The Houston Church Sanctuary goes dark as a psychiatrist and a US Army major prepare to speak.
A power outage has caused technical difficulties, but the dim setting illuminated only by light shining through the stained glass windows seems appropriate, they say, for their purpose: “talking about soldiers who are in darkness.”
Major Jeff Matsler describes a bestseller at the military supply store just outside the gates of Fort Bragg, a large Army base in North Carolina. It’s a heavy-duty black T-shirt with a single word emblazoned across the chest in white gothic letters: guilty.
The fact that the shirt “is purchased and worn by the soldiers of a volunteer army speaks to the very root of . . . the spiritual state of our modern warrior,” says Matsler. The soldiers who buy it feel “at odds with what is right—including God.”
The shirt, says Matsler, an Army chaplain now completing graduate studies at Yale University, “reflects the thoughts of so many combat veterans: Where was—where is—the God who let me experience war? I am without him. He is not here.”
After Matsler finishes his presentation, psychiatrist Warren Kinghorn describes how he diagnoses veterans who come to Durham VA Medical Center, one of the 1,700 VA (Department of Veterans Affairs) facilities set up for veterans and their families.
Then Matsler poses a startling question. “Warren, if one of your patients—a combat veteran—came into your office this morning and said he was living in the ruins of an abandoned church, and during the night the altar crucifix opened its eyes and spoke to him, commanding him to restore the church, what would you do?”
Combat can cause “a sickness of the soul,” Matsler observes. “One of the most obvious markers of the war-torn soul is suicide.”
The statistics are grim: Veterans commit one-fifth of all suicides in America today, at the rate of about 8,000 suicides every year. In 2012, the United States lost more active-duty soldiers to suicide than to combat in Afghanistan. It was the highest number in a year—349—since the Pentagon began tracking numbers in 2001.
While war is everywhere in human history, a clear sign that we live in a fallen world, only relatively recently have we begun to study the psychological trauma it can cause. Now, thanks to new research on combat trauma, veterans—and the church—are getting a better understanding of war’s assault on the human soul.
Matsler’s question about the altar crucifix is the kind of inquiry that has intrigued Kinghorn since he began his medical career nearly 20 years ago. In the fall of 1997, Kinghorn was a first-year at Harvard Medical School. He was shadowing a clinician at an alcohol detox facility in one of Boston’s poorest neighborhoods. Kinghorn noticed that patients commonly described feeling bound by their addiction. He began to wonder how that description connected to Christian teachings on sin.
So Kinghorn rode his bicycle across town to the Harvard Divinity School library, where he found an encyclopedia of religion. Under the entry for sin, he read about the Pelagian controversy. Church theologians concluded that, rather than being free moral agents, human beings are trapped by their sin. Kinghorn realized that for nearly two millennia, the church had “sustained deep reflection about core issues that are absolutely relevant to modern medicine.”
The insight disrupted Kinghorn’s career path. He left Harvard to obtain a master of theological studies at Duke Divinity School. Then, after receiving his medical degree in 2003, he returned to Duke as a resident in psychiatry.
Kinghorn's first assignment was at the Durham VA, where—in keeping with the way that post-traumatic stress disorder (PTSD) was understood within psychiatry at the time—he "learned the wrong things about PTSD." Defined as an anxiety disorder, PTSD was believed to be driven by “intense fear, helplessness, or horror” following a traumatic event, resulting in an array of symptoms. In 2003, most of Kinghorn’s patients were Vietnam veterans, some of whom complained of struggling for decades with insomnia. Many also suffered from nightmares and hypervigilance, avoided crowds, and had marital difficulties.
Kinghorn learned to give “a quick PTSD diagnosis” and apply “a simple formula” for treatment: Prescribe medication to blunt the fear response, recommend social support, and refer the patient for talk therapy. “You didn’t have to get inside anybody’s world,” says Kinghorn, “or know anything about combat or that person’s particular traumatic experiences.”
But then a VA colleague, also a combat veteran, introduced Kinghorn to the writings of Jonathan Shay, a psychiatrist who began treating Vietnam veterans in the 1980s. Shay concluded that the “psychological and moral injury” sustained in combat destroys trust. He wrote that when “the capacity for social trust is destroyed, all possibility of a flourishing human life is lost.”
As Kinghorn read Shay’s Achilles in Vietnam: Combat Trauma and the Undoing of Character, he was struck by one veteran’s description of himself as a “typical young American boy,” an 18-year-old virgin with “strong religious beliefs.” When he went to Vietnam, “I wasn’t prepared for it at all.” He found that “It was all evil. All evil. . . . I look back, I look back today, and I’m horrified at what I turned into. What I was. What I did.”
Kinghorn’s training had taught him to focus on fear. But his patients didn’t talk primarily about fear. They talked about right and wrong. He realized that the focus on fear had blinded him to veterans’ deepest struggles. For those with severe, long-lasting PTSD, “the burner under the pot” was often “a combination of fear and guilt and shame.” Those potent emotions came not only from what they had witnessed, but also from their own actions in the morally confusing situations of modern combat.
Michael Yandell, a veteran, wrote for The Christian Century earlier this year:
For me, moral injury describes my disillusionment, the erosion of my sense of place in the world. The spiritual and emotional foundations of the world disappeared and made it impossible for me to sleep the sleep of the just. Even though I was part of a war that was much bigger than me, I still feel personally responsible for its consequences. I have a feeling of intense betrayal, and the betrayer and betrayed are the same person: my very self.
In the Frontline documentary The Soldier’s Heart, Marine veteran Rob Sarra tells of manning a vehicle outside of an Iraqi town. He saw a burqa-clad woman carrying a bag approach another vehicle full of Marines. They gestured and shouted for her to stop, but the woman continued walking. Having been warned about suicide bombers, Sarra had seconds to decide whether to shoot the woman or risk seeing his buddies blown up.
He shot. Other Marines opened fire as well. As the woman hit the ground, she pulled out what was in her bag—a white flag. Sarra began to weep.
For Kinghorn, Sarra’s story is a paradigm of the impossible moral situations of combat, of “the real stakes for people having to make these decisions.”
In the final year of his psychiatry residency, Kinghorn began doctoral studies in theology at Duke. He researched the social history of PTSD, which was birthed out of the work of psychiatrists Robert Jay Lifton and Chaim Shatan and social worker Sarah Haley. Based on a series of “rap sessions” with Vietnam veterans, Shatan penned a 1972 New York Times op-ed titled “Post-Vietnam Syndrome.” The syndrome was marked by alienation, rage, feelings of betrayal by military leadership and the broader culture, and an inability to give and accept love. These are all “deeply moral categories,” Kinghorn notes. But their “moral resonance” had been lost in the codification of PTSD and the 30 years of research that followed.
Kinghorn was not the only clinician who was dissatisfied. In 2009, VA psychologist Brett Litz and colleagues appropriated Shay’s once-obscure term—“moral injury”—as another way of understanding combat trauma. They believe that moral injury occurs when a soldier is exposed to or partakes in “acts that transgress deeply held moral beliefs and expectations.” While traumatic events and atrocities can cause moral injury, so too can more “subtle acts” that “transgress a moral code.”
Photographing Dead Bodies
Logan Mehl-Laituri Isaac is a decorated Iraq war veteran who knows firsthand the moral pain of combat. In his memoir, Reborn on the Fourth of July, Isaac recounts how, after 11 months of active combat in Iraq, he was assigned to a hospital morgue. The morgue’s capacity was so overwhelmed that bodies had to be left outside “to swell and stink mercilessly in the desert heat.” He was ordered to photograph the corpses before they decomposed beyond recognition.
“Not one tear tumbled down [as] I photographed countless dead and dying Arab faces,” writes Isaac. He recognized at that moment how numb he had become to human suffering. It “was like finding a membership card to the Ku Klux Klan in my wallet—with my own signature on it. I could not believe that I could be so callous, so immune to the human cost of war.”
After being honorably discharged, Isaac struggled with profound nihilism, tempting fate repeatedly by surfing in dangerous conditions off the coast of Hawaii. “My church had nothing to say to me besides party lines like ‘God bless the troops.’ ” As he struggled with depression, Isaac found that reading Lamentations was “incredibly therapeutic.” The prophet’s words gave voice to his own emotional and spiritual devastation.
Isaac used his GI Bill benefits to study theology at Duke. His first year was “very challenging because of the things people would say, coming from this very liberal, academic, and young culture.” Although he embraced pacifism—and found many classmates at Duke who shared his beliefs—Isaac was dismayed that many remained ignorant about and insensitive toward service members. When the Duke War Memorial was defaced by graffiti, his classmates questioned how, as a pacifist, he could respond with grief. He was similarly troubled when a classmate dismissed Lamentations, saying that now that we have Jesus, “Shouldn’t we be encountering God with joy and clapping our hands?”
Then Isaac heard of a new professor who understood his concerns.
While finishing his dissertation, Kinghorn had been recruited to join the faculty of a new initiative in theology, medicine, and culture at Duke. He expected that his views on combat trauma would be relevant mostly in his clinical work. But that changed when Isaac sought him as an academic adviser.
As he supervised Isaac, Kinghorn grew increasingly dissatisfied with the medical approach to combat trauma. He concluded that the issues raised by PTSD and moral injury are the ones that mental-health professionals are not fully equipped to address.
Kinghorn resists the tendency of modern health-care systems to call on psychiatrists to prescribe medication and leave talk therapy to others. He believes medication is a useful and sometimes necessary tool that can help manage symptoms. But it hardly ever provides a cure.
New evidence-based talk therapies offer more hope. Such therapies, Kinghorn notes, ask the therapist to practice “moral guidance and discernment.” One manual for practitioners of cognitive processing therapy, for example, teaches therapists how to help clients forgive themselves.
Kinghorn says this creates a “structural dilemma” for practitioners in a field that aspires to be scientific and value-neutral. To answer, “What does it mean to go on as a moral self in the world after an experience in war?” requires a vision of “the shape of a well-lived human life.” This vision can’t be conjured scientifically. It must rest instead on “thick and particular conceptions of human flourishing and failing.” Clinical psychology does not always possess such a robust vision. But the church does.
The Gospel and PTSD
At the heart of the gospel is a narrative of creation, brokenness, redemption and reconciliation, and new creation. Kinghorn turns to this narrative for a rich language and set of practices through which each war veteran can understand “what it means to be claimed by a God who created a good world.” He points out that in Jesus Christ, we have a “paradigm of mental health and flourishing.” After all, Jesus was once rumored to suffer from mental illness (Mark 3:21) and endured physical and mental anguish. The church has language and practices to foster healing for veterans: lament, confession, and reconciliation. All of these allow us to “listen, reflect, bear, and grieve” with our veterans.
The church can acknowledge that while war may sometimes be justified, says Kinghorn, it is “always a tragic manifestation of human brokenness.” We also have the hope of the Resurrection, and “the peace that is not simply the attenuation of distress but, rather, the right and ordered alignment of desire toward God and to God’s good creation.” Finally, we have the “healing resources of the community,” which can be brought to bear as we create spaces where veterans can experience reconciliation.
Churches and faith-related organizations have launched programs in recent years to better care for veterans’ mental and spiritual health. The Brite Divinity School in Fort Worth, Texas, started the Soul Repair Center in 2012 with a focus on research and recovery methods for those suffering from moral injury. They serve as a resource to educators, caregivers, employers, and religious and nonprofit organizations in general. Partners in Care, initiated by a chaplain in the Maryland National Guard and later expanded by chaplains in the Missouri National Guard, connects soldiers to their local congregations. Wheat Ridge Ministries, a Lutheran organization committed to assisting local congregations’ healthcare ministries, gave a grant to a Lutheran pastor and former Minnesota National Guard chaplain to help widely distribute his book Welcome Them Home, Help Them Heal to congregations.
Moral injury is really “a rediscovery of an older set of truths,” says Kinghorn. The church has a long history of ministry to and by veterans, and Kinghorn believes “the old stories need to be told.” Matsler, one of Kinghorn’s students, introduced him to just such a story—the life of Saint Francis—which takes on an unexpected shape when seen as a tale of combat trauma.
Kinghorn invited Matsler to share this story at Walking Together, a conference in Houston convened to unearth these stories and help the church envision “creative and faithful ways” to walk with people suffering from a range of mental-health issues. And so, in the darkness of the Houston sanctuary, Matsler tells the story of this “posttraumatic saint.” This Francis hardly resembles the “pop-culture icon of . . . a pure and saintly youth who gave up wealth for the simple life.” Matsler draws a more realistic picture based on early and recent biographies of Francis.
Francesco Bernadone was born in the medieval town of Assisi, Italy. When he was 16, armed conflict broke out between his wealthy merchant class and the nobility. Trained as a member of the cavalry, Francis likely participated in skirmishes that culminated in a disastrous assault against the heavily fortified town of Perugia. Francis joined the “bloody day of fighting crowned by an even bloodier afternoon of extermination” in which many of his companions were killed. In a time when “no pity was shown to those whose lives were spared,” and torture was used to encourage ransom, Francis and his fellow survivors became prisoners of war.
After nearly a year, Francis was released, and he began to show classic signs of trauma. He wept frequently and uncontrollably, stopped eating and sleeping, and saw and heard things that nobody else did. He “became convinced that in order to be happy, he must hate and despise all that he had loved and instead embrace that which brought him horror, including intimate contact with lepers—kissing them on the hands and mouth—perhaps the most dangerous act one could perform in his day,” says Matsler.
Francis hid from friends and family, living as a recluse in a dark pit under a house. He was rumored to have a drug problem and to be possessed; fellow townspeople wrote him off as mad. Chased and mocked in the streets, he became an outcast.
One day Francis came upon an abandoned chapel outside of town. There, the figure of Christ on the cross appeared to come alive: “Francis, go, repair my house, which, as you see, is falling completely to ruin.” Francis spent the next two years literally repairing abandoned church buildings.
To respond to Christ, Francis gave away not only his own possessions but his family’s as well. Fed up, his father dragged him before the bishop in the town square and accused him of thievery and dishonoring his parents. Francis, rather than replying to the charges, stripped himself and gave his clothes to his father. He said that from then on, he was going to give his allegiance to his Father in heaven. With that, the bishop embraced him and became his champion.
That moment “set in motion a movement that salved war-weary souls across Europe and the Middle East,” says Matsler. Francis’ message “of rigorous discipline and obedience to Christ” was “a familiar and appealing method for a soldier”—and his first recruits were fellow veterans. Together they created a community where they found healing, reconciliation, and a new mission.
Covered by Grace
While the church has much to offer veterans, veterans also have much to offer the church. From Martin of Tours (a soldier who founded the first monastic community) to Francis to Ignatius of Loyola (the founder of the Jesuits)—all were veterans who laid down their weapons and pledged allegiance to Christ. But in so doing, they didn’t abandon their gifts of military formation and training. As Isaac says, “There is good in war as well as bad.” And one of the goods is soldiers’ willingness to serve and sacrifice for the mission and for each other. The military forms people “to be ready to die, suffer, and persevere despite suffering—and that is something the church can learn from.”
Inspired by the Franciscans, Matsler wants to create monastically inspired communities where veterans can experience healing. Isaac agrees that veterans need safe spaces to support each other: “Veterans will tell fellow veterans something different than they will tell a counselor or pastor.” Kinghorn believes that programs designed to engage veterans must be done patiently and on a small scale, such as sharing a meal together. “I am becoming convinced that the most determinative thing Christians do is to eat together,” says Kinghorn. “Things happen when Christians eat together that open up spaces.”
Kinghorn cautions that, because there are many roles in the armed services, veterans’ experiences differ widely. And while between 15 and 30 percent of veterans who have been deployed in Iraq or Afghanistan meet the criteria for PTSD, the remaining majority do not.
If there is one thing veterans share, says Kinghorn, it’s hatred for the question, “Did you kill anyone?” It’s best to simply ask a veteran what their deployments were like, keeping in mind that people feel differently about their time in the service. Most important, says Kinghorn, is to “be human and work on friendship.”
When Francis was an outcast, two kinds of people reached out to him and helped him find his path: veterans and church leaders. In the town square, the bishop removed his own red robe and draped it over Francis, claiming him as a child of the church now covered by grace. Matsler believes this was a “moment in history when restoration and healing of the human condition became the focus of the church.”
Like the bishop, the church has the opportunity to dress the wounds of each war-torn soul among us. Good mental healthcare is a necessary and valuable part of that work. But if we seek the full flourishing of those who have been formed by war, Kinghorn is convinced, the church has an irreplaceable role to play.
Annalaura Montgomery Chuang is a writer, editor, and church leader in the Boston area.
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