Document1.docx

The combat

trauma spectrum, a very important topic. It's important because

it's important to show the point of pain and match that up with the

right intervention. The combat trauma

spectrum does that well, it shows on the far

left-hand side, for instance,

reintegration issues. And in the middle it has something that's

called and the services Combat

Operational Stress. And then on the

far right it has post-traumatic stress

and most right, the post-traumatic

stress disorder. As you go through

that spectrum, it's very helpful

to understand it as a means of the first

step in treating it. Now, a book that

is available, combat trauma

healing manual. And I show this

because this is authored by one of

our presenters today, corsets it, corsets it. And his wife for nella

are both going to be presenting 30-year

members of Campus Crusade for Christ. They have just put a

new book on the street, Carlton war comes home. So in addition to writing

books and helping, they're also counselors and they've been

working with the military ministry

post-traumatic stress disorder task force the last two years. So Kristen are now

a very qualified, very crafted

both reverence and they are the parents

of four children. So a Christian

or no answer, we'll do a wonderful job illuminating this combat trauma spectrum for us, which is an

important first step in understanding how to treat combat trauma among active duty and veterans

across our land. Thank you. Now I gave you a

Christian or no ads. Today. My husband,

Chris and I want to give you

the big picture, kind of a whirlwind

tour of what combat trauma is and how it impacts

individuals lives. The word trauma actually comes from the

Greek word wound. A traumatic

event can cause such severe wound that it can become

life-threatening or overwhelming to

almost anyone. Another way to

describe it is when a person is impacted

by a traumatic event, it etches the thumbprint

of that trauma on the person's body,

soul, and spirit. These thumbprints

can affect a person's will to live, their beliefs about God, themselves and

their world, their dignity, and their

sense of security. For our chiefs

and families. The thumbprint of trauma has touched their

lives as well. According to a

recent report from the VA National

Center for PTSD, 40 percent of OEF or OH, IF veterans have or may acquire PTSD For those

who don't know it. Oef is Operation

Enduring Freedom. These are our

troops that are fighting terrorism

in Afghanistan. Oh, IF OR operation

Iraqi Freedom is our tubes fighting

terrorism in Iraq. In addition, the

VAs National Center reports that 80

percent of OEF 0, 0 troops acknowledged that they have serious

mental health issues. 40% say that they weren't interested

in getting help. But only 26 percent actually took steps

to receive help. And 38% of those who sought help were

diagnosed with PTSD or combat trauma. This compact trauma, or PTSD has been called many names

throughout

the centuries. Which makes it clear

that this disorder is not unique

to modern wars, but as common to all wars. During the latter

half of the 600s, to Swiss observed

a consistent set a sentence in some

of their soldiers. And they called it

nostalgia german doctor. So the same period

used the term Hive a, and the French called

it validate to pass. But both terms roughly translated homesickness. The Spanish called

an ester oto, which needs to be broken. During the American

Civil Wars. It was called the

soldier's heart. World War One. They

called it shell-shock. World War II, they called

it battle fatigue. In Korean War, they

called at war neurosis. And in the 1970s

they coined the term Vietnam

veterans syndrome. It wasn't until 1980 that the American

Psychiatric Association formally identified, named and defined

the results of an extreme traumatic

experience as post-traumatic stress

disorder or PTSD. As we've traveled

around the country, scores of veterans

from World War II On have shared their

stories with us, and many still carry

unresolved pain. Richard Gabriel

is coded by David Grossman from

his book on killing, the psychological costs of learning to kill in

war, in society. In which Gabriel says. In every war in which American soldiers had

fought in this country, the chance of becoming a psychiatric casualty, a bean debilitated

for some period of time as consequence

of the stress, military life were greater than the chances of being killed by enemy fire. So what is combat

trauma? As I choose to turn

from combat or other intense

operational deployments, it's probably safe to say that they all

experience stress. As you know, there's

positive stress and there's

negative stress. Positive stresses,

what kept them focus, energize, and

probably saved their lives and others. Negative stress. I have and can put themselves and

others in danger. But any kind of

stress, good or bad, can affect their spirits, their souls, and

their bodies. Most stress reactions, although unpleasant

in the short time, do not resort, result

in long-term problems. In some cases, however, the stress of operation

deployment can cause more serious problems that require additional

helped to overcome. Chris will now

be giving you a further

description of what combat trauma is and give a brief overview of the combat traumas

spectrum that covers the five kinds

of deployment related stress problems that you should

know about. There are many

things in life that are not

black and white, not either or not. You have it or you don't. And the symptoms and diagnoses that

are related to combat certainly cannot be classified in

this way either. You can't say this person has combat drama and this person does not have combat

trauma so easily. There's a broad

spectrum of responses that a

person would have. The traumas that are

associated with war. And these fall on a

wide continuum based on a number of factors

that we're going to go into later in the series. The term combat trauma is a general term that

we use to describe the responses

that a troop will have to the various

stressors of war. Describes the

same spectrum of conditions that the US Army Center for

Health Promotion and preventive medicine cause deployment related stress. We've chosen to use the

term combat trauma simply because we feel that communicates the concept a little more succinctly.

And it links easily with the terms and concepts that the general public has already heard

and recognizes. Now as you see

on the graphic on your screen or in

your notes right now, there is a broad

spectrum that involves a variety of conditions on this This combat

trauma spectrum. And they progress

in severity from the left end of

the spectrum where the mild end all the

way up through the very severe in the mild

end of the spectrum. These include

relatively easy to mitigate condition such as pre-deployment stress and deployment stresses

and the stresses that accompany

reintegration of the troop back into

his or her family or community or culture that they left

from earlier. We're going to

be going into a lot more detail regarding these conditions

in just a moment. But the next stop

on that spectrum as you progress from

left to right, identifies Combat Operational

Stress reactions, which describe

normal reactions to the abnormal

events of combat. Now these symptoms tend to occur immediately

after the stressor and are generally resolved fairly quickly without

significant treatment. Next, we see

adjustment disorders. Now these are

symptoms or behaviors that show distress in excess of what we

would expect to see based on the stressors

that we observe. To meet the definition

of this diagnosis, the symptoms must

present within three months of

the original onset of the stressor

and be able to be resolved within

six months. Next, we see acute

stress disorder and post-traumatic

stress disorder. These are at

the severe end of the combat

trauma spectrum. You can imagine these are very serious

conditions and in the vast

majority of cases they require

proactive informed therapy in order for them

to be resolved. Now, if a troop

doesn't receive this kind of therapy, it's very likely that

the symptoms will persist for

months or years or even for a lifetime. What about those who

come back from combat? And they never were

actually involved in direct trigger pulling or conflicts while they're

in the theater. They never fired a shot, and yet they still return home with very

distressing symptoms. Exactly similar to those who were involved

in direct combat. Well, these

troops can also experience combat trauma. Long periods of sleep deprived duty, monotony, stressful

assignments. And with the full

knowledge that because of the kinds of conflicts that

exist right now, over in the

Middle East where there is no clear

fighting line, there's no safe place. It's very difficult to

identify the enemy, and there's no

telling when a mortar or an IED or a sniper might

particularly strike that

kind of stress. 24, 7, eventually

he's going to take a severe toll on any

troop that's over there. So when a troop knows

that at any moment, even when they're in the green zone of Baghdad, which supposedly safe, at any

moment there could

be a mortar attack. There could be any kind of a thing that

could happen. And they know it could

be their last moment. This eventually

is going to have an effect that could cause them to

experience even full-blown PTSD. What I'm going to

be talking about in this third section is how our troops

and families are impacted by

combat trauma. The first three components

of the spectrum includes the

pre-deployment deployment and reintegration issues. The second is combat or operational

stress reactions, and the last is

adjustment disorders. The mild distress are on the spectrum includes pre-deployment, deployment

and reintegration. One of the issues are chips and

their families face is the stress

a pre-deployment? This starts

when a troop is notified that they are

going to be deployed. When that happens,

there's usually immediate anxiety regarding their

impending deployment. They and their

families often experience a wide

range of emotions. Other stressors they may face include

financial issues. They have to deal with emotional and

logistical stretches while preparing the family for the troops absence. There's also

an increase in training tempo in preparation for

the mission. For couples and children. It can be emotional

outburst as they try to cope the looming reality of long-term separation. Another issue

our troops and families face is

their deployment. Deployment stress

includes being on life or death alert

almost all the time. There is no enemy lines in Iraq and Afghanistan. They may experience

traumatic, horrific events. Some make it

physically wounded or face near death

experiences, or even see their

comrades get wounded and die forever on their hearts and minds is a concern they have for their

families welfare

while downrange. There is anxiety over the children's

development. Missing out an important

family occasions, births, deaths. Many have fears regarding their spouses loyalty and fidelity

whilst separated. There can be poor

communication infrastructures

resulting and feelings of helplessness regarding family

emergencies. Many faced loneliness,

boredom, fatigue, sleep deprivation,

discomfort, fear, sadness,

and exhaustion. And remember, we're not just dealing with

one deployment. Many are facing

multiple deployments which last six

to 15 months. The last component of the first section

of the CT section that are chips and

their families are facing is the

reintegration issues. As our troops return, return home to

their families, there's usually a

honeymoon period. But after time, there may raise rising tension

in their lives. They often will encounter various

difficulties during the transition

from deployment back home and

the family life. Pursuits and concerns that can bring about

this tension can include a myriad of issues like change

in the tubes, main emotional link

and support from their military

buddies back to their spouse or family. Resuming and sharing household or family roles, getting used to

communicating with their spouses

and an intimate, frequent basis, again, adjusting to

different levels of order and control in the home when they are used to

being deployed. Adjusting the different family dynamics due to the aging of the

children, coordinate, coordinating with his

or her spouse regarding child rearing and child

discipline issues, synchronizing his or her emotional or sexual needs and expectations

with their spouse. Getting used to altered psychological and

social skills in response to

combat trauma. Deciding how major and

day-to-day decisions are to be made

in the home. Dealing with

multitudinous briefings, debriefings, training sessions

and surveys, enjoying Welcome Home

ceremonies without them becoming Bergson or

triggering events. Our troops and

their families face many issues and these are listed in the

student notes. The next section on the

CT spectrum includes the Combat, Operational

Stress reactions. This is a normal reaction for anyone who goes into battle or other

dangerous operations. This is not a

mental illness, and people who experienced this are not sick or weak. It's just the

body's way of protesting and say, Hey, slow down,

because they push themselves past their regular limits

of endurance. The sentence

of ceos are or Combat Operational

Stress reactions can look a lot like symptoms of post-traumatic

stress disorder, acute stress disorder or adjustment disorders. But they tend to occur immediately after

a stressful event. And they get

better quickly without significant

treatment. The COS are symptoms

can include things like tension,

aches and pains, jumpiness, trembling,

cold sweats, expecting the worst,

irritable, miss. Poor attention,

poor mental focus. The can't

remember details. They get out of breath. Their fingers and

toes can tingle. They can have an

upset stomach, they can vomit. They can have diarrhea, they can have

constipation. They have that

thousand yard stare. That can have bad dreams. They can get mad

at their leaders. They can have trouble

communicating. They can lose faith

in their unit. And their leaders

in the unit. He had trouble

sleeping and they can hit, start

blaming themselves. Symptoms and others are listed Austin and

your student notes. The last one I'd like

to talk about is about just adjustment

disorders. Adjustment disorders

are much more common than either PTSD or acute stress disorder. And on the whole, are usually much

less serious. And adjustment

disorder occurs when an individual

is exposed to an identifiable

stressor or stressors causing

a reaction which results in

significant accepts this excessive distress or significant impairment. The reaction can

involve three symptoms. The first one

is depression, where they can

experience cheerfulness and feelings of

hopelessness. The second one is anxiety, where they can

experience nervousness, worry, or jitteriness. Or there's the third one was disturbance

of conduct, where they can violate

the rights of others, such as reckless

driving or fighting. Or it can be any

combination of these three. When someone has been diagnosed with

the disorder, I like to tell those

that I counseled that this is place when a

person gets stuck. Sometimes they get stuck for a short

period of time, and other times

they will get stuck for a long

period of time. For someone who

has been diagnosed with adjustment disorders, they're usually not stuck for a long period of time.

Sentence can occur as late as three months

following an event, but usually are resolved

within six months. Chris is going

to be sharing next and the stressors

and behavioral, emotional responses

of truths and families to the final two components have this. Acute stress disorder and post-traumatic

stress disorder are very similar in terms

of their symptomology. Both are extreme

long-term reactions to an abnormal stressor. Except the main difference

between the two is that with acute

stress disorder, there's an increased

incidence of dissociative episodes

and a shortened onset and duration of symptoms. Now what actually happens physiologically when,

when someone experiences

ASD or PTSD, one of God's top

design priorities when He created us, was that we would

be equipped to defend ourselves in a wide variety of

dangerous situations. And with this in

mind, he equipped us with an amazing set of response mechanisms that help us

in our brains. Our brains, as you

probably know, or divided into

two halves. On the left side, that's

our analytical side. It scrutinizes incoming information logically. It thinks rationally in

very concrete terms. It's on this side

that we store our practical information. Things like how to read, how to speak, how to

spell, how to do math. In this side, remembers names and craves

precision. Now if our left side is

more like a computer, or right side is more

like a photo album. This side remembers

faces and craves, rapport and relationship

and fellowship. This is our

emotional side. It is very intuitive, very spontaneous,

experience oriented. It's artistic,

creative stores, emotions and we dream on the right side

of our brain. And very

importantly, this is the alarm side

of our brain. Nobody, these two

halves of the brain is our lower brain

or brain stem. Now this part of

our brain controls all the automatic

responses and functions in our body, such as breathing and digestion and,

and heart rate. The lower brain always trumps the two halves

of the upper brain. For instance,

doesn't matter how logical that may seem to you or how passionately

you may want to. You cannot stop your heart from beating just by

thinking about it. Plus, if you want

to stop your, yourself from

breathing, you can hold your

breath for a while. But before long,

that brainstem is going to assert

its dominance and force you to

take that breath, even if you're

underwater at the time. When we encounter

something that we would consider is a life

threatening situation. A cascade of hormone base reactions

is triggered. Our hearts beat faster, our lungs pump faster. Thousands of small muscles in our arms and

legs constrict, which pushes our blood, pushes blood deepened

or our muscles so that we can have quick movement

and strength. Are energy levels spike. We gain all kinds of

amazing stamina and muscle power so that

we are ready to fight or fly like we

never have before. The ultimate objective in this set of reactions

is survival. And it was put

there by God. This you see,

something also happens deep inside our

brains as well. Our right brain alarm

goes off and drowns out all the

logical analysis of the left brain. And basically a

start shouting less thinking

in more action. It also starts taking

pictures like mad. Very strong and clear memories are

being recorded probably so that we will remember this event and avoid it in the future. At this point are

lower

brain takes over, it is live or die time. With this organ

and control, nothing else matters. It automatically

directs the rest of the body into

a series of very complex and

focused ways to make sure that

we will do whatever it takes in order to flee the danger and to survive. Okay, a person might

say, the crisis is over. I survived. But why

can't I move on? Why do I keep reliving the trauma that

I experienced? Often, a trauma survivor can go through a

short period of decompression and

processing and returned pretty

close to normal. But if the

traumatizing event was exceptionally violent

or life-threatening, or if there are

multiple episodes, the brain stays stuck in this crisis alert mode. It's kinda like

what this one, Vietnam veteran instead, when he was asked,

when did you leave Vietnam and his

responses last night. And it'll be that

way every night until my soul leaves

this whole body. Think of it in

terms of walking across a frozen lake. Many of you may have

done that or you can imagine what

it's like at first, it's a lot of fun sliding

around and acting like some kind of a ice dancer and doing

pirouettes at all. But then all of a

sudden you hear this cracking and

popping all around you. You know, the ice

is getting ready to give way. What happens? Well immediately you

spread your arms and legs to give yourself

balanced and support, your eyes become as

big as softballs. You hold your breath, your heart starts beating like mad because

you're just getting ready to go

into that icy water. And so as you stand

there frozen for a couple of seconds

and you realize that, hey, I'm not going down. You start very

slowly and very carefully backing away

the way you came from. Well after a while

you find that you're back on relatively

solid ice, well then what

would you do with is it likely that

you would start jumping around and

skipping again like you were before?

Probably not. Because now you

realize that the ice underneath

you could give way at any moment. And so you continue to walk very carefully until you get to the shore

of the lake and

where safety is. C, after a

traumatic event, our brain knows

that it just had an incredibly close

call and it is determined to be

ready to react. If it confronts

that danger again, that's a really good idea. Except if it gets

stuck in that mode, which is essentially what ASD and PTSD

are all about. It's like that ice Walker vetoing the two

miles of concrete, cement sidewalk

all the way back home because he's stuck in that crisis alert mode. It is illogical, but ASD and PTSD are

not logical, their emotional, so it doesn't have to make sent, since that's just the way your body is

going to react. Now the shock physically alters parts

of your brain. Your reactive

pathways modify, your brain

chemistry changes and it becomes

hypersensitive, overreacting to a lot

of the normal stimuli. Your hippocampus, that's the part

of your brain that interprets and calms your emotional

responses. It actually shrinks and works less

effectively. Your left brain and your right brain

hemispheres have trouble communicating and

balancing each other. So you're either

all emotions and unordered or your emotionless

and cold and withdrawn and

not a whole lot of fun to be around. Sometimes both extremes

within five minutes. And whenever your

brain senses that, get near to the scene of the crime that it

had encountered before via some kind

of a sensory trigger like a site or a sound or a smell

or a memory. It quickly opens up that

photo album that it created during the earlier traumatic

event and puts on this intense slide and video show to

rayon structs you that you do not want to go back

there again. You know, it kinda says What are you

nuts, you know, don't you remember the last time we went there, we almost died, you know, get away,

run as

fast as you can. Well, in both cases with acute stress disorder and post-traumatic

stress disorder, there are three

main categories of symptoms that have

been identified now, no one is going to

have all the symptoms. But in order to meet the actual definition

of ASD or PTSD, they need to have

at least one or a few from each of these three

categories I'll be sharing with you next. The first category

is called re-experiencing symptoms. They see memories

and images of the traumatic event

will intrude, unbidden into the

sufferers mind. And they may, they

will experience them as if they are

actually happening. They're not just a

memory. They're actually feeling like

I'm back there and it's happening again. They're often

accompanied by very intense emotions such as anger

and grief and, and fear and guilt. You can see in

your notes there that they include

many symptoms like nightmares, sleepwalking,

sleep fighting, daydreams, flashbacks,

somatic flashbacks, which have to do with

physical pain and medical conditions

which will suddenly emerge linked to

the feelings or the bodily

experiences that they had during the

traumatic event. They may fixate on

war experiences. They live in the past. Have spontaneous

psychotic episodes where all of a

sudden the world, the present world seems to vanish and they are back in that

traumatic situation, experiencing the

traumatic event as well. Again, it's also called

the association. Panic attacks or phobias are also involved in these re-experiencing symptoms. The

second major

category of symptoms are called

avoidance symptoms. You see a traumatized

individual will attempt to

avoid situations, people or events that remind them of

their trauma. Consequently,

they feel numb, emotionless, withdraw

into themselves. They try to shut out any of the painful memories that they

experienced earlier. Friends and family feel rejected by them

because they are simply unable to show appropriate affection

or emotion. Some of the symptoms

involved in the avoidance category are avoiding anyone

or anything that reminds them of the

traumatic event. Physical or

emotional reactions that remind them of

the traumatic event. They become self

isolating and they become very

anxious in crowds, are in traffic,

they experience a lot of despair

and depression. They have an

inability to trust other people very closely, very reluctant to talk about their traumatic

experiences. They lack interest

or motivation in things like employment and things that they

used to enjoy, like, for instance,

recreation or our hobbies or

sex or exercise. Relationships

that were once very close and

even intimate, become very strained

and cold and distant. They require just too

much, too much energy. In order to maintain them. They experience

emotional numbness. They can't get

happy or sad. Substance abuse in

order to get numb, abusing things like

drug and alcohol or food, suicidal

thoughts, suicidal attempts,

physical fatigue, neglecting or abandoning

personal care, hygiene, nutrition,

exercise. These are all avoidance

symptoms that we see and those

experiencing ASD or PTSD. The third major

category of symptoms is called

the arousal symptoms. You see for fearing

further traumatization. Lot of PTSD and

ASD suffers are always on the alert, on guard, jumpy,

unable to sleep, very angry,

irritable, keyed up. How many also have concentration and

memory problems that fit into the

same category? Some of those

arousal symptoms are things like anger, irritability, having

a real short fuse, throwing fits of rage,

hyper-vigilance, always on the alert, always need to be armed with a knife or

a gun nearby. Very easily startled, reacting to loud noises. They get involved

in substance abuse in order to get unnamed. Very opposite of what the avoidant symptoms

would produce. They have reduced

cognitive abilities. They're slower and

they're thinking, they're more confused. Poor problem-solving

abilities, trouble falling asleep

or staying asleep, very prominent among

ASD and PTSD sufferers. They experienced

night sweats. They have an

accelerated heart rate, rapid breathing. Many times,

particularly Christian soldiers and troops

who go over, well question or

abandoned their faith, feeling like God has betrayed them or

abandoned them. They're very mad

at God because things didn't work out

the way they were pot. They should work out back when they were in

Sunday school. They often have a fear

of becoming violent. And very often

they actually do become violent and

provoke fights. They have

homicidal thoughts from time to time. Many times we'll have an anniversary

reaction where when the month or

year anniversary of the traumatic

event rolls around, they often become

very anxious. They become

adrenaline junkies, sometimes being

involved in a high-risk behavior just to get that

adrenaline pumping. Sometimes they're

involved in self-mutilation, cutting or access

of tattooing, just to be able to

feel something and keep themselves

feeling something. It's very high

level screen. When we flew out to the to the comfort the

hospital ship, I had to make several

mental notes. I had to decide where each patient

was going to go based on how

critical they were. The ones that weren't

that critical or on the other side where

my crew chief was and he would keep

an eye on them as best he could and let me know what

was going on. The space that I had to move was about the

size of this chair. So I had the ability to either be

on my knees or squat if I could

maneuver it my myself because not only we were

carrying that, the patients we're

also carrying some of their gear and records

and different things. So I didn't have

a lot of room. So choosing where they were going to go

in the aircraft, who is going to be

the first one out? That was usually

the one that was on a portable ventilator, battery operated

ventilator that was breathing for them. The next thing I had to do is make a mental note of since we're

going

out to a ship, we're flying over water. And in the eventual case

of landing in water, I had to decide who I was going to get

out if I could. And it was that mental

checklist that out. That I had to

make if I could, if if the situation arises and I have two and then I

choose this person. And it's not the

person that's on a ventilator

because they're already had the whole justification

in my head. And then those are the two main

things that I had to mentally do and then physically I had to monitor each patient

depending on what their level of injury was. And I would say ninety eight ninety five ninety eight

percent of the time. The one on the

portable ventilator, the ventilator would stop working for

whatever reason the battery would run out or it just would

stop working. And so I would have to

do the quick maneuver, detaching the ventilator

from the patient. They had a tube

down their throat, so I had to hook up a bag to the tube

and move the oxygen and do all of this stuff just so I

could breathe for them. And that's what I would

do on my knees on the heart aircraft,

is just breathe. Every three to

five seconds I would I would

squeeze a bag or this person knowing that if someone else

on that aircraft were to start going down, I would also then

have to choose okay. Who which 01:00 AM I

going to attend to? Because this person

that I'm breathing for can't breathe

on their own. Do I stop and help this other person or do I have to let this

other person go? Do you do you ever find yourself back on

that helicopter? Almost nightly,

even still. The nightmares

are the scenario I just presented

and I'm breathing for someone and

then one patient, then another one starts crashing as we call it, their vital signs start diminishing and

and

I can't get tone or I can't get to the helicopter where I know where the patients are in my medical gear. I

mean, that's the biggest My biggest

nightmares not being able to get to my patients or

if I do then no, I I'm paralyzed somehow

and I can't help. And that's one of my biggest fears

is not being able to to get there. So every night

you're providing urgent care early in

your in your dreams? Just about well, let

me fast-forward. You've been on a

lake. The deployment. I understand the dynamic that goes goes with coming home versus certain

euphoria associated with, but it's also short live. So tell us about the, the height and the

depth of coming home. We finally did

make it home. And because we were

national guard, there was media there

when we arrived. There was some pomp

and circumstance, but we just wanted

to get home. We wanted to sleep

in her own bed. We wanted to see

our families. For me, it was my dog. I hadn't seen

her in a year. So the use of the euphoria lasted

about a day for me. And then the reality of being back to

normal started to settle or just to

set in and realizing that Nothing's

normal anymore. I didn't sleep

that first night. Well, actually I ended up not sleeping for a year, but that's a whole

other story. I got up the next morning, had to drive an hour

North to get my gear because that's

where the plane had dropped it off. And then I well,

while I was gone, there was 11 thing that kinda

sustained me that I looked forward

to that place that I could go

to in my mind, that safe place,

that familiar place. And it was my

favorite coffee shop. My Saturday routine, go

to full city coffee, get my drink, my bagel, my newspaper, my journal, and sit there

for two hours. And that was just

that was me time. And that was one

thing that I wanted to do

when I got back. I wanted to go

to full city, sit down, read the

paper, drink my coffee. So that first

day I got home after running

some errands. I went to full city and I got my drink

and my bagel, and I sat down

and I started to feel really,

really uncomfortable. Sitting next to

plate glass windows are three blocks

from the hospital, so ambulances and

fire trucks are screaming by there's

loud noises, people are

dropping chairs. I had to leave.

The one place that I thought that

I could go back to that was safe and familiar was

wasn't anymore. And and as I went throughout the

day and month after, I started to realize that nothing was the same. Those places

that I would go to him I had just to go back home

in a sense. They weren't

there anymore. The way that I saw life

was very different. And then the town that I live in is very,

very liberal. And so when we returned

or there were still a lot of those

protests going on and just the anger

inside of me. These people

that had no idea what they were

talking about and listening to people

complaining in mind that that they had to stand in line

was very annoying. And I couldn't understand

what was going on. Why was I reacting, responding to these people like and they

just ignore them. Kind of like what I

did when I can just shut off my emotions. But I was I I

couldn't died the anger which

was starting to build and I wanted to, I wanted to punch

the pianist. Tell me about some

of those triggers. So for instance, you mentioned the

firehouse and the sirens. What do you think of

when you hear a siren? Well, for us, when we were

deployed, the siren, which actually

sounds much like an air raid siren that

you would hear in, in London when the bombers were coming and Germans

were coming in. That meant a missile

or some sort of for an object was

heading our way as good alert. Scott

alert, yes. So that meant we

had to get in our mass because get into our gas masks

and protective suits. And as you know with

all your training, you have put that mask

on and nine seconds, which means you

first hold your breath and you

close your eyes, you grab for

your mass, you put it on, clear

it, seal it. And then you put on

the rest of your gear, will see that

alarm became so automatic nine times the first day that

alarm went off. The first day of the war. One of them was actually

a chemical alarm, which you get your

pucker factor going up. You think about all

those chemicals that could that could be coming our way and the effects that but it was a

conditioned response. Those alarms go off. Hold your breath, close your eyes, grab fear mask. And when

I got back home and there was sirens or alarm similar to that that crescendoing

siren and coming down? It was an automatic

Pavlov type response. You quit breathing. First of all, stop

breathing. Hold my breath. And we instantly

even though I was in that this actually

happened when I when I went back to

work where there was it was on the

television behind me. The History Channel

was on and, and it was a World War

Two bombing series. And this error rates

I rent went off and I jumped up and kicked over the chair

and held my breath and my eyes

were closed and I went for my mask

and it wasn't there. But I'm also

moving forward. And I run into a

chair, another chair. And that's what kind

of brought me to and I was I was humiliated and I was just in

shock that okay. I know I'm in Sacred

Heart Hospital, but I just wait for my

mass that isn't there. And then I started

feeling unsafe. I don't have my mask, I don't have my weapon. I don't have the

things that I need that I know are

going to protect me. So that's that's one

of my major triggers. And how are we doing today with with that

particular triggered? I mean, even today

you here's iron. Oddly enough.

This happened last night when I was

outside and it was a fate crescendoing siren and I jumped up

from where I was. And whereas I don't go through the

whole process now, I have to verbally I have to physically

tell myself to breathe. I have to say it out

loud because that will get me to to breathe. If I'm talking,

I'm breathing. But the initial jump up response is still there. And it's a little embarrassing

when I'm around people that

don't understand what that's all about. And they're looking at me. That happened when

I was at work. They looking at me like I was crazy and then they didn't

know what to do. So they just started talking to themselves

or they left. And I'm standing there

in the middle of the room almost

hyperventilating because of what was

just going on and nobody nobody

knew what to do. Now, as I

mentioned earlier, the main

differences between acute stress disorder and PTSD has to

do with time. The rule of thumb is that if the symptoms begin within four weeks of

the traumatic event, a condition the

condition is called acute

stress disorder. During the first month of them experiencing

those symptoms. Acute stress disorder

will resolve itself within those

first four weeks. But if the

symptoms persist longer than a month

than a diagnosis has changed to PTSD as long as it still meets

that full criteria, the definition of PTSD for the next three

months after that initial month

when it's ASD. For the next three months, it's called acute PTSD. If the symptoms persist longer than

those

three months, it's called chronic PTSD. And you see all that on the graphic either on, on your notes or

on the screen. Now with PTSD,

a person could actually function

pretty close to normal for many months

or even years after the traumatic

event before they begin to experience

symptoms. If the symptoms start longer than six months after the initial

stressor, then it's called

delayed onset PTSD. This is something

that a number of World War II veterans are experiencing

even today. Back when World

War II was over. They experience a lot of high emotion and anxiety. They stuffed it on down because

they didn't

know what else to do about it and never

dealt with it. And so they

raised families, had careers retired, and now that they're in their 80s and they're

seeing things on the TV relating to the war in Iraq

and Afghanistan. A lot of these

PTSD symptoms are beginning to surface in these men some 50 and 60 years after the conflict. And

that's definitely

delayed onset PTSD. As you might imagine,

experiencing combat is not the only way that a person can

encounter PTSD. One can end up

having PTSD through natural disasters

because of things like floods and hurricanes and tornadoes, earthquakes and tsunamis. Just accidents

traffic accidents or household accidents. Assault, sexual

assault, kidnapping, torture, viewing

any of the above. And this is a big

problem with a lot of firefighters

and policemen, and police women

that are involved in their normal duties. Or receiving

tragic news about yourself or about

a close loved one. Perhaps it might

be a prognosis of a terminal illness

or something like that. Now not everyone who is exposed to a

traumatic event, the ones that I

just mentioned necessarily will get PTSD. Numerous authorities

estimate that anywhere between 7590% of Americans have experienced

or witnessed some kind of an event that could produce PTSD. But only about

five to 10 percent of noncombat general public individuals will actually

develop PTSD. There are several

factors that make it less likely that a person will

be affected and experience either

ASD or PTSD. These are factors such as fewer and less

intense events. The person's mental

or emotional interpretation

of the event. In other words,

giving meaning to the traumatic event

that happened to them. For instance, if they

were involved in, let's say a

tornado, and they can just say this is just a natural occurrence. It's not like the universe is out to get me I

can understand that

these sorts of things simply happen. A troop over there,

I might have the attitude of saying that I am glad to have been able to

suffer from my country. I counted a privilege. And this is something

that I will absorb for that

greater purpose. The person's

foundational, mental, and emotional state has lot to do with it as well. For instance, faith will come in

very

strongly here. Belief in one's mission is also a very

positive mitigator, which was a problem

for a lot of our Vietnam

veterans because they weren't supported

by the country. And then when they came home and they

were insulted and spat upon and they felt like they were

criminals coming home. This greatly exacerbated

their symptoms and cause many of them

do end up with PTSD. Another mitigating

factor on the positive side

has the ability to envision a good

possibility or the greater good. Kind of Romans 828, we know that all things work together for good.

Then who are the called,

them who love God? And then also positive

unit leadership is also a very positive thing that helps mitigate that if they've got a

good platoon leader or officers

above them that helped them keep

things in context and know that they're

being taken care of. That makes it a

big difference. Teamwork and buddy

support during and after the traumatic event makes a big difference as well. We see a big

contrast between today's troops

and World War Two troops in this respect. Because back in those days after the war was over,

let's say in Europe, it took them several weeks to make their ways

back to the coast. And then they get on a troop ship and they were six weeks going

across the ocean, during which time

they had lots of time to debrief with their fellow

soldiers and talk about the experiences

that they had. And this is very therapeutic

for all of them. And then finally debriefing

within 72 hours. Those who are

very involved with critical incident

stress management have determined that if a

person is able to talk about the

experience they had within that

magical 72 hours, it seems to

greatly diminished the likelihood that

they will develop PTSD. There are some

other factors that make it more likely that a person

will be affected. More recent

intense events, which is happening

over in Iraq and Afghanistan all the time. A greater level of

personal involvement in the traumatizing event. In other words, experiencing it

rather than simply witnessing it

when the event occurs on top of other

current stressors. Like for instance,

a person may be afraid of what's

happening with their relationship

to their fiance. And they're also

having a lot of anxiety about the

combat they're in. And all of a sudden

they receive a Dear John letter

from their fiance. This makes things

a lot worse. Traumatic events

in childhood. If somebody is

involved in as a child with parental

abuse or sexual abuse, then what happens is their abuse cup is kind of Closer to full when they head off

into combat. And it doesn't

take much more to send that cup over the edge and help them to develop actual post-traumatic

stress disorder. Then finally,

strong feelings of responsibility over

what happened, what the witness

to what they experienced in the

traumatic situation. When a shift our attention next to the effects of deployment on the spouse and the

children

of a troop. When a husband or a

wife goes off to war, many and just

adjustments have to be made by the

homefront spouse. They assume the

roles of both father and mother as best

they can for awhile. They assume all the

household chores and responsibilities of the deployed spouse or

what used to involve teamwork now has become

a solo operation. And there's now many

emotional burdens which they can't share with the one that they are closest to on the planet. And also

various

temptations I'm were accessible

during that time. Family logistics, such as trips

to the doctor, shopping or or

school activities, recreation are

also harder to accommodate and

physical respite are also more

and more rare. So as you can see, the

diploid troop is not the only one who is being stressed out during

the deployment. As vanilla brought

up earlier, when a troop comes home, he's stressed and

she's stressed. And that reintegration

period can present a number of great

difficulties to both the husband

and the wife. They need to be very

carefully negotiated. One of the most debilitating

problems has to do with how

returning troop, how they can affect

their spouse or their children when

they come home with ASD or PTSD. An increasing

amount of study is being done on a condition known

as secondary traumatic stress. That is the

traumatizing effect of the combat

troops condition. Having a very

negative effect on his or her spouse

and children when he comes back as a

combat trauma, suffer struggles with

their symptoms of PTSD. And the spouse tries

to understand and adjust to this

different person who has come back

from the war. Then many times

the spouses, children will

actually begin to manifest many of the same symptoms or even different symptoms of the troopers

come back, come back with PTSD. Espouse can

also experience primary traumatic

stress if the combat trauma sufferer threatens them or

harms him or her. For instance, let's say a combat trauma

veteran has come back and

they're having a nightmare about

being attacked. And a half wakes up and notices his wife in

the bed next to him, and thinks that she

might be the enemy. And so simply as a

matter of self-defense, begins to attack her. And obviously if she feels her life is being

threatened, she could also

develop PTSD or ASD. I'm going to be

talking about combat trauma and how it has impacted

military women. The Pentagon says

that there are more than a 182

thousand women who have served in

Iraq and Afghanistan. That's 11% of US

troops deployed. That dwarfs the 7500

who served in Vietnam. And most of those

were nurses. During our brief Golf War, there were approximately

41 thousand women who were deployed. Women are barred from ground jobs such as

infantry, armor, and artillery

units, and are technically confined

to support roles. But those jobs

include some of the most dangerous

driving convoys, being a medic,

guarding checkpoints, and searching women as part of neighborhood

patrols. According to

Patricia rhetoric, who was the director of the Women's Health

Science Division at the VAs National Center

for PTSD in Boston. She calls the war in Iraq and equal

opportunity war. With a tax not only come

from enemy fighters, but also from

roadside bombs or IEDs and murders. There is no front

or rear line in Iraq or Afghanistan. A person has no

clear idea where, who, who, or where

the enemy is. There is no uniform. It could be a man, a woman, or even a child. There is no safe place. All

our military men and women are in

enemy territory. According to the VA,

women diagnosed with PTSD accounted for

14% of the total, 27 thousand recent

veterans treated for PTSD. For some women,

combat trauma is complicated and intensified by rape or

other sexual abuse. Often by the comrades they train and

fought beside. Sometimes they are raped by a military superior. The VA says that 20% of women seeking

care since 2003. Showed signs of

military sexual trauma. That's MST.

Compared with the 1% of the male veterans. There may be more

sexual assaults, but many women hesitate to report it for

various reasons. And others may be waiting

till they get home. In the newspaper on

January 20th, 2008, there was a cartoon by

June of Doonesbury by Gary try do the scene

as a woman combat that, talking to the therapist. And she says, ma'am, I've been trying

to think of myself as a wounded warrior, like alias told me so. But it's been

a tough sell. A key, calling myself out, I go, wait a minute, suffered sexual assault

from my country. How's that work? Like, where's my

purple heart? But guess what

happens today? Pd comes up to me today, puts this in my hand

and walks away. The therapist

looks at what that's in the bets

in her hands and says it's a candy heart into that says

Purple of course. Hinted therapist

reads the heart, which says,

boring to roll. And the vet replies, someone's got my

back again, ma'am. That's not forget the

vets who are women. That's become their

battle buddies and watch their backs as well. And I have been sharing the wide spectrum

of reactions that our troops can

have, the combat trauma. We hope you've been

able to appreciate how complex the subject

actually is, the variety of stressors

that a troop can experience when he or she is involved in combat. And the complexity of

every individual that God has created is putting those two

variables together. It's almost infinite. And so a one size

fits all approach to combat trauma is

never going to very easily produce any kind

of useful results. Instead, we must recognize three important points. Number one, God

is the healer. Number two, you are

not a number 3. Nevertheless, God wants to partner with each one

of us in order to construct a healing

environment in which the spirit of God can have optimal

access to the body, soul and spirit of

the combat trauma suffer in order to

bring about healing. Now how can this

be accomplished? Military ministry offers two publications

that anyone who is very serious about

constructing that healing environment

will benefit from. One is entitled to combat trauma

healing manual, Christ centered solutions

to combat trauma. It was my privilege to do the research

and the writing on this mania with

my wife and Ellis help and the help of many other people as well. And that's

specifically for the returning

troops who is suffering from

combat trauma. It's interactive,

designed to bring the troop into the Bible and understand

what the Bible has to say about what he or she is experiencing. And it's designed for either a small

group situation, a one-to-one situation, even in a self-study mode. But it's best used in a

small group approach. The other publication

is for the wives of combat trauma suffers and it's entitled when

war comes home, Christ centered

healing for the wives of

combat veterans. This was co-authored

by myself and run Ella and along with

Michelle Carter Waddell, who was the wife of

Commander Mark what L, who was a Navy seal for 24 years and experienced

11 deployments in a hot war places all over the world and it's currently struggling

with PTSD. So I mentioned that a

lot more needs to be said about what happens to the wives and

the children of combat traumas spectrum or combat trauma sufferers. And this is certainly a resource

that

would be helpful. They're both

manuals combine the best insights

of the medical and the counseling

communities with the principles that

are found in the most tested and verified change agent in

all of history. And that is the Bible. We have plans to produce additional materials

that'll be addressing the specific needs

of the husbands of combat trauma suffers

their parents and their

children as well. And we'll, we'll be

putting together small group study

guides for these. In addition, let us conclude with

Isaiah 30, 22, which I think eloquently sums up what

our role should be as we are involved with those who suffer

from combat trauma. And that verse says

that a man will be like a hiding place in the wind and a refuge

from the tempest. Like rivers of water

in a dry place, like a shadow of

a great rock. In a weary land. We can't be healers, but we can be that man or that woman that

provides a safe place, a refuge, a

refreshment, a shelter, and enabling place

that will help them to connect with their one

and only true hope.

It's very important to understand the ecosystem in which the people

we care for operate. In the case of a soldier say, or

airman Marine, that represents

the military medical system run by the Department of Defense and Veterans Affairs

Medical System for those that have departed from the service. These two medical systems to find the

ecosystem. And it's wise for

the counselor of these folks to

understand what that system exist for and what some of the

complications are. Now, as we move forward

into this series, we're going to learn

about the specifics. How does, What's

the bridge between those two medical systems, how our soldiers processed after they come back

from the battle front. For understanding

of whether they have mental

health issues, whether they carry the

hidden wounds of war. All of these are

important for the practitioner

to understand. Now the good news

is that we have some wonderfully

talent people that will be presenting

to us today. Dr. Ken Farmer, major

general retard Qin, former United States Army. Can is currently the Executive Vice

President of try West, handling a large

region of our country, Tricare support for our troops

and our veterans. And in addition,

his career tracks the last

assignment, for instance, as Commander Walter

Reed Army Hospital and the North Atlantic region of our military

medical system. He also as men involved in many other

military things. He was a Desert

Storm veteran. He was flight surgeon of the 101st Airborne

Division. He was commander of

an army hospital it for Polk, Louisiana. Here we have a

man with great experience and wisdom that goes far beyond the

military system, but it goes certainly into the civilian

community. Certainly a benefit

to all of us. And in complimenting

him is Dr. Lee Bishop. Dr. Lee Bishop is a

staff psychiatrist at the Michael

DeBakey hospital, Veterans Affairs hospital

in Houston, Texas. Dr. Bishop was assigned by the Veterans

Affairs to help us understand the Veterans Affairs

Medical System so that we as counselors, best team with

them on behalf of troops and veterans

across this country. So please welcome Dr. Ken Farmer and Dr. Lee

Bishop. Thank you. We are honored

today to have Dr. Ken Farmer with us to initiate our discussion of military and veterans

healthcare systems. Dr. Ken Farmer, Major General,

retired Qin farmer, former commander

of Walter Reed and many other wonderful

assignments in the military. And now he's the

Executive Vice President and Chief Operating Officer of trike here of try West Health

Care Alliance, which Really services

the Tricare system in a large number of

our Western states. So it's an honor

to have you, Dr. Farmer, can Bob, it's very nice to be here. It was a great

privilege for us to bounce off one another in our military

career site. And I had great

respect for your compassion

and your expertise with military

men and women. Well, I'm glad

to reconnect and to reconnect and such a wonderful focus on ministry here,

yeah, for sure. Well, what we wanna

do is give the counselors that

are listening to this, the

church members, the pastoral Councils,

an idea about the ecosystem and that the military

person swims in. And particularly for

the wounded warrior, maybe it's most

appropriate. Let's just start

off. We have a great American in Iraq

or Afghanistan. He's out there

doing his job. But he gets nicked. He gets nicked physically or it gets

nicked mentally. That's sort of starts

the medical system on the triage side. So could you discuss the military

medical system and particularly

in wartime? Well, I sure and it's

a very complex system, but let me sort of start first on, on this side, when you look in the and across the

United States, the military

health system is really a combination

of the direct system, military hospitals

and clinics and managed by the Army, Navy, and Air Force in support of

our services. And a lot of

the care is in those direct hospitals

and clinics. But they can't

do everything for the 9 million

milligram or members and

family members and retirees and their families eligible

for care. So they've partnered with some companies

like mine to build networks of private

practitioners and facilities to augment the military

health system. And that's what we call the private sector care. That has been particularly important as

we have been in this war effort in

Afghanistan and Iraq. Because the doctors and nurses in the military

hospitals and clinics, while that's

their day to day job, many of them, most of them have an alternative

duty assignment. When the nation, when

the service needs them, they will deploy with

a deployable hospital or a ship or another

deployable platform. And so you have

many doctors and nurses and healthcare

professionals who normally serve

in a hospital or clinic and

somewhere in states. But today are

serving in Iraq in a combat support

hospital or A another deployable unit. And so this private sector Care Network fleshes

out on this side. But now let's jump over to the Iraq and

Afghanistan. The audience watching this who may not be familiar with with the

military system would be amazed at the, the sophistication

and the technology of what we got

over there and very likely the

best in the world. We've got the best

trauma center in the world is right now, is that sitting in Iraq supporting supporting those great men and

women. And so a person

injured IED or, or another injury in

Iraq or Afghanistan is generally got first-line

medic intervention. And those medics are very, very well-trained to do lifesaving interventions. And they

that every day. Then a very sophisticated

evacuation system with ground vehicles

and helicopters, which we'll get to them generally

within minutes, to a forward

surgical team where life-saving care and intervention

can be done. And then deployed

combat support, hospital's trauma

hospitals in the theater of operations. One of the things

that these different today than in

previous wars is our ability to

move from Iraq or Afghanistan to

launch fuel Germany. Very seriously

injured servicemen and women very,

very quickly. In the past, we can only

move when they were stabilized and that's

sometimes took weeks. Now we can move stable but are we can move stabilized but not

stable patients now. So because of the

amazing technology, amazing technology, we have the

ability to have literally intensive

care units in the air. So we are often moving seriously injured

service men and women within 24 to 48 hours to a very sophisticated

Military Medical Center and lunch to Germany. And then often within

a day or two of that back to

Walter Reed are Bethesda or Brooke

Army Medical Center or another one

of the medical centers in the States. So this seamless

transition of care from unemployed theater to generally Launch

Tool Germany, and then back to the most appropriate

Medical Center here in the States

chosen by service, by where the family is, by where they

would get their best, best level of care. And along the way,

and no doubt, care and compassion

for the families and loved ones who are wondering and so forth. That's absolutely. And as a matter of

fact, over the course of the

last number of years, the knowledge areas but

policies, procedures, authorizations in

place to to to bring family members to be where they're seriously

injured, loved ones. Sometimes in lunch

tool, Germany. But at other times, back to Bethesda

and Walter Reed are broke or wherever

and to care for that family

and to give that family some

support and per dm and transportation to be there for as long as it's appropriate and necessary

for them to be with the loved one in

the wonderful work or the Fisher Houses. I as a, as an

extinction really of the military

medical system to care for that family. Exactly. And that we have

found that, that It's very, very important

to the patient. It's very important

to the milieu of recovery and treatment of the patient

and the family. Exactly. Now, garden reservists are being deployed with

unprecedented tempo. Even greater in many

cases in World War II, right there in the

woodwork of America, they have

healthcare needs. They get banged up there, the ectoderm, they

get cut and bruised. How how is it

different for them? Well, you know, the

Guard and Reserve used to be if I'm

at euphemistically referred to as

weekend warriors because they

would go out and train a weekend, a

month or whatever. No longer is that

moniker used because there

operations tempo and the the both

the frequency and the duration with which they're deployed is, has been phenomenal as

you just alluded to. And in recognition

of that, the Congress and the Department of

Defense has put in place a number of improvements and

advantages for them, specifically targeted

to the Guard and Reserve and their

family members to, to recognize and sport. I mean, there are

new programs of coverage in the

military health system. Track your prime remote, tricare Prime remote for family members that

specifically address this Tricare

military benefit to places that aren't around military hospitals

and clinics that, that apply to

the Guard and Reserve members out in

the small towns and, and hamlets across

the country. My company and, and those in the

other regions. We have gone to

great efforts to extend our networks, which used to be largely

focused around the, the hot military

hospitals and clinics. Look to expand those

networks across to meet the needs of the Guard and Reserve to Prescott, Arizona just north of

you, for instance, exact near Fort Hood or big military hospital. But but we've got a robust network and

that is in part to

support the guardsmen, reservists and their

families that are there. Well, that's

great. Now, these Guard and Reserve

families, they're all in the

woodwork of America there across the holes,

expansive our nation. Do we have enough

health care providers to really meet that need across the whole

breadth of our country? Well, that's one of

those questions. Where do you have enough? Yeah, there's there's

always going to be the the question

for any anyone each. But as I said,

we've we've moved over just the last few

years dramatically. I mean, we have a 140

thousand plus providers and our Fry West

Health Care Alliance over a 21 stakes. About 16 thousand of

those providers are in the behavioral health,

mental health area. And as I said,

the growth over the last few years has been particularly focused. And, you know, and the the the broad

areas away from military

treatment facilities. We're always looking

for gaps and needs and opportunities

to expand that to meet the

needs of people. But when we don't have, when we have a need

of an individual and we don't have

someone who is officially a part

of the network. We get them to other providers to

meet that need. Sure. It seems like there might be an

opportunity for those that are viewing this

video and go through the certification

process to in fact become part of this track your provider network

as a way to access needy military families in the behavioral health

arena as his address? Absolutely. And I think, you know your your

audience. Viewing this. Many of them

probably are part of the american Association of

Christian counselors. And, and, and I want to assure them that

pastoral counselors are one of the categories of tricare certifiable

providers. And so in addition

to psychiatry, psychiatrist and PhD psychologist

and licensed social workers and other

kinds of counselors. Pastoral counselors can be part of the network and we would be very interested in

as a

follow-on to this, providing those avenues of connection to express that interest

and do that. That's tremendous

because I know there's a lot of

people out there, a lot of educated, bright, competent people

that want to Hilda. Now the challenge

sometimes is that we can bring

the horse to water, but we can't

make him drink. The stigma of

seeking health care, particularly behavioral

health care. On the military side, military leaders are

trying to reduce that. Secretary of

Defense has just taken some recent drugs. But there's

still a stigma. Would you address sent? And it's absolutely. And I applaud the efforts across the nation

and

the secondary defenses, recent efforts out

of the Chairman of Joint Chiefs of Staff

and others to two, to destigmatize the,

the the getting, seeking mental health, behavioral health care. I go back to shortly

after the the, the Gulf War. Gadgets

she'll storm. The, the, the army specifically put into

play something we call combat

counseling teams to the heart of the

deployable force. And these were

psychiatrist, psychologist, and other behavioral

health professionals and small cells to, to be deployed

into a theater. To be the eyes and ears and support

of commanders. And be out there

to look for opportunities of preventive

behavioral homecare and assist with

critical if there's a brief things are critical when there

was a critical incident to go in and not do counseling

or do therapy, but to work with

soldiers and units to prevent that from

blossoming into. Serious problems.

We put into place a lot of

other things, suicide prevention

programs and other things to,

to begin to, to work proactively and preventively with

soldiers, with units. And the second-order

of that is to begin talking about it and talking about it

in a routine, preventive sort of way. That is really germane to your question about

destigmatizing. It's not something

to ignore. It's not coming to

shove into the clause. I think that as a result of the war

efforts and many, many looked at early on, amputations

were often call the signature injury of the war and then

traumatic brain injury. And more recently, some are beginning

to say no, maybe the real signature

injure there were those injuries that

we don't see visibly. But it's the impact

on the psyche, on the, on, on the mental and behavioral

aspect, right? In, and maybe just

a bit more we can address the hidden

wounds of war, right? You're obviously familiar term

co-morbidity, right? So many of these

wounded warriors that haven't outwardly

visible wound also have inward wounds it can write

seen and so you have to treat

these together and it's a complicated

process. Well, I more than

25 years ago, I developed a talk at a, at an army chapel at

Fort Polk, Louisiana, built around the verse and the 12th

chapter of Mark 38, first switch where the

Lord says than usual, of the larger God

with all your heart, with all your soul, with all your mind, with

all your strength. And my talk, which I've given on a number of loci, locations and

situation since then was sort of

built around. Why did the war choose

those forwards? And it addresses

the, the emotional, the spiritual, the mental, and the physical

dimensions of who we as

human beings are. And that we are

complex creatures. And every one of us has

a part of who we are. And in those dimensions we aren't just physical. And if we ignore

spiritual, the emotional, we are ignoring

part of who we are. And balance

requires addressing all of those dimensions

of our being. And nowhere is that

more true than in an injured

person and a person who's been exposed

to atrocities and horrors and the

ravages of war. So I think that that's

the context here, is whether the

primary problem appears to be mental, emotional, behavioral, where the primary problem is something

physical. All of us have a need to pay attention to what's going on

inside of us. And, and, and so this, this effort to

destigmatize that, right. And to open those avenues

both for the care. And they open the avenues within an individual to get and seek care is

extremely important. That's that's

wise counsel, I think this

holistic approach and what we're seeing is a faith-based organization

is that there's a very direct role for

faith in this process. And we say that in a, from a faith-based

perspective, god is the healer, right? And we're finding amazing anecdotes of troops. They come back

and they have these hidden wounds of war and through

spiritual renewal, they in fact, begin to heal from there, right? Hidden wounds that that complements

their

total healing process like well, I know Dr. Farmer, you have spent

many times in hospitals and particularly military

medical hospitals, Walter Reed and others. Probably the

counselors across our country would

benefit from some of your observations about how do you deal with

a wounded warrior? How do you talk to him? How do you get out of your comfort zone

and just wrap a norm of compassion

around the well, I they the first

response to that is you just

talk to them as you would talk to any of your other friends

and neighbors and contacts. They're ordinary

people who have done extraordinary things when the nation needed

them to do that. And they are generally very open to

talking about that. And so just, you know, asking them to talk about their

experiences and hey, you know, how how was

it over there and and don't tell me about tell me about

your your mission. To an injured to

an injured, true. Well, tell me about

your injuries. Many people are

afraid to ask that, but most wounded

warriors are very happy to

talk about their, you know, their injury,

how it happened. And then just going

with the flow of a conversation

like you would with anybody else that

you're talking to. That's the best

the best counsel. Well, I think that's

wise counsel. And then obviously

the healing process doesn't end in the

hospital, right. But then they go out

into the community. Can you address the

role of churches, the role of other

community organizations? Absolutely. Again, back to this holistic approach. I think the, that the

church and, and the, the Christian and carrying community becomes a particularly

important to art of dealing with not

only the spiritual, but with the

emotional needs of, of these folks. One of the one of the individuals

that writes a lot about treatment of Post-Traumatic

Stress Disorder. Dr. Martin Glasser out of San Diego, California, who himself served as a psychiatrist

and supportive of the moraines and Vietnam. When he talks about the

steps to trading PSD, his first step is

building trust. That. And that's

written from the perspective of psychiatrists

treating a patient. But I think it applies

to your question about a church community with

a patient and family, building trust,

building relationships. And then moving on

to other steps of, of connection, of openness and of

carrying exactly. And they come out

of the hospital, they go into the community and they also then have the opportunity to teen or the

Veterans

Affairs at system. Could you just

briefly address transition into the

veterans fair system? Absolutely. First of all, they for a wounded

warrior, they, they may get their

care depending on the needs and

where they are. Wounded warrior

will generally get most of their care inside the military

health system and a navy or air force

or an army hospital. But they make it some

of that care out in our civilian networks at the appropriate specialist

and facilities. Even while they're

on active duty, we will get them into

VA medical centers, into their poly

trauma centers for some of their

specialized care, particularly some of the traumatic brain

injury care. So the military

health system and the VA health

system intersect and interact and work together even for those

wounded warriors are still on active duty. For when a service

member who is discharged and

released from the military who does not have a retirement

in the military, will generally then be

eligible for care in the VA system and

would get most of his or her care

in the VA system, not in the

military system. Those who retire from the military or have

a medical retirement are generally eligible to get their follow-on care in the military system, but also

may be getting

some of that care in the VA. And so

we intersect. We look for where is the best care for this

particular condition. That's great. And our goal is obviously to make a seamless

transition exam or that wounded warrior

for the better. And we may be

talking about Vietnam veterans

that are in the VA health

system now and so forth. Well, well Good. This has been a

wonderful benefit, I think, to the counselors

across America. I would ask I

would afford you the opportunity

I can to just anything you would

say to affirm first our military men

and women that service day and night

and their families, and then also anything to the counselors that

would seek to help them. I think. First of all, I applaud your

organization and this effort

and which is directed largely

at familiarizing a segment of

society that wants to help who hasn't necessarily been

exposed a lot to military and military

system and soldiers. So this linearization

is important. I would encourage

your folks who are interested in becoming a more

formal part of this care to contact folks

like our company to become part

of the network. But I think that Building relationships

and, and, and caring for people, men and women as

men and women, not, and families, not just patients is

extraordinarily important. And I appreciate

this effort. Well, that's wonderful.

And thank you again for your service

to the nation, your service, my God, your service to

many others. Not only in the

military but now beyond the military. And so now we

transition to Dr. Lee bishop

who's going to give us the other half of this equation helping us understand the

Veterans Affairs Medical System so that we get really total comprehensive

health care for those that are

serving our country, but also those that

have served but continue to linger with

the wounds of war, both physical and hidden. So thank you very much. I previously had

the honor of introducing Dr.

Lee bishop from the Michael DeBakey

Veterans Affairs hospital in Houston, Texas. I also noted that he was a lieutenant commander

in the US Navy. I want to expand

upon that. It's good to have

you with us, Lee. I can thank you so much. Our Lieutenant Commander

in the US Navy, and this is a

recent thing. Now, you recently

enlisted? That's true. And you've already

been on a deployment. That to me says you have the heart

of a great patriot. And what was it

that caused you to, to do this at rather

late stage in life? Well, I guess it's a

combination of factors. Bob, by you work with these men and women

that are coming back from the combat

zone long enough and and it kind of

rubs off on you. And one of the

things that I had a growing sense of

was that the costs of the current conflicts are being disproportionately

born by a small group

of Americans. And those are our men

and women in uniform. And so when

recruiting card arrived in the

mail looking for some psychiatrists to, to join the military. The idea kind of

got under my skin. I've got family members who've served in

the military. An uncle who was

a Silver Star winner in World War Two. Cousin who was a Marine

and war in Vietnam. And, and I guess thinking

not only of them, but all the men and

women that have served. This was just a small way for me of saying

thank you. Well, you're a great

American yourself and we really appreciate you for your service. Is there anything else

you might like to say on behalf of

troops and families, any work to them

before we begin? Well, I guess the

word would be just to encourage them to let them know that their work, their sacrifice, all that they're

giving is

greatly appreciated. And oftentimes, they may not hear

that directly from, from people around them, but the appreciation

is there. That's great In this. A fitting way to start is to honor those to

whom honor is due. While our purpose today is to chat a bit about the Department of

Veterans Affairs Medical System so

that counselors across America

can understand how the system operates, how they might refer

into that system, how they might receive referrals from

that system. So that altogether,

we can class arms on behalf of our

troops and families that suffer in particular

from combat trauma. So with that as

a preface, Lee, Could you give us a

broad understanding of the VA medical system? I'll try to do that.

The VA medical system grew out of the, the, the mission really first articulated by

Abraham Lincoln to care for those

that have borne the battle and their widows and

their children. And over the years, that system has

developed into the quite comprehensive

enlarge department that we now see is as

an integral part of, of our, of our government. The system of course, is probably most people

are familiar with, is built around medical centers

around the country that serve veterans who have served in all

areas of, of combat. And in peacetime as well. These medical centers in many cases are

affiliated with some of the finest medical

schools in the country. And not only

take advantage of those affiliations and the faculty that are associated with

those schools. But also, I think

have been over the years developing

approaches that are on the cutting

edge of medical care. Just a brief

example would be the VAs electronic

medical record system, which is probably the best in the

world right now. Very, very. So. A soldier goes through

the Department of Defense medical system, which we have discussed in another part

of this video. And then he comes into the Veterans

Affairs system. What's some of the

first encounters he has with

Veterans Affairs? What does that

look like for the new veteran,

your case? I know that you

work with OH, IF and OEF, Iraq and Afghanistan

veterans. Yes. Well, it it may

vary depending on the urgency of the individual

veteran's needs. The process is first to

enroll in the system, which can be done

simply by either visiting a local

VA hospital. The processes is

relatively simple. But I think that

one thing it's important to convey as we, as we educate counselors, is that for those veterans who are

not

enrolled in system, particularly if

they're veterans returning from the

current era of combat. If they're in an

urgent situation, urgently feeling

the need for care, they shouldn't

let the fact that they're not already enrolled in the

system keep them from making contact. In an urgent need. It may be as simple

a matter initially as presenting to

an emergency room in a VA hospital, are, in the case of

mental health needs, presenting to

what's called the mental health

triage clinic. We are in the VA system very proactively

trying to reach out to veterans from the OEF OF operations

at this point. And in fact, in just

the last few months, we completed a project that involved

proactive late trying to make phone contact

with every one of the veterans that has returned from Iraq

and Afghanistan. So I mentioned that by way of illustrating

how important, how important

it is to us in the VA system to

get these men and women into the system and to try to smooth the way as much

as possible. And so if they come in and an urgent situation, our staff will take

care of getting them enrolled and getting

them into the system. Great. And so you have the veterans

hospitals and then there's also something

called vet centers? That's correct. A

number of years ago, largely as a result of

recognizing the need of Vietnam veterans

to have counseling, psychotherapy for post-traumatic

stress disorder. The system of

veterans centers, centers, we call them,

was established. And so in addition to the main hospitals in most of our larger

communities, there will be one

or more vet centers that are facilities

that are exclusively dedicated

to counseling and psychotherapy for

the returning veteran. And also to the degree that problems have come up in the family related

to the veterans, psychological symptoms, mental health symptoms. And then they

can also provide support and therapy

for family members as well, for sure. Now, your role in the Houston

veterans hospital is to deal with OH, IF AND OF patients, particularly post-traumatic

stress disorder. Yet, could you address your overall the hats you wear in the VA hospital? And then just

generically who you see as patients. Okay. That's that's the

correct description. About a year ago, I assumed a

position where I'm exclusively working

with returning OF and hawaiian veterans. We have a team that works with these veterans

made up of myself, one other psychiatrist, three psychologists,

and social worker. Basically our process

is once we identify the veteran and we

set up a schedule, interviews of clinical

contacts with them. The initial contact

is with one of our psychologists or with our social worker

initially. And they undertake

to do what we call the returning

veterans mental health screen.

It's a wink. The interview goes

through not only the particular

symptoms that they may be having

at that time, but a fairly extensive

background history. Some family history,

some medical history. Once that's completed by the psychologist

or social worker, then the veteran has a scheduled

appointment with me as one of the

psychiatrists on the team. With the advantage of that background history

already accumulated, then I can focus in on the particular

symptoms that the individual is

experiencing at that point, review and confirm those symptoms

with the veteran. And then that gives

me an opportunity to talk with them about any diagnosis that has been made at that point, to talk with

them about treatment options that

may be appropriate. Particularly since

I'm the psychiatrist, the MD on the team, I can focus in

and talk about the biological and

neurological aspects of PTSD and post

combat depression, medication and physical

forms of treatment. So that's really the first exposure to you and those are the things

you investigate yes. With this person? Yes.

Now, I know that I there's a gentleman named Robert nodal and wife Amy, who had a particularly

complicated experience coming out of

the military. He had PTSD, but then a very

serious traffic accident which left him with traumatic

brain injury as well. And I know he's given

permission for you to chat a bit about

his situation. Any observations

or lessons learned that might be more

broadly applied. Well, I think

that certainly Roberts situation

in many ways, even though his

his brain injury occurred after he'd come out of the commas own. It illustrates one of the most common

combinations of problems that we see in the current

era, veterans. It's often said that the two signature

injuries of the current era

of combat or post-traumatic

stress disorder and traumatic

brain injury. And Robert has had

both of those. I think that he has

done a wonderful job in making use of a variety of treatments

sources around him. And in adapting with

these conditions. Making some very

difficult decisions about changing career plans that were necessitated

by these injuries. Robert has drawn very deeply on his own

deep Christian faith. And I think that that's been a tremendous

support for him. And I think that his his ability to

do that has really made a difference

in his recovery. Do you find to

Lee that faith is a very relevant factor

as a complement to other approaches

related to PTSD. In particular, I do Bob, I as I am, whereas as are

many therapists, psychiatrists that

in the setting of post-traumatic

stress disorder, particularly in

the situation for, for combat veterans. Very often there is

what we might call an existential

crisis that's associated with having it gone through the trauma. Veterans come back

with questions like, how could God

let this happen? Or how could God let this go on without intervening? In many cases, they

may have gone into the combat situation

with with, with at a stage in

life when they still have some questions

in their own faith, life is in a

formative stage. And for those who

are able to address those questions and to find a grounding in faith. My experiences

in most often, they're able to make a more rapid transition toward recovery

or their PTSD. There there remains

to be done, definitive

scientific work on many areas of that. But we do have

good studies in other areas of mental

health conditions, suggesting that

faith very often is a strong factor

in recovery. I was going to

ask about that the term resilience is often in some

scientific studies, I know that resilience is enhanced from a

faith perspective in, in a, in a more

pragmatic sense, ounce of prevention is

worth a pound of cure. I'm, I'm just wondering, do you think If a man

or woman looks at life through a faith lens in route to their

traumatic experience, that they are more resilient at

the other end? My personal opinion

is that yes, that's likely to be true. Well, as you deal with many situations in

the Veterans Affairs, I know that you do not have the

single solution, but you have to partner

with many others. And part of

that partnering is the local community. It you discuss

the benefits of outreach to the

local community, churches, civic organizations,

other things like that. Sure. I think that one of the things that we

see in a lot of our returning

veterans because of the effects of PTSD and because of the

transition they're experiencing from a close-knit

group of buddies, fellow marines,

sailors, soldiers, to back into

civilian life is that in many cases it's a little

bit difficult. May be very difficult

in some cases to reconnect with

people around them. And I think that one of the things that

we certainly want to encourage them to do is to find ways that

they can do that where they can be

supported by a mature, loving community

of people. Faith based

groups, churches. Particularly if they have taken some time to learn

about the needs of veterans coming

back can provide a very natural environment for that reconnection

to take place. That's great. Have you seen any examples of this in Houston? I think back

speaking back, Robert, certainly

he's a case in point. Somewhat unusual case

because Robert himself has now move forward to actually enter

seminary training. But I've seen a number of others in my practice. Individuals who have connected with

the church, a church, a group of one kind or another

that supports them. And in, I'd say in

most of those cases, It's been a very important factor

in their recovery. Recently Secretary

of Veterans Affairs, Jim peak remarked to me that oftentimes these

troops coming home, understandably

are not real serious about their post-deployment health

risk assessment. They just want to

check the block, get off to see

mama or whatever. You get on with life. And really the first time that they

seriously consider their situation in the first wake-up

call perhaps is in a church or a

community organization or within the body

of the family. And so it seems very important for us

to help orient these type of groups

to partner with you in many ways,

I've been construed. Now I'm thinking

what we've described as sort of

an out-patient system where a veteran

might go to Events Center

or they might go to the Veterans

Affairs hospital. Is there also an

inpatient process? What if somebody's

very serious? For instance, I've

heard of the Martin Berg West Virginia

facility. Could you discuss it

inpatient matters? Well, most of our AR VA medical

centers are going to have inpatient

facilities available for treatment of PTSD, depression, and

the variety of difficulties that

are veterans bring home with

them in many cases. I think one of

the things I, I like to address with my veterans is that if there is a need

for inpatient care, that oftentimes

that involves a fairly short stay

in the hospital. I think there's a

lot of myths around inpatient psychiatric

care that keep some veterans from from considering that

as an option. But in many cases, particularly

in a situation where there's a crisis where an individual may be experiencing

suicidal thoughts. Getting them into the

hospital helps to move the treatment

along more rapidly. It allows us to do a

number of things that would take a longer

period of time to do on an

outpatient basis. It also allows the

veteran to kind of step back from the pressures that often face

them when they've come home from deployment and be in an environment where they're

not being pushed quite so much to deal with so many problems as

kind of a timeout, if you would. Good. Now, many

counselors across our country are

dealing with Vietnam veterans and

some are dealing with the younger veterans

coming back from OF OEF. Is there any way you

would distinguish your words of wisdom about dealing with these different

populations as it useful to deal

with them together, deal with them separately. Any thoughts about that? Well, I've seen it

work both ways. In some cases I have

seen where there are enough

differences that dealing with

them together. Hat has been a challenge. In other cases. I've seen situations where the younger

veterans

Find the experiences of the Vietnam veterans and the knowledge

that they've been through it before and they have survived and in

many cases flourished. Where that can be

very encouraging. I do see some, some differences

between them. And the most obvious

and logical one is they are dealing with different

generational issues. The Vietnam veterans by enlarge in their

50s and 60s, are dealing with

life stage issues that are particular

to that age group. That's a little

different from the the 20 year-olds, 30 year-olds that

are coming out of the current era of combat. We're just

starting families who are starting careers. They have

different kinds of issues that they're

dealing with. I do think the historical

context is pretty important to the

Vietnam generation. Came back from the war at a time when the

United States was in a great deal of turmoil about the

purpose of that war. And in some cases, the Vietnam veterans found that what was

traumatic for them even more

than being in the combat zone or what they felt was

more traumatic, was coming back

and facing a very ambivalent public

that tended to identify them

and over identify them with their doubts

about that war. I think at least

to some degree, America learned from

that experience. And, and to a much

greater extent, extent is trying to support the troops as

they're returning now. And I think that shows, I think that our

current troops coming back are not having quite the stress that perhaps the

Vietnam veterans had in return in finding that

ambivalence and, and, and in some cases, really negative kind of view of them when

they come back. Well, these are

great words of wisdom for counselors

all across America. Is there anything

else, LEA, you might that

might come to mind to mention

for those who are interacting in

a counseling sense with these

returning veterans. Well, I think

one thing that studies have borne out is that that makes

this generation of veterans very much like those that came before. And that is that

they're very uncertain and wary

about seeking health, mental health evaluation

and treatment. They're concerned about the stigma

that's attached. Studies that have recently been done have really confirmed that some of the biggest

barriers to seeking mental

health treatment, or the fear that it will be a sign

of weakness. The fear that it'll

have an effect on their military or even

civilian careers. And the fear that

others around them may be particularly

their, their, their buddies

are shipmates, will see it as a

sign of weakness. And so I think overcoming that's very important. In my first encounter

with with the veteran, I first of all, try

to make it clear to them that this is not

a character problem. It's not about being weak. Some of the bravest

amendment men and women that I've ever met

suffer from PTSD. And they suffer from it indirectly because

they are so brave, they were willing to

put themselves in situations where

their life was constantly in danger. And they were

under some of the worst

battlefield stress. And so the fact of having PTSD or Post

combat depression doesn't signify

that there's a weakness or a problem. In character. It's an illness and we need to see

it that way, to treat it that way, and to try to help the individual move

beyond that stigma. Lee, I know that

you're familiar with the combat trauma

healing manual. This manual is a new tool. It does provide Christ centered solutions

for combat trauma. We've talked about

the importance of faith in many

people's eyes. Do you have any comments regarding combat trauma healing manual and how

it might help others? Well, I have

reviewed the manual. I think that it's a well-written and

encouraging summary of not only the problems that can be faced by returning combat veterans, but

some of the ways

that faith can be integrated into

a whole package. Recovery from that. For those veterans

that I see who are wanting to integrate their faith life into

the healing process. I will sometimes

suggests that they take a look at

the combat trauma healing manual and look at some of the resources

in there to see how they might use that. The VA, the VA for me

has been fantastic. I started out in

a VA hospital in Waco mean with a

psychologist and he met me, fit me in his

schedule when he didn't even have

time because new patient and he had

been booked booked out significantly

and he made time for me as much as I

needed to meet with him. They offered

me medication. They offered in

inpatient treatment, and they offered

a small group setting at a different

VA hospital. I didn't want to try the medication at first and ever and ever did. I didn't want it to do the

inpatient

treatment because I needed to be with my family working

through this as well. But eventually

when I moved towns to new VA hospital, they had a small group

of veterans from Iraq, Afghanistan, and in the first Gulf

War who were meeting to talk about

their symptoms. And that was

beneficial for me, although it was

provocative for me. And it was it brought out a lot

of volatility in me because it may be

deal with symptoms. And it was at times depressing to look

around the room and see how these

other guys are dealing with their

own problems that had come from

combat stress. It also helped

me understand that this was a normal reaction

at memorial events. That although we

call it a disorder, it's actually a normal. I mean, if you if you don't have

these kind of reactions and

then you have to ask the same questions of why am I not affected

by these things? Because we weren't created to do these things. Just a result of

sin in this world. And so the VA gave me a lot education

about what PTSD was, what the

symptoms were, still had individual

treatment was really good for me to understand from

from from a from a mental perspective

what I was going through and how to recognize signs and how to defeat

some of the symptoms, or at least cope with

some of the symptoms. But for me as a Christian, there were still

some things missing. And month or two after I started

going through PTSD group at the VA, we started a PTSD

small-group at our church, which gave me the

spears spiritual aspect of exploring these trauma, traumas and how to make sense of them through

scripture and through relating the Bible and praying through it when talking through

it with other people. From a Christian

perspective.

Military assessment and

treatment protocols with Dr. Eric skull ace, and Dr. Lee Bishop. You've met Eric

before, as you know, a licensed

professional counselor and licensed marriage and family therapist

and the executive or the vice president of American Association of

Christian counselors. And you've also heard

from Dr. Lee Bishop, Dr. Lee Bishop

staff therapist at the Michael

DeBakey Veterans Affairs hospital

in Houston, Texas. And also relevant to today's discussion

is that Dr. Bishop is in charge

of the group that takes O IF

Iraq veterans, OEF, Afghanistan Veterans, and work specifically with these young returning

warriors that have serious hidden

wounds of war, in particular, post-traumatic

stress disorder. He in fact, we'll use

some examples out of his current practice that makes it very topical, very relevant.

In addition, Dr. Scholarly springs

his whole experience of counseling to here,

to this discussion. We will discuss

in this piece about assessment and

treatment protocols is how do you assess it? There's something in

the military calls pd, HRA, that post-deployment

health risk assessment. It's a way to

try to assess. And one of the

challenges is that as troops come back

from the war front, the last thing

on their mind is a health risk

assessment, a mental health

assessment. And so they do it very

quickly sometimes. And it doesn't indicate what is necessarily

going on in their lives. And so there's other

means of acceptance and perhaps the first

touch point at the Veterans

Affairs or within the military

medical system, or sometimes the first stretch

touch point is in a church or a community

organization. And so in their

discussions they will talk about the importance of teaming, the importance

of partnership, and the importance that many hands make

light work. And the importance

of community, particularly given

the significant Guard and Reserve mobilizations of

this ongoing effort. And again, I would

ask all parties that listen to this to view it through

a wide lens, understand the

broad ability of the treatment

methodologies we see in the military. In many ways.

Sometimes it's a fore runner of the treatment

methodologies that you may find useful in your own practices

that may not always relate

to the military. So I gave you now Dr. Eric Aeschylus

and Dr. Lee Bishop. Hi and welcome

to this session. I'm here today with our guest, Dr. Lee bishop, who is a staff

psychiatrist in Houston with our

returning troops. And Dr. Bishop Lee, It's great to

have you with us. And today we're going

to be talking about assessment and

treatment protocols specifically as it

relates to the military. Are veterans are

returning troops. So let's start with the assessment side

of the equation. As you think about

what you do as a staff psychiatrist in your team there and

in the VA Center, what would you say are the critical core

issues that you must take into account as you're assessing

your patients. I think first of all, we want to get

a good sense of specific describable

symptoms that the individual

presents. Its only with a clear

understanding of those symptoms

that we can really make a diagnosis

whether of PTSD or depression or

some other form of anxiety or

mood disorder. Or perhaps if there's substance abuse involved, being able to make that sort of

diagnosis as well. So it's very important

at the outset to facilitate the

individual in describing what

their experience is. Sometimes that involves

also talking to people around

the individual family members who can oftentimes

provide information based on their

observation that the veteran or the

service member themselves may not

have been aware of. Particularly, for example, just taking one example, sleep is very

important issue. And very often spouses can tell us something about the sleep behavior that of course

the

veteran often or the servicemen were often cannot be aware

of ourselves. I imagine it could

either be a lack of awareness or in some cases it might just be denial. Not wanting to

knowledge that a person is

struggling with a particular set

of symptoms. It's often very true. Very often. The service

member or veteran doesn't realize,

for example, how their irritability and difficulty in

managing anger, which often is one of

the real changes that family members

and friends pick up when they've returned from the combat zone. They often

themselves don't realize that

it's affecting people around them in

the way that it is. And getting that

feedback from family members,

sometimes from, from friends or

associates can be very helpful, I suppose. And one sense, it's,

it's difficult to extinguish or resolve a treatment issue

and tell you can distinguish or

identify that issue. Well, that's

absolutely true. The old rule and all

of medicine is you can effectively

treat something if you don't know what that something is right, diagnosis has

to come first. You have to make

as accurate diagnosis as you can. And then the treatment. Then while it may not

altogether be obvious, it It's certainly

gotta be much more on track than if you started out with the wrong

diagnosis to begin. And as you think about the Combat

Trauma spectrum, because there will

be a continuum of symptoms leading

to more severe end of the diagnostic scale. How important is it

that you identify where that person is along that spectrum on

that continuum? How does that relate to eventual treatment

decisions that you'll

make as a team? Well, as there at

the milder end of the spectrum than as common sense

might dictate. One might not have to

involve as many of the more intensive and frequent clinical

encounters with that individual to successfully treat

the disorder. With a more

intense symptoms, with more with more of the symptoms of a

given disorder, say of post-traumatic

stress disorder, then very often that may indicate a more

comprehensive and more intensive

approach to treatment. For instance, with mild or PTSD and depression. We may see those

individuals on a once every couple of weeks basis for

some psychotherapy? I may see them once every three to four weeks for a medication check, right? But

individuals

who are having much more

intensive kinds of symptoms having

difficulty functioning on a day-to-day basis, going to work relating to family members in the way that

they want to

and needed to. Those individuals

may need to be involved in sessions

multiple times a week. At how common is it to see as you're making

this assessment along the scale to see suicide potential

or a risk, I would think that

that would be one of the things

that would be a marker for you that

you will specifically look for in people you might suspect of

having PTSD or our returning veterans

that are coming, that certainly the safety of the individual

is a priority. And so one of the

first things that we want to do at

the very outset is to get some sense

of whether that individual is risk

to themselves. Either because they're,

they, they're, they're having an actual suicidal crisis

with a plan. Or perhaps just someone who feels like that

they have lost the purpose for living

and maybe haven't even thought of suicide

in a serious way. But nevertheless this

having those thoughts. So you want to assess that at the outset and get a sense of how high the risk is

for

harm to self. Do what we need to do to make sure that

individual is safe. I would assume there

are times that hospitalization

might be required. Indeed, certainly in those cases where

an individual has an active plan for suicide is having an impulse to

harm themselves. Than we think seriously about putting him

in the hospital or an envoy and endangerment

to others, correct? Correct. And I guess

I would add to that that the vast majority of our veterans with

posttraumatic stress disorder don't pose a danger

to themselves. And the vast majority do not pose a danger

to other people. But if that dangers there, we want to spot

it very early on. Certainly. There

are two terms that in this

trauma spectrum that are often out there that are listeners may be already

familiar with. One is TBI or traumatic brain

injury and the other is post-traumatic

stress disorder. And there are some

overlapping symptoms between those

two categories. How do you assess and determine exactly what

you're dealing with? What are some things

you would do to determine the accuracy

of diagnosis? Well, again, symptoms can point you in the

right direction. Sure. For instance. There, there, there are indeed a number

of overlaps. Individuals with

traumatic brain injury and individuals with PTSD, oftentimes had difficulties

with mood swings, with depressed

mood, problems, with concentration,

problems, with memory. Some of the things

that helped me when I'm interviewing the patient is to find

out, first of all, did they have a

significant brain injury, either close exposure, exposure to a blast, which is quite frequent in the combat

zone in both

Iraq and Afghanistan. Did they have a fall

that was significant? Did they have any blow to the head where they either lost consciousness

or maybe even if they didn't lose

consciousness, had their bells

wrong or saw stars are or were dazed for a period of

time after that. Then symptoms such as chronic and

severe headache, symptoms such as

sensitivity to light, those more

physical symptoms are less likely

to be seen. If you're dealing

just with PTSD. If those have continued, you want to think

strongly about the possibility that

TBI is present. Now that alone is not enough to make a

diagnosis of TBI. That's simply

tells us that the individual needs to go to the next step

of screening. And with that often

includes neurological, psychological

testing to verify. It would typically what we will do in those cases is just get a neurological

exam performed, which is a

specialized form of physical exam that checks things such as reflexes, sensory difficulties, motor muscle

abilities

and so forth. We'll also usually get some form of brain

scan done with that. And in addition, then the individual often

will go through a battery of more refined

neuropsychological tests that can give us a clearer understanding

of the kind of impairment that the

individual is having with functions such as memory and

concentration. Lee I think you're

pointing out an important factor,

an issue that, that all of us have to

keep in mind is that different people

have different areas of training or expertise. All the way

from, from lei, how being pastoral

counseling to psychological training

to medical training such as yourself and, and sometimes it takes a treatment team

approach to, to, to be able to come up with what's

accurately going on and and to also

understand that might be beyond me and it would it would be wise to get as much information

as possible. As a therapist myself, I've often said listen, I think you need to go

see a doctor and have a medical examination to rule out or rule

in certain things. And so I think that's probably important

as we're talking about

assessment protocols. It is we take a team

approach at the VA. Our particular

team is composed not only of myself and one other psychiatrists. We have three psychologists,

social worker. We expect that team will even grow in the future. But each of those members, by virtue

their discipline and training and bring special abilities that

not all the members of the team have. And our combined

efforts are stronger than our

individual efforts alone. That when a patient presents themselves

at the VA, how do you have any sense of how long after

a return from a deployment a

troop might back before they may

seek out care. Are you looking at

immediate cases? Are you looking at cases that have perhaps

lingered, undetected or untreated for

months, for years. Any any standard there? Well, we're seeing

the whole spectrum, certainly seeing some that have come back

from deployment with within just

a few weeks of our first

encounter with him. Unfortunately, we see some that had been back

from deployment for a long time and for whatever reason have not come into the system. As I

mentioned in my

earlier conversation with bob, Ds, we are at the VA or making a very proactive effort to make contact

with

all the veterans that are coming

back from Iraq, Iraq, and Afghanistan

currently. And I think

that's helping us get them into

the system much earlier than we have

perhaps in the past. But no system

is foolproof. And the thing that we face is that

in many cases, some of our veterans

are uneasy or uncomfortable

about coming in to get that assessment. And even in spite of

our best efforts, don't get in as early

as we would like. Now a common

secondary issue that people come in when they have experienced

traumatic stress or may in fact

have PTSD or TBI, our substance

abuse problems, perhaps alcohol

or other drugs. And so talk for

meet with me for a minute about

when someone comes in and we

know they have a drinking problem or some other substance

issue going on. How do we assess that in the overall

assessment picture? And what do you

address first and why? Well, I always in my initial session

with a Veteran, ask them about

substance use. Ask them specifically how much they're drinking if they aren't

drinking at all. And I think it's important

for counselors to do that in a, in a way that gets a very clear

quantity of that. Sometimes counselors, particularly

young counselors, will be satisfied with

an answer such as, oh, I'm drinking a little bit but

not much or oh, it's just social drinking. Always ask them

to tell me what they mean by

social drinking in terms of how many drinks

per week or per day? Because some people

may minimize exactly going on,

Exactly, Yes. And studies have

borne out that there's a tendency

to do that. I will ask them

specifically about use of any typical

substances of abuse, marijuana, cocaine, amphetamines, and try to get a very

clear history on that. If I suspect that there is more history

than the individual is willing to convey

at that point, then if I have permission to speak

with a family member, I'll ask them about that and what they

have observed. I like to to get that established very early on because the experience of most clinicians

and treating post combat PTSD, depression is that

as long as there is substance abuse

ongoing and active, that the treatments for those conditions

are not going to be very successful. And we're increasingly

beginning to understand

that there really are matters of

brain physiology in brain chemistry that

account for that, that the

treatments that we have are helping the brain to repair itself,

if you will. And the substance that are substances

that are being abused or actually

blocking that process. In many cases,

when you have a dual diagnosis or a co-morbid condition

for the proper term, the treatment

protocol would be to address the

substance issue first. So you can remove those

issues off the table. So as you're addressing other neurological

functioning, especially when

it comes to medication issues, you know, there's,

you know, exactly what you're

dealing with, you know, that whatever is going on neurochemically is not related to

the substance. In essence,

that's correct. The way I would put

it is that we we don't necessarily delay

treating the PTSD, but we make it a priority to have that individual in treatment for their

substance abuse at the same time. Because as we say to them, If if you're not getting the substance

abuse treatment and you're not getting in recovery from your

substance abuse, then what we do for

you for the PTSD, we can still do that, but it's not going to

be very effective. Okay, Let's shift

gears for a minute. We've talked a little bit unless

there's anything else you want to say

about assessment. Okay, let's shift over to the treatment side

of the equation. You've done your

your work up, you've done your

evaluation. If you've done a neurological or

psychological profile, you've received some input from family, from spouses. What happens next? How

do you formulate

that treatment plan? What are the

first steps that you will do next? Well, the first

steps are for the team members

to communicate with one another, to pool their information, to discuss the case, and then to determine

based on that

individual's needs, based on the intensity of their of

their symptoms. What kind of

treatment plan, what intensity of

treatment plan is going to work best? We actually draw

that up in a, in a written treatment

plan that's part of our documentation

initiated this with the patient and we do share that with

the patient. And we explain to them the rationale

for the treatment, why each component

is important. Maybe it's, it's, it's

most informative. Maybe talk about a more severe case

because that would involve more

of the kind of treatment that we

have available. Let's say that

we're dealing with an individual

who is having very severe

symptoms of PTSD that are disrupting

life on a daily basis. They're experiencing

frequent nightmares, frequent flashbacks, avoidance symptoms so that they are avoiding

public places, avoiding any

situations that remind them of the trauma. And let's say that that's

an individual who's perhaps even if

they're not suicidal, have had some

suicidal thoughts or having panic attacks, perhaps on a

frequent basis. And all these things are making it

difficult for them to get out and pursue gainful employment or to relate to family

members in a way that's healthy and and and supportive

for that individual. Typically, we

would probably recommend that

they'd be involved in some form of

individual psychotherapy that initially

might be fairly frequent once or

twice a week. Another very

important piece of a whole treatment

package is as simple and common sense as it may sound,

sometimes forgotten. And that's just educating

the service member, the veteran about the

PTSD or depression, helping them to understand why they have

the symptoms, how long they can

expect to have them. What a realistic

expectation about the outcome

of treatment is. And maybe

especially helping to educate spouses, family members about this. And what they can

expect to see. That goes back to

the principle of consent and disclosure at the very beginning

because what you're trying to create

a sense of ownership? Yes. With the patient, with patients, family members. I think I suppose it's

because human nature, as we tend to take care of what we think

belongs to us. If a person can

in essence, ONE, What's going

on with their life. My sense is that as a treatment

professionals, a physician and

treatment team, you would see a

person engage more readily into the

treatment process. And so let's talk

a little bit about that education

piece for a minute. Not just post-deployment, post symptom evidence, but let's talk about pre-

deployment education

for a minute as actually a

pre-treatment or an inoculation of sorts. We, we certainly inoculate our troops physically

for a number of things. What about sort

of an emotional, psychological inoculation? Where does

education fit in, in terms of a

pre-treatment protocol? Well, it's very important. The more that the

service member can understand that

these symptoms are not a rarity. That exposure to combat

events can lead to a brief episodes of

symptoms similar to PTSD or may lead

to PTSD itself. I think it takes away

some of the fear and the anxiety about the

condition itself. And it also helps communicate to

them that the bravest and best I can and often do experience

these things. And then it's not a matter of there being weaken

character if they do, what we want to do is to set the stage for them to to be able to acknowledge that

those

symptoms are there. Which is one of

the hardest things for a service

member to do, very often shared,

especially in the military culture, perhaps, certainly,

certainly. And with that sense of

ownership, as he said, and perhaps it

helps reduce anxiety not only

for the true, but perhaps also for

their family members. Because they are at home trying to prepare

for that return. And they remember

their husband or wife or their son or daughter in the condition that they were

emotionally, psychologically,

spiritually, socially before

they deployed? Yes. And so without

some education and awareness for them, that may increase some secondary or

vicarious trauma as there are now observing for

the first time, perhaps after

months or longer, face to face

reality of what that experience is done for their family member. That's right. And

that education also helps them understand

that there's a difference between say, PTSD versus the whole set of habits of mind that their training

and

their experience in combat have

engendered in them. The Army has come up with the concept

of battle mind, which I think is

very useful for, for service members

to think about. And that concept simply encompasses those

habits of mind that one has to have to

survive and to help one's fellow

service members survive in the

combat zone. In the combat zone, those habits of

mind, the vigilance, the being in

control of details, and a number of

other habits of mind are, are important. One has to have them

to be a good soldier, sailor, or marine

or element. But unless one is

able to begin to relinquish those

coming back into civilian environment. It can cause a lot of

turmoil in trouble. Let me go back

to something you said just a

moment ago, Lee, about when people exhibit symptoms or signs of traumatic stress or PTSD. It's not

necessarily

a failure of character or even

sometimes even a willful choice that

people are making. But a trauma, especially depending on the severity of

that trauma, can alter brain chemistry. And so certain things

can be set into motion that are perhaps beyond a person's initial

willful choices. And yet they may feel very responsible for

that and bothered by the fact that they

can't automatically shut those things down

and change direction. That's right, Eric. It's very common for me to hear from a veteran

statements such as, you know, I I don't want

to do these things. I don't want

to lash out in anger at my family. My wife had my husband. It's like I have

no control over it or don't have

as much control as I used to have. And what I explained

to them is that this is not just, if you will, a

psychological condition. Increasingly, based

on our studies, we're coming to understand that PTSD

represents really a change in function

and maybe even to some degree in the actual anatomy

of the brain. We think that

the exposure to high levels of stress

hormones that occur day after day after

day in the combat zone is creating a process that's going on

in the brain. And it's changing some vital elements

of brain chemistry. There's even some

preliminary data that we, we probably have to get

more confirmation on. But there's some

data at this point that

suggests there are crucial areas of the

brain that are actually being physically

changing like this. And so what we

have really is a true brain or neurological condition

going on with PTO. And because of the release of the adrenalin,

cortisol, those hyper

arousal chemicals in our body to to

handle that stress. It, it hijacks the, the messages that are intended perhaps

for the neocortex, that thinking part

of your brain immediately goes to

the limbic system. Uh, you're, you're feeling part

of your brain. And all of a sudden

you're feeling powerful things and

not always thinking clearly and in the middle of that crisis or trauma. That's right. And we also think it

helps us

explain a lot of the difficulties with

memory that are being reported by

individuals with PTSD. In some of our studies, we've seen that a

very important part of the brain

that helps to, to modulate memories is actually shrinking

some point. And we think that that explains why we're

seeing these things. Let's talk about something associated with

that for a minute. Because if you're

talking about neurochemistry

being altered or changed as a psychiatrist,

as a physician, I'm sure that medication

regimens are part of your treatment

protocols in your standard

operating procedure depending on

the diagnosis, how often you

prescribe medicine, what medicines perhaps

are particularly helpful for traumatic

stress or PTSD? And then I'd like to ask

a follow-up question about issues of faith as it relates

to medication. Sure. Well, we are using medications

quite frequently in mildest cases of PTSD and depression that oftentimes is

associated with PTSD. The class of medications that we're finding

most useful are actually what we

call antidepressants. But in a way that's probably a misnomer

because they're really antidepressant and anti-anxiety

agents as well. Most of these

medications are ones that impact on the serotonin

neurotransmitter system in the brain is to say the brain works by

chemical messengers. And one of the

most important of those is serotonin. These medications

by enlarge work to help serotonin be more available at

critical parts of the nerve pathways

in the brain. And they're probably

doing a great deal more than just

that as well. The typical things that we can expect to

see when we start individuals on those medications

are, for instance, reduction in

irritability is very often one of the first things

that I will hear reported improvement

in mood, reduction in panic attacks and severe anxiety. These medications

are helpful for a variety of

different symptoms. They increase

the presence and the availability

of serotonin for the right

messages to get to the right places at the right sequence

and the right time best, correct. There are additional

medications that work on different neurotransmitter systems. But basically they all are going to

hopefully accomplish the same end. There are certain common medications that are out there that you

talked about, ones that impact both

depression and anxiety, would Wellbutrin be one of those or what are some of the medications that

you see that you use are prescribed

most frequently? Probably. Some of the most frequent

ones that we prescribe in the VA system would

be citalopram, also fluoxetine, respectively, that's

in trade name selects. And Prozac. Paroxetine is

another sertraline, another one, Wellbutrin

or bu, bupropion. Oftentimes can be

very useful as well. Okay. I've had Christian faith oriented

clients before. I'm sure you've

had patients who are very active in

their Christian faith. And the thought of

taking medication as a treatment may sometimes cause some stress for them as they think

about matters of faith because they

may feel that since I'm a believer and I'm supposed to be

trusting in God. Why can't I manage

my thought life? Why can't I manage this roller coaster of emotions going

on inside me? I should be able

to do that. And so sometimes

that within the faith

community there's even a resistance to medication as a treatment option because of that. Can you

speak to

that too a minute? Well, first of all, so the juice acknowledge that the SEC needed

a physician? Yes. And the other

thing that I would say is that the, of all of creation, the most complex piece

of matter that God created is that right

between a ears. There's nothing out

there in all of space and all of the, the black holes

and the galaxies. That is as complex and intricate as

the matter that we have that we call the brain and the central

nervous system. Because our behavior,

our emotions are to a great extent tied

to the health and good functioning of the central

nervous system. It's, it's natural

at some point, probably for all of us, whether we've been

in combat or not, that there may be

some degree of mild and in some cases in more severe problems with that physical

structure that can either lead to or be found in conjunction with depression, PTSD,

anxiety disorders. And so when we give them medication,

we're, we're, I think it's important to understand, first of all, that most of these

medications, the vast majority

of them that we use are not addictive. They're not

intended to snow the individual or to take away their

normal behavior. And in fact, a

good psychiatrist when they sees when he or she sees the medication is having some side

effect like that, been a line that they want to find

something else, some other medication

that's going to actually help the individual to

function normally? Yeah. I've often

heard it described that Traumatic Stress,

major depression. It's like mean and a

small rowboat out in the open sea

in a bad storm and the wind is blowing, the rain is coming

at you sideways. And you're just

trying to survive. You're bailing water, you're not going anywhere. And what medication can do is help

calm the storm, but it won't row

your boat anywhere. There's still

work to be done, but medication can

sometimes help calm the storm

to give you now the foundation or the basis in

which you can do some cognitive work and work through some

of the issues in a more productive way. That's a great analogy. So, so in combination

with medication, often one of

the most common treatment approaches is some sort of

talk therapy. Many therapists

employ what we call cognitive

behavioral therapy. Let's talk about

that for a minute. You mentioned that you

had psychologists and social workers that

work in a team format. How much D utilize

talk therapy and cognitive behavioral

principles in your treatment

approach? Well, it's one of the

more common forms of counseling or

psychotherapy that we use. It's got the greatest body of research supporting

it in terms of its efficacy and has

long been one of the staples of treatment for a variety of

anxiety disorders, including post-traumatic

stress disorder. Cognitive therapy

is, is based on the understanding

that when we experience an event, say a traumatic event, and then we have an

emotional response to it. It's based on the

recognition that between that traumatic event and that emotional response, there is a

thought process. It may be a very rapid

thought process. It may be one that we're hardly aware of

in many cases, but that there is a

thought process there. And that sometimes

thought processes, ones that are not

rational or maladaptive, can become a habit for us. And because they're

maladaptive, because they are perhaps not viewing reality as accurately as they could, may lead to

emotions that aren't very helpful, such as depression

or unnecessary. And Indian Oceans impact behaviors and ultimately, behaviors will impact

things that are happening at a

relational level, exact. And a lot of times people come into

treatment because something is not going well at some

relationship level. Maybe it's a marriage

or something going on within the work environment or

family environment. But after you

start digging down a few layers, you start seeing what in essence become

processing errors. And so cognitive

therapy in combination sometimes with medication where

it's appropriate, can help people sort

out and maybe reprocess those traumatic

events in a way that helps them

get unstuck, move beyond it, find new ways to adapt

and to live. Which let, let's

talk for a minute about where faith

comes into that in, and using scripture and the truth of God's word, the ability is,

is the scripture says to renew one's mind. I think that's why within the Christian contexts, the concept of

cognitive behavioral

therapy works so well for people. Well, I think that's true. I think that what we are trying to do with

cognitive therapy is to change those

habits of mind. And one of those

perspectives are habits of mind that can be most

important to change. One that gives

hope, share, and clearly individuals

with depression, very often

individuals with PTSD have little hope

either for the future, are ultimately

about the meaning of life, their existence. And so I think it's important when they have a faith

foundation

for that home. It can be very

important in helping to move beyond that

hopelessness, right? Because when life

doesn't make sense, you need to have something to anchor your soul to a foundation to

stand on for many, and it is God's word. And then there are

other tools that utilize faith-based or

scriptural materials that the combat

trauma healing manual that is part of who we're

partnering with. This series is an

excellent example of how to utilize some scriptural principles and help people work through some

cognitive material integrated with,

with scripture. And so tools like this are helpful in

a faith community. I would imagine,

important to the overall treatment

program that you're trying to implement for

people of faith where that part of life is a significant part

of who they are? Yes, it can be. How about pulling in resources outside

of your team? I used to tell my

counseling students when I was training them that they would have a client for perhaps

one hour a week, maybe one hour

every other week. But that person

who's hurting, especially someone

experiencing PTSD or trauma, may need a lot more care, a lot more support, a lot more resources

that because of time and other factors, I can't give them

but so much. So how do we incorporate

other resources? How do you do that

through the VA? Do you do that? What are some things

that are out there? Because I think this

is where the church could step into play

an important role. Well, you know, Eric, we've long recognized

that having a community of individuals

around oneself as one's going through

difficulties in life. Having a community

of people who share in supporting

one another, who themselves

had been through, if not exactly the

same difficulties, at least the difficulty, the difficulties

that we all face in one form or

another in life. Having that community is an important part

of recovery. To take a just as one historical

example, a has, has really tapped

into that idea and developed it into a

very effective healing and recovery tool. In the VA. We

can do that for limited periods of

time, both Baja, by having an individual

in the hospital as part of that

community of patients, it's in treatment

in the hospital. But for most people

that's going to last a very short

period of time, a few days or maybe a couple of weeks

in most cases, we can have them

in a community of veterans that extends over a longer period of time, an intensive

outpatient program where they're attending

groups and so forth. The advantage the

faith community is that they can continue

as long as they want. With that, that community. They can find

ongoing source in a network of

fellow believers that also in foals, their family in

that community. And, and I think in that way over

a period of time, they can, they

can really sink deeper roots

than they might be able to do

in many cases in a treatment setting. So for those,

those individuals, those veterans and

service members that that either

already have a connection with the church are

contemplating some relationship where the faith-based

community in general, I will encourage

them to pursue that and find ways that they can use that as a real source

of support for. The research

out there shows that when a person is treated within

the confines of their basic

core worldview, that the engagement into the treatment process and the results and

benefits out of that treatment process or enhanced when

people feel it's, it's in alignment

with where they are in terms of their worldview

and their faith. I think that's

true. One of the concepts

that is gaining increasing importance

in psychiatry and psychotherapy is the whole concept of

mental ionization. And that involves

the ability of the patient not only to begin to have an appreciation of the mental processes

in other people, but also to know that

they are understood, empathized with

the therapist and caregivers with them, have a sense of what they're experiencing

subjectively. And, and so I, I think that that's, that points the

importance that having a sense of

connection around one's worldview has

in the whole process. It's like bringing

the whole community into the picture to help treat the

whole person. Yes. And then one of

our hopes out of this entire

series is that people will

have the sum of the education and

training they need to, to be able to develop, utilize resources like

the combat trauma healing Mano manual

and where to start. Support groups

that they can start in their churches and ministry organizations that will help provide such needed

services to

our returning troops, to our veterans who

perhaps had been suffering with

some form of traumatic stress

or PTSD for years, but never step forward or receive any

kind of benefit. And I've just believe that the church

is uniquely positioned within a

community to offer, as you said, that that ongoing

support network as the person

leave treatment because you and I both know IS professionals

whether it's medicine or therapy sooner or later the

therapy is over. The sessions are done At people are now stabilized

on medication, but it doesn't mean

that they don't need ongoing

treatment support. That's true. And there's another issue too that I think is very important. And that is

that

as the, as, as faith

communities become educated about

these conditions, as they come to understand more

about the effects of combat and

military service on the veteran and

the service member. I think that that helps

to combat the stigma is associated with

PTSD and depression. We're a culture that's so quick to label people. So we call people

and alcoholic a, and an addict or whatever. And I think we have to remember is we're dealing

with human beings. And we were talking

about symptoms. We're talking

about behaviors that we have

to help people recognize that

they are uniquely created in the

image of God for a plan and for

purpose in life, and to be able

to look beyond the symptoms, beyond

the diagnosis. I understand

in the medical world and in the

clinical world, we have to use diagnostic categories for

various reasons. But ultimately we need to get beyond that and

look at the person. Yes. It's often said that the churches a hospital for centers. All right. Well, I think that

when it healthy, well-functioning faith

community is able to n-fold within its within its membership,

within its community. Those individuals

who are suffering from conditions

such as PTSD, which we should say is not just combat veterans try many different

people can't. And conditions such

as depression and the whole array of mental

health conditions. There's a way in

which that idea of the faith community as a hospital really takes on a very concrete

kind of sense. And it can become that faith community can become a true

healing community, a mash unit way

of speaking, yes. All right. Well,

Lee Dr. Bishop, it it's been just great to have someone

of your expertise and knowledge and

background and experience sharing

your insights and your thoughts and your

experience with us about traumatic

stress and PTSD, especially for our

our military troops, both who are about

to be deployed, those returning

from deployment, those who are veterans and perhaps have

never receive care, but you're interacting, so thank you for

being with us. And so as we close, I would just ask you, is there any

closing thoughts, comment that you would want to share with those

that are listening. Our counselors are, our pastoral

caregivers are professionals

that you would just want to

encourage them with? Well, I think

first of all, one of the most

important things that both our service

members are returning veterans and faith

communities sheets can do is simply to educate themselves about

these conditions. Part of the

difficulty with stigma is the

fact that there are myths that

continue to float out in our society

about these conditions. And and to the extent that we can all

understand them better and address

those myths. I think in that way

we can serve and honor the tremendous

work that our men and women and services have done and support them

in the years to come. Well, thank you.

Wise words. Great words to close on and thank you for

the thank you. Dr. Clement, and tell me about what you do

that's very unique to the climate's

clinic and some other

clinics in terms of the brain scanning or SPECT scanning, right. I'm a adolescent and

adult psychiatrist and I do brain imaging, particularly SPECT

brain imaging inspect stands for single photon emission computed

tomography. And that's a big word. Basically, what

these scans do, they look at your

brain's functioning. So they look at the activity levels

in your brain. So it tells me

three things. Areas of your brain

that are working good. Areas of your brain that aren't working

hard enough. In areas of

your brain that are working too hard. There's a little

bit difference in these scans and what you normally think of as the

brain scans? Ct or MRI scan, are

they different? Right. Those scanned CTs, MRIs show your

brain's anatomy. The show the specs are another type that show your brain's activity

or its functioning. And so what you're

talking about is when your

brain is working, certain areas of

it are working, maybe working

we're actively than others or

less actively. You can see that, right? We can see the

activity levels. And why are those

type of scans, that type of image

of the brain? Why is that important

to the field of psychiatry and diagnosis

and treatment? What we see is that

most psychological problems or not problems with your brain's anatomy, but they're rather

there a problem with your brain's

functioning. So most of the time, CTs, MRIs on patient with psychological problems

will come out normal. So it's really

the functioning that you have to look at. Another reason

is you can't just look at

somebody and tell what's going on with the almonds It's guessing and one statement I hear all the time

as it psychiatrist

there the only specially a medicine that doesn't look at the

organ they treat. And that's true.

But these do, these scans do give us a way to look at the brain and

how it's working. Todd could've maybe

take a look at some of the scans that

you've done and help explain to us what happens to a

person's brain in trauma and then the

things that you see in someone who would

have trauma, PTSD? Sure. I think that

would be very helpful. Here's a scan. We're going to start with a normal one just so we can go on and

saying

where we are in a, I've got a small

model brain here, so hopefully that

will help orient you. But what we're looking

at is the SPECT scan of a normal SPECT scan of a female in her 20s. And it looks at different

views of the brain. We're going to

just really focus on this one right here. We're looking at the

brain from the bottom up and we see three

different colors. Calmer areas of your

brain are blue. And then is your brain

gets more active, you've got read, the

most active areas white. So we'll call this hot, the more accurate

your brain gets. That's kinda

the terminology we use, the hotter it is. And so in this normal

brain, It's that, is it this or the back

area of the brain that is normally in a normal person

the most active, Exactly If you look here, the green part,

the cerebellum, it's normally, has all the white

in most of the red. And the reason being the neurons are very packed in this

area of the brain. In fact, this area, the brain makes up 10 percent the

brain's volume, but it has about 50

percent of the neurons. So now when you look up in the other areas

of the brain, you want to see

blue mainly. I don't mind seeing spots of red

here and there, but I don't

want to see any white in the other

areas of the brain. So, so other hot spot,

Exactly, exactly. Don't want to see

any hotspots there. So this is up. This was a 22

year-old female who was brought into

us xy by her parents. She didn't want to come. And two years earlier, she had been living in a halfway

house

situation and had been repeatedly

physically abused. He had also been sexually traumatized as well. And so some pretty

severe cases of trauma exactly in

the parents said said, you know, it's totally changed

her personality. She went from

this happy go lucky teenage girl to now. She's depressed

all the time. She's very irritable. Her parents describers it She's chronically mad. They said that

chronically

mad statement. I've heard that about

a lot of people that have been

diagnosed with PTSD, especially some of

our veterans or military personnel

that that anger yeah, kind of chronic anger is a real symptom of PTSD? Exactly. Anger is one of the things

that

they would say. They said she

had really had no motivation or

drive it back. She spent most of

her day at home, wouldn't leave the house, watch TV most of the day. Parents couldn't get

her to go get a job. She would talk

about wanting to go to college, but then she never

couldn't even yeah. Can even fill out an application form, couldn't even

get that far. She had panic attacks,

had suicidal thoughts. She would have periods

of binge-eating, something that was just

a ton of Scott stuff. I mean, this

girl was a mess. So when we look

at a brain, let me lo and behold, you can definitely

see, wow, some areas of

abnormal activity. You can see a lot of white in the

brain right here. And I'll explain

those colors that we're seeing there. And what that

would mean in terms of what

what function in the brain and how

that would relate to the symptoms that you were describing exactly. Now, if you look right here in the

middle

of the brain, this is an area we call the deep limbic system. Then we can see

that there's a lot of white

in this area, so it was too active. Now, this is an area of your brain that

has a lot to do with your emotions. In fact, it,

It's the area of your brain that

emotionally tags advance. There's one other

thing that, that we see

reported a lot and that is traumatic

brain injury. A lot of that that's

coming back have had injuries to their

brain and I know that's something that

you're also able to work with very

specifically, tell me a little bit

about how you use the SPECT imaging

with people who have traumatic

brain injury. Where again,

they're saying last I heard was

they estimate one out of five soldiers

that comes back from Iraq will have a

traumatic brain injury. And one things we

find is here again, these are people you can't just look at

them and tell. I mean, they look regular. They may either

they're smart, but something's not

right with them. They're not the person

that they were. Here again, with the

spec brain imaging, it's it's going to

be very sensitive to show if there's

any trauma. What we find CTs, MRIs, they're looking

at the anatomy so it's not nearly

as sensitive. So you can have

a head injury, but the anatomy still

be fine your brain, but the functioning

won't be. And here again, what

area of the brain you have a traumatic injury has a lot to do with

how we treat it. I know that men's and

women's brains are somewhat different structurally and

how they function. Would that lead

there to be differences in

men and women who develop PTSD are actually females have a larger

limbic system. And that was area

of the brain that we talked

about that has to do with the

expressing emotion. So that's why females are probably more in touch with their feelings, are better

able to

express feelings. That's area of the

brain has to do with bonding with people so little better

relationally exactly well, there's, there's no

society in the world today where men are the primary caretakers

of children. And that probably has to do with the limbic system. But what this

has to do with emotional trauma and PTSD, is this going to

mate females more susceptible to emotional trauma and

post-traumatic stress. Now sometimes this is

a surprise because many people think of post-traumatic

stress disorder. That's something that men, yet soldiers in

particularly are somebody that

gets shot at, but you're seeing

more women. And why is this important? Because when we look

at the combat today, we have more

women than ever before that had

been in combat. And are we probably

than saying higher percentages

of those veterans who are women being more susceptible to and maybe having higher

rates of PTSD. And from what I hear, we actually are as far as like veterans are

going homeless, that there's or percentage actually compared

to men of females, that, that's

happening too. Now, one good thing

is women will tend to be more open to

going to get help. So now that's where

the man have problems. A lot of times, you know, usually when a man with post-traumatic

stress shows up to see me, It's already

after, you know, alcohol or drugs had been added on as a way

to self-medicate. And because There's still the stigma with me

and if I go at MIT, something like that,

then I'm weak. So even though women

may be more prone to PTSD because of our

larger limbic systems. That larger limbic system also makes us more

willing to relation, namely reach out for

help and support. And as you've said,

that's one of the most powerful

treatments are things that facilitate

healing from PTSD. Is that connection and support with

other Exactly.

War, deadly force in the Bible on structure for this lesson is

Pastor Todd Wagner. Todd is the pastor of watermark Community

Church in Dallas, Texas. One of the most

innovative and exciting new

churches in America. But it is, it's wonderful. I, I've worship there

are a number of times and it

is a church of normal people that love one another and love the community around them. Really

reaching out.

Very innovative, creative way to do that. He's a graduate of both the University of Missouri and Dallas

Theological Seminary. He has extensive

experience in church and pair church

ministry is Bob was referring to served

both on young life and K Life staff as well as 10 years at Canada

GSC, right camp. That's a nice place to be. At, deleting it. He stepped into leading a local church there

back in 990. Important topic. Oh, it's a credit

off with topic. It's a tough topic. It basically in

a broad sense. I've said the

military analogy is going to be powerful

throughout this series. We're starting this

segment now this unit that talks to

the military analogy. But any profession has to reconcile the

requirements of their profession with

the requirements of faith and with

biblical truth. And so in this case, for a soldier going

off to combat, it's very important to him for him to understand. What does God

think about this? What does God think about the military profession? And the good news is that Jesus

Christ commanded the Romans insurance and total bring out some of these biblical

references. And then I'll talk

about some of the moral dilemmas

that one faces. And this is not

a new problem over the course

of warfare. There's been

the Augustinian theory of just war and nations have wrestled

over this and have crafted the law of

war and so forth. So it talks about

how a soldier can be in the military, can use lethal force

when required to satisfy the

requirements of the God ordained

government that he serves. And yet it also points out the moral dilemmas that

a soldier might face when sometimes

he might have to disobey unlawful order, he might have to say no because of his

convictions of faith. So these are tough issues, very tough issues to

get sorted out ahead of time rather than after a traumatic

experience occurs. So now we have

Pastor Todd Wagner. Hello, my name

is Todd Wagner and I'm grateful

that you've joined us for this session in our little series. We've gone here,

we're going to talk during these next few

minutes about war, deadly force

and the Bible. It's often asked of military service men and service women.

What they are. Most desired question

that they have to be answered is and again and again, there

is no second. In fact, the first

question that people ask again

and again is, how can I reconcile my

calling as a soldier, as a member of

the military with the commandment

that we all know, thou shall not kill. It's wrong to

take human life. So how can I do my job, which often involves

exactly that and reconcile that with my very soul and the

person that I am. We hope to give you

some answers to that from God's

Word and just make some observations

throughout history and lets you

understand a frame of reference that can both bring you comfort

and allow you to comfort

others with the truth that God

has given us. Let me just begin by

saying this, that, that war is awful

and we should never try and make it

seem as if it is not. A soldier that does not fear the use of

deadly force, is a deadly soldier,

a policeman, officer, a person who is

under the authority that government

is give them to use whatever means is

necessary to protect the innocent and

to allow piece to, and the land who is

not hesitant to use that deadly force is a deadly Officer

of any cat. Want to begin

by just making a comment and giving

you a frame of reference through

which you can evaluate all things and understand the basic premises that we're going to build from. It's

a statement that

I would say like this war is not what was, is not what should be, and it's not what

will be war. The need for

the restriction of evil is what is, what do I mean by that? More is not what was initially when

we were created. We were created

to be people that love God and love others. And because we trusted

God the good when we had no conflict

amongst us, because we leaned upon his instruction

for our life. We lean not an

understanding. And other ways

we acknowledge him and he made our

paths straight. But from the very

beginning, man was tempted to

go his own way. And there's a proverb that Solomon wrote and

progress 14, verse 12. It says there's

a way which seems right to man. And in the end,

that way is death. The way it would

seem right demand from the very

beginning was to not continue to enjoy

the relationship he had with God, the good. When God told

man initially, walk with me, trusted

me, have faith in me. I will provide for you everything that you need. You don't need to eat

from that tree of knowledge of good and evil because I am the good one. And if you walk with me, you

lean not on your

own understanding, but in all your ways

you acknowledge mean I'll make your

paths straight. Well, we believe the

lie that God wasn't good as word was not

something to be feared. That judgment wasn't

that severe and that obeying Him was not

necessarily that good. And so therefore,

disobeying him wasn't bad. When we made

that decision. We did in fact have

the ability from that moment on to discern between

good and evil. The problem is, is that the reason that

God did not want us to take that

responsibility on ourself. To know the difference

between good and evil is because we are

not innately good. All of us have had the experience of

making mistakes. And most of us

would admit that our mistakes are not made because of a lack

of information. Most of our mistakes are made directly

in the face of knowing the right thing

to do and just not having the will or

the desire to do it. That is because we are

not innately good. Got is the innately good when we

are only good, in that we are connected and in fellowship

with the good one. War is not what was initially there

was no war, but when our own

we'll got involved, we became insecure, we

became isolationists, we became self-serving, we became self exalting. And that resulted

in conflict, which eventually

resulted in war. War is not what was, it's not what should be. God desires that today

that as much as we're able that we live in

peace with one another. But again, because sin continues to rein

in our hearts, or even those of us

that have come back into relationship

with God by grace, through faith

and dependence on Jesus Christ in the acceptance of his

provision for our sin. We continue sometimes to quench the spirit

and to grieve the Spirit and to go to our own way and to break fellowship

with one another. So war exists today. It exists and families it exist a neighborhood. It exists sometimes

even on platoons. It exist in churches when people don't respond to God's instruction

for their life, war is not what should be, and it's not what

will be one day. It is. What is war is something that produces great trauma

and people's lives. A good friend of

mine, father-in-law was a World War II vet. He fought in the

South Pacific and he shared this

and I wrote it down. I'm going to

read this quote. He said to put a human, a human being and your

crosshairs and to pull a trigger on a rifle that you know has a

bullet that could penetrate seal to see it hit another man

and watch that man flip to be in a foxhole. And to be so

scared that you grip a knife so

tight that it hurts to come up

behind a man is stick the knife under

his ribcage and a reach for his lungs. He said the human psyche, not wired to do that. This men who love

God, love this country

who served, who did kill men. In World War

II. It said it took him years to

recover from that. And the things

that we're going to talk about today. The truth that he had

to get his arm around are the means through

which some of that healing and

restoration came. But war is not

as it should be. War is how those of us that have seen the movie Gods

and Generals, robert of all playing

the character of Robert E. Lee captures the great quote

by Robert E Lee, delivered December 13th, 860 to at the Battle

of Fredericksburg. When Lee looking

over the, the, the Confederate

forces as they saw the federal charge

repulsed there. He looked over

at long street and he said it is good. War is so terrible. Less we grow

too fond of it. War is not something that should be

taken lightly. Effort, the use

of deadly force is not something

that should ever be taken lightly because the men and women that are called execute it can

not take it lightly. The human soul is not

wired to do that. Augustine, Amanda

will refer to later who was really the father of the churches

understanding of what is a just war said this, a person must lament

the fact that he is faced with the

necessity of waging, even adjust war. And anyone who experiences such evils or even

thinks of them without heartfelt grief is assuredly in a

far more pity able position than others. Again, a soldier,

an officer, a man or woman who uses deadly force without

fear and trembling, is a deadly soldier. So it is good that

war is so terrible. It's good that

it affects us to think twice before we execute ultimate justice. War is not what should be. War came as a

result of the escalation

of evil in man. What happens is men

can grow in every way they can grow in their understanding

of science, of knowledge,

of intellect, of literature, of music. In all realms,

men can improve, but in the one area

man will never prove is in the

area of morality, morality keeps

spiraling downward. When you look

at the record of humankind in scripture. And you see what

happened the very first time

that evil really expressed itself in the context of

human relationship. Other than the

natural break and oneness that was there when we see with

Adam and Eve, who formerly were one

of a sudden hiding from God and each other

ashamed of who they were, instead of

celebrating who they work with one another,

their offspring. Cain and Abel. We know that there was a moment

when Cain and his anger at how God responded to

Abel's of faith, sacrifice and

Cain's offering to God what he thought

was acceptable. When God said, Kane, I told you to

come to me and faith depending

on what you had, but what I called you

to accept and put faith in as an expression of a sacrifice

made for you. Cain took himself

and said to God, Hey, I will do

what I'm gonna do. God curse came

and said to him, You should one do the rest of your life as a result of your choices. And cane didn't do

that. Cane fact, creators city. He named his son Enoch, which means dedicated one. And then as you go

forward on the progression of, of humankind within

the lineage of Kane, which represents

men and women who walked away

from God and faith. You'll find that seven

generations from cane we have somebody

by the name of LQ. And limbic is a man

who said, Look, if cane event is somebody who brings harm him, I'm going to do it

seven folder 70 fold, he continues in his

rebellion against God. Well, this continued

until God finally said, this will not

stand anymore any judge the world through

a universal flood. After that

universal flood, God was going to restore a relationship

with man through Noah and his sons Shem, shape it and, and ham. And it's those

three sons got off the ark and their wives and God began to

work with them. God put a sign

in the heavens. I'm going to put away

my instrument of judgment through a

universal flood. And he put his bow down. And he said, Never gamble, I destroy the world through a

universal flood. He didn't say never

flood the earth again. And instead they've never be a judgment again. He said, I will

never judge the world again through

universal flood. What he did also

say though is this. Initially, I

worked with you in the age of innocence

as you walked with me, and then as you

rebelled against me, I gave you a

conscience to know what the difference

with good and evil is. And then God

instituted because men did not respond

to conscience. He institutes in

Genesis nine, the idea of government,

authority from God. And this is what it

says in Genesis 96. Whoever shed, sheds

man's blood by man, his blood shall

be shed for the image of God.

He made man. What God says. I'm

going to give you the right to

execute justice. I will sovereign

li give to you the ability to execute

deadly force when men does not respect

that which I created when human life

is taken from them, their life should

be accounted for. God says, though, this is not the

way I wanted it, it's just the way it

is because of sin. And now we're not

going to isolate sin. I'm not going to judge sin ultimately

from heaven. I'm going to allow

you to be my reagent. I'm going to allow

you to be my deputy. That with the

authority that I give you executes this justice.

That's interesting. We'll see that evil

is continue to, continue to grow

through the ages. And we've had many

wars, world wars. We've called some

of the wars, the war to end all wars, but there will not

be the war to end all wars until piece

comes another way. You'll find that if you go to the United Nations in New York after the

war to end all wars. World War 1 was over. The League of Nations

came together, but through a lack

of support for that, another war was begun. And after that, the

nations of the world came together and

tried to bring about peace another way, if you've got any United

Nations in New York, you'll see a averse

in Isaiah Chapter 2, verse 4 is inscribed

on the outside. That building

specifically says this. They will hammer

their swords into plow shares and their spears into

pruning hooks. Nation will not lift up

sword against nation. And never again will

they learn war. Well, that's a

wonderful idea and one that we

look forward to one day when there

will no longer be war. But that's not

what it is today. That's a little verse that comes in the context of Isaiah talking

about what will happen when the Prince

of Peace comes. We need to know

this. No war will ever be the ultimate

solution to peace. No political process will ever be the ultimate

solution to piece. The solution for peace for the world and for each

of us individually. Relationship with

the Prince of Peace. In Revelation 21,

what we have is a reference to when war

will cease forever. And it's when god himself in the person of Jesus

Christ will come. And I reckon back to

Isaiah Chapter 2, where that little verse

that is pulled from Isaiah to put on the

United Nations is place. It says he will judge

between the nations, not that the nations

will judge between each other and through

diplomacy will bring world peace. It's not going

to work because some men are so wicked, they will not respond

the diplomacy, they don't respond

to anything but superior force. And one day, God

will come with absolute superior

force and himself execute

justice against evil. And it says in

Revelation Chapter 20 1 fourth, the

end of your Bible. At that day, he will wipe away every tear

from their eyes. They will no longer

be any death and no longer any mourning

or crying or pain. There will no

longer be war. Because the

Prince of Peace will have come and eradicated evil

once and for all. Now, wars not what was, it's not what should be, its not what will be. It is what is,

and what do we do with war? Well, we

need to know this. War is a divine right. War is a divine privilege. And I will tell

you that war is a divine responsibility to not war is to rebel, as well as to war

unjustly, towards, unjustly is to not obey, but people need

to understand. And soldiers can be

comforted by this. To not war is to rebel as well as

warring unjustly. What do we get

that? We get that from a number of

places in the Bible, but specifically

in Romans Chapter 13 in verses one

through four. Says this, every person is to be in subjection to

governing authorities. For there is no authority

except from God, and those which exist

are established by God. A good friend of

mine was speaking to a group of servicemen

and women. And he started

by saying this, it's good to be

speaking to you today to fellow

ministers of God. And of course, they

kind of looked around. So does this guy in

the right place? What do you mean

where service men and women were in

the military? What do you mean

that we are fellow ministers of God? What he was referring to is what Paul understood in Romans 131

through

four in verse 2, it says this, Therefore, whoever resists

authority has opposed the

ordinance of God, they who have opposed will receive condemnation

upon themselves. For rulers are not

a cause of fear for good behavior,

but for evil. Do you want to have

no fear of authority? Will then do what is good. And you will have

praise for the same. Now we've all had this

particular experience in our life when we're

driving down the road. And is one of my

friends said, you know, kinda we're doing a

rear view mirror, sideview mirror,

sideview mirror, rear view mirror,

sideview mirror. So I remember

why because we fear governing

authorities because we're not obeying

speed limit. Like when you get a

letter in the mail and it's got Internal

Revenue Service on it. If you have not responded correctly to your

income and file taxes, there is a sense of tension that will

arise in your body. You're in a classroom

setting taking a test. You've got a sheet

down there to help you on that test that

should not be there. The teacher walks around, your blood pressure

is going to escalate in a ways

that others wouldn't. Why? Because you're not doing

right and you have a fear of the authority

that is there. But if you do what

is right and good, you'll have praise

for the same. This is what it

says. Look, Romans 13 for war is a

divine right. I'm saying words,

divine privilege. It is a divine

responsibility. This is where

it comes from. The authority that we

have as a government, as stirred of the

justice of God that he gives to men is right

there in Romans 134, says it, meaning

the minister, the centurion,

the government, the military, the King is a minister of

God for your good. But if you do

what is evil, be afraid for it does not bear the sword

for nothing. For it is a minister. The word is deacon. A deacon of God, an avenger who

brings wrath on the one who

practices evil. Again, government exists because men are evil. As y in Israel, you'll find that

at the age of 20, every man, a woman, and their country

is enlisted in the military for some

obligatory services. They know theologically from the scriptures and experientially through what they've

lived

through the ages, that men are evil

and they know they need a military to ultimately

provide for them some level of protection

against injustice. Now, anybody who believes that ultimate

piece is going to come through

military prowess, through science

and technology, through prosperity, or even through allies

with other men, is going to always

be frustrated that true peace

doesn't come. Piece only comes in the hearts of

all of us and in society through

our relationship with the King of the

Prince of Peace. But the idea that war is necessary is something that

scripture tells us. Because of rebellion, we need to prepare to

deal with evil men. That's why in Genesis 96, God gave us that right? If you don't believe me, this is what

it says in Romans Chapter 3 in

verses 10 through 18. There is none righteous,

not even one. There's none who

understands, there is none who

seeks forgot. All have turned decide together, they've

become useless. There is no one who does good. There's

not even one. Their throat is an open grave with their

tongues they keep deceiving

the poison of AST is under their lips, whose mouth is full of cursing and bitterness. Their feet are Swift.

The shed blood, destruction and

misery are in their path and the path of peace they

have not known. There is no fear of

God before their eyes. We live in a wicked,

godless world. So we need policeman, we need military

to bring order. We need police to enforce laws when he

judges to rule. There are a number of

great institutions that are necessary for

human kind of work. God has ordained that

the home has authority. He is ordained that the

church has authority, and he is ordained that government

has authority. He has said that it's the job of the

home to educate. But if men rebel against the education

of the home, it's the job of the

church to encourage and to remind men of

what is right and good. But if men won't listen to being trained up

and righteousness in the home or

the home fails to train up men and women in the way

of righteousness. The church doesn't get on regenerate men to repent, or even people who

have professed love for Christ to walk in the way of righteousness, then God has said, government must

step

in and restrain evil, less chaos,

continue to rain. You. A lot of people would, would just suggest that what needs to happen

is that we just pull back and we just focus on doing good ourselves and let

God deal with evil. But God said, Here's my plan to stand

up against evil. In fact, he's only

got one plan for us to eradicate

injustice in our world. And there is no plan B. This is what he

says in Micah chapter six, verse 8. He has told you, Oh man, what is good and what is right and what the

Lord requires of the butt

to love kindness, to do justice, and to walk humbly

with the Lord. Now again, God has given government the right to

execute this justice. And when

government decides to not fulfill its role, people suffer, just like in the home when

the father, the mother don't execute. The rural people suffer in the church when pastures become

cowards and cut deals with the

congregation and say things like, Hey, you guys to show up, give me enough money

to keep the lights on, and you come here each

week and validate my existence by

your attendance. And I'll tell

you you're done what God wants you to do, and I won't ask

too much of you. And you tell me

I'm doing what God wants to do and we'll

just get along. It's a tear in the church and the

church loses its way. God says, here's how people are going to

know that I'm good. Here's how people are

going to know that I'm a God who can be trusted and that there is in fact, love and goodness

in the world. It's when you,

as my servants, let your light

shine before men in such a way

that others see those good works and glorify your

Father in Heaven. One of those good works is to stand against evil. Men. And women don't

often know that. Letting evil alone

and trying to isolate evil and keep it in one place,

it doesn't work. Again. One of the things we see is that evil grows. It didn't work in

the 30s in Germany, it didn't work in

the 40s with China, we see the

imperialistic loss of the axis of evil in

Japan and Italy in Germany throughout

the Second World War continued to

want to encroach China when

godless communism began to move

and take over, wasn't satisfied

with China. It moved into Korea then not just North Korea, but below the 38th

parallel and began to push that direction into

Indochina in the sixties, we see that Hussein wasn't going to be satisfied with

just Kuwait. He was going to

continue to move. Appeasement is a failed understanding

of how to deal. Evil. Appeasement is a problem, because wicked men don't respond to calls

from morality, civility, ethics, righteousness

and diplomacy. By all means, those

should be used first, we should

use reason. We should use diplomacy, we should use pleading. We should use prayer and we should use

more prayer. But in the end,

we've gotta be ready to ante up. A retired

four-star general. And Jerry manure was

making an observation in a paper that

I read where he studied history

of US diplomacy. And one of the

things that he said, he didn't know it, maybe, but he was quoting Solomon from Proverbs 30

is he said You cannot satisfy the

insatiable powerless of dictators by giving them in-degrees what they

demand in whole. Because the wickedness

of man and the craving for injustice has

no satisfaction. And proverbs 30, verse 15, it says the leech

has two daughters give, give. The terrors of men

will continue to grow. And the only

thing that Hitler understood was

not diplomacy. He understood

superior force. Appeasement didn't

work when England and France gave it to him, and we almost lost Europe. What works is when

men stand up to wicked men as agents

of God and say, injustice will

rule no more. So war is a divine right. It's divine

privilege, it's divine responsibility. And if the folks

that are stored that responsibility in fact

don't execute on it. Chaos and tear were

reign in the world. Now here's a very important

point and it gets into something that is

often misunderstood. And one of the troubles

that soldier's hat, or one of the problems that men and

women that are commonly called

pacifists have is they miss this next

salient point. Here's words that you

can give to individuals in the military that

have suffered in, that are experiencing

that soul trauma, which naturally comes when you do difficult things. Who are maybe feeling

guilty about whether or not they've violated

a command of God. You need to let them

know and remind them that God gives the

sword to the state, but not to the individual. How the governments

are of the world are called to respond

to abuse, to wrong, to evil is different

than how followers of Christ or

individual humans are called to respond. If in fact you are

sent by the military, there's war breaking

out in the land and you are recruited

and your drafted. And you are asked to come serve and you are

put on a plane, you go out my

little community to Dallas-Fort Worth Airport

and they fly you on that plane and

they take you to Fort Bragg and they

train you and they equip you and they

get you ready for service and they transport you

to the site of conflict and

you get there. And an evil men that

are prosecuting and creating Jr.'s and chaos in lands are there. And there's a just cause which we'll speak

about in a minute, then soldier do your duty. But on the other hand, if as a young man

or young woman, you are called to

serve in the military. You get on the plane

and you fly to Fort Bragg and on your way of driving that

particular fort, you're going

down the highway and you are confronted by somebody in more of

a hurry than you and they cut you off and they flip you off and they. Curse at you.

And they're not satisfied with just that aggression from

a distance, but they somehow corner you and create

conflict with you, your call to respond

differently. If you pull off the

road a little bit ahead into a Dairy Queen. And at that Dairy

Queen, you find yourself right there

with that guy. God would not say

execute justice. I'm a enlisted man of the military and you

have offended me. And so I am now going

to bring justice to know your call as an individual net

moment is found not a Romans 13, but

in Romans 12. This is what it

says in verse 14. You to bless those

who persecute you. Bless and not

curse in verse 17, year to never pay

back evil for evil to anyone you to respect what is right in the

sight of all men. If it be possible, so far as it depends

on your to be at peace with all men. You're done not be

overcome by evil, but to overcome evil with good just

puts a Buster. It looks like you've

got tough life. If you're so angry

with me that just driving in a law abiding way, I

frustrated you. I want to buy you a dip

cone or a Buster Bar. I'm gonna, I'm gonna heap burning coals in your head by being kind

of, you're not. That says, Remember

the military, I've got the right

execute justice on you because

you are not, in that sense, acting as an agent of the

authority of God. You're an individual

and individuals who follow Christ

or to not kill. The command to

government is Thou shalt kill

wicked men. Those instances,

you're not acting in that

situation as needed. The state pacifists miss this whole idea that the command and not murder again,

does not apply. You need a good home. Who teaches righteousness? You need the

body of Christ reminds people who've

read righteousness is. And then every

country needs a solid judiciary

to execute against immorality

from within. So that people do what

is morally right. And you need a

military so that men who are outside

your military might, can keep them

from destroying you from without. If you don't have

a good judiciary, you will die from within. If you don't have

a good military, you will die from without. And so God has given

government for the sense for

the purpose of maintaining peace. Now, this is what people

have to understand. You can be a pacifist

because of conscience, but you cannot

be a pacifist because of Christ. There are individuals who take the commands

that are given to individual followers of Christ and they

extrapolate them out to all

of society. And they tell

individuals that look, if you

shouldn't kill, as it says in the

sixth commandment, how can you go and work

for the government? The answer is,

it's because God has ordained that government would

be temporal restrainer of evil. And as a man

or a woman who is called by God to

serve in that way. Soldier, you must

do that duty. The gentleman that

we're going to make reference to here

in just a moment. Is a guy by name

of Augustine. And the Just War theory really was birth when

in the fourth century, the barbarians

were moving on Rome and a believing Roman General came to Augustine said,

what should I do? Should I go and

face my foe? Should I render

the monastery? And Augustine searching the scriptures and

looking at what the individual call to members of the

citizenry are. And to look at what the call to this

general were. He said, soldier,

go do your duty. You go stand

against injustice, against Barbarians that come and

war against us. And this is an

important note, got approved, just war. But he abhors imperialism. God will never

allow a country to just out of wanton

**** to decide. You've got resources

that I want. So I will take them

for me because of my greater military power

or might or number, god does not stand for. In fact, even

when Israel was on its way to be a, an instrument of God to

judge the wickedness of the Canaanites

that we're living in rebellion

against God. He told them

as they travel through the lands

of the Edomites, of the Moabites

and the Ammonites. You can't just walk across their land even if you're

going to do my job, you must ask permission before you can drink

from their wealth, before you can travel

across their land. If they say no, you

walk the long way. You find that

our government does the same thing. You find that our

government says, Hey, Turkey, we'd love to enter into this particular

region where we've gotta do war against

unjust men by your land. If you say no, that will come in

from the south. If the people who

sat well, those will come in from the air. But we will not be

imperialistic in the sense that

we'll just claim what is not ours for ours, we're not looking

to widen borders. In fact, got

again and again, commands people

from nations and certainly individuals

from just using might to take

what is not theirs. So we know God

doesn't want us to be imperialistic in our

motives for war. But what exactly are the tenants of a just war? Specifically what

that Augustine breakout for that

Roman general and what does the

church continued develop over the

last 1700 years? I'll give them

to you quickly with some specific

observations. First of all, as we

see from Romans 13, the very first thing

that is important is you have a legitimate

authority. In recent wars that we've been in,

for instance, had been resolutions even passed by the

United Nations. The Executive Branch joins with our

legislative branch and saying, Here we go. And so there is authority there to move and against.

Legitimate authority.

Secondly, just cost. Is there a threat to freedom that's

being addressed? Has it been

ruthless attacks on neighbors and people? Is they're just intent. Again, if there's

any intent to occupy, exploit, or destroy for

destruction sake, if it's about oil or some other commodity,

it is not correct. Has there been

every effort made to go another

direction? In other words, before surgeon inflicts

pain on a patient, then want to make sure

that that pain has an invasive procedure

has become necessary, that all other means of treating that patient

had been eliminated. We're not just going

to rush to surgery. We're going to

see is there another way to

treat that patient? Before we go in that way, we've gotta ask ourselves, have we made every

effort through diplomacy and

through reason, and taken the time and been careful

to see if there's other means other than deadly force to accomplish

this objective. So the last

resort mindset, are there specific

and achievable goals? What are they? Are we to disable

weapons that are going to be used

in an evil way? Is it possible that we can accomplish what we

need to accomplish and know what that

objective is. And then the

withdraw is there proportionately in

cost and response. Is the human cost of war less than the cost

of not going to war. And as the

intent of war to respond to the

threat aggression, not to vent anger, all associated

with our enemy. We have to make

sure that we take every effort to not expand targets beyond

military ones. But war is an

imperfect science. And we know that

the rise of civilian casualties

has increased dramatically over

the last years with the weapons

of warfare. Although we are

grateful for technologies have allowed us to move back now and be even more specific. But there is

always

collateral damage. Every effort should be

made and the just war to minimize those.

We know that today. So if our enemies even intentionally use

humans as shields and put themselves in

military operations in areas where other

civilians are. That's what wicked men do. And war is ****. That's why with

great fear and trepidation, do

we go forward? A just war is made

up of these things. There's other

specifics that are broken down and

it's worth studying, but the basic

tenants are there. And anything that

has motivated myself and by greed or by vengeance or not,

the right motives. God would call us to

think differently. I'll say else would

God wants us to do? God wants us to be

very specific as we go on to just doing a little story here might be a little

lighthearted store, but there is some

application to it. God does care. Who wins a war, their sovereignty

in victory. One of the things

that God has said, if you go back

and even look at the history of warfare

in the scriptures, is that when the people of Israel went

to do battle, God said, you make sure if you're going

to represent me, you represent me rightly. This is true of the

collective army and its servicemen and service woman

that watch this. You need to know it's

absolutely true view. God is not just

concerned about justice on a macro level

around this world. He's concerned about

individual justice. And in fact, you see that God has no pacifist. He has moved against

evil ultimately. And in fact, if you go and you look at the scriptures and you find

out why Christ himself was crucified. Christ was

crucified because God is concerned

about justice. It says that

the father was pleased to Bruce him. Why was he pleased

to person? God is a holy God. He's adjust Scott. He's a loving and

merciful God. You'll never compromise

one of the other. And so because

he cares about that individual soldier

cares about me. He cares about you. He himself bore the

brunt of the justice. Do us the wages

of sin is death, but the free

gift of God is eternal life through

Christ Jesus. It says he made

him who knew no sin to become

sin on our behalf, that we might become the righteousness of God. In him. God has done something

so that each one of us won't be the victims of God's just war

against sin. And each of us

individually must respond to His

provision for our sin, less the wrath of God be poured out on

us on that day. Having come into

relationship with God or having been his army that seeks to execute justice. God does care that that

army is wholly,

we find that Israel, when the first

time that it went out underneath Josh, what to do war against

the Canaanites. One, a great

victory at Jericho. But then the next

time they go to battle,

they're defeated. And the reason

they're defeated is because there is

sin in the camp. Now listen,

there's never been any military that has made it completely

righteous men. But with fear

and trembling, each of us ought

to think through, are we as a country, are we as individual

men and women, people that God would

be pleased to use as a means through

which Justice is executed in this world. In fact, one of the

things that you'll see is that God says that judgment always

begins with His people. And there are many, many records throughout

history and in the scriptures

of God using and even more wicked force

to bring judgment against the force that's a bit more rights

just because God purifying this people. It is a serious thing

when we go to war. And so many times

we believe that God needs us to

glorify himself. Not so I'll tell

you a story about a gentleman that I've had the

privilege of making the acquaintance

with Lance Berkman, who is a well-known major

league baseball player, first baseman for the

Houston Astros in 2005, the Astros were

playing St. Louis Cardinals in a game five, the National League

Championship Series. And Lance and

the bottom of the eighth inning

hit a home run and put Houston ahead. There are about to

move to 44 years of a frustration into

the World Series. And last study

was out there at first base,

praying all along. A god would allow

this, this, this home run the stand

that he was ready to go give God glory

in the locker room. And does he talk to the

media and talk about how the skills

that he has are a gift of God and

provision of God. Well, as he sat there and they've got two quick out, the top of the

ninth inning. All of a sudden

against they're all star reliever

Brad lids, David Epstein

with two strikes. I've got a

little single to the left side and then

up to the plate step, the man by the name

of Albert pupils will pool halls,

if you know, baseball history,

took one really deep, really hard and really it. And Lance Berkman,

some red did not stand up the Cardinals

one gamefied. And good for the Astro

fans that are out there that they

came back and won game six

and St. Louis. But as Berkman stood

there and just disbelief that this

monumental home run, it was not going

to be a means through which he

could give God glory. He went back in

the locker room. And as he sat in the Astros lacquer

and we looked up at the TV screen there. Any saw Albert to host

being interviewed. He walked up close and

turn up the volume and the very first words that have Albert's mouth where I just want to start by

saying I want to

give glory to God for the build

it he gave me as athlete to perform. And I'm grateful

that tonight it turned out well for me, Bergmann to set

their stunned and was reminded

that moment, you know, at the

end of the day, doesn't need me to

bring forth glory. God just wants all men to pursue and seek

glory for him. We need to remember this and be careful

before we just assume that God is on our side and any action, god tells us to look

first to ourself when we see other people

that are struggling unless we to be tempted. And in every means, again, as we get ready to

execute justice, he says, You bet a first examine yourself and make

sure you get the log now to Matthew 7 under your own eye before you go and try to move the

spec from another. There are times however, that it's clear

that there is a spec that is doing great destruction

of people. And as a sovereign

agent of God, you need to move for His glory to

restrain evil. I want to talk

about one of the other commands

that we have, that gratefully

our military demands of its leaders. And it is to provide for the Met and it's

underneath are charged to

provide emotional and spiritual and

physical care and also Tactical

Leadership. I have a friend that is served in our military, in fact, in a special

forces within the Navy. And I asked him to speak to me about this specific issue

and I'm going to read to you

his response because those of you that are watching this video, those of you

that are going to serve alongside

our military in the chaplaincy or as counselors or a

spiritual shepherds. Part of the role that you have is being part of that provision

for our soldiers that's going to make

them effective, both in their execution

of justice and in the recovery from being these men who bravely go, these women who bravely

go and serve in a way that is

unnatural to man. He said this. He says

your responsibility to your men is to position

them emotionally, spiritually, physically, tactically, in a way that enables them to

bring the maximum sustainable impact

to their mission. It's your charge. You must lead a combat

effective unit. Otherwise, they're

not useful in combat. And combat

effectiveness is the mission of a

military unit. In order to make your unit relevant and worthy

of being tasked to close with evil and to kill the injustice

that is out there. They must be

ready, they must be trained, they

must be equipped. They must be encouraged

and motivated, and there must be clearly

let equipping them. And the four pillars is your fundamental duty as a commander to feel to come back

defective unit. And I would say it's the fundamental

responsibility of all of us who have the opportunity

to come alongside our military and a care for any one of those four pillars in the

way that we can. Men like me, I don't have the

privilege of being tactically making them relevant

and effective. But the come

alongside them in every way emotionally, provide for their

physical needs, but do what I provide for our government and also through caring for them, through

different

military ministries and providing them words

of encouragement and, and things that

the military wouldn't provide

them other overseas, absolutely. And then especially

in a spiritual way, he goes on to say this, It's a matter

of regulation. Of course, if

you cannot lead them by regulation, you will be relieved

of command. The cost of your

inability as a leader in combat is not measured

in dollars, is measured in lives, but leading your

unit in a way that equips them

spiritually, physically intact,

lead emotionally is also a product

of loving them. The men and women

are armed forces are so worthy of

their commanders love and respect that it should not be a

matter of regulation. It should be, it

should stand as a matter of purpose

and integrity. He says they are worth it. They volunteered there in the breach because

they want to be and sweat and blood

committed to this effort. They have fought

for the moment. They've cried and worked hard repair themselves for the moment to be there. And

they observe,

they deserve the very best of

their commanders. And I would say along

with him of us, the obligation of a

commander and each of us is to equip those

that have served us. And as a command

to those they lead with the ability

to win in combat. And then after. And the after part

is what is lacked. And we're emotional

and spiritual care is so critical. The emotional and

spiritual care that you're going to get

these soldiers comes and helping

them understand a biblical

worldview of war. And understanding that

God's commandment to the individual is not the same as God's

commandment to the authority

of government. And those that serve underneath that

uniform, that uniform, that batch is

the mean that gives them the right

to have that awful, terrible privilege

of executing temporal justice

on this earth. Because evil men will not respond to words

of reason. They won't respond

to diplomacy, they won't respond

depleting. They respond to one

thing, superior force. And from Genesis

through Romans, from Romans to Revelation, you see again and again, God says, don't ever

put your hope and war. Don't put your hope

in the military. Put your hope and government put

your hope in me. But part of government's

responsibility is fulfilling

its duty to me. And God will hold governments

responsible who were unjustly or who choose

not to war at all. It takes selfless men to serve in our

military and to take selfless people who

aren't serving in the military to

equip themselves, be able to serve the men and women of our

armed forces. The men and women

who serve to bring civility

in our country. Here in the United

States of America. Each of us should

increasingly equip ourselves

with these tools to encourage these

men and women. So when they come

home filled with stress, filled

with trauma, filled with memories of har that we can

comfort them, that we can thank them, that we can remind

them that as awful as it was

for them to go and execute

that justice. Even more. It was awful to see

the justice that got executed for

all of our sin. And God is a Redeemer. And that Redeemer

that provided for their sin, not at all. And what they

did in battle, that was God's call. But maybe how they didn't battle effectively

or righteously, or maybe the choices

they made individually, that forgiveness is

available for that. And that nobility and reward and honor

is due them for their selfless sacrifice

and putting themself at risk for the sake of a righteous

and just cause. That's why the scripture tells us, by the way, to pray for those that

are in authority. Because all of us, we don't have

the information. We don't know what men in leadership

must know as they make that awful

decision to send men and women to

those front lines, to send military

forces into battle. We must assume, we must believe as we

pray for those men, we must vote to

get the right men and women in office to

make those decisions based not on self-concern and self-protection

and self comfort, but what is good and right for the world

and the name of God, we must trust them when

they tell us to go. We must be willing

to honor God, if a command is ever

given to us that we know is in direct

contradiction to his word. We must do what followers

of Christ have done the past as they stand before that authority

in fear and trembling. And they say whether

it is right for us to obey you

were to obey God, that is for you to decide. But as for us, we know the soldiers

ever called to do something

that is clearly outside of the realm

of what God, once, we must give them

courage to stand up, we must tell them to avail themselves

to others that can go in and evaluate the command that

they've been given, but we must comfort them. Having followed by faith, not violating known dis,

acts of foolishness. We know from

Nuremberg that just to say I was commander

do so, so I did it. It doesn't fly. But

where we don't have all the intelligence

and we've acted in faith based on what we've

been instructed. God would tell them that what they're doing is noble and we must

comfort them. Thou shall not

kill is a command. Individuals

Thou shalt kill with fear and trepidation, with legitimate authority, with just cause, with right intent, with

proportionality, with prayer in care is a noble act of service. Scriptures tell

us to comfort one another with

these words, not specifically related

only to just cost, but with the words of hope that are in all

of Scripture. I thank those of

you that have equip yourself to maybe learn a few things here and take this as a prompting

for further study. So that you might be

a man or a woman that could serve those

men and women who serve us by

standing up against the evils in

the world must share moment of

prayer together. Thank you for

just the chance that we have to, to just trust you with revelation

that will allow us to make our way through this world in a

way that will honor you and be a

blessing to others. Indeed, in this

conversation and topic as

an all others, we don't want to lean on our own understanding. But in all our

ways acknowledge, you know, that you'll

make our path straight. You tell us the

steadfast in mind, you will keep in

perfect peace. And so in all that we do, we want to be steadfastly mindful of your will

and way for us. We reminded been

a scripture. The one individual

that you said must write his own copy of the Scriptures

was the king. The king should be so thoroughly acquainted

with your word. And that he has

written it out himself and learned it and understood it so

that he can rule justly as your agent

here on this earth. And so we do pray for our kings and those

that are in authority, that those that rule us would be ruled by you. That those that defend

righteousness and honor would be men and

women ruled by you. Father, we thank

you for grace. We thank you for

your provision for all of our injustices. And we thank you for words that you can give us to

comfort one another, to encourage each other, to instruct one another, and to remind us

of all that is true and right and

good and holy. Lord, I pray

for those that have sat with me here

these last minutes, that they would take the words that

they have heard. They would compare

them to the scriptures to see if they are So. And they would

study your word. And they would be reminded of these things

as they are true and that you

would protect them from those things. Lord, that are not of you. We thank you

for your word, which is able to teach us, reprove us correctness, and to train us

and righteousness that we might be adequate, equipped for

every good work. From comforting

to healing, to providing hope and restoration to men and women in and out

of the military. Would you allow us to be men and women that would commit yourself

to this end, that we might be

useful to you. And a blessing to

others in Christ name. Amen. Well, I think Chris, being a Christian makes it harder because it gives you

something else

to think about. If you're looking

at life through the lenses of Christ, everything has a

different look. And so how do

you be Christ? How do you see your enemy

as children of God? And I have a lot

of conflict, even still have

unresolved conflict. What happened over there? Nowhere in the

gospel that I've found that Jesus

and Jesus, his life or his testimony

advocates violence, nor does it give the

criteria for war. But I also know

that God raised up warriors like David who slew Goliath

and the Philistines. And I know God raise

me up to be aware. I can look back

on my life, going all the way back

to elementary school. I was a kid, has stood

up to the bully. And I believed I

was standing up to the bully out

there in Iraq. I was fighting for those

who couldn't fight. Speaking for those who

have been silenced. And unbinding knows

who had been bound. And so I still have

tension with with that. But I resolve it by

just looking to Jesus. Because where I see

Jesus is where I see mercy and forgiveness

and Grace. And I know that

whatever tension a soldier may have with what he or she

did over there. The moment that you ask forgiveness, you

are forgiven. And you have to,

in the problem that I have is not not understanding the forgiveness

that God gave me. It's forgiving myself.

And there again, you had to look to Jesus. You exchange

blood for blood. You take the blood,

the nastiness and the messiness of war, and you exchange it for his blood and let

his blood heal you. And that is a

constant struggle, I think most people probably deal with

as Christian.

Tim, another

important subject, we're going to look at the impact on the

soldier Sanger, airman, and Marine

Coast Guardsmen. It's entitled

the realities of military service on

the service member. And today we have two very qualified

presenters. First of all,

Lieutenant General Robert Van

Antwerp, US Army. General Van Antwerp,

still on active duty, will be speaking in

his private capacity. But he and his wife Paula, wonderful insights into the life of

service members, both as a leader, as a service member himself, as a father of three

sons deployed in combat. All of this makes him a person well

worth listening to wonderful,

illustrious career. And then at his

side will be Dr. Don Snyder also giving some input about the civil military relationships

of our country. And he has, he's the, perhaps the foremost

expert talking about national will and

the demographics of the military

culture and why the military

culture so important to our

society at large. So Tim, wonderful

presenters today and yeah, I know you might

want to cover some of the topics

if they're going to discuss anytime you are trying to reach out

and help someone, you have to understand the uniqueness

of the person. This particular

application is looking at the military. And we're going deep, we're taking a

deep for a reason. So you understand how serious and how

intertwined everything is. In this particular

lecture, you're going to look at everything from

demographics, the reasons why people and enlist in the service. And I'll talk about family members will

get to the point of understanding deployment and

redeployment. Also some

challenging issues. But it keeps going deeper. The wounds of war

and how to deal with the death or loss of a

service man or woman. That's difficult. It's

really difficult. It's important to see then through those

eyes when you do, you'll be more effective

and you're helping. Let's go now to

the realities of military service

on the service member with Dr. Don Snyder and Lieutenant General

Robert Van Antwerp, US Army. I'm honored to be

with Dr. Don Snyder, long-time personal

mentor, a distinguished

veteran, a scholar, Professor Emeritus

at West Point, and one who has

thought deeply about the civil military

relationships in our country, in the military

profession at large. So Don welcome. We're glad to

have you here. I first would honor

your service. You had three

tours in Vietnam. You've been recently

at West Point interacting on a

daily basis with the soldiers and

their families that are coming and

going from that post. So overall, you have a

pretty good foxhole to view these current

issues in the military. I thank you for

your service and I wonder what thoughts you might have about this. Those that are serving

today in the military. Well, thank you,

Bob. Those that are serving today

and the military are remarkable

young people we've known now

at the academy, just as one example for about the last four years, every class

coming in new at the time they

committed that come to the academy that

when they graduated, they were going

to be deployed. They didn't know where.

They did though, how rapidly they were

going to be deployed. But they came knowing that active duty service in harm's way was what

they were choosing. And so I find it just

very encouraging that our nation is still

producing the quality, the quantity, the breadth of the population

that they represent. This is a

remarkable group of people and I'm

delighted to be part of this project to a

system. Well, thank you. And I know you've

thought not only about the active duty from your viewpoint at West Point, but a lot about civil military

relationships and the citizen soldier. What are your thoughts

about their service? Well, let's take the concepts

citizen soldier, because I think it's a

very helpful concept for counselors of many different callings to think about people

in the military. They all started citizens. Some citizens are called to come into the military, is everybody

pretty well knows now we have a

volunteer force. That means no one is taxed to serve their country. They choose to do that. And those

that

choose and come on active duty then begin to fade as they view their own identity

as a citizen. They placed the

role of soldier in front of the

role of citizen. They see themselves

as soldiers. They don't give

up their rights to being a citizen. They know they don't

give up their rights. I have great arguments

with cadets about whether or not they should vote in general elections. And they will come

right back and say, but it's my duty to vote. I'm still a citizen

and they are. But for the

reserve components of our armed forces, of all the services, they still see themselves. And in fact,

they really are more citizen

soldiers than they are citizen soldiers with the emphasis on

the last word, they still draw

the majority of their support from the community in

which they reside, which is not normally a military installation, from the job

that they hold. The normal workweek, not counting what

they're going to do on the weekends

and training times as reserved verses. And then we've

complicated this since 9, 11 by taking these

folks who had a very comfortable

identity as citizen soldiers

are very useful, productive identity. And we now have made

them deployable soldiers just like

the active army. And so the

adjustments that have occurred in the

human fabric of the reserve components

are deeper and are more difficult than the adjustments that

we've had to make. They have had to make on the active duty force. And I think that's

a useful way of understanding these two this bifurcation and all of our armed

forces mgh. Well, I think you and

I certainly applaud the citizen soldiers

and those that are in the reserve

and the guard and the contributions

of sacrifices, the way they dig

really deep on behalf of their country

in various ways. And, and what we know is we could not do

it without them. We could not be

prosecuting this war. We did not have a large enough

armed forces to prosecute this

war successfully, calling up the

reserves in this war, it was absolutely the

right thing to do. And these folks are

performed magnificently. But now that we are in the wind down phases of the war and we're dealing

with the trauma of many of them coming back

wounded and injured, then they're going to need to be dealt with and to be understood a little

different light than the active

duty component. And that's the

point that I want to get across. Good in this regard. These folks are

in the woodwork of America there

in Prescott, Arizona, and

Peoria, Illinois. Not necessarily Fort

Hood, Texas, etc. Could you characterize how the great American public can make a difference

in the lives of the citizen soldiers,

can affirm them. This notion of

national will. Any thoughts? Yeah, let me give

you another and the counselors

that maybe looking at this eventually

another way to think about this. And that is the

concept of purpose and service that everyone has when they go into

the military. Soldiers in the

military want to do something that is

bigger than themselves. Now, many soldiers

come in for short-term economic

reasons of wanting to go to

college, et cetera. There are many incentives. But the larger

transcending idea is that I want to be

part of something larger than myself. Many of them recognize full while their nation is threatened and

they want to be a part of the defense

of their nation. We have some great

research coming out of the early phases

of the Iraq war. This is the

first time that military sociologists

have been able to clearly document

the influence of mission on performance. Establishing a

democratic regime became a significant

incentivize or to the soldiers

that are in the first phases

of the war. Now, admittedly

that trailed later, but it was clearly documented in the early

phases of the war. So all soldiers in, in their identity

of themselves want to be a part of

this transcendent, bigger calling

than their own. And they're willing to add negate themselves to that. The key ethic and the

military profession is they are willing to put down self so that the

unit be successful. And that is not a ethic that is practice

widely in our culture, which is much more self referenced, much more

individualistic. Some would even say

hyper individualistic. But this is the core of the professional ethic for the Reserve

component folks, when they come

on active duty, they accept that

core the same way. They've already

accepted it by coming into the

reserve components. But once they're mobilized and deployed,

it becomes a. So the question is when they come

back from the war, who is the moral community that

they're now going to identify with while they were deployed,

while they were. That's an intensely

intimate moral community that you're a part

of in your unit in combat you and I have

experienced that. It's hard to describe

to someone else, but when you're

depending every day for your livelihood

on your brother or sister on your left, the right, or in the young folks

language today, who's watching my back as I'm patrolling

down the street. That's an intensely

moral community. Stop and think. How many decisions

military leaders make every day that is deeply steeped in

moral content. Let me ask the decision

the other way. How many decisions do military leaders

make in a day that does not have deep

moral content to it. It influences the well-being of

another person, not just our soldiers, but the innocence

on the battlefield, who we also take

an oath to protect as much as two

prosecuting the enemy. So when the

Reserve component soldiers come back and they've been a part of

this intensely moral, close-knit subset

of our society. And they come back and are back in

their community. It's much more diffuse, much more diverse

in their contacts. Who are they

going to turn to? Who are they

able to turn to? Who will provide for them. Reflection of

who they are, what they have done and

help them construct the meaning that

they have to construct out of this

very intense period. I would submit to you

that it's going to be the same ones

before they went. Family, unit, job, civilian community,

and faith group. But I would also

submit given the intensity of what

they had been through, they're going to need more from each of those. And in my own

judgment personally, they're going to need more from the faith group. And the reason

they're going to need more from the faith

group is that the meaning that

they're trying to construct in

their minds about what happened is

meaning that it can only become real to them in the context of something transcendent. That's what

they

went to serve for. If they come back and

there is no touch with the transcendent,

I would see, I would have serious

questions about their ability to process healthily and to construct

the meaning they need to out of that very

intense experience. A wonderful comments and I think those will be very useful to the counselors that

we're addressing. Let me back out of the guard reserve

experience for a moment to a

broader discussion. I've heard you describe

the intersection, if you will, of two

greedy institutions. Could you tell us

more about that? Yes, that the military

sociologists, the folks who study

the military as a sub society, right? Quite often using

this phrase of two greedy institutions

in American culture, one being the

family and one being the military

vocation. Now they are greedy in four dimensions

as they say. Both of these commitments take an immense

amount of time. They take an

immense amount of emotional energy. They take this kind of purposeful

commitment to making things happen

in this group. And then lastly, they

require sacrifice. They are both 3D

and sacrifice. The military cannot

accomplish its mission. If every person

says Me first, we gotta do it my way. So you have to add negate self to the mission

of the unit. It's the same in a

family, the parents, while they are

the guardians of their children than the mentors and parents

of their children. They still have

to sacrifice immensely because

children are greedy. So the whole family is

a greedy institution. So when a young couple is both accepted the call from God to have family, and they

accepted

a vocational call from the Republic to

be in the military. We have an intersection of two greedy

institutions. These are immense demands. How best to meet

those demands? The institution has

learned that we should provide two things to

those young soldiers, to those families,

whether their officers, enlisted, guard or active. They need two things. They need consistency in

commitment

and inaction, and they need

predictability in the short and midterm. Well, what's happened

during the war? We can't provide

the consistency because of the constant rotations and deployments. And then even amidst

those deployments, the predictability that was there that

you're going to go for a year and

be back for two. That has now been

ruptured with the surge of necessity. Another sacrifice

by the military. But these institutions who need consistency

and predictability, the flourish to thrive, don't have it right now. And so they are intensely

needy institutions. As we weave down from institutions

to individuals, there's the

whole subject of identity and the

relevance of identity to the psyche of the soldier,

sailor, airman Marine. Any thoughts about that? Well, I think the greatest generation had it right? They

called themselves

in the service. We are service

men and women. The concept of service became central in

their language. The concept of service is still central to

the military. I mean, why did we

have a military? Why does the

military even exist? The only reason the

military exist is to provide for a

defenseless society. What the society cannot provide for themselves. So we create military

institutions all the way back

to the colonies, the colonial legislatures

and the militia, the Minutemen, to provide for the society

what it could not provide for itself, and that is

their security. So some group through history has been called out one way or another. Unfortunately, in

part of our history, we had to call them

out by a draft. That, but it's an

immense human tax. Now we call them out by the incentive

disservice and some financial incentives to education beyond that. But the concept is the moral concept

around which the military

grounds itself, the identity is,

I am of service to someone else who

needs my service. That makes the military a social trustee form

of profession. It is providing that

which the society, the society can't

heal itself. So we have medicine.

The society can't represent itself

before the bar, so we have barristers, and the society can't defend itself against

foreign threats. So we have a military. That concept of Service, the identity of service, the satisfaction

of service. One thing we always

talk about when we talk about

the military is, are they voted

by intrinsics or are they motivated

by extrinsic? Fundamentally the

extrinsic that the junior level may

count in getting them into the service will pay four years of your college if you come into the army. But

those who stay beyond the six to ten year

period for a full career. Interview after

interview shows that the satisfaction

of service is what keeps them

on active duty. Lord nodes, they're not overly remunerated

for what they're doing and the

sacrifices that they're giving to

their country. Those are wonderful. It's a great

construct for us. I'm wondering, can

we dive a bit deeper into specific applications

you mentioned, for instance, at

less than a notion of identity

through service. What about this

identity concept when we have a

wounded warrior, one who is

perhaps received an IED or some

other injury. And now he's

coming back in as identity has been marred. How do they

deal with that? What, how do we

advise counselors? What's a whole dynamic

you think that goes on in the life of

the wounded warrior? That's a difficult

question because in my experience, it's particular to

each wounded warrior. And that goes back to the concept of identity. Identity is not

necessarily a mast identity.

In the military. Officer, NCO,

squad leader, platoon leader, platoon commander

in the Marines. Each of those identities

are personalized by the individual within a generalized

framework that the, that the profession

wants them to have. But it has to be personal and it has to be accepted. They have the construct that

meaning on their own. They have to reconstruct that meaning on their own. Now, if there

is no trauma in their life and they're progressing through

the military. Or as we probably

should discuss. There are other vacations like the military of first responders

where it's the same identity issue. They find their identity in the act of service, the motivation in

the act of service, providing care for others. And then when something detours them

from doing that, they're going to have to reorient their identity significantly within

the limitations that they have

to continue. Now, that is an immensely

difficult task, and I would only submit a couple of

general comments on it for the

counselors who probably know more in

detail about this? I do. But the first is what they're

hopefully going to be able to do in the

future should not be detached from what they have done

in the past. In the military

and for all people and risks, full

situations. Leadership in extremis

as it's called. Now in some of

the literature. That is a very deeply

ingrained identity, providing intense satisfaction from

what they're doing. The closer they

can come out, finding new purpose in their life within

a new set of capabilities to that

original identity. Obviously, the

less adjustment, the more rapid the intrinsic satisfaction

are going to flow. The second thing I would

suggest is that they need around them that moral caring

community to help them, if necessary,

bring closure to a part of their life that was very satisfying. Draw those

satisfaction from it. A new move to a

phase of life where they should be

helped to understand, they can find equally

satisfying results. That won't be easy. I can assure you that many military

folks would claim, perhaps incorrectly, but would claim I will never do anything

that will make me a satisfied is

what I did over there. Well, that may

not be true. And there are plenty

of examples in congregations of people in other vacations and in

other lives that are doing just as much service with just as much

satisfaction. And they should be

networked for sure. I guess this passion that they've had

for the military, we would hope that

the wounded warrior who may not be

able to resume is military profession, can attain a new passion that pulls him

into the future. And it takes him away from the challenges of his past to profession is

past experiences. Exactly. And faith is an immense has

to be to me. And let me backup and talk just

a minute about faith and the concept of construction

of meaning. Faith in its broadest view for those of us who study professional

worldviews and how a professional thinks of themselves and

their identity. Faith is that

element which is an intertemporal dimension of their worldview. If I am this person today and do these

things, then in the future, X, Y, or Z will happen. We have expectations

about the future. The difficulty of

the trauma is that those expectations

in many cases have either been truncated or those expectations

have been opened up and they

must be re-exported. Can I still proceed on the same expectations

I had before? Well, that both the

secular concept of faith. And the Christian concept, the faith have an awful

lot in common there. And the biggest

thing that I have found in my limited

experience in working in the wounded warrior

program and we had to have them in our department

at West Point. In my experience

was a reminder. And then the Christian intertemporal dimension. There is a faithful

God, a loving God, and a manifestation

of his care here on Earth until he comes

again is his church. And in his church we

should be able to find the love and the care that he will be

able over time to show us what we're

going to do next. For him. Again, the concept of service,

not for self. Oh, wonderful words about the church and the

role of the churches. Maybe the most

compassionate arm within community that can help

our wounded warriors. So any more tangible

ideas about how churches might be relevant in the lives of

military men, women, and to include those that are

returning from combat. While the one

suggestion I would make that I have observed being done in a church that I'm a part of now. And that is

the very

conscious commitment of the older

military veterans in the church to become a part of the lives of the younger veterans

that are returning. It serves two purposes. It has in our case, done some rejuvenation for

the older veterans. Now. They live in

different worlds, they lived in

different wars. The communications, the self-awareness,

much different. But there's still

that bedrock ethos that I served. You serve, we have

things in common. So I would submit

that networking within a faith

community to veterans of different

generations is something that should

not be overlooked. Also, you have

of recent TED, wonderful observation of the society

at West Point, the comings and goings, the people that come in from deployment perhaps, than they are

in a pretty

intense environment as instructors and faculty and

tactical officers. And then they

go off perhaps back to the

battlefront again. Can you give any of

your observations about troops or families and the impact of these repeated

deployments and just the dynamics

you observe. I can give you

an observation. This is not grounded

empirical researcher except in a much larger

study it has been, there is an intense

intersection between growing spirituality

and higher education. And this is a

wonderful opportunity for churches who have ministries to

college campuses or to junior colleges, or do whatever kind of educational

institution. But we know that

humans as they are constructing

new meaning in their lives from what

they are studying. The disciplines that

they're studying in school that is also influencing their

understanding of themselves and their

human essence. I will use the word humans spirituality because

it is in fact, part of their finding, part of their essence. What I've noticed

in this war in the, in the multiple

deployments is given the fact

that Generation Y was already more

inclined towards spiritual issues than its predecessor

generation. The repetitive

deployments have simply deepened

the desire, the willingness to explore

spiritual meaning. And that is true both

of the non-believers who are seeking some form of faith to believe, as well as those

who have already made a Christian

commitment and recognize that great power comes from deepening

that commitment. So the nexus between spirituality and their

current existence, I find an absolutely

fascinating one. At a fundamental level, the expression that says an ounce of prevention

is worth a pound of cure may apply to these matters of preparing for the rigors of combat, the trauma of

military life. D, can you find anything

in your experience that would suggest

that ahead of time, people becoming spiritually

grounded people, understanding the scriptures to

a greater degree, people exercising the

discipline of prayer. Does that better

prepare them to have the right lens

through which they view their traumatic

experience and from which they can be more

resilient? Absolutely. And most of my experience,

I'm drawing from men's ministries

and I'm drawing from my work, as you know, with Christian ministry to military youth

around the world on, on military

installations. We know in the

military that the cycle of pre-deployment,

preparation, deployment and then

reintegration back into the sending society

and descending unit. But we cannot focus just in one area

and be successful. We have to focus

as much in the pre-deployment as we do while they're gone, as we do after

they come back. And then I would submit, we are all learning

that there is now another phase that is much longer than any of

us anticipated. And it's the phase

that after they are back and

rayon integrated, there are still those who have lost

capacity and lost some capabilities

and their re-entry is not going to be

the six months, nine months, it's

going to be years. Fortunately, as a nation, I believe we are accepting this much more this

war than we did after the last

long war, Vietnam. And hopefully we'll

do a better job. Spiritual preparation has to be a part of that. At the beginning, the spiritual daily

reinforcement

and inspiration. The steady group

while deployed, the wives steady group, the spiritual activities

for the children. All of those things

have to continue. And in clearly

there is a role for spiritual formation

in the reunion and in the redefinition, in the reintegration of the rolls back

into the family. Now, nothing has

changed as long cycle, it is life, right? The Lord came

to redeem life. He should be part

of all of it. Very well said

and I think none. We have some

super takeaways for counselors and

church members, pastures across

this country. Is there anything

else that you would think

of that would be relevant to pass along to the counseling core

of this nation. That the last

thing I would, would say it was a tick off from what we

just discussed. And that's about

this generation, why we're still learning a great deal about

Generation Y. Much research has

yet to be done. What I would encourage these counselors and they may know this far better

than I do already. But what I would encourage them as I believe that the potential for

spiritual growth, spiritual maturation,

spiritual commitment from this generation is

immensely untouched. The war is causing, Well, at least

to this point, almost a million

of them to ask themselves the

transcendent questions of, why am I here? What is my purpose in life and what am I to do now? I think

this is a

golden opportunity for the work of

the gospel to be a natural and

normal part of the developmental

advancement of these people in whatever condition they come back from the war. And they'll all

be different. But the opportunities are just amazingly

abundant. Don, thank you for investing in the lives

of our military men, women, and their families through providing

these insights. Thank you. God bless you. Thank you. I welcome

lieutenant General Robert L. Van Antwerp. Today, General Van

FERPA is going to assist us in understanding the realities

at our service. Men and women

are soldiers, sailors, and Marines, Coast Guard men face in our nation as a serve

in peace and in war. So welcome gentlemen

into our band. West Point classmate is good to have

you here today. Thanks Bob. You bet. Can you describe for us, for starters, though, the raw ingredients

that our nation brings together to form a soldier, sailor,

airman, Marine. Yeah, that's a

great question. First of all, there's 32 million young people, age 724 in our country. And as you look at

that group of

young people, they are the ones

that businesses after the services

are after to recruit. How basically the,

the army has to recruit about a 175 thousand young

people a year. And I jokingly

say that's about the size of the United

States Marine Corps, no offense to my

marine buddies. But in that number, as we look at the, the eligible population

of that 32 million, only about 30 percent of that population

is eligible to come into the army. There are several

factors, education, offenses, felony offenses, medical problems

and other things. But it gets

down so that it breaks that population

down quickly. Now the, on the,

the majority, 62% to be exact, of our young

people come in because of

education benefits. They want to continue

their education. They want to

earn that from the Army GI Bill

army college fund. But I think during

the process of basic training and AIT, there is a change

that happens. I've seen it

so many times. It's the notion of selfless service and

service to the nation. And of course all

their leaders and the people

that they're with. That becomes the

thing in actuality, I think a lot of the

young people today, all of the young

people today I'll say they know they're

going to deploy. This is an unusual

generation that we're getting

that's coming up. Knowing that we

have two theaters, Afghanistan for

seven years or rack over five years, that they are

going to deploy. So there's a great

young people out there willing to sacrifice for this nation. That's the starter, that's the grit in these

young people. Well, that certainly puts it in context

for all of us. Now, I often say that they are there great Americans

as you point out, but they also are the exit arm of

our country. And they are wounded

and they bleed and sometimes they even

die on our behalf. Can you characterize

their sacrifice hit our service

members make? I think it's interesting

when we go and visit people at Walter

Reed and others, we talk about them

BY and heroes and all of them say,

I'm not a hero. I was just doing what

I was trained to do. So they're very

self-effacing in that and don't look at

this hero status. But you do see the

wounds of war. And when you visit. Injured in the hospital or you attend a funeral, you see the impact

on families. And I might add that

in the old days, we didn't have a large

married population. Today, about 50 percent of our soldiers

are married. And it's a very, so it's

a different dynamic. The other part of this

entry population is about 50% of them come from families that

have soldiers, mother, sister, brother, uncle, aunt, whatever. So there's even a

force of our size, about 1.1 million

for the army. A lot of those people come from military family. So a lot of America doesn't realize

the sacrifice. You've recently, you

mentioned Walter Reed. You've recently been at Walter Reed with some

wounded warriors, went through on action

and Afghanistan. Any reflections

on the challenges somebody faces like that, a young truth,

it's at the point of the spear, right? A couple of observations

from visiting those folks just

this past week. Number one is

there's usually a soul searching

about what they personally did and what

others did for them. And so there's that

first dynamic of recounting and I don't know if that

helps or hurts, but almost everyone

that goes into their hospital room

says what happens. And so I think we've got the what's the best

way to help that. I think some of it is

to tell the story. But after a while it keeps bringing up

those same memories. So this is a, it's

a challenging time. In fact, one of

the soldiers, their parents said

before we went in there, he does not want

to tell what happened and he's very angry about what happened. So I think the

range of emotions, one of the one

of the mothers said asked me if I would talk to her son

to tell him to treat her more nicely. Because I think

part of it is I think your family's

kind of safe. And so there

is going to be eventing or I

see that a lot. And I think in that case that young soldier was

taking a safe person, his mother, kind of

venting on that. So there's the range

of emotions and then there's

medication involved. There's there's

certainly memories of of their buddies

and what happened. And so a lot of

dynamics in that. But what we try

and do is listen, put our arms around them. Steve Meyer, that

we want with prayed with every single soldier. At least one of those

did not want that. I don't think. I mean, at least he was resistant. The others welcomed

it with open arms, prayed for their

healing in those and that of

their buddies. Mm-hm. Mm-hm. So you bring up prayer and the

subject of faith. And we've often heard that there's no

atheists in fox holes, but there are differing responses to God when

something like this, something so

traumatic happens. What do you see? How

do you counsel people? What do you as a

senior army leader, how do you help

their faith aspect of their lives as well? I guess first of all, I know the importance

of faith. And this isn't

a denomination or a particular

faith group, but it is a factor in, and I think as you say, there's no atheists,

everybody's coming to grips and death. It's one of those

things I think God uses to have us examine

that faith. And they are right

up against that. They either know someone that died or they know someone that's

severely injured. We have found that

most of those young people

welcome prayer. They want to be around

people that have that strength and it's

outside themselves. I think we did see a

element and we do see of anger that there is

this notion that God, how could you let

this possibly happen? And so we've seen kind

of that spectrum too. I would think I say

it's more common for my experience

of ones that said, yes, please do

pray for me. And I've never met

a parent that said, don't pray for my

son or my daughter. They all say, please pray for them and

remember them. Certainly, you do have

all the emotions of anger and guilt and false guilt and

bitterness. And, and what we've seen personally in

our ministry is that faith does make a

difference and helps in amazing ways as a complement to

these other things. We are doing this

video series on behalf of

counselors across our country who will interface and

the woodwork of America with military

men and women. Let me pose two-part to hear one, National

Guard Reserve, we have a tremendous

deployment, unprecedented

certainly since World War II of

these forces. Can you characterize their service and their

challenges? And then I will ask, okay, what do

we do about it? Given that the

military is just in certain locales and not throughout the

woodwork, right? I think first of all,

their service is characterized exactly

as the active component when they're on

active duty. I mean, they are doing

an incredible job. I think the differences

when they come home, when you come home and

your active duty are still part of that unit

integrally involved. Not that you're

not still part of the unit and the guard

national reserve, but are in the National

Guard and Reserve, but you live out

in the community of where you may have been for 10 or 15 years dependent on your age

and I'm out of time. So the dynamics out

there are different. I think the

garden reserve. Tends to fall back on their local community to, to a greater

degree because the active component

your community is within your

installation or your unit. So there is definitely a different dynamic there. I do know about when

we visit soldiers, their first desire

is to get out of the hospital

and get back home to do their

rehabilitation. So even an active

duty soldier, a lot of times, if they're going to have a fairly link the rehab, they're going to leave a

military hospital

and they're going to go back to

their community. They're going to be

at their local church and they're going

to probably be using maybe a VA hospital to go in and do

physical therapy. So I think in all cases

here really and so maybe it's kind

of a converging at, at some point. Ultimately the

active duty soldier, if everything works out, he'll go back

to his active duty unit and join them. But there is

very likely to be a period of

time that he's in the civilian community

and he is being dealt with by either Tricare, outside physicians or

physical therapist or the VA system. So you have

active duty and then also guard

and reserve that one way or another are in the

woodwork of America, I believe that's it. Oh man, I wanted

to ask you about the Grassroots

of America. Many of these troops, they come back, they don't come back to

Florida, Texas, they come back

to Prescott, Arizona and

they're flipping hamburger for working in the bank selling cars. And they are one of one

many times don't have all the robust

systems around them that may be an active duty Soldier would have. What, what is the dynamic with

the

Guard and Reserve? And how do we keep them

in the fight hurdle? How do we help them return is contributing

citizens. I think the support group is tremendously important. Some people have a very strong family

support group, but a lot of

soldiers don't. And so where can they find those

support groups? So I think what

we're strongly encouraging National

Guard Reserve an active if they're outside of

a military location is to is to get involved and to be part

of a support group, your local church, a club that is something that you can be part of, an organization

where people can see you and see

changes in you. Also a place where

you're safe. That's part of what

your family is, should be a safe haven

when you come home. But a lot of these

young people find the dynamics of

their home has changed even when

they come back. That there were things that while you were

gone and you were doing your thing that your family was

carrying a load that they didn't carry

when you were there. And so now it's

what is the dynamic of that kind of

balance coming, finding a new,

a new place, especially in young

married couples, I think so. So how do we encourage? Number one, I think

they've got to want to, that's part of it,

but they're also, we need to reach out

to them and say, pull them in, come

be part of this. Because I think one of the worst things

as isolation, then you are isolated, which your thoughts

are ready, some which are

very hard, is, as we've talked before, when you have when you

have these memories of what happened and you

keep replaying them so you're you can be

isolated with those, but I don't think you can. You've got to join with other people even if you don't feel

like it. That's what we tell soldier who may

not feel like being with anybody

or seeing anyone. You've got to do it

for your own health. And I think the

faith basis of that is very important. So strongly encourage churches and

church counselors to wrap your arms

around and be a sounding board and

let him talk to you. When I was a good comment. Let me follow up on that. How how would you advise a

church to be effective in the life

of a returning warrior? Any any thoughts or tips? I guess first

of all, I think that several

association I guess if I were in a

church and I knew I had one or a 100 veterans, I would begin to

put something, a special program for

them to recognize, not to isolate

them or say, you're different

than everybody else, but to allow them to, to join up with others who may have experienced. If there's

only

one of them. You might have some

veterans in there. You might have

other people that could come alongside that. They could just talk and take them out to lunch. And I

think this is real basic relationships

at that point. But I think it's

important that you get that young

soldier Sharing. Be able to verbalize

some of where they are. And then I think

it will open the other doors that the professionals know

how to deal with. But if it's again,

it's that isolation. So I would start at like you might have a

young singles fall. What about a young

Vets or an old that's on or some other program

that you could. Good ideas. And I think we might agree that the church is one of the most

compassionate arms of any local community. And so if we can mobilize churches across America to be

intentional in

their ministry to the military

in their midst. Then we really have a

whole nother safety net of community that can wrap loving arms

around them. Now, some of these

things are really tough. Church members and others in the community

encounter. The realities of

post-traumatic stress disorder in some of our troops or lesser degrees of

combat trauma. What about the unseen

wounds of war? We see the amputee

and we have, we have great

sense of honor there and appreciation

for the sacrifice. Some of the wounds

that we can't see a lot tougher. Yeah, I agree with

that totally. I think some of the

visible wounds, an amputee when the

young people that I've seen with that

they want to do things they've

never done before. They're going to

climb a mountain, run a marathon, right in a triathlon, swim, do these things they've

never done before. For the unseen womb, it tends to make you go a different direction. You don't want

to be part of society or do anything. It's, I think a much more difficult thing

to overcome. And what I might

just add, I, it seems to me that for a church, if you know, you have a

soldier deployed the time to build

the relationship or to begin it is while

before they deploy, if they're

already a member. But if when you

find out about it, they're in your community, reach out to them while

they're in theatre. Because I think too

for a soldier to come back and then be in a

totally foreign group, that will take more time. So I think we

could move the, move the bar back a

little bit and say, you know, you

have someone in your hometown and

they're deployed. Begin that relationship. Have your kids in

Sunday school, right? That soldier begin to make kinda have a couple

of veterans content. Meet him when he

comes to the airport, stand back and

let the family of time but be there. There'll be a much

quicker integration into whatever community. So I think that's

part of it, but the unseen

moon is the, I think that will be the challenge for

the long-term. And the reason

I say that is having to ride

a motorcycle. And every year we

have this thing in Washington and cold

rolling thunder and the people from

the soldiers from Vietnam come back. And much of the wounds, they're not

physical there, there between their ears, their in their

ability to process. And it's a, it's a very, that generation was

impacted greatly and I think it was in the unseen world

more than any. Mm-hm, Mm-hm. If there is any silver lining in some of this or there's a much

better appreciation of post-traumatic

stress disorder, combat trauma, and

how to deal with it. We're seeing

80-year-old veterans from World War

two that have wrestled for decades

with these challenges. That finally,

through some of the new procedures,

new awareness, faith, and otherwise are really

being able to hand that baggage off

to somebody else if they've cared

for so many years. So there are some

good things it seems coming out

of it as well. Now, I mentioned the

ectoderm of our country, our troops or

cut or bruise, bleed and yes, a even

die on our behalf. Perhaps some of the most challenging

instances are when they see their

buddy killed, the one that they've

trained with, can you address

the reality of death and the impact

on the service member? I think for a lot of

these young people, first of all, they think

they're invincible. No, we were probably

there once. And when that when that is shaken by the

death of a buddy. And a lot of times it's in a situation

where that buddy may be trying to recover, help, support this

other person. So there's that

additional element that He died for me, specifically, not just for the country or the cause. That is a very

challenging thing. A lot of those

soldiers you see, and our son in

particular did this, had a gotta had

a tattoo put on with the names of the soldiers that

died with him. Why is that? To

keep that with them forever to keep

that memory alive. But that creates an

additional burden that you go back in, kind of in

retrospect saying, why did this

have to happen? Why did they do

it? I think, I think a great part

of the solution is defined purpose

that only God can help you define. And we know there's, as the purpose-driven

life says, Life's a test, a trust, and a temporary

assignment. Those are hard

concepts to grasp, but to have a purpose. And so I think the

other part, the, the part out

through the end of the tunnel where

the light is, is a part where you now

regained new purpose. So who's best able to help define that purpose and find that purpose? To me. A

lot of it is to get back

with your unit. If you're active

guard reserve as quickly as you can to begin to get back into that purpose for

which you were. It's kinda the old saying if you fall off

your horse, get back on that horse, or there'll be a time

you can't get back on. I think that's the

unseen hidden thing. So we want them

to get back on as quickly as they can and begin to find and

define that purpose. So I know there's a

lot of states that are working on programs

to reintegrate, to get these

young veterans, wounded veterans back

in a business setting, something where they

can contribute and have a think it's

really important. And I think

that's happening now at the highest

levels of government, just this last week, I was privileged

to have to go to the White House for

faith-based initiatives, meeting about carrying

for veterans, active duty and

their families, those that have served us, and those that have sacrificed in

that service. And there's a

tremendous outreach across our country of faith-based and

community organizations and many great patriots that are reaching out. So all of that. Counts for

something in the lives of our

troops and families. While we are doing this video on behalf of many counselors

across our country, tens of thousands

of counselors that to touch-based, perhaps first with

the soldiers, sailors, and Marines. Do you have any guidance counselors or additional guidance to

counselors

within churches, say Stevens ministers, in how they ought

to deal with the combat trauma they see returning or post-traumatic

stress disorder, any of these issues? I think, yeah, I

wouldn't begin to tell a counselor

how to do it because they're much

more trained than I am. But I would say that as they go to counsel

these young people, the more they know about what we're

talking about here. I think that's why I'm doing this

video with you. I think it's

crucial that they understand from

once they come. What makes up

this soldier. I'll tell you there's

a couple of things. And this is ingrained in soldiers from the day

they come in the army. The first one is to

place the mission first. It's to never

accept defeat, to never quit and never leave a

fallen comrade. Those are the

four pillars of these soldiers that

have come in today. And I believe they really take that

into their heart. So now they've

in some cases, not completed the

mission as they want. They feel like

they're quitters because they're not

with their unit anymore because their injuries took

them out of it. They they don't accept defeat and they don't

want in their mind. But there's a lot of

voices in their head, especially for the unseen. That is, that it's telling them you're a quitter and you

accepted defeat. And they're being

defeated in their mind. And then the other part never leaving a

fallen comrade. That part, especially if they're comrade has died, they're going to search

their soul to say, What could I have

done different? So I think if our

counselors understand that basic framework

they came from, so it's going to take a

lot of understanding. I think the other

thing a soldier knows, a soldier knows how

to take orders. Soldier knows how to

be under authority. I think for me that's

always been, I think, for a soldier to have a faith basis because they understand authority,

you have a leg up. So I think with

in some cases, you have to say,

okay soldier, come on, Come up with

me, let's go do this. I mean, so it may be a little different

approach than saying, What would you like to do. I think they're

used to being said, Follow me, sir. Great symbol of

the infantry. So I think that some of the things

that I've heard that really help people

recover and talk with Scotty and some

others that we know. There are opportunities

to go out and physically be engaged, climb a mountain,

water ski, do things. So I think there's

some approaches there. If you're in a church and you're going on a mission, take this soldier

on that mission, have them be part of it. Having to be part

of something that is making a difference

for others. I think all kinds of recreational

aspects I think are very healthy and good because they

get the soldier out of their room. And that room could

be in their home or it could be in

their hospital room. But get them out and get them out where they are. Single talk feel like

a normal person. A lot of them don't

feel like normal and they don't know

if they ever can feel normal again, but we know they can

feel wise words. I appreciate that and

I know the counselors across our country

will appreciate that. I would offer

we're coming to the cause of our time. Is there any

final comments about honoring soldiers or the importance of faith or other wisdom

that you would pass along as a

experienced army leader? Well, I guess having

been in 36 years, i've and taking over

platoon at the end of the Vietnam War and seeing the way our country

accepted those soldiers, vice how they do now, I want to thank

American everybody watching this

that tell you, I've been in

many an airport in uniform or seen other soldiers in uniform

and seeing people. Honestly grateful

whether you believe in the war or not, this soldier of today has felt the warmth of

America in that. Now, the next

part is really this long haul after

you've been injured. How can they continue

to feel that support? Because I think the

tendency sometimes is really respond well right after the injury. But the long haul

to get this done, It means a huge commitment over a long

period of time. So I guess we'd ask for that from all the

counselors there, be persistent

hang in there, be there for the long

haul that that soldier know that you'll never leave them nor

forsake them. That's a wonderful thing. And they will, they will

eventually know that their God will never leave them or

forsake them. Well said. Good, sir. Thank you, Bob. Lieutenant General

Robert Elvin, Antwerp, US Army. Hi.

Of the realities of military life

for families. A signifigant course

as we continue our journey and

understanding the life of those who

serve our country, we have a very

special guest for you in Dr. Rosemary Hughes. Rosie is actually the

dean and professor of the School

of counseling and psychology at

Regent University. She's a professional

counselor, earned her PhD at Old

Dominion University. A dear friend and a very knowledgeable

person in this area because she comes from this

background. And we also have

Lieutenant General and Mrs. Robert Van

Antwerp, US Army. Robert will be speaking in his private capacity, but it'll be a

wonderful dialogue to understand them as

a military couple, them as military parents of three boys that were deployed in harm's way in Iraq at the

same time. And then 1 who

have many years, many decades of wisdom. So in this section

there's a TAM, there's an expression that says there's nothing harder than loving a

soldier or sailor, airman, Marine,

Coast Guard MAN, nothing harder than that. So you think about the family on

the homefront, those great

stroller brigades. It was bakers of cookies and senders of letters. Those ones that put steel

and the backbone of our fighting men and women there on

the home front. And they don't

get the same rush of adrenaline or, or adulation that

the troupe does. And so we gotta

love them the same. We've got to

care for them. There's this thing

called secondary trauma. We're going to talk

about secondary trauma. We're going to talk about the challenges

of separation. We're going to talk about just the overall lifestyle of the military and

the difficulty that, that poses for families. So how do we keep

families together? How do we even thrive? And how do we rest on a biblical foundation

as we work? The realities of

military life for families of

service members. Now we turn to our panel. Several years ago, a

young woman was pushing a stroller and

a shopping area and San Diego, California. In the stroller

were her two sons. One who was not quite 11, who would just turn

to a man passed by wearing khaki navy

officers uniform. And the two-year-old

pointed and said Daddy. The woman

explained that no, that was not daddy. Daddy was a way and

we'll be back one day. That young woman had no idea at the

time that she and her family were at risk marital and

family problems. At that time. She was

in her early 20s, married only a few years. They were 2500 miles

away from any family. And recently moved

duty stations from East Coast

to West Coast. Money was tight for them. The father was

deployed and flying in combat on

a regular basis. In addition, the

younger child later received

a diagnosis, is having an

intellectual disability. Any of these factors, and certainly all

of them together. Mark, this is a

high-risk family for potential problems. Well, by now you

may have guessed that young woman was me. The children

were the first two of my four sons. We were an active

duty military family for 25 years with deployments

that lasted anywhere from a few

days to ten months. In the first ten

years of marriage, I lived in ten

different places, in seven different cities, east coast, west

coast, south. Two of my sons

were born with dad present in to when

he was deployed. As Paul said, I have

learned to give thanks in all

circumstances. And some of the

circumstances are a little difficult to

give thanks for. I will be honest

with you though, to tell you that once my military

spouse retired, our marriage did

not survive. So that even though we had over 25 years together, the last at risk

period retirement proved to be the end

of the family unit. As a country we

are now 40 years past my Vietnam

experience. Some things have changed

and some have not. We have 700

thousand children living in military

families. We have an all volunteer military National Guard and reserves are being sent to war and

increasing numbers. We have seen many

years of fighting in Afghanistan and Iraq. While there is

much to talk about regarding

military life, I'm going to focus on

the military child in this segment and what a counselor should know

to assist that child. In this brief time. I can only give you bare bones if you will, of

information. And then I hope to

encourage you to continue to consult additional

resources. Because a counselor should only

ethically practice within the bounds

of their knowledge. A common error

would be to take information and then to apply it to all Miller

cherry children into stereotype them. While all groups

have some things in common or they would

not be groups, it is necessary to know

the commonalities. But you have to keep in

mind that each child and family will

be idiosyncratic. Counselor skills come into play to fit the

two together. I have organized

this segment into four main areas of general knowledge

needed when working with the

military child, the military

culture and system, the realities

of deployment, homecoming, and the

wounded warrior. If you have never been

apart of the military, you may not have

an understanding of its unique culture. Unlike working for

civilian organization, the military owns the

service member 24, 7. There's no 40

hour work week. There are no holidays that you are entitled to. There are often no choices of where

your next

duty station will be. There are behavioral

expectations of military children, especially when they're

on a military base. Children may have

higher standards than their peers

to adhere to. On a positive note, this may teach the children respect and good

manners which will serve them

well in life. But on a negative note, some insights into

the adverse side of running a home

as though it were a military station are depicted in the film, The Great Santana, which shows the effects

on the family. The military culture

runs the family's life. Medical and

dental care for active duty spouses and children are

considered benefits. And this is often

provided by the military

or pay in for, in part by the

Tricare system. In fact, spouses and children are

called dependence. They each have military

dependent ID cards that have to be renewed regularly for access to services or to even

get on the base. Frequency. Chains

of residents can be a part of a military

child's life. The military does not take into

consideration that your child is shy or introverted when you

have orders to move. A child may be

in a new school every year or two, have to make new

friends quickly. This can be positive

or negative. On the positive side, the child may learn

the skills to be sociable and develop

friendships. They may find their

special talents and carry those from

school to school, such as being on

the track team or playing an

instrument in the band. Or the downside,

children may feel as though they have never

belonged anywhere. It may mal adapt. The literature shows that the mother and I

use mother here because that is the usual non-military spouse. The mother is the key to the children

adapting

to new circumstances. It may put an undue burden on the mother to

take the lead. But if she can be

positive about the move and the

new circumstances, the children

usually are also another situation

is moving from a foreign duty station

back to the USA, which can also present

challenges for the children to readapt to a change in lifestyle. Depending upon where the military

families

stationed. Others may or may

not understand the military

culture and how it affects the

family's life. There is a large

concentration of military in an area. Then teachers

and pastors and neighbors and

others are usually aware of the

circumstances in a remote station or in the case of National

Guard or Reserves. The fact that the

family as military may not be well known

nor understood. Deployments. Or

the next factor that is huge for

the military child. A child has to adapt

to a parent going away for a long time

on a regular basis. As we are to j in

a time of war, anxiety levels

may increase with the first concern that the service member

return safely. It is hard to escape the current war situation because of the media. Children may have to

limited and watching the news so as not to raise their

anxiety levels. Also today, we did not talk about the cycle

of deployment, but the spiral

of deployment. In that spiral

deployments have been longer and the

turnaround time shorter. We are seeing

people return to combat areas 23 times. Families are experiencing

deployment fatigue. Again, research shows that the way the parent

remaining at home handles

the deployment is the key to the

child's well-being. A positive factor is

that technology is such that today

families can use email, video, cell phones

to stay in touch. That's much better than the past reliance

on the US mail. The challenge

for the family is to keep the father psychologically

present in the home while he is

physically absent. There are many ways to do this, including photos, presence, letters, and pictures that

children make. Maps showing where the

service person is. A prominent calendar to

mark off the time to homecoming and making

plans for homecoming. However, there are

many ways that a deployment can

become problematic. And so I'll discuss these, but in no particular

order of importance. The father may

over time and deployments become

more and more remote. Child or the children, he may not want to

invest time with them because he knows

he has to leave again. Or you may have been so used to being

without children in his daily life

that he does not know how to

reintegrate with them. If there is an R&R

rest and recreation break and the deployment when that R&R is over, facing more time

away can be more difficult for

our I'm sorry, more difficult for all in starting a pattern

of being together. Again, child

physical abuse, usually neglect

by the mother rises when the

father is away. Conversely, physical

abuse, again, using neglect

by the father rises when the

father is at home. The longer the deployment, the higher the

risk of emotional difficulties

for the child. However, when the

deployment is six months or less, the behavioral

problems usually resolve after

deployment ends. Boys are more affected than are girls

by difficulties. For families, the

pre-deployment phase can be the most stressful

military person is preoccupied with

preparing to deploy. And the military unit has a lot of demands for time. The families and

no man's land. For Native families,

for example, there are usually

workups when ships and planes go in and out for a period of weeks of

pre-deployment. All of this before

the actual deployment begins to many children are parental five

during deployments, it is huge mistake to

tell the oldest that they are in

charge of being mommy's helper until

daddy returns. Boys especially are told they are now the

man of the house. Not so the parents

are always the parents and

the children are always the children. Putting burdens on

children that are not age appropriate nor

boundary appropriate can have repercussions

later on. In a deployment situation, one parent is

now responsible. All of the PTA meetings, sports, the lessons,

chauffeuring, getting to church,

discipline, homework, chores apparent, can

get easily overwhelmed. In addition, today at parent is also more likely to be working and

must manage the job, childcare and all

the other facets of the children's needs. Finances maybe tighter

in the case of National Guard or

Reserves recalled up, some families

take a drop in pay if the service

member has not taken out an allotment to be deposited for

the family monthly. They can find

themselves in difficult circumstances. An unplanned

emergency can throw the family's finances

into turmoil. I worked as a volunteer at Navy relief for awhile. And I saw how easily a few financial

mistakes can throw a family

into chaos. The return from deployment

that seemed to be a happy occasion,

and it usually is. However, this can

be a time when the child is

negatively affected. Let me first give you the idealized version

of homecoming. Dad returns to a

perfectly clean house, laundry folded

and put away, refrigerator stocked, spouse and children

beautifully dressed, and a special meal

plan for tonight. The bills are all paid to prepares on the

house are done. And once the

children are in bed, parents bedroom

will become a magical place

of intimacy. Now here's the

reality version and has many variations. Being back with the family means that there

are spouse. So when family man's that did not

have to be dealt with when deployed

while dad was gone. Things may have

seem to run well without him and that

may surprise him. The spouse has

been handling Bill's house repairs, car repairs, kids,

illnesses, all on her own. She's not ready

to turn it all over because she

has done well. Now the converse

could be that she has not done well. And he comes home to deficits and

credit card bills. The shipper playing

could have been late and there's no time for that special dinner. One of the kids has

an ear infection and the bedroom

tonight will not be a place of magic. Anything. What is

important is not to put large unrealistic

expectations on that first day

or week back, but to allow the process

of reacquainted and reorientation to take

place naturally. The couple has to

communicate before the day of return as to

their expectations. Being flexible

and adaptable to form new patterns

of interaction brings the resilience

military families need and one in which the children

can thrive. Certainly discussing

homecoming with the children and how Daddy is now

going to fit back into their lives is

an important step. Children may also have unrealistic expectations and may not be happy when dad has

to go back to work the next day

because he's on duty or that the family doesn't have enough money to go to Disney World. They also

have to

relinquish having mom so attention for all the

time dad was away. They may not respond

to dad stepping into discipline or doing things for them that are not

the way mom does. A study has shown

that there are higher rates of new

onset heavy drinking among national guard and reserve troops returning from Iraq

and Afghanistan. Heavy weekly drinking,

binge drinking, and alcohol related

problems were reported. Also, Marines and

younger soldiers were identified as

high risk persons. Children in these

families would be suffering the

same effects of children of alcoholics or alcohol abusers who

were civilians. There are a few

more aspects that I have not yet discussed. When mom is in

the military, when mom is military

and a single parent, and when both parents

are military. These are

situations that are relatively no one numbers and yet deserve

consideration. In the case

where mom is in the military and

dad stays behind. All that I have

said can apply when both are

military parents. Both have to deploy

at the same time or when mom is a single

parent and deploys, the children may

find that they are staying

with relatives. They may or may

not know well. They may have had to move to be with those

relatives. They may have had

to move in the middle of the school term. They are military children with additional

situational circumstances. Now to recap,

we've talked about the culture and system

of military life, the deployments,

the homecomings. And the fourth area is the wounded warrior

returning home. Another aspect

to families are dealing with and

we are seeing more about on the

media is when the service member returns

seriously injured. We know that there are many more missing limbs in this war than

in any other, except perhaps

the Civil War. We also know that there are more head injuries. Each of these

circumstances has different

implications. Each of these requires an adaptation

of spouse and children that

could not have been anticipated

or prepared for. The long-range concerns

are of the family being able to return

to a sense of normal. The injured spouse being kept in the

service or not. The availability

of the military to care for these needs. The possibility of loss of income for the family, and the spouse no

longer able to do all she did previously because of new caregiving needs. And finally,

the realization that things will

never be the same. The deployment as

they were before, the deployment can

all affect children. If the service

member returns with her develops PTSD, there was a strong chance of secondary

traumatization of the spouse and children because this is discussed

in another segment, I will not duplicate

this information, but just ask you to

be aware of that. And another issue I do not have time to discuss here, but I think it's on

another segment is when the military person

dies in service. The longstanding

implications of such a death are enormous. There are no magic

answers your formulas. I can tell you I could

not have made it through having a son

with a disability, raising four sons, the deployments and

even the divorce without faith and prayer. Supportive other

military wives. However, I did not. All we see faith and

prayer is resources. It took my getting

to the bottom of my own resources to allow God to

work in my life. And as we all are, to allow God's grace to continue to be

present in our lives. I want to emphasize

that there are many healthy and resilient

military families, justice, there are healthy

families in all sectors. We counselors do

not usually see those folks in

our offices. And on the other

hand, you'll see families who were

able to do well in the past that have hit

what I call a speed bump in need

your assistance to return to wellness. One last thing

to be aware of is the child's position

in the family. Timelines of service

and deployment is I talked with my

own sons about their experience

with the military. It was clear that the experiences

were totally different depending

upon the age of the child at the time. The youngest, for example, has little memory of

active duty time. While it is very

clear to the oldest, I mentioned the

at-risk time of retirement from

the military. Not many people realize that for some families, these are

treacherous waters. Family income may be reduced. They may

have to move. Children are older and leaving the military

life to become civilian may not be

a smooth transition. The family is no

longer looking toward the dates for

the next deployment. Data will be home

all the time. Couples in marriages

that were saved only because of periodic

breaks may not realize they have

nothing to keep them together for the next

20 or 30 years or so. In closing, I

want to encourage you to stay current if you are dealing with children in a military family, to avail

yourself of resources that I have

put on the PowerPoint. Web resources are probably the best way to

keep current. And at the time of taping all of these worker ant. But I can't guarantee that in subsequent

years. I thank you very much

for allowing me to talk with you about this

very special area of children's needs. Thank you. And may God

bless you abundantly. We welcome today,

Lieutenant General, Mrs. above in Antwerp, or as I've known him

for 30 plus years. Bob and Paula.

Welcome today, a great army family. It's good to have

great being with you. I think a great place to start would be Tell us about your family,

your army family. It's just incredible.

Your service. But your service

through your children. Okay. They want to start. Yeah. Okay. Well, we we go way back

as Bob knows, the four years

at West Point we dated and then we'd been married 35 years

now, So 39 years. You can pretty much affiliated with

the military. They have five

wonderful children. Sons and our two oldest, our class of 98

in class of 99, West Point graduates, now a major and a captain. And our youngest son, or adopted son

enlisted

in the army a few years back and was wounded in Iraq and now

medically discharged. But we also have

a nephew and a nephew in law

in the Army. And so at 1 or another, someone in our

family husband deployed the last

several years. And not to forget your

two wonderful girls. Yes, we have two

wonderful daughters who, who, who probably

have green blood because they are

so patriotic, they are already was

the army as well. They are important. Well, tell us a bit about the culture as

an Army family. There's a real

service ethic here. Tell me about this. Why do you know

what you do? Maybe I'll take that on a little bit and

then ******* and fill in the details. But I think the first, at this stage in our life, we do what we do

because we're passionate

about soldiering. We're passionate about what the contribution

that troops make. This is Army, Air Force, Marine, Navy, Coast Guard. There's a very unique bond that all

of us in

the service have. I think there's a

reason they say you're in the service. And so we feel very fulfilled by being

in that service. So it is a blessing

that's come back to us. I think the

other part that we're very proud

of is that are really our

whole family as service oriented. Even our daughter is going to go on a

mission trip to Africa for nine months and teach school

to orphans. Does your heart good?

I think some of that's on how an

Army family has brought up all

and I've moved 22 times dependent on where

the kids came along. They move 16, 15, 14, 13 times their

expeditionary in what they do there. Have a missionary focus because every

new place you move in a way you're a,

you're a missionary. And so I think

that kind of characterizes at

least our family. I agree. I don't

know that we can picture life outside

the military right now. We we have chosen to stay in putting

retirement papers twice in the army, said Not yet,

and we're good. We enjoy our time with Army families

and just feel a real commitment to

do whatever we can. And in part of the

joy at this stage for van I know for me is because of his rank and the knowledge

that he has of how the army works were able to turn

around and help some of these

younger soldiers and families in, in ways that would have been difficult

for them. So we feel like

we can give back and really

encourage them. And that's been a joy for us at this

stage actually. And I appreciate you mentioning the

younger soldiers and families because Some might look

at you and say, well, they've got it

May they've they've done it all and they know how to deal

with things. But I think the same

mote nobility and the same service ethic we find in a

staff sergeants. Why for young PFC wife, it's just a very

inspiring to me to see. Do you have any

thoughts about the young military family

and what they are, what their challenges are, but also there are

opportunities to serve. I guess first, my

impression is a lot of these young

married are taking this on with a with a joint NAS

that I haven't seen. A particular couple

that we met recently. A young engineer, one the best Safra

of the year, had just gotten married.

A young lieutenant. I was amazed in

talking with his new wife of she didn't understand everything about the army, but she was so willing to

go and to do and be

in part of this, a real adventurous spirit. So I think that for a young wife

can enter or a, or a young husband

of a soldier. Because I think

we're talking, or sailor airman Marine, we're talking both

sides of this because we have we have a lot of female troops and

male troops and all. But I think that part of that is that you take on the adventure of

that other person if they love what

they're doing. I think in our family, I think the reason our

three boys join is because we have loved

what we've done. We feel there's

purpose in it and some of that

hopefully was caught. I know it was

in your family to bomb for sure. Well, it is we tend to focus perhaps on the

divorce statistics or even suicide

statistics or things that are on

the negative side. But the first

perhaps to be made about the

Army Family, navies, airmen, marines, is that it's a noble task. And to see these

young wives and young husband still stand by their

soldier Sarah and memory is inspiring

and it's incredible. And we often talk about the departure

ceremonies in the welcome home and

those young bakers of cookies and

centers of letters. It put steel in

the backbone of the fighting

men and women. So it really is inspiring. That said, there's

an expression that says there's

nothing harder than loving a soldier. It is tough when you face the threat of death, when you face

separations. In your own case, you had three boys, I believe in harm's

way at one time. What was that like, Paul, a particular I'd say Man, what was then like

very, very difficult. They were only

overlapped a very short period of time, but it was during

that period of time. In fact, our oldest

son had just returned from

Iraq and I had flown out at Thanksgiving

couple of years ago to visit him. Bam

is going to follow. And I had just gotten in that night and early

that morning because the time change I've

gotten up to do require time and I was

sitting there and about 05:00 AM, the phone rang and

it was our son, Luke in Iraq, who called it

with his voice trembling to say Mom,

have you talk to Dad? I said no. Why? And

he told us that our youngest son had been severely injured

at that point, we didn't think he

was going to live. So that was probably the darkest period for me of the reality

come true. What if one of your

son's gets wounded? But we you move forward, you do the next right thing, whatever that is. And for

van, it

was to go over to launch tool and for

me it was to fly back and meet him at Walter Reed when

Robbie came home and continue

to move through. And I think

sometimes when you face your fears

head on like that, What's the worst

that can happen? Obviously worse

would be death. But then God comes along and people come along and the army

and the support. And you begin to feel that that surge of

inner strength that comes when

you need it. Then the subsequent

deployments, which we've had

some with our sons, had been a little easier because you've kinda face down that I'm very,

very difficult time. Thank for me above it's to have knowledge that there

is a sovereign God. And in one of the scriptures that

was shared to me when Robbie was hurt and others were

comforting me. And Ben a matter of

faith for a long time. And you were instrumental

in that, my friend. But it was shared

Psalm 139 that says all your days

were numbered before the first day. It just reminded me that they're in the

palm of God's hand. He has these

days numbered. We don't, we don't see it and it could happen

on the streets of Washington DC or anywhere else that this

could be your last. But it gave a

comfort that they were in the hands

of a sovereign God. I think to just I think it was

probably easier when I was deployed

than it is when our boys

are deployed. You still think I'm

a measure boys, although they're

men and they can, they're perfectly

capable of making great decisions and

handling themselves. But you still think

them as your boys that you taught to

drive or ride a bike. So I think it will there will always

be that dynamic. We have an

additional dynamic and you shared this when you are an active duty is that we're in a

family business. To me that that is a kind of a

priceless thing. It's a business where

you're able to talk to your sons in this case about their profession, but also to be involved

with their friends. And to as Paula said, I'm in a position that sometimes I can do

some things to help. Where new programs

like when the wounded warrior

program was real, knew I was in a protective mode

of those that we knew had been hurt until the system could

catch up and say, we do want you to stay in. We do want you to be continued to be party

if you're able, because at first

that wasn't the orientation of it. So very, uh, we feel

very privileged, I guess, to do this for

the younger families. Many, many dynamics. But I think even

for those of us, they've been married

a long time. When you reenter, There is a new

dynamic because we've asked our

spouses to do everything to get the

oil changed in the car, to fixin whatever is wrong and colon of the people and

they become, we find they're perfectly capable of doing that. But now re-enters

the service person. And now that

dynamic has to find its right balance and

equilibrium again, can be a very stressful

time and take months. Especially if there's that inner wound in

that soldier. Whether or not

communicating, they don't want to talk

about what happened or they've got some

trauma in their life. They're waking

up every night in a cold sweat. Many, many

stories of that. So a lot of burden

and especially, I guess over time you're able to

handle that more. But as you're a young

married would be very, very

challenging time. For sure. Recently to our Rapid Response Center at military ministry, we had a call

from a

army wife and she said, it was very honest

open question, why do I need a

husband as an I've learned as

a military wife to be somewhat

independent. And now as I share with

one of my other wise, we say, well, why do we really need

our husbands? And it was a line of thinking that she

wanted to clarify. She was a woman of faith

is so she called in, needed to be reminded of God's plan for marriage and just the very basics. But that's,

that's

the challenges you face. When you have. They're here, they're

not here, they're here. Let's discuss that

for a minute. The whole subject

of separation that's on one end

of the spectrum. It's not wounded or

not this or that, but separation in

itself is difficult. What are some of the

dynamics of family faces with these frequent

deployments of today? I hate them. They were separated

during Desert Storm as some in our generation. And that was a

difficult deployment, not a difficult war. But when he left, we didn't know when he

would come back. And and he did not because there had not been

worn quite some time. There was no

familiarity with What might happen,

what could happen, weapons of mass

destruction, whatever. So that dealt with that. But what happened for us, and I've encouraged our

daughter-in-law and

others, many others, is to communicate because though they're separated

from you physically, they are not

unapproachable or it's not like

you can't talk with them, you

can't communicate. Van wrote over

400 letters, snail mail back then, which I still have

and I treasure them. But there are

young families now have email which is available in

nearly every day for many of the

soldiers and families, as well as phone calls, many more than we had. So there's every

reason to be encouraged that that communication

can remain open. And why do you

need your husband? Because he could

still help you with some major decisions

in your family with some discipline

problems with your children when

bandwidth, right. And I'm sure this could

happen by e-mail. From that distance,

our kids listened. They actually took

counsel from him an ocean away because they were concerned with their dad would think when

he came home. And so I really think that though the

separations difficult, it doesn't need to be

a total separation. In fact, good can

come out of it. You can maybe

communicate more intimately in on some ways than you can when they're

when they're home. I found anything to add to separations and

maybe characterize the frequency of

deployments and services thinking about making them shorter, perhaps

you're right. I guess first of all,

my personal experience in seeing a lot

of soldiers, if you go into

their tents where we hang out when you're going to just

go sit with them, you know, whose

pictures on their, their spouse, the

majority of soldiers. And so I think that picture is

worth fighting for. And I always talk

to them about what a beautiful

family are. Beautiful wife you

have can you wait? And he said, Yeah, that keeps me going everyday. So that is there there's a very

important

aspect to that. Now I think Paula touched on how do you

stay engaged, although your 7

thousand miles apart, you can I would recommend espouses if you could do a joint decision

on something, if the time a lots

and with email, it can be a day or less. Why don't you make

those decisions jointly to

continue some of those things

that make you a family and to as much

as possible do that. The other part, I

think as you know, for those that are on these multiple

deployments, like is a first

of all, 15 months is a long time. And we really want

to get back to a 12 month in the army. The other services generally have

shorter deployments. But I think the

the goal would be no longer than a

one year tour. And then of course you

have this other part, which is the dwell time in between deployments. Very, very important

to realizing that the first

month or two of that it is a re-entry. It you don't get to the point that you really, I think a normal family,

again with parentheses are no quotation marks until you've been through that period and let

that settle. And also we in the services have to

be careful what we do with that soldier immediately upon

his return. We're trying to give

them time to do that re-entry with them. These multiple

deployments. I do think that it's important after

each deployment, if you think of it on

a scale of one to 10, to try and get back

down to a one. But there is a

cumulative effect, I think for many that you never get

back down to one. So to go, you're just

it's creeping up. So all of a sudden, the next notification that you're going to deploy, you're at a 10

because you don't know how you can

handle this anymore? Maybe the first time.

Okay. The second time I'm at a two or three, but I can handle this. But at some point you

may get to attend. So how do we get

them back down? That every

deployment is taken as a brand new adventure, a new thing because I

think unfortunately we're at the period

of time when we're going to do multiple

deployments. Now from a soldier's standpoint

is very interesting. The reinvestment rate is higher than it's been. I mean, it's an

amazing thing. I saw a picture of General Petraeus

and one of the big palaces with 1200 people

realising in Iraq, It's an amazing thing. Part of that is

for a soldier, you are doing what you

were trained to do, and it gives you purpose. And when urine not been to Afghanistan and Iraq,

there is real purpose. There is a sense that we are making

a difference. And I've talked to some Marines

last week too, when I was in Afghanistan. They felt were really

making a difference. So that gives

them purpose. But what's the purpose

for the spouse? What's the purpose on yet, where did they

get the purpose? Is it just a

waiting purpose? So to me, one of

the healthy things that has to happen

in the rear, so to speak, is that they need

to stay engaged. They need to be involved in things worthwhile. Maybe part of the

support group or maybe even something

totally different, something that

you've wanted to do. This young married girl I talked to said I'm

going back to school. I said, You go for it. That is great. Get

that education. Then when your

husband comes back, you won't be going

to night school. Yeah, that was so but

to have that purpose. So again, I think everyone has to

have purpose. And if they can find those things

that's helpful. Nothing like hope on the home front

in these things. Now, I want to ask

another question because you have the difficulty of separation and

deployment redeployment. But you also

along the way, as you said about Robbie, you have wounds of war

in some heal rapidly, some heal for a lifetime, some take away that

soldier altogether. Do you have comments about the wounds of war seen and unseen and particularly

the impact on families. In this case, what do

we see among families? I would say we we kind of have seen somewhat of

the spectrum of it. We our son Jeff had

a platoon leader, Captain Scott Smiley

who was quaint O3. He's a classmate

of our nephews, and he was blinded. No other wounds

except the portion of his left frontal lobe

and both of his eyes. And devastating loss when they told him

he was going to lose his second eye. But he and his wife

and his strong, supportive family

very quickly settled their family faith

that this was God's sovereign permission that

this happened. He saved Scott his life, and he was going

to make it count. He moved forward with such rapid such a rapid

pace did not seem to go through

any anger and all those stages of grief and loss that you

would expect. And within a very

short time was out of Walter Reed to

the blind center, gaining skills and

how to operate. Now that he's blind, came and worked for van at the assertions

Command and S Now in school at

Duke University. And just last week

got an SP award for most outstanding

mountain climber of the year or

something. I mean. And then route

to West Point to teach and request

wanted to teach. So and he has had numerous opportunities because of his attitude, because of his

acceptance of this and an

almost seeing it as a platform of some sort make a difference and

a unique platform. There's not a lot

of blind soldiers in the army,

maybe one other. And so he's move

forward quickly. And then there are sudden Rob has gone

the other way. He did not accept what

happened with him, has been angry and bitter and has suffered

the consequences of his attitude

and his choices no matter how much support

was given to him. And so it puts families we've seen our

family has has its had a difficult time

trying to support Rob to know when we back off and let him face the consequences of poor choices in

poor attitudes. And when you kind of

stay there and to Ketchum to make sure

that he doesn't fall. And I've seen that with numerous

other families of not knowing what does enabling

what is the necessary, stepping back and

letting them take those steps by themselves. And recently you were with some wounded warriors at

Walter Reed and some of their family

members, I believe. What, what do you tell these family members

as they are starting this journey of having a wounded warrior

in their midst. I talk with one

of the moms who, one of the

moms who said, Tell the soldier

to be nice to me because the mom

is the safe one. And generally

the soldier will Event somewhat

his anger and frustration at

being bed bed written and not with his

buddies on somebody. And it's probably

going to be a family member

rather than a doctor. But what we've told what we told

most of them as we had a chance to talk with the parents

individually, is is stay close,

stay supportive, but don't hover and try

to do everything for them and get in the way and when they Event don't

take it personally. It's just part of that that recovery that it let them kind

of go through. There will come a time, I think when it's appropriate to

begin to help them be more sociable and the way to bay

a product's life, but not those first few weeks and every campaign first few months

on and make a couple observations to, I think one thing, just like in the old days, if you've got

knee surgery, you'd be laid up

for six months and in a cast. The new medicine

is to get up on that leg and the exercise that and get bled into it. I think it is the same for both the

hidden

and the unhidden, the seen and the unseen. Now a soldier, I've heard a lot of talking

to parents. I mean, you hear

this, you can feel the dynamics

sometimes when you go into the room

and the soldiers say, just leave me

alone or you don't understand why

I hear that. You don't understand it. It kinda now I crossover what do soldiers that had

been injured? And as we were

talking earlier about an amputee,

for instance, a lot of those

amputee soldiers now work back in MPT units. They are now rehired. That's what they

want to do. I think it's the, it's the scripture that says, Only you can

comfort others in the manner in which

you've been comforted. There is a unique

they do understand if I'm an amputee and I'm talking to

another amputee. I understand. Whereas apparent. You don't understand what I'm going through here.

You don't know how I feel, but that other

present. So I think. Part of the healing

is where can you join in with people

that have had similar injuries to

you, for instance? And so we're

doing a lot of that in our medical

facilities, but I think it's crucial. And then part of it is. And I'll go back

to Scotty again. One of the early

questions was, what am I going to do now? That was a big fear. A big challenge in my

life is so different. I can't see, I maybe I can't do

anything, I think. And then then over

a very short time, Scotty was able to

say, I can do a lot. Some of the other

soldiers are still at that place

a year later. I don't know

what I can do. I don't know if I

can make a living, I don't know if

I can can go. That's a very So

I think get up. It's fat, just

like we do now with other

visible medicine, that mental medicine

is get up and let's, let's go try something

and see what you can do with

the bonsai. I applaud. I applaud

employers that will take on a soldier and give them,

You can do this. And I think that in

many cases that's, that's a healing element. And so those two things, I guess if they can link with people

that

have similar injuries, it's very helpful because they won't tell one of them you don't understand because

that personal

se right back, You better believe I do. And then the other part is to get them involved as

someone with purpose, something that

gives them purpose. I think there's

a lot of jobs that and then what you can do as

you're in that job, you can come alongside. I think another

excellent thing is to get them involved in a Bible study

where they can start to hear

from God about, what do you think about these injuries

and what do you think about

myself worth it? My fearfully

and wonderfully made her. Is that Ally? And, you know, did you permit this

to happen or not? Well, maybe you have

a purpose in it. Now, how can I

fulfill that? And in those realities, in the wounded

warriors life, or sometimes

amplified in the life of the espouse in, and the children who

understand even less. But the principles apply across the whole

family fabric. I wanted to, many of

the things that you've said are really relevant to counselors who

deal with families, military families

around our country. Is there anything

else that you might offer of in terms of advice to counselors

across our country. Were you thinking

about I think is that specifically

related to family? Yeah. One thing

that comes to mind and it's

along these lines. If if you love

what you do. Like, for

instance, with us, I think part of the reason are whole family is green, that they wanted to come into the

army are boys. And that is because

of the way we've gone about our Army time,

that we've loved it. We've been

passionate about it. We've, when the

army says move, we taken it as a, as a mission

that, you know, is not just from the army but from God and said, That's what we're be

incent, let's go do it. And let's, let's go

for this adventure. I think the same

thing happens sometimes for a soldier

that's wounded, the family begins to take on and it isn't in

a positive sense, if they're really

struggling and dealing, the rest of the

family begins to struggle with that person. Especially, I believe that the husband should be the head of

the household. Is that partnership

with the spouse. But if that head of

the household is in, mired down in

a, in a trench, I think it will drag the rest of that

household down. So I believe what you

said is true that that trauma can be almost transferred to

another member. So I guess it says, don't just deal with that service

person and leave that spouse and

those children off to the side while this

one's recovering, he may have transferred

or she may have transferred some of that to the rest of the family. So it's a package deal

To a great extent. Well said a

package deal flow. Anything else you and I think what we've

said before about bringing others

alongside that have experienced the same kind of

thing because a counselor definitely has the skills to be able to help a person think more clearly

about their situation. But if they've

never experienced what this family's

going through, it, there might

be somewhat of a disconnect at times. So I think to try to get these families

that are going through that the

serious business and it's hard

work I think to, to go from what

was once a quote, normal life too now a different kind

of normal with the wounded soldier

that may not ever re-enter the service. And they're like maybe in the disabled category of some sort to

have them when

they're willing. And sometimes you need to encourage them

to be willing to meet with other

families that are kind of going

through the same thing. And that's where

churches can come alongside and unite

these families together. And I think they, I see them and

Walter Reed, they, when we go down

to have lunch, they, there are people

there that are meeting and really

drawing strength from each other

because they're all going through

the crucible of this very near term wound with their

soldier in the, in the hospital cleaning to own clinging

to one another. So that's good. One other thing, just

can my model, I think. In many of the

hospitals now you'll see dogs

brought it. And those dogs are very comforting because

they don't ask you how you're doing or to me whose story

or any of that. The other elements in Scott he's like

from particular, I can visually see

pictures where the babies, they their family,

young families heal. His brothers having

children and everything, brought those in our son with his child

and and brought them and just

set them on the bed and Scotty with his arms around

these little kids, they don't know the

different Scott, he's reading a

book to him upside down and they're laughing and

having fun and you're getting it

wrong, Scotty. All of that.

That is that's another world there

that says re-enter, um, you know, because they accept him like he is. So the family from the youngest

child forward, part of the healing brush. I don't want to say don't you don't want to go

in there and see him because it might be

traumatic for the child. I think you've got

to gauge that, but as soon as you can let that child engaged, call up on the bed

there with daddy or mommy and just

sit there with them. Let's watch

watch a TV show. The more normal,

the more whatever. Very hasn't very

good effect on. Well, those are

good words and particularly wise words to counselors across

our country. Also just want to

conclude here by again, honoring the

two of you and your service to nation, your service

to your fellow man, to your family. And then the legacy

that your whole family and your sons and daughters are

leaving today, It's wonderful, it's rich and God

bless you for that. Any words in a

similar vein that you might have for

young families, military families,

it might be watching this video or others might want to encourage

military families. Well, first of all, we are extremely proud and

thankful to have our, our kids in the military and realizing that

for them it's it's a much tougher early married road than we had. They've already faced

several deployments and with more coming and lots of training times that are that are long-term

training, not just a week or

two, but they go away for several months. And so I just want

to personally thank our kids and all of

these young families. And and just to say that there are

a whole host of us, the older military

and soon to be retired military

that want to come alongside them and, and remained beside

them as they go walk this

long, hard road. But also to say that whenever sacrifice

is called for, whenever adversity

is faced, there is a flip

side of that, that is valuable and not to miss those lessons. That there are many people in the world

that will never have the opportunity

to learn and grow spiritually, emotionally as these

young families are. And we've seen

many of them become so very strong in their commitment

toward God and country and to each other. That, that gives me purpose now is to

see that there's a good side of

this adversity that our nation will benefit from

in the future? Well, that's a good word, mean anything to I guess

I would just kind of echoing that as we look at the other side

of the tunnel, that light there

for families that have been impacted

was wounded warriors. That this can make

them stronger. If they can realize

that it can, it at the time, it's

hard to realize. But yeah, I think it's a little bit like working out in the gym that if you want to

build muscle, you got to press

up against it. You got to lift

the weights, you got to work

the machines. And so this hard

time you're in right now is a machine

work in time. So let it take its

course in that. But let's work it. Cuz I think coming out the other side you will built, you will have

built a muscle and a strength of

family. In the army. Our motto was Army Strong, but we say it's the family that makes the

soldier strong. So that's that

partnership again. But Let's work the

muscles on this and have hope that we

can come out of this time no matter

how dark that feels. I've seen so many

families come out of it. The other end and four or five years from now, their families closer

and tighter and stronger than it

ever was before. That is the possibility.

That's the hope. Amen. Well, Lieutenant

General and Mrs. above in

Antwerp. Thank you. God bless you, and God bless all the

military families around our nation that are likewise

standing strong, firm in their faith firm

and their service of nation on behalf of you and me and the

rest of the country. So God bless you

all. Thank you. What I've found with the

combat experience in the PTSD or what

came out of the combat experience

was that it caused me to withdraw from my personal

relationships, that tight personal

relationships with my family

and with my wife. It caused me to

want to distance myself from them

because I didn't want them to to be a

part of what I did, what I had seen and done, and think I was maybe trying to

protect myself, but at the same time

trying to protect them. And so I think what began was what they

called. You see? Now after I came

back and Kosovo, my sister and my

mom, a common set, you seem darker, you don't seem to be as

happy anymore. You see more serious and I just kind

of blew that off. But it turned into kind of a gap and

communication because everything became kind of just administrative

surface level and our communication

with my family and even even with my wife because I didn't want to I didn't want to go into those dark

areas with her. And so with

anything in life, if you have a

burden to carry, you turn it inward and you don't allow

someone else to help you carry

that burden. Particularly if you're a Christian and you don't allow Jesus to take on those burdens than

just gets too

heavy to carry in and it becomes a barrier to

relationship growth. And for me, now I

reached a point where I was ready to sever my relationship with the whole world

by way of suicide because I didn't like where I'd taken my life

and my relationships. So I think that a

lot of veterans, so withdraw from everyone that

they're close to. And now even when

those loved one, loved ones try to reach

out to the veteran. The veteran or

the soldier will say it back off now because it's a

threat to happen, to re-experience

those things. So for me, it just caused a distance

and a gap. Communication that was

hard for us to get beyond early on when we were dealing with the worst parts of the PTSD. Once it

became

clear that we had to deal with

this problem, Julie force me to deal

with it with her, to talk to her

about things, and she pleaded with me to talk to her about about situations that

I've experienced and what is the

cause of all this. And I felt that

that was a threat to my own safety and trying to have to re-experience

those events. So it was difficult for me to walk out

into that void with her and and trust even myself with talking

about those things. But she was always

very tender. She was always wanting to turn to this Scripture. She asked me to journal

with her if I could talk to write with her. And we would then after we wrote read to each other these

journal

entries even on a daily basis, right

out our prayers. And then exchange

the journals to to read each other and then

talk about that. I mean, I don't know where she got some of

these ideas, but they were

really effective. And she at times I think that she was

on No, she was hurt. But at times I

think that she was felt almost wronged, that her the man that she knew and had been

taken away from her, and then she just

wanted me back. So she respond

with anger at times and frustration and not being able

to to help me. Like she felt like

she wanted to nurture or be there to help the situation,

but there wasn't that. There's only so much

that she could do. And I think when she

started to realize that it was only really God that could that could bring about

the real healing the situation

and that she may not get the same man back there she hadn't before. That God was

still going to be able to use these

experiences for something greater. But that she would walk

through that change. I think that was a much more gracious

response at that point.

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