Moral Injury, Another Veteran Crisis

William is a Vietnam Veteran in failing health who I met through a veteran’s program. William is starting to look back at his life and starting to prepare himself for his death. Like many Vietnam veterans William is struggling with what he had to do in Vietnam. The unconventional battlefield that started in mass numbers during the Korean uses women and children to carry out some of their attacks, service members have no clue who their enemy is, you just have to follow orders, make judgement calls, and hope for the best.  

When William’s unit entered a village in Vietnam, they were ordered to destroy the village and kill or capture anyone who was there, this included women and children. Military intelligence had informed his commanding officer (CO) that the village was a haven for Viet-Cong and must be destroyed. They completed their mission and proceeded to follow orders to burn the village to the ground and kill all those who refused to surrender, even women and children. What was accepted by his superior’s and his chain of command as following orders is something William would live with the rest of his life. William is starting to look back at his life and wonders how he could go to heaven after killing so many people and breaking his moral code. Thanks to following orders William has spent most of his life self-medicating with drugs and alcohol trying to forget the pain he has had since he was 19 years old. William is not only suffering from PTSD, he is suffering from moral injury.

Moral injury is a relatively new term but the idea is as old as war. The term was first used in the late 1980’s and described as “the psychological burden of killing and the betrayal of leaders. The definition of moral injury is the damage done to one's conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress their own moral and ethical values or codes of conduct. Moral Injury is a slow burn that takes time to sink in. It requires a healthy brain that can understand moral reasoning, evaluate behavior, experience empathy, and create a coherent memory narrative. It is a negative self-judgment based on having transgressed core moral beliefs, values or feeling. Many time in war, soldiers are placed in high stress situations and are told they must betray there sense of “what’s right” to carry out orders given by someone who has the position of legitimate authority.

When we think of what military members go through we look for and expect to hear fear. But what is coming to light is sadness related to loss, but also attributed to bearing witness to evil and human suffering including death you participated in. There is fear in most who have seen combat, but what happens after fear. For some it takes minutes, for others it takes years to feel the sadness or sorrow of forgetting your human morality. Veterans try and suppress their moral injury and some succeed through the use of drugs and alcohol which brings on its own set of issues. Others work hard to support their families and place their morality on the back burner, they are doing what is moral, providing for their family and working. 

A common theme is veterans feel that nothing can prepare you for what war is really like. When they return home to some it feels like they have lost their soul. It not hard to believe when society states, thou shall not kill, military culture states thou better kill, be killed, or suffer the shame of not trying. In today’s wars veterans do not know who their enemies are. Many women and children, including babies have been killed by accident or necessity. Driving past wounded women and children and not stopping to help because of orders, making the decision to shoot civilians because you don’t know who your enemies are, killing families because of one enemy sympathizer, killing someone over anger because they killed or shot your comrade are all breaches of Americans moral code.

In war, military members must follow orders without question, and at times those orders shake the soldier’s moral beliefs. There appears to be no end in the breach of moral codes in war. The symptoms of moral injury include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live.

Some military leaders reject the idea of moral injury and one leader advised a suicidal soldier to “be an adult” and get over it. In the future, the loss of morality and moral injury is going to explain a big chunk of why veterans suffer as they get older. Some feel moral injury is one of the primary factors in military suicide rates. The key for friends and families is to be on the lookout for moral injury and get them the help they deserve.

Many soldiers who serve in combat reach out to counseling from Chaplains. The same mental health stigma is not attached to talking to the Chaplin as a mental health professional. Also speaking to a Chaplin will not go into their permanent records. They also believe that most therapist do not have knowledge of theological issues such as morality concerning good and evil, or religious meaning. Veterans also believe when they raise moral questions about conscience in therapy they get referred. There is nothing wrong with reaching out to both. There are also clinicians who have been trained in religion and are pastors who are licensed therapist.  

Moral injury is not something that can be cured by medication. The restructuring of their moral identify and meaning is the key. What it takes is the support of caring non-judgmental community who can find a way for veterans to forgive themselves. Our communities need to understand the war does not end when our troops return home, it is just the beginning, just ask the Vietnam Veterans who are still dealing with this issue 40 plus years later. There is hope, in the VA there is funding for a 4-year study on moral injury in Marines. Let’s see where that leads.  

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