Written by Vicki Lane

For quite some time PTSD has been considered to be the most common and prevalent wound of recent wars—PTSD involves fear, hyper-vigilance, anxiety, flashbacks, and nightmares.

However, some leading mental health experts are finding moral injury to be an even more insidious wound of war. Moral injury can shake the very moral fiber of service men and women. It violates deeply held moral and ethical values and beliefs that are rooted in our spiritual, religious, cultural, and family life. Our moral upbringing typically teaches us about fairness, right from wrong, do unto others, and the value of life—but many of these teachings are not always compatible with the horrors, chaos, and uncertainties of war. Warriors in combat can be caught in situations in which they have no opportunity to choose between right and wrong; often there is no clear distinction between enemy insurgents and innocent civilians.

The morally injured feel shame, guilt, grief, sorrow, and regret. They often wonder how they could possibly be the good person they thought they were if they could kill another human being, fail to save a “brother’s” life, witness human suffering and do nothing, become numb to atrocities of war.

My first introduction to a veteran experiencing moral injury was almost two years ago. This veteran shared that, six months after returning from Iraq, he left his base without authorization—to kill himself. Fortunately, he was found in time.

I began working with this veteran about a year after this event and he slowly began opening up and describing what had led him to contemplate suicide. He told me while he was in Iraq he was ordered to fire rockets into civilian homes even though it was known that inside, along with the insurgents, were innocent family members. He told me that the first time he was ordered to fire, he was completely devastated and did not think he could do it. He said even though there were RPGs being fired at him and his brothers, it was gut wrenching to fire back and he became physically ill afterwards. He shared that the same scenario played out numerous times during his deployment, and although he found it difficult each and every time, he nonetheless fired on the homes—knowing that there were civilians being killed or injured.

He shared that he thought about that frequently after returning home and wondered what kind of person can kill innocent women and children? He told me he was raised to value human life, to treat others kindly, and he could not forgive himself for the things he did while in Iraq. He shared that he used to think of himself as a good person, that he joined the military to help protect our country, and that he used to be proud of who he was. But then he discovered he wasn’t the person he thought he was, and that he was not a good person after all. How could he be? He killed innocent men, women, and children.

This veteran withdrew from his family and friends because he didn’t feel he deserved their love. He shared that he felt ashamed and guilty for his actions in Iraq and eventually began to believe he did not deserve to live when so many had died “at his hands.” This veteran was drastically suffering from moral injury.

Fortunately, this case has a happy ending thanks to senior officer who agreed to talk with the veteran. This officer helped him understand that it was not his decision to fire on these homes, that he was ordered to do so and had no choice but to follow orders. The officer shared that he also struggles with the knowledge that he was the one that gave the orders It took some time (quite a bit of time), and some deep, soulful conversations with others who were experiencing similar feelings of shame, guilt, and regret, but he finally began to see that although he may have had a small responsibility for his actions, he was following orders and could not continue to blame himself completely for his actions. He still struggles with the fact that he was the one who ultimately fired, but he said sharing his thoughts and feelings with others who have been in the same or similar situations is helping. He is beginning to recognize that he is not a bad person, and that he needs to find a way to forgive himself.
Moral injury is still not an officially recognized diagnosis and there are still may unanswered questions about the most effective way to help service members and veterans who are struggling with the effects—but for this veteran, sharing with others has made a positive difference. The last time I spoke with him he had reconnected with his family, found an apartment and a job, and was helping other veterans overcome the shame, guilt, grief, and regret they were experiencing due to moral injury.