The Spiritual Costs of being in Combat

PACEM 8:1 (2005), s. 93-106

ISSN 1500-2322

Where can I flee from your presence? If I go to the heavens, you are there; if I make my bed in the depths you are there (Ps 139,7-8).

Introduction

God will never forgive me for what I did in Vietnam. I know, I will never forgive myself either. It is hard living like that. It is like I am at war with myself.

Where was God when we needed him the most? He deserted us. You see, my problem is not that I do not believe in God. I do believe in God. I know God is there. But he did not look after us, like they said in the church that he would. Now, what do you make out of that? He was there, but he did not look after us.

The close fellowship we had over there was so strong that you will not believe it. Nothing will ever compare to that. Here I do not even have my wife and kids anymore. They left me. Or to be honest, I made them leave me.

All of the three above quotations are from pastoral encounters I have had from September 2003 through August 2004 at a hospital for war veterans, Portland Veterans Affairs Medical Centre (PVAMC) in Oregon, USA. Bill, Joe and Robert are only three out of many hundred thousands of Americans diagnosed with Post Traumatic Stress Disorder (PTSD). As the number of people having served in Iraq increases it is expected that the PTSD-numbers will grow explosively. In a recent study from the Walter Reed Army Institute of Research it is suggested that one out of six of the American soldiers serving in Operation Iraqi Freedom will return from Iraq with PTSD-related problems.^¹

Sometimes we hear of the chaplain’s role in PTSD-issues being discussed. Is this not a mental health issue? Shouldn’t mental health medical staff deal with it then? The answer is yes to both of these questions, but that doesn’t mean there is no need for a chaplain to be part of the team. In fact, the chaplain can prove to be a centerpiece in a number of the cases. I think the quotations above are good examples of cases where spiritual and religious issues seem to be at the core of the problems. After having had regularly contact with PTSD-veterans for a year I have come to the conclusion that PTSD wounds are spiritual wounds. Questions related to purpose in life, feelings of guilt and relationship to oneself and God come up consistently in interactions with PTSD-individuals.

In this paper I will first try to explain what PTSD and spirituality is. Then I will briefly point out in what way this has to do with a Norwegian context. From there I will be looking into what kind of responsibility both the Norwegian Armed Forces in general and the Chaplaincy Norwegian Defense in particular have in facing the probable PTSD-challenges. After I have disclosed the responsibility we are facing, I will explore in what way the chaplain can be of use in PTSD-related issues. Before I conclude I want to share a patient-interview that I think is illustrative for some of the challenges soldiers with PTSD may present to us. I hope to show by all this that a well-trained chaplain will play an important role in the treatment of PTSD.

What is ‘PTSD’? What is ‘spirituality’?

It is generally accepted that many soldiers who have been in combat or combat-like settings struggle with their experiences a number of years following the actual experiences. The psychological diagnosis given to some of them is Post Traumatic Stress Disorder. PTSD is a result of being exposed to a stressor, an experience that is extreme in nature, and threatens a person’s feeling of being well and safe. The re-experiencing of the incident is one of the symptoms of PTSD. The PTSD-individual may re-live the trauma in different ways, e.g. by flashbacks, nightmares or intrusive thoughts. Other symptoms of PTSD are emotional arousal, hyper vigilance and sleep disturbances. To be diagnosed with PTSD, a person must experience the symptoms for over one month, and the symptoms have to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning”.^² Often this re-experiencing seems so hard to deal with that PTSD-individuals start to avoid different activities that can trigger the re-living of the traumatic event(s). Emotional numbness often is the result.

I have already suggested that PTSD-wounds are spiritual wounds. At this point it will probably be helpful to offer a definition on what spirituality actually is. Barton and La Pierre provide us with a definition on spirituality. They understand spirituality to be:

a multi-dimensional aspect of human experience. Spirituality may be conceptualized as six such dimensions or factors: journey, transcendence, community, religion, ‘the mystery of creation’ and transformation.^³

These factors include search for meaning, the relationship to a transcendent force or being, the connectedness or sense of belonging to some sort of community and the awe of the creation as it can be experienced with the five senses. These factors also make room for the personal change, which result from spiritual experiences. The impact that spiritual issues have on the quality of life cannot easily be exaggerated. Needless to say, a person unable to find any purpose in life will have a lower quality of life than a person who can find meaning and purpose. It will be important to note that religion and spirituality are not equals. Religion is often an important part of a person’s spirituality, but the two are not interchangeable. Religion most often has an organizational side. This organizational side is not necessarily a side of the spirituality.

PTSD in Norway? What is our responsibility?

Over the last few years, there has been a significant change in the use of Norwegian soldiers. Peace support operations (PSO’s), in which Norway take part, are taking place in some of the world’s major conflict areas and Norwegian soldiers have often been involved in violent incidents in several out-of-country-missions. There are no indications that this activity will decreace. Rather, in recent years, the trend has been continuously developing. Norwegian soldiers are being used in more combat-like settings, and they are sent into complex areas of high-intensity conflicts. It seems reasonable that the Norwegian Armed Forces prepare to meet the consequences of this type of military deployment.

It belongs to the military ethos of most Western countries that one should as an officer “accomplish your mission and take care of your men”. This ethos applies not only to the commanding officer individually. In my mind, it also applies to the Norwegian Armed Forces as a whole. I hope with this paper to highlight the second part of this ethos; to care for the personnel. The fact that Norwegian soldiers are sent into areas of high-intensity conflicts, will add dimensions to the responsibility the Norwegian Armed Forces have in taking care of its personnel.

I would like to argue that this focus on PTSD is not only interesting and beneficial in a Norwegian setting, but also that we have a duty to be prepared to meet the needs of soldiers, who have been exposed to combat or have had combat-like experiences. This preparedness would demonstrate the will to put action behind the words of taking care of the personnel, and not allow it to be nice words only. The soldier is perhaps a political tool, but can never be just that. The Norwegian Armed Forces will always have to treat a soldier as more than a means to get something. A person is him- or herself an end, and not a means for other ends. Although it is expected of the soldier, if necessary, to be willing to make the ultimate sacrifice of his or her own life, the general rule is still of course that the soldier’s life is supposed to continue after the end of the military service. Returning to civilian life is not always uncomplicated, and for individuals with PTSD, it is often a long-lasting and painful process. My suggestion is that the responsibility of the Norwegian Armed Forces lasts until this process of adjusting to civilian life is completed.

With this in mind it is commendable that Chaplaincy of the Norwegian Armed Forces (in Norwegian Feltprestkorpset, hereafter abbreviated FPK) is showing awareness of the possible rising challenge of PTSD in the context of the Norwegian Armed Forces. FPK has shown this awareness not only by sending two chaplains to Clinical Pastoral Education and PTSD-training for a year at a Medical Center for veterans (PVAMC), but also by pointing this area out as one of two that needs attention and further development in the following years.^⁴ In this context it is important to point out that by giving PTSD ongoing focus, FPK will be able to update and provide its chaplains with information and education on PTSD and issues related to PTSD so that FPK will be prepared to face the challenge.

Although FPK has no formal responsibility in this area, I would like to add the civilian context as one where FPK might be able to offer an important contribution. A growing awareness about PTSD among military chaplains and education of military chaplains opens possibilities for FPK to make a contribution in a broader sense of the Church of Norway. PTSD is a general term. It is a challenge not only in the military theatre. The trauma that causes PTSD need not be related to combat or other military service. Other traumas include, but are not limited to, rape, sexual abuse, accidents and natural catastrophes. Even though FPK’s chaplains are trained to meet the needs of the Norwegian Armed Forces, much of the content of the training can also be applied in a non-military context.^⁵ The role that a chaplain can play in treatment of combat related PTSD is basically the same that a clergy-person can play in relationship to a PTSD-individual in the context of civilian life. For PTSD-individuals the need to address spiritual issues will exist whether the trauma is related to combat or not. Where the attitude often has been to “support, befriend and pray for the victim”^⁶ (which is a lot in itself), I would like to suggest that clergy can play a more significant role in the treatment of PTSD.

The use of the chaplain

As already stated: I have come to agree with numerous war veterans and members of the PTSD Clinical Team that wounds from PTSD are spiritual wounds. As one war veteran expressed to me (and I am sure that many other war veterans have used these exact words): “I lost my soul in Vietnam.” Statements like this indicate to me that the chaplain has a natural and central place, not only in the treatment of PTSD, but also in a process of preventing PTSD. My theory is that military chaplains can contribute before a mission, they have a role in preventing PTSD during a mission, and, as I have already said, chaplains can contribute to the treatment of PTSD after a mission. The important thing is not to pinpoint the exact use of the chaplain in these three phases. Such pinpointing represents a danger of setting inappropriate boundaries for how the chaplain can contribute in PTSD-related issues. What is important is to focus that the chaplain is a member of a team. Within this team the chaplain need to step forward and take responsibility in all appropriate places and in all the different phases. Consequently, the following is not meant to be an exhaustive and detailed list of the chaplain’s fixed tasks. Rather, it is some thoughts of how the chaplain can be of positive effect in a team’s effort to prevent and treat PTSD.

The chaplain’s role before a mission

It is important to realize that PTSD-related work starts a long time before the mission. The presence of the chaplain during the process of building a unit for a mission in a high intensity conflict area can prove to be important. A chaplain contributes to the building of a unit’s cohesiveness. As a person not in the chain of command the chaplain is often perceived as ‘not dangerous’ and can easily be trusted. Knowing that there is a person that one can come to with thoughts and difficulties is in itself a relief to the soldiers. To build the bonds of trust within the unit obviously is no task for the chaplain alone, but his contribution often is of significant value. A soldier who feels that he/she has support and that he/she has someone to trust with personal matters will be better prepared to handle extreme stress he/she potentially is put under.

The chaplain already has educational responsibility in teaching ethics. This is not the place to go into details about how ethics and PTSD sometimes are interwoven themes. However, it is important to state the following: To participate in atrocities or to be involved in unethical conduct creates wounds and can mean the difference between developing PTSD or not. Together with others the chaplain can take on responsibility in teaching both officers and soldiers about what PTSD is and when it can become a challenge. Everyone in a unit needs to know the connections between combat exposure and PTSD, they need to get to know what the normal human reactions are in settings of combat stress, they need to know what kind of situation they can expect to meet and they need to know how important it is to stay within ones own ethical standards and the standards put before them by the authorities, such as the Commanding Officer, the Rules of Engagement and the Geneva Conventions.

An officer has challenges in addition to the ones mentioned above. In extreme situations the officer obviously has to be willing to put his/her soldiers’ lives in danger. Facing the possibilities of entering such situations is part of what makes the officers work unique and profoundly different from what other do for a living. What does it do to an officer to lose personnel because of orders given by him/her? I talked with a veteran who was a platoon leader in the Korean War. He still sees himself crawling from his own foxhole to other foxholes to comfort his men as many of them cried and trembled with fear. He kept his own posture, but finally back in his own foxhole he fell apart and cried and trembled of fear like the others. He lost many of his men, and still today blames himself because, as he says: “It was my responsibility to take care of my men.” Although this officer clearly put too much responsibility upon himself, the fact remains: The officer has a responsibility to take care of the personnel; not only to keep them alive, but also to keep them from being wounded. It follows that the officer has to act in a way that, as much as possible, protects soldiers from experiences that might lead to PTSD. The paradox is that we are preparing our soldiers for combat, which in its nature is extreme, and at the same time, want to keep the very same soldiers from extreme experiences, like combat. Maybe the chaplain can think together with the officers about what basics they need to face their responsibility. Also: What can the officers offer to the soldiers to make them well equipped to handle combat-like experiences?

The importance of the chaplain during a mission

I heard a lecture from a psychologist that recently came back from army duty in Iraq. I grew taller every second when he talked about the importance of chaplains in mental health work. He called the chaplain his most valuable ally in his work. One of the things that made the chaplain’s contribution so valuable was that the chaplain stayed close with the rest of the unit and lived under the same conditions as them. The chaplains were the eyes and ears that the psychologist needed to know who really struggled. They provided the necessary place of ventilation and morale support that the units needed.

The point is that the chaplain is in a good position of picking up problems. The chaplain can refer a soldier to psychologist when necessary.

It has repeatedly been shown how stressful settings make people more receptive and more in need of what a chaplain can offer. Prayer and religious services grow more important when in a stressful setting. Even for personnel who choose not to participate actively in chaplain-related activities, the mere facts that there are church services and that there are someone praying for them can be consoling. The chaplain is expected and qualified to be a spiritual resource that becomes increasingly important and more frequently requested in a stressful theatre.

During a mission the personnel will need someone to talk with. Stressful events are likely to be debriefed in their natural contexts, but that does not take away the valuable contribution the chaplain can bring. It has been documented that the situation in the home country and the relationships to those who is left behind often will create stress for personnel in out of country mission. Many soldiers hold the chaplain to be the natural point of contact regarding issues related to the situation at home.

After the mission: A chaplain’s role in PTSD-treatment

What is it the chaplain can bring to the treatment of PTSD that is unique for the chaplain? PTSD is a diagnosis included in the ‘bible of the psychologists’, The Diagnostic and Statistical Manual of Mental Disorders, since the third edition (1987). So obviously PTSD is defined as a psychological disorder. However, the fact that PTSD is a mental disorder does not make the chaplain irrelevant. The traumas of the PTSD-veteran impact the veteran’s spirituality. Questions appear that have to do with the meaning of life, relationship to God and feelings of guilt. The chaplain is highly relevant in helping people with these questions and consequently with their quality of life. As earlier mentioned; wounds from PTSD are spiritual wounds.

It is very common to turn away from God as a result of being in combat and of experiencing the evil close up, as is the case for people in combat theatres. In this perspective it may be surprising to hear that the use of liturgy has helped a number of PTSD-veterans work through some of their toughest issues. This is not the place to elaborate on the possible use of liturgy in this context, but liturgy as a way to help a PTSD-veteran to mourn fallen soldier friends is one relevant example.

The issue of the veterans’ guilt and feelings of guilt is worth giving some extra attention. My impression is that a traditional mental health approach to guilt is effective and helpful in dealing with guilt that is inappropriate or ‘stolen’. Survivor-guilt is one example of guilt that is not appropriate. One feels guilty of other soldier’s death. “Why did he die and not I?” “I should have been the one dead and buried. Not him!” It is necessary to underline that this type of guilt lacks any grounding in reality. It is something negative that sets boundaries and inhibits people’s quality of life.

Many veterans definitely take on too much responsibility and blame themselves for things far from their area of responsibility. But other times the guilt feelings represent something not only valid, but also something appropriate and necessary. This is guilt that is not ‘stolen’. It is an accurate feeling corresponding to reality. It is important that this guilt is not treated as inappropriate guilt. Many regrettable things happen in a stressful military theatre. Soldiers do things that are against the Rules of Engagement, the laws of war and their own consciousness. There is a longing to make up, but often it feels difficult or seems too late to make it up. How do you for example make up for having killed a defenceless POW when he was looking you straight in the eyes praying for his life? I think that a chaplain can be helpful in a process of making up. This is far from uncomplicated work. The chaplains involved must receive a training that helps them to be both pastoral and clinically wise. It takes more than the traditional invitation to confess ones sins and then receive absolution. Often, the problem for the PTSD-veteran is not only to accept that God forgives, but also to be able to forgive oneself. The PTSD-veterans need to be given responsibility for actions committed by them. No easy way out will work for them. The process will take them to places that have to do with guilt and atonement, sin and forgiveness. I can see no better resource to handle this than the chaplain. Here again, though, I want to underline that the chaplain always needs to belong in a team where it is possible to draw on other professionals. The chaplain does not have the skill to deal with this alone. The chaplain represents one piece in the puzzle.

Yet the basic remains: The chaplain often will be a helpful resource. I am a firm believer that a theological and spiritual approach can contribute to the process of recovering from PTSD.

Where to go from here…

My hope is that this paper contains a positive challenge for chaplains and pastoral care providers. People who provide pastoral care have traditionally been too modest, and maybe also a little afraid of relating as professionals to PTSD-individuals. I hope this paper highlights the important role pastoral care providers have in this area.

Another challenge for the chaplains is to stay within their own professional area of competence. It is precisely as chaplains we are needed. The awareness of own role and competence is important. Chaplains are trained to be aware of that. Thus, it should be little cause for concern that the chaplains’ role could blend into a psychological role.

I imagine that this paper can represent a challenge for psychologists, psychiatrists and other professional groups working with PTSD as well. I have the greatest respect for the work that the different professionals involved did in the PTSD-treatment at the PVAMC. The openness I met as a chaplain entering the arena of PTSD-treatment suggests that other professional groups often have an inclusive attitude towards chaplaincy, which chaplains not always anticipate. Still there might be skepticism from different professional groups as for what the chaplain will bring to the interdisciplinary team. It might be that members of other professional groups working with PTSD have met or heard of church representatives who have displayed a judgmental and destructive attitude. It might also be that professionals working with PTSD have seen cases where religion is a part of the problem, rather than the solution to the problem. In these cases it is not spirituality or faith-perspectives in themselves that are the problems. Rather, the problem is the way religion is applied and misused in some peoples’ worlds. Maybe the presence of a chaplain could prove especially important in these cases.

This paper hopefully opens up some possibilities and ideas of where to go from here. There are a number of challenges waiting ahead and research waiting to be done. The following are just a few suggestions of focuses that can be made:

Meeting with a veteran

I want to share one of many pastoral encounters with war veterans last year. I think that the interaction makes a good example of what a war veteran can struggle with. It also shows how the chaplain is a natural point of contact.

The patient is a Catholic, diagnosed with PTSD after participation in the Vietnam War. The patient is 57 years old. He is hospitalized for other reasons, and uses the opportunity to meet with a chaplain. I visit the patient in his hospital room where he is sitting upright in his bed. The patient is staying in a long-term relationship with a counsellor. This relationship seems to have helped him to be able to have this conversation.

Me 1: Hey mr D. I am chaplain Klevberg. I thought I would stop by to see how you were doing. I heard you had asked to see a chaplain?

Patient (Pt) 1: Hey, chaplain. I am not sure if I want to or not… But my therapist said he think it would be a wise thing to do to see a representative of the church. But as I said: I am not sure.

Me 2: It sounds like it is hard for you to talk about whatever is on your mind.

Pt 2: It definitely is. But I think my therapist is right. I think it really could be helpful to me.

Pt 3: Yes, it is my choice. He gave me his advice long ago, and I did not do what he wanted me to. Now I feel … I guess it is not exactly something I am looking forward to, but still it is something that I need to do.

Me 4: Sounds like this somehow has forced its way. I would just like to remind you, since it appears that this might be hard for you to bring up, that you can trust that what you bring up stays with me.

Pt 4: I know. I am a Catholic. That is, I used to be a Catholic a very long time ago. I am not able to go back to church.

Pt 5: Before I went to Vietnam, I checked with the priest in our congregation if he thought it was all right to go to Vietnam. He told me: «It is OK for you to go to Vietnam. God is fine with you going there.» I wish I could talk to that priest today and ask him over again. I wonder what kind of an answer he would have given me… Well, anyway I went with the priest’s words in my ears. And it was hell. To me it was hell. And he sent me there. I am struggling with so much that happened back then.

Pt 6: I was going through this village, myself and two other soldiers. It was a friendly village, but you never knew. It was tense. We had to be alert all the time. I had my eyes fixed on this vehicle two cars behind us. For some reason that vehicle caught my attention. Then our driver said: «It looks like they are piling some stuff at the road ahead of us. We need to slow down.» I responded: «Keep our speed up. There might be something wrong going on here.» Soon afterwards we heard a sound like something hitting our jeep. I was carrying my gun. I pulled it and as a reflex fired it into the crowd of people, where I felt the object was coming from. (The patient takes a short brake and becomes tearful.) It turned out I hit a little boy. The dump I heard was a ball hitting our jeep. There was no threat to my life at all, and I killed an 8 or 9 years old boy…(Silence). He was just playing with his friends.

Pt 7 (Looks like he is in his own world, tears still rolling): Now, how am I ever going to be able to forgive myself of what I did? At first I just kept thinking about the little boy and his mom. I stopped his life. I really wish I could be in the grace of God. But how can I be in the grace of God after what I did? That is what I have been struggling with all the time. When I came back from Nam, I backed off from going to church… I have not been there since.

Me 8: Those are really big questions. I think one of your questions was how to be able to forgive yourself. Did I hear you right?

Pt 8: Yes. That is what I said. I did wrong back then, and I will have to live with that for the rest of my life.

Me 9: For some reason I see that question as the key issue: to be able to forgive yourself. Maybe that would help to get the other pieces into their right places as well.

Me 11: I do not know either, I think. But I have an idea that somehow you will not let yourself be forgiven.

Pt 11: It is just too simple. I cannot say «it is all right» and then be done.

Me 12: How long has it been now since you came back from Vietnam? It must be in between 30 and 40 years. I am sure it has not been many days that without having been affected by what happened over there. I think everyone would have to agree that you have had your punishment. These many years have not been simple. Thinking about that kid and his mother every day. To be upfront: I do not agree with you when you say it is too simple.

Pt 12: Thank you for saying that. (Break.) You know, I carried so much with me from the war. I have taken out my anger on so many that didn’t deserve it. But still I gave it to them. I beat up a co-worker once, because of some small remark of his. The first year I could not keep a job for more than a couple of weeks… I could not come near a child. I still struggle to be able to enjoy my grandkids. I see that kid’s face on every kid I see.

Pt 13: Yesterday my granddaughter at seven years came by and she brought me that lion. (The patient points his finger to a toy-lion in the window post.) I asked her why she brought me a lion. She answered me back that it was because I was so angry, so a lion was a good fit for me. I tried to laugh, but I really felt bad inside. I have not given them what they deserve.

Me 14: Have you shared with anyone in your family how you feel about not being able to give them what they deserve?

Me 15: It isn’t easy to share those kinds of things. It sounds to me that it hasn’t been so easy for you all together after Vietnam... I have a feeling you have prayed God to forgive you of everything you felt you did wrong?

Me 16: I think you keep yourself from receiving the forgiveness that God has tried to give you for very long. God has forgiven you. In a way it is as if you keep God from doing what he wants to do. (Long break.) It sounds to me you have a longing to somehow find the way back to God. We have a Catholic priest on the staff. Would you feel comfortable talking to him?

Pt 16: I do not think I am ready yet. But you have given me much to think about.

Me 17: You can do things in your own pace. I would like to say, though, that I am sure you are already forgiven by God. And I would like to think that God has been at your side all along. We have a God that knows a lot about suffering.

Pt 18: No, thanks. I can pray here, and if you want to pray for me where you’re at I would really appreciate that.

Me 19: I will definitely keep you in my prayers. Thank you for sharing. You did a great job. Take care.

The patient clings on to his decision not to forgive himself. Thus, he is blocking out the possibility to be loved by God and by himself. It seems to me that he feels that he deserves to have a hard time, and sees his hardship as appropriately payback for what he did. He seems to have a problem to see God as the forgiving God that loves him unconditionally. The chaplain’s tasks are to listen, to walk along side with the patient, to let him claim the proper responsibility for what he did and to express to the patient the image of a God that is forgiving and a God that can understand his world of suffering because he himself has been there.

Conclusion - and where my heart is

I have reached the end of a year (four units) of Clinical Pastoral Education (CPE) at the PVAMC. This setting has provided me with numerous possibilities to talk with war veterans. I have also been very well received in the PTSD Clinical Team at the PVAMC. I am grateful for both, and I feel that this has been immensely rewarding for me at a personal level. But maybe most important: This passed year has convinced me that the chaplain is valuable and needed in PTSD-related work because of the spiritual dimension of PTSD.

I have been deeply impacted by my meeting with PTSD-individuals. They have paid tribute to their country by going to war, and their lives have been changed in radical ways. Many of these war veterans have visible physical wounds. But often it is the wounds that are not physical that are the most serious wounds. Their family relationships have fallen apart. Many of these veterans never sleep more than two hours in a stretch. They wake up from nightmares that have brought them straight back to the place they fear to go the most. They avoid living normal lives in fear of triggering the thoughts and fears that will make them re-experience their traumas.

The Norwegian Armed Forces send soldiers to high intensity conflict areas. Young men and women run the risk of being affected by their experiences in a way similar to the PTSD-individuals I have worked with this last year. During my service as a chaplain in the Norwegian Armed Forces, I have come to grow attached to many of the young men and women I have met in their line of duty. I feel it is in my line of duty to do what I can to keep the Norwegian soldier safe from such painful wounds.

Bibliography

American Psychiatric Association 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed.

Barton and LaPierre 1999. “The Spiritual Sequelae of Combat as Reflected by Vietnam Veterans Suffering from PTSD”. American Journal of Pastoral Counselling. Vol. 2 (3): 3-21.

Boehnlein, James K. 2000. Psychiatry and Religion – The Convergence of Mind and Spirit. Washington DC: American Psychiatric Press.

Grossman, Dave 1995. On Killing – The Psychological Cost of Learning to Kill in War and Society. Boston: Little, Brown and Company.

Hadley, Donald W. and Richards, Gerald T. 1992. Ministry with the Military – A Guide for Churches and Chaplains. Michigan: Baker Book House.

Hoge, Charles W. et al. 2004. “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care”. The New England Journal of Medicine. July: Vol 351: 13-22.

Mason, Patience H. C. 1998. Recovering from the War – A Guide for All Veterans, Family Members, Friends and Therapists. High Springs, Florida: Patience Press.

Shay, Jonathan. 1995. Achilles in Vietnam – Combat Trauma and the Undoing of Character. New York: Touchstone.

Siemon-Netto, Uwe. 1990. The Acquittal of God – A Theology for Vietnam Veterans. New York: The Pilgrim Press.

Kyrre Klevberg (f 1969). Garnisonsprest ved Garnisonen i Sør-Varanger (GSV). Studier ved Portland Veteran Affairs Medical Centre fra september 2003 til august 2004. Adresse: Sætra 10B, 9912 Hesseng. E.mail: kklevberg@mil.no

1 Hoge, Charles W. et al.

2 American Psychiatric Association 1994: 424-429.

3 Barton and LaPierre 1999: 6.

4 In a letter from the Chief of Departement of Ethics and Chaplains’ Education to the Chief Chaplain in FPK, dated Jan. 16. 2004.

5 Military chaplains often move on to ministry in a civilian context after a year or two. If they do so with PTSD-training acquired during their military service, FPK eventually could provide the Church of Norway with ministers with skills needed to deal with PTSD in a civilian context.

6 Hadley and Richards 1992, 174