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.
