Religious and Spiritual Aftermath of War

James K. Boehnlein, MDProfessor of Psychiatry

Oregon Health and Science UniversityAssociate Director for Education

VA Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC)

Questions After TraumaUnpredictability of life and deathLossMoral Complexities

Religion Across CulturesExplanation of how universe began, how life

is maintained, what happens when life ceases to exist

Explanation of life’s meaning and rationale for suffering

Symbols, beliefs, valuesRelationship between the self and the world

SpiritualityBridges religion and scienceInsightful relationship between self and

othersPersonal valuesMeaningful purpose for lifeConnectedness between self and the

natural/supernatural

Explanatory FrameworksPain, suffering, atonement, forgiveness

Judaism – Restoration of relationship with God through atonement

Christianity – Repentance, forgiveness and rebirth

Buddhism – Acceptance of suffering; reincarnation

Islam – Death divinely ordained – impact on survivor guilt

Hinduism – Suffering a result of conflict/tension

Core Assumptions Altered by TraumaBelief in personal invulnerabilityPerception of an understandable worldTrust in self and others

Healing After Trauma: Psychotherapeutic ThemesTrustSecurityAcceptanceIdentity and Self-

WorthSocial

Connectedness

Grief and mourningAnger and RevengeControlMeaning

Barriers to Treatment-Beliefs and Values

AvoidancePride in self-relianceLoss of control/autonomyTreatment is for those who are weak, “crazy”Provider will not understand or believe

traumaSocietal rejection

Factors in Religious / Spiritual Healing

Telling the story honestlyEnding isolationMoral inventoryForgivenessHelping othersGiving and receiving love

Clinician ReactionsSadnessAngerVulnerabilityFatigueIntolerance of other patientsIntolerance/avoidance of violence imagesIndifference vs. overinvolvement

Ethical Principles in TreatmentCreation of trust, predictabilityCause no harmRespect for personal boundariesPrimacy of reducing suffering and promoting

healthRespect for patient autonomy, independence,

and creativityPromotion of justice