{"id":10438,"date":"2017-11-11T02:59:13","date_gmt":"2017-11-11T02:59:13","guid":{"rendered":"http:\/\/www.lifeandnews.com\/articles\/?p=10438"},"modified":"2017-11-12T03:04:25","modified_gmt":"2017-11-12T03:04:25","slug":"what-is-moral-injury-in-veterans","status":"publish","type":"post","link":"https:\/\/www.lifeandnews.com\/articles\/what-is-moral-injury-in-veterans\/","title":{"rendered":"What is moral injury in veterans?"},"content":{"rendered":"

Holly Arrow<\/a>, University of Oregon<\/a><\/em> and William M. Schumacher<\/a>, University of Oregon<\/a><\/em><\/span><\/p>\n

On Nov. 11 each year, Americans honor military veterans who have transitioned to civilian status from active duty. <\/p>\n

The cultural transition back to civilian life goes smoothly for some, but for others it is a challenging and sometimes lengthy process. Those who have deployed overseas or spent a substantial amount of time in the military may even deal with \u201creverse culture shock\u201d<\/a> \u2013 that is, upon return, their home culture can feel distant and disorienting.<\/p>\n

Along with the cultural transition, veterans may be coping with post-traumatic stress disorder<\/a>. More recently, clinicians who work with veterans have identified an additional cluster of symptoms<\/a> that are related to military deployment but do not fit the criteria for PTSD. <\/p>\n

These symptoms fit with what has been called \u201cmoral injury<\/a>.\u201d <\/p>\n

What is moral injury?<\/h2>\n

Moral injury can occur when a personal moral code \u2013 one\u2019s understanding of \u201cwhat\u2019s right\u201d \u2013 is violated<\/a>. Most individuals develop this code in childhood based on instructions from parents, teachers and religious leaders. <\/p>\n

This sense of morality can incorporate fundamental values of religious and legal doctrines such as \u201cThou shalt not kill<\/a>\u201d and \u201cDo unto others as you would have them do unto you<\/a>.\u201d Most of us occasionally stray from what our code says is right, but military service \u2013 especially in combat zones \u2013 can expose people to situations in which every available choice has morally fraught results. <\/p>\n

One combat veteran who served in Afghanistan, for example, told my psychology of war class that he had shot and killed a child soldier who was about to fire on his men. He knew he had made the \u201cright\u201d choice, but the responsibility for a child\u2019s death was still a heavy moral burden. <\/p>\n

The moral conflict created by the violations of \u201cwhat\u2019s right\u201d generates moral injury when the inability to reconcile wartime actions with a personal moral code creates lasting psychological consequences. <\/p>\n

Psychiatrist Jonathan Shay<\/a>, in his work with Vietnam veterans, defined moral injury as the psychological, social and physiological results of a betrayal of \u201cwhat\u2019s right\u201d<\/a> by an authority in a high-stakes situation. In \u201cAchilles In Vietnam<\/a>,\u201d a book that examines the psychological devastation of war, a Vietnam veteran described a situation in which his commanding officers used tear gas on a village after his unit had their gas masks rendered ineffective due to water damage. The veteran stated, \u201cThey gassed us almost to death.\u201d This type of \u201cfriendly fire\u201d<\/a> incident is morally wounding in a way that attacks by an enemy are not. <\/p>\n

Psychologist Brett Litz<\/a> and his colleagues expanded this to include self-betrayal and identified<\/a> \u201cperpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations\u201d as the cause of moral injury. <\/p>\n

Guilt and moral injury<\/h2>\n

A research study published in 1991 identified combat-related guilt<\/a> as the best predictor of suicide attempts among a sample of Vietnam veterans with PTSD. Details of the veterans\u2019 experiences connected that guilt to morally injurious events. As the authors noted,<\/p>\n

\n

\u201cOne man, for example, shot and killed a woman who was advancing toward his patrol and did not heed his order to stop. She turned out to be wired with explosives, but the veteran ruminated about whether he could have stopped her by firing a warning shot or wounding her in the legs.\u201d<\/p>\n<\/blockquote>\n

A more recent study of active duty service members found that the connection between guilt and suicidal thoughts was strongest among those with combat exposure<\/a>. Another review of research concluded that service members who committed acts that violated accepted bounds of behavior were more prone to substance abuse and suicidal behavior<\/a>.<\/p>\n

Can moral injury be healed?<\/h2>\n

The truth is that military engagement will always involve morally problematic actions. However, healing from moral injury is possible. <\/p>\n

\n \"\"
\n Veterans and volunteers participate in Dancing Well, an evening of community dance designed for veterans and families affected by PTSD.<\/span>
\n AP Photo\/ David Stephenson<\/span><\/span>
\n <\/figcaption><\/figure>\n

Mental health treatment can help. Preliminary evidence suggests that cognitive-behavioral therapy<\/a> modified to treat issues related to moral injury<\/a> can reduce depression as well as guilt- and shame-related thoughts. Treatment can come in other forms as well. Psychotherapist Edward Tick<\/a>, for example, organizes trips to Vietnam for U.S. veterans to meet their Vietnamese counterparts, for the healing of decades-long wounds.<\/p>\n

However, we don\u2019t need to be trained therapists to make a difference. Everyday social connections can also help the morally injured heal. For his dissertation<\/a>, the second author of this article conducted a series of interviews with veterans exposed to potentially morally injurious events and found consistent differences between those with higher levels of depression and suicidal thoughts and those with fewer symptoms. Veterans who weren\u2019t doing so well felt isolated and lacked support by friends, family and peers. Veterans with few symptoms felt supported by family, friends, peers and by their community. That\u2019s the rest of us. <\/p>\n

When we discover that someone has a military background, replacing the perfunctory \u201cThank you for your service\u201d \u2013 which rarely leads to a meaningful exchange \u2013 with questions that start a conversation can create a new connection. The hopes, dreams, insecurities and mistakes of those who have served may be somewhat different based on their military background; many won\u2019t be different at all. <\/p>\n

More positive social connections aren\u2019t just psychologically healthy for veterans and their families. They are good for all of us, on Veterans Day and every other day of the year. <\/p>\n

\"TheThis is an updated version of a piece published on May 21, 2017.<\/em><\/p>\n

Holly Arrow<\/a>, Director, Groups and War Lab, University of Oregon<\/a><\/em> and William M. Schumacher<\/a>, PTSD Postdoctoral Fellow, New Mexico VA HCS, University of Oregon<\/a><\/em><\/span><\/p>\n

This article was originally published on The Conversation<\/a>. Read the original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Holly Arrow, University of Oregon and William M. Schumacher, University of Oregon On Nov. 11 each year, Americans honor military veterans who have transitioned to civilian status from active duty. The cultural transition back to civilian life goes smoothly for some, but for others it is a challenging and sometimes lengthy process. Those who have […]<\/p>\n","protected":false},"author":44,"featured_media":10439,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[2450],"tags":[2412,2413,3478,1871,2336,3476,779],"_links":{"self":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/10438"}],"collection":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/comments?post=10438"}],"version-history":[{"count":1,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/10438\/revisions"}],"predecessor-version":[{"id":10440,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/10438\/revisions\/10440"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media\/10439"}],"wp:attachment":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media?parent=10438"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/categories?post=10438"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/tags?post=10438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}