Romans 12:1-9 - Making Good Biblical Choices

I. Definition.

A. "a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or serious personal assaults like rape." This definition is found on the website for the National Center for PTSD, Department of Veteran affairs at http://www.ncptsd.va.gov/ Most of the information on this site is helpful.

II. History

A. A changing disorder with changing military tactics.

1. During the Civil war the problem was called "Da Costa Syndrome."
2. During WW 1 was called shell shock.
3. In WW II it became battle fatigue
4. Since Viet Nam the disorder has been called PTSD
5. Changes in the deadly nature of war and improving on the battlefield healthcare may account for
the numbers of military personnel with the problem.

III. Diagnostic Criteria for Post-traumatic Stress Disorder
A. The person has been exposed to a traumatic event in which

1. The person experienced, witnessed, or was confronted with threatened death or injury
2. The person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in recurrent and intrusive distressing
recollections of the event, including images, thoughts, or dreams of the event.

3. Acting or feeling as if reliving the experience, with illusions, hallucinations, and dissociative
flashback episodes, including those that occur on awakening or when intoxicated
4. Intense psychological distress and physiologic reactivity at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of trauma associated:

1. Thoughts, feelings, conversations, activities, places, or people
2. Inability to recall an important aspect of the trauma.

D. Persistent personality changes

1. Markedly diminished interest or participation in significant activities.
2. Feeling of detachment or estrangement from others.
3. Restricted range of affect (e.g., unable to have loving feelings).
4. Sense of a foreshortened future

E. Persistent symptoms of increased arousal with sleep disturbances, anger, difficulty in concentration,
hyper-vigilance, and exaggerated startle response.

F. Duration of the disturbance is more than one month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of function. The above is condensed from the article “Diagnosis and Management of Post Traumatic Stress Disorder,” Grinage, www.aafp.org p2402, vol 68/12, Dec. 15, 2003. The complete criteria can be found at aafp.org in the PDF format.

IV. Current Medical/Psychiatric Treatment.
A. Behavior/Lifestyle Changes

1. Education, support groups, relaxation techniques, recreation, work, exercise, service to others, building friendships
2. Safe environment at home and work.
3. Avoiding destructive coping habits: smoking, drinking, drugs, social isolation, "workaholism", continuous avoidance, violent behavior, anger.

B. Psychiatric/Psychological treatment.

1. Cognitive Behavioral therapy
2. Exposure Therapy

C. Medical care

1. Sleep disturbances, REM Sleep disorder, Sleep Deprivation.
2. Chronic medical problems that adversely affect sleep and mood need to be treated.
3. Medication for Anxiety and Depression.

V. What does Biblical Counseling have to offer? 2 Peter 1:3
A. Elijah was a man just like us! In 1Kings 19, Elijah meets the criteria for PTSD.

1. The traumatic event is his killing the 500 prophets of Baal.
2. He was mortally afraid of Jezebel. He repeats his fears multiple times.
3. He responds to the recollection the same each time.
4. He ran to avoid meeting Jezebel and her crowd.
5. He was operating under the delusion of being the "only one left."
6. Elijah felt isolated, was a loner, and believed his life was going to be short!
7. We know he persisted in this state for more than a month.

B What did God do to help Elijah?

1. He lets Elijah run. Sometimes people have to cry.
2. God put Elijah in a safe environment. Elijah never was in danger. Counselee needs a perceived safe place. Also needs to sleep. Physician’s help required here perhaps.
3. Gods sends an angel with food and water. Physical needs must be met with mercy.
4. God sends Elijah running. Literal physical work is good!
5. Be patient! God is patient and listens to Elijah. He watched him run in the wrong direction for 40 days.
6. After 40 days, God gets to the point with Elijah. God does not directly answer his statement. He shows Elijah his power. The counselee must see God’s power in his word to deal with the issues of fear and worry/ trust, anger/forgiveness, Guilt/forgiveness, personal loss/ growth and change. The must come to see themselves as soldiers in Christ’s army who are victors instead of victims of circumstances beyond their control.
7. God repeats the question, "What are you doing here?" The answer is nothing of value! God sends Elijah back the way he came, with specific instructions about the work he is to do. He then tells him that he never was alone! PTSD counselee’s have to return to the normal routine of the Christian life. REGULAR hours, meals, exercise, work, Bible reading, prayer, church attendance, fellowship, small group accountability, service to others, and memorization of Scripture.
8. Counselee needs a Biblical plan to deal with Worry and fear.