In the Spotlight: The Moral Injury of the Soldier’s Soul

“War is hell.”  -William Tecumseh Sherman[1]
 
 

Erv Janssen, M.D., retired psychiatrist, U.S. Navy
The psychological wounds of war cut deeper than the terror of Post Traumatic Stress Disorder. There is a “moral injury” that occurs from the legitimization and encouragement of murder, and an important new dialogue is emerging around the topic.

Fearful flashbacks from traumatic events are not the same as the moral confusion soldiers experience. In their new book, “Soul Repair: Recovering from Moral Injury after War,” Rita Brock and Gabriella Lettini[2] explain:

Moral injury is not PTSD. Many books on veteran healing confuse and conflate them into one thing. … PTSD occurs in response to prolonged, extreme trauma and is a fear-victim reaction to danger. It produces hormones that affect the brain’s amygdala and hippocampus, which control responses to fear, as well as regulate emotions and connect fear to memory.

Meanwhile, moral injury affects a different part of the brain. “We organize emotionally intense memories into a story in the brain’s prefrontal cortex, where self-control, planning, reasoning, and decision-making occur,” write Brock and Lettini.

In other words, moral injury impacts one’s conscience. Retired Navy psychiatrist Dr. Erv Janssen notes: “Moral injury relates to deep, personal issues of right and wrong, of remorse, guilt and grief.”

Conflation of the two is especially unhelpful for anyone who has suffered traumatic brain injury. Janssen notes the treatment offered is cognitive processing therapy, yet TBI compromises the ability to use cognitive abilities.

“If you’ve had a traumatic brain injury, like with so many of the roadside bombings, you may no longer have the advantage of using cognitive resources,” he says. As with recovery from PTSD, “One also has to use cognitive skills in the healing process for moral injury, because dialogue and introspection are necessary – you need a healthy brain.

“But with TBI you take away the potential tools for recovery.”

The terrifying reality of moral injury is always a factor in war. Jonathan Shay compares the plight of American soldiers facing moral injury to those of Greek heroes Odysseus[3] and Achilles[4].

“It’s not new, but it isn’t visible,” says Janssen. “It simply hasn’t been recognized as an issue that needs to be attended to.”

One reason it is often overlooked is that morality is subjective and so, as Janssen notes, “It falls between the clinical area and the spiritual area.” It is important, though that treatment for veterans be holistic, addressing the “whole” human.

The Rev. Ray Hickman, Executive Director of Tulsa Metropolitan Ministry, is guiding a movement to unite faith leaders around the issue. “I’m interested in providing a theological filter for persons involved with war,” he says, in order to explore “how can faith communities be a part of the conversation.”

Just as it is crucial we address the “whole” human that returns from combat, so too must we see how this is the responsibility of the “whole” society.

Not only has less than one percent of the American population served in active duty[5], the numbers are not evenly distributed because it is a volunteer military. Certain groups are disproportionately affected by our wars, and Janssen and others are desperate for all of society to recognize the plight of veterans as “our” problem.

“We tend to bring people back but we don’t bring them home,” says TC, who was on an M-60 gunner in the Gulf. “It has taken me 20 years to try to get home. Don’t think you can go to the airport with a flag and salute me, and then you’re done. All these people were there when I came home with flags, and not one came to my house two weeks later.”

Through TC’s story we see that three levels of dehumanization are experienced by some veterans, each with residual conflict. First, there is the dehumanization of the enemy in order to legitimize murder. This is, of course, the strategy of wartime propaganda and of anyone training a killer. “There are atheists in fox holes because that’s the only way you can survive it,” says TC. “But the last thing you see when you take down a plane is the pilot’s eyes.”

Also dehumanizing is the lack of adequate support veterans are given by their own community. Through a failure to recognize and meet the needs of moral injury, we implicitly rob soldiers of their humanity. Janssen notes mistrust of government relates to the reality that only half of veterans are seeking services from a weakly funded Veterans Administration, making it even more crucial for the greater community to open its arms. Another barrier is transportation links to services, particularly for returning service members from rural areas.

Finally, the invisibility of groups within the veteran community is itself dehumanizing. “Women did serve in combat zones in the Gulf,” says TC, contrary to the Pentagon’s assertion. “The V.A. says women don’t exist.”

TC, who works with homeless young people and is also pursuing a Master’s in Divinity, was and is marginalized as a woman veteran, as a gay veteran, and as one of many homeless young people who join the army “because it’s three hots and a cot,” referring to the food and shelter it offers. Benefits are frequently inaccessible for the poorest veterans when they return to the U.S., and so they return to the streets. There are 63,000 homeless veterans, and the number has been much higher than that in recent years.[6]

Through the damage of moral injury and, crucially, our failure to address it, we reach disastrous
consequences: Janssen is one of many who point to moral injury as connected to military suicides. In addition to one soldier per day taking his or her own life,[7] a stunning 22 veterans per day do the same.[8]

It isn’t just peace among nations we must pursue, then, but peace of mind for those morally wounded.

Fortunately, one precedent for positive response is available. “Native American communities have done this historically,” says Janssen, “and we need to learn from these experiences not from a scientific standpoint but from a community standpoint.”

The Rev. Don Marshall, a Lutheran minister who has spent most of his ministry in Native American communities in Oklahoma, notes in his experience veterans are embraced and celebrated, and that ritualized healing services are often successful. These not only address suffering by focusing on the whole person, they recognize that person’s importance to the whole community.

The spirit of ubuntu demands that in recognizing every person’s humanity, we realize that “my humanity is tied to yours.”[9] Only then might we dream of peace.

 

 

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[1] William T. Sherman (1879) “Address to the graduating class of the Michigan Military Academy.” Delivered 19 June 1879. Accessed 2 Feb 2012 at < http://en.wikiquote.org/wiki/William_Tecumseh_Sherman>.

[2] Rita Nakashima Brock and GabriellaLettini (2012) “Soul Repair: Recovering from Moral Injury after War.” Boston: Beacon Press.

[3] Jonathan Shay (2003) “Odysseus in America: Combat Trauma and the Trials of Homecoming.” New York: Scribner.

[4] Jonathan Shay (1995) “Achilles in Vietnam: Combat Trauma and the Undoing of Character.” New York: Simon & Schuster.

[5] Sabrina Tavernise. “As Fewer Americans Serve, Growing Gap is Found Between Civilians and Military.” New York Times 24 Nov 2011. Accessed 2 Feb 2013 < http://www.nytimes.com/2011/11/25/us/civilian-military-gap-grows-as-fewer-americans-serve.html?_r=0>.

[6] “Volume 1 of the 2012 Annual Homeless Assessment Report to Congress.” The U.S. Department of Housing and Urban Development. Accessed 2 Feb 2013 at < https://www.onecpd.info/resources/documents/2012AHAR_PITestimates.pdf>.

[7] Rita Nakashima Brock. “Moral Injury: The Crucial Missing Piece in Understanding Soldier Suicides.” Huffington Post 23 July 2012. Accessed 2 Feb 2013 at < http://www.huffingtonpost.com/rita-nakashima-brock-ph-d/moral-injury-the-crucial-missing-piece-in-understanding-soldier-suicides_b_1686674.html>.

[8] Bill Briggs. “22 veterans commit suicide each day: VA report.” NBC News 2 Feb 2013. Accessed 2 Feb 2013 at < http://usnews.nbcnews.com/_news/2013/02/01/16811249-22-veterans-commit-suicide-each-day-va-report>.

[9] “Ubuntu” is short for the Zulu proverb, “Umuntu ngumuntu ngamantu,” meaning: “I’m a person through other people. My humanity is tied to yours.” See <http://en.wikipedia.org/wiki/User:ArdentMaverick>.

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