The Trauma of Following Orders

A colleague and I were discussing one of his veteran clients.  My colleague is a Vietnam Era veteran and I am a Desert Storm veteran and we often consult with each other about our cases. His client William, is a Vietnam Veteran in failing health. I had met William through another veterans program and referred him to my colleague because I felt he would be a better fit. Due to his failing health William is starting to look back at his life and psychologically preparing for his passing. Like many Vietnam veterans William is struggling with what he had to do in Vietnam to survive. The Vietnam battlefield used civilians, women and children to carry out some of their attacks. As a Soldier, Sailor, Airman, or Marine you had no idea who your enemy was. All you could do is make instant life or death decisions, follow orders, and hope you are doing the right thing.  

When William’s unit entered a village in Vietnam, they were ordered to destroy the village and kill or capture anyone who was there, including women and children. Military intelligence had informed his commanding officer (CO) that the village was a haven for Viet-Cong and needed to be destroyed. Williams platoon completed their mission and proceeded to kill those who refused to surrender, and burned the village to the ground. What was ordered and accepted by his superior’s is something William would live with the rest of his life. Since the age of 19 he has spent most of his life self-medicating with drugs and alcohol trying to forget the action he had to take in that village. He wonders how he could go to heaven after killing so many people.

William is suffering from what is called moral injury. Moral injury is a relatively new term, but its pain is as old as war. It is a negative self-judgment based on having transgressed core moral beliefs, values or on feeling they possess. The term is described as “the psychological burden of killing and the betrayal of leaders”. Moral Injury appears to be a slow burn that takes time to sink in. The victim of moral injury needs to accept moral reasoning, evaluate behavior, experience empathy, and create a coherent memory narrative. Many times, soldiers are placed in no win situations by their leadership and told they must betray there since of “what’s right”. These actions cause confusion concerning one’s morality because they knew it was wrong, but were told by your superiors its ok. For some it takes minutes, for others it takes years to feel the sadness or sorrow of not following your moral beliefs. Veterans try to suppress their moral injury and some succeed through the use of drugs and alcohol. Others work hard to support their families and place their moral injury on the back burner, they are doing what is moral, providing for their family and working.  

A common theme is veterans feel nothing can prepare you for what war is really like. To some when they return home it feels like they have lost their soul. It is tough when society states, thou shall not kill, and military states thou better kill, be killed, or suffer the shame of not trying. Many have endured the moral pain of driving past wounded women and children and not stopping for help because of orders, having to shoot civilians because you don’t know who your enemies are, killing families because of one enemy sympathizer, or killing someone over anger because they killed or shot your comrade. There appears to be no end, the symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live. In war military members have to follow orders without question, and at times those orders shake our moral beliefs.

Moral injury is not something that can be cured by medication. The restructuring of their moral identity and meaning is the key. Seeking help from clinicians and chaplains is the first step. What it takes is the support of a caring non-judgmental community who can find a way for veterans to forgive themselves. Our communities need to understand the war doesn’t end when our troops return home, it is just the beginning of their battles. Some Vietnam veterans are still dealing with this issue 40 plus years later. We now have a new generation of troops who will be facing the same issues. In the future moral injury is going to explain why some veterans suffer. Some feel moral injury is one of the primary factors in military suicide rates. The key is for friends and families to be on the lookout and get them the help they deserve. There is hope, the VA is funding a 4 year study on moral injury in Marines and there are numerous counseling options for veterans and their families.  

For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

PTSD Is Not Always Combat Related

Johnathan came into session upset that his family feels his problems that brought on his Traumatic Stress Disorder (PTSD) is no different than anyone else’s issues and minimizes his fears. Johnathan struggles himself with is PTSD diagnosis because it was not caused by combat. Johnathan’s PTSD came from an incident that happened while he was in the Army but did not come from what everyone expects. Johnathan’s PTSD came from a vehicle accident that happened during training. Johnathan discussed how the Humvee he was riding in rolled down a mountain while he was serving at Ft. Wainwright Alaska. The accident occurred on the bombing range on the back side of Ft. Wainwright, they were alone while driving from one location to another and it took hours for someone to find them. Johnathan was stranded in the Humvee for hours beside his troop who was killed in the accident.    

Johnathan states his spouse; Evelin and his family don’t understand or want to understand what he is going through. Johnathan disclosed that he feels his family looks at his issues as no reason to have PTSD because people have automobile accidents every day.  Johnathan’s family don’t see his PTSD as anything different, they struggle to understand why Johnathan suffers and others don’t who have been in an auto accident. Johnathan’s family makes him feel invisible and refuses to make concessions for his PTSD and just looks at him as being weird. Johnathan was not married or have children while he was in the Army and struggled the rest of the time he was in; he has been dealing with the loss of his troop since the incident. Johnathan began to drink heavily causing him to fall out of favor with his command causing more issues. Johnathan’s family did not know him before the accident and never knew him without his PTSD.

Johnathan recently realized through counseling that he has been going throughout life accommodating his PTSD. Johnathan found job’s that allow him to feel safe with his PTSD which helped hide the PTSD symptoms. But his family continues to not understand. Johnathan feels the sacrifices he has gone through has been unnoticed because his family feels his PTSD is not valid because it was not due to combat. He believes his family looks at his incident as just another automobile accident. Not the fact that he was stuck for an extended time with a dead troop beside him in the Humvee. Johnathan has stopped talking to his family about his triggers because they blow them off and don’t take it seriously. With his family blowing off his triggers Johnathan feels invisible.

One of the biggest things I see in our veteran population is people discounting the sacrifices of those who’s military service’s PTSD did not involve combat. It appears to most people, even combat veterans, that those who did not deploy should not look at their PTSD as the same as a combat veteran’s. The people around Johnathan discount his experiences because they believe Johnathan’s automobile accident is no different than the thousands of accidents that happen in the country every day. What his family does not understand is auto accidents cause more PTSD than combat… it just not talked about. Johnathan continues to struggle with his PTSD because his family discounts his experiences casing him to feel invisible and helpless.

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For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

The Trauma of Following Orders

A colleague and I were discussing one of his veteran clients.  My colleague is a Vietnam Era veteran and I am a Desert Storm veteran and we often consult with each other about our cases. His client William, is a Vietnam Veteran in failing health. I had met William through another veterans program and referred him to my colleague because I felt he would be a better fit. Due to his failing health William is starting to look back at his life and psychologically preparing for his passing. Like many Vietnam veterans William is struggling with what he had to do in Vietnam to survive. The Vietnam battlefield used civilians, women and children to carry out some of their attacks. As a Soldier, Sailor, Airman, or Marine you had no idea who your enemy was. All you could do is make instant life or death decisions, follow orders, and hope you are doing the right thing.  

When William’s unit entered a village in Vietnam, they were ordered to destroy the village and kill or capture anyone who was there, including women and children. Military intelligence had informed his commanding officer (CO) that the village was a haven for Viet-Cong and needed to be destroyed. Williams platoon completed their mission and proceeded to kill those who refused to surrender, and burned the village to the ground. What was ordered and accepted by his superior’s is something William would live with the rest of his life. Since the age of 19 he has spent most of his life self-medicating with drugs and alcohol trying to forget the action he had to take in that village. He wonders how he could go to heaven after killing so many people.

William is suffering from what is called moral injury. Moral injury is a relatively new term, but its pain is as old as war. It is a negative self-judgment based on having transgressed core moral beliefs, values or on feeling they possess. The term is described as “the psychological burden of killing and the betrayal of leaders”. Moral Injury appears to be a slow burn that takes time to sink in. The victim of moral injury needs to accept moral reasoning, evaluate behavior, experience empathy, and create a coherent memory narrative. Many times, soldiers are placed in no win situations by their leadership and told they must betray there since of “what’s right”. These actions cause confusion concerning one’s morality because they knew it was wrong, but were told by your superiors its ok. For some it takes minutes, for others it takes years to feel the sadness or sorrow of not following your moral beliefs. Veterans try to suppress their moral injury and some succeed through the use of drugs and alcohol. Others work hard to support their families and place their moral injury on the back burner, they are doing what is moral, providing for their family and working.  

A common theme is veterans feel nothing can prepare you for what war is really like. To some when they return home it feels like they have lost their soul. It is tough when society states, thou shall not kill, and military states thou better kill, be killed, or suffer the shame of not trying. Many have endured the moral pain of driving past wounded women and children and not stopping for help because of orders, having to shoot civilians because you don’t know who your enemies are, killing families because of one enemy sympathizer, or killing someone over anger because they killed or shot your comrade. There appears to be no end, the symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live. In war military members have to follow orders without question, and at times those orders shake our moral beliefs.

Moral injury is not something that can be cured by medication. The restructuring of their moral identity and meaning is the key. Seeking help from clinicians and chaplains is the first step. What it takes is the support of a caring non-judgmental community who can find a way for veterans to forgive themselves. Our communities need to understand the war doesn’t end when our troops return home, it is just the beginning of their battles. Some Vietnam veterans are still dealing with this issue 40 plus years later. We now have a new generation of troops who will be facing the same issues. In the future moral injury is going to explain why some veterans suffer. Some feel moral injury is one of the primary factors in military suicide rates. The key is for friends and families to be on the lookout and get them the help they deserve. There is hope, the VA is funding a 4 year study on moral injury in Marines and there are numerous counseling options for veterans and their families.  

For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

PTSD Is Not Always Combat Related

Johnathan came into session upset that his family feels his problems that brought on his Traumatic Stress Disorder (PTSD) is no different than anyone else’s issues and minimizes his fears. Johnathan struggles himself with is PTSD diagnosis because it was not caused by combat. Johnathan’s PTSD came from an incident that happened while he was in the Army but did not come from what everyone expects. Johnathan’s PTSD came from a vehicle accident that happened during training. Johnathan discussed how the Humvee he was riding in rolled down a mountain while he was serving at Ft. Wainwright Alaska. The accident occurred on the bombing range on the back side of Ft. Wainwright, they were alone while driving from one location to another and it took hours for someone to find them. Johnathan was stranded in the Humvee for hours beside his troop who was killed in the accident.    

Johnathan states his spouse; Evelin and his family don’t understand or want to understand what he is going through. Johnathan disclosed that he feels his family looks at his issues as no reason to have PTSD because people have automobile accidents every day.  Johnathan’s family don’t see his PTSD as anything different, they struggle to understand why Johnathan suffers and others don’t who have been in an auto accident. Johnathan’s family makes him feel invisible and refuses to make concessions for his PTSD and just looks at him as being weird. Johnathan was not married or have children while he was in the Army and struggled the rest of the time he was in; he has been dealing with the loss of his troop since the incident. Johnathan began to drink heavily causing him to fall out of favor with his command causing more issues. Johnathan’s family did not know him before the accident and never knew him without his PTSD.

Johnathan recently realized through counseling that he has been going throughout life accommodating his PTSD. Johnathan found job’s that allow him to feel safe with his PTSD which helped hide the PTSD symptoms. But his family continues to not understand. Johnathan feels the sacrifices he has gone through has been unnoticed because his family feels his PTSD is not valid because it was not due to combat. He believes his family looks at his incident as just another automobile accident. Not the fact that he was stuck for an extended time with a dead troop beside him in the Humvee. Johnathan has stopped talking to his family about his triggers because they blow them off and don’t take it seriously. With his family blowing off his triggers Johnathan feels invisible.

One of the biggest things I see in our veteran population is people discounting the sacrifices of those who’s military service’s PTSD did not involve combat. It appears to most people, even combat veterans, that those who did not deploy should not look at their PTSD as the same as a combat veteran’s. The people around Johnathan discount his experiences because they believe Johnathan’s automobile accident is no different than the thousands of accidents that happen in the country every day. What his family does not understand is auto accidents cause more PTSD than combat… it just not talked about. Johnathan continues to struggle with his PTSD because his family discounts his experiences casing him to feel invisible and helpless.

---

For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

The Trauma of Following Orders

A colleague and I were discussing one of his veteran clients.  My colleague is a Vietnam Era veteran and I am a Desert Storm veteran and we often consult with each other about our cases. His client William, is a Vietnam Veteran in failing health. I had met William through another veterans program and referred him to my colleague because I felt he would be a better fit. Due to his failing health William is starting to look back at his life and psychologically preparing for his passing. Like many Vietnam veterans William is struggling with what he had to do in Vietnam to survive. The Vietnam battlefield used civilians, women and children to carry out some of their attacks. As a Soldier, Sailor, Airman, or Marine you had no idea who your enemy was. All you could do is make instant life or death decisions, follow orders, and hope you are doing the right thing.  

When William’s unit entered a village in Vietnam, they were ordered to destroy the village and kill or capture anyone who was there, including women and children. Military intelligence had informed his commanding officer (CO) that the village was a haven for Viet-Cong and needed to be destroyed. Williams platoon completed their mission and proceeded to kill those who refused to surrender, and burned the village to the ground. What was ordered and accepted by his superior’s is something William would live with the rest of his life. Since the age of 19 he has spent most of his life self-medicating with drugs and alcohol trying to forget the action he had to take in that village. He wonders how he could go to heaven after killing so many people.

William is suffering from what is called moral injury. Moral injury is a relatively new term, but its pain is as old as war. It is a negative self-judgment based on having transgressed core moral beliefs, values or on feeling they possess. The term is described as “the psychological burden of killing and the betrayal of leaders”. Moral Injury appears to be a slow burn that takes time to sink in. The victim of moral injury needs to accept moral reasoning, evaluate behavior, experience empathy, and create a coherent memory narrative. Many times, soldiers are placed in no win situations by their leadership and told they must betray there since of “what’s right”. These actions cause confusion concerning one’s morality because they knew it was wrong, but were told by your superiors its ok. For some it takes minutes, for others it takes years to feel the sadness or sorrow of not following your moral beliefs. Veterans try to suppress their moral injury and some succeed through the use of drugs and alcohol. Others work hard to support their families and place their moral injury on the back burner, they are doing what is moral, providing for their family and working.  

A common theme is veterans feel nothing can prepare you for what war is really like. To some when they return home it feels like they have lost their soul. It is tough when society states, thou shall not kill, and military states thou better kill, be killed, or suffer the shame of not trying. Many have endured the moral pain of driving past wounded women and children and not stopping for help because of orders, having to shoot civilians because you don’t know who your enemies are, killing families because of one enemy sympathizer, or killing someone over anger because they killed or shot your comrade. There appears to be no end, the symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live. In war military members have to follow orders without question, and at times those orders shake our moral beliefs.

Moral injury is not something that can be cured by medication. The restructuring of their moral identify and meaning is the key. Seeking help from clinicians and chaplains is the first step. What it takes is the support of a caring non-judgmental community who can find a way for veterans to forgive themselves. Our communities need to understand the war doesn’t end when our troops return home, it is just the beginning of their battles. Some Vietnam veterans are still dealing with this issue 40 plus years later. We now have a new generation of troops who will be facing the same issues. In the future moral injury is going to explain why some veterans suffer. Some feel moral injury is one of the primary factors in military suicide rates. The key is for friends and families to be on the lookout and get them the help they deserve. There is hope, the VA is funding a 4 year study on moral injury in Marines and there are numerous counseling options for veterans and their families.  

For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.

Veterans Among Heroes in Las Vegas

Photo credits to: Prayitno (Flicker) License: https://creativecommons.org/licenses/by/2.0/legalcode

Teaching psychology in college opens a lot of doors for conversation. After the events in Las Vegas we discussed the aftermath. One of my students had two friends shot at the concert in Las Vegas. As I talked to her you could see the shock in her eyes and the concern for her friends. In Southern California Las Vegas is one of the key places to go for entertainment. Many people in California like to visit "sin city" and let their hair down and have a good time. Las Vegas is known worldwide for its ability to put on good shows, and handle huge crowds that come for the gambling and entertainment. This was not the case a few weeks back when over 2200 descended upon Las Vegas to see a country music festival. These 2200 + concert goers are now cemented in history for being a part of the largest mass shooting in recent American history. No city could prepare for the events of October 1, 2017, not even Las Vegas. It was helpful to the concert goers and Las Vegas that there were a lot of veterans and off duty first responders in attendance or the situation would have been a lot worse.

Veterans continue to be a staple of helping during a crisis, and Las Vegas was another example. According to multiple witnesses some veterans stepped up showed their ability to act heroically and do what it takes to get the job done. During the terrorist attack at the Las Vegas music festival veterans sprang into action and provided help where they could, at times risking their own lives, or the possibility of going to jail. The horrific events in Las Vegas continues to remind us that there's evil everywhere, even in the United States. There were 2 veterans among the 58 killed, one was a veteran who survived a tour in Afghanistan. He is not the first, and probably will not be the last veteran to survive a war to be shot and killed at home. It is bothersome when someone survives a war and is killed at home where he should have been safe.       

All veterans, not just war veterans are trained in first aid and how to handle a stressful situation. Putting skills that were taught in the military to good use, more than likely saved a lot of lives. Veterans and first responders understood the need to provide help quickly and they did in mass. Once the veterans and first responders realized the noise from the shots were not a part of the show, and were actual bullets, they sprang into action, helping where they could. Veterans, first responders, and regular citizens started giving first aid while the shots were still being fired, putting themselves at risk, some people even lost their lives rendering aid to the fallen.   

Knowing what to do and how to handle stressful situations is what saved lives during the attack. Also doing what you “have to do” even if it is illegal, also saved multiple lives. The Veteran who “stole” the truck in Las Vegas to take the injured to the hospital is an example of how veterans think outside the box to make things happen. He took a chance that stealing a truck for a good reason would be ok with the owner, he was right. Thinking quick is a key to saving lives and many veterans have been in stressful situations and know what to do and how to respond when under attack.  

Continuing to serve the community is what many veterans do. Whether it is becoming a volunteer, first responder, police officer, nurse, doctor, or mental health clinician like myself it is done to help the public. If you look at any of the tragic situations that happens, there’s usually a veteran there to help, putting their skills to work and their lives on the line. When a crisis occurs, I can only hope there are veterans around to help, bringing their training to the forefront and saving lives. Veterans are trained to handle stressful situations and usually step up to the challenge when faced with a stressful life changing event. I would like to give a shout out to those veterans and first responders who continue to serve. By acting on their training, skills, and not running from stressful situations, makes us all proud to be veterans.

For questions or comments, I can be reached at afterdutyvets@gmail.com or visit our website at marriedtoptsdpro.com and like us on Facebook at Married to PTSD Pro.