I recently spoke at a conference sponsored by the National Association of Social Workers discussing the moral injury suffered by veterans returning from war. Other speakers included a clinician from the local Veterans Administration Medical Center, a woman Somali veteran and poet, and a panel composed of veterans from Korea, Vietnam, Iraq, and Afghanistan. The audience, primarily clinicians working in the field and veterans struggling to make sense of their experiences in war, were enthusiastic and appreciative of the information provided. As is customary at such events, upon the completion of the conference, attendees were asked to complete a feedback form evaluating and commenting upon content, relevance of the information presented, the strengths and weaknesses of the presenters, etc. I am pleased to say that for the most part, the feedback was positive and complimentary. One comment, in particular, I thought quite noteworthy.

“My son is seriously considering joining the Marine Corps, but as a result of hearing the experiences of the veterans both while in the military and afterward, after learning about the prevalence and seriousness of Moral Injury, we are now going to rethink this decision. Thank you for saving my son from all the grief and pain!”

What this attendee’s comment makes clear, I think, is that as parents and their offspring become educated about the realities and perhaps, the likely consequences of military service and war – Post Traumatic Stress (PTS), moral injury, etc. – information that is not readily available, perhaps intentionally so, from the recruiters who frequent our high schools, prospective enlistees and their families become better able to make informed choices.

Creating Soldiers who Will Kill

Any discussion of moral injury inevitably encompasses a review and analysis of military service, and more specifically, the war experience. For example, conference attendees learned that human beings are not killers by nature, and that political and military leaders, whose aim it is to further their national goals and objectives through violence, have recognized that this reluctance to kill, this foundational aspect of a human being’s moral identity, jeopardizes their ability to wage war effectively.[1] They learned that to remedy this “problem,” create soldiers who will kill, recruits are subjected to a sophisticated regimen of value manipulation, moral desensitization, and psychological conditioning – basic training/boot camp – aimed at destroying/overriding the recruits’ moral aversion to killing. They learned of the effectiveness of operant conditioning techniques like reflexive fire training and how, upon completing basic training, most soldiers have embraced the warrior mythology and view themselves as part of a select group of courageous knights with a noble and chivalric tradition willing (programmed) to kill, without question or hesitation, the “demonic agents of evil” and selflessly to sacrifice their lives, if need be, for right and justice.

What the presentations and the moving and often gut-wrenching testimony of the veterans made clear was that war is not a game and with combat, as the screams of the mutilated and the dying replace the sounds of inspiring anthems, as the chaos, insanity, and horror of the battlefield become apparent, comes the realization that however just the goal and righteous the initial intent, as William Tecumseh Sherman aptly pointed out, "War is destruction and nothing else . . . (it is) cruelty and you cannot refine it.”

Moral Injury

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Conference attendees soon began to understand etiology of moral injury. How life amid the violence, death, horror, trauma, anxiety, and fatigue of war erodes our moral being, undoes character, and reduces decent men and women to savages capable of incredible cruelty that would never have been possible before being victimized and sacrificed to war. They learned how, in many if not most cases, as the mythology crumbles and the reality of one’s actions on the battlefield become apparent, the warrior is left to confront not only the effects of trauma, PTS, but the guilt, shame, anguish, and grief – the moral distress and confusion – at having violated deep-seated moral principles so integral to their pre-programming moral identity. Moral injury is a “dissonance and conflict,” that is, the lasting psychological, social, spiritual, and behavioral impact consequent to perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held beliefs and expectations about right and wrong and personal goodness. Moral guilt is the painful cognitive and emotional experience tied to an awareness of having transgressed one’s personal or shared moral convictions and the anxiety precipitated by a perceived breakdown of their ethical cohesion – their integrity – and an alienation from the moral community. Shame is the loss of self-esteem and/or an expected negative evaluation by valued others consequent to a failure to live up to personal and communal expectations.

Having recognized, some for the first time, the severe life-altering effects of moral injury, many conference attendees were outraged to learn how military mental health professional, their colleagues, understand implicitly if not explicitly, that their function is to "cure" the soldier quickly, or, more likely, to mask his symptoms with medication and return him to the fighting. Many expressed their disappointment and frustration that the mainstream therapeutic community, until rather recently, have neither recognized nor adequately addressed moral injury, and how, as a result, veterans received the signal that an inability to forget, to put the war behind them, is either weakness or, perhaps worse, illness. How veterans were advised to ignore what has occurred, to “de-responsibilitize,” i.e., to “neutralize” their feelings by accepting the “naturalness” of their behavior in a specialized environment like a battlefield, and/or to undergo a myriad of conventional therapies (psychoanalytic, behavioral, pharmacological, etc.) intended to enable them to deal with the stress and trauma of their experiences (PTS). In either approach, moral considerations are, for the most part, irrelevant.

During discussion, attendees spoke of moral injury as an important contributing factor to the prevalence of suicides among veterans – some 22 veterans commit suicide each day according to a study released by the United States Department of Veterans Affairs in 2013 – though I believe the number to be much greater if one factor in single occupancy car accidents, motorcycle accidents, “death by cop,” etc.

Conclusion

Though the information presented at this conference may have persuaded the attendee quoted above to reconsider her family member’s decision to enlist, it is important to note that it was not our intent to discourage enlistment into the armed forces, certainly not to disparage members of the military. I am confident that all involved were concerned only with furthering the wellbeing of veterans, particularly in promoting an awareness of moral injury. Nor were they anti-military or unpatriotic. Speaking for myself, if I am anti anything in this regard, I am anti the neglect and mistreatment of veterans and the way the military is and has been misused, exploited by the military industrial complex, war profiteers, and their cronies in the executive and congressional branches of government. I am anti the militarist’s lies and his portrayal of war as noble and virtuous – the warrior’s mythology – to lure a new generation of young people into military "service" to do their bidding fighting their unnecessary and futile wars for profit. I am not anti-recruitment per se, though I am convinced that given the exploitive and criminal manner in which the military is currently employed, we are morally, and probably legally obligated, not to participate, not to "serve." I am pro truth in recruiting, that's why I and so many other war veterans do what we do, educate about war and its consequences, usually at great personal cost, so as was the case above, prospective enlistees (and their families) will have the information necessary to make informed choices whether to enlist.

It is for these reasons that I celebrate this attendee’s comment and the fact that the conference provided information that allowed clinicians and veterans to better understand moral injury, and though not its primary intent, perhaps just as importantly, gave a mother pause about her child's decision to enlist and “for saving (her) son from all the grief and pain” of military service.