Veterans and Moral Injury
The Wound Within
When a soldier comes home from war, he or she is not the same person who left home. It is not uncommon for a civilian to thank a veteran for serving and have the veteran get mad and not want to be thanked because in their mind they did not do the right thing.
I read an account of a soldier who, when he stepped off the plane and when his wife handed him his new baby daughter, he immediately handed the baby back to his wife with an almost disgusted look and almost dropped her. In his mind he thought that his new daughter was so beautiful, perfect, and pure that he didn't want his filth to contaminate her.
Every day 22 veterans commit suicide. I think one of the major contributing factors is the guilt they feel that they were not prepared for upon their returning home. One of the things that one reads about in Unspoken Abandonment was just how much anger and guilt the author had from things he had seen in war.
The term "post-traumatic stress disorder" appeared in the 1960s after the Vietnam War. This was when the draft was still in effect. Now, the armed services are made up of all volunteers who go on repeated back to back deployments that they can not get out of. With 22 veterans a day committing suicide the new term is "moral injury." The new term has its own definition. It is defined as when someone has his or her sense of right and wrong seriously violated bringing grief, a feeling of being numb, and more than anything a terrible sense of guilt.
P.T.S.D. verses Moral Injury
Civilians Do Not Understand the Brutalities of War
"A Bruise of the Soul"
As a civilian, I basically agree with Chris Kyle, that civilians, including me, do not understand the brutalities of war. With Chris Kyle saying something to the effect of, "What haunts me is all the guys I couldn't save," it makes me realize he probably had moral injury. After realizing many of the P.T.S.D. patients needed help with moral injury, several clinicians launched a program in 2013 that provides therapy for moral injury. The drugs and therapy designed to treat P.T.S.D. help extinguish fear, not guilt. For P.T.S.D. they relive the experience over and over and the fear subsides. But, when dealing with the guilt, you feel if you are talking about a battle scene or losing a patient reliving the experience only makes it more painful. So, when addressing moral injury therapists help the patient try to accept that wrong was done. Yet, it does not have to define their lives.
As terrible as some of this stuff is - and sometimes what we hear makes your toes curl - what I see in these people is incredible goodness. Their efforts to punish themselves is just further evidence of their goodness.— Michael Castellana, Psychologist
Trying to Hide the Pain
What I remember most about watching videos on Clay Hunt is him saying, "The Marines are at war. Americans are at the mall." He felt like he was alienated from all of society. It is within my opinion, that he felt guilt, like it was his fault certain things happened and he could not live with it. It is estimated he had moral injury. As a civilian, I think that infantry would be hit very hard with moral injury. However, there are medics who have it, too. Billie Grimes Watson, a Navy Medic who served in Iraq in 2003 and 2004 would run through the fire intermixed with smoke from improvised explosive devices to try to save lives. She knew the soldiers who were maimed and would only get a few hours rest in between missions. She was only 26 years old. Even, a decade later she is still trying to cope with what she saw in war. She said, " I avoid talking about it, try to keep it down. But, inside I'm trying to do the happy face so no one knows how much I'm hurting."
The Worse Wound
Typically when a soldier comes into treatment for moral injury he says, "I did something unforgivable and I want to tell you about it." For treating the problem a technique called, "adaptive disclosure" is used. It is a therapy technique in which the patient briefly discusses what caused his moral injury. The therapists found that when dealing with combat marines, many times the cause was when the marine figures out he or she has a love of the thrill of combat and killing. Then, he feels tremendous guilt for feeling that way. Billie Grimes- Watson, the female medic, described her guilt, "I have all this guilt inside and I want to let it out but I can't. I want to tell my husband and family what is going on, but I don't. I just put on a happy face until I'm alone." The medic was eventually put on disability for physical injuries and P.T.S.D. However, she went on to talk about the worse ailment, "But, moral injury is the one that really gets you. Its hard to find yourself again, because you're never going to be the same person. I am trying to figure out how to forgive myself for everything I did over there, and it's hard to figure out. We are still having suicides by people who don't tell anyone why they are hurting inside. We are still at war."
When soldiers go to therapy with moral injury, they think that they are to blame for everything. They say things like:
- It was my fault.
- The world is dangerous.
- I am a monster.
The mental health professionals try to get them to unearth what is causing them to be distressed. When they say that everything is their fault the mental health professionals try to get them to see a more realistic perspective that they are not solely responsible. The blame is then even broken down into percentages, something like the government is 50 % responsible, the opposing forces are 25 %, and so on. What has been stated as being one of the more effective tools is having a veteran stand in a room full of veterans and just say what happened. The other veterans who all have stories of their own do not say, "It is o.k." In reality it is not o.k. They just sit silently.
Hope for the Future
In conclusion, it is easy for me to understand why someone would think that this blog is very depressing. Yet, there is hope. If more people are aware of moral injury they will be more likely to identify the symptoms and know what they are. Chris Kyle gave some good advice. He said random acts of kindness like babysitting the kids so he or she can go on a date, mowing the lawn, cooking a meal, donating to charities that support veterans, and even writing your local congressman or politician about what he or she is planning on doing about the lack of care for our veterans. If there is nothing you can really do, praying for them every day is always a good idea. Our troops home and overseas need our prayers and our support.
For More Information
- Moral Injury Resources - Military Outreach
These moral injury resources will help in identifying and learning more about moral injury.