A strong case could be made that marriages are the types of relationships that are most affected by Post-Traumatic Stress Disorder (PTSD). PTSD reaches all relationships, obviously, but think of a wife who has waded through the dark waters of trauma with her husband and now he is struggling with PTSD. It is not only the original trauma, but also the husband’s present struggle with PTSD that she is facing. Patience only lasts for so long before the wife needs some help and needs her husband to be who she married—at least that is what she starts to think. As much as she wants to support him, she also needs someone who can help around the house and help make ends meet. One wife said regarding her husband’s diagnosis of PTSD, “I’m in total disbelief. This is not the man I married.”1Military.com, “Is This PTSD or Does He Just Want a Divorce?,” accessed February 28, 2019, https://www.military.com/spouse/relationships/ms-vicki-is-this-ptsd-or-does-he-just-want-divorce.html.
Or think of the husband who is seeking to change and love his wife well while suffering with PTSD. One husband said, “I can’t be to her what she needs and she can’t be to me what I need. Our life paths had diverged too much and there was no foundation of trust or communication for coming back from the precipice.”2Combat Veteran’s With PTSD, “PTSD, Depression, and Divorce—When Too Much Water Has Passed Under the Bridge,” October 16, 2014, accessed February 28, 2019, https://www.combatveteranswithptsd.org/blog/ptsd-depression-and-divorce-when-too-much-water-has-passed- under-the-bridge This husband is tempted to ask—“can I be who she needs me to be? Would she be better with someone else?” At no fault of the wife, the husband can believe that she needs someone other than him. PTSD has made him ineffective as a husband, at least from his perspective.
Yet, marriages do not make it “through” PTSD, per se. Even though a marriage does not make it “through” PTSD, a marriage can be equipped to face PTSD even if PTSD and its symptoms never leave their marriage. This essay aims at speaking to marriages that are facing PTSD. My thesis is that to help marriages facing PTSD, we must equip husbands and wives with a theological understanding of suffering, a biblically-rooted anthropology, and a biblical epistemology. Perhaps these seem a bit esoteric, but I will demonstrate the relevance of each as we progress through this essay. I attempt to demonstrate that a theology of suffering entails the couple knowing how to appropriately view their trial, that all of the conversations regarding PTSD have an implicit anthropology, and finally that a biblical epistemology is necessary to frame a correct response.
A theology of suffering is necessary for the married couple facing the implications of a PTSD diagnosis.3Bob Kellemen started using this exact term, but the idea is a good theology of suffering in God’s Healing for Life’s Losses: How to Find Hope When You are Hurting (Winona Lake, IN: BMH, 2010). I hope to offer a few aspects to you through a critique of my essay title, my book title, and a brief historical overview of PTSD. If you view PTSD as a form of suffering, it gives you hope and understanding that God works in the midst of and through suffering.
Next, we help marriages as we commit to a biblical anthropology. PTSD has an uncanny ability to force us to re-evaluate what we believe about people and their responses in suffering. What of human responsibility? What of the body/soul interplay? How does one spouse respond to their spouse with PTSD? What you believe about a person will shape your care for that person. If your anthropology wanes, then the methodology for helping people will also wane.
Finally, one should consider the epistemological loyalties that are the truth claims and commitments of the marriage. Who will be their authority for truth? If the couple lets Veteran’s Affairs (VA) be their ultimate epistemological authority, it will dictate their response and ministry. Or, if they let their criterion for PTSD be their epistemological authority, they will suffer. We as biblical counselors are seeking to offer a biblical epistemology that will equip them to respond faithfully.
A Theology of Suffering
A Teleology of Suffering
Our first priority is to frame a right theology of suffering for a marriage facing PTSD. Just to be clear in this topic, as I mentioned above, a person does not make it “through” PTSD. And that’s not really the end goal. A theology of suffering recognizes that making it “through” PTSD isn’t the goal, but honoring God in the time of suffering is (Rom. 5:3-5). Paul says in Romans 5 that our trials are used to cultivate endurance and patience. We must be accurate in this perspective of suffering: we are not trying to help couples make it through PTSD but are seeking to help them respond to PTSD in a way that honors the Lord. If you understand PTSD to be suffering, then your goal is not to get them out of the suffering but to respond in a way that pleases the Lord in their suffering (1 Pet. 5:10).
No Temptation Is Totally Unique
Second, Curtis Solomon, director of the Biblical Counseling Coalition, talks about the importance of 1 Corinthians 10:13 regarding PTSD. Solomon says that PTSD is not “uncommon” to man and that others have gone through this experience.4Curtis Solomon, Institute of Biblical Counseling and Discipleship Annual Pre-Conference, San Marcos, CA, “PTSD: Helping the Individual Through PTSD,” June 24, 2018. I agree with him, and he is hinting at a mutual experience of suffering. Perhaps PTSD is more common than we have even emphasized?5For instance, The Wall Street Journal published an article recently that suggested parents of ill children are demonstrating signs of PTSD. The article is describing that what was once known only to soldiers is now becoming a more common place with parents of children facing long-term illnesses. “Historically, psychiatrists didn’t consider medical diseases traumatic events. In 2000, the profession’s official handbook of diagnoses—the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders—explicitly added ‘life-threatening illness’ as something that might trigger PTSD in patients and their loved ones” Wall Street Journal, “For Parents of Ill Children, A Growing Recognition of PTSD,” February 19, 2019. Let me explain that for a moment. Dietrich Bonhoeffer spoke of this idea of helping others in his letters and papers from prison, “The Church is the Church only when it exists for others … not dominating but helping and serving. It must tell men of every calling what it means to live for Christ, to exist for others.”6Dietrich Bonhoeffer, Letters and Papers from Prison.
Many are probably familiar with Dietrich Bonhoeffer and would agree with his assessment that the church cannot have a myopic focus, but must have one that seeks to live for the glory of Christ and good of others. What you are probably unfamiliar with is Bonhoeffer’s connection to PTSD. Karl Bonhoeffer, Dietrich’s father, was engaged in a public debate regarding PTSD in 1916, over 100 years ago. Essentially, Karl Bonhoeffer is bringing out this commitment that we must help others, including married couples, facing PTSD.
Eric Metaxas said that Dietrich was born into a family of high accomplishments, and yet was not overwhelmed by that fact.7Eric Metaxas, Dietrich Bonhoeffer: Pastor, Martyr, Prophet, Spy (Nashville, TN: Thomas Nelson, 2010), 7. Perhaps this is true because Karl was a leading psychiatrist who lived and studied in Tubingen, under the direct mentorship of Carl Wernicke. It was during this time that he “was elected chair of the Department of Psychiatry at the University of Breslau/Wroclaw Mental Hospital.”8Andreas StröhleJana, “Karl Bonhoeffer (1868-1948),” The American Journal of Psychiatry 165, no. 5 (2008): 575–76. In 1912, Karl Bonhoeffer moved to Berlin where he was elected the chair of psychiatry and neurology at Charité Hospital.9IBIC
Hermann Oppenheim’s Proposition and Rejection in 1916
What is noteworthy about this Bonhoeffer transition is that in February of 1916 six leading medical doctors, neurologists, psychiatrists, and soon-to-be psychologists met in Berlin to discuss traumatic and war neuroses.10Hermann Oppenheim, Schuster, Karl Bonhoeffer, Hugo Liepmann and Karl Birnbaum. Bernd Holdorff, “The Fight For ‘Traumatic Neurosis’, 1889-1916: Hermann Oppenheim and His Opponents in Berlin,” ed. Tom Dening, History of Psychiatry 22, no. 4 (2011): 471. Table 2. Diverse concepts of traumatic neurosis (war neurosis) in the Berlin debate of February 1916: The meeting was gathered to discuss the findings of a man named Hermann Oppenheim who coined the terms Traumatischenneurosen and Kriegsneurose, which literally translates as “War Neurosis.”11Hermann Oppenheim, Textbook of Nervous Diseases for Physicians and Students (London: Otto and Schulz Company, 1911), 814, FN1. Although some mockingly referred to it as pension neurosis because of an epidemic in 1889 when one would be paid a pension for their post-traumatic neurosis after being injured in the railway.12[In 1889] “The Imperial Insurance Office granted post-traumatic neuroses the status of actionable conditions. … Before long the 1889 act was held responsible for the epidemic appearance of pension neurosis (Rentenneurose), a widespread addiction to compensation that seemed to sap the productive potential of the German workforce” (33) in Paul Lerner, Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890- 1930 (Ithaca & London: Cornell University Press, 2003). Oppenheim wrote and researched primarily from a medical perspective and particularly focused on the undergirding neurology when he published his Textbook for Nervous Diseases for Physicians and Students in the late 1800s.13Hermann Oppenheim, Textbook of Nervous Diseases for Physicians and Students (London: Otto and Schulz Company, 1911). It was this book where Oppenheim started using the term Traumatic Neurosis, which he stated to be “accidents where physical trauma is associated with mental shock.”14Oppenheim, Textbook of Nervous Diseases for Physicians and Students, 1163. “Mental Shock–fear and excitement plays an important part in the etiology of this morbid condition; indeed, it is the sole cause of the trouble in some instances. Accidents in which a physical trauma is associated with a mental shock, as in a railway accident, are specially liable to produce this neurosis. These have indeed been the main source of our knowledge of traumatic neurosis” (1163). Hermann Oppenheim started using the term Traumatic Neurosis to explain the patients he studied who first suffered from railway injuries, but then his studies also focused on soldiers engaged in the recent wars. Oppenheim was not proposing the modern-day equivalent of PTSD but was the one who developed the terminology and original thinking regarding PTSD.15As regards Oppenheim’s organic view, we cannot equate his traumatic neurosis with the contemporary concept of post-traumatic stress disorder (PTSD) because its clinical picture is predominantly a neurological or quasi-neurological one (see Table 1) rather than a psychiatric category such as PTSD. Oppenheim (1917, 1918) maintained that the principal features of traumatic neurosis were neurological or quasi-neurological syndromes like muscle cramps (Crampusneurose), different forms of trembling such as ‘pseudo-spastic paresis with tremor,’ ‘reflex paralysis’ or ‘reflex epilepsy’” (473). Bernd Holdorff, “The Fight For ‘Traumatic Neurosis’, 1889-1916: Hermann Oppenheim and His Opponents in Berlin,” ed. Tom Dening, History of Psychiatry 22, no. 4 (2011): 473. It was his ideas that Karl Bonhoeffer, Dietrich’s father, discussed with others in Berlin in 1916. Each man at this colloquium offered his own perspective of Oppenheim’s work, and each came to different conclusions on the subject.16Holdorff, 471.
Hermann Oppenheim was all but condemned at this conference in February and would later that year debate Karl Bonhoeffer directly regarding Traumatic Neurosis. During Oppenheim’s second debate with Bonhoeffer, Oppenheim felt provoked. Bonhoeffer was arguing that if traumatic neurosis was accepted as having unknown organic causes, it would only make the matter worse—supporting his conclusions with information from nine different patients.17At the meeting of the Berlin Society for Psychiatry and Neurology Bonhoeffer and Oppenheim engaged in their first ‘confrontation’ on this topic. Bonhoeffer reported on nine cases with hysteric paralysis following shell explosions (referred to as ‘shell shock’ in English, the new horror of war); the symptoms were astasia and abasia, speech loss, functional trembling, shaking, wide amplitude twitching and vegetative disturbances. ‘The worst were those who went to the military hospital or their relatives under the wrong flag as severe organic cases and could abandon themselves completely.’ He considered it dangerous ‘if unclear conceptions of organic brain damage seize these cases’, as this was already known from earlier pension hysteria. Oppenheim felt provoked by this; he reminded the audience of his research conducted some 25 years earlier, in particular with railway accidents, ‘which led to the much fought over theory of traumatic neurosis.’” Bernd Holdorff, “The Fight For ‘Traumatic Neurosis’, 1889-1916: Hermann Oppenheim and His Opponents in Berlin,” ed. Tom Dening, History of Psychiatry 22, no. 4 (2011): 468– 469. Bonhoeffer demonstrated that if a person were to “abandon themselves completely” (as some with traumatic neurosis were doing) it would only exacerbate the problem. Perhaps we could find Bonhoeffer’s comments strikingly relevant to today’s PTSD conundrum? It was at this final debate that Oppenheim would become frustrated and slowly withdraw himself from the conversation and public practice.18 At the end of the long debate, Oppenheim found himself disappointed and isolated and in the end he resigned as President of the Gesellschaft Deutscher Nervenärzte (Society of German Nerve Doctors). He also gave up his practice at the reserve military hospital in the Kunstgewerbemuseum “Museum of Applied Arts and Crafts” (471) in Bernd Holdorff, “The Fight For ‘Traumatic Neurosis’, 1889-1916: Hermann Oppenheim and His Oppenents in Berlin,” ed. Tom Dening, History of Psychiatry 22, no. 4 (2011).
Freud’s Budapest Summit in 1918
Karl Bonhoeffer effectively ended the conversation for two years until Sigmund Freud organized a conference in Budapest with The Fifth International Congress on Psychoanalysis on September 28-29, 1918.19“After WWI, Bonhoeffer (1922, 1926)––together with Ewald Stier and William His, Jr—favoured the offering of capital compensation, ‘because it is not a remuneration, but a cure, the only well-known cure’ and he pleaded for finally abolishing ‘the so-called traumatic neurosis,’” in (Holdorff, 472). The topic of this conference was, “War Neurosis and Psychoanalysis.” One author noted, “In 1915 there was only one meeting concerning this topic [traumatic neurosis], but in 1916 it was on the agenda of no fewer than four. Undoubtedly the most significant and exciting session was on 14 February 1916, where Oppenheim defended his concept of traumatic neurosis.”20Bernd Holdorff, “The Fight For ‘Traumatic Neurosis’, 1889-1916: Hermann,” 469. Oppenheim and His Opponents in Berlin,” ed. Tom Dening, History of Psychiatry 22, no. 4 (2011): 465–476
At Freud’s summit in 1918 two years later, Oppenheim’s ideas were used and critiqued.21S. Ferenczi et al., Psychoanalysis and the War Neurosis (The International Psychoanalytical Press, 1921), 1. “When the subject came up for discussion at the Fifth Psycho-Analytical Congress at Budapest (September, 1918), official representatives of the Central European Powers were present to obtain information from the lectures and discussions” (1). The Fifth International Congress on Psychoanalysis was held in Budapest on September 28 and 29, 1918, and Freud spoke on “Wege Der Psychoanalytischen Therape” (The paths of psychoanalytic therapy)—an essay that was to have considerable influence on the evolution of the psychoanalytic movement in the next few years. Of note, Freud would perpetuate the idea of trauma and war neuroses, suggesting his own reasons for trauma. What I want you to see in this survey is that these two conversations were both about anthropology. Oppenheim suggested an anthropology, Bonhoeffer suggested an anthropology, and Freud offered an anthropology. As will be demonstrated, anthropology is everything in the care of a person facing PTSD. But for now, you can see that these conversations about War Neuroses and PTSD are not anything new (these two summits happened 100-plus years ago).
A theology of suffering is one that demonstrates to those facing PTSD that there is not anything uncommon to them. Other couples have faced PTSD, and a right theology of suffering is that their trials are not totally unique to them.
Of note, however, is that both of these were summits that centered around anthropology. Oppenheim had a heavy body/neurological emphasis and Freud had an immaterial, traumatic interpretation emphasis.22The conflict is between the soldier’s old peaceful ego and his new warlike one, and it becomes acute as soon as the peace-ego realizes what danger it runs of losing its life owing to the rashness of its newly formed parasitic double.” It would be equally true to say that the old ego is protecting itself from a mortal danger by taking flight into a traumatic neurosis or to say that it is defending itself against the new ego which it sees is threatening its life (209). [Freud argues that a conflict in the ego is what causes war neuroses (209)]. The solution to war neurosis is a professional army from Freud’s perspective (209), while he even commends the potential of a shock therapy. Sigmund Freud, The Standard Edition of The Complete Psychological Works of Sigmund Freud, vol. XVII (London: Hogarth Press, 1955), 214. Freud demonstrated how electric shock was part of the treatment for those with “war neurosis” in Germany (213-214). He claimed that the shock was primarily a punishment that encouraged the soldiers to go back to the front lines, which in turn led towards increasing voltage as patients refused to stay on the front lines. Oppenheim’s theories faded, but much of what Freud taught continues to this day.23For a resource demonstrating the connection of PTSD to War Neurosis cf. Wilbur J. Scott, “PTSD in DSM-III: A Case in the Politics of Diagnosis and Disease,” Social Problems 37, no. 3 (1990): 294–310. For instance, modern definitions of PTSD have a heavy emphasis on the “mental shock” component, which is something that Oppenheim suggested but Freud solidified. The VA says of PTSD that it is “a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault” in Veteran’s Affairs, “What is PTSD?”, accessed May 11, 2018, https://www.ptsd.va.gov/public/ptsd-overview/basics/what-is-ptsd.asp. Also cf. Sidney S. Furst, ed., Psychic Trauma (New York: Basic Books, 1967).
Within the conversation of PTSD, anthropology is paramount in counseling and a proper theology of suffering—even demonstrated in these summits—is that PTSD is something common to man. A theology of suffering that bolsters faithfulness will understand that PTSD is not new. Now, however, we must emphasize what you believe about people will shape the way that you care for them.
Embedded in the conversation of PTSD, and how to help the marriage facing PTSD, is a strong battle for what we believe about human nature. Our anthropological commitments are evidenced in this. Really, methodology for helping couples is intimately connected and reliant upon anthropology.
In meeting with a counselee who experienced PTSD from the wars in Iraq, I noted the importance of anthropology. He did not have significant flashbacks, or re-experiencing symptoms, there was no hyper-arousal, but military doctors diagnosed him as having PTSD from his time in Iraq from 2012-2013, based on his anxiety and decision-making. He described it as a fog that he was in and he also became anxious about very basic, everyday decisions. This is a common experience among those who have been diagnosed with PTSD.
Furthermore, he used alcohol to address his anxieties. He would go to alcohol in order to sedate his life because of the anxieties he was experiencing. But his alcohol use led him toward lying and extreme defensiveness with his wife. The issue comes down to this—what you believe about this man will determine the way you care for him. If you truly understand people as living out their heart attitudes, then you understand that the alcohol and the anxieties are merely symptomatic (Prov. 4:23; Matt. 12:34). There is a heart-level problem with this man. Your anthropology and your methodology are inseparable.
There are a few aspects of this that I want to mention and two anthropological emphases that I want to elaborate upon. First of all, we must assume—in some way—that the married couple facing PTSD understands a few fundamental aspects about themselves: (1) Their actions overflow from their heart (Prov. 4:23), (2) They are created in God’s image (Gen. 1:27), and (3) They are worshipers (Rom. 1:25). I want to, for the sake of brevity, assume these to be true. However, I recognize there are other aspects that need to be highlighted among the murkiness of PTSD. One anthropological insight that should be highlighted is the body/soul interconnectedness.
Historically there are those who have emphasized the body (i.e., Hermann Oppenheim) and those who have emphasized the immaterial (i.e., Sigmund Freud) when caring for PTSD. The married couple going through PTSD needs to know that the Bible places great emphasis on the complex unity of the inner and outer man.
For instance, Psalm 32 presents a scenario where David harbors sin to the effect that his own physiology is influenced (v. 3). Additionally, Elijah faced great physical trials, and the corresponding effects of those trials of the body had an impact on his inner man (1 Kings 19:4). We see Paul describe an external deterioration, yet an internal maturation: the body wastes away, but the inner man is renewed (2 Cor. 4:16). Anthony Hoekema would call us a “psychosomatic unity” to describe the distinct interconnectedness of the inner/outer man.24Anthony Hoekema, Created in God’s Image (Grand Rapids, MI: Eerdman’s, 1986), 217. I prefer John MacArthur’s understanding of the this as a “complex unity” as it represents the same idea but is more palatable when it comes to spelling!25John MacArthur, Biblical Doctrine (Wheaton, IL: Crossway, 2017), 424. The married couple needs to know that we cannot bifurcate the soul and body, and that a proper plan for ministry is one that includes attention to the physiology while emphasizing inner man renewal.
First of all, we are not counseling physiological responses. Startled reaction, hyper-vigilance, and insomnia are not inherently wrong. In fact, those physiological issues may be used by God to refine a person’s faith (2 Cor. 12:9).26Paul demonstrates that God, at times, chooses to give physiological challenges for the sake of greater dependency on him. Hyper-vigilance is a potential means of refining a counselee, so our goal is to equip them with godly responses even when they sense a hyper-vigilance. However, we do not aim at taking away hyper-vigilance alone. Our goal is not to rid the marriage of any seemingly abnormal hyper-arousal or reactivity struggles. Our goal is to help the individual with PTSD respond to arousal in a way that honors the Lord. At the moment when fear is feeding their insomnia, that is when we take God’s sufficient word to understand fear and how they can address their fear, which will address their insomnia.
The last implication of our anthropological unity is that neither an emphasis on body-only care or an emphasis on soul-only care in PTSD are entirely correct. When we over-emphasize one aspect of our humanity, we underemphasize the other aspect. Meaning, it should invoke great pause when someone wants to approach PTSD as entirely a material/body-only issue. Augustine said it this way, “We ought not, therefore, to blame our sins and defects on the nature of the flesh, for this is to disparage the Creator. … [On the contrary] Anyone, then, who extols the nature of the soul as the highest good and condemns the nature of the flesh as evil is as carnal in his love for the soul as he is in his hatred for the flesh, because his thoughts flow from human vanity and not from divine Truth.”27Augustine, City of God (New York: Image Books, 1958), 302; Chapter 3, Book 14. This is what is happening in modern research where grey matter is being suggested as the cause of PTSD or a form of shock treatment is employed.28Scott Pelley, “How IEDs May Be Physically Causing PTSD,” 60 Minutes, CBS News, April 1, 2018, https://www.cbsnews.com/news/brian-mancini-brain-how-ieds-may-be-physically-causing-ptsd/. Also see L. Meng et al., “Trauma-Specific Grey Matter Alterations in PTSD,” Scientific Reports, 6, no. 33748 (n.d.), http://doi.org/10.1038/srep33748 and Henry Howard, “Electrical Stimulation Treatment Helps PTSD Patients,” The American Legion, April 16, 2018, https://www.legion.org/veteranshealthcare/241722/electrical-stimulation- treatment-helps-ptsd-patients. Thus, entirely physiological methods are employed to help this person.
However, an entirely soulical emphasis is also imbalanced. If we really are embodied souls, then we must understand that soulical issues can and do affect the body. There is no need for consternation on this. As biblical counselors, we know that the body cannot make a person sin, and that we are called to help a person make an appropriate inner man response even if their outer man is encouraging sinful actions (i.e., hyper-arousal leading to aggression).
A balance of the etiology of PTSD is one that is a both/and. No one is absolutely certain why specific people develop PTSD and others do not.29This claim is demonstrated in a simple definition of what is trauma and by a lack of conclusive evidence for how one determines an event to be traumatic. For instance, Christian integrationist Mark Yarhouse and Edward Butman, “Any extraordinary trauma can cause a stress disorder. But the event alone cannot explain why some people develop a trauma or stress disorder and others do not. Conventional wisdom assumes that it is a synergistic combination of biological, psychosocial and sociocultural factors that form the ‘critical mass’ necessary for a stress reaction to become pathological” (Worden, 1996, 2008; p. 250)” in Barrett W. McRay, Mark A. Yarhouse, and Richard E. Butman, Modern Psychopathologies : A Comprehensive Christian Appraisal, vol. Second edition, Christian Association for Psychological Studies Books (Downers Grove, IL: IVP Academic, 2016), https://ezproxy.masters.edu:4443/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=13 61652&site=ehost-live&scope=site. My claim has consistently been that it is highly interpretive.30Cf. Greg E. Gifford, Helping the Family Through PTSD (Eugene, OR: Wipf and Stock, 2017). However, a wise posture toward sinful/sanctification responses of PTSD should reflect the original corruption of mankind in Genesis 3, where the soul corrupts the body. Or the cry of the saint in 2 Corinthians 4:16-5:5, which gives primary credence to the soul. If you desire an empirical suggestion of the body/soul interaction in sin/sanctification, an Augustinian perspective would say something like 51% soul, 49% body.31Cf. Augustine, City of God, “Our faith teaches something very different. For the corruption of the body, which is a burden on the soul, is not the cause but the punishment of Adam’s first sin. Moreover, it was not the corruptible flesh that made the soul sinful; on the contrary, it was the sinful soul that made the flesh corruptible” (299; Chapter 3, Book 14). A healthy balance in sin/sanctification responses in PTSD is one that gives primary credence to soulical responses. Soulical responses lead to sanctification, but it’s still an embodied soul.
If we really want to help couples facing PTSD, we can equip them with a biblical anthropology and help them discern their responses in light of that anthropology. This leads to my last anthropological emphasis: personal responsibility.
If you understand the complex unity of people, then you also grasp that a person has been set free from the power of sin (Rom 6:18) even though they may have great physiological encouragements toward sinful responses. Yet, a married couple needs to know that God has both given them the grace to honor him and will hold them accountable for their own responses (1 Cor. 10:13; Heb. 9:27).
I was counseling a married couple that, when the husband struggled with PTSD symptoms, he would take too much medicine and pass out in the living room. Thus, leaving his wife to take care of the children and domestic responsibilities. He was an ex-special operations soldier and would allow for the encouragements toward sinful responses to reign over him during moments of temptation. The answer is that God has provided him the grace to do what is right in that moment, and God will hold him accountable to those responses.
One of the worst things that we can do is off-load personal responsibility from those suffering with PTSD. Even the liberal Germans of the Twentieth Century recognized that when you take away personal responsibility, you exacerbate the problem itself!32[In 1889] “the Imperial Insurance Office granted post-traumatic neuroses the status of actionable conditions. … Before long the 1889 act was held responsible for the epidemic appearance of pension neurosis (Rentenneurose), a widespread addiction to compensation that seemed to sap the productive potential of the German workforce” in Lerner, Hysterical Men, 33 It doesn’t mean the capacity is the same as before the trauma, but you must recognize that a person’s responsibility to please God does not change if they are struggling with PTSD. Our anthropology does not need to waffle if we understand people can honor God in the middle of PTSD. This is an anthropological commitment that we must never forfeit. As soon as we give on human responsibility, we become extraordinarily unhelpful to our counselees.
Francis Schaeffer said, “Unless we get our epistemology right, everything else is going to be wrong.”33Francis Schaeffer, Francis A. Schaeffer Trilogy: The Three Essential Books in One Volume (Wheaton, IL: Crossway, 1990), 275. When we speak of an epistemology, we are speaking of what we believe about knowledge and how we know what is true. We are speaking of epistemic authorities; how do we validate truth claims? Every marriage has epistemological commitments. Some marriages are committed to the truth of medical science, of their counselor, pastor, or a Veteran’s Affairs therapist. What is noteworthy is that all marriages have certain epistemological commitments, and the contribution that we can make is to help them see their commitments and demonstrate the call to place the Scripture as the authoritative truth in their epistemology.
The waters are muddied for couples because there are competing sources of truth in their lives. Some sources of truth would suggest that the husband, for instance, cannot control his angry outbursts—he has angry outbursts because of PTSD, after all. So we just need to learn how to cope when he struggles with angry outbursts. Other sources of truth would claim that there are entirely biological origins to their spouse’s PTSD. How do we help them? We help them establish a biblical epistemology. In so doing we will clarify at least two dynamics for them: (1) the authority of God’s Word over experience, and (2) the call to obey truth over their own emotions.
The Authority of Truth over Experience
The Process of Reorientation to Truth
1 Peter 1:16-20: The context of this passage is that Peter was working through the role of God’s Word and he compares it to one of the magnificent experiences he had with Jesus during his earthly ministry—the transfiguration. 1 Peter 1:16-20 says:
For we did not follow cleverly devised myths when we made known to you the power and coming of our Lord Jesus Christ, but we were eyewitnesses of his majesty. For when he received honor and glory from God the Father, and the voice was borne to him by the Majestic Glory, “This is my beloved Son, with whom I am well pleased,” we ourselves heard this very voice borne from heaven, for we were with him on the holy mountain. And we have the prophetic word more fully confirmed, to which you will do well to pay attention as to a lamp shining in a dark place, until the day dawns and the morning star rises in your hearts, knowing this first of all, that no prophecy of Scripture comes from someone’s own interpretation.
Peter reminds his readers of the spectacular experience of the transfiguration. He, himself, witnessed Jesus being transformed and appearing with Moses and Elijah! Note three things of significance: he visibly saw the transfiguration of Jesus, he audibly heard the voice of God, and physically felt the touch of Jesus to calm him in his fears. Peter had this multi-sensory experience that is pretty hard to rival. However, listen to the words of Peter as he talks about this experience: “we have something more sure” (v. 19). We see that experience as spectacular, but not authoritative. Literally the idea is that the word of God is “more reliable” than their experiences, even their grandiose, spiritual, positive experiences.
We equip couples with this understanding that what God says about them is more authoritative than what they say about themselves. Literally, they may have experienced the most grandiose of spiritual moments, or one of the lowest and most terrible experiences of their life. In either case, those experiences are still not as authoritative as God’s Word. This is a biblical epistemology, one that says we will ascribe epistemic authority to God’s Word first. We want to teach marriages what Peter is saying here: your experience is important, but it is not authoritative. God’s Word is authoritative.
God’s Word is authoritative over your trauma. God’s Word is authoritative over your experiences! We help marriages who have a loved one with PTSD by showing them that God’s Word is authoritative over their experience. They cannot trust their experience as being authoritative. We help marriages facing PTSD by pointing them to trust in what God says, over what they say. An outworking of this in their epistemological commitments is that they will seek to walk by truth over their feelings.
Truth Led vs. Feelings Led
If Scripture is your epistemic authority, then you will seek to walk by it first-and-foremost. This is the historical approach where Jay Adams would use a train engine and caboose to represent an epistemological commitment, and a willingness to pursue it over one’s feelings.34Cf. Jay Adam’s, A Christian Counselor’s Manual (Grand Rapids, MI: Zondervan, 1973), 296-98. Also cf. Ron Allchin’s “Feelings versus Faith Motivation Worksheet,” Biblical Counseling Center, Arlington Heights, IL. And finally, Brian Borgman’s, Faith and Faith: Cultivating Godly Emotions in the Christian Life (Wheaton, IL: Crossway, 2016). The marriage with PTSD must orient itself toward truth. Truth enters the world of emotions and organizes thoughts. “What if I had done this? I should have just done that. If only they would not have . . . .” In my book, Helping Your Family Through PTSD, I seek to explain the implications of orienting oneself toward truth in regard to guilt, regret, rehashing, reliving, and some of the other intensely emotional experiences. But first we must start with the premise that truth is the beacon of light shining through the fog of interpretation. Even when we do not know what lies around the next turn, we can still see the direction of the light.
Truth must always be the guide in both our lives and the lives of our family members. One way that I like to describe that process is using the links of a chain. If you pull the first link in a chain, the remaining links will follow. Yet, if you push the last link in an effort to move the chain forward everything gets out of alignment. In the same way, our family members must know that when truth leads their life—not feelings—they will be moving the direction God wants them to move, which is toward greater Christlikeness (2 Cor. 5:7). But if they try to push forward with their feelings, life gets pretty messy.
If your epistemological commitments are to the VA and their suggested treatment, then you will not hold the Scriptures in their proper authority. Yet, when you recognize that Scripture is to be held with highest authority it warrants your allegiance and obedience. This is the idea of walking by faith and not feelings. The bottom line is that biblical truth must guide feelings, or to say it another way: truth must interpret and direct feelings. We call marriages to push forward from PTSD by walking in faith, not by feelings (2 Cor. 5:7, 9). Yes, their feelings may not currently line up with truth, but their feelings will—eventually. And even if their feelings never align, we cannot succumb to the temptation to invert this process and let feelings steer their response. We call them to walk by faith, not feelings. This is an epistemological commitment that we are calling marriages to make.
In conclusion, if we are going to be a help to marriages facing PTSD, we must equip them with a right theology of suffering, a biblical anthropology, and a biblical epistemology. You have seen that the problem of PTSD is not anything new, as the Bible describes it to be something that is “common to man” (1 Cor. 10:13). I’ve argued that it is perhaps more common than we have understood—even demonstrating this to be true from a historical perspective.
And in the commonality of PTSD, there is an implicit anthropology for the one with PTSD. They are seen through a certain lens and how you view people will affect how you minister to them. When we contribute a right theology of suffering, we call marriages to make certain epistemological commitments. If the married couple facing PTSD holds Scripture as their epistemic authority, then they will walk by truth in their struggle with PTSD. As said before, our goal as counselors is not to help a married couple “through” PTSD, but to honor God in their response toward PTSD. May He count us faithful for that.