By Cindy Wallace

As the mental health chaplain at the Washington D.C Veterans’ Affairs Medical Center, I have the privilege of being a part of our veterans’ journey to spiritual and mental wellness.  I work with veterans in the mental health inpatient unit and in outpatient programs to address the spiritual and emotional pain related to their mental health struggles. While Chaplain Service does offer care to meet religious needs, our spiritual care focuses on the positive connections to self, others, the world and something greater than ourselves, however that may be defined.  Recent studies show a regular spiritual practice helps people who struggle with mental health issues in many ways: 

• Lower rates of depression/depressive symptoms and anxiety in patients who use religious/spiritual coping tools with faster symptom improvement.
• Spiritual/religious practices can comfort, offer a sense of control, enhance feelings of security and boost self-confidence.
• Is positively related to life satisfaction, self-esteem and meaning in life.
• Increased hope and meaning in life, reduced psychotic symptoms, reduced suicide attempts, reduced SUD and increased adherence to psychiatric treatment.
• People who received professional treatment and attended spiritually based programs (AA, NA, Refuge Recovery) were more likely to remain sober, especially found in women (Koenig, 285-289).
• Hope, forgiveness, spiritual well-being and existential well-being, regardless of religious connection are protective factors against suicide (Steffa-Missalgi, et al., 548-549).

“Overall, the empirical research indicates that spiritual struggles are related to greater psychological distress. . .results suggest that interventions targeting spiritual struggles may help reduce and prevent psychological distress and psychopathology in individuals facing stressful situations” (McConnell and Pargament, 2006, 4469-4484). One of the ways we address spiritual struggles is to provide spirituality groups. These groups address spiritual distress such as guilt and shame, grief, meaning, hope, acceptance, gratitude, forgiveness, self-compassion, suffering and resilience. We also meet with the patients on an individual basis to address any spiritual needs, grief support or support for moral injury from combat or military sexual trauma (MST). My colleagues and I also facilitate grief groups, groups for veterans who are at high-risk for suicide and moral injury groups for veterans with combat trauma and military sexual trauma.

One veteran I met with suffers from Post Traumatic Stress Disorder (PTSD), Military Sexual Trauma, multiple failed suicidal attempts and substance use disorder. In group we were reading an article titled “Things Someone Who Loved You Should Have Told You” and discussed what we wished someone had said to us when we were younger and what we want to hear now. He shared that his mother left him in another country when he was a child to be raised by his grandparents. As he shared his story with the group of veterans, the pain was palpable. I visited him individually to follow-up. He has been on the inpatient unit many times over the last several years and most recently a few weeks ago after a failed suicide attempt.  We have had multiple conversations over the years, and he shared he feels ashamed coming back here. As we were talking about his mother and his childhood experience, he said, “I wish I could just kill Little K” (speaking about the younger version of himself). I said, “I think you actually are trying to kill Little K and are going to take Big K out with him.” He looked me in the eye and said, “You’re right.” He then shared another painful memory, and I sat with him as he cried.  I asked if he could try loving Little K the way he wanted his mom to instead of trying to kill him. We talked about what that might look like and what steps he could take to move in that direction. It was a powerful visit that I was so thankful to be a part of. As he starts to put the pieces together, my prayer is that it creates some hope for his future.

This and other traumas in his life are examples of moral injury by betrayal. Moral Injuries, or soul wounds, are injuries that occur as the result of doing something, seeing something, having something done to you or not doing something that causes a conflict between the traumatic event and the veteran’s personal values/morals. Moral injury is a spiritual and emotional wound that leaves the person with a sense of shame, betrayal, grief and loss of identity.

 Moral injury and PTSD often co-occur but are not the same thing. The diagnosis of PTSD focuses on the physical and mental health issues that occur after a traumatic event. Moral injury is not an official diagnosis in the DSM-V or ICD 11, and therefore is not reimbursable through insurance. This means the moral injury may not be addressed in typical mental health visits. This is where Chaplain Service comes in. 

One of the groups I started this year is a moral injury group for male veterans with Military Sexual Trauma (MST).  Studies show that around 38% of male veterans report military sexual trauma understanding that this is an underreported number due to barriers to reporting (Campos, 2021). Chaplain Service also facilitate moral injury groups for women with MST and all veterans with combat trauma. These groups serve to provide a safe space for veterans to come together, understand they are not alone in their suffering, and begin the hard work of addressing their spiritual distress related to their trauma. The goal of the groups is to help them find hope and meaning to keep taking the next best step forward.

I also serve as the co-chair for the Suicide Postvention Team. This team provides support for family, friends and staff who experience the death of a veteran by suicide, overdose or other undetermined means of death. I reach out to provide grief support, refer to resources in their area and lead memorial services to honor these losses. 

I provide support for staff through my work as the co-chair for our Critical Incident Stress Management team at the medical center. In this work, I lead a team of peer volunteers who provide crisis support to our colleagues in times of work and personal crisis. This important work provides a safe space for our colleagues to share the spiritual pain they carry with them as they are providing care for others. 

My work as a mental health chaplain inspires me daily to be a light of help, truth and healing in a world that is hurting. It continues to remind me that many of us carry invisible wounds that pierce our soul and threaten our mental and emotional stability. It reminds me our mind, body and spirit are integrated and affect one another which is why tending to the spiritual wounds is vital to our overall health and wellbeing.

Cindy Wallace is a board-certified chaplain with specialty certifications in Suicide Prevention, Critical Incident Stress Management and is a Certified Grief Specialist. Chaplain Wallace serves as the mental health chaplain at the Washington DC VA Medical Center. 

Additional Reading: 

Spiritual Care Week 2023: Chaplaincy & Mental Health (Renee Owen)
Spiritual Care Week 2023: Welcome to Spiritual Healing (Angel Lee)
Spiritual Care Week 2023: Learn to grieve well (Cari Willis)   Spiritual Care Week 2023: Towards Healing and Wholeness (Megan Pike)  Spiritual Care Week 2023: Workplace chaplaincy (Thomas Kelly Russell) Spiritual Care Week 2023: It’s healthy to get help (Michon McCorkle) Spiritual Care Week 2023: Pastoral Care: Nurturing Soul Freedom and Offering Self-Determination (Will Beaver)

Learn more about Spiritual Care Week here: https://www.spiritualcareweek.org/

References

Campos, K. (2021). What little we know: Peer-reviewed articles on the impact of United States Military culture on male victims of Military Sexual Trauma. Violence and Gender 8(2). DOI:10.1089/vio.2020.0072

McConnell, Kelly M and Pargament, Kenneth I. “Examining the Links Between Spiritual Struggles and Symptoms of Psychopathology in a National Sample,” Journal of Clinical Psychology, Vol. 62 (12), 4469-1484 (2006).

Stefa-Missagli, S., Unterrainer, H-F., Giupponi, G., Wallner-Liebmann, S-J., Kapfhammer, H-P., Conca, A., Sarlo, M., Berardelli, I., Sarubbi, S., Andriessen, K., Krysinka, K., Erbuto, D., Moujaes-Droescher, H., Lester, D., Davok, K., Pompili, M. (2020). Influence of spiritual dimensions on suicide risk: The role of regional differences. Archives of Suicide Research, 24(4), 534-553. https://doi.org/10.1080/13811118.2019.1639571