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
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.
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
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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.
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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.
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Re-setting for Civilian Life
Crisis
Individuals post-trauma
are at a constant state
of readiness. Easily
triggered.
Hypervigilance
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Re-setting after multiple deployments
Crisis
Crisis
Crisis
Over time, resources for managing crisis are eroded.
Crisis comes earlier.
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Reactions to Traumatic Events
Psychological
Physical
Cognitive
Emotional
Behavioral
Interpersonal
Spiritual
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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
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Spiritual Consequence of War
Difficulty reconciling beliefs with
traumatic warzone events
Agree
Neutral
I abandoned my religious
faith during the war.
Disagree
0%
20%
40%
60%
80%
100%
Agree
Neutral
Disagree
0%
20%
40%
60%
80%
100%
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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.
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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.
.
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Resilience Defined
 Doing
well in adversity
 The
ability to overcome setbacks
and obstacles; maintain positive
thoughts during times of adversity.
 The
capacity to cope effectively with
the internal and external stresses.
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.
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.
Resilience Research

Genetic approach


Personality approach


seeing emotions as the result of the meaning a person attributes
to particular events and experiences
Developmental approach


looking at how positive and negative outcomes can be attributed
to temperamental traits and developed characters.
Cognitive approach


looking at genetic codes for resilience
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.
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.
Spiritual Resources for Resilience
Community


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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
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:



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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.
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."
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”
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.
Hope
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
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
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
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
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
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

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.
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.
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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

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Value of Teams for Clients
Hope
 Decreased isolation
 Increased quality of life
 Decreased stigmatization
 Early intervention
 Adherence to treatment regimen
 Peer-to-Peer support

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Value for Team Members
Altruistic experiences
 Decreased social isolation
 Increased awareness of problems
experienced
 Gratitude
 Mission and Purpose

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Concentric Circles of Care
Veteran
Spouse / Family
Care Providers
Community
Support at any level ripples
back in a positive way to the
veteran.
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Support Team Philosophy

Do what you can, when you can

In a coordinated way

With a built-in support system
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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.

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Resources
Project Compassion
180 PROVIDENCE RD STE 1-C
CHAPEL HILL, NC 27514
(919) 402-1844
www.project-compassion.org
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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
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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.
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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
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