Understanding Moral Injury Among Combat Veterans

Moral injury is a profound and often overlooked aspect of the combat experience that can have lasting effects on the mental health and well-being of veterans. In this article, we’ll explore the concept of moral injury among combat veterans, its causes, impacts, and strategies for healing, drawing on research and expert insights.

What is Moral Injury?

Moral injury refers to the psychological, emotional, and spiritual distress that arises from experiences that violate deeply held moral or ethical beliefs. In the context of combat, moral injury can occur when service members witness or participate in events that conflict with their sense of right and wrong, leading to feelings of guilt, shame, and existential questioning.

My direct experience with this occurred in 2007 while deployed our Patrol Base was attacked by RPG fire at one of our towers. We observed the vehicle that engaged us driving northbound through the city where they parked at a home near the end of the village in Riyadh Iraq. The then turned and came back towards the Patrol Base again, where I loaded a vehicle with a couple Soldiers and maneuvered outside the wire.

We engaged the vehicle killing three inside the truck from machine gun fire from our tower. I exited my vehicle along with a squad leader from another vehicle. We each engaged the two other combatants in different locations. We killed five insurgents in that moment.

We had to place them into body bags and bring them back inside the Patrol Base for processing and sensitive site exploitation. It was learned they ranged in ages from 15-16 years old. They were kids, that had parents and siblings. This humanized them and made dealing with it very difficult.

Two months after the event I went to confession when a priest was available on Forward Operating Base McHenry. Shockingly the Priest wouldn’t give absolution, which I struggled with understanding.

Then he explained, warfare rules are different. It helped process that part of it knowing I was performing my duties and spiritually wouldn’t be held responsible for it. The Priest said the Nation will be held accountable in the eyes of God if something were wrong with the actions.

But this is the anatomy of moral injury. Thou shalt not kill and then we kill.  

Causes of Moral Injury Among Combat Veterans

Several factors contribute to the development of moral injury among combat veterans:

1.  Acts of War: Participation in acts of violence, killing, or witnessing atrocities during combat can challenge veterans’ moral frameworks and lead to feelings of moral distress.

2.  Command Decisions: Orders or directives that conflict with individual moral values, such as rules of engagement or treatment of enemy combatants, can contribute to moral injury.

3.  Survivor Guilt: Veterans may experience survivor guilt or remorse for actions taken during combat that resulted in the loss of fellow service members or civilians.

4.  Betrayal: Perceived betrayal or abandonment by leaders, peers, or institutions can exacerbate feelings of moral injury and erode trust in others.

Impacts of Moral Injury on Combat Veterans

Moral injury can have profound and long-lasting effects on the mental health and well-being of combat veterans:

1.  Neurological Distress: Veterans may experience symptoms of guilt, shame, anger, and self-condemnation, leading to depression, anxiety, and post-traumatic stress disorder (PTSD).

2.  Spiritual Crisis: Moral injury can shake veterans’ beliefs about themselves, their comrades, and the world, leading to existential questioning, loss of meaning, and spiritual distress.

3.  Social Isolation: Feelings of shame and unworthiness may lead veterans to withdraw from social relationships and support networks, increasing their risk of isolation and loneliness.

4.  Risk of Self-Harm: In severe cases, moral injury can contribute to suicidal ideation and self-destructive behavior as veterans struggle to cope with their moral pain.

Strategies for Healing Moral Injury Among Combat Veterans

Addressing moral injury requires a holistic approach that recognizes the complexity of veterans’ experiences and supports their psychological, emotional, and spiritual well-being:

1.  Non-Clinical Interventions: Success-based interventions such as the Peer Rescue Protocol (PRP), Trauma Resiliency Protocol (TRP) and moral injury-focused interventions can help veterans process their moral experiences, challenge maladaptive beliefs, and develop coping strategies. Tactical Resiliency USA have developed these nonclinical interventions and have been successfully using them as well as in the nonprofit space with peer led initiatives.  “Healing the Hero” is a faith based nonprofit but will also meet the veteran where they are and apply nonfaith based models of healing at no cost to the veteran or their immediate family members.

2. Peer Support: Connecting veterans with peers who have shared similar experiences can provide validation, understanding, and mutual support in navigating moral injury.

3. Spiritual Care: Providing access to chaplaincy services, spiritual counseling, and faith-based support groups can address veterans’ spiritual distress and help restore a sense of meaning and purpose.

4.  Community Reintegration: Supporting veterans in reintegrating into civilian life through employment assistance, education opportunities, and community engagement can promote social connection and belonging.

5.  Policy and Leadership: Implementing policies and practices within military and veteran support systems that promote ethical leadership, moral resilience, and accountability can help prevent moral injury and support those affected.

Conclusion

Moral injury among combat veterans is a complex and multifaceted phenomenon that requires compassionate understanding, specialized care, and targeted interventions. By acknowledging the challenges faced by veterans and providing comprehensive support that addresses their moral, psychological, and spiritual needs, we can honor their sacrifices and promote healing and resilience in the aftermath of war.

As we continue to raise awareness, invest in research, and advocate for improved mental health care for combat veterans, we reaffirm our commitment to supporting those who have served and ensuring their well-being and dignity in the journey toward healing.

Sources:

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706.

Bryan, C. J., Bryan, A. O., Anestis, M. D., Khazem, L. R., Boduszek, D., Gutierrez, P. M., & Rudd, M. D. (2016). Measuring Moral Injury: Psychometric Properties of the Moral Injury Events Scale in Two Military Samples. Assessment, 25(5), 557–570.