The soldiers were pinned down, taking heavy fire and casualties from what they determined was a lone gunner behind a protective wall. Finally, one soldier broke from the group, made his way to the wall and in a fervent burst of gunfire took the sniper out — it was an 11-year-old boy.
Later, that scene in the soldier’s head kept him from sleeping, played on his spiritual beliefs and made him question his moral compass. He felt unworthy of his religion, unworthy of his family. He knew he needed to talk to someone. He went to see a chaplain.
“Chaplains are often the first line of defense for service members wrestling with issues of moral and spiritual concerns,” said chaplain and Navy Cmdr. Raymond Houk, who related the sniper story. Houk is assigned to Pastoral Care at Walter Reed National Military Medical Center and works at the National Intrepid Center of Excellence.
“The unique relationship between chaplain and service member creates a pocket of trust wherein we can help with issues like forgiveness, grief, survivor’s grief and inner moral conflicts — issues that stay with people after experiencing difficult situations and making life and death decisions. Often what’s needed is for them to accept that they made the best decision under the circumstances,” said Houk. “In those cases, we offer support and compassion to help them forgive themselves.”
Chaplains can be in the unique circumstance of having to counsel a service member on both spiritual and psychological loss — and be able to distinguish differences.
In many parts of the world where deployed units are on smaller ships or isolated outposts, behavioral or psychological health care providers are not commonly attached to the units, but most often chaplains are. That puts them in the position of also being the first line of defense for service members having psychological concerns, such as posttraumatic stress. Although some behaviors are common to both spiritual and psychological concerns, chaplains are trained to identify symptoms of posttraumatic stress disorder (PTSD). “We’re trained to know when the service member needs to seek behavioral health care so we’re very familiar with sleeplessness, intrusive thoughts, nervousness and anger issues,” said Houk. (Read this post about one chaplain’s personal experience with PTSD.)
A spiritual assessment is often the first step for a chaplain faced with helping service members showing signs of PTSD. An assessment helps identify spiritual needs important to their psychological health care, said Houk. “It may include faith practices or beliefs that give their life purpose, meaning, depth and value — beliefs that can impact their behavioral health,” said Houk.
At military treatment facilities chaplains can read, make notes to and include the spiritual assessment in electronic records. “Knowing that a spiritual assessment is not separate from treatment but an integral part of the healing plan encourages the patient to be more forthcoming about their spiritual beliefs, and raises their awareness that their beliefs can be a source of strength and healing during the recovery process,” said Houk.
Houk pointed out that it’s critical for the patient to understand that the chaplain is part of the medical team. Historically, chaplains have had close relationships with medical personnel. “From my perspective, the process of moving service members from spiritual counseling to provider care is handled well, but chaplains still need to be intentional about keeping proactive relationships with health care providers,” said Houk. “Providers need to be aware of chaplains’ capabilities and trust them to make solid referrals.”
Chaplains can find support and resources in this PDF: fact sheet and through the Chaplain Working Group hosted by Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Contact the group for details.