J Relig Health DOI 10.1007/s10943-015-0034-5 PHILOSOPHICAL EXPLORATION
Help for Heroes: PTSD, Warrior Recovery, and the Liturgy Karen O’Donnell1
Springer Science+Business Media New York 2015
Abstract The incidence of PTSD is on a steady rise in combative countries around the world, and civilian churches are increasingly like to encounter persons suffering from PTSD. This article will consider the ancient rituals for the purification of warriors after battle to demonstrate the responsibility of the church toward returning warriors and explore how the liturgy can function as a place for recovery. I will demonstrate how the sacraments of Reconciliation, the Eucharist, and the Anointing of the Sick function as sites of reintegration into the world the warriors have fought for, recovery from trauma, and purification after battle. Keywords
PTSD Trauma theology Liturgy Sacrament Trauma recovery
The British services charity Combat Stress currently works with over five thousand sufferers of post-traumatic stress disorder (PTSD; Combat Stress is here to support you 2014). This is only a fraction of the eleven thousand soldiers, sailors, airmen, and marines in the UK who are diagnosed with some form of PTSD. The figures are expected to rise by up to 12 % every year for at least the next 5 years as a result of Britain’s ongoing military involvement in conflicts around the world (Rayment 2013). In the American context, the National Center for PTSD estimates that between 11 and 20 % of service personnel will experience PTSD (Gradus 2014). It is now generally acknowledged that all warriors who experience combat will suffer from some form of stress either during combat or, in some cases, many years after combat. Post-traumatic stress disorder is most usually associated with those who have been in combat. And the focus of this article will be on the healing offered to those who have
& Karen O’Donnell [email protected] 1
Department of Theology and Religion, Amory Building, University of Exeter, Rennes Drive, Exeter EX4 4RJ, UK
123
J Relig Health
suffered the moral injury of warfare. But trauma itself is not so particular in seeking out its victims. Therefore, the symptoms of trauma are common to those who have fought in a war, who have suffered abuse, rape, or domestic violence, those who have lived through a war, and those who have survived a horrific tragedy, as well as many more. Thus, the recovery outlined in this paper would be equally applicable to sufferers of other traumas, as well as to combat personnel.
Symptoms of Trauma Erich Maria Remarque’s novel The road back, his sequel to All quiet on the western front, provides an insight into the effects of warfare upon the person and the difficulties of reintegrating into civilian life. Further up the table the accountant has just been explaining how, if only we had held out a bit longer, the war would have been won… Lower down, they are talking about stocks and bonds and peace terms, and all of them, of course, know much better what should be done… All the talk makes me stupid in the head, and I am soon unable to follow any longer… At this moment – God be praised! – crisp, grilled chops appear on the table. I sniff. Real pork chops they are, fried in real fat too. The sight of them consoles me for all the rest. I lean over and secure a good one and begin chewing with relish. It tastes marvelous. It’s a power of time since I last ate a fresh chop. In Flanders… I neither hear nor see anything now; I lose myself in memories – A giggle awakens me. About the table is dead silence. Aunt Lina has a face like a bottle of acid. The girl beside me is stifling a giggle. Everybody is looking at me. Sweat breaks out on me in streams. Here I sit, just as we did then out in Flanders, absentminded, both elbows on the table, the bone in my two hands, my fingers covered in grease… But the others are eating cleanly with knife and fork. Red as a beetroot, I look straight ahead and put down the bone. How could I have so forgotten myself? But there is anger too in my embarrassment…(Remarque 1998) There are many ways of defining the symptoms of trauma. Exploration of these symptoms has, over the years, ebbed and flowed in response to the concerns of communities. Beginning with the hysteria of women in the nineteenth century, interest in the effects of trauma peaked in the two world wars, but little further work was done in the years following these wars until the seventies saw hundreds of thousands of warriors returning from Vietnam alongside increased recognition of the effects of rape and domestic abuse. The trauma stories of men and women met at this point (Herman 2001). I suggest that in Remarque’s story the way in which trauma causes three ruptures in a person becomes apparent. Firstly, trauma ruptures a person’s sense of identity. They no longer know who they are. They struggle to identify with the person they were before they experienced the trauma. They may even feel that this person is dead. Horowitz (1986) defines traumatic events as ‘‘those that cannot be assimilated with the victim’s ‘inner schemata’ of self in relation to the world.’’ As well as posing a physical threat to the body, a traumatic event can be one that shatters the previously held identity of the victim, something which evokes a need for redefinition of self in the aftermath of their experience and throughout their recovery. Secondly, there is a rupture in time. A traumatic event is one in which the empirical notions of time are disrupted by an event or encounter (with death) that is missed (Lange
123
J Relig Health
2010). For example, for some sufferers of PTSD, much of their trauma comes not necessarily from the event their experienced, but rather from the fact that they survived when they did not believe they would or should. The past continues to invade the present for those suffering PTSD. This occurs in a form of repeated nightmares, repeated flashbacks, repeated hallucinations, and repeated experience of the trauma (Caruth 1991). The sufferer of PTSD lives in the site of the trauma, never quite knowing when it will rear its head once again. The third rupture caused by trauma is a rupture in cognition. This is characterized by a failing of words and an impotency of language (Pound 2008). A traumatic event is one that escapes accessibility (Lange 2010), and the response to trauma, that which gives it meaning and comprehension, is usually delayed (Caruth 1991). The trauma victim cannot make sense of the experience they have had and often fails to articulate both what they have experienced and how they now feel. Perhaps they cannot understand why they survived when their friends and compatriots did not. Perhaps they cannot understand why God would allow something so awful to happen to them. There is an inability to understand what has happened and often a profound anger connected to the experience. This may be linked to the rupture in time when a person physically cannot remember the trauma and therefore cannot understand why they are responding in such a dramatic way to an experience that is blank before them. Mahedy (2005) notes that, after the Vietnam War, many therapists overlooked the possibility that in addition to the psychic stress experienced by the soldiers there could also be a profound moral pain or that some soldiers who were without any clinical symptoms might nonetheless be afflicted with a deep moral and spiritual malaise. The effects of this moral and spiritual sickness reach into our communities.
Coming Home: An Old Story Coming home is difficult. Reintegration into civilian life is hard. This is not a new narrative. The difficulty of warriors returning home is an old, old story. Jonathan Shay outlines the nature of this old story of warrior reintegration in his analysis of the story of Odysseus. This, for Shay, forms the backdrop to his work with the Veterans Association. The story is particularly telling. After victory at Troy, it takes Odysseus 10 years to make it home and when he does he is a different man—quite literally thanks to the disguise he wears. He is emotionless and blank in the face of his wife’s distress. Falsehoods all, but he gave his falsehoods all the ring of truth. As [Penelope] listened on, her tears flowed and soaked her cheeks… so she dissolved in tears… weeping for him, her husband, sitting there beside her. Odysseus’ heart went out to his grief-stricken wife but under his lids his eyes remained stock-still – they might have been made of horn or iron – his guile fought back his tears (Homer 1996). He mistrusts those around him and is uncomfortable in a crowd. Shay (2003) notes that Odysseus’ behavior is hardly endearing ‘‘[C]onstant lying, coldness toward his wife, cruelty toward his aged father, killing off more than a hundred townsmen, and ordering the
123
J Relig Health
extermination of a dozen of his women servants…’’ In Odysseus, it is possible to see that the valid adaptations to danger, which kept him safe in both the Trojan War and his long journey home, have persisted into a time a safety afterward. This is a classic experience of PTSD. Odysseus has suffered the three traumatic ruptures of self, time, and cognition.
Ancient Cultures Ancient cultures understood better than our modern culture does, the need to aid warrior in their homecomings. For example, in Rome, the vestal virgins would bathe returning soldiers to purge them of the corruption of war. The Maasai warriors of Africa had purification rites for the homecoming of their fighters. The Native Americans held sweat lodge purification rituals for returning warriors in which their stories could be told and their ‘‘inner pollution’’ could be left among the hot stones, evaporating into steam and cleansing the warrior (French 2005a). Even within the Judeo-Christian culture, there is some understanding of the need to purify soldiers after warfare. In numbers chapter 31, the Hebrews are instructed to purify themselves before entering back into the camp after battle. Moses instructs the returning soldiers to [C]amp outside the camp seven days; whoever of you has killed any person or touched a corpse, purify yourself and your captives on the third and on the seventh day. You shall purify every garment, every article of skin, everything made of goat’s hair, and every article of wood. (Numbers 31: 19-20, New Revised Standard Version (NRSV)). While this instruction does provide for the purification of returning warriors, it is not necessarily aimed at relieving guilt and shame, but rather is most likely connected to Hebraic concerns regarding the impurity that contact with blood would cause. As this prohibition found its way into Christian penances, it became clear that church fathers were concerned with the inward impurity of heart rather than the outward impurity of the hands. In Medieval warfare, penances were handed down to all those who fought in battle, even those who did not kill. Those did kill were given extra penances. This imposition of penance is obviously not connected to concerns about contact with blood, since even those who had not killed had to perform penance, but rather with assuaging a sense of guilt and culpability—giving relief from shame. These cultures understood something innate about returning warriors, and it is my suggestion that the sacramental experiences of the Eucharist, reconciliation, and the healing of the sick have much to offer to returning warriors in aiding them in a successful homecoming and in helping to heal the trauma of PTSD.
Different Worlds? Soldiers and other military personnel are often encouraged to think of the world of warfare as a different world to the one in which their friends and families live (French 2005b). They are told not to apply the same principles and standards to the battlefield as to the domestic world. They are told not to share the details of the world of war with loved ones when they return home. But to encourage soldiers to think of two different spheres is to do them a disservice. Shannon French, a military ethicist and an expert in warrior transitions,
123
J Relig Health
suggests that we place the character of our troops and our fundamental values at risk if we encourage our warriors to imagine themselves entering another realm governed by divergent moral laws (or worse, by no moral law at all) whenever we ask them to face combat for us (French 2005b). If our goal is to protect our warriors, we do them an unintentional disservice if we invent a fictional divide between our moral universe and theirs. To reduce all the soldier’s symptoms to stress alone is to empty their experience of moral content. This is simply not the case. I suggest that warriors require transitional assistance because there is only one moral sphere, and their actions in war and in peace are judged against the same set of values and principles.
Trauma Recovery Recovery from trauma happens in three stages although it would be a mistake to consider these to be clearly delineated period of time. Recovery is more likely to be messy, nonlinear, and with a repeated need for confirmation that each stage has been achieved. Throughout recovery as a whole, the element of community is essential. Herman (2001) notes that recovery ‘‘… is based on the empowerment of the survivor and the creation of new connections. Recovery can take place only in the context of relationships; it cannot happen in isolation.’’ Firstly, the victim must establish a sense of bodily integrity—that they are safe in their own skin. Secondly, the trauma sufferer must construct a narrative of their trauma that helps them to remember it clearly and grieve for what has been lost. Thirdly, to fully recover, the trauma victim must reconnect with society and ultimately make their trauma a gift to the world. The Fathers who formed the liturgy in the early church had an instinct for trauma recovery. Its scent is redolent in the liturgy. Trauma recovery is at work in the Eucharist, reconciliation, and the anointing of the sick. All Christian denominations have some tradition of sharing a community meal— whatever title they prefer to give it. All Christian denominations recognize the important of confessing sins and receiving forgiveness where necessary. And all Christians have a tradition of praying for the sick. Some Christian denominations take a less ritualistic, more ad hoc approach to both reconciliation and the healing of the sick. But all Christians respond to the instruction given in James’s letter. Are any among you sick? They should call for the elders of the church and have them pray over them, anointing them with oil in the name of the Lord. The prayer of faith will save the sick, and the Lord will raise them up; and anyone who has committed sins will be forgiven. Therefore confess your sins to one another, and prayer for one another, so that you may be healed. The prayer of the righteous is powerful and effective. (James 5: 14-16, NRSV). While traditional, liturgy-based Churches have specific liturgies and rites that, I argue, reflect the process of trauma recovery with great accuracy, all denominations have the resources to offer a pathway for trauma recovery to those within their communities that require it.
The Stages of Trauma Recovery It is possible to mark out three stages to trauma recovery (Herman 2001). Stage one is the establishment of safety and bodily integrity. In order to recover from any trauma, the sufferer of PTSD must feel like they are safe and have control over their own body. Stage
123
J Relig Health
two of this recovery is focused on constructing a trauma narrative. The victim must both remember the traumatic event and mourn what has been lost in the experience. A trauma narrative not only begins to articulate their experience, but also to shape its ongoing influence in their life. Finally, stage three is focused on giving the trauma value—making, of it, a gift. This gift inevitably involves the reconnection of the trauma sufferer with the world. A gift requires a recipient. Judith Herman summarizes this analysis of recovery by suggesting that … in the course of a successful recovery, it should be possible to recognize a gradual shift from unpredictable danger to reliable safety, from dissociated trauma to acknowledged memory, and from stigmatized isolation to restored social connection. (Herman 2001).
The Eucharist The reception of the bread and wine of the Eucharist—central to the life of any Christian Church and regardless of the specifics of Eucharistic theology in a particular denomination—is, I suggest, a gateway to recovery from trauma. Most Christian celebrations of the Eucharist connect the sharing of bread and wine among believers to the suffering and death of Christ—the trauma of the cross. Serene Jones puts forward a model of interpreting the cross through the lens of trauma. Acknowledging that there is great variety in the interpretations put forward by Christian communities in order to explain how God saves the world through an event of traumatic violence, she suggests a Christology of mirroring (Jones 2009). The mirrored cross reflects our own stories of suffering back to us. And so for a woman suffering the trauma of a loss of a child, that experience is mirrored on the cross. For a warrior repeatedly experiencing the violence and horror of warfare, that violence and horror is mirrored at the cross. But that mirroring is clearly complex, more complex than a simple action of reflection. Given the unstable nature of the theology of the cross, how can the cross-centered Eucharist be an acceptable narrative to offer those caught in trauma? It is precisely in its difficulty, its instability, its repetition at each celebration that the cross-centered Eucharist mirrors the experience of a trauma and thus provides healing from trauma. The trauma experienced and recovered from in the Eucharist is the trauma of the Body of Christ both in its particular and universal sense.
Reconciliation For those who have experienced trauma and are caught in the unending repetition of PTSD, it is clear that they need some way to be released from the things they did or witnessed that seem incompatible with the values to which they are committed. These values, as has earlier been demonstrated, are universal and not suspended in some imagined alternate sphere of battle. Though their guilt and shame perhaps might be expected to bring warriors closer and deeper into the human community, more often than not it only serves to set them apart and keep them locked in a silence that is as much a cause of their pain as the trauma they experienced. The Catholic theologian, Karl Rahner, understood that human beings have an inner need to express their guilt and hear words of forgiveness (Egan 1998). He suggested that
123
J Relig Health
[S]acramental confession is in its ultimate meaning an ever-renewed self-surrender of the total person to God’s merciful grace… the courage to let our guilt be forgiven through the incomprehensible mystery we call God. Christianity is this message: we should allow ourselves to be forgiven. And the Church offers us the means: the sacrament of penance (Rahner 1977). For Rahner, the sacrament of penance, this concept of reconciliation, held great significance. For it is through forgiveness that God can communicate his love and his self to the person seeking reconciliation. Rahner acknowledges that it is possible to do this in private between the individual and God, but argues that [T]his word of God’s forgiveness is Jesus Christ – the one in whom God’s unconditional word of forgiveness has also become historically evident and irrevocable – and remains present in the community of those believing in this forgiveness in the Church. The Church is the fundamental sacrament of this word of God’s forgiveness (Rahner 1977). There is, therefore, value in hearing forgiveness spoken by the Church, whether that is in a corporate setting, in a confessional booth, or face to face with a fellow Christian. Rahner (1983) notes, in his account of the history of penance, that ‘‘[W]here the Church recognizes that God forgives, there it also recognizes its own right to grant full church forgiveness.’’ The corporate, public element to reconciliation is not to be underestimated. Traditional practices that involve some kind of confession or purification do not create guilt or self-loathing in warriors; rather, such rituals allow warriors to release any guilt or shame they may be burdened with and cleanse away any sense of being tainted or ‘‘unfit’’ to be a member of the civilian community from which they came. Ultimately, healthy transitions give warriors a chance to forgive themselves so they can move on. Far from being a punishment, the opportunity to confess their sins is a gift. The confession of the believer forms the construction of a trauma narrative which includes, as it does in the Eucharist, a reliving of the trauma. The PTSD sufferer will often have to recount and examine very difficult aspects of the experience at the heart of their trauma. The person hearing the confession of this trauma narrative has a significant role to play here in witnessing and hearing the account, acknowledging the reality of the warrior’s experience. Finally, the absolution of the believer functions as the third element to recovery from trauma as the penitent is encouraged to amend their conduct, make reparation for injury, and give satisfaction. In short, the PTSD victim is encouraged to make meaning from their trauma and give it as a gift in action to the world. What is essential here is an understanding, unshockable, and committed listener who can hear a warrior’s confession without recoil in horror. One who can confirm absolution and the forgiveness of a victim without adding to their trauma.
Healing the Sick If PTSD is a psychological injury, it is one that requires medical, cultural, and spiritual healing (Shay 2003). If a warrior returned home from the battlefield with a physical injury, a chaplain, minister, or parish priest might immediately think to offer to pray for their healing. But PTSD is an injury. It is a moral injury which requires treatment that deals with its ethical and spiritual nature. The anointing of the sick has a profound part to play in healing from PTSD. The first stage of recovery from trauma, as I outlined earlier, is the
123
J Relig Health
establishment of bodily integrity. In a post-structuralist understanding of the body, the psyche cannot be easily dissociated from the physical body. A more holistic approach is required. The establishment of bodily integrity requires the healing of non-physical illnesses too. The second stage of trauma recovery is focused on constructing a narrative of the trauma that enables the victim to remember the truth about what has happened to them and to grieve for what they have lost. Experiencing the anointing of the sick has the benefit of enabling victims of trauma to understand their injury as just that—an injury. Not a defect in their strength or bravery, not some weakness on their part, but a moral and spiritual injury for which God can provide healing. A reconstruction of the narrative of trauma along these lines can be very releasing. If the third stage of trauma recovery is being able to reconnect with community and make trauma the survivor’s gift to the world, then it is in the healing that comes through this sacrament that the recovery from trauma is completed. All three of these sacramental acts—Eucharist, reconciliation, and healing of the sick— are available to all believers at any time. Unlike other sacramental acts such as baptism, traditionally only experienced once, these three acts can be entered into as often as is necessary. A trilogy of sacramental acts I suggest would be of repeated benefit to returning soldiers suffering from PTSD.
Conclusion Warriors returning home require spiritual help in their transition, especially those who are suffering from PTSD. The ruptures suffered in the experience of trauma—of self, of time, and of cognition—are too profound, an injury to merely be treated by doctors. There is a spiritual element that requires recognition. The mirrored cross in the Eucharist provides a beginning point for trauma recovery as all victims of trauma are able to see their own experience reflected in the cross. As the Eucharist provides us with a recovery from this cross-trauma, so can all traumas be healed in the experience of the Eucharist. The spiritual injury caused by trauma is healed in the sacrament of the anointing of the sick. The shame and guilt of PTSD sufferers are absolved in the sacrament of reconciliation. Each of these sacraments heals the ruptures caused by trauma and allows the warrior to progress through the stages of trauma recovery. Participation in sacramental ritual allows these warriors to participate as individual bodies within the corporate body of Christ, thus serving to reconnect them with their community as an element of their trauma recovery. This is not a once-for-all process. Each of these sacraments can be received by the believer as often as is required. So for the returning warrior, spiritual healing is not a sprint but a marathon, passing by the same places over and over again until there is safety, remembrance, and reconnection.
References Caruth, C. (1991). Unclaimed experience: Trauma and the possibility of history. Yale French Studies, 79, Literature and the Ethical Question, 181–192. Combat Stress is here to support you. (2014). Retrieved from https://www.combatstress.org.uk/ veterans?gclid=CO-uu4iwp8ICFa7LtAodIzoAyQ. Egan, H. D. (1998). Karl Rahner: The mystic of everyday life. New York: The Crossroad Publishing Company.
123
J Relig Health French, S. E. (2005a). The code of the warrior: Exploring warrior values past and present. Lanham, MD: Rowman & Littlefield. French, S. E. (2005b). Warrior transitions: From combat to social contract. JSCOPE, 1–13. Gradus, J. L. (2014). Epidemiology of PTSD. Retrieved from http://www.ptsd.va.gov/professional/PTSDoverview/epidemiological-facts-ptsd.asp. Herman, J. (2001). Trauma and recovey: From domestic abuse to political terror. London: Pandora. Homer. (1996). Odyssey (R. Fagles, Trans.) Odyssey. New York: Viking Pengiun. Horowitz, M. (1986). Stress response syndromes (2nd ed.). New York: Aronson. Jones, S. (2009). Trauma and grace: Theology in a ruptured world. Louisville, Kentucky: Westminster John Knox Press. Lange, D. G. (2010). Trauma recalled: Liturgy, disruption, and theology. Minneapolis: Fortress Press. Mahedy, W. P. (2004). Out of the night: The spiritual journey of vietnam vets. Knoxville, TN: Radix Press. Pound, M. (2008). The assumption of desire: Kierkegaard, Lacan, and the Trauma of the Eucharist. Journal for Cultural and Religious Theory, 9(1), 67–78. Rahner, K. (1977). Meditations on the sacraments (S. Attanasio, J. M. Quigley & D. White, Trans.). New York: Seabury. Rahner, K. (1983). Theological investigations XV: Penance in the early church (L. Swain, Trans.). London: Darton, Longman & Todd. Rayment, S. (2013, 17/03/13). PTSD on the rise among British servicemen and women after a decade of war, The telegraph. Retrieved from http://www.telegraph.co.uk/news/uknews/defence/9934809/PTSDon-the-rise-among-British-servicemen-and-women-after-decade-of-war.html. Remarque, E. M. (1998). The road back. New York: Fawcett. Shay, J. (2003). Odysseus in America: Combat trauma and the trials of homecoming. New York: Scribner Book Company.
123
Help for Heroes: PTSD, Warrior Recovery, and the Liturgy Karen O’Donnell1
Springer Science+Business Media New York 2015
Abstract The incidence of PTSD is on a steady rise in combative countries around the world, and civilian churches are increasingly like to encounter persons suffering from PTSD. This article will consider the ancient rituals for the purification of warriors after battle to demonstrate the responsibility of the church toward returning warriors and explore how the liturgy can function as a place for recovery. I will demonstrate how the sacraments of Reconciliation, the Eucharist, and the Anointing of the Sick function as sites of reintegration into the world the warriors have fought for, recovery from trauma, and purification after battle. Keywords
PTSD Trauma theology Liturgy Sacrament Trauma recovery
The British services charity Combat Stress currently works with over five thousand sufferers of post-traumatic stress disorder (PTSD; Combat Stress is here to support you 2014). This is only a fraction of the eleven thousand soldiers, sailors, airmen, and marines in the UK who are diagnosed with some form of PTSD. The figures are expected to rise by up to 12 % every year for at least the next 5 years as a result of Britain’s ongoing military involvement in conflicts around the world (Rayment 2013). In the American context, the National Center for PTSD estimates that between 11 and 20 % of service personnel will experience PTSD (Gradus 2014). It is now generally acknowledged that all warriors who experience combat will suffer from some form of stress either during combat or, in some cases, many years after combat. Post-traumatic stress disorder is most usually associated with those who have been in combat. And the focus of this article will be on the healing offered to those who have
& Karen O’Donnell [email protected] 1
Department of Theology and Religion, Amory Building, University of Exeter, Rennes Drive, Exeter EX4 4RJ, UK
123
J Relig Health
suffered the moral injury of warfare. But trauma itself is not so particular in seeking out its victims. Therefore, the symptoms of trauma are common to those who have fought in a war, who have suffered abuse, rape, or domestic violence, those who have lived through a war, and those who have survived a horrific tragedy, as well as many more. Thus, the recovery outlined in this paper would be equally applicable to sufferers of other traumas, as well as to combat personnel.
Symptoms of Trauma Erich Maria Remarque’s novel The road back, his sequel to All quiet on the western front, provides an insight into the effects of warfare upon the person and the difficulties of reintegrating into civilian life. Further up the table the accountant has just been explaining how, if only we had held out a bit longer, the war would have been won… Lower down, they are talking about stocks and bonds and peace terms, and all of them, of course, know much better what should be done… All the talk makes me stupid in the head, and I am soon unable to follow any longer… At this moment – God be praised! – crisp, grilled chops appear on the table. I sniff. Real pork chops they are, fried in real fat too. The sight of them consoles me for all the rest. I lean over and secure a good one and begin chewing with relish. It tastes marvelous. It’s a power of time since I last ate a fresh chop. In Flanders… I neither hear nor see anything now; I lose myself in memories – A giggle awakens me. About the table is dead silence. Aunt Lina has a face like a bottle of acid. The girl beside me is stifling a giggle. Everybody is looking at me. Sweat breaks out on me in streams. Here I sit, just as we did then out in Flanders, absentminded, both elbows on the table, the bone in my two hands, my fingers covered in grease… But the others are eating cleanly with knife and fork. Red as a beetroot, I look straight ahead and put down the bone. How could I have so forgotten myself? But there is anger too in my embarrassment…(Remarque 1998) There are many ways of defining the symptoms of trauma. Exploration of these symptoms has, over the years, ebbed and flowed in response to the concerns of communities. Beginning with the hysteria of women in the nineteenth century, interest in the effects of trauma peaked in the two world wars, but little further work was done in the years following these wars until the seventies saw hundreds of thousands of warriors returning from Vietnam alongside increased recognition of the effects of rape and domestic abuse. The trauma stories of men and women met at this point (Herman 2001). I suggest that in Remarque’s story the way in which trauma causes three ruptures in a person becomes apparent. Firstly, trauma ruptures a person’s sense of identity. They no longer know who they are. They struggle to identify with the person they were before they experienced the trauma. They may even feel that this person is dead. Horowitz (1986) defines traumatic events as ‘‘those that cannot be assimilated with the victim’s ‘inner schemata’ of self in relation to the world.’’ As well as posing a physical threat to the body, a traumatic event can be one that shatters the previously held identity of the victim, something which evokes a need for redefinition of self in the aftermath of their experience and throughout their recovery. Secondly, there is a rupture in time. A traumatic event is one in which the empirical notions of time are disrupted by an event or encounter (with death) that is missed (Lange
123
J Relig Health
2010). For example, for some sufferers of PTSD, much of their trauma comes not necessarily from the event their experienced, but rather from the fact that they survived when they did not believe they would or should. The past continues to invade the present for those suffering PTSD. This occurs in a form of repeated nightmares, repeated flashbacks, repeated hallucinations, and repeated experience of the trauma (Caruth 1991). The sufferer of PTSD lives in the site of the trauma, never quite knowing when it will rear its head once again. The third rupture caused by trauma is a rupture in cognition. This is characterized by a failing of words and an impotency of language (Pound 2008). A traumatic event is one that escapes accessibility (Lange 2010), and the response to trauma, that which gives it meaning and comprehension, is usually delayed (Caruth 1991). The trauma victim cannot make sense of the experience they have had and often fails to articulate both what they have experienced and how they now feel. Perhaps they cannot understand why they survived when their friends and compatriots did not. Perhaps they cannot understand why God would allow something so awful to happen to them. There is an inability to understand what has happened and often a profound anger connected to the experience. This may be linked to the rupture in time when a person physically cannot remember the trauma and therefore cannot understand why they are responding in such a dramatic way to an experience that is blank before them. Mahedy (2005) notes that, after the Vietnam War, many therapists overlooked the possibility that in addition to the psychic stress experienced by the soldiers there could also be a profound moral pain or that some soldiers who were without any clinical symptoms might nonetheless be afflicted with a deep moral and spiritual malaise. The effects of this moral and spiritual sickness reach into our communities.
Coming Home: An Old Story Coming home is difficult. Reintegration into civilian life is hard. This is not a new narrative. The difficulty of warriors returning home is an old, old story. Jonathan Shay outlines the nature of this old story of warrior reintegration in his analysis of the story of Odysseus. This, for Shay, forms the backdrop to his work with the Veterans Association. The story is particularly telling. After victory at Troy, it takes Odysseus 10 years to make it home and when he does he is a different man—quite literally thanks to the disguise he wears. He is emotionless and blank in the face of his wife’s distress. Falsehoods all, but he gave his falsehoods all the ring of truth. As [Penelope] listened on, her tears flowed and soaked her cheeks… so she dissolved in tears… weeping for him, her husband, sitting there beside her. Odysseus’ heart went out to his grief-stricken wife but under his lids his eyes remained stock-still – they might have been made of horn or iron – his guile fought back his tears (Homer 1996). He mistrusts those around him and is uncomfortable in a crowd. Shay (2003) notes that Odysseus’ behavior is hardly endearing ‘‘[C]onstant lying, coldness toward his wife, cruelty toward his aged father, killing off more than a hundred townsmen, and ordering the
123
J Relig Health
extermination of a dozen of his women servants…’’ In Odysseus, it is possible to see that the valid adaptations to danger, which kept him safe in both the Trojan War and his long journey home, have persisted into a time a safety afterward. This is a classic experience of PTSD. Odysseus has suffered the three traumatic ruptures of self, time, and cognition.
Ancient Cultures Ancient cultures understood better than our modern culture does, the need to aid warrior in their homecomings. For example, in Rome, the vestal virgins would bathe returning soldiers to purge them of the corruption of war. The Maasai warriors of Africa had purification rites for the homecoming of their fighters. The Native Americans held sweat lodge purification rituals for returning warriors in which their stories could be told and their ‘‘inner pollution’’ could be left among the hot stones, evaporating into steam and cleansing the warrior (French 2005a). Even within the Judeo-Christian culture, there is some understanding of the need to purify soldiers after warfare. In numbers chapter 31, the Hebrews are instructed to purify themselves before entering back into the camp after battle. Moses instructs the returning soldiers to [C]amp outside the camp seven days; whoever of you has killed any person or touched a corpse, purify yourself and your captives on the third and on the seventh day. You shall purify every garment, every article of skin, everything made of goat’s hair, and every article of wood. (Numbers 31: 19-20, New Revised Standard Version (NRSV)). While this instruction does provide for the purification of returning warriors, it is not necessarily aimed at relieving guilt and shame, but rather is most likely connected to Hebraic concerns regarding the impurity that contact with blood would cause. As this prohibition found its way into Christian penances, it became clear that church fathers were concerned with the inward impurity of heart rather than the outward impurity of the hands. In Medieval warfare, penances were handed down to all those who fought in battle, even those who did not kill. Those did kill were given extra penances. This imposition of penance is obviously not connected to concerns about contact with blood, since even those who had not killed had to perform penance, but rather with assuaging a sense of guilt and culpability—giving relief from shame. These cultures understood something innate about returning warriors, and it is my suggestion that the sacramental experiences of the Eucharist, reconciliation, and the healing of the sick have much to offer to returning warriors in aiding them in a successful homecoming and in helping to heal the trauma of PTSD.
Different Worlds? Soldiers and other military personnel are often encouraged to think of the world of warfare as a different world to the one in which their friends and families live (French 2005b). They are told not to apply the same principles and standards to the battlefield as to the domestic world. They are told not to share the details of the world of war with loved ones when they return home. But to encourage soldiers to think of two different spheres is to do them a disservice. Shannon French, a military ethicist and an expert in warrior transitions,
123
J Relig Health
suggests that we place the character of our troops and our fundamental values at risk if we encourage our warriors to imagine themselves entering another realm governed by divergent moral laws (or worse, by no moral law at all) whenever we ask them to face combat for us (French 2005b). If our goal is to protect our warriors, we do them an unintentional disservice if we invent a fictional divide between our moral universe and theirs. To reduce all the soldier’s symptoms to stress alone is to empty their experience of moral content. This is simply not the case. I suggest that warriors require transitional assistance because there is only one moral sphere, and their actions in war and in peace are judged against the same set of values and principles.
Trauma Recovery Recovery from trauma happens in three stages although it would be a mistake to consider these to be clearly delineated period of time. Recovery is more likely to be messy, nonlinear, and with a repeated need for confirmation that each stage has been achieved. Throughout recovery as a whole, the element of community is essential. Herman (2001) notes that recovery ‘‘… is based on the empowerment of the survivor and the creation of new connections. Recovery can take place only in the context of relationships; it cannot happen in isolation.’’ Firstly, the victim must establish a sense of bodily integrity—that they are safe in their own skin. Secondly, the trauma sufferer must construct a narrative of their trauma that helps them to remember it clearly and grieve for what has been lost. Thirdly, to fully recover, the trauma victim must reconnect with society and ultimately make their trauma a gift to the world. The Fathers who formed the liturgy in the early church had an instinct for trauma recovery. Its scent is redolent in the liturgy. Trauma recovery is at work in the Eucharist, reconciliation, and the anointing of the sick. All Christian denominations have some tradition of sharing a community meal— whatever title they prefer to give it. All Christian denominations recognize the important of confessing sins and receiving forgiveness where necessary. And all Christians have a tradition of praying for the sick. Some Christian denominations take a less ritualistic, more ad hoc approach to both reconciliation and the healing of the sick. But all Christians respond to the instruction given in James’s letter. Are any among you sick? They should call for the elders of the church and have them pray over them, anointing them with oil in the name of the Lord. The prayer of faith will save the sick, and the Lord will raise them up; and anyone who has committed sins will be forgiven. Therefore confess your sins to one another, and prayer for one another, so that you may be healed. The prayer of the righteous is powerful and effective. (James 5: 14-16, NRSV). While traditional, liturgy-based Churches have specific liturgies and rites that, I argue, reflect the process of trauma recovery with great accuracy, all denominations have the resources to offer a pathway for trauma recovery to those within their communities that require it.
The Stages of Trauma Recovery It is possible to mark out three stages to trauma recovery (Herman 2001). Stage one is the establishment of safety and bodily integrity. In order to recover from any trauma, the sufferer of PTSD must feel like they are safe and have control over their own body. Stage
123
J Relig Health
two of this recovery is focused on constructing a trauma narrative. The victim must both remember the traumatic event and mourn what has been lost in the experience. A trauma narrative not only begins to articulate their experience, but also to shape its ongoing influence in their life. Finally, stage three is focused on giving the trauma value—making, of it, a gift. This gift inevitably involves the reconnection of the trauma sufferer with the world. A gift requires a recipient. Judith Herman summarizes this analysis of recovery by suggesting that … in the course of a successful recovery, it should be possible to recognize a gradual shift from unpredictable danger to reliable safety, from dissociated trauma to acknowledged memory, and from stigmatized isolation to restored social connection. (Herman 2001).
The Eucharist The reception of the bread and wine of the Eucharist—central to the life of any Christian Church and regardless of the specifics of Eucharistic theology in a particular denomination—is, I suggest, a gateway to recovery from trauma. Most Christian celebrations of the Eucharist connect the sharing of bread and wine among believers to the suffering and death of Christ—the trauma of the cross. Serene Jones puts forward a model of interpreting the cross through the lens of trauma. Acknowledging that there is great variety in the interpretations put forward by Christian communities in order to explain how God saves the world through an event of traumatic violence, she suggests a Christology of mirroring (Jones 2009). The mirrored cross reflects our own stories of suffering back to us. And so for a woman suffering the trauma of a loss of a child, that experience is mirrored on the cross. For a warrior repeatedly experiencing the violence and horror of warfare, that violence and horror is mirrored at the cross. But that mirroring is clearly complex, more complex than a simple action of reflection. Given the unstable nature of the theology of the cross, how can the cross-centered Eucharist be an acceptable narrative to offer those caught in trauma? It is precisely in its difficulty, its instability, its repetition at each celebration that the cross-centered Eucharist mirrors the experience of a trauma and thus provides healing from trauma. The trauma experienced and recovered from in the Eucharist is the trauma of the Body of Christ both in its particular and universal sense.
Reconciliation For those who have experienced trauma and are caught in the unending repetition of PTSD, it is clear that they need some way to be released from the things they did or witnessed that seem incompatible with the values to which they are committed. These values, as has earlier been demonstrated, are universal and not suspended in some imagined alternate sphere of battle. Though their guilt and shame perhaps might be expected to bring warriors closer and deeper into the human community, more often than not it only serves to set them apart and keep them locked in a silence that is as much a cause of their pain as the trauma they experienced. The Catholic theologian, Karl Rahner, understood that human beings have an inner need to express their guilt and hear words of forgiveness (Egan 1998). He suggested that
123
J Relig Health
[S]acramental confession is in its ultimate meaning an ever-renewed self-surrender of the total person to God’s merciful grace… the courage to let our guilt be forgiven through the incomprehensible mystery we call God. Christianity is this message: we should allow ourselves to be forgiven. And the Church offers us the means: the sacrament of penance (Rahner 1977). For Rahner, the sacrament of penance, this concept of reconciliation, held great significance. For it is through forgiveness that God can communicate his love and his self to the person seeking reconciliation. Rahner acknowledges that it is possible to do this in private between the individual and God, but argues that [T]his word of God’s forgiveness is Jesus Christ – the one in whom God’s unconditional word of forgiveness has also become historically evident and irrevocable – and remains present in the community of those believing in this forgiveness in the Church. The Church is the fundamental sacrament of this word of God’s forgiveness (Rahner 1977). There is, therefore, value in hearing forgiveness spoken by the Church, whether that is in a corporate setting, in a confessional booth, or face to face with a fellow Christian. Rahner (1983) notes, in his account of the history of penance, that ‘‘[W]here the Church recognizes that God forgives, there it also recognizes its own right to grant full church forgiveness.’’ The corporate, public element to reconciliation is not to be underestimated. Traditional practices that involve some kind of confession or purification do not create guilt or self-loathing in warriors; rather, such rituals allow warriors to release any guilt or shame they may be burdened with and cleanse away any sense of being tainted or ‘‘unfit’’ to be a member of the civilian community from which they came. Ultimately, healthy transitions give warriors a chance to forgive themselves so they can move on. Far from being a punishment, the opportunity to confess their sins is a gift. The confession of the believer forms the construction of a trauma narrative which includes, as it does in the Eucharist, a reliving of the trauma. The PTSD sufferer will often have to recount and examine very difficult aspects of the experience at the heart of their trauma. The person hearing the confession of this trauma narrative has a significant role to play here in witnessing and hearing the account, acknowledging the reality of the warrior’s experience. Finally, the absolution of the believer functions as the third element to recovery from trauma as the penitent is encouraged to amend their conduct, make reparation for injury, and give satisfaction. In short, the PTSD victim is encouraged to make meaning from their trauma and give it as a gift in action to the world. What is essential here is an understanding, unshockable, and committed listener who can hear a warrior’s confession without recoil in horror. One who can confirm absolution and the forgiveness of a victim without adding to their trauma.
Healing the Sick If PTSD is a psychological injury, it is one that requires medical, cultural, and spiritual healing (Shay 2003). If a warrior returned home from the battlefield with a physical injury, a chaplain, minister, or parish priest might immediately think to offer to pray for their healing. But PTSD is an injury. It is a moral injury which requires treatment that deals with its ethical and spiritual nature. The anointing of the sick has a profound part to play in healing from PTSD. The first stage of recovery from trauma, as I outlined earlier, is the
123
J Relig Health
establishment of bodily integrity. In a post-structuralist understanding of the body, the psyche cannot be easily dissociated from the physical body. A more holistic approach is required. The establishment of bodily integrity requires the healing of non-physical illnesses too. The second stage of trauma recovery is focused on constructing a narrative of the trauma that enables the victim to remember the truth about what has happened to them and to grieve for what they have lost. Experiencing the anointing of the sick has the benefit of enabling victims of trauma to understand their injury as just that—an injury. Not a defect in their strength or bravery, not some weakness on their part, but a moral and spiritual injury for which God can provide healing. A reconstruction of the narrative of trauma along these lines can be very releasing. If the third stage of trauma recovery is being able to reconnect with community and make trauma the survivor’s gift to the world, then it is in the healing that comes through this sacrament that the recovery from trauma is completed. All three of these sacramental acts—Eucharist, reconciliation, and healing of the sick— are available to all believers at any time. Unlike other sacramental acts such as baptism, traditionally only experienced once, these three acts can be entered into as often as is necessary. A trilogy of sacramental acts I suggest would be of repeated benefit to returning soldiers suffering from PTSD.
Conclusion Warriors returning home require spiritual help in their transition, especially those who are suffering from PTSD. The ruptures suffered in the experience of trauma—of self, of time, and of cognition—are too profound, an injury to merely be treated by doctors. There is a spiritual element that requires recognition. The mirrored cross in the Eucharist provides a beginning point for trauma recovery as all victims of trauma are able to see their own experience reflected in the cross. As the Eucharist provides us with a recovery from this cross-trauma, so can all traumas be healed in the experience of the Eucharist. The spiritual injury caused by trauma is healed in the sacrament of the anointing of the sick. The shame and guilt of PTSD sufferers are absolved in the sacrament of reconciliation. Each of these sacraments heals the ruptures caused by trauma and allows the warrior to progress through the stages of trauma recovery. Participation in sacramental ritual allows these warriors to participate as individual bodies within the corporate body of Christ, thus serving to reconnect them with their community as an element of their trauma recovery. This is not a once-for-all process. Each of these sacraments can be received by the believer as often as is required. So for the returning warrior, spiritual healing is not a sprint but a marathon, passing by the same places over and over again until there is safety, remembrance, and reconnection.
References Caruth, C. (1991). Unclaimed experience: Trauma and the possibility of history. Yale French Studies, 79, Literature and the Ethical Question, 181–192. Combat Stress is here to support you. (2014). Retrieved from https://www.combatstress.org.uk/ veterans?gclid=CO-uu4iwp8ICFa7LtAodIzoAyQ. Egan, H. D. (1998). Karl Rahner: The mystic of everyday life. New York: The Crossroad Publishing Company.
123
J Relig Health French, S. E. (2005a). The code of the warrior: Exploring warrior values past and present. Lanham, MD: Rowman & Littlefield. French, S. E. (2005b). Warrior transitions: From combat to social contract. JSCOPE, 1–13. Gradus, J. L. (2014). Epidemiology of PTSD. Retrieved from http://www.ptsd.va.gov/professional/PTSDoverview/epidemiological-facts-ptsd.asp. Herman, J. (2001). Trauma and recovey: From domestic abuse to political terror. London: Pandora. Homer. (1996). Odyssey (R. Fagles, Trans.) Odyssey. New York: Viking Pengiun. Horowitz, M. (1986). Stress response syndromes (2nd ed.). New York: Aronson. Jones, S. (2009). Trauma and grace: Theology in a ruptured world. Louisville, Kentucky: Westminster John Knox Press. Lange, D. G. (2010). Trauma recalled: Liturgy, disruption, and theology. Minneapolis: Fortress Press. Mahedy, W. P. (2004). Out of the night: The spiritual journey of vietnam vets. Knoxville, TN: Radix Press. Pound, M. (2008). The assumption of desire: Kierkegaard, Lacan, and the Trauma of the Eucharist. Journal for Cultural and Religious Theory, 9(1), 67–78. Rahner, K. (1977). Meditations on the sacraments (S. Attanasio, J. M. Quigley & D. White, Trans.). New York: Seabury. Rahner, K. (1983). Theological investigations XV: Penance in the early church (L. Swain, Trans.). London: Darton, Longman & Todd. Rayment, S. (2013, 17/03/13). PTSD on the rise among British servicemen and women after a decade of war, The telegraph. Retrieved from http://www.telegraph.co.uk/news/uknews/defence/9934809/PTSDon-the-rise-among-British-servicemen-and-women-after-decade-of-war.html. Remarque, E. M. (1998). The road back. New York: Fawcett. Shay, J. (2003). Odysseus in America: Combat trauma and the trials of homecoming. New York: Scribner Book Company.
123
