By / Apr 13

He sat against the wall, looking at his phone, seeming to pay little to no attention to our discussion leader. His wife sat next to him with her arm looped through his, occasionally patting it lovingly. She was a regular attender to our class, but this was the first time I remembered seeing him. 

As our Bible study continued, the topic of mental illness came up in our discussion. I mentioned the book I was reading, The Body Keeps the Score, and explained how it was opening my eyes to the effects of trauma on an individuals’ health, behavior and relationships, and specifically, the effects of PTSD. I explained how it was changing the way I viewed many interactions and experiences, as well as the interpersonal dynamics of ministry, including small groups. 

He raised his head and said, “I have PTSD. It is hard for me to sit in this room. We’re too close. I have friends who would have never come in. And if I had thought that I would have been expected to shake hands or hug people in the worship service, I would have never come either. A lot of churches don’t think about me. I hope more people in the church read books like you’re reading.”

My mouth fell open, and my eyes filled with tears.

An exercise in compassion

Dr. Bessel van der Kolk, an expert on trauma, has spent decades working with survivors, beginning during the time when Vietnam veterans were returning home. In his book, he walks us through his education, experiences, and research to explain how trauma literally reshapes both body and brain. 

Trauma is all around us. For example, van der Kolk points out that one in five Americans has been sexually abused, one in four grew up with alcoholics, and one in three couples have experienced physical violence. These are the shocking statistics of acute trauma experienced by so many. Van der Kolk’s research has also shown that chronic emotional abuse and neglect can also be devastating to individuals.

Reading this book and the patients’ accounts it features, although painful, ushered me into imagining experiences far from my own. Compassion requires imagination. After reading this book, I found myself pondering the stories and experiences of the people within my church. It was a profound emotional experience to consider how trauma has affected those I am called to disciple, encourage, and love. I was moved to tears when considering the effects of trauma on those I know, as well as those I’ve yet to find out about. 

Hope and dignity 

This book wasn’t written from a biblical perspective or to a ministerial audience, yet I was struck by the echoes of biblical themes it contained. The cohesion between van der Kolk’s scientific findings and the truths of Scripture was fascinating. One of the fundamental truths that he presents in the book is that, “Our capacity to destroy one another is matched by our capacity to heal one another.” This truth echoes the power of the tongue as described in Proverbs, Ephesians, and James. It was a reminder of how powerfully we can influence those around us, whether positively or negatively, with our words. His findings also highlighted that simple acts of friendship, kindness, community, and encouragement are critically important in people’s lives.

While dealing with both the horrific past experiences and current realities of his patients, the author maintained hope and an uncompromising ethic of human dignity. Van der Kolk’s compassion and patience with those he helps and his work are inspiring. He attributed his mindset to his “great teacher,” Elvin Semrad. He described a formative experience with Semrad during his education. “I remember asking him once: ‘What would you call this patient—schizophrenic or schizoaffective?’ He paused and stroked his chin, apparently in deep thought. ‘I think I’d call him Michael McIntyre,’ he replied.” This reflects a biblical ethic of seeing and treating human beings according to their intrinsic, God-given worth, no matter their current mental and physical condition.

New practices

The greater awareness of trauma I gained through reading this book has shaped my ministry in the local church forever. I have changed how I situate myself and engage in group settings. I have a new focus on considering social conditions to make people feel safe, as well as a cautious awareness related to physical touch. I have lowered my expectations of participation in discussions, recognizing how difficult it is for some people to contribute. I also now believe understanding the deep physical and psychological effects of trauma is critical to helping others finding healing and freedom from shame. I have a desire to be more patient with others, as well as with myself.

Personally, van der Kolk’s research gave me a sense of permission to acknowledge how the experiences of my life, although not acute acts of trauma, do affect me, even in my physical body. My husband and I have ministered to people during the most difficult days of their lives as a part of local church ministry. The Body Keeps the Score helped me to articulate those experiences, understand the reality of the impact they had on me, and prioritize my own healing. This book was an encouragement for me to care for my body and my mind in more holistic ways. I am now convinced of the importance of physical activities such as exercise, breathing, and walking for my mental health. I see these as gifts from God, given to strengthen and equip me for ministry. 

The Body Keeps the Score influenced many areas of my life. It opened the door for conversation that day with a new friend in a God-orchestrated way that I will never forget. It gave me a vocabulary and awareness of trauma that has allowed me to discuss difficult things with friends and family in a new way. I pray that many Christians will read this book. I recommend it to everyone I know, but especially those who seek to disciple and minister to others. To love our neighbors well, we must have this holistic understanding of the way God made us, body and soul, and the way our experiences in this life shape us. 

By / Feb 19

You have probably heard that veteran suicide is alarmingly high. The oft-cited statistic which has become a rallying cry to end veteran suicide is that 22 veterans take their lives each day. While some have helpfully chimed in to bring context to this number, suggesting that the number is probably much lower, the reasoning behind why veteran suicide is so high has remained unchanged.

The misconception 

As it is understood, the commonly held belief for why veteran suicide is so high is typically distilled into this line of thought: 

  1. Our troops are deployed to situations wherein they see and do terrible and perhaps even horrific things in combat.
  2. Exposure to abnormal and traumatizing experiences is what brings about post-traumatic stress disorder (PTSD).
  3. PTSD is nearly impossible to cope with which eventually leads to suicide.

In short form, this line of reasoning makes sense and, for the most part, it has been the accepted narrative as to why things are the way they are. But there’s more than ample evidence that this narrative, this combat-PTSD-suicide chain, is mistaken. What’s more, if we assume suicide is mostly related to combat and PTSD, we may fail to help those most in need.

Breaking the combat-PTSD-suicide chain

In a paper published in 2015 by the Annals of Epidemiology, it was demonstrated that veteran suicide is substantially higher than their civilian counter parts. The unsettling finding of the study, however, was that among military personnel, suicide was higher among noncombat roles suggesting causes beyond combat exposure. The conclusions drawn from the study stated, “Veterans exhibit significantly higher suicide risk compared with the US general population. However, deployment to the Iraq or Afghanistan war, by itself, was not associated with the excess suicide risk.” This measured conclusion could be strengthened. If someone did not see combat, then the suicide could not have been because of PTSD derived from combat exposure. 

In 2019, The Air Force Times, likewise, published its discontent with the increase among its ranks for suicide. At the time, a mandatory stand-down was ordered for all personnel across the branch to focus on suicide prevention in this “resilience tactical pause.” Suicide for that year was significantly higher than the previous year jumping from 50 in 2018 to 78 in 2019.

This increase in deaths deserves more attention. The Air Force, though it possesses some MOS’s (military occupational specialty; one’s job) that do experience combat, is predominately non-combative in its roles; they are not a branch of the military that comes to mind with the combat-PTSD-suicide narrative. Yet disturbingly and tragically, they too, are witnessing an increase in suicide.

Finally, the past year has brought about new challenges. Suicide in the military has seen yet another wave of increases, rising 20% from the previous year. What was different from 2019 to 2020 that would significantly affect the rate of suicide? COVID-19. Many are reserved in giving an answer and avoiding labeling the correlation of COVID-19 and added stress to be the causation behind recent deaths. When looking at the pattern of evidence, though, it seems to suggest that combat-PTSD-suicide is not necessarily the dominant reason behind veteran suicide. Likewise, the increased isolation that lock-downs and prolonged quarantines have brought about are worthy of a closer look.

PTSD

PTSD itself is a bit of a quagmire. It is almost inescapably tied to the belief that only someone who experiences combat can unwittingly acquire this diagnosis. This is false. Many may see combat and never experience a single symptom. Cited in an article appearing in Task & Purpose, the Pentagon’s Inspector General put forth a report that shows sexual assault is “[M]ore likely to result in post-traumatic stress disorder than going into combat.” Combat is not a necessary link to PTSD nor the only way to experience its effects. But in the commonly held belief and discussions around veteran suicide, PTSD from combat sucks the air out of the room.

Though PTSD is a serious problem that has been connected to increased rates in suicide among veterans, there are at least two studies, one published by the Archives of General Psychiatry in 2009, and the other by the National Center for PTSD in 2017, that suggest the link is not as definitive as most believe. PTSD simply does not account for enough deaths to satisfactorily answer the unsettling questions behind why veterans are taking their lives. In light of this line of evidence, where should we be looking for why suicide is so high among veterans?

The complicated truth

A more complete answer as to why veteran suicide is so high nests more neatly under the heading of sociological factors. Stated differently, it has more to do with culture, isolation, and lack of shared experiences and values when comparing a veteran population to their civilian counterparts than combat and PTSD. Those who serve in the military are grafted into a subculture with its language, communities, duties, judicial system, boundaries and contours of honor and shame. The sum of these differences and experiences is something that is unshared by the majority of the population. The second world war had approximately 9% of the population serving directly in the military. The rest of the country, while not wearing the uniform, was still aiding in the war efforts in ways that the whole of society was oriented toward. Today, less than 1% of people serve on active duty.

Serving in the military brings about experiences that will never be shared by the majority of the nation. This lack of shared experience and values isolates and exacerbates the problems our society is already plagued with in the veteran’s personal life.

It isn’t only that sharing a relationship with a service member is now less likely, but also that our relationships look drastically different than they did a generation ago. The average Facebook user has 338 friends. Contrast this with the fact that some research indicates that 75% of people are not friends with their neighbors, 26% of people don’t know their neighbors, and social gatherings with neighbors before COVID-19 were already relatively rare. If we are desiring to find a place we need to dig deeper as to why veteran suicide is high, community disconnect is a prominent factor that demands further investigation.

We are already detached from community more than we consider. Geographically, we live in one place, work in another, shop on one side of town, go to church on the other, and pursue our weekend hobbies and recreation in someplace different than the rest. This description of our disparate lives is not an anomaly, but the norm for many. The only thing we have in common with neighbors is that we live next to them. Other than that, we are different people with different lives who rarely intersect.

Exacerbating our own problems

New York Times bestselling author Sebastian Junger struck a chord with many in his recent book, Tribe: On Homecoming and Belonging. Junger provocatively suggested that the problem of PTSD was not a matter of “what’s wrong with them,” referring to our troops, but rather, “what’s wrong with us”, referring to our culture outside of the military. While there are areas in which Junger does not fully deliver on his thesis, his impulse is correct: the issues our culture and society has are no different than what the military possesses. Serving in the military brings about experiences that will never be shared by the majority of the nation. This lack of shared experience and values isolates and exacerbates the problems our society is already plagued with in the veteran’s personal life.

For every specialty and niche interest that exists today, community options abound. But this menu list of choices has not brought people together, it’s divided, subdivided, and distanced people into communities based on hobbies, shopping preferences, media consumption, and even our places of worship. Yet we do not need more of the same, we need more of each other. Where we would once pursue relationships with those in our communities, we now seek the friendships of others through social media. Where personal friendships could serve as a kind of “general practice” for struggles with anxiety or depression, veterans are now outsourced to experts when what they need is not another visit to a therapist or a prescription refill, but authentic relationships that are abiding, meaningful, and faithfully attended to. If one believes the problem with veteran suicide is something that only a trauma specialist can address, they will disqualify themselves from any sort of help they can give through genuine friendships.

Suicide and the mission of the church

The trends of suicide in the United States reveal some alarming trajectories. Before the prolonged isolation and social restrictions that COVID-19 has added, suicides in the U.S. had increased 33% from 1999-2017. If the factors listed above are truly more decisive in suicide than combat or PTSD, then we should expect suicide to continue to increase. Moreover, veteran suicide will also continue this trend based on the expectations of our non-communal and increasingly isolated society. If this can be stated differently, veteran suicide is a sneak peak at where we are headed as a culture as a whole. If we desire to combat suicide, the place to do it is within community that seeks to disrupt isolation by loving one’s neighbor. The vehicle that is best equipped with a mission and purpose for reaching communities across our country is the church armed with the good news of Jesus Christ.

By / Mar 11

“My help comes from the Lord, the maker of Heaven and Earth” (Psalm 121:2)

By now, most everyone has heard of PTSD or Posttraumatic Stress Disorder. Just to provide a little bit of context, here is a brief explanation of PTSD:

According to the Diagnostic Statistical Manual (2013), those with PTSD have experienced a horrifying event that has resulted in them re-experiencing the trauma, avoiding reminders of the trauma, having negative thoughts and moods, and experiencing increased arousal (such as irritability or trouble with sleep) for more than a month. In order to receive this diagnosis, one must be assessed by a mental health professional and meet certain diagnostic criteria based on what is listed above.

You can learn more about PTSD at the National Center for PTSD.

According to the National Institute of Mental Health, 3.5 percent of adults suffer from PTSD (2013). However, the National Center for PTSD states that twice that will experience PTSD at some point in their lifetime (2014). For veterans, this number can increase significantly. For example, it is believed that among Vietnam veterans, 30 percent have PTSD (NCPTSD, 2014). As of yet, it is harder to pin down a number for those who have served in Iraq or Afghanistan, but it is believed to be anywhere from 11-20 percent. In addition to combat experiences, sexual assault can trigger PTSD, and approximately 23 percent of women report this experience during their military careers (NCPTSD, 2014). Men also experience sexual trauma while in the service and develop PTSD as a result.

Offering support and holding out hope

Supporting those with PTSD may not come easy. Those who are struggling with this difficult disorder may have a tough time with sleep. They may have a difficult time being in crowds. They may jump at the sound of firecrackers or a car backfiring. Things that most people consider enjoyable may lead to fear in those with PTSD—for example, going to the movie theatre, shopping at a mall or attending a sporting event.

It can be frustrating to have plans changed or cancelled, deal with someone who is irritable due to insomnia, or be awakened in the middle of the night because a loved one has had a nightmare, again. Sometimes, the symptoms of PTSD are even more severe and cause significant problems within relationships.

However, families can work together to cope with this disorder. One of the most important factors is the installation of hope. PTSD does not have to be something that the service member deals with forever. It does not have to be something that robs those with PTSD from having healthy relationships and joyful lives. There is hope for recovery and stability. And, having the family there for support, and possibly involvement in the PTSD therapy, may aid in the effectiveness of the treatment for the individual with PTSD (Monson, Macdonald, and Brown-Bowers, 2012).

Does someone you care about have PTSD? Here are some basic tips for supporting your suffering loved one:

  1. Let them know you are there for them, but give them space. Allow your loved one to take personal time outs so that they can work through some of their symptoms without taking anything out on the family. Don’t hover or constantly ask them to talk about their memories. Allow them to share what and when they want to share. If they want to share something with you that is too difficult for you to hear, gently tell them that you want them to be able to talk about their memories but suggest they share those with their mental health professional.  
  2. Learn to be flexible. If they are willing to try shopping, for example, be willing to leave when your loved one is ready to or drive separate cars and allow them to leave when they are ready. Don’t force your loved one to continue with the status quo as if nothing has changed. They may no longer like crowds or fireworks or large family gatherings. Your patience and understanding will mean a lot. And, remember, this doesn’t mean they will never want to go to the movies again. Just perhaps not right now.
  3. Participate in their mental health treatment. Understand what treatment your loved one is going through, and be available to help your loved one in any way you can. For example, help ensure that they have quiet and private space to complete practice assignments at home. Also, know the treatment plan and attend sessions if and when asked. It may also be helpful for you to participate in a support group for those whose loved ones have PTSD (Many Vet Centers offer these.).
  4. Pray. John Bunyan said, “You can do more than pray, after you have prayed, but you cannot do more than pray until you have prayed.” As Christians, we must pray. We must pray for those that are suffering, for those that love them, and for their relationships. Above all, we should offer those that are suffering the hope that can only be found in Jesus Christ. He tells us clearly in John 16:33 that we will have trouble in this world. However, many forget the first part of that verse, which includes this promise: “in me, you may have peace.” This peace through Christ is what can sustain a loved one during the trial and recovery of PTSD.

Taking the journey with someone who has PTSD is not easy, but support is not only important, it may also be essential to a loved one’s recovery.


References

Medical University of South Carolina (2009). Retrieved from https://cpt.musc.edu.

Monson, C., Macdonald, A., & Brown-Bowers, A. (2012). Couple/family therapy for posttraumatic stress disorder: Review to facilitate interpretation of VA/DOD clinical practice guidelines. Journal of Rehabilitation Research and Development, 49(5), 717-728.