Resiliency and Hope

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Resiliency and Hope

• Engaging Spiritual Resources
• Post trauma
• Rev. John P. Oliver, D.Min., BCC, ACPE Supervisor
• Chief of Chaplain Service, Durham VA Medical
  Center

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Overwhelming Task

• Having looked into the abyss of evil, death
  destruction our veterans return with the one
  thousand-yard stare.
• We, the care providers, see the coming storm and,
  in parallel process feel overwhelmed.

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Where we are today. . .

• As of June 26, 2008
• 4,633 USA - Fatalities (OEF/OIF)
• 17,627 WIA Returned to duty within 72 hrs
• 14,782 WIA Not returned to duty within 72 hrs
• OVER 1.6 Million service members are involved in
  the Global war on terror (GWOT).
• http//www.defenselink.mil/news/casualty.pdf

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Challenges in Returning Home . . . .

• Trauma reactions upon returning from war are
  NORMAL reactions to abnormal circumstances.
• Resetting - Difficulty of coming home and
  turning off combat skills.

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Typical Crisis Cycle
Crisis
A typical crisis has a beginning where stress
builds, a high point of stress and then a slow
tapering of anxiety and fear that leads to
recovery.
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Re-setting for Civilian Life
Crisis
Individuals post-trauma are at a constant state
of readiness. Easily triggered. Hypervigilance
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Re-setting after multiple deployments
Crisis
Crisis
Crisis
Pre-deployment
1st Deployment
2nd Deployment
Over time, resources for managing crisis are
eroded. Crisis comes earlier.
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Reactions to Traumatic Events

• Psychological
• Cognitive
• Behavioral

• Physical
• Emotional
• Interpersonal

Spiritual
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Spiritual Reactions to Trauma

• Confusion about God
• Altered sense of meaning in/of life
• Loss of previously sustained beliefs
• Confusion about core ethical beliefs.
• Grief around loss of relationship with God
• Questions of Theodicy
• Feeling dirty and unworthy
• Feeling permanently damaged
• Feeling guilty

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Spiritual Consequence of War
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Weakened Faith

• Research showed that a Veterans' war zone
  experiences (killing, losing friend, etc.)
  weakened their religious faith, both directly and
  as mediated by feelings of guilt.
• Weakened religious faith and guilt each
  contributed independently to more extensive
  current use of VA mental health services.
• Fontana, A., Rosenheck, R. (2004). Trauma,
  change in strength of religious faith, and mental
  health service use among veterans treated for
  PTSD. J Nerv Ment Dis, 192(9), 579-584.

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Spirituality Rebuilding a Life

• Spirituality is that which gives a person meaning
  and purpose.
• It is found in relationships with self, others,
  ideas, nature, and, possibly, a higher power.
• These many relationships are prioritized
  according to an organizing principle and form an
  intra-, inter-, and trans-relational web that
  houses a person's sense of meaning and purpose.
• Spiritual distress arises when one of these
  relationships that provide meaning is threatened
  or broken. The more significant a particular
  relationship is, the greater the severity of
  spiritual distress if that relationship is
  threatened or broken.
• Spiritual wholeness is restored when that which
  threatens or breaks the patient's relational web
  of meaning is removed, transformed, integrated,
  or transcended.
• Mark LaRocca-Pitts, Ph.D. .

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Resilience Defined

• Doing well in adversity
• The ability to overcome setbacks and obstacles
  maintain positive thoughts during times of
  adversity.
• The capacity to cope effectively with the
  internal and external stresses.

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Resilience is Not

• Invulnerability . . .
• The idea that everyone can succeed in fame and
  wealth when faced with difficulty.
• A replacement for erred public policy nor is it a
  reason to avoid social change.
• Resilience comes at a cost. Psychological scars
  often, if not always accompany the resilience
  that individuals attain in the most difficult
  situations
• Titus, Craig Steven Resilience and the Virtue of
  Fortitude Aquinas in Dialogue with the
  Psychosocial Sciences, 2006.

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Facets of Resilience

• Resilience helps us cope with hardship (endures,
  minimizes or overcomes hardships)
• It helps us resist the destructive pressures on
  our physiological, psychological and spiritual
  self (maintains capacity)
• Resilience moves us to achieve a new proficiency
  out of the unfavorable experience.

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Resilience Research

• Genetic approach
• looking at genetic codes for resilience
• Personality approach
• looking at how positive and negative outcomes can
  be attributed to temperamental traits and
  developed characters.
• Cognitive approach
• seeing emotions as the result of the meaning a
  person attributes to particular events and
  experiences
• Developmental approach
• identifying adaptive reactions to developmental
  challenges of the life span
• Social Relationship approach
• exploring how changes in family, religious and
  other social relationships contribute to the
  challenges we face or help us overcome them.

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Spiritual Resources for Resilience

• Faith
• Explore questions of meaning and purpose in life.
  There is a meaning . . . I will find it.
• Reframing the meaning of the event.
• Forgive and be forgiven.
• Trusting God for protection / guidance.

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Spiritual Resources for Resilience

• Community
• Sense of belonging to and being loved by God.
  God as a supportive partner.
• Attachment to God and others. (Bowlbys
  attachment theory suggests When we feel secure,
  well attached, we are not fearful.)
• Subject rather than Object (I and Thou)
• Purpose within the community
• Reduced risky behaviors.
• Rituals establish belonging and patterns of
  behavior

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Spiritual Challenges for Resilience

• Negative Prayers
• Prayer study shows deleterious effects of
  negative prayers for removal of problems rather
  than positive prayers for support through the
  problems.
• Problems arise when
• One views traumatic events as punishment from
  God.
• One views God as angry, unfair and punitive.
• There are unclear boundaries within congregation
• Pastoral and congregational responses do not
  engage the person at their point of need.

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Resilience as a Choice

• Viktor Frankl
• described those prisoners who comforted others
  and shared their scarce rations as "sufficient
  proof that everything can be taken from a man but
  one thing the last of the human freedoms--to
  choose one's attitude in any given set of
  circumstances, to choose one's own way."

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Resilience and Moving Ahead

• Harold Kushner
• suggests that when bad things happen, "All we can
  do is try to rise beyond the question why did it
  happen?' and begin to ask the question what do I
  do now that it has happened?"
• Helen age 10
• Bad things can turn into good things.
• Joseph
• You meant it for evil, but God meant it for
  good

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Cost of Resiliency

• Psychological scars often, if not always
  accompany the resilience that individuals attain
  in the most difficult situations
• Giving up precious relationships, ideas and
  self-understandings
• Forgiveness Pardon
• Change of life goals / mission / purpose.

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Hope
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Hope Defined

• Hope is a belief in a positive outcome related to
  events and circumstances in one's life.
• Hope implies a certain amount of despair,
  wanting, wishing, suffering or perseverance
  i.e., believing that a better or positive outcome
  is possible even when there is some evidence to
  the contrary

Wikipedia
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Hoping Defined

• Hoping is a realistic and adaptive response to
  extreme stress or crisis in which the person
  acquires a patient and confident surrender to
  uncontrollable, transcendent forces. 
• Hoping contrasts with wishing, which implies more
  urgent ego claims and controls aimed at
  particular objects and goals.   
• Similarly, despair may be regarded as a more
  objectless and profound state of being than, for
  example, grief, which attaches to specific loss.
• Dictionary of Pastoral Care and Counseling 

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Hope and what is Possible

• Hope is a sense of what might be possible.
• Imagining that what we really need is possible,
  though difficult.
• Hopelessness means being ruled by the sense of
  the impossible.
• Hope is an arduous search for a future good of
  some kind that is realistically possible but not
  yet visible.

Lynch, William F., Images of Hope Imagination as
Healer of the Hopeless, 1974
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Hope and Imagination

• Hope is tied to the life of the imagination
• The nature of hope is to imagine what has not yet
  come to pass but is still possible.
• Hope imagines and refuses to stop imagining (or
  hypothesizing)
• Hope imagines With it is a collaborative venture

Lynch, William F., Images of Hope Imagination as
Healer of the Hopeless, 1974
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True Hope

• Hope is not initiated and sustained by erasing
  emotions like fear and anxiety, it integrates the
  genuine threats and dangers that exist into the
  proposed strategies to subsume them.
• Hope takes into account the real threats that
  exist and seeks to navigate the best path around
  them.
• Hope brings reality into sharp focus. Hope
  incorporates fear into the process of rational
  deliberation and tempers it so we can think and
  choose without panic.
• Groopman, Jerome The Anatomy of Hope

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Actualizing Hope and Resilience

• Honest, caring relationship
• Truthful imagination of the future
• Resource review what was lost? What was
  gained?
• Acceptance of humanity
• Pardon
• Collaboration / Community

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Need for a Community Response

• No one system can provide all the services
  needed.
• Supporting the family will support the
  individual.
• 78 of survivors receive 100 of their support
  from family members.
• Survivors and caregivers needs are different.

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Veterans Use of Clergy

• Veterans feel more comfortable approaching their
  pastor than they do a mental health professional.
• Individuals seek council from ministers more than
  all other mental health providers combined. In
  minority populations this is even more true.
• Often seeing a member of the clergy is less
  threatening and has less stigma attached. Is
  viewed as engaging a known community resource.
• Negative reasons. . . Magical thinking, avoiding
  truth of diagnosis, etc.

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Community-based Support Teams

• A community-based support team is
• a group of volunteers
• organized to provide practical, emotional
  spiritual support
• Team Philosophy
• Do what you can, when you can
• In a coordinated way
• With a built-in support system

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Value of Teams for Clients

• Hope
• Decreased isolation
• Increased quality of life
• Decreased stigmatization
• Early intervention
• Adherence to treatment regimen
• Peer-to-Peer support

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Value for Team Members

• Altruistic experiences
• Decreased social isolation
• Increased awareness of problems experienced
• Gratitude
• Mission and Purpose

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Concentric Circles of Care
Support at any level ripples back in a positive
way to the veteran.
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Support Team Philosophy

• Do what you can, when you can
• In a coordinated way
• With a built-in support system

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Support system

• Members support one another by
• setting personal and team boundaries,
• sharing the care,
• inviting new persons to join the team.
• The support system encourages
• mutual, respectful relationships
• appropriate educational and emotional support and
  supervision.

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Resources

• Project Compassion
• 180 PROVIDENCE RD STE 1-CCHAPEL HILL,
  NC 27514(919) 402-1844

www.project-compassion.org
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Bibliographic Resources

• Cantrell, Bridget and Chuck Dean, Down Range to
  Iraq and Back, 2005.
• Drescher, Kent D., National Center for PTSD
  Menlo Park.
• Figley, Charles, Strangers at Home Comment on
  Dirkzwager, Bramsen, Adèr, and van der Ploeg,
  Journal of Family Psychology, 2005.
• Fowler James, Stages of Faith The Psychology of
  Human Development and the Quest for Meaning.
  Harper Row San Francisco 1981.
• Frankl, Viktor, Man's Search for Meaning An
  Introduction to Logotherapy Boston
• Groopman, Jerome, The Anatomy of Hope How
  Patients Prevail in the face of Illness. Random
  House, 2003.
• Hasty, Cathy and Mona Shattell, Putting Feet to
  What We Pray About. Journal of Hospice
  Palliative Nursing, 2005
• Jaffe, Jaelline, Jeanne Segal, Lisa Flores Dumke,
  Fontana, A., Rosenheck, R. Trauma, change in
  strength of religious faith, and mental health
  service use among veterans treated for PTSD.
  Journal of Nervous Mental Disorders. 2004

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Bibliographic Resources

• LaRocca-Pitts, Mark, Walking the Wards as a
  Spiritual Specialist. Harvard Divinity Bulletin,
  2004.
• Lester, Andrew D Hope in Pastoral Care and
  Counseling, Westminster John Knox Press, 1995.
• Lynch, William F., Images of Hope Imagination
  as Healer of the Hopeless. Notre Dame Press,
  1974.
• Paynter, Emily, Ph.D. Compassionate Care,
  Meditations and Insights. (2006)
• Shumann, Joel, Keith Meador Heal Thyself
  Spirituality, Medicine and the Distortion of
  Christianity. Oxford Press, 2003.
• Titus, Craig Steven Resilience and the Virtue of
  Fortitude Aquinas in Dialogue with the
  Psychosocial Sciences, The Catholic University of
  America Press, 2006.
• Weaver, Andrew, Laura Flannely John Preston
  Counseling Survivors of Traumatic Events, 2003.
• Wolski Conn, Joann (ed.), Womens Spirituality
  Resources for Christian Development. Paulist
  Press, 1986.

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Other Resources

• http//www.helpguide.org/mental/emotional_psycholo
  gical_trauma.htm
• http//www.hooah4health.com/mind/combatstress/defa
  ult.htm
• www.ncptsd.va.gov
• Rev. John P. Oliver, D.Min.
• Chief, Chaplain Service
• Durham, NC 27712
• [phone] john.oliver_at_va.gov

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