Feelings of Overwhelming Shame/Unworthiness
Combat related Post Traumatic Stress Disorder causing feelings of overwhelming shame and unworthiness in part, underscore the growing incidents of military suicides in the United States. According to the Associated Press of America “Suicides in the U.S. military surged to a record 349 last year, far exceeding American combat deaths in Afghanistan, and some private experts are predicting the dark trend will worsen this year (2013).” These figures reveal 11 to 20 percent of every 100 veterans of both Iraq and Afghanistan suffer PTSD. These figures also provide an over representation of female soldiers who not only experience the traumas associated with combat but in addition experience the stress factors aligned with sexual assault and sexual harassment. (Castillo, 2012) The onset of this type of PTSD symptom often arises from previous psychological and emotional traumas in the soldier’s life
According to Schultz, PTSD remains typical of the mental and emotional ramifications of combat-related psychological issues plaguing the veteran. Viewed as a “combat stress injury”
In this process, Wilson et al (2001) explain typically the initial answers the survivor formulates contain fundamental inaccuracies. The PTSD itself’ affects the persistence of these inaccuracies. The significance of the answers in the recovery process lend to further struggles for the combat-related PTSD survivor. (p. 337) With the emotional aspects of feelings of shame and unworthiness, symptoms include inaccurate recollections of the event where they may unjustifiably blame self.
The significance of this relates to how the answers affect recovery. Research reveals the cognitive issues aligns with the emotional symptoms including feelings of shame and unworthiness directly because of the PTSD and proves an impairment of function in “almost every aspect of their life (Sympson, 2000, p. 287).”Typical to the PTSD emotional and mental symptoms is the onset of mental processing issues and loss of memory as well as other memory impairments. There exists a stress related hormone affecting function of the cortical brain. Wilson (2001) explains studies of PTSD in part depend on the distressing and fragmented recall of the combat-related trauma resulting in negative aspects to their quality of living and life. (p. 320) As Wilson (2001) explains this fragmented issue concerns a lack of accurate appraisal and information processing. (p. 71).”
The negative self-image of unworthiness of the combat-related PTSD symptom too often becomes self-prophesizing as well as perpetuating cycles of episodic PTSD, 2001, p. 72) In reading the literature the underlying reasons for the combat-related PTSD is obviously the survivor incurring feelings of shame and unworthiness (and the other symptoms) arise because of taking on the burden of the deaths of combat casualties. In this, Hughes and Honzo (2009) explain the overwhelming sense of blame incurred by the survivors become underpinnings of their PTSD. These survivors avoid review of the catastrophic events from the perspective of the actual events continuing retention of the shield of self-blame, shame, and unworthiness. (pp. 20-28)
In this process as described by Hughes and Honzo (2009) there exist missing parts of the combat situation and with this avoidance of reviewing the trauma there remains lost opportunities to correct the inaccuracies. In the ensuing recourse the survivor with PTSD continue taking the blame for every heinous actions leading to the deaths of othersfrom the self inflicted guilt, shame, and unworthiness for surviving when others did not. This is a cognitive process of trauma interpretation when the survivor digs for explanation coming up with self-recrimination. Their inventory of the characteristics of the deaths of others in combat becomes an emotionally distressed and inaccurate assessment that changes the survivor as much as the actual combat event. In this, the recovery process becomes a reconciliation of a person‘s moral, religious, and spiritual beliefs aligned with their view of self. In the recovery process, therefore the individual begins a journey of rediscovery pf life amid the tragic understanding of life’s evils. (pp 20-28)
In their study findings Besterman-Dahan, Gibbons,, Barnett, and Hickling, report the benefits of the service member suffering the combat-related PTSD symptoms of feelings of shame and unworthiness (and other mental and emotional issues) view the “natural setting for counseling and for mental health screening” as a welcomed personalized process. Due to the confidentiality offered by the setting and relationship the PTSD survivor builds with clerics in both the military and non-military role, these individuals gain the much needed trust and safety factor aligned with recovery. (p 1032)
According to Plante and Sharma (2001) the positive association of mental health outcomes in treating combat-related PTSD survivors living with self imposed shame and unworthiness. Regaining their well-being and positive sense of self, the combat-related PTSD survivor integrates their spiritual foundations with the mental health treatments gain positive outcomes toward recovery of a life worth living. (p 254)
Hughes and Hondo (2009) explain how the PTSD survivor suffering from the combat-related PTSD with feelings of shame and unworthiness may work within the “framework of spirituality and religion” may choose focusing “on altruism and helping others can serve as a way to move the focus off of one’s own struggles. “ In doing so, the beginning of rebuilding their self-esteem ensues. From this process the positive outcomes with connection to others replaces shame and unworthiness with feelings of worth as well as identifying and embracing healthy growth and maturity. (p 52-53)
Hughes and Hanzo (2009) further advise the pastoral professional of the beneficial position they hold in assisting the PTSD survivor with “recognizing that the trauma” can provide the transformational opportunity for the survivor making their lives into more of what they desire. Through the spiritual foundation of the relationship built in the face of such dire adversity and disruption of their lives the cleric offers profound support for making meaning from the traumatic experience of combat. (52-53)
At this juncture of the relationship between the pastoral professional and the PTSD combat survivor the time together becomes an island of nonjudgmental discourse. Within the confines of the safety, comfort, and freedom to speak in detail of the combat experience changing their life forever, the PTSD combat survivor shares what continues causing the feelings of insurmountable shame and unworthiness. Within this profoundly neutral environment, the PTSD survivor remains protected as they recreate this horrific stressor. This may incur graphically minute details of an experience no human should ever have according to Hughes and Honzo (2009, p 31).
Hughes and Honzo (2009) further explain the importance of the neutrality of the cleric as God or spirituality in general representative at this pivotal time in the safety bond created with the PTSD survivor as they share these intimate details of the horror of their experience. Every nuance and reaction as well as response from the pastoral professional remains “gauged by the patient and potentially used to confirm or deny some of his or her doubts or concerns about God’s response to his or her behavior (p. 31).”
Another aspect of this critical time intervening in the PTSD survivor’s sharing these memories of the combat event centers on his or her concern their actions places them outside the sphere of God’s forgiveness, grace, and love as further defined by Hughes and Honzo (2009) again, places the pastoral professional in need of checking how they interact in gesture and comment during the P TSD survivor’s narrative as one cringe or subtle expression of repulsion during this time can turn this neutral and safe environment into confirming this survivor’s worst fear that indeed, God condemns these unwanted feelings and the memories of their actions during combat and only add to the psychological and emotional turmoil already existing in their precarious emotional existence. Key to successfully continuing the environment of safety remains the pastor’s ability remaining detached as they attend the combat veteran’s retelling of their war nightmare. Listening in the same manner as to the retelling of a benign high school high jinx underscores the pastor’s role of sensitive advocate of the veteran in crisis on their road to recovery. (p 31)
Combat related Post Traumatic Stress Disorder causing feelings of overwhelming shame and unworthiness in part, underscore the growing incidents of military suicides in the United States. Research literature continues underscoring the importance of the pastoral professional creating a safe and nonjudgmental environment where the combat-related PTSD survivor suffering any of the debilitating symptoms of this condition can express the narrative of their horrific experience on the battlefront. Sensitivity to diversity of the religious, spiritual, racial, gender, culture, as well as sexual preference needs consideration in the spiritual care intervention of feelings of shame and unworthiness as the veteran works recovering a life forever changed by war.
APS (American Press Association) (2013) US Military Suicides Exceed Combat Deaths. Retrieved from http://www.cbsnews.com/8301-201_162-57563857/u.s-military-suicides-exceed-combat-deaths/
Besterman-Dahan, S., Gibbons, S.W, Barnett, S.D., & Hickling, E. J. (2012). The Role of Military Chaplains in Mental Health Care of the Deployed Service Member. Military Medicine 177(9), 1028
Castillo, M. (2012) Study: Suicide Rates Among Army Soldiers Up 80 Percent. Retrieved from http://www.cbsnews.com/8301-504763_162-57394452-10391704/study-suicide-rates-among-army-soldiers-up-80-percent/
Hughes, B. & Honzo, G. (2009). Spiritual Care and Handbook on PTSD/TBS/ Retrieved from
Plante, T.G., & Sharma, N.K. (2001). 10: Religious Faith and Mental Health Outcomes. In T.G. Plante & A.C. Sherman (Eds,) Faith and Health Psychological Perspectives New York. Gilford Press.
Sympson, S. C. (2000). Chapter 15: Rediscovering Hope: Understanding and Working with Survivors of Trauma. In C. R. Snyder (Ed.), Handbook of Hope: Theory, Measures and Applications (pp. 285-300). San Diego, CA: Academic Press.
Schultz, P. (2013). Meaning-making, PTSD, and Combat Experiences Retrieved from http://deploymentpsych.org/topics-disorders/ptsd
Wilson, J.P., Friedman, M.J., & Lindy, J.D. (Eds,) (2001). Treating Psychological Trauma and PTSD. New York. Gilford Press.
Zoroya, G. (2011) Study Suggests Feelings of Guilt May Be a Top Factor In PTSD. U.S. Today News.com Retrieved from http://usatoday30.usatoday.com/news/military/story/2011-11-23/study-of-marines-ptsd/51386488/1