Statement of Chaplain Robert W.
Mikol
Department of Veterans Affairs
VA New Jersey Health Care System
March 11, 2004
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Mr. Chairman and Members of the
Subcommittee, I appreciate the opportunity to appear before you today to
discuss the role of Department of Veterans Affairs (VA) Chaplains in
providing pastoral care for veterans who suffer Post-Traumatic Stress
Disorder (PTSD) and other mental health problems from the rigor of a
combat or hardship deployment.
Post-Traumatic Stress Disorder Psychiatric Residental Rehabilitation
Treatment Program (PRRTP)
The VA New Jersey Health Care System provides the outpatient PRRTP at
the Department of Veterans’ Affairs Medical Center, East Orange, New
Jersey, and the inpatient PRRTP at the Department of Veterans’ Affairs
Medical Center, Lyons, New Jersey. Both medical centers share the
responsibility for extended outpatient care to veterans of all
conflicts. I am Primary Chaplain to the PRRTP on the Lyons Campus. The
Lyons PRRTP is a 45-day, 24-hour inpatient program. The model for
treatment is an inclusive multi-disciplinary team approach of
psychiatric, medical, psychological, social, spiritual/religious* and
support staff. The focus of the therapeutic model is intense group and
individual counseling settings by the mental health and social services
staff members. Our unit has a 25-bed maximum capacity.
As one of two assigned Chaplains to the PRRTP at Lyons, I have the honor
and privilege of recognition as a member of the healthcare team. I
participate in team reviews and have conferred with clinical members
regarding veterans’ spiritual/religious issues as presented in this
therapeutic treatment. I accept and receive referrals and consults from
clinical staff to enhance the progress of the clinical rehabilitation of
the veteran. Veterans are encouraged and invited to establish private
appointments with the Chaplains and most accept this invitation to do
so. The clinical team is aware of the significance of
spiritual/religious/moral/ethical values and beliefs in the lives of
combat veterans. Hardship or combat tours may have PTSD
spiritual/religious influences; this lasting impact may occur during
combat or well after repatriation. PTSD Chaplains are uniquely trained
and familiar with combat related spiritual/religious issues either by
personal experience with these issues or through the wisdom of years in
ministry with combat veterans. Chaplains also document in veterans’
charts relating opportunities used by veterans for counsel or
instruction. Issues with direct clinical relevance are cited in the
interdisciplinary notes as well as formal spiritual assessment for each
veteran.
Confidentiality provides the veteran the freedom to share openly and
honestly his/her feelings and difficulties with beliefs, values,
morality, and ethical questions related to their declared God/Higher
Power, themselves, their significant others, families, and their
military experiences. Chaplains are available 24 hours/day for pastoral
care to all veterans. Crisis care is provided in the case of immediate
need during a veterans’ program tour such as death in the immediate
family or other critical event. Chaplains also provide unit didactic
group settings in the program such as Feelings Group and Survivors’
Guilt Group for inpatient and outpatient veterans. Chaplains will assist
veterans with Twelve-Step Programs in alcohol and drug abuse
rehabilitation when requested by the staff or veterans.
A vital event of the Lyons PRRTP is a visit to the National Vietnam
Memorial in Washington, D.C., every six weeks. This is a mandatory field
trip for all inpatient veterans. The visit begins in the early morning
and ends in the evening with return to the hospital. I accompany staff
and veterans as their Chaplain to assist with grief and separation when
confronting the names of lost and missing comrades. A significant
obligation and responsibility of the Primary Chaplain for PRRTP is to
invite veterans to share with each other the names and memories of lost
or missing friends who are inscribed on “The Wall.” Warmly named “The
Gathering,” this experience provides veterans opportunities to commit
their friends to “The Books of Heroes.” This experience enhances
grieving, sharing, and bonding among veterans as well as closure.
Chaplain Service has been awarded national “Best Practice” recognition
for this event.
The PRRTP invites veterans to an annual PRRTP Reunion each year on the
campus. Veterans who have completed the 45-day tour are invited to
fellowship with their significant others and veterans of earlier and
later unit groups. Food and entertainment are provided for families and
close friends.
The Chaplains are available and regularly present information to the
staff and veterans regularly on and off the unit. The acceptance and
welcome of Chaplains is a valued enhancement to the mission of the PRRTP.
Spiritual Issues and Injuries of Combat Veterans
I have served our veterans as a full-time Clinical-Pastoral Chaplain for
over 15 years within the PRRTP at the Lyons Campus of the VA New Jersey
Health Care System. Pastoral responsibilities are vastly different with
veterans diagnosed with mental health and PTSD from the rigors of combat
and/or hardship deployments. Training for Chaplains in PTSD is adequate
but not specific to the ministry of Chaplaincy. Chaplains participate in
all disciplinary, mental health, and PTSD training offered throughout VA
as well as the Department of Defense and private sector settings.
However, most of the experiences and wisdom is acquired through close
dialogue with clinicians and other mental health Chaplains especially
those who have experience with PTSD combat veterans. Simply stated,
Chaplains learn by experience the critical issues of combat- related
trauma and its impact upon the spiritual/religious/moral/ethical
dimension of a person. I will list here the spiritual issues and
injuries that I have confronted in my years as Clinical-Pastoral
Chaplain in the PRRTP at Lyons.
1. Lack of meaning and/or purpose in life
2. Hopelessness in personal efforts to return to God, family, and self
3. Inability to control emotions, passions, and behavior
4. Rage
5. Fear
6. Revenge against members of the cultures/nationalities of “the enemy”
7. Distrust of government systems and some political principals
8. Isolation from family, friends, and society
9. Lack of empathy or sympathy for others and systems
10. Diminished trust in spiritual/religious beliefs, values,
denominations, and clergy
11. Guilt regarding responsibility for death or injury to fellow combat
veterans and the perceived responsibility for their capture or death
12. Loneliness due to the feeling that “intimacy is painful”;
separation, injury, or death of loved ones reflects upon responsibility
to protect and to serve others
13. Grief over the loss of innocence, morality, faith values and
beliefs, commitments, and the loss of fellow combat veterans and friends
14. Survivors’ Guilt is the perceived responsibility of expectations not
fulfilled to prevent injury and/or death or to survive while others did
not survive
15. Depression
16. Dysfunctional relationships in marriage, family, employment, and
with systems such as communities of faith and government agencies
17. Battered self-esteem, self-worth which discounts positive feelings
of duty, honor, sacrifice, and bravery
This listing is as inclusive as possible. Degrees of intensity and depth
are not expressed here due to the inability to address the pain,
brokenness, and desperation of combat veterans to their military
experiences. Many veterans revisit and reprise their trauma during the
calendar year, especially when the months reflect the period of the year
the initial trauma occurred for them. This reprising of the
“anniversary” adds more stress to Clinical and Chaplain personnel and
resources.
Model of Ministry to Combat Veterans of PRRTP
I will outline the result of years of experience with our combat
veterans on and outside the PRRTP from my tour of duty of over 15 years
at the Lyons Campus, veterans outreach centers, and community-based
outpatient clinics of the VA New Jersey Health Care System.
Veterans teach Chaplains about their pain and brokenness. Chaplains must
actively listen, actively observe, discern, and learn from veterans
before he/she can effectively minister, shepherd, and understand their
lives. This is my “prime directive” of ministry to combat veterans
diagnosed with PTSD and mental health disorders.
I must accept the individual veteran as he/she presents him/herself to
the team and to the Chaplains. Projecting or transferring from the
Chaplains’ experience or life events diminishes ministry and pastoral
care.
Chaplains must not be judgmental or convicting of the integrity of the
veteran. Combat veterans have convicted and condemned themselves over
years of regret, guilt, and shame. A Chaplain must acknowledge and
validate this in the veteran and begin to rebuild and resurrect the
spiritual core of the veteran in understanding the context of war,
conflict, and the role of the warrior. This requires humility and
strength in the Chaplain and in the veteran.
The Chaplain reflects to the staff and veterans a Power Greater Than All
of Us. This Power is identified by many names and understood in many
interpretations. Rage against the Chaplain may not be personal but in
many instances against whom the Chaplain represents to the veteran. The
God/Higher Power who is condemning will solicit rage from the veteran as
the God/Higher Power who is forgiving and compassionate will solicit
surrender from the veteran. A Chaplain must discern this and begin
pastoral care from that point in the veteran’s experience.
A Chaplain must be supportive and empathetic to the pain, suffering, and
brokenness of the veteran and his/her family. This would allow
opportunities to invite spouses, children and significant others into
counseling and pastoral care. This is by invitation not by demand, as
the veteran will not allow control of the family beyond his/her
influence at times.
Chaplains by role and representation challenge the veteran and his/her
present life values and behavior, positive or negative. Chaplains
celebrate the accomplishments and challenge patiently to evaluate
alternatives to failures. This is an exciting and fulfilling dimension
to ministry with combat veterans.
A mode of operation I believe in ministry to combat veterans that has
been learned by trial and error over the years is not to be political
about foreign national policies with combat veterans. This encourages
diversion from the more critical spiritual/religious issues of trauma,
combat, and repatriation. I express to the veteran when conversations
evolve into the political justifications or assumptions of war that the
issues are more profound in him/her than political policy judgements. In
group settings, I encourage spirituality issues rather than religious
issues. Our veteran population on the unit is diverse in faith
expressions from orthodox to unaffiliated to any belief system. These
consults are delegated to private counseling sessions other than group
settings.
A Chaplain is a person who has the competence, ability, skill, talent,
and mission to partner with veterans to reestablish belief and faith.
The resources are varied and many in ministry to accomplish this in
Chaplaincy. Chaplains enrich understanding through teaching, counseling,
and advising in supportive ways the latent spirituality of the veterans.
The uniqueness of Chaplains within VA and the Department of Defense is
the ability to integrate the healing into a life filled with pain and
distrust. The former complements the latter. The mercy and healing grace
of God will restore the deficits and guilt/shame of decisions and
actions of the past and present. This I call “conversion of the spirit.”
In conclusion, I would summarize the Chaplain ministry to combat
veterans diagnosed with PTSD and mental health disorders as walking with
a veteran from the “valley of the shadow of death” to the light of the
honor of warrior as understood in the ancient codes of valor. In other
words, each day of Chaplaincy I repeat to myself, “Today I must walk
with each of them from the place of victim to the place of
survivor…victorious, honorable and on the way to peace and integrity.”
Resources of Ministry
Scriptural and ancient teachings of the Bible, Torah, Koran, Gita etc;
Cultural, literary and the fine arts;
Meditation, prayer, rituals and rites;
Faith Group Chaplains, community clergy;
Interdisciplinary clinical professionals, journals, and papers;
Dr. Elisabeth Kubler-Ross: Death and Dying; Grief;
Eric Erickson: Personality Development;
Twelve-Step Programs for Alcohol, Drug Addiction, and PTSD;
* “spiritual/religious” is defined as follows: “…spiritual” qualities of
the heart, mind, and soul of a person; that is emotional, rational, and
intangible qualities (love, hate, sadness, joy, peace, hope, courage,
etc.) unknown to others and core to a person’s beliefs and values;
“…religious” is acting out, living, and manifestation of values,
beliefs; sharing and teaching others those qualities that each possesses
within themselves.
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