Combat Trauma Treatment From A Mystical Spiritual Perspective

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Combat Trauma: Treatment from a Mystical/Spiritual Perspective

Larry R. Decker Journal of Humanistic Psychology 2007 47: 30 DOI: 10.1177/0022167806293000 The online version of this article can be found at: http://jhp.sagepub.com/content/47/1/30
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What is This?
COMBAT TRAUMA: TREATMENT FROM A MYSTICAL/SPIRITUAL PERSPECTIVE
LARRY R. DECKER, PhD, is a licensed clinical psychologist in Santa Barbara, California. He has been the clinical coordinator of the Vet Center for more than 20 years. He is a student of Sufism. His publications vary from theoretical information processing to mysticism. He is writing a book on the treatment of combat trauma with the working title The Horror of God.
Summary
Psychological recovery from combat trauma may depend on discovering a personal meaning in the traumatic experience. Veterans traumatized in combat struggle with finding meaning in the war and in civilian life. Spiritual concepts and experiences can generally help in the discovery of meaning. However, the term spirituality is traditionally reserved for the experience of prayer and worship. This article presents a rationale for the integration of the spirituality of combat and civilian life into the clinical treatment of traumatic sequelae via a mystical perspective. The spiritual may be viewed as either immanent or transcendent. These perspectives are integrated into an individual treatment program for the reduction of serious psychological difficulties stemming from combat trauma. Keywords: posttraumatic stress disorder; spirituality; veterans
There is a war that opens the doors of heaven, Arjuna! Happy the warrior whose fate is to fight such war. Sri Krishna, The Bhagavad Gita War is a mad minute, sixty seconds of Godhood: let there be light in the rockets red glare and the Zippo flame of razed hootches. John Cory (2006)
Journal of Humanistic Psychology, Vol. 47 No. 1, January 2007 30-53 DOI: 10.1177/0022167806293000 2007 Sage Publications
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Most research indicates that finding personal meaning in a traumatic event is a critical factor in recovery from traumatic sequelae (Frankl, 1978; Herman, 1992; Solomon, 2004; Tedeschi, Park, & Calhoun, 1998). This seems reasonable, as the very nature of trauma is such that it attacks our basic beliefs and challenges our processes of accommodation and assimilation (Falsetti, Resick, & Davis, 2003; Resick & Schincke, 1993). However, soldiers, through training and experience, alter their belief schemas (i.e., accommodation) to include the information that in war other people are trying to kill them and that it is the soldiers job to try and kill those other people (now labeled the enemy, the bad guys, and other appellations). As combat experience continues, the new belief systems become normalized, and it is only later when soldiers, now veterans, return to civilian life that we label their belief systems a disorder. We ask the veterans to again change their belief schemas (albeit this time without any training) to no longer include the information that kept them alive in the violent hostile environment of war. However, lessons learned in combat are not easily forgotten (Wahlberg, 2001). Where is the meaning of the combat experience if not in the new consciousness that one must be eternally alert, live in the expectation that anyone could be the enemy (i.e., the new enemy does not wear uniforms), and trust only fellow comrades? Although there is little doubt that most trauma survivors beliefs (including combat veterans) are deconstructed and set into disarray (Janoff-Bullman, 1992), the nature of trauma also challenges the trauma therapist to find meaning in survivors experiences. If the therapists belief system is restricted or not sufficiently developed, such that he or she cannot find meaning in the clients experience and negates the value of the survivors experience (i.e., labels the veterans hypervigilance as pathological or maladaptive), the likelihood is certainly reduced that the therapist will help the client find that meaning. This idea is expressed very well in Liness (2002) assertion, believing is seeing, in which he states (following Bubers 1958 thesis): If I face a human being as my Thou and say the primary word I-Thou to him, he is not a thing among things and something magical occurs between both parties (p. 11). Of course, there are many levels of meaning (i.e., the meaning of words, the intellectual meaning of experience, the meaning of emotions, etc.). In addition, meaning can be both negative and positive. We can think of negative meaning as enjoying someones
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pain and of positive meaning as being inspired by someones sacrifice. In War Is a Force That Gives Us Meaning, the war journalist Chris Hedges (2003) asserts that war
can give us what we long for in life. It can give us purpose, meaning, a reason for living. Only when we are in the midst of conflict does the shallowness and vapidness of much of our lives become apparent. (p. 3)
An example of this need for meaning can be easily observed after most therapy groups with combat veterans:
The men mill about in a small group on the sidewalk. The therapy group has been over for more than an hour but the veterans dont want to leave this aura of camaraderie. The groups remind them of when life was meaningful, when they mattered.
Unfortunately, the sort of meaning that war provides is not only negative; it is also addictive and destructive. It is easy to succumb to the addiction and subsequently struggle for the rest of ones life to free oneself from that sort of meaning. Many combat veterans found war to be the most meaningful experience of their lives and frequently long for a return to the intensity of the horror (Ehrenreich, 1997; Hedges, 2004; LeShan, 2002). This desire can be thought of in the Freudian sense as the wish for Thanatos (Hedges, 2004), in the cognitive sense as the inability to reduce belief schemas back to precombat status, in the existential sense as a search for meaning and comradeship, and in the spiritual sense as a longing for the experience of heroism, honor, and sacrifice. The idea of the spiritual is commonly included with the religious. However, there are differences between spiritual and religious. This article returns to the definition of spiritual and religious that I used previously (Decker, 1993b). In an article published in 1993, I used spirituality
to indicate the search for purpose and meaning involving both the transcendent (the experience of existence beyond the physical/psychological) and immanence (the discovery of the transcendent in the physical/psychological), regardless of religious affiliation. The term religious will be used to denote the part of the process when spiritual impulses are formally organized into a social/political structure designed to facilitate and interpret the spiritual search. (Decker, 1993b, p. 34)
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Regardless of the suffering and pain those veterans endured and perpetrated, many of them often state that it was a singular moment; never again in their lives have they felt so purposeful, so worthwhile, so important, so filled with meaning. However, they are ashamed of those feelings and recognize the negative meaning inherent in their love of killing. They are haunted by their guilt over their revelry in killing and their joy in its intensity. Yet their beliefs, forged in the fire of battle, are not going to easily be condensed back to the nave views of civilian life. But those acts that raised the soldiers on the battlefield are not conducive to adjustment to civilian life. As trauma therapists, we ask the veterans to return to their shallow lives and give up the meaningfulness of war in exchange for the mundane world of materialism. In addition, we may ask them to refute the meaning of war, and generally we dont get much of an obvious argument. But many combat veterans repeatedly state that their experience of the meaningfulness of war was such that they never felt so alive. For perhaps the only time in their life, some of these veterans had a clear sense of purpose, and the resulting civilian life pales in comparison to the adrenaline rush and clear focus of combat. Then they come to therapy, and we may, inadvertently, ask them to further negate themselves by emphasizing the negativity of war (Greening, 1997). The veterans beliefs have been significantly altered by their experience in combat. Most of our beliefs (both in and out of combat) are constructed as a result of our interaction with the environment, creating what I termed the interactive self (Decker, 1993a). Those interactively formed beliefs generally depend on the ideas of predictability and control of our environments to develop and sustain our imago mundi (world view) (JanoffBulman, 1992). The soldiers experience of war attacks that foundation of predictability and control. Is it possible to discover meaning in the mundane world after war? The basis of the veterans belief systems that provided meaning, predictability, and control has been seriously challenged. In addition, veterans both long for the exhilaration of war and dislike themselves for that longing. That struggle of longing and aversion produces feelings of unease or anxiety, low self-esteem, depression, anger, intrusive thoughts, fear of loss of control, emotional numbing, nightmares, and an avoidance of those reminders of a time when they were at their best (now seen as their worst).
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Our Western culture emphasizes a materialism that no longer suffices to provide meaning to many veterans. The lack of meaning in material life forces them to face their existential limits, and religion may provide a balm for their resulting anxiety. Fundamentalists of all religions have discovered that if one believes in something literally, then existential angst, at least temporarily, diminishes. Many veterans have found a greater sense of peace after the adoption of a literal, fundamentalist religious perspective. On the other hand, there is also something to be said for the more liberal open-minded spiritual view. This perspective also offers a reduction in anxiety but at a considerably higher price than simply blindly giving oneself over to narrow exclusive mindsets. This view requires an inner examination of ones life, meditation and prayer, experiencing other forms of devotion, enlarging ones imago mundi, recognizing the artificial limits of cultural distinctions, and accepting the basic humanness of all. The trauma literature generally supports the notion that spiritual or religious perspectives are helpful in recovery from trauma sequelae (Connor, Davidson, & Lee, 2003; Linley & Joseph, 2004; Parappully, Rosenbaum, van den Daele, & Nzewi, 2002; Pargament, Smith, Koenig, & Perez, 1998; Solomon, 2004; Witvliet, Phipps, Feldman, & Beckham, 2004). However, some researchers indicate that the relationship between post-trauma recovery and having spiritual beliefs is complex and not always positive (Falsetti et al., 2003). Most recently, research has indicated that the greater the loss of meaning (defined as the loss of predictability and control), the more the veteran seeks help from both clergy and mental health professionals (Fontana & Rosenheck, 2005). What is the value of trauma if, as therapists, we simply attempt to restore the veterans pretrauma beliefs? The experience of trauma has provided the veteran with the possibility of moving beyond the interactive self to a basis in an innate/transpersonal self. In an earlier article (Decker, 1993b), I discussed in depth the potential stimulation by a traumatic experience of an alchemical process of transformation of the interactive self into the innate/ transpersonal self. Trauma breaks down our ordinary perspectives, and through appropriate treatment, it is possible to gain a greater depth of worldly understanding. Regardless of the relationship between religion and recovery from trauma, the spiritual seems antithetical to the experience and concept of war. Certainly, in keeping with the dualistic thinking
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(cogito ergo sum) of Western society, there is a distinction between the spiritual and the experience of combat. However, when we discuss the spiritual, we also refer to something that is beyond the mundane, beyond the ordinary, something that is deeply meaningful. The spiritual has the ability to inspire us beyond the physical life and give us hope for the possibilities of humanity. Thus, the spiritual (similarly to combat) takes us away from our regular lives and changes our ordinary thought. Of course, the spiritual symbolizes innocence, purity, the clear spring rising out of the virginal snow with the power of lightning that creates bewilderment and reverence (Vajra in Tibetan Buddhism, the Holy Spirit in Christianity, Quddus in Islam, and Kaddush in Judaism). The spiritual is the uncreated light that is behind all of manifestation. It seems that we have two poles of awareness, both with their degrees and types of meaning: the mindless, adrenaline-filled, horrible violence of war and the powerful, cosmic, transcendent force of spirituality. However, the effect of trauma is not so dualistically simple, and with some thought, we recognize that instead of dualistic thinking, we can see this in terms of one. It is vital to our patients that we think of war and the spiritual in terms of unity. From the mystical perspective, all possibilities are present within every moment of our lives (the forever and always; Khan, 1977), and thus immanent and transcendent spirituality also simultaneously exists with the tragic horror of war. The following poem by the 13th-century Sufi poet Jellal ud din Rumi expresses the unity of transcendence and immanence. Drinking wine with you, getting warmer and warmer, I think why not trade in this overcoat Made of leaves and dirt. Then I look out the window, For what? Both worlds are here. (Rumi, in Moynes & Barks, 1984, quatrain 1243) Our veteran patients, caught up in the dualism of God and horror, are struggling with the soul of the damned. I broke one of the greatest commandments, is a common phrase I hear in my practice. Although the words of the Dalai LamaThere is a difference between killing and murder, and as a soldier it is your duty to kill (personal communication, 1988)may be enlightening to some, unfortunately those words many times do little to relieve this deeply felt sacrilege. If I have violated a basic commandment, if I
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have broken my covenant with God, there is little in the therapists acumen that will relieve my agony except a true challenging of my notion of God. The mystics path is a constant challenge of the God concept. It is a path of extreme discipline involving lengthy and difficult spiritual practices. Although it increases the individuals ability in the world, it also leads to a profound sense of oneness with all individuals (LeShan, 2002).
TREATMENT OF POSTTRAUMATIC STRESS DISORDER (PTSD) The question now is, how do we help our traumatized veterans share these awakenings? In previous articles (Decker, 1993a, 1995), I have suggested the presence of an innate/transpersonal self as different from the self created through our interactions with the environment. Those articles also suggest that we believe we are the interactive self and we have only glimpses of the innate self. However, the mystic (Underhill, 1961) challenges us with reports of transcendent or immanent experiences beyond our limited interactive self. Integrating a mystical perspective into a treatment program for PTSD is a very challenging prospect. Mysticism is not without its risks, and it is important to have a guide. At the least there are several possible pitfalls in the use of these ideas. I discussed these cautions in detail in an earlier paper (Decker, 1995). Initially, we must always refrain from proselytizing. Regardless of how much our spiritual path has helped us, the client must be free to find his or her own way. Second, most therapists are not well trained in spiritual matters and may feel uncomfortable in an area usually dealt with by the clergy. Finding our own spiritual discipline is essential if we are inclined to include this force in our therapeutic repertoire. Third, there is always a danger of blaming the victim in trauma work. This becomes an even greater danger if spiritual ideas are introduced (i.e., God is punishing you, you have failed God, humans are innately flawed, etc.). Fourth, suggesting that the trauma occurred to create personal growth usually elicits the indignation it deserves. The idea that my child died so that I could improve my psychological functioning is ridiculous. Fifth, we should always be careful not to introduce or suggest spiritual disciplines unfamiliar to us. For example, Native American
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religions have seen an increase of interest by non-Native Americans, but those religions require a very different way of thinking than most non-Native Americans may be able to comprehend. Even if we actively practice the teachings and spiritual exercises of a discipline, we may not be qualified to offer guidance in that discipline. Sixth, the use of spirituality opens the door to a vast, infinite reality that contains not only transcendent divine light but also deep pits into which the nave can stumble. We need to have our own spiritual guides if we use these powerful medicines to heal the traumatized psyches (i.e., do no harm). Seventh, it is important to remember in work with the traumatized that they have been irrevocably changed by trauma. They cannot go back and regain their ordinary self (i.e., the interactive self). In addition, they may have lived with their symptoms for many years and have come to identify with those symptoms. Their symptoms, as in many psychological difficulties, have become their identity. If we work too hard at taking away their symptom identity without offering a greater and less environmentally bound identity (greater than their memory of their ordinary self), we are doomed to perpetuate the environmentally bound reality (Decker, 1993b). Finally, the process of war will challenge and destroy many combatants faith. It is important to recognize that the loss of faith itself can be a significant psychological issue (see religious or spiritual problem in Diagnostic and Statistical Manual of Mental Disorders, 4th edition; American Psychiatric Association, 1994, p. 685).
TREATMENT MODALITIES The primary PTSD treatment modalities are based on the interactive self and are dominated by the cognitive-behavioral perspectives (Foa, Keane, & Friedman, 2000). There are also analytically oriented modalities (Van der Hart, Brown, & van der Kolk, 1989), but the cognitive perspective is easily the most common form of treatment. Trauma focus therapy (Wahlberg, 2001) is a form of cognitive exposure treatment primarily used in the group format. A type of gestalt therapy oriented to treatment of PTSD has emerged in the writings and practice of Raymond M. Scurfield
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(1994; Scurfield & Powch, 1997). There are other existential approaches (Fisher, 2005; Greening, 1997; Yalom, 1980), all of which focus on the trauma survivors damaged sense of being: The adult survivor lives in a distorted world with a fragmented sense of self originally formed in response to the chronic threat of harm (Fisher, 2005, p. 31). Rollo Mays concept of the daimonic (The daimonic is any natural function which has the power to take over the whole person; May, 1969, p. 121) is also a basis of existential work with PTSD. Although the daimonic may have been released through the heat of battle, its destructive force can be transformed into constructive activities through the more peaceful process of psychotherapy (May, 1969).
THE INTEGRATION OF THE SPIRITUAL In association with other clinicians (most notably Philip Buglione, Harold Flowers, Freda McKeown, and Robert Reed) in the Vet Centers, I have developed an informal eclectic model of treatment that combines the cognitive exposure model, analytic considerations, trauma focus, gestalt work, existential concerns, and a basic spiritual perspective into a very specific therapeutic modality for combat PTSD. This eclectic and pragmatic modality uses a walk-through, phase-oriented exposure (Keane, 1995) approach to facilitate the goal of integration of traumatic experiences without losing the value of those experiences. This Vet Center eclectic model has shown excellent results (albeit reported primarily through case histories and anecdotal evidence; Readjustment Counseling Service Training, 2004) in the diminution of the symptoms of PTSD and the assisting of a greater (i.e., non-environmentally bound) identity. Exposure treatment is not appropriate for all veterans. There are many potential risks to the re-experiencing of traumatic experiences. Keane (1995) suggests that certain individuals are inappropriate for exposure treatment particularly individuals with medical and psychiatric comorbidity (i.e., cardiovascular disease, psychoses, and impulse control issues). Alternatively, the solutionfocused models (OHanlon & Weiner-Davis, 1989) avoid any reliving of traumatic experiences, focusing instead on the reduction of symptoms without the potential rekindling of memories. Because exposure treatment increases the risk of further destabilizing the veterans emotional functioning, it requires that
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the veteran acquire specific and improved coping skills. The basic coping skills, such as exercise, diet, support groups, anger management, assertion training, and communication skills, are very important, but the most important is arguably education regarding PTSD. The Web site www.ncptsd.org contains a wealth of very readable material regarding PTSD. In addition to basic coping skills, some form of meditation may be taught if the setting seems appropriate. Meditation is generally associated in this culture with relaxation, so it is probably acceptable in most environments. Unfortunately, this linking of meditation to relaxation tends to perpetuate a stereotype of meditation as primarily for stress reduction. Contrastingly, in most mystical approaches such as Sufi teachings, meditation is presented as an attunement to God (Khan, 1989, p. 225). A form of meditation that has worked well in my own practice has been a modified form of the Sufi fikhr, of which a form can also be found in Christian mysticism and in Zen Buddhism, particularly in the latter as practiced by the Vietnamese Zen Master Thich Nhat Han. This is a repetition of thoughts of words on the breath. For example, on the exhalation one thinks calm, and on the inhalation one thinks relax. There are many possibilities and variations of meditative techniques that may help to reduce stress. Of course, prayer is also a basic foundation of coping. In mystical prayer, it is difficult to determine if there is any difference between prayer and meditation. The mystical prayer is exemplified in the following instruction from a Hassidic master: A person should be so absorbed in prayer that he is no longer aware of his own self. There is nothing for him but the flow of Life; All his thoughts are with God. He who still knows how intensely he is praying Has not yet overcome the bonds of self. (Unknown Hassidic master in Green & Holtz, 1977, p. 55) To become so lost in mystical prayer holds a key to recovery from horror. This sense of unity, the prayer so beautifully illustrates, creates the discovery of what is beyond the narrow confines of the self. But before this loss of boundaries can be experienced there will need to be a deep relationship between the therapist and the veteran.
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Therefore along with teaching the necessary coping skills is the establishment of rapport. The establishment of rapport with a combat veteran is problematic at best. The veteran generally does not have a high regard for psychotherapy, is relatively uneducated regarding its process, struggles with the stigma of needing help, and does not believe that the nonveteran therapist is able to understand the experiences of combat. However, many forces have driven the veteran into the therapists office, and this struggle to seek help must be regarded as a holy process. It is important that this sense of the holy is not verbalized; indeed, it is better if the therapist simply holds the awareness of the sacredness of the contact with this broken warrior.
CHILDHOOD/ADOLESCENCE PHASE The walk-through model (it has its variations depending on the practitioner) begins with exploration of the innocence of childhood. Hopefully, childhood offers a safe place for the combat veteran. It is important to have a safe place when the veteran begins the more intense combat experiences. Perhaps even more, it is an opportunity to reconnect with the innocence lost in combat. If childhood was not a safe place, then ask the veteran regarding any time in his or her life when he or she felt safe. It is important to delay the focus on the traumatic experiences until it is clear that rapport and the sense of a safe place have been established. Emotional catharses that may accompany the veterans articulation of the trauma in early sessions may cause the veteran to experience humiliation and embarrassment. It is the rare veteran who will return to treatment if he or she experiences this loss of dignity. William Mahedy (1986), a chaplain in Vietnam, wrote the seminal text Out of the Night: The Spiritual Journey of Vietnam Vets on the use of spirituality in treatment of combat PTSD. In his book, Mahedy points out that innocence, exuberance, and the American can do feelingqualities that usually accompany religion in Americaare no longer possible for veterans of Southeast Asia combat (p. 81). This loss of innocence now includes those veterans of southwest Asia (i.e., Iraq and the Persian Gulf). Mahedy further points out, An underlying assumption within our culture is that we are the morally innocent agents of good in an evil world (p. 81). Certainly there could be an extensive
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debate regarding whether that national innocence ever existed, but personal innocence has been significantly shattered in combat veterans. For many veterans, the response to this cognitive dissonance (i.e., How can the country be good and still perpetrate the horror of war?) is frequently to adopt an extremely rigid perspective on the politics surrounding the war and all future wars, blaming politicians for the difficulties but praising the warrior. The spiritual perspective is challenged in helping to restore the warriors innocence without the usual accompanying naivet. Possibly the protection or restoration of innocence in trauma work is similar to the preservation and honor of dignity in spiritual work. To restore innocence, the jaded, compassion-fatigued, and vicariously traumatized trauma therapist must find his or her own innocence. If that is accomplished, the therapist has excellent guidelines for how to help the traumatized.
MILITARY TRAINING PHASE After exploring childhood, with its family dynamics and school issues, introduce military training. Here is the beginning of combat as the recruit is initiated into a society of warriors. The induction physical, transportation to the training camp, training campbasic/boot, AIT (advanced infantry training)/ATI (advanced training individualMarines)and any technical schools are reported by the veteran in some detail with the accompanying emotions. It is the rare veteran of any war who has ever discussed his training. Yet it was the training that bound the soldiers, that prepared them for the battles to come. The training was also the beginning of a basic change in belief systems. Military training, LeShan (2002) asserts, parallels mystic training in what he terms the way of the one and the way of the many (LeShan, 2002, p. 27). Military training is also the beginning of the projection of the daimonic (May, 1969). As May (1969) points out
It may help to see what happens when the daimonic is not experienced in dialogue. Examples of this can be seen in every nation at war. Unfaced within ones self and ones group, the daimonic is projected on the enemy. It is no longer seen as a nation which has its own security and power needs, but as the Evil One, the personification of the devil, ones own daimonic tendencies are placed on it. (p. 157)
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Veterans clearly enjoy this process of attention to training and become very involved in therapy and empathically connected to the therapist. The level of empathy achieved during this phase is critical if the veteran is to trust the therapist to be with him or her in the ensuing focus on the horrors.
COMBAT PHASE Now focus, with excruciating detail, on the experiences in the theater of operations. Perhaps in the first examination some details will be omitted; the veteran either may not remember or may prefer to leave out the details of combat (i.e., the blood, the body parts, the intense fear, the defecation in ones pants, and the joy of the killing). In addition, the veteran will test the therapist to see if the therapist is capable of coping with this material. Will the therapist allow the veteran to avoid the details? Is the therapist repulsed by the action? What are the emotions the therapist displays in response to this narrative? The degree of focus on the detail of combat is open to clinical judgment: Where is the veteran in his or her process? In this combat phase of treatment, several difficulties will emerge. One of the most prominent and frequent is that of survivor guiltthe complete confusion and bewilderment the veteran experiences as being a survivor of intense combat. The term survivor guilt is not adequate to describe the soul searching and struggle the veteran experiences attempting to understand why he or she was spared when so many of his or her fellow veterans perished. There are several possible conclusions the veteran may settle on to reduce his or her confused state. Many times the veteran believes that he or she was spared because of some greater purpose that God had for him or her. However, that simplistic notion does not always suffice. In addition, after many years of unsuccessful attempts at accomplishment, the veteran feels his or her perceived failures even more deeply (I never lived up to what I was saved for.). In addition, the fellow soldiers who perished probably had a purpose and many times may have been perceived by the survivor to have greater potential than the survivor. Another reason the veteran may express for his or her survival is that events are random and that randomness is evidence for the lack of existence of a supreme being. Here is an opportunity for the therapist to help broaden or expand the veterans concept of God. The famous story of Einstein and Nils Bohr illustrates this point.
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The two eminent physicists were arguing about quantum mechanics when Einstein reportedly made his famous comment, God does not play dice with the universe. The lesser-known and less-quoted response by Bohr was reportedly, Quit telling God what to do! Randomness is not an antispiritual concept and does not have to be a negative conclusion. The assertion of a random condition simply states that all events within that condition have an equal probability of occurrence. Because of many variables, the true randomness of events in combat is reduced; still, the presence of random tendency continues to exist and may be enhanced in chaotic events. This conclusion is significantly more freeing for the veteran and may expand his or her concept of God instead of resulting in rejecting the concept outright. This is an opportunity to reduce our dependence on the interactive self by giving our minds a greater rationale for the inner life. Finally, the more recent the traumatic events, the greater the possibility that the emotion of survivor guilt can be modified. Once the emotion becomes chronic, it becomes more difficult to accept other possibilities. Another difficulty that is common during the combat phase is the veterans aforementioned pain and agony regarding not just having killed, but having killed and enjoyed it. Some veterans express real fear of attending any sort of religious service, believing that they are no longer acceptable. The mystic expresses unconditional acceptance in the following poem: Come! Come! Whoever you are. Wanderer. Worshipper. Come! Join our caravan! This is not a caravan of despair. Even though you have broken your vows ten thousand times. Come! Come again! (Hazrat Mevlana Jellal Ud Din Rumi in Khan, 1977) A subtle difficulty is one of positive countertransference in which the therapist is so overwhelmed by his or her empathic response to the veterans suffering that the therapist is unable to adequately process those events and/or attempts to protect the veteran from any further pain by curtailing the traumatic dialogue. If the therapist is adequately aware (i.e., able to modulate overwhelming emotions), countertransference can be avoided, and those empathic emotions can be used as unconditional positive regard (Rogers, 1947). This empathic contact is essential for therapeutic change and must be established early in treatment.
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Traumatic incidents (e.g., combat) have the power to emotionally fixate the traumatized (Herman, 1992). However, the late Sufi master Pir Vilayat Inayat Khan points out (as did Bohart et al., 1993; May, 1969) that we are not doomed by the past, as behavioral conditioning might assert; instead, the pull of the future is stronger than the push of the past (Khan, 1977). Many possibilities, regardless of past events, are still present within each moment. Jack Mangold, a therapist in Washington, D.C., has structured this teaching into a practical application for psychotherapy (personal communication, 2004). Mangold combines the writings of several postmodern thinkers (including Erikson, 1964; OHanlon, 1999) who have posited that we create our realities and that all psychological constructs are relative to person and culture. This technique of freedom from the past can also be found in narrative and solutionfocused therapeutic modalities where the therapist initially aids in the construction of a belief in what could be and also aids in finding some evidence for this potential future in the present. (For a more complete presentation of this technique, see OHanlon, 1999.) An interesting illustration of this process is offered by Mangold in his discussion of a football game. Mangold, citing the physicist David Bohm (1990), asserts that conventional thinking is that the results of the game determine the score. However, it is interesting to consider that it is also likely that the score has determined the actions of the game. The future has determined the past. To free the veteran from his or her thinking that he or she is doomed by his or her past is a monumental step in freeing the veteran from despair and depression. A short explanation or exercise involving the Jungian concept of projection of the soul archetypes (Jung, 1958) helps the veteran experience this future effect. Most veterans are fascinated with the concept of projection, particularly by the projection of the anima and how it relates to their romantic interests. Jung (1958) asserted that we fall in love with the projection of our soul archetype (in essence, we fall in love with our feminine or masculine unconscious). Ask the veteran who, throughout history, he or she finds inspiring, preferably someone he or she does not know. Then ask him or her what it is about that person he or she finds inspiring. Ask him or her how he or she recognizes that quality. The point is that if he or she did not have that quality in himself or herself, he or she would not recognize it in someone else. Of course, the opposite is also true in the case of the shadow (i.e., who you dislike represents the qualities of your shadow).
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The idea of projection leads into a meditation taught by the Sufi teacher Pir Vilayat Inayat Khan (1999) and also cited by Mangold (personal communication, 2004). This is a meditation on a perfect master. The student, veteran, or client is instructed to conceptualize a perfect friend. The friend would have all of the qualities the veteran would want in a friend. Qualities such as loyalty, caring, power, light, honesty, and all the other attributes we could possibly imagine in our friend can be brought into the meditation. Finally, after the veteran has constructed this friend and is suitably emotionally ready, instruct the veteran to recognize himself or herself as the friend. Again, it is emphasized to the veteran that, just as in projection, he or she would not recognize these qualities if he or she did not have them in himself or herself. If the veteran is able to accept and/or experience this expansion of his or her sense of self, then it is possible that the veteran can begin to understand the potential meaning of his or her experiences in combat. Combat is now seen by the veteran as an experience that has helped to create a deeper understanding of the veterans self-awareness. However, even with an expanded sense of self, it is difficult to find any meaning in the following experience, which is a compilation of several veteran patients:
He was 19 when he was manning the 25mm cannon on the Bradley vehicle through the streets of Baghdad. The helicopter overhead warned his team of an upcoming ambush. The soldier turned his weapon toward the street, and a door opened ahead of them. He fired his weapon, completely demolishing the doorway and the small family of husband, wife, and two small children standing behind the door. Now he only wants to drink to excess, to numb his pain, to overturn his anger, to be punished for his crimes, to end his hell.
Mangold (personal communication, 2004) proposes that there are certain skills that might alleviate this veterans despair. The first is based on the mystical sense of unity, inclusivity, conflicting thoughts and feelings existing together. The veteran can simultaneously feel despair and sorrow and hope for the future. The second skill is similar to the first and comes from Gendlins (1978) focusing. Focusing is defined as a process in which you make contact with a special kind of internal bodily awareness. Awareness of the internal is called a felt sense (p. 4). Focusing is where many apparently contradicting emotions can be focused on simultaneously. To allow those emotions to exist
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together requires that we relax our ordinary process. Relaxation is a particularly difficult step for veterans because of their hypervigilance. Relaxation was, and may still be, impossible because if the veteran relaxed, someone might die. This skill may not be developed until treatment has progressed for several sessions. Treatment proceeds with the trauma narrative and many times repeats the narrative until the veteran is no longer overwhelmed by emotion. In the repetition of the narrative, there are always new details, new memories, that emerge, creating new challenges for integration. Underlying this process is a deepening of faith. It is a faith that the process of existence, regardless of its traumatic experiences, has purpose and meaning.
If we could free ourselves from the temptation to make forth a mindless assent to a dusty pawnshop of doctrinal beliefs we would discover with alarm that the essence of biblical faith lies in trusting God. (Manning, 2000, p. 6)
When the traumatized veteran is unable to find meaning in his or her experiences and has rejected the intrinsic meaning of the present, the time arrives to aid in the realization of the immanent. A former University of California, Santa Barbara professor of religious studies (who taught an enormously popular class on the Vietnam war) and a later representative to Congress, the late Walter Capps, once said, Vietnam was not an altogether negative event. It made us deeper and more profound as a people (personal communication, 1984). In Walters statement, he clarifies a possible purpose of trauma and makes the spiritual immanent. The immanent has several levels of understanding. If the veteran is sincere in his or her struggle to discover meaning (being stuck may produce less anxiety than risking growth), his or her combat experience may be seen as unique, something only other combat veterans can share. He or she has experienced something that makes him or her different; he or she has a knowledge of existence that is worth sharing with those who have been spared its horror. Although it is usually difficult for the veteran to relate his or her experiences to the civilian, it is important that the civilian population is clearly informed regarding the experience of combat. The greater the understanding of combat by civilians, perhaps the greater consideration of options other than war to resolve disputes. To accept the experience of the spiritual in combat, the veteran has to focus on the immanence of the spiritual. Modifying terms
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help in the realization of the immanent. The combat experience was certainly special. This indicates that the veteran was chosen for this experience. Some quality necessary for the veterans continued emotional development may have been triggered by the experience of combat. Combat can be seen as a pivotal experience, an experience that had great significance in how he or she decided to direct his or her life. How did he or she decide to face future events? How did the anticipation of the future influence his or her choices in the present? How did the experience of combat change the direction of his or her life? Combat is such a mix of horror and bravery that it can be called mysterious. It is difficult to understand how such an experience can not only horrify and repel but also attract and sanctify. The communication of these concepts can be adjusted according to the veterans level of understanding and general life orientation. But, generally, they are concepts that appeal to all levels of understanding.
WELCOME HOME The final phase of the treatment is in the returning home. The veteran discusses his or her reentry into civilian life. For World War II, Korean War, Vietnam War, and even Gulf War veterans, this is the beginning of another lengthy phase of treatment. However, for the Iraq veteran (now termed a veteran of the Global War On Terror or, more specifically, a veteran of Operation Iraqi Freedom), this return may have been only few months. This veteran is relatively fresh from the struggle in the streets and highways, the roadside bombs, snipers, suicide bombers, car bombs, and all of the other activities of the so-called insurgents. Although the Iraq War has become extremely politicized and polarized in our society, returning veterans may have very different concerns. The veteran is usually concerned about his or her fellow soldiers and completing the job. For the grunt (the infantryman), anyone outside of U.S. military presence in the war zone (i.e., all of Iraq) is suspect. This includes American civilians along with civilians from other countries (e.g., Italy). The soldiers response to accidental shootings of foreign or American civilians is one of some regret but more of anger that those civilians had the temerity to be there and make the grunts job even more difficult. The therapist must always keep in mind to practice what he or she preaches and remain nonjudgmental, in touch with all of his or
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her conflicting and difficult emotions. Regular spiritual practices are essential for this work. The veteran of the Iraq War has some differences with veterans of other conflicts that are important to treatment considerations. For a complete discussion of these differences, see the Iraq War Clinician Guide (2005, available as a PDF file at http://www .ncptsd.va.gov). Briefly, the phases of deployment must be included in the exposure treatment and may contain some traumatic experiences. The idea that traumatic experience can occur from simply the anticipation of trauma emphasizes the fact that trauma is in the eye of the perceiver. As the Gulf War pointed out, simply believing that one may have to go into battle is sufficient to create many of the symptoms of PTSD (Rosen, Wright, Marlowe, Bartone, & Gifford, 1999). Deployment in any war is highly stressful for its high degree of uncertainty, especially with an unknown enemy, untested equipment, uncertain supply lines, and changing rules of engagement. Iraq reportedly involves an increase in hand-to-hand combat, confusion regarding the location of enemy troops, and increased civilian casualties from American forces when compared to previous wars (National Center for PTSD, 2005). There are many other factors not taken into account by therapists focused on the interactions between the veteran and the environment. It is important to remember that many of these young men and women are in an internal emotional or psychological struggle that determines whether interpersonal intimacy or interpersonal isolation develops as a quality in their lives (Erikson, 1964). Their ability to disclose their most difficult and painful emotions is critical for their resolving this stage, developing the virtue of love, and learning how to be with significant others. The lowering of personal boundaries, becoming vulnerable, and trusting others is critical for becoming effective in their lives. The danger is that they will instead stay with their feelings of self-devaluation. They will experience others as not to be trusted in a close, intimate manner. They will decided it is too painful to be vulnerable, it is safer to be isolated. Self-devaluation is evident in one Iraqi vets statement regarding the huge celebration he endured when he returned home. He had been a scout/dismount for a Bradley and had been through extreme combat difficulties, including being involved in the killing of women and children. Everyone was telling me what a great job I had done. They didnt know what I had done. I hated
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them. If they had known what I had done they wouldnt have been so nice. There will also be some veterans beginning to develop resilience to trauma (Bonanno, 2004). This type of resilience development may allow the veteran to regain a clearer and more effective direction of his or her emotional development, possibly in an expanded consciousness (Decker, 1993b). The veterans experiences do not have to be crippling and cause the development of a disorder but can help the veteran to clarify the transient nature of existence, aid in the discovery of internal meaning, and reveal a greater purpose for existence. All of the environmental, psychological or emotional, and spiritual factors must be taken into account as we begin to treat the young men and women whose lives have been significantly altered by their participation in our countrys invasions of Iraq and Afghanistan (Litz, 2005).
TRANSCENDENCE The other level of the spiritual is in the transcendence of our ordinary physical existence into the awareness of the nonphysical, the unseen, the inner world. This is what in Islam is termed the inner jihad (Lifton, 2003). As Krishna advised in the quote from the Bahagavad Gita at the beginning of this article, the inner jihad is a war we fight internally, and external combat is but a symbol of our inner battles. This is not easy to communicate to most veterans. However, clinical judgment can guide the therapist and offer assistance to some veterans toward transcendence. Certainly, bibliotherapy (a referral to selected readings) may help the veteran find his or her spiritual path. In addition, the veteran needs a spiritual guide. The more advanced practices of the mystic should not be attempted unless the patient and the therapist have a clear background in a mystical discipline. It is important that the therapist have some experience in transcendent realization. If the patients mind is not sufficiently balanced, then transcendent practices will usually exacerbate emotional or mental difficulties and thus are not recommended. Transcendence is grace. We can do our spiritual practices repeatedly, daily, devotionally and still not experience transcendence. However, those practices may aid in transformation, and that is the real issue for us and for our patients.
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Poets express what cant be expressed. Are you longing for me? I am in the next seat. My shoulder is against yours. You will not find me in stupas. Not in Indian shrine rooms, Nor synagogues, nor in cathedrals, Not in masses, nor kirtans, Not in legs winding around your own neck, Nor in eating nothing but vegetables. When you really look for me, you will see me Instantly You will find me in the tiniest house of time. I dont know what sort of a God we have been talking about. The caller calls in a loud voice to the Holy One at dusk. Why? Surely the Holy One is not deaf. He hears the delicate anklets that ring on the feet of an insect as it walks. Go over and over your beads, paint weird designs on your forehead, Wear your hair matted, long, and ostentatious, But when deep inside you there is a loaded gun, how can you have God? (Kabir, 13th century)
REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author. Arberry, A. J. (1972). Discourses of Rumi. New York: Samuel Weiser. Bohart, A., Humphrey, A., Magalleanes, M., Guzman, R., Smiljanich, K., & Aguallo, S. (1993). Emphasizing the future in empathy responses. Journal of Humanistic Psychology, 33(2), 12-29. Bohm, D. (1990). Wholeness and the implicate order. London: Routledge & Kegan Paul. Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20-28. Connor, K. M., Davidson, J. R. T., & Lee, L.-C. (2003). Spirituality, resilience, and anger in survivors of violent trauma: A community survey. Journal of Traumatic Stress, 16, 487-494. Cory, J. (2006). Writings on the wall. About war. Retrieved September 21, 2006, from http://www.john-cory.com/pages/4/index.htm
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Decker, L. R. (1993a). Beliefs, post-traumatic stress disorder, and mysticism. Journal of Humanistic Psychology, 33(4), 15-32. Decker, L. R. (1993b). The role of trauma in spiritual development. Journal of Humanistic Psychology, 33(4), 33-46. Decker, L. R. (1995). Including spirituality. National Center for PTSD Clinical Quarterly, 5(1), 1-3. Ehrenreich, B. (1997). Blood rites: Origins and history of the passions of war. New York: Owl Books. Erikson, E. (1964). Insight and responsibility. New York: Norton. Falsetti, S. A., Resick, P. A., & Davis, J. L. (2003). Changes in religious beliefs following trauma. Journal of Traumatic Stress, 16, 391-397. Fisher, G. (2005). Existential psychotherapy with adult survivors of sexual abuse. Journal of Humanistic Psychology, 45(1), 10-40. Foa, E. B., Keane, T. M., & Friedman, M. J. (2000). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford. Fontana, A., & Rosenheck, R. (2005). The role of loss of meaning in the pursuit of treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 18(2), 133-136. Frankl, V. (1962). Mans search for meaning: An introduction to logotherapy. Boston: Beacon. Gendlin, E. (1978). Focusing. New York: Bantam. Green, A., & Holtz, B. W. (Eds./Trans.). (1977). Your word is fire: The Hasidic masters on contemplative prayer. New York: Paulist Press. Greening, T. (1997). Post-traumatic stress disorder: An existential humanistic perspective. In S. Krippner & S. M. Powers (Eds.), The varieties of dissociative experience (pp. 125-135). New York: Brunner/Mazel. Hedges, C. (2003). War is a force that gives us meaning. New York: Anchor. Hedges, C. (2004, February). War is a force that gives us meaning. Presented at George Gerven lectures, Santa Barbara, CA. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books. Janoff-Bullman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press. Jung, C. G. (1958). Psyche and symbol. New York: Doubleday. Keane, T. M. (1995). The role of exposure therapy in the psychological treatment of PTSD. National Center for PTSD Clinical Quarterly, 5(4), 1-6. Khan, P. V. I. (1977, June). Meditation in action. Talk given at a meditation retreat, Big Bear, CA. Khan, P. M. H. I. (1989). Complete works of Pir-O-Murshid Hazrat Inayat Khan. Original texts: Lectures on Sufism, 1923 I: January-June. London: East-West. Khan, P. V. I. (1999). Awakening. New York: Tarcher/Putnam. LeShan, L. (2002). The psychology of war: Comprehending its mystique and its madness. New York: Helios. Lifton, R. J. (2003). Super power syndrome: Americas apocalyptic confrontation with the world. New York: Thunders Mouth Press/Nation Books. Lines, D. (2002). Counseling within a new spiritual paradigm. Journal of Humanistic Psychology, 42(3), 102-123.
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Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17(1), 11-21. Litz, B. T. (2005). The unique circumstances and mental health impact of the wars in Afghanistan and Iraq: A National Center for PTSD fact sheet. Retrieved May 3, 2005, from http://www.ncptsd.va.gov Mahedy, W. P. (1986). Out of the night. The spiritual journey of Vietnam vets. New York: Ballantine. Manning, B. (2000). Ruthless trust. San Francisco: Harper. May, R. (1969). Love and will. New York: Dell. Moynes, J., & Barks, C. (1984). Open secret: Versions of Rumi. Putney, VT: Threshold. National Center for PTSD. (2005). Supporting our troops in Iraq. 2004 Annual Report. Washington, DC: Author. OHanlon, B. (1999). Do one thing different. New York: William Morrow. OHanlon, B., & Weiner-Davis, M. (1989). In search of solutions: A new direction in psychotherapy. New York: Norton. Parappully, J., Rosenbaum, R., van den Daele, L., & Nzewi, E. (2002). Thriving after trauma: The experience of parents of murdered children. Journal of Humanistic Psychology, 42(1), 33-70. Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37, 710-724. Readjustment Counseling Service Training. (2004). Presentation of clinical cases. Reno, NV: Author. Resick, P. A., & Schincke, M. K. (1993). Cognitive processing therapy for sexual assault survivors: A therapist manual. Newbury Park, CA: Sage. Rogers, C. R. (1947). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103. Rosen, L. N., Wright, K., Marlowe, D., Bartone, P., & Gifford, R. K. (1999). Gender differences in subjective distress attributable to anticipations of combat among U.S. Army soldiers deployed to the Persian Gulf during Operation Desert Storm. Military Medicine, 164, 753-757. Scurfield, R. M. (1994). Treatment of war-related trauma: An integrative experiential, cognitive, and spiritual approach. In M. B. Williams & J. F. Summer (Eds.), The handbook of post-traumatic therapy (pp. 204218). Westport, CT: Greenwood. Scurfield, R. M., & Powch, I. G. (1997). A video and outpatient PTSD group therapy project with veterans of three wars (A companion monograph to the film Journey of Healing). Honolulu, HI: U.S. Department of Veterans Affairs. Solomon, J. L. (2004). Modes of thought and meaning making: The aftermath of trauma. Journal of Humanistic Psychology, 44(3), 299-319. Tedeschi, R., Park, C., & Calhoun, L. (Eds.). (1998). Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum. Underhill, E. (1961). Mysticism. New York: E. P. Dutton. Van der Hart, O., Brown, P., & van der Kolk, B. A. (1989). Pierre Janets treatment of post-traumatic stress. Journal of Traumatic Stress, 2, 379-395.
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Wahlberg, L. (2001, February). Treating PTSD: The group process. A training given for the Readjustment Counseling Service, Seattle, WA. Witvliet, C. V. O., Phipps, K. A., Feldman, M. E., & Beckham, J. C. (2004). Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. Journal of Traumatic Stress, 17(3), 269-273. Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.

Combat Trauma Treatment From A Mystical Spiritual Perspective

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Combat Trauma: Treatment from a Mystical/Spiritual Perspective

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COMBAT TRAUMA: TREATMENT FROM A MYSTICAL/SPIRITUAL PERSPECTIVE

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