[ Music ] >> Central to the
incorporation of spirituality into healthcare is the notion
of patient-centered care. The fact is that the patients,
veterans, service members and families that we are
privileged to serve each come to us with their own
personal story to tell. For many these stories
are likely to include a dynamic
interplay between variables that we might label as
spiritual, religious, psychological, social
or physical. As healthcare providers
it is our job to meet the dynamic complexities
of our patients' stories with correspondingly dynamic
approaches to healthcare. That is what patient-centered
care is all about. It is what the integration
of mental health and chaplaincy is all about. And it is what will help
cultivate vibrant, meaningful, truly healthy lives
for those we serve.
[ Music ] >> I believe in God, but
I don't believe God was over there at all. [ Music ] I go to church, but I wonder
if I'm going to go to heaven. I wonder if what
I did was right. I wonder why it couldn't
be controlled from a higher level
which would be God. >> I feel bad about all the
things, I feel guilty in a lot of things but this — it's
like I can't get rid of that, can't get rid of that feeling.
>> I saw people blown
apart, I saw people without heads and
mutilated bodies. And the most horrific things
you could ever imagine, and I had to take
pictures of it. I can't erase those pictures. And as long as those
pictures exist my memories of that won't go away. [ Music ] >> I was buried alive and
in a great amount of pain. I could hear the
wounded and the dying. >> And still it's been four
years since I came home from my last deployment. I still don't go to a mall. I will do all my
shopping online. I don't want to go to a mall because there are a
lot of people there.
>> You get stuck into that
feeling that there is a threat around you which brings you
back from actually connecting with people that are
outside and around you. >> I've gone through a lot
of different therapists and different therapy types. And they'll say that
spirituality is important because everyone has
their higher power and ask for forgiveness. But I've still never been able
to ask anybody for forgiveness because I'm not ready to, I'm really not ready
to be forgiven yet. >> I think the first
thing that came to my mind when I didn't feel right
was feeling guilty. Here I am on a med team of
ten guys, I mean nine marines, one sailor, and not quite
sure what was going to happen with my team left behind. I know the guy that got hit, and
as a corpsman we're not trained to be the guys that
got hit, you know.
And it messed with
me for a while. But I was sitting there
in the bed and I said, hey you know what, I need
to talk to a chaplain. >> Hey, good morning. >> How you doing, sir? >> Alright, good
to see you again. >> Good to see you, too. >> When you hear the stories
of so many of these servicemen and women and what
they've been through and what they've overcome
and what they've achieved and the sacrifices they've
made it's an inspiration. It reminds you of
what an honor it is to really support them
and serve with them. My name is Bill Cantrell,
and I am a commander in the United States
Navy Chaplain Corps. >> Heavenly Father we
give thanks for this day. >> Perhaps the best known of all
scripture in the Old Testament. >> In the midst of his most
difficult trial King David was able to write this psalm. The Lord is my shepherd. >> Whether they're on
the ship or on land or whatever's going
on we're there.
And anytime a seabee or a sailor or marine need a chaplain
we're within arm's reach. >> Incredible. When they're suffering,
you're suffering. When they're eating
dust you're eating dust. >> I've had the opportunity
to work with a number of combat veterans who
have really taken — their experience in the
war has taken a toll on them emotionally,
psychologically, oftentimes physically. Clearly the great risk that
they take in sacrificing so much of their life to
do these things is such an invitation
for moral injury. And that is really an
opportunity for the chaplains to step in and really take
up the reigns where science and medicine can't necessarily
provide all the answers. [ Music ] >> I remember vividly
on my first baptism to combat operations I was on
the deck of the USS Princeton, LPH5 in the South China Sea.
I had been awakened at
3:30 in the morning, and after a traditional
breakfast of steak and eggs we were all
marched up to the flight deck where the helicopters were
getting ready to take us out into our first
exposure into combat. While we were standing on
the deck of the USS Princeton in the distance the skyline
was nothing but explosions and flashes and flairs
and aircraft going into attack mode and
artillery firing. And my anxiety along with everyone else's
was getting pretty high. Not so much because of whether
I would live or die but more so would I let the people
down to my left or right. Would I be able to do the
things that I needed to do in that kind of an environment? Well, lo and behold, right before I boarded the
helicopter a chaplain would come up behind me, put his
hand on my shoulder, and say God bless you son.
And that kind of settled
me down a little bit. You know, if I knew that God was
on my side or the chaplains were on my side I as in
a better position to do those things
that I needed to do. [ Music ] After I came into the
VA in the year 2000 with the Chaplain Corps
I thought part of my role in being a marine and a chaplain
in this teaching institution was to let chaplains know what
it is that they needed to do to survive and to
be more effective when working with veterans. If I had five chaplains in
the medical center each one of them could give
me a different story of what it is that they do. And so one of the things that
I taught very early on was how to have a consistent
message of who you are as a professional chaplain and
what is it exactly that you do.
One different issue might be
I am a professional chaplain. I provide pastoral care by
listening to a veteran's story, identifying areas of spiritual
injury or spiritual distress, and from that provide the
pastoral care they need to be well and to help
with their other injuries. I think the chaplain
is very unique in that they bring something
to the interdisciplinary team that was not there before. They bring parts of
the veteran's story. Rather than looking for a
diagnosis the chaplain looks to hear and to understand the
story of that unique person, that individual who has
suffered some kind of loss. Everyone in a veteran's hospital
has some kind of a loss. One veteran we had in hospice
care was very uncooperative with the treatment team. He did not want to share,
did not want to do anything, didn't want to be
where he was at. And the issue was that
the chaplain found out is the veteran
missed his dog.
Every morning for ten years
that dog went with him. But since his wife
died and since that veteran became sick he
was displaced from his home, his familiar surroundings,
but mostly from his dog. So even though he was diagnosed
with depression and diagnosed with other issues,
PTSD or whatnot, the issue for that
veteran was I miss my dog. And that was [inaudible]. And so what happened, the staff
downstairs went to the family, where's the dog, and developed
a visitation with the dog coming to the hospital with the
veteran, share the bed, be petted, and it made
a tremendous difference in the ability of that
veteran to actively participate in his treatment plan. >> Our primary mission is simply to be visible reminders
of the holy. And in this context, these
often unholy situations that we find ourselves. And so we want to
provide hope to the staff and to the patients
that come through.
>> And awareness of spirituality
and whatever that means to our airmen we bring
that to the fight. >> Unless we have people
dedicated to take care of individuals that comprise our
war fighting force the system will break down. People break down. And when they're at that
low point in their life where there is a Chaplain
Corps, both chaplains and chaplain assistants to help
build them back up and make sure that they continue forward with the mission
they're charged to do. >> I think sometimes people
hear the title chaplain or they see the various
religious badges that we wear and their first thought is
it's only religious stuff. And we cover that and we're
very proud to cover that, but we do a lot of emotional
and mental stuff as well where if you want to
talk about spiritual or religious stuff that's cool
and we're happy do to that. But if you don't want
to talk about that, if you just have things going on
in your life or you're stressed or you just need somebody
to listen we're that person.
>> This is a common occurrence
I've experienced in 30 years of being a military chaplain in that we often
find ourselves having to define what our role is. But one thing is clear in
that chaplains don't diagnose and we don't treat. We don't prescribe medications. We serve as advocates, our
gateway for service members to get the right kind of support
before problems escalate. As the principle moral,
ethical, spiritual advisor to commanding officers chaplains
enjoy a certain measure of standing and trust
because they're on the front line during crisis. And they do provide that
gateway to support services. Placement of a chaplain in a unit makes the chaplain
a first responder when dealing with combat and operational
stress because chaplains
are organic resources in a particular command. They're bystanders in combat, we're ready to support service
members during very traumatic and stressful times. In other words chaplains are on the front line whenever
any kind of crisis occurs.
[ Music ] >> I just really gained an
appreciation for the soldiers that serve us and put their
lives in danger every day so that we can live in
the freedom that we do. And this is an opportunity
for me to be able to give something back. >> We have a thing we
call ministry of presence, and it's getting
out of the chapels, getting out of the
staff office and going and being with the soldiers. Because you're there with them
when they have those questions and they're feeling down. And I've had my most profound
ministry experiences just as I've gone out to my guys to
remind them that God is present, to remind them that they
are spiritual in nature and they can grow in that. [ Music ] >> The kinds of problems
that service members bring to chaplains fall out in
three different areas, spiritual distress and
struggle, emotional problems and behavioral problems. Spiritual distress and struggle
might look like loss of meaning and purpose and hope
in one's life. Issues of grief and loss, anger
with God, a sense of abandonment or guilt over what
one may have done.
Then there's certainly trauma
whether it's the trauma of being to war or trauma
experienced in other areas such as sexual assault
or harassment. Service members talk to
chaplains about a variety of emotional problems, things such as post-traumatic
stress disorder, anxiety, depression, substance
abuse or misuse and anger. Behavioral problems that
service members bring to chaplains include
aggressive behavior, domestic and intimate partner violence,
relationship problems, suicidal thoughts, or they
may be sent to a chaplain after they've had an
actual suicide attempt.
From an operational
standpoint commanding officers or service members leadership
sort of have the mentality of fix them and send
them back to work. So many times a chain of
command for a service member who will send them
to see a chaplain. What's unique about the role
and function of a chaplain is that as chaplains we provide
absolutely confidentiality to service members. So that one does not have
to suffer in silence. The service member can discuss
their fears and concerns, and they can be understood
and heard. Talking to a chaplain is a
safe place to tell one's story without fear or judgment. [ Music ] >> My name's Mark Bates. I'm the Associate Director
for Population Health and the Deployment
Health Clinical Center, one of three centers in the
Defense Centers of Excellence for Psychological Health
& Traumatic Brain Injury. We've had the good fortune to
be assigned as the DOD lead for the integrative
mental health strategy for a chaplain's role
as a mental health. That's been a very
exciting activity to be part of because it's truly historic. They have both the Secretary
of Defense and Secretary of the VA say this is one of the
top 28 priorities for DOD and VA to look at to support
our service members and family members.
As a prior training director in the clinical psychology
residency I especially like seeing it because spiritual
health was one of those areas that we all knew was
very important with many of the people we
were working with, but wasn't always something that we were trained
well on how to address. And also the area of working with chaplains we did it
fairly well informally, but there really wasn't
much guidance on the ways, the best leverage
connections with chaplains and supporting patients. And to tell you the truth there
might have been even a little bit of stigma for talking
about spiritual issues as a mental health provider. So that we now have a
way to look at this issue to better understand
what chaplains bring is incredibly important. I had the good fortune of
starting out on the line side in the Air Force as a pilot
getting a lot of direct contact with chaplains during the
course of the regular day.
As a cadet at the Air
Force Academy you go through a very rigorous
basic training. It's all summer. The chaplains would be there
walking through the units, checking in with the
basics and the staff. They'd actually sit
and eat lunch with us and make a connection. Later as a pilot I flew airlift,
and chaplains often came to our squadron to check
in on their rounds. Typically it was the
same day each week, and we became very
familiar with the chaplains. We learned to trust them, and they also flew
on missions with us. That's what chaplains do is
they are right there side by side with unit members. So they had the unique
connection with the people doing
the work in the military that mental health
providers often don't have.
In my assignments prior to
being a training director I got to work directly with chaplains
on trauma response incidents. For example, we had a
very gruesome fatality at Hanscom Air Force Base,
and I worked with the chaplain in supporting the
unit that lost one of their members in an accident. That was not your
typical clinical encounter because we were working
with the whole organization. And then staying around a little
bit later to talk with people that may have been more
affected by the event.
I think that's one example of
how mental health providers and chaplains often work well
together is responding together to a group event often at
the request of leadership and then providing
support to the leaders, the larger group and
then individuals. Spiritual health and
wellness is a critical part of the DOD readiness mission. Right. So we focus
on making sure that our service
members are fit for duty. That's the minimum
bar to be able to deploy and do the mission. So anybody below that
bar not fit for duty. But what we want is people
that aren't at the minimum but really are resilient.
Spiritual fitness especially
when you think of key components like meaning and purpose
is the engine often that keeps people going. It's the reason why they stay a
little bit longer, why they want to be there for their team. It also is when they
come back a source of strength for reintegration. And when we think about this
critical transition period for when they leave service and
they go to the VA and they go to a civilian life it's a source of strength during
those transitions. And hopefully we can
help minimize examples of where we've seen in past
conflicts veterans having a hard time making that transition.
>> When VA mental health
and chaplaincy began to address the portions of the integrated mental
health strategy that had to do with how chaplains may integrate into mental healthcare
services we thought that one of the things that we really
needed to look carefully at was the distinction
between the chaplains who serve in the VA and the
chaplains who serve in the Department of Defense. I think that most everyone
understand the Department of Defense is about
our national security. So they conduct war and combat. They defend our country
at home and abroad which takes our chaplains to
various places across the world and in various settings. They provide humanitarian aid.
They oftentimes are responding to crises whether it's an
earthquake or a tsunami or some other even that
takes place in the world. And so chaplains operate in a
very fluid and diverse context, and also one that has a
very high what we call an operational tempo. A lot of energy, a lot of stress
that sometimes is involved in that particular setting. And then the population
they serve typically a younger population.
Within the Veterans
Administration we're looking at a 100 percent
clinical environment. So the chaplains
that are serving in this particular
environment are dealing with primarily an
older population and a hospital setting. Or they may be working in an outpatient clinic
in a rural community. >> I've often been asked about
the similarities and differences between VA chaplaincy and
chaplaincy within the military. All VA chaplains work in
a healthcare environment. They are all healthcare
chaplains. And with that they
tend to specialize. You have chaplains that work
in acute care with an ICU unit or a medical unit, those
who work in a nursing home, those who work in mental health
be it chemical dependency or open psych or locked psych. One of the major differences
is a VA chaplain can stay at the same assignment for
their entire career, 25, 30 years if they so choose.
Another difference is
that VA chaplains tend to have a much smaller ratio
of chaplain to veteran. For instance, in a hospice
palliative care unit you could have a ratio of one chaplain
for 12 or 15 veterans. In a domiciliary which is
more of a transitional kind of environment it
could be as high as one chaplain for every 150. The VA chaplains tend to
have more education not because they're special but
because they tend to be older and have pursued maybe another
degree or clinical training in preparation for
VA chaplaincy. One of the requirements
now to be a VA chaplain is that they have at
least two units of clinical pastoral education. But today most applicants
who are contenders for a position have at least
four or five, six units of CPE, and beside that maybe some
other specialty they bring to the table.
But there are similarities
between DOD and VA chaplaincy. First of all they start with
the same military event. Oftentimes there's a
bad military experience. And what happens with
that is VA chaplains deal with this is it's become
cauterized and calcified, and the VA chaplain is
dealing with a military event that is now five, ten,
fifteen, fifty years old with a thick layer of
calcification around it. And that's where the VA
chaplain earns his or her pay. For many vets their
military time no matter when it was was their
crowded hour.
I remember visiting
patients in the nursing home that still spoke about their
time in the Second World War. Or in some cases when I was
a younger VA chaplain times in the First World War it's
still vivid in their minds. One of the similarities that
really unites VA chaplains and military chaplains
is there's kind of like this handoff
that goes on. Military chaplains have
tremendous goodwill with veterans. >> The relationships that
are built in the Department of Defense between chaplains and those they serve are
very what we call organic. And what we mean by that
is because they train with and they live with and eat
they basically conduct their day-to-day work side by side with the military
personnel they support. >> Many times a veteran could
be standoffish initially in the VA environment.
And yet they'll see the
name chaplain and because of the goodwill that they have with the military chaplain they
will approach the VA chaplain for help. And maybe they wouldn't do
that with any other clinician. >> The stigma that exists with service members seeking
mental healthcare oftentimes often influences the access to
care that service members have when they think of the chaplain. It's a source, a confidential
source for them to seek support without being concerned
about the ramifications or maybe the results
of their disclosure. >> Another thing
that's very evident within both VA chaplaincy and military chaplaincy is
how integrated the chaplain is into the daily life of both the
veteran and the service member. And, again, this
could be attributed to the goodwill that's created
by the military chaplain.
>> Over 50 percent
of the chaplains within the Veterans
Administration have prior military service. So military service members
who are now veterans probably because of their experience
during the military service may understand the role of a
chaplain and that it is a source of support that is unlike the
other providers and caregivers that they meet within
the VA facility. [ Music ] >> The crucial part of why
we need to be a team is that patients don't
come into the hospital and say today I want
my spiritual care done, today I want my psychological
care done, or today I just want medical
care, only medical care. No. Patients come
into a hospital, to a healthcare setting
and say I'm hurting, I'm suffering, can
somebody help me. So we need a group of
people with multiple angles of world views and expertise
who when they hear the story of a patient they have their
interpretive lens focused on that patient.
And through their lens they
hear variable components of the suffering and not with
the commitment to the idea of we're going to
fix that person. Chaplains are gifted in the
work of spiritual exploration. Their mission is
not one of fixing. With a lot of the
symptoms that our veterans and service members have we
can't just make it go away. And I think that
makes us afraid. We get afraid of that
which we can't fix. We're so frequently not
willing to say, you know, I don't think I can fix
you, but I will stay on the journey with you. I will absolutely be with
you through this process and will persevere with you.
And so often especially with
a lot of what we're doing with mental healthcare for
service members and veterans, what they want more
than anything is someone who will say I will
faithfully stay with you. And so the idea of having the
strength and the resilience to stay in the journey
with someone who is suffering
that takes courage. [ Music ] >> Different people
mean different things by that term spirituality. To me it involves a broad
series of things, why am I here, what's the purpose of my life,
what happens to be when I die? Why did this harmful
event happen to me? Why does this child
have this illness versus these other people
they don't have their children being ill? All sorts of things
that come up, all sorts of specific situations
where people are grappling to try to understand
what this all means. And then it ties into well then
how best should I live my life? What's the fight
thing for me to do? So all of those things
definitely and how people answer those.
And, of course, it's not like they have an answer
once and it's over with. These are ongoing questions
that people struggle with throughout their life. But how they answer them
definitely affects how to heal. So psychological health
certainly has to do with are you anxious, are you
depressed, do you feel good, do you have a degree of
confidence, do you have I think to some extent a sense of
purpose to what you're doing? And to the extent that
you have answers to some of those questions that
that will influence how well you feel. The two have a very
strong relationship. And it's not uncommon for mental
health providers to have to take on some of those
existential questions that people are struggling with. And it's not uncommon for
chaplains to have to take on addressing some of the
psychological symptoms that the service member or family member might
present to the chaplain. >> One of the things
that's relatively unique to our veterans when it comes
to mental health is PTSD.
And a lot of research on
PTSD has really been advanced primarily coming out of
research on veterans and much of that research
coming out of the VA. Often when we've done this
research looking at PTSD in veterans we've looked at what
are the things that contribute to the development of PTSD and
to the maintenance of PTSD. And in terms of our psychotherapeutic
practices something that we've focused a fair amount
on in recent years is avoidance. And we found that avoidance of feared stimuli tends
to perpetuate PTSD. In terms of religious and
spiritual variables that seem to be related to PTSD some
research suggests that veterans who harbor combat guilt
and who have difficulties with forgiveness, both
forgiving themselves and others, tend to have more severe PTSD. Now, research that's been done
on veterans who are in treatment for PTSD has actually
found that a majority of those veterans report
abandoning their religious faith while they were at war. A majority of those veterans
report feeling abandoned by God. And a majority of them have
also reported feeling punished by God. Much of this research is
telling us that, in fact, variables like guilt,
variables like forgiveness and variables having
to do very directly with an individual's
religious, spiritual and faith beliefs
are intertwined with the experience of PTSD.
>> Survivor's guilt affected
me, like I felt guilty for what happened to them and how it happened
to them and not me. >> Could I have been
there and did something that would have brought
them home alive? >> I just don't feel good
about, you know, being here and my team still
being over there. >> Maybe that's how
my guilt rolls off for me is what we did
there is because it's war. It's not because we're there to
play with them or be friends.
>> I even had some thoughts
of suicide there for a while. >> There's guilt and regret. There's Monday morning
quarter backing. >> It's always hard to
go back and say what if. But the point is is
that I was home and safe and eating good food, and
they were still over there and something bad
happened to them. That never sat right with me. >> Should have done this or
maybe I should have done that. >> The first marine that
I was in charge of, a PFC, ended up committing suicide. I had lost a lot of trust in
my ability to be a leader. I'd say I felt really guilty.
His life, part of
the responsibility of him being alive was on me. And I felt like I had failed. >> I can tell you just from
firsthand experience working with a lot of patients
in the military and then supervising
residents working with patients across different mental
health conditions like PTSD and depression often there is
a strong spiritual component that can take many forms.
One of the more important
spiritual factors we're seeing that researchers are pursuing
currently is post-traumatic growth and moral injury. >> One of the ways that
moral injury has been defined in the literature
is as perpetrating, failing to prevent, bearing
witness to or learning about acts that transgress
deeply held moral beliefs and expectations. >> The sense that what
was experienced was in direct confrontation
with beliefs about how the world should be. And that needs to be
repaired and needs to be confronted directly,
and the person needs support in finding another way to
understand what they saw happen and repair their view of
life and what it means to life with integrity. >> Thinking about moral injury
along with some of the research on guilt and forgiveness
makes it apparent that there are a number of ways in which we might consider
inviting chaplains into the care of veterans with PTSD to
address the very issues that chaplains have
some expertise in. Post-traumatic growth
is a wonderful concept. It's about part of the
recovery process resulting in increased sense of
purpose and meaning. >> There was some research that
was published in 2004 by Fontana and Rosenheck in which these
researchers asked the question what is it that motivates
veterans with PTSD to turn to the VA and seek help? And as mental healthcare
providers one of the things that we would expect is that perhaps these veterans
have had their PTSD symptoms get so bad that they ultimately
felt like it's time to reach out and seek help.
What Fontana and Rosenheck
found in their research is that is was not so much a
worsening of PTSD symptoms or even a lack of social skills,
but instead it was feeling like they had lost meaning
and purpose in their lives. And that's why they
turned to the VA for help. >> A really important part of
living is this idea of the sense of why am I here, am
I living a full life, am I meeting my commitments
to myself, my God, my higher power, my family? When we treat a patient
I think we partly focus on reducing symptoms, and
another part of that it can be as important or more important
to patients is that idea of sense of meaning and purpose. >> So we need to think about
in our healthcare system where veterans with PTSD are
turning to us because they feel like they have lost meaning or
they have lost purpose in life. Do we have a system of care that
is set up to optimally take care of these veterans and address
the reasons why they turn to us? >> Religion frequently serves
as a way for persons to cope who are suffering or are
in the midst of trying to make sense of
their suffering.
This varies according to the experiences these
persons have had and the life that they've had with regard
to their own faith traditions and their own religious
traditions as to what their
expectations are. The degree to which persons
relate using religion as a primary coping mechanism
has been more evident in recent literature although
we have much to still learn about the reality that when
persons are disappointed, when persons find themselves
suffering and not being cured. How do they struggle with that? How do they understand
and process that reality in their life and what does that
mean for their own spiritualized and spiritual struggle? One of the domains in
which we find that religion and spirituality tend
to have an impact within mental health is
what might be thought of at times is the existential
notions of coherence, the sense of purpose, the
sense of where am I headed.
For a number of people
their religious and spiritual life can be
a crucial instrumental part in helping them to
discern those kinds of factors within the life. At the same time there are
persons who their religious and spiritual struggles
will sometimes contribute to their sense of a
lack of coherence. All of these things have
to be considered fully and more optimally
when we're thinking about these intersections
of spirituality and health. Chaplains are central
to that consideration. The chaplain is a vital person
for rightly interpreting and understanding
and making sense of how does my spiritual
life intersect with what I'm experiencing within my physical
and mental health? [ Silence ] >> One of the big
issues that we have within chaplaincy today is
the whole idea of research. More and more as you look at the literature we're
finding all these articles and all these essays
talking about the things that chaplains do, talking
about pastoral care, talking about interaction between chaplains
and other people.
But surprisingly they're not
being written by chaplains. Most of the new information
that we have and the literature is coming
from doctors, psychologists, social workers, nurses,
everybody but chaplains. And we asked ourselves why
aren't chaplains more involved in the research process. Well, one reason might be that
they don't like doing research. Chaplains really see themselves
as more there for the person and what the person's story and what the person's
lament is all about. It bothers them sometimes
if the focus of psychiatric or psychological care
can shift to evidence- based diagnostic processes where everyone is
very focused outcomes.
They're afraid that with
the focus and the emphasis on evidence-based outcomes that
they will lose that connection, their connection between the
pastoral care and the veteran that they're used
to establishing. Because of the fear of losing
this connection some chaplains don't jump at the
opportunity to become part of a research team
or a research study. >> Chaplains may fear being
co-opted by mental health, that it would just be a
one-way conversation focused on a chaplain making referral
or a handoff of a service member to mental health
instead of a partnership with mental health
that's patient centered. Chaplains may have a concern that adopting evidence-based
practice kinds of tools may push them more
into a medical model as opposed to providing spiritual
care and pastoral care. They may think that looking
at outcomes and metrics for an area that's very
intensely personal and subject and concern about how do you
measure the outcomes of working with someone and moving them
out of spiritual care into more of a science-based model. >> First of all, how we even
interpret, what do we mean when we say we're researching
religion and spirituality? For some that might be
understood to be an assessment of how valid are these
beliefs or what's the efficacy of this particular
religious practice in terms of a person's well being.
And I think there's a lot of
caution among chaplains to look at it in that way simply because
for most chaplains it's not so much about the efficacy
of what they do but perhaps who they represent and
what they represent and the power of faith. And so I think to
measure outcomes based on what a chaplain does in terms of their activity is a
very difficult thing to do. And it's something we
continue to struggle with.
Another concern that comes up is
the evaluation of an individual, for example a patient or a
service member or veteran, and the impact that their
belief or their practice of their belief has on their
health, their contentment in life, how quickly or
effectively they heal from whatever it is
they're being treated for. And we begin to look
at it almost like yet another pill
in their arsenal. If they just take this pill or if they just take
this particular treatment that the chances of you
being well will be greater. And I think most chaplains
see the spiritual realms as being something much bigger, and it encompasses
existential questions that don't have black
and white answers. And sometimes even the ability
to articulate our response to someone's existential
question oftentimes is so complex that it really
surpasses discursive reasoning. It's almost something that in
some cases has to be modeled or demonstrated through story
and narratives and example and parable or metaphors,
all these different ways in which we help someone
to understand the context of their struggle in a different
way, not with a formula.
>> Other concerns chaplains
have in the intersections with mental health is
that there is a concern that they may become mini
mental health providers. Mental health providers
diagnose, treat and resolve emotional
and behavioral disorders. Chaplains on the other hand
do spiritual assessments, intervention and
provide spiritual care. Chaplains also need to claim
what's unique in their role as a pastoral care provider. Oftentimes the role of the chaplain is not
clearly articulated to mental health providers. And it's simply a matter
of having a conversation with the mental health provider
to talk about what chaplains do and can bring to the care
and treatment of patients.
Chaplains speak a
different language than mental health providers. We have a different
reference point or lens. We don't function
from a medical model. Instead we come from an
internal perspective. We talk about issues
of meaning and purpose, of human worth and dignity. So it's a different
framework or a lens in which we approach
talking to people. >> Because of these reasons
I think chaplains are often concerned about measurement. And I think one of the things
that may be helpful for us to consider is looking at
it from a different way. If we're referring to in our
research about spirituality and religion, about how one
navigates through the ebb and flow of life, through
life's challenges, the struggles that seem to be a very normal
part of life, pain and suffering and joys and celebrations
and so forth, if that's what we're talking about when we're
researching spirituality and religion then I think
it's well worth the cause and the effort to research it and better understand how
chaplains can help facilitate people, navigate through these
normal experiences in life.
It's an opportunity for us
if we look at it in this way when we're considering metrics
and measurements and research about spirituality and religion
perhaps we can reframe it and think about it from the
perspective of how can we join with everyone else that's in the
healthcare professions and look at what we do from
the perspective of continuous improvement? How can we take the great
skill sets that we bring to the table already, the
things that we do quite well and continue to improve what we
do so we can better serve those who are entrusted with our care. >> We have to look for more
opportunities for chaplains and the mental health to
work together collaboratively so that we can provide new and
better information to the field.
[ Music ] [ Silence ] >> When considering
the relationship between spirituality and
health and the research that has been done over
the last couple of decades, there are a number of promises
and a number of pitfalls. The promises include the
significance of the volume of research that's been done. No question that it has become
part of the medical literature to include spirituality
and religion as a variable in many research efforts where 30 years ago it would have
been unequivocally excluded. We do truly hope and assume that
psychologists, psychiatrists, social workers, other mental
healthcare providers will increasingly look to chaplain
colleagues and other types of persons involve in spiritual
care as part of their team.
But as we start to think through
that relationship it's all important how we work together. >> I'm Lieutenant
Commander Steve Dundas. I've been in the
military 30 years. I've been in the
Navy since 1999. When we got to Iraq
our mission was to support the U.S. Marine
Corps and Army advisors across the entire
Al Anbar Province. I would go out and
provide counseling and religious services. The hardest parts of the
deployment, one, I've had a lot of experience as a
trauma department chaplain and seen a lot of death. But when I got there and
actually saw our wounded marines and soldiers, prayed with them,
anointed them that was one of the really hard things was to see what war does
to these warriors. When I came back to
the states I just felt so disconnected from
people, church. Finally our medical officer did
an assessment and was convinced that I was really beginning to
suffer PTSD and got me connected with the Deployment
Health Clinic at Port Smith Naval
Medical Center. And I started seeing a therapist
there trying to figure out how to deal with my experience.
My role as a chaplain is to
provide the spiritual support for people as they make this
journey, as they begin to open up about what they've
gone through. But many times it requires
more than just the chaplain. And so I'll say, you know, I
know it's scary but I think that you need to seek the help
of a mental health professional because it's a way
to get better. And I tell them my experiences
which are good experiences with both of the therapists
I've had, that they understood and they didn't push
me into some track that I was unable to go to. I realize you can't go back. You can't go back
to what you were.
You have to adapt
to what you are. You want to be healthy? Yes. You want to
be well adjusted? Yes. Does that mean you're going to be the same person you
were before you went to war? No. Nobody is but that's okay. If we open ourselves
up to get help. It's not something that we're
going to be better overnight. What it will be, though, is
a step on the way to healing, a step on the way to
integrating those experiences with our daily life now. I don't think of it as
weakness to seek help. In fact, I think it's
a sign of strength. I think it's a sign that
you want to move forward. And what I hope is that when
I spend time with people, when I share with people,
when I listen to people that I can help them
to begin that process if they haven't already
started and to encourage them if they're already getting
some therapy and provide that extra bit of support,
that extra bit of connection so that they don't feel
that they're alone.
[ Music ] [ Silence ] [ Music ].
