November 30, 2016

By Luna Greenstein

Imagine you are a young soldier leading your unit on a foot patrol in an Afghan village. One moment your environment is peaceful, the next your unit hears a loud explosion and you realize you are taking fire from the enemy. You find a secure position to radio your overhead observer, to determine where the threat is originating. It’s your job to take out the enemy before any soldiers or innocent civilians are harmed. Your overhead observer gives you the location and describes the enemy for you: an 11-year-old Afghan boy who is firing at your unit with a machine gun. At this point, you are ordered to take out the enemy. You follow the orders to save your soldiers and the innocent civilians in the village.

There are many troubling factors that impact our nation’s warriors leading to the unfortunately high suicide rate of 20 veterans a day. But one factor which has recently been under consideration is moral injury. The term was coined in 2009 by Dr. Jonathan Shay, but the issue has been affecting veterans for much longer than a short seven years.

What is Moral Injury? 

Moral injury is any action that violates a person’s sense of moral, religious or ethical understanding of what it means to be human. While this definition is straightforward, the concept of moral injury is a much more complex issue than can be written on paper.

Six months later, you finished your deployment and are welcomed home by your friends and family. You begin to remember many of the experiences from your deployment, several you wish you could forget—including the day with the 11-year-old boy. This experience has made you question who you are, the morality you believe you had and causes you to worry that people may view you differently.

The resulting shame and guilt from a moral injury can present itself as a stand-alone experience or it can co-occur with post-traumatic stress disorder (PTSD), among other mental health conditions. Moral injury has only recently been viewed as a possible separate phenomenon from PTSD.

The primary distinction between PTSD and moral injury are the root emotions that cause the symptoms. According to the DSM-5, PTSD is characterized by distressing nightmares, flashbacks, and memories that make the person feel as if they are re-living their traumatic experience. These “intrusion symptoms” can lead to other symptoms such as sleep disturbance, hypervigilance, exaggerated startle response, problems with concentration, reckless or self-destructive behavior, irritable behavior, angry outbursts and avoidance of stimuli associated with the traumatic event.

Rather than experiencing symptoms based off fear, moral injury produces symptoms based off of feelings of shame and guilt for acting or witnessing behavior opposing what the person considers moral. According to the VA, moral injury is characterized by an inner turmoil that often leads to anxiety, anger, purposelessness, social instability, withdrawal, self-condemnation, self-harming, self-destructive behavior and avoidance of stimuli associated with the immoral action.

Unlike PTSD, there isn’t a clinical diagnosis for moral injury. It’s not necessarily a condition that calls for a standard therapy or recovery program. Rather, it may be something that faith, spirituality and forgiveness can help.

How Can Faith Communities Help?

Faith can be one the best places for someone who needs compassion and healing—especially for someone who has disrupted their moral code due to war. If they were to hear from a spiritual leader that the acts they did in war can be forgiven and understood, it may help them heal their moral injury. Having reassurance that their soul isn’t permanently damaged, and that they can move on from their past can be an extremely helpful step towards recovery.

In order for this to happen, the confession process needs to be open, understanding and compassionate. For someone who personally reaches out to their higher being for forgiveness, they need to be open and understanding towards themselves. And for someone who approaches their spiritual leader in order to confess the incident that caused their moral injury, then the spiritual leaders should show compassion towards them.

In addition, if a spiritual leader talks openly to their community about veterans and the moral/spiritual dilemmas they face, it is likely that the congregation will follow. Community members may even consider reaching out to veterans (who may be struggling in silence) to reassure them that they are welcome and loved in their faith community.

Even if you are not a part of a faith community, it’s important for everyone to practice understanding, kindness and compassion towards any service member who may be experiencing a moral injury. Let them know that they should not feel personally responsible for the actions that took place during wartime. NAMI Advocacy and Public Policy Manager, Emily Blair states that: “War is vile. Many of the actions and choices service members are forced to make in the heat of battle, when life and death decisions are on the line, often result in moral injury.”

And if you are interested in learning more about moral injury, take a look at the slides from the major topic session: Faith Journeys of Veterans & Military Personnel from our National Convention in Denver earlier this year.

Italics provided by Emily Blair.

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