At 48 Bill is a complete loner. Ever since he returned from Vietnam he does not like to talk with anyone, not even his wife. He often drives around aimlessly in his pickup truck for hours on end. He is moody and drinks a lot.
Cathy, 32 and single, had been happy and content. But recently she always seems tired and depressed, complains about headaches and night mares, and cringes if someone ad dresses her from behind.
Betty is a happy-go-lucky young woman most of the time. She is active in her church and sings in the choir. At times she appears to be different. She seems unable to remember conversations and people, is more argumentative and really strange. But then she is her old self again.
Bill, Cathy, and Betty have one thing in common: they suffer the effects of severe trauma and need help.
What is trauma?
Trauma is an experience that threat ens the life and health of an individual or someone close to that person, with the threat going beyond any coping mechanism the individual may possess. If the trauma is human-made, the sense of being overwhelmed and devastated is especially harmful and lasting. Such experiences as cited above illustrate the kind of trauma that war (Vietnam), rape, and child abuse can cause.
Trauma can shatter trust in people, institutions, and even God. It is difficult to believe in a loving God if a grenade ripped to pieces a friend next to you, if you were raped, or if your father abused you as a child. Physiological responses to trauma also make the integration of the experience extremely difficult, resulting in confusion, denial, and isolation.
One way abused children often deal with trauma is by "pretending" that they are not hurting or that somebody else is experiencing the pain. This phenomenon is called dissociation and can, if carried over into adult life, result in multiple personality disorder (MPD). Some psychiatrists deny the existence of MPD; others diagnose it in almost every patient. Some would suggest that MPD is demon possession and point to increased discoveries of satanic ritual abuse. These discussions should not detract us from recognizing that child abuse (especially sexual abuse, including incest) is more prevalent than previously thought. Child abuse results in deep psychological wounds and possible physical injury and should never be blamed on the victim.
Despite the mysterious nature of MPD, it simply is an extreme form of what mental health professionals call post-traumatic stress disorder (PTSD). Psychologists began to research this phenomenon when more and more Vietnam veterans showed up in the Veterans Administration hospitals with such symptoms as anxiety, depression, frequent nightmares, flash backs (horror visions, auditions, or sensations in the waking state), head aches, spaced-out or distant feelings, and suicidal or homicidal fantasies. The researchers found that severe traumatic events can cause immediate or delayed reactions, resulting in such symptoms, independent of the person's background or mental stability. The PTSD was a common occurrence among Vietnam veterans.
Similar reactions were observed in veterans of World War I (often falsely attributed to "shell-shock"), World War II (sometimes called "combat neurosis"), and other wars. Further more PTSD is also found in abused and battered women and children, in rape victims, in survivors of catastrophes, and in anyone who survived a traumatic experience. Not all the symptoms have to be present, and many of the symptoms can have causes other than trauma. This makes it sometimes difficult to detect trauma as the cause of a problem.
What you can do
Listen, listen, listen! Trauma victims must be encouraged to voice their experience, pain, humiliation, frustration, and loneliness. Often they have not had an opportunity to share their experiences and feelings with anybody. In fact, they may even try to hide the ugly truth from themselves. But night mares, flashbacks, cold sweats, and headaches are painful reminders of some dark secret in the past. Often the survivor resorts to some kind of self-treatment and turns to alcohol and/or drugs. If you start to listen in a nonjudgmental way, you can break the cycle of silence and denial and begin to allow a healing process that involves body, mind, and soul.
What about prayer and Bible? The good news is: healing and wholeness are possible, even for the most severely abused trauma survivors. Obviously many Bible texts could be used to help trauma victims. But a word of caution is necessary. Trauma survivors, even if they are believers, may not be able to hear the Word, unless you first have really heard their suffering. It is all too tempting to opt for an easy way out, and "soothe" the pain by simply quoting a Bible text and saying a quick prayer. Often this serves more the pastor's need to avoid the pain, rather than the survivor's need to deal with it. Pray for the person, if you cannot pray with him or her. And pray for patience and stamina to listen to the horrendous stories that are part of our sinful world. By listening, being deeply moved, and sharing the pain, you will proclaim the gospel loud and clear, long before you open the Bible or bow your head in prayer.
Learn more about trauma. The list of suggested readings provides some relevant literature to learn more about trauma. But here most pastors will quickly reach their limits in time and expertise. Do not attempt therapy if you are not trained for it! Be pastoral in your help, and refer the trauma survivor to a trusted counselor or therapist. Referral is not a cop-out, but a skill that requires tact and sensitivity. Affirm the person in his or her struggle to talk about the trauma. Explain that you want to offer the very best and therefore would like to recommend counselor X, or psychologist Y, or the VA outpatient services (if the person is a veteran). If possible give the per son several names to choose from and offer your continued support and avail ability. You are not giving someone up, but you are utilizing the best re source available for the person's benefit!
Good resources for a referral of the trauma survivor are the American Association of Pastoral Counselors and the more conservative American Association of Christian Counselors. AAPC certified pastoral counselors usually hold at least a master's degree in pastoral counseling in addition to their theological training and have received many hours of clinical training and supervision. There are no comparable standards for the AACC. Thus it is advisable to check for other credentials, such as licenses or state certification. For any war-related trauma your parishioner should be referred to the nearest VA medical center, where specialists in trauma work are avail able, and services are usually free of charge for veterans. The Loma Linda University Behavioral Medicine Center, Loma Linda, California, can also provide referral sources.
One final word of caution. As long as you have to deal with trauma or when referral is not an option, be aware that working with trauma survivors is a highly intense, draining, and painful activity. You will often find yourself confused, angry, sad, or hurting. This is normal and may just give you a taste of what the person you deal with is going through. What is true for them is also true for you. You need someone to talk to. As pastors are bound to confidentiality, this may be a difficult issue for you. However, not getting help can produce a double risk. It can seriously affect you ("secondary traumatization"), making your efforts of pastoral care unaccounted for at best, harmful at worst. Thus the strong recommendation has to be: treat yourself to some counseling and/or supervision.
Chester, S. E. Making Effective
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Flannery, R. B. Post-Traumatic
Stress Disorder: The Victim's
Guideto Healing and Recovery.
New York: Crossroads
Herman, Judith L. Trauma and
Recovery: The Aftermath of
Violence from Domestic
Abuse to Political Terror. New
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Putnam, Frank W. Diagnosis and
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Guilford Press, 1989.