The Burden Left My Heart

Abstract

This paper presents psychosocial services for displaced women living in the war zones. Two study groups were formed from two cities in Croatia, Zenica and Tuzla. The services were designed to ameliorate distress and improve psychosocial functioning. A questionnaire-based evaluation indicated that highly distressed women derived greater benefit from group psychotherapy (Tuzla) than did the group who participated in occupational activities (Zenica).     

TRANSCENDING JUSTICE: Pope John Paul II and Just War

Pope John Paul II's opposition to the Iraq War was not that it failed to meet the conditions of Just War Theory. Indeed, we cannot tell from what he publicly said whether he thought it met those conditions or not, for he would have opposed it in any case. His thinking was rather that even just and necessary wars always come, as it were, too late, and are never able to solve the problems that made wars just and necessary. He was not trying therefore to enter into the details of Just War Theory. He wanted to subsume the principles of war into the principles of peace and to do so, not by denying justice, but by transcending it with charity. This article shows how this thinking is to be understood and the many means the Pope devised for putting this thinking into practice.     

Exposure to War Trauma, War-Related PTSD, and Psychological Impact of Subsequent Hurricane

This study explored the impact of psychological outcomes to war on response to subsequent natural disaster. Participants were 312 military personnel, 66% of whom saw Gulf War duty. All were exposed to the 1992 Hurricane Andrew. Troops were compared on reported traumatic events, hurricane impact responses, and psychological symptoms in subgroups defined by war or no war exposure prior to hurricane and by presence or absence of war-related posttraumatic stress disorder (PTSD). Data were gathered in face-to-face clinical assessments. War trauma prior to hurricane was associated with more reported traumatic events, greater fears for safety during the hurricane, and heightened psychological symptoms. Troops with preexisting war-related PTSD showed more adverse psychological hurricane sequelae and reported more traumatic events, higher depression, anxiety, anger, PTSD symptoms, and physical symptoms, and lower self-esteem than those free of diagnoses. Results point to the negative influence of exposure to one traumatic event on the experience of and response to a subsequent stressor.     

UNJUST WAR AND THE CATHOLIC SOLDIER

Roman Catholic teaching holds both that wars must conform to certain criteria in order to be considered morally justifiable, and that individuals are accountable for the moral content of their actions. Are Catholics serving in the armed forces therefore required to refuse to serve in unjust wars? Are they entitled—or obligated—to defer to the judgments of others as to whether a war is just? If so, whose judgment? I suggest that there are exceptional characteristics of military service that may factor in the formation of conscience as it is described in Catholic teaching. Specifically, just as the Church sees the indispensable role of the armed forces in protecting society as reconciling the use of force with the Catholic injunction to seek peace, so too may the indispensable role of obedience and deference to authority in the armed forces—while never supplanting the responsibilities of individual discernment—reconcile fighting in an unjust war with the obligations of conscience.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

Posttraumatic symptoms and growth of Kosovar war refugees: The influence of hope and cognitive coping

Research on war trauma has been dominated by a pathological focus for decades. Researchers have now counterbalanced studies of trauma with a new focus, positive changes following crisis. This prospective study examines how specific psychological factors might influence post-war adaptive outcomes (the coexistence of posttraumatic growth [PTG] and posttraumatic stress disorder [PTSD] symptoms) in a sample of 50 Kosovar war refugees. Individual differences in positive attitude and coping strategies were explored. Hope assessed during resettlement, and cognitive coping strategies, employed between resettlement and follow-up, were associated with PTG, controlling for war-related trauma and baseline symptoms. PTG and symptoms were unrelated. No predictors for present symptoms were identified. Future mental health practice with refugees should address both positive and negative aspects.     

What will the future bring? Thoughts of children after missile bombardment

Abstract

We examined how cognitive views of the future relate to degree of exposure to trauma and to posttraumatic stress reactions in children. Following the experience of Scud missile bombardment during the Persian Gulf war, 492 Israeli pupils from grades 5, 7, and 10 from regions actually hit and from regions under threat but not hit, described what they thought life would be like next year for children of their age. Based on recent cognitive theories, it was expected that children who experienced higher levels of stress would also express more pessimistic views of the future. We found that children's dominant perception of the future was positive. However, children who expressed stronger postwar reactions also tended to have more pessimistic future views, especially in areas that were hit by missiles. Discussion focused upon views of the future as a direct consequence of the stress as well as a means of coping with stress.     

Can the doctrine of just military intervention survive Iraq?

The disastrous consequences of the US-led invasion of Iraq in 2003 appear to discredit just war theories that justify military intervention in sovereign states in the name of human rights. It is possible, however, to identify factors that distinguish a defensible military intervention from the kind pursued in Iraq, and to incorporate these into a doctrine of humanitarian military intervention that would not have permitted the Iraq invasion. This improved doctrine stands in contrast to the militant interventionist doctrine that endorsed the invasion – a variant referred to here as the doctrine of just anti-totalitarian war (JAW). In order to critique the JAW doctrine and distinguish it from the improved doctrine, I examine critically the JAW-supporters' attempt to make sense of what went wrong in Iraq, and propose an alternative diagnosis. It is this alternative diagnosis that grounds a defense of moderate versions of the doctrine of just military intervention, which I seek in turn to render ‘Iraq-proof’. My Iraq-proof refinement is expressed in a list of injunctions. These require, among other things, critical interrogation of the moral standing of intervening powers and greater attention to the legitimate grievances of adversaries in regions targeted for intervention. They would also permit military intervention only in moral emergencies, and usually only to establish safe havens and protect relief supplies.     

Psychological Adjustment,Coping, and Emotion Regulation as Predictors of Posttraumatic Growth

Abstract

The present study examined factors contributing to reported benefits of traumatic experiences or posttraumatic growth (PTG) in a college sample. Specifically, we examined dimensions typically associated with trauma recovery (i.e., psychological functioning, coping, emotion regulation) and features of the trauma (i.e., number and recency of traumatic events, average, and maximal distress). Participants (N= 193) completed standardized questionnaires measuring these constructs. Results indicated that active coping and subjective well-being independently contributed to PTG, but social desirability and symptom distress were independent of growth. These results were consistent with study expectations. Although not specifically predicted, maximal trauma distress also uniquely predicted PTG. Contrary to expectations, effective emotion regulation did not contribute to PTG.     

Algorithm Versus Cut-Point Derived PTSD in Ex-Prisoners of War

This study compared symptom-based algorithm to cut-point scoring of the PTSD Checklist (PCL) in a sample of 504 World War II ex-prisoners of war not seeking treatment. There was relatively high correspondence ( = .80) between the scoring methods; the algorithm identified more participants as having PTSD than the standard cut-point of 50. Receiver Operator Curve analyses revealed that a cut-point of 42 distinguished optimally between the algorithm-defined PTSD and non-PTSD groups. An optimal scoring method might use both cut-point and algorithm, ensuring individuals have the symptoms necessary for a diagnosis and of sufficient severity.     

Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma

Breslau, Peterson, and Shultz (2008) reported that prior trauma alone, in the absence of PTSD, did not predict an increased PTSD risk, relative to no prior trauma. Only prior trauma that resulted in PTSD predicted an increased PTSD risk following a subsequent trauma. Recently, Cougle, Resnick, and Kilpatrick (2009) proposed that the effect of prior trauma might vary by type of prior trauma, a possibility not considered in Breslau et al. They report that childhood sexual or physical assault, in the absence of PTSD, increased the PTSD risk following a subsequent trauma. This report examines the PTSD effects of prior assaultive violence, using data from Breslau et al. (1998). The study assessed PTSD in relation to up to three events. Analysis was performed on the subset with PTSD assessment for two distinct events, the earliest trauma and a subsequent trauma (n = 967), using as reference persons with no prior trauma (n = 972). Neither prior assaultive violence nor other prior traumas, in the absence of PTSD, influenced the subsequent risk of PTSD. In contrast, prior PTSD increased considerably the PTSD risk of a subsequent trauma. The limitations in Cougle et al. (2009) and in this study and future research directions are discussed.     

Clinical Perspectives on Neurobiological Effects of Psychological Trauma

Physical trauma to the brain has always been known to affect brain functions and subsequent neurobiological development. Research primarily since the early 1990s has shown that psychological trauma can have detrimental effects on brain function that are not only lasting but that may alter patterns of subsequent neurodevelopment, particularly in children although developmental effects may be seen in adults as well. Childhood trauma produces a diverse range of symptoms and defining the brain's response to trauma and the factors that mediate the body's stress response systems is at the forefront of scientific investigation. This paper reviews the current evidence relating psychological trauma to anatomical and functional changes in the brain and discusses the need for accurate diagnosis and treatment to minimize such effects and to recognize their existence in developing treatment programs.     

The Forensic Examination of Posttraumatic Stress Disorder

Abstract

The diagnosis of posttraumatic stress disorder (PTSD) has achieved a major level of significance in our judicial system. The forensic examination of PTSD is identified as a specialized assessment that is non-biased and non-prejudicial. This article attempts to provide a standard methodology to offer an objective and neutral forensic assessment and diagnosis of PTSD that will stand up to legal scrutiny by identifying problems in diagnosing PTSD and establishing a six-step methodology for the differential diagnosis of the disorder. Procedures for providing a forensic examination of PTSD and details of the author's methods of providing a forensic examination are presented.