Active-duty military service members’ visual representations of PTSD and TBI in masks

Active-dutymilitary service members have a significant risk of sustaining physical and psychological trauma resulting in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Within an interdisciplinary treatment approach at the National Intrepid Center of Excellence, servicemembers participated in mask making during art therapy sessions. This study presents an analysis of the mask-making experiences of service members (n = 370) with persistent symptoms from combatand mission-related TBI, PTSD, and other concurrent mood issues. Data sources included mask images and therapist notes collected over a five-year period. The data were coded and analyzed using grounded theory methods. Findings indicated that mask making offered visual representations of the self related to individual personhood, relationships, community, and society. Imagery themes referenced the injury, relational supports/losses, identity transitions/questions, cultural metaphors, existential reflections, and conflicted sense of self. These visual insights provided an increased understanding of the experiences of service members, facilitating their recovery

Therapeutic Horticulture as a Healing Tool for Veterans

The Department of Veterans Affairs (VA) faces a plethora of challenges as it daily encounters and treats veterans. With a great prevalence of co-occurring diagnoses, veterans’ needs today are significant and arguably more complex than ever before (Clark, Bair, Buckenmaier, Gironda & Walker, 2007; Phillips et al., 2016). The following two papers seek to build a justification for reconsidering how post-traumatic stress disorder (PTSD) is treated given the illness’ prevalence and the efficacy of current treatments. The first paper reviews the literature and includes: a chronology of the PTSD diagnosis; an examination of current treatments offered by the VA and consideration of their effectiveness; a discussion of current and alternative treatments offered for PTSD; and an exploration of therapeutic horticulture as a healing modality for veterans coping with PTSD. After reviewing the historical and theoretical foundation for this research, the second paper details a mixed method study designed to better understand the depth and breadth of therapeutic horticulture programs that have been operationalized at VA facilities. Using survey and interviews of VA personnel, the author elicited information about VA therapeutic horticulture programs and was able to deduce themes related to the genesis of programs, details of programs’ operationalization and facilitation, and the impact on veterans. The author concludes the study with recommendations for those VA facilities considering implementing a therapeutic horticulture program along with an appeal that the VA begins to more earnestly consider the increasing body of evidence concerning the efficacy of therapeutic horticulture

Lived Experience of Military Mental Health Clinicians: Provided Care to OIF and OEF Active Duty Service Members Experiencing War Stress Injury

Military mental health clinicians (MMHCs) have been essential to Operations Enduring Freedom and Iraqi Freedom. They served in extreme stress conditions, including on the front lines. As co-combatant/clinician, the MMHC bridged unique perspectives on the effects of war stress experienced by Active-Duty Service Members (ADSMs). To date, no study has focuses uniquely on MMHCs narratives as they provided care from this multiple perspective. This investigation was carried out from a phenomenological perspective. A single, open-ended question was asked of seven MMHCs about lived experiences while serving, resulting in in-depth interviews. These were textually coded. Though clinician positive and negative experiences were consistent with previous research, significant differences bear discussion. Following data analysis, participants identified duty as the superordinate theme that led to the question, Duty to military mission or service member? This dilemma could not be reconciled that resulted in unrealized fulfillment of duty. MMHCs responses to unrealized duty defined an overarching polarity of Integrity-Corruption A hermeneutic approach was used to identify the author\u27s relevant understandings before, during, and after the interview process. In reconstructing and contextualizing interview material, one finding was that MMHCs were required to operate in a place of turbulence between contradictory military and psychological traditions. Another finding concerned a growing divisive fissure between military and the public at-large, impacting reintegration efforts for those who serve. Public and governmental silence about traumas of ADSMs and MMHCs suggests a parallel, cultural dissociation occurring about war trauma. A question is posed if diagnosing trauma as pathology is a further way that external, contextual forces are consistently kept unformulated, distanced or denied. Rather than locating the etiology and treatment entirely within the individual - resulting in blaming and isolating of those who serve - the suggestion is made for widespread discussion of socioeconomic and political factors that are behind psychological war injury. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLink ETC Center, https://etd.ohiolink.edu

Lived Experience of Military Mental Health Clinicians: Provided Care to OIF and OEF Active Duty Service Members Experiencing War Stress Injury

Military mental health clinicians (MMHCs) have been essential to Operations Enduring Freedom and Iraqi Freedom. They served in extreme stress conditions, including on the front lines. As co-combatant/clinician, the MMHC bridged unique perspectives on the effects of war stress experienced by Active-Duty Service Members (ADSMs). To date, no study has focuses uniquely on MMHCs narratives as they provided care from this multiple perspective. This investigation was carried out from a phenomenological perspective. A single, open-ended question was asked of seven MMHCs about lived experiences while serving, resulting in in-depth interviews. These were textually coded. Though clinician positive and negative experiences were consistent with previous research, significant differences bear discussion. Following data analysis, participants identified duty as the superordinate theme that led to the question, Duty to military mission or service member? This dilemma could not be reconciled that resulted in unrealized fulfillment of duty. MMHCs responses to unrealized duty defined an overarching polarity of Integrity-Corruption A hermeneutic approach was used to identify the author\u27s relevant understandings before, during, and after the interview process. In reconstructing and contextualizing interview material, one finding was that MMHCs were required to operate in a place of turbulence between contradictory military and psychological traditions. Another finding concerned a growing divisive fissure between military and the public at-large, impacting reintegration efforts for those who serve. Public and governmental silence about traumas of ADSMs and MMHCs suggests a parallel, cultural dissociation occurring about war trauma. A question is posed if diagnosing trauma as pathology is a further way that external, contextual forces are consistently kept unformulated, distanced or denied. Rather than locating the etiology and treatment entirely within the individual - resulting in blaming and isolating of those who serve - the suggestion is made for widespread discussion of socioeconomic and political factors that are behind psychological war injury. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLink ETC Center, https://etd.ohiolink.edu

A Disability Theology of Limits for Responding to Moral Injury

The lament of Jeremiah, “they dress the wound of my people as if it were not serious,” reverberates today as veterans return home from a decade of war, ridden by PTSD and moral injury, only to discover lethargy, lack of seriousness and complacency in societal response. The seriousness of our soldiers’ wounds, to body and spirit alike, demand ethical, societal and theological responsibility. Failure to address the seriousness of these wounds results in distress, depression and even suicide for the soldier. Statistics may describe a portion of the reality, but the degree to which soldiers suffer in silence and the wider circles in their lives (family, work, faith, civic responsibility) are affected is difficult, if not impossible, to assess. The emerging field of Moral Injury describes a wound created by social suffering and moral distrust wherein a soldier’s sense of what is morally right is compromised. The loss of a meaningful and moral worldview creates a shattering of moral identity both within the soldier and from the perspective of the solider to the outside world. While the precise contours of the field are still being navigated, what is clear is moral injury has a disabling effect on the individual, their circles of support and the wider society. My intention in this dissertation is to construct a revised “limit model” of Moral Injury drawing on the highly regarded scholarly work of Deborah Creamer’s “limit model of disability.” Her model critiques the medical and social models of disability and provides a constructive alternative of a “limit model of disability.” In addition, this dissertation nuances her model by resourcing Dietrich Bonhoeffer’s theological assessment of “limit” from his commentary on Genesis Creation and Fall. Situating Moral Injury within the limit model of disability will help provide pastoral resources and theological nuance to the individual veteran in distress due to moral injury. Two working hypotheses guide this study. First, moral injury carries within the ‘injury’ a theological component wherein a presenting wound for the veteran reveals a component of divine struggle. Whether that component regards providence, protection or lack thereof from a transcendent presence is yet to be seen. Second, theological work on moral injury has bypassed robust theological assessment of a theological anthropology, working Christology and overarching theology in order to move quickly toward nascent human need. The methodology needed to accomplish this task is fourfold. The first step is to create a working definition of moral injury by examining work across disciplines in the scholarship surrounding moral injury to determine a working definition of moral injury and its presenting characteristics. The second step is to draw alongside the discourse on moral injury contemporary understandings of disability, particularly from a theological perspective. Of particular interest to this study is the current project of Deborah Creamer who proposes a “limit model of disability” as an alternative to prevailing medical and social models of disability. The third methodological step vital to this project will be to draw into conversation the biblical theology of Dietrich Bonhoeffer who engages an extensive conversation on limits in his work Creation and Fall. The historical retrieval of his work will require an eye to the nuances of the German language, the context of the theological discussion at the time that necessitated his reflections, and the dogmatic theological method he engaged which allowed Scripture to be a place of divine revelation. In addition, Bonhoeffer’s conceptualization of limit offers a Christological account in addition to a theological anthropology and divine theology. Particular care will be taken to compare and contrast Creamer and Bonhoeffer in these areas with attention paid to the Christological addition Bonhoeffer suggests creating a threefold schema for anthropology, theology and Christology in the face of limits. This historical review will be key to understanding the particular nuances “limit” presents for Bonhoeffer and then drawing those into conversation with the disability theology of limit and its implications for moral injury. The final methodological step in this project will be to allow the conversation across these three areas to create constructive possibilities for our understanding of moral injury, its treatment and a theological assessment of the issues at hand. At stake in this conversation are the implications for practical and pastoral theology that the theological nuances will construe. This four-fold methodology will provide an overarching construct thereby allowing critical reflection on moral injury and the very real limits humanity faces in the midst of particular moral codes and their presenting crises. This cross discipline conversation will contribute to a deeper understanding of what moral injury is and how it must be both respected and addressed within our society and among our churches. Responding well, as ethicists, theologians and civilians, requires better understanding the transgression of moral limits a veteran experiences and the subsequent shame and soul-shattering repercussions of this injury. Responding well means medical treatment, when necessary, and social accountability beyond latent acceptance, but also a recognition of human limits and divine limitations within complicated moral dimensions. Bonhoeffer serves as helpful corrective to Creamer’s model in three ways: deepening the emotive space for anger, wrath, hatred and lament humans face when confronted with limits, offering a theological anthropology in the face of limits, and suggesting a Christology that upholds humanity in spite of limits through Christ’s “orders of preservation.” Moral Injury needs this model to transcend medical and social accounts of moral injury to a deeper theological account recognizing divine and human limits. Military Consultant David Wood calls moral injury “the signature wound of this generation.” Situating moral injury as a transgression of limits provides a helpful resource for moving beyond restrictive views of moral injury as a wound that can be treated medically through particular treatment, or as a socially inflicted lesion from the collapse of a particular moral world. Instead, a robust description of limits initiated by a conversation with the disability theology of Creamer and strengthened by the theological anthropology of Bonhoeffer can help moral injury be tended to in a socially serious and theologically astute manner

Free Form Creation vs. The Mandala and Their Effects on Veterans with Posttraumatic Stress Disorder: A Recreational Therapy Intervention

Objective— The objective of this study was to compare free form creation to the mandala and examine their effects on veterans with posttraumatic stress disorder (PTSD).Method— Data for this study was collected from 18 veterans who self-disclosed as being clinically diagnosed with PTSD. Veterans participated in either the creation of an unstructured mandala or coloring of a pre-drawn mandala as interventions, and free form creation as the control group. The PCL-5 was used to detect clinically significant change.Results— All the hypotheses were exposed through analytical and statistical analysis to be the opposite of what was expected. In terms of clinical significance, the free form group was superior over the unstructured mandala, with the pre-drawn mandala most inferior. However, there was no superior intervention individually or among groups related to statistical significance. Limitations and delimitations need to be taken into consideration when interpreting results.Conclusion— The results of this study demonstrated that free form creation delivers clinically significant reduction in the overall symptomology of veterans with PTSD. This thesis supports the theory that creative art modalities, which are free of structural form and autonomous in nature, show promising results as an alternative treatment for veterans with PTSD.International Studie

Teaching Trauma Theory and Practice to Master’s Level Counselors-in-Training: A Multiple Case Study

The purpose of this qualitative multiple case study was to understand how counselor educators (CEs) facilitate learning in their master’s level trauma theory and practice courses. The study addressed two research questions: (a) How do counselor educators choose which trauma content to address in master’s level trauma theory and practices courses? and (b) Which teaching methods do counselor educators utilize to facilitate significant learning in master’s level trauma theory and practice courses? Three CEs participated in this study. All three participants worked in CACREP accredited or aligned programs in three different regions (south, north central, north east). The participants had been employed as counselor educators from 3 years – 15 years. Data sources included two interviews each participant, an open-ended questionnaire completed by each participant, and document review of each instructor’s course syllabus and assignment descriptions. Three methods of teaching were consistent across the three Cases: lecture, discussion, and case study. Themes were examined within and across individual Cases. Case 1, Jade, chose course content and teaching methods based on responsivity to students, instructor awareness of contextual factors and current events, and embracing and capitalizing on instructor expertise and limitations. The hybrid format of the course, mentorship relationships, and program accreditation also impacted course design. Case 2, Jimmy, chose course content and teaching methods based on conceptualizing the role of students as advocates and his role as facilitator, the instructor’s experience, and choosing course methods to facilitate application of material. Additionally, the asynchronous online course format and the instructor’s conceptualization of Bloom’s Taxonomy impacted course design. Case 3, Alex, chose course content and teaching methods based on instructor clinical experience, creating course pedagogy focused on application, wanting to elicitstudent self-awareness, and various student influences. Additionally, the face-to-face format of the course and the use of a co-instructor impacted course design. Cross-case analysis indicated themes related to instructor role, instructor identity, methods of teaching that elicit fundamental change in the learner, and methods of teaching to develop student skill acquisition. Based on these findings, I provide implications for CE and recommendations for future research

“LET ME TALK MY SHIT”: EXPLORING RACIOCULTURAL TRAUMA THROUGH EMBODIED ARTS

This dissertation focuses on a qualitative study drawing on critical ethnography in conjunction with the self-reflective components of autoethnography, the critical race methodology of racial and counter-storytelling (Johnson, 2017; Solorzano & Yosso, 2002), and youth-centering components of Youth Participatory Action Research (YPAR) (Cammarota & Fine, 2010; Duncan-Andrade & Morrell, 2008; Torre et al., 2012). The purpose of this study was to explore the complex relationship between trauma, the lived realities of racially minoritized youth, and the arts. As theory-building research, this study sought to expand trauma theory toward raciocultural perspectives of trauma while expanding performance arts theory into an embodied understanding of performance arts. Moreover, this theory of trauma is based in the lived realities of racially minoritized youth as they live with and through trauma. In this way, trauma functions as a haunting for racially minoritized youth (Derrida, 2012; Gordon, 2008). Observations were conducted at a monthly open mic, L!t (pseudonym) that the researcher volunteered at for two years and hosted prior to gaining permission to conduct research. One cisgender woman and two queer women youth artists participated in the study, which consisted of 10 unstructured interviews held over the course of a year in the New England region of the United States. The participants and researcher identified as Puerto Rican, although one participant identified as bi-cultural and another participant identified as multi-cultural and were mentored by a Puerto Rican artist who was the founder of the monthly open mic, powerful community leader, and a member of the Nuyorican Literary Vanguard. Instead of focusing on pain narratives, this study focused on the various forms of power and wisdom that come from being haunted by traumatic experiences. Findings from this study reveal that participants use embodied arts as a means of therapy that is rooted in culturally sustaining practices. Participants also view performing embodied arts as a pathway toward disrupting the culture of silence around trauma that exists in their communities