trauma Treatment.”
[lii] Fuller-Rogers, Pastoral Care.
[liv] Tick, War and the Soul.
[lv] Fuller-Rogers, Pastoral Care.
[lvi] Bonura, “A Biblical Approach.”
[lvii] Philip G. Salois, “Spiritual Healing and PTSD,” National Center for PTSD Clinical Quarterly 5, no. 1 (1995): 12; Fuller-Rogers, Pastoral Care.
[lviii] Salois, “Spiritual Healing and PTSD.”
[lix] Steve Hokana, “The Body of Christ in the Presence of Their Pain,” Caring Connections: An Inter-Lutheran Journal for Practitioners and Teachers of Pastoral Care and Counseling 4, no. 3 (2007): 13–16.
[lx] Fuller-Rogers, Pastoral Care.