The Rev. Dr. Vance P. Davis on Spiritual Care for PTSD victims

SPIRITUAL ASSESSMENT AND CARE FOR VETERANS WITH
POST-TRAUMATIC STRESS DISORDER

I came to the Mountain Home Veteran’s Affairs  Medical Center (later renamed the James H. Quillen VA Medical Center) in Johnson City, TN in 1993. I had worked in a state psychiatric hospital in Knoxville, TN for nearly 20 years before that. In my work with veterans and incest victims in Knoxville, I became aware of the deep spiritual injury to those who had been traumatized by combat or sexual and physical abuse.  But it was my work with the outpatient Post-Traumatic Stress Program at the Quillen VA Medical Center that taught me about the nature of spiritual injury. I will refer the readers to the Diagnostic and Statistical Manual for Mental Disorders, Volume IV (DMS IV) for the official list of diagnostic traits for post traumatic stress disorder (PTSD). PTSD is still regarded as a type of panic disorder, even though panic attacks are only part of the symptom picture.

In the late 1980's and early 1990's VA chaplains were working with a variety of spiritual assessments to help with spiritual care of veterans. Gary Berg, chaplain at White Cloud VA Medical Center in Minnesota, developed a comprehensive assessment tool, which included a section on "spiritual injury." The spiritual injury scale asked veterans to report if they never, sometimes, often, or very often experienced such spiritual injuries as guilt, shame, rage, grief, unfair treatment by G-d or life, and other injuries of the soul. (See below assessment form currently in use at the Quillen VAMC.) At Quillen we extracted the spiritual injury scale and expanded it to use in the Substance Abuse Treatment Program, and with veterans with PTSD in the psychiatric inpatient unit and the outpatient Post Traumatic Stress Program. Assessment is very important to spiritual care in this arena.

We discovered that veterans with PTSD report that they often or very often  experience rage, guilt, shame, grief, and betrayal . Underlying all of these experiences is a pervasive lack of trust. We deal with  these issues in educational seminars for veterans with PTSD: 12 two-hour sessions over a six month period. You might call this psychoeducation program “All you Ever Wanted to Know about PTSD, but were Afraid to Ask.” We  follow this with coping skills workshops to teach anger management and assertiveness training.  Spiritual recovery is very much a part of this training. This is where the Spiritual Injury Inventory comes in. We help veterans discern the difference between shame and guilt, we help them look at how they have unresolved grief from combat experiences in which buddies were killed, and we help them deal with the sense of betrayal by their superiors and/or their political leaders. 

A distinction between spirituality and religion is drawn in these sessions, and the focus is on spirituality: defined as a group of relationships (with self, others, nature, and G-d or Higher Power) which help us make meaning and find purpose in life. A spiritual injury usually indicates brokenness in relationships in one of the realms mentioned above. Perceptions of betrayal may lead to rage, which may make one feel guilty, all of which is injurious to one’s spirituality. Trust is important, since recovery depends upon a person's willingness to trust in a Higher Power and/or other persons who would guide them.

We also have a 12-step program for PTSD, which is two hours per week for 12 consecutive weeks. We deal with each of the twelve steps, as rewritten for PTSD, and hope that this beginning will lead to more effective spiritual recovery for those who participate.

It is helpful to use the concept of spiritual injury in ministering to trauma victims, especially those with combat-related PTSD.

I am attaching the spiritual assessment tool I currently use as a "Readjustment Counselor Therapist" in the PTSD program. Since I retired from chaplaincy in 2002, I have been serving part-time with the PTSP in this capacity.

JAMES H. QUILLEN VA MEDICAL CENTER
POST TRAUMATIC STRESS PROGRAM
SPIRITUAL/RELIGIOUS ASSESSMENT

This is an assessment of your religious/spiritual practices and the extent to which you may have been spiritually injured in your life. This information is confidential and will be used only to help you deal with your spirituality as it relates to your PTSD.

A. Do you have membership in or participate in any local church/ synagogue/mosque or other organized expression of religion?
____yes                     ____no (skip B)

B. If A is yes, how often do you participate?
Religious Holidays ___                  Four or more/year___Monthly                      ___                 Weekly                       ___

C. Do you have a personal/private spiritual practice?
____yes                     ____no (skip D)

D. If C is yes, what do you do?
Pray    ___                 Meditate___  Read  ___Listen to Music ___ Walk   ___     Run  ___Talk to Others  ___  
Other  ___

Comments:________________________________________________________________
            _________________________________________________________________________
            _________________________________________________________________________

E. If you are not religious and do not have a spiritual practice, how do you cope with life’s cares, and what gives you a sense of purpose or meaning in life?
Comments:________________________________________________________________
            _________________________________________________________________________
            _________________________________________________________________________

F. Do you worry about your doubts/disbeliefs in G-d?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

G. Do you feel G-d (or Life) has treated you unfairly?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

H. Do you feel that life has no meaning or purpose?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

I. Do you have feelings of despair or hopelessness?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

J. Do you worry about or fear death?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

K. Do you think about taking your own life?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

L. Do you feel sad or experience grief?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

M. Do you feel shame or humiliation?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

N. Do feel disappointed or betrayed by others?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

O. Do you feel anger/rage or resentment?
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

P. Do you feel guilty over past behavior (including what you should have done?)           
1.   Never           2.  Sometimes       3.   Often        4.   Very Often

Q. Would you like to discuss any of these issues with a member of the PTSP staff?   
   ____Yes                ____No

If yes, how can you be contacted? _______________________________________________
_________________________________________________________________________

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