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Sermon for the Second Sunday in Lent – February 17, 2008
Appearing in various cultures over the course of untold centuries – the earliest recorded reference to it is by the ancient Greeks; called by a variety of names – “shell shock,” “battle fatigue,” and now “Post Traumatic Stress Disorder” or PTSD – all who suffer from and all who treat this ailment agree on one thing: it exacts a harsh toll; it goes largely untreated and it’s worse at night, much worse. God knows this current generation has seen its share.
A recent study in the New England Journal of Medicine reported that of soldiers returning from active duty in Iraq, some 11 to 17 percent met the criteria for PTSD, which includes disturbed sleep. To give some perspective, rates of this disorder among the general adult population in this country are three to four percent. Due to the threat of stigma, most members of the armed services will never receive treatment. The study’s authors say that “In the military there are unique factors that contribute to the resistance to seeking help, particularly concern about how a soldier will be perceived by peers and by the leadership.”
It’s been that way for a long time.
Towards the end of World War One, Dr. W.H.R. Rivers delivered an address to the Royal Society of Medicine in London called “The Repression of War Experience,” in which he outlined his groundbreaking treatment of what he called “war neurosis” among soldiers returning from the Western Front.
One case involved a young officer who was sent home from France due to a wound he received just as he was digging himself out of a pile of earth in which he had been buried. While hospitalized in England, he reported that he was nervous and suffered from disturbed sleep and loss of appetite. While his physical wound healed, his psychic wounds grew worse and worse; so much so that he was finally sent to Craiglockhart War Hospital in Scotland for further observation and treatment.
“On admission he reported that it always took him long to get to sleep at night and that when he succeeded he had vivid dreams of warfare,” Dr. Rivers told his well educated, slightly skeptical colleagues. “He could not sleep without a light in his room because in the dark his attention was attracted by every sound. He had been advised by everyone he had consulted, whether medical or lay, that he ought to banish all unpleasant and disturbing thoughts from his mind. He had … succeeded in restraining his memories and anxieties during the day, but as soon as he went to bed they would crowd upon him and race through his mind hour after hour, so that every night he dreaded to go to bed.”
Strongly influenced by the then revolutionary technique of psychoanalysis developed by Sigmund Freud, Rivers began the long process of helping this soldier face and, if not overcome, then at least come to terms with his fears. Working through problems slowly through the use of verbal therapy was a new school of thought to the military mind in World War One. All this talking was just coddling, the top brass sniffed.
Rivers held firm; the treatment he performed at Craiglockhart, he said, aimed “at bringing out in the open again traumatic experiences that had been repressed and teaching the patient to live with these experiences.”
Hearing this officer recount his symptoms and describe his so far unsuccessful method of dealing with them, Rivers said, “I asked him to tell me candidly his own opinion concerning the possibility of keeping these obtrusive visitors from his mind.” Naturally the soldier said that he would never be able to forget what happened to him in the trenches and in “no man’s land.”
As Rivers told it, “I agreed with him that such memories could not be expected to disappear from the mind and advised him no longer to try to banish them but that he should see whether it was not possible to make them into tolerable…companions instead of evil influences which forced themselves upon his mind whenever the silence and inactivity of the night came round. The possibility of such a line of treatment had never … occurred to him, but my plan seemed reasonable…”
Reasonable and effective; the young officer’s health improved and his tortured insomnia, while not eliminated, was significantly reduced. “When in place of running away from these unpleasant thoughts he faced them boldly and allowed his mind to dwell on them during the day,” Rivers said, “they no longer raced through his thoughts at night.”
Dr. Rivers - whose father was a Church of England priest - features prominently in a novel called “Regeneration” by Pat Barker, a contemporary author with a keen interest in the effects of World War One on British society. In this book Ms. Barker blends historical figures with fictional characters and shows how Rivers compassionately and skillfully restored a sense of balance and brought renewal to wounded, seemingly hopeless lives, most of whom carried the diagnosis of “neurasthenia,” another name for PTSD at that time. Literally, the term means “weak nerve,” and in a 1913 dictionary, was defined as “a condition of nervous debility supposed to be dependent upon impairment in the functions of the spinal cord.” Later it came to mean any sort of emotional condition whose origins were thought to lie in an exhaustion of the nervous system.
What was needed for these traumatized soldiers, Rivers thought, was some sort of psychic repair, some sort of new growth, figuratively anyway, in the nervous system. Interestingly, in his student days in Cambridge, Rivers and a friend of his conducted an experiment into nerve regeneration in which they cut some of the nerves in his friend’s arm and then recorded what it felt like during the healing process. (The source I consulted does not say how they decided who would do the recording and who would get cut.)
“Regeneration” - the title fits, although these days the term is chiefly used in only two disciplines. In biology textbooks it refers to the process by which some organisms replace or restore lost body parts. Every kid knows, for example, that an earthworm, split in half, simply sprouts a new head and tail; some insects can grow back missing legs and most fish, whose fins are lost, manage to manufacture new ones. For some unknown evolutionary purpose certain creatures can simply replicate what was damaged or destroyed.
We don’t have that ability, at least physically; mentally and spiritually is another matter.
Outside of science books, the only other place you’re likely to stumble on this term is, yes, in the Bible. (You probably wondered when I was going to get there!) The term itself, which literally means “a new birth,” is only found twice in the New Testament; in Matthew, Jesus refers to the “renewal of all things” at the final judgment and in Titus, Paul speaks of being saved through the “water of rebirth and the renewal of the Holy Spirit.” Still, the principle pervades our faith just as it pervades the discussion John records between Jesus and Nicodemus on the need for renewal and rebirth; a spiritual regeneration.
“Very truly, I tell you,” Jesus says. (Anytime he says “Very truly,” as he does 25 times in John’s Gospel, it means we’d better pay attention. Sometimes translated “Amen, amen” - the meaning is the same - when we hear it, something very important is about to follow.) “Very truly,” he tells this well educated, slightly skeptical religious leader, “no one can see the kingdom of God without being born from above;” or “without being born anew.” The same Greek word can be used for both.
Without some kind of new birth, we will continue as we are, following in Nicodemus’s dim shadow, groping our way in the dark, beset by the terrors of the night, unable to stop our minds from racing through the past, dwelling on every injury, every trauma, every mistake; eyes turned to any spark of light, ears attentive for any word of grace; souls anxious for any sign of hope. Without some sort of regeneration, the kingdom will be a day dream, not a reality.
Nicodemus, unable to sleep, dreading to go to bed, is filled with the kind of questions we shove out of our minds when the sky is bright and the talk is loud and the day is filled with frantic activity. He asks what we would ask were we there with him: “How can these things be?” And Jesus tells him that to understand the work of the Spirit one would have to be lifted up to the highest reaches of the heavenly spaces. Since that cannot be done, the one who descended from there will be lifted up on the cross – just as Moses lifted up the serpent in the wilderness.
The comparison is significant. In the Book of Numbers, Israelis in the wilderness, complaining against the Lord, suffering death from serpent bites. They come to Moses and plead, “We have sinned … against the Lord…pray to the Lord to take away the serpents from us…And the Lord said to Moses, ‘Make a poisonous serpent, and set it on a pole; and everyone who is bitten shall look at it and live.’… and whenever a serpent bit someone, that person would look at the serpent of bronze and live.”
Perhaps we have to come face to face with our death, our pain and our fear of loss before we can know what it means to live and grow in freedom. Some is a matter of technique; some is a matter of faith.
Currently the most effective treatment for PTSD is what is called Cognitive Behavioral Therapy in which a person is gradually exposed to upsetting memories and thoughts which he has tried to avoid and then learns new, healthier ways of reacting to them. Little different from the method practiced by Dr. Rivers who encouraged his young wounded men to face in the daylight the kind of demons that only come out at night. Only then can healing occur.
It seems a natural way of doing things. Under the heading of “Regulation of Regeneration,” my biology textbook says this: “There are certain prerequisites without which regeneration cannot occur. First and foremost, there must be a wound…” In the First Letter of Peter, my Bible says this, “He himself bore our sins in his body on the cross, so that, free from sins, we might live for righteousness; by his wounds you have been healed.”
Despite Nicodemus’s plea – and ours - there is no one formula for spiritual regeneration; no one way to effect being born anew. We have all been wounded in different ways and likely we have sought healing in different ways. The best way to begin, it seems to me, is to stand where we are, as we are, as open and unafraid as we can be, seeking a reasonable, healthy balance in our lives, trusting in the one who was lifted up on the cross before our anxious, questioning, searching eyes, the one who was wounded on our behalf; who suffered for our sake; and who rose anew that we might understand what it means that “God so loved the world that he gave his only Son, so that everyone who believes in him may not perish but may have eternal life.”
Amen, amen.