Daily Archives: March 20, 2014

Moral Injury: The Silent Killer of Veterans

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This morning I woke up and got ready to go to work. My wife was up. She had been up most of the night because unbeknownst to me I had been fighting something in my sleep. Judy tried to wake me up, but I didn’t wake up, and evidently the episode lasted much of the night. I do remember some dreams, or rather nightmares last night dealing with a particular situation that I experienced in Iraq, but such nightmares are so common that unless there is something really unusual about them I really don’t think much about them.

I first heard of Moral Injury in 2009 about a year after I was diagnosed with severe and chronic PTSD. However, that being said as a military historian I have to admit that I have read about it time and time again in less clinical language. What I had more experience with were the memoirs of common soldiers and officers, as well as the experiences of Sailors, Marines and Soldiers who had confided in me at various times as their chaplain.

Marine Major General and two time Medal of Honor recipient Smedley Butler wrote in his book War is a Racket:

“Boys with a normal viewpoint were taken out of the fields and offices and factories and classrooms and put into the ranks. They were remolded; they were made over; they were made to “about face”; to regard murder as the order of the day. They were put shoulder to shoulder and through mass psychology, they were entirely changed. We used them for a couple of years and trained them to think of nothing but killing and being killed.

The suddenly, we discharged them and told them to make another “about face”! This time they had to do their own readjusting, sans mass psychology, sans officers’ aid and advice, sans nation-wide propaganda. We didn’t need them anymore. So we scattered them about without any “three minute” or “Liberty Loan” speeches or parades.”

Last year I was interviewed by David Wood of the Huffington Post for a series of three articles that he just published on moral injury.* If PTSD and TBI are considered “invisible wounds” then moral injury must be included. It is a condition as old as war itself and can be seen even in the most ancient of writings about war, Homer’s Iliad, King David’s grief over the loss of his friend Jonathan and many others.

I came home from Iraq forever changed. I served with Marine and Army advisers to Iraqi Army, Border Troops, Police, Highway Patrol and Port of Entry Police in Al Anbar Province in 2007 and 2008. That assignment, which took me throughout the province brought me into contact with a part of the war that many Americans, even those serving in Iraq were shielded from, a part of the war that was never shown in the media that exposed me to realities that before serving there I was unaware.

They were uncomfortable truths. The tensions between the various Iraqi factions, the real hopes for a better Iraq held by many Iraqis and the absolute devastation that the American invasion of Iraq had brought to that unfortunate country. I saw some of the disrespectful and insulting things done by American troops that had to be dealt with by the advisors, men who were as much diplomats as they were Soldiers and Marines. I saw the damage inflicted by bombing campaigns that had little to do with winning a war, but more with destroying infrastructure that even our own war plans had determined was vital to Iraq’s recovery after the success of our campaign. I saw children wounded in fire fights, as well as ministered to the wounded coming through the Fleet Surgical Facility at Ta’Qaddum on their way elsewhere.

I have spent time with Marines and Soldiers who feel real guilt from the actions that they saw or participated in both in Iraq and Afghanistan. Likewise I have dealt with the grief of men and women, Corpsmen, Doctors and Nurses who wish that they could have done more to save the lives of others or done more to prevent suffering. I have also dealt with those who have attempted suicide after taking part in actions that they could not live with or due to what they saw or experienced in Iraq or Afghanistan.

Unfortunately Moral Injury is not taken seriously by the military. This despite the fact many military physicians, mental health providers and chaplains are on the cutting edge of dealing with it. We are doing research, writing and treating those afflicted the services themselves do not even acknowledge it. Even as we do this some in the military, including Chaplains want to call it something more ambiguous using the Orwellian term “inner conflict” to describe something that is far more damaging and insidious.

I suppose that a big part of the reason is that all of the services do an amazing amount of work to built a set of moral values in those that serve. In the Navy we talk about courage, honor and commitment. We talk about being men and women of principle, doing what is right. Such ideas are a part of who we are, Douglas MacArthur spoke of “Duty, Honor Country” and our military academies have long taught the principle that “I will not lie, cheat or steal, or tolerate those that do.”

We teach our Soldiers, Marines, Sailors and Airmen values that are often more rigorous than what they grew up with at home or in school. Then we send them to war and they see and sometimes do things that are at odds with those values as well as the values that we as Americans cherish. We place them in situations where the moral values we teach them contradicted by what we teach and train them to do, and the real unvarnished truth about war, it is hell. Smedley Butler wrote:

“But the soldier pays the biggest part of this bill.
If you don’t believe this, visit the American cemeteries on the battlefields abroad. Or visit  any of the veterans’ hospitals in the United States….I have visited eighteen government hospitals for veterans. In them are about 50,000 destroyed men- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital in Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed home.”

How we expect anyone to retain their soul and their sanity when we teach them a set of values that we as a nation fail to uphold is beyond me. The fact that the politicians, pundits and preachers who constantly insist on using the under one percent of the population that serves in the military to bear such burdens to satiate their bloodlust and then refuse to recognize their injuries and then deny them care or benefits is abhorrent.

One of the survivors of the famed World War One “Lost Battalion” wrote:

“We just do not have the control we should have. I went through without a visible wound, but have spent many months in hospitals and dollars for medical treatment as a result of those terrible experiences.”

While I was impacted very much by what happened to me and what I saw. The sad thing is that I was far better prepared and seasoned to survive what I experienced than most of my younger counterparts. After years of training and experience I felt that I was immune to PTSD or Moral Injury. Sadly, I was wrong and today, more than six years after I returned from Iraq I deal with the consequences of war, in my life and those of those that I serve.

I don’t pretend to have answers, but I do expect that our country takes responsibility for the injuries and suffering that its policies have created. Specifically I am speaking to that Trinity of Evil, the Politicians, Pundits and Preachers who constantly lobby for war and refuse to take personal responsibility for it when it comes, and who then for matters of political expediency throw aside the volunteers who went to war for far higher ideals and motives than those that sent them.

Okay, it is time for me to take a deep breath. But I do get really spun up about this, because I have lived this reality and I get angry when I see look around and realize that for most people in this country, the plight of veterans doesn’t matter. We are just another “special interest group” to use the words of a member of a committee appointed by former Secretary of Defense Donald Rumsfeld that wants to decimate military benefits. But even now people like Bill Kristol who have never served a day in the military and never seen a war that they didn’t like, urge that we send more men and women to war over Crimea. But I digress…

Moral injury is a silent killer of the soul and it is high time that we recognize just how deadly it is.

Guy Sager, author of the classic The Forgotten Soldier wrote: “Only happy people have nightmares, from overeating. For those who live a nightmare reality, sleep is a black hole, lost in time, like death.”

I don’t know what nightmares I will have tonight, hopefully at least for Judy’s sake I won’t have any.

With that, I will sign off for the night.

Peace

Padre Steve+

Wood’s Articles can be found here: http://projects.huffingtonpost.com/moral-injury/the-grunts
http://projects.huffingtonpost.com/moral-injury/the-recruits
http://projects.huffingtonpost.com/moral-injury/healing

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Filed under iraq,afghanistan, Military, PTSD