Pastoral Response to Combat Trauma 1997

8/11/2019 Pastoral Response to Combat Trauma 1997

1/16

C OMBAT T RAUMA AND P ASTORAL R ESPONSE

Don Sensing/ Div. 3052/ 8 Dec. 97

I NTRODUCTION

Combat trauma is the term used to describe adverse psychological, emotional and spiritual

reaction to the experience of armed combat. It is a subset of post-traumatic stress syndrome

(PTSD). However, while PTSD can be brought about by any life-threatening situation

automobile accident, robbery or a heart attack (Foy, 622), combat trauma is specifically the result

of battle.

There are almost 27 million veterans, of whom 22 million served during conflict. Forty-three

million other Americans are dependents or survivors of a veteran (VA figures). Probably most

Americans have a veteran somewhere in their families, and frequently several across generations.

For example, my grandfather was drafted in World War I, my father served in World War II. My

older brother escaped Viet Nams draft, but many of his age did not.

In this paper, I will examine some psychological, emotional and spiritual characteristics of

combat trauma and propose a pastoral approach to dealing with it in a civilian congregational

setting. This paper does not address care of combat veterans still on active-duty or immediate

responses to combat trauma such as would be used by military chaplains or mental health

professionals. It does not address veterans who are receiving professional care through theVeterans Administrations systems.

R ELATIONSHIP OF THE T OPIC TO THIS C OURSE

According to the classic military theorist Karl Clausewitz, killing is the sine qua non of war:

without killing there is no war. Soldiers in battle are surrounded by death and the threat of death.

The battlefield is a grisly place. William Manchesters description of Iwo Jima could have been

written about almost any large-scale battlefield: You tripped over strings of viscera fifteen feet

long, over bodies which had been cut in half at the waist. Legs and arms, and heads bearing only

necks, lay fifty feet from the closest torsos. As night fell, the beach reeked with the stench of

burning flesh (Manchester, 340).

Veterans cope with death in three broad categories. First, they struggle to accept that it is

Page 1 of 16


2/16

American soldiers, stripped of all equipment, liedead, face down in the slush of a crossroadssomewhere on the western front.

possible (even likely) that they might die. Second, they wrestle with the death of close friends

due to enemy action, accident or disease. 1 Finally, many veterans carry the burden of having

killed other human beings, sometimes in carload lots.

These experiences lead to a pastoral challenge in our churches for which pastors should be

prepared. Several World War II veterans have indicated to me that as their twilight years

approach some of these issues are resurfacing. Even the youngest World War II veteran is at least

70. In addition to the common issues of aging and loss that elderly parishioners face, some of

them (mostly men, but not exclusively) are now struggling with combat trauma again.

T HE E XPERIENCE OF C OMBAT

Fear and Fear Management

The fear of death is the soldiers universal lot (Keegan, 17). In one U. S. division in Francein 1944, two-thirds of the soldiers admitted that they

had been too frightened to do their jobs properly at

least once and forty percent said it happened

routinely. A post-war Army study found, There is

no such thing as getting used to combat. Each

moment of combat imposes a strain so great that

men will break down in direct relation to the

intensity and duration of their exposure (Dyer, 142,

143). Indeed, several studies have noted that in

battle, the seeds of panic are always present in

soldiers.

A Marine wrote of single-handedly entering a

building to take out an enemy sniper: There was a

door which meant there was another room and the sniper was in thatand I just broke down. I

was absolutely gripped by fear that this man would expect me and would shoot me (Dyer, 101).

1World War II was the first American conflict in which deaths due to disease were fewer thancombat deaths. In the Persian Gulf War of 1990-1991, more American troops died in accidents than fromIraqi action.

Page 2 of 16


3/16

Medics help a wounded solider in France, 1944.

The symptoms of fear are well documented. The heart pounds violently; frequently the

whole body shakes. Nausea occurs in about half the soldiers. A fifth lose control of their bowels.

There is an urgent need to urinate. Many troops clench their jaw so tightly to control themselves

that it aches for days afterwards (Dyer, 142; Keegan, 261).

Stephen Getsinger noted that being

wounded was often a relief to soldiers

because the inevitable had finally happened

and it meant that they would be out of action,

at least for awhile. It also generally raised

their esteem in the eyes of their fellows, since

they had done their duty and had not broken

down (assuming they werent wounded while

fleeing) (Getsinger, 217). James Jones said

the wounded had passed through some veil

isolating him, and entered a realm where

others, the unwounded, cannot follow. He has become a different person, and others treat him

differently. . . . The lucky ones, those hurt badly enough [would obtain] everybodys secret goal:

discharge (Jones, 86, 89).

Armies must form fighting units in which fear is managed and subdued enough so that the

military objective can be obtained. Therefore, commanders give extraordinary care and concern

to their soldiers physical and mental well-being. The most effective means of managing the fear

is to foster bonds of loyalty and affiliation for one another among the troopsbonds that only

death can break, not the mere fear of death. If this effort is successful soldiers will ultimately

cherish two things more than life: the lives of their buddies and their own reputations among

their comrades. Personal honor is the one thing valued more than life by the majority of

soldiers (Keegan, 52). One soldier wrote, We became great friends and one just cant describethe affinity there was. We were all in it together and it was a question of whats mine is thine

(Keegan, 273).

There is no civilian equivalent of this environment, with these bonds, except possibly in

Page 3 of 16


4/16


5/16

About the last thing to go was the old sense of esprit . That was the hardest

thing to let go of, because there was nothing in civilian life that could replace it

(Jones, 255,256).

The Loss of Friends

Soldiers frequently fear the death of friends more than their own death. 2 That is the reason

that self-sacrificial acts are common, such as jumping on top of a grenade to shield others from

the blast. William Manchester, badly wounded on Okinawa, wrote, Among men who fight

together there is an intense love; the thought of his friends facing danger without him to help

them was just intolerable. Those men on the line were my family, my home. They were closer

to me than I can say. I had to be with them, rather than let them die and me live with the

knowledge that I might have saved them (Manchester, 391).

Upon learning of Jonathans death, King David lamented, I grieve for you, Jonathan my

brother; you were very dear to me. Your love for me was wonderful, more wonderful than that of

women (2 Sam 1:26).

As David discovered, the deaths of friends can cause strong reactions. A veteran of World

War I wrote home, One of the most pathetic features of the war, he wrote, is this continual

forming of real friendships which last for a week or two, or even months, and are then suddenly

shattered for ever by death. However, the death of a comrade is more than just depressing: it

knocks away one of the props which sustains a soldiers morale, and suggests to him that his own

death may be near (Keegan, 265).

That their friends die is bad enough, but the deaths are harder to bear because they are often

so violent. Rifleman John Harris heard his friend cry out in battle and looked around to see him

sitting doubled up, swaying back and forth as if he had an intense stomach ache. He had been

shot sideways through both hips. Oh, Harris! said he, as I took him in my arms, I shall die!

The agony is so great I cannot bear it! . . . the froth came from his mouth and the perspiration

poured from his face. . . he suffered more for the short time that he was dying than any other man

2 During the Panama operation of December 1989, I heard that my best friends unit had beenmortared. The mere idea that he could have been killed or wounded made me break down. Later, Idiscovered that the report was false, to my great relief.

Page 5 of 16


6/16


7/16


8/16

The immediate effects of combat trauma from taking life is greater on infantrymen than, say,

artillery troops, who rarely see the results of their work. A Viet Nam infantryman related,

I got around to the side [of the enemy] and pointed my M16 at them and this

person turned around and just stared, and I froze, cos it was a boy, I would say

between the ages of twelve and fourteen. When he turned at me and looked, all of

a sudden he turned his whole body at me and pointed his automatic weapon at me,

I just opened up, fired the whole twenty rounds right into the kid, and he just laid

there. I dropped my weapon and cried. . . (Keegan, 257).

High-altitude bomber pilots had some cushion against the psychological effects of daily

combat (Dyer, 153a). A fighter pilot noted that you dont hear the shouts, you dont see the

face and you dont see the blood of the enemy in an airplane (Keegan. 193). However, crews of

aircraft such as bombers do face the horror of suffering and witnessing violent deaths.

For pastoral purposes, then, it is useful to remember that veterans experiences of killing

were different, depending on how they did it. The lingering issues needing pastoral intervention

cant be lumped into one hat, all benefitting from similar responses.

Guilt and Guilt Conflicts

Veterans of ground combat may have deep-seated problems with what they did in the heat of

battleacts that violated their innate sense of rightness or the Law of Land Warfare. 3 An infantry

sergeant told James Jones how his platoon had taken eight German prisoners during the battle of

the Bulge:

We needed some information, but they werent talking, not those tough old birds.

So we took the first one off to the side, where they could see him, and shot him

through the head. Then they all talked. Horrible? Evil? We needed that

information. Our lives depended on it. We didnt think it was evil. Neither did

they. But how am I going to tell my wife something like that? Or my mother?

They dont understand the problems (Jones, 255).During the battle for Okinawa, 85 Japanese nurses took shelter in a cave. Marines heard their

3This is the U.S. statute that codifies the various Hague and Geneva treaties and conventions.

Page 8 of 16


9/16

voices, but neither they nor their interpreter recognized them as feminine. When the nurses didnt

surrender, the Marines killed them all with flamethrowers (Manchester, 381). More than 30

American troops were killed in the Gulf War by erroneous or careless fire from other Americans.

One of the most difficult things for combat soldiers to adjust to is the fact that in battle, st

happens. As an old Army saying goes, Anything you do in combat can get you killed, including

doing nothing. The deaths of friends or civilians killed by accident or bad luck in the middle of

battle can be terribly traumatic, especially for the soldiers directly involved in it, such as the

Marines who killed the nurses. These sorts of lingering guilt issues over what should have been

done or not done can be the most difficult ones for veterans to work through.

One aircrew member wrote home from the front, Now more than ever I am determined to

wipe these rotten bastards off the face of the earth. Total and complete destruction is the only

way to treat these animals. I never thought I could hate them as much as I do now (Keegan,

159). Such feelings of animosity can be very strong long after the war is over. A pastor told me

this year that he was upbraided by one of his parishioners, a World War II veteran, for buying a

Honda automobile, a Japanese make.

More frequently, though, a veterans combat trauma is conflicted because of mixed feelings

toward the enemy whom he has tried to kill. A Viet Nam veteran wrote of the North Vietnamese

soldier, He was a trained soldier, and I was a trained soldier. And I respected him, and Im

pretty sure he respected me, you know. His job was to kill me, my job was to kill him (Keegan

267). Impromptu truces are commonplace between opposing forces. In 1914 German and British

officers and men met peacefully in most sectors, exchanged presents, took photographs and

even played football [soccer] (Keegan, 268).

In the Normandy battle in 1944, an American commander granted a truce to the Germans so

the wounded could be evacuated. The German officer came out to meet the American, who spoke

German. The German related that his forces had been ordered to withdraw from their position at

dusk. Immediately, the American said he would not continue the attack until after dark, when theGermans would be gone. They shook hands and did not shoot at each other again. In the same

campaign, an American ambulance driver made a wrong turn and was stopped by a German

sentry. The German saw the wounded soldiers and pointed the driver toward American lines. A

Page 9 of 16


10/16


11/16

Nurses caring for patients in a MASH unit, KoreanWar.

nurses. 4 The first female veterans who were recognized to have combat trauma were military

nurses in Viet Nam. Of the female veterans who served in the Vietnam theater 8.5 percent suffer

from war-related PTSD, while an additional 7.2 percent show partial symptoms of the disorder

(Dougherty, 1).

World War II Nurse Ruth Hess described setting up an evacuation hospital just behind

American forces sweeping through France:

We arrived late in the evening

and spent all night getting ready to receive

patients, setting up the tents and equipment.

Then went to work, for nine days we never

stopped. Eight hundred eighty patients

operated; small debridement of gunshot and

shrapnel wounds, numerous amputations,

fractures galore, perforated guts, livers,

spleens, kidneys, lungs, everything imaginable.

We cared for almost 1,500 patients in those

nine days. Then the hospital packed and

moved forward, closer to the front (Ambrose,

1). There are differences in the effects of combat trauma on females than on males. Compared to

men, women veterans:

are five times more likely to develop combat trauma symptoms, and have a higher

lifetime prevalence of combat trauma symptoms,

have a lower rate of alcohol and drug disorders but higher rates of major depression,

obsessive compulsive disorder, and phobias,

are more likely to be suicidal,

suffer more severe depressive episodes (Dougherty, 1).The most likely type of combat trauma for women is survivors guilt, the nagging feeling

4 The Womens Army Corps and the Army Nurse Corps were not the same. Nurses were not partof the WAC.

Page 11 of 16


12/16

that they could have done just one more thing to save a particular patient. Professional, or career,

nurses may be less likely to manifest this symptom than women who joined the service to be a

nurse for the present emergency, as the saying went in the world wars. However, field hospitals

and aid stations were by no means immune to enemy attack despite convention restrictions.

Combat-area nurses shared the same fears of death and wounds as their patients.

One of the chief contributors to womens combat trauma difficulties was the lack of peer

groups upon demobilization. There were no distaff equivalents of the VFW. Women veterans

had little opportunity to talk out their feelings and emotions.

P ASTORAL C ARE FOR V ETERANS IN A C ONGREGATIONAL S ETTING

At the outset, congregational pastors should realize that overt manifestations of combat

trauma will be unlikely. Usually, serious psychological disorders requiring professional care willhave manifested themselves before the veteran left the service. These persons will almost

certainly be under care of the VA. If so, a pastor should not attempt independent care for that

veteran.

Recent research into combat trauma suggest strongly that memories are amplified as time

passes. In a study of Gulf War veterans, Seventy percent of subjects recalled traumatic events at

2 years that they had not reported at 1 month. Subjects with greater PTSD symptom levels were

significantly more likely to amplify their memory of combat trauma at the 2-year assessment

(Hales, 143).

It is most likely that lingering effects of combat trauma will be triggered by certain dates,

such as Memorial Day, Veterans Day or VE/VJ Day, since pain is often associated with

anniversary reactions (Foy, 630). These days should not pass unnoticed by a congregation with

significant veteran membership. It is not necessary to dedicate an entire service to these occasion,

but there should definitely be some sort of pastoral recognition. Something as simple as a timely

phone call or an encouraging note can be meaningful to a parishioner who is experiencing painful

memories (Foy, 630).

A ecclesial distinction should be made between Memorial Day and Veterans Day. Memorial

Day is intended to honor war dead; Veterans Day is intended to honor living veterans. Pastors

should not confuse the two intentions because veterans certainly dont, especially those who lost

Page 12 of 16


13/16

With a canvas tarpaulin for a church and packingcases for an altar, a chaplain holds memorialmass for Marines at Saipan.

friends in the service. It would be a good idea to approach one or two veterans of the

congregation and ask them to design the appropriate recognition, within the limits of the order of

service.

Of course, pastors must be careful to honor the intentions of these days without glorifying

war. Rhetorically, one must walk a fine line between honoring the sacrifices on the one hand

(good) while not using triumphal language of domination and conquest (bad). By no means

should the nations erstwhile enemies be subjected to calumny. Not only is it lousy theology, it

would almost certainly be very offensive to most

veterans. 5 Themes of peace and reconciliation are

well received.

Issues of war and peace offer a pastor an

opportunity to wrestle with some of the most

difficult theological problems. In particular, a

service of communion brings forth stark images of

blood and broken body which offer chances to

address the spiritual issues of combat trauma.

Sacred heart of the crucified Jesus, take away this

murdering hate and gives us thine own eternal

love, William Manchester prayed (Manchester,

391).

In the eucharistic feast, wine becomes blood and bread becomes flesh. The

5 However, I continue to be surprised by the very strong feelings of hostility against the Japanese

by many (but not all) World War II veterans. Such animosity is rare against the Germans. A man in mycongregation was shot down over Germany and held prisoner for 14 months. His apparent feelingstoward Germany are positive, but he is venomous toward Japan, even though he never fought againstthem.

The reasons for this sort of hostility against Japan are complex, but seem to be due to the PearlHarbor attack, the fact that the Japanese method of war was exceptionally brutal, and outright ethnic spiteagainst the Asian race.

Page 13 of 16


14/16

The sea gave up the dead that were in it . . .

material is transformed into the spiritual. The transformation is accomplished by

the historical and material sacrifice of Jesus called Christ. This sacrifice is the

material transformation of the dichotomy of existence. To the extent the pastor

presents through word and sacrament this transcendence, he or she represents the

actions of Jesus Christ. . . . In the

issue of war, one clearly finds the

dichotomy of human existence.

(Dictionary, 1315).

Veterans may suffer from survivors

guilt in dreams, where unconscious

guilts are often manifested. . . . Fears that

they could have done something to save

their buddies if they had tried frequently

haunt veterans (Getsinger, 217). This

kind of guilt will likely not be verbalized

readily.

It is the pastors goal to foster insight and self-actualization. He promotes a climate

in which realistic understanding of needs, goals and options may be examined. This

takes place within the context of a religious community as regards acceptance,

nurturance, and the ultimate regard of every individual as an end in himself . . .

within the context of an ethic of redemptive love (Getsinger, 218).

Specific tips for a pastor helping a veteran with combat trauma are: 6

Do not marginalize veterans in the congregation because of ones own political, religious

or ideological beliefs and values. Remember that there is almost no one more inclined to

pacifism than those who have served in war.

Do not try to shut off expressions of guilt, condemnation or anger by the veteran. Do notmoralize about the rightness and wrongness of the veterans feelings.

6 Most of these suggestions generally follow Getsinger, 217, and Foy, 631, with my ownamplification. Since I have conflated them, it would be too awkward to attribute each point individually.

Page 14 of 16


15/16

. . . and death and Hades gave up the deadthat were in them, and each person was

judged according to what he had done. (Rev20:13)

Make use of the pastoral office as a representative of a religious tradition that stresses

both the reality of sin and forgiveness and healing.

Be alert for self-destructive indications.

However, listen carefully. Many veterans may

express bafflement at having survived, such as, I

just dont see why I am alive. This kind of

expression is not a suicide indicator.

Be observant for changes in emotional states

as significant dates come up. It is normal for

reminiscing to occur, but morose emotionalism may

indicate a need for pastoral intervention.

Do not stereotype veterans as permanently

scarred spiritually. Assume that their stress is caused

by their experiences, not spiritual weakness or

immaturity.

Appropriate role expectations for the helper are support, alliance and advocacy.

Recognize that recovery from combat trauma can be a lifelong process.

Help the veteran to understand that experiences cannot be done over and losses cannot be

restored, but they can be grieved. Be willing to encourage private rituals on the veterans

part to help work through grief and loss.

Page 15 of 16


16/16

B IBLIOGRAPHY

Photo credits: National Archives

Ambrose, Stephen E. The Toughest Job in World War II: Medicine in the U. S. Army.American Heritage magazine, Nov. 97, Internet pagehttp://www.americanheritage.com/97/nov/medic.htm

Bellafaire, Judith A. The Womens Army Corps: a Commemoration of World War II Service.Center for Military History Publication 72-15, undated, published athttp://www.army.mil/cmh-pg/wac.htm

Dictionary of Pastoral Care and Counseling. Rodney J. Hunter, ed. Abingdon, Nashville. 1990

Dougherty, Willie. Women Veterans: Survivors of a Secret BattlePTSD. Veterans News and

Information Service, undated, published at http://www.vnis.com/vetnews/vvoa9697.txtDyer, Gwynne. War. Crown Publishers, New York, 1985

Foy, David W., et. al. Posttraumatic Stress Disorder in Clinical handbook of PastoralCounseling, Volume 2, Robert J. Wicks and Richard D. Parsons, ed. Integration Books,Paulist Press, New York, p. 621

Getsinger, Stephen H. Pastoral Counseling and the Combat Veteran in Journal of Religionand Health 14, 1975, p. 214

Hales, Robert E., M.D. What is PTSD? The American Journal of Psychiatry, Feb. 97.

Jones, James. World War II. Ballantine Books, New York, 1975Keegan, John and Richard Holmes. Soldiers, a History of Men in Battle. Hamish Hamilton,

London, 1985

Manchester, William. Goodbye, Darkness: A Memoir of the Pacific War. Little, Brown andCompany, 1979.

________ . Sunset on the Western Front, Life, magazine, Nov. 1997 p. 94

Page 16 of 16
http://www.americanheritage.com/97/nov/medic.htmhttp://www.army.mil/cmh-pg/wac.htmhttp://www.vnis.com/vetnews/vvoa9697.txthttp://www.vnis.com/vetnews/vvoa9697.txthttp://www.army.mil/cmh-pg/wac.htmhttp://www.americanheritage.com/97/nov/medic.htm

Pastoral Response to Combat Trauma 1997

Documents

Transcript of Pastoral Response to Combat Trauma 1997