Pastoral Narrative Disclosure

Pastoral Narrative Disclosure (PND) is a contemporary rehabilitation counselling strategy for chaplains developed by Dr. Timothy Hodgson (School of Historical and Philosophical Inquiry, University of Queensland) and Assoc. Professor Lindsay Carey (Adj., Public Health, La Trobe University, Melbourne) based upon Litz et al's (2017) 'Adaptive Disclosure' treatment for trauma, loss and moral injury (Litz et al 2017). PND involves, firstly, the ‘pastoral’ which embraces the individual holistically, secondly ‘narrative’, which involves the individual’s story as part of their being, and finally ‘disclosure’, which is a more modern term for admission or confession. PND was initially developed as a strategy for military chaplains using a multidisciplinary bio-psycho-social-spiritual approach to address the complex syndrome known as ‘Moral Injury'  (MI) occurring among military personnel. More recently however, MI is now also being identified among non-military personnel (e.g., police, firefighters, paramedics) who witness or experience traumatic life and death incidences - and thus PND may also prove a useful strategy for chaplains within the police force, paramedic services, firefighters, and other first responder services.

Moral Injury - Holistic Definition

Since the original definition of Moral Injury by Psychiatrist Jonathan Shay (2002 ), there have been numerous explanations trying to account for the coagulated complexity of associated trauma symptoms due to the personal impact of moral transgressions that are not considered under post-trauamtic stress disorder (PTSD) (see for example: Hodgson & Carey, 2017 Yeterin et al, 2019 ). The definition of 'moral injury' utilised for PND, is an amalgamation of the works of Shay (2002 ), Litz et al (2009 ), Jinkerson (2016 ), Hodgson and Carey (2017 ). It is also now the Moral Injury definition of the Australain Defence Force; namely:

“Moral injury is a trauma related syndrome caused by the physical, psychological, social and spiritual impact of grievous moral transgressions, or violations, of an individual's deeply-held moral beliefs and/or ethical standards" (Carey & Hodgson, 2018   ).

Moral Injury is due to: (i) an individual perpetrating, failing to prevent, bearing witness to, or learning about inhumane acts which result in the pain, suffering or death of others, and which fundamentally challenges the moral integrity of an individual, organization or community, and/or (ii) the subsequent experience and feelings of utter betrayal of what is right caused by trusted individuals who hold legitimate authority.

The violation of deeply-held moral beliefs and ethical standards—irrespective of the actual context of trauma—can lead to considerable moral dissonance, which if unresolved, leads to the development of core and secondary symptoms that often occur concurrently. The core symptoms commonly identifiable are: (a) shame, (b) guilt, (c) a loss of trust in self, others, and/or transcendental/ultimate beings, and (d) spiritual/existential conflict including an ontological loss of meaning in life. These core symptomatic features, influence the development of secondary indicators such as (a) depression, (b) anxiety, (c) anger, (d) re-experiencing the moral conflict, (e) social problems (e.g., social alienation) and (f) relationship issues (e.g., collegial, spousal, family), and ultimately (g) self-harm (i.e., self-sabotage, substance abuse, suicidal ideation and death)” (Carey & Hodgson, 2018 ).

Moral Injury and Post-Traumatic Stress Disorder (PTSD)
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Research

There has been a considerable amount of research regarding moral Injury (mostly within the US but also Canada and Australia) and subsequently various reviews of moral injury research have been undertaken. Much of this research has led to a number of treatment or rehabiliation programs being developed or modified to address moral injury. Koenig and Al Zaben (2021),Jones et al (2022) and Hodgson et al (2022), provide examples of these rehabiliation programs relevant to moral injury (see Table 1).

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PND Stages of Rehabilitation

Pastoral Narrative Disclosure (PND) comprises eight stages, namely: (i) Rapport, (ii) Reflection, (iii) Review, (iv) Reconstruction, (v) Restoration, (vi) Ritual, (vii) Renewal and (viii) Reconnection (refer Table 2). Greater detail relating to each of the stages is freely and publically available via the journal Frontiers in Psychiatry. It is important to note that PND, as a rehabilitative / restorative process, is being futher developed and "feedback from the wider professional community is being recruited to permit the PND process to be tested for validity in order to ensure therapeutic credibility". Currently PND is one of several published systematic strategy for chaplains/spiritual carers that is based upon a holistic 'bio-psycho-social-spiritual model'.

Interested chaplains and other pastoral care/spiritual care practitioners are invited/encouraged to consider PND within Frontiers in Psychiatry and provide feedback regarding the PND stages via the following emails: Tim.Hodgson@uqconnect.edu.au and/or Lindsay.Carey@latrobe.edu.au

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