A Book Review: Pastoral Care for Iraq/Afghanistan veterans.

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More American veterans of the Vietnam war died by suicide after returning home than the 50 thousand who came home in body bags, whose names are inscribed on the monument in Washington, DC. The lethal nature of war persists even when they come home alive–and (allegedly) unscarred. Here’s a look at all that from the inside. Reviewer Matthew Becker’s father was one such survivor who came home wounded. Severely so. Becker reviews here for us a book about those badly damaged survivors, that then goes on to spell out the rubrics for distinctive Christian care to move them to fuller recovery. Matt is a prof in the Theology Department of Valparaiso University in Valparaiso, Indiana.

Peace and joy!
Ed Schroeder

When my dad returned from Korea in the fall of 1951 he was a wreck. He had been severely wounded in the Battle of Heartbreak Ridge. Actually pronounced dead on the battlefield and then later found breathing, he was rushed to a MASH unit, stabilized, and sent back to the states for months of rehabilitation. He was blind in one eye, partially blind in the other, deaf in one ear. He had lost part of his brain. Bullet wounds and grenade fragments had left other scars on his chest, legs, and head. But the more troubling scars were hidden, psychological, moral, soul-scars. His father, a Lutheran chaplain at the Oregon State Hospital, and mother did their best to try to help their 20-year-old son to accept what had happened to his body and to move on with his life, but they were overwhelmed by the challenges to help heal his spirit. As my grandfather told me later (I was born a decade after my dad was injured), the only medicine for the deepest wounds were the gospel and persistent Christian love and care. At my dad’s funeral I commented on how my dad had died twice before his final physical death: the first death was in his baptism, when he died with Christ and was raised to new life in him, and second was on that fateful day in October, 1951. His “third” death happened in June, 2004, long after the 7-10 years that the VA doctors had given him to live after his terrible injuries. Of course, in between these “deaths” my dad died daily in remembrance of his baptism. Such daily dying was necessary, especially when memories of what he had done in the war surfaced to trouble his conscience. (One evening, decades after that Forgotten War, while my dad was watching a report on the news about Korean and Vietnam widows and orphans, he began to cry. “Maybe I killed that woman’s husband or that child’s father or brother…” We three kids went to bed early that night.)

I often think about my dad when I see reports about the young service personnel who are returning with similar wounds from Iraq and Afghanistan. What kind of spiritual care will they receive for their troubled souls?

Given that nearly 70,000 Americans have been severely injured in these wars and that 500,000+ have been injured or damaged in other ways, both physical and psychological, Christian caregivers and church workers will likely face situations where they will be called upon to provide ministry to such individuals and their families.

My grandparents could have benefited from the booklet, WELCOME THEM HOME–HELP THEM HEAL: PASTORAL CARE AND MINISTRY WITH SERVICE MEMBERS RETURNING FROM WAR, a 2009 publication of Elim Lutheran Church of Blackhoof (Barnum, MN) that was written by John Sippola (military and hospital chaplain, parish pastor), Amy Blumenshine (candidate for diaconal ministry in the ELCA), Donald Tubesing (retired pastor, prolific author on wellness and stress management), and Valerie Yancey (professor of nursing). Blumenshine has an MSW and a masters in theology, and both Tubesing and Yancey have earned doctorates (in counseling and nursing ethics[!], respectively). The book was partially underwritten by a grant from Wheat Ridge Ministries.

The purpose of the book is to provide knowledge and resources for pastors, parish nurses, counselors, and Christian caregivers in their ministry to service personnel and their families. By reading the book, I gained new understanding of the challenges that military personnel face before, during, and after deployment. Frankly, I learned about my dad and his similar combat and post-combat experience, even though he served in a different war half a century ago.

All wars are not the same and these current American wars are unique in several respects, not least because the mental and spiritual trauma of the Iraq and Afghanistan wars is extensive and intense. A key strength of the booklet is how it offers helpful avenues for addressing these deep and widespread wounds.

The book is divided into six brief chapters. After an introduction that underscores how serious the crisis of care is for America’s combat veterans, the first chapter provides an historical overview of the wars in Iraq and Afghanistan. Chapter two is devoted to an analysis of the challenges that military personnel face when they return from foreign wars to civilian life. Chapter three helps the reader to understand the complexities of warrior wounds, the ones that have injured the body, the ones that have done damage to the conscience, the ones that have done damage to the spirit. The final three chapters define three key roles that Christian churches have with respect to caring for wounded veterans. The first role is “to reach out” to each individual veteran by listening and encouraging self-expression, by relating to the veteran and not the war, by offering honest encouragement, by encouraging self-care, by making appropriate referrals to professionals, by praying, by being genuine and trustworthy, by receiving care themselves. The second role of the church is “to create a healing environment.” Caregivers within Christian communities do this by being tactful, offering hospitality, praying for veterans and their families, creating a “circle of care,” remembering veterans in regular staff meetings, learning about the phases of military service (pre-deployment, deployment, post-deployment, re-deployment), working toward peace, allowing for confession and forgiveness and making amends. A final role for the church is to provide healing rituals throughout the church year. This chapter offers several creative ways that congregations can implement spiritual healing exercises and activities into the rhythm of the church year, e.g., one Lutheran congregation developed a Lenten worship series to address personal and communal “spiritual wounds” and the brokenness of war.

While these chapters offer a wealth of practical tips and advice on helping veterans to heal, I was a little surprised that the theological dimension of that healing process was not more explicitly articulated in the chapter that summarizes the church’s “first role.” The primary role of the church is to proclaim and teach the gospel and administer the sacraments according to the gospel. This role involves inviting individual members of the congregation, including veterans, to repent of their sins and to trust that for Christ’s sake they are forgiven. That, of course, is what my Grandfather said finally was most helpful to my dad in his healing. Certainly the gospel is implied throughout the book as essential in the healing process, but there really isn’t any careful articulation of how the gospel specifically applies to the lives of these veterans in that chapter four, where it would best fit. What difference does Jesus really make for combat veterans? The lack of explicit gospel articulation in chapter four was the most glaring weakness of the book to me. For example, in that chapter, “Basic Principle #3: Offer honest encouragement” begins with the following assurances: “It’s not your fault. Your struggles, whatever form they take, are not your fault nor are they signs of weakness” (p. 52). Are Christian caregivers ever really in a position to say this, especially if in fact some of the veteran’s struggle is due to actions (or inactions) that the combat veteran is convinced were sinful? It would seem to me that an appropriate pastoral response to the veteran who struggles with guilt and anxiety, at least in some pastoral situations, is not to excuse or deny or explain away the veteran’s guilt, but to help the veteran to come to the point of being able to confess “the struggle” and guilt to God and to receive the forgiveness of Christ. Perhaps one ought to help the veteran to die daily with Christ and rise anew in Christ’s mercy and forgiveness. (Sacramental theology is not really addressed until the final chapter on liturgical practices that promote healing.) Thankfully, chapter five does in fact underscore this need for Christ’s forgiveness in the section, “coming to grips with guilt,” which does involve confession and forgiveness. Maybe the problem here is one of placement. Wouldn’t Lutherans put a section on “law” and “gospel” in chapter four (“the church’s first role”) and at least acknowledge that Anfechtungen (“spiritual struggles”) and the accusatory nature of God’s law in one’s conscience (“guilt”) are results of sin that all sinners experience, and that these are only properly addressed through the consolation of the gospel of Christ crucified and risen? That seems to me to be the church’s primary role, and thus an articulation of that role belongs in chapter four and not mentioned in passing at the end of chapter five.

Three appendices are tagged on at the end. The first addresses how to make a referral for a veteran and includes an overview of the Veterans Administration and helpful community resources for veterans (such as online organizations). The second appendix includes several screening tools that parish nurses could use for preliminary detection of possible Post-Traumatic Stress Disorder, depression, and traumatic brain injury. These tools are not diagnostic, but are designed to help a caregiver to decide if further evaluation would be helpful. The final appendix is a “wounds of war assessment,” which is designed to help the caregiver “identify factors that may affect the health and well-being of veterans who have served in combat and thereby suffered wounds of war” (p. 103).

The style of writing makes each chapter understandable and interesting. Helpful quotations from veterans of several wars, caregivers, and professionals are highlighted in the margins to connect human experiences with the themes in each chapter. “Key point” boxes are interspersed throughout. At the end of each chapter there is a page for the reader to make notes to him- or herself. This is a very practical resource that Christian congregations will want to utilize in their outreach and ministry to veterans and their families.

To order a copy of the booklet ($10) and learn about additional resources, visit http://www.welcomethemhomebook.com/.