Moral injuries have been around for as long as people have engaged in combat. Historic works like the “Iliad,” the “Odyssey,” and modern blockbusters like “Oppenheimer” also explore the topic.
However, the term “moral injury” has only recently been given a name and started to be understood. That is partially because only 15% of enlisted military personnel ever see combat, according to research from the National Personnel Records Center. The percentage of commissioned officers to see combat is even smaller. But for those that do, it is often a life-altering event.
While war’s physical wounds are easier to see and treat, trauma that can’t be seen often poses the biggest challenge to those affected. Most people know about post-traumatic stress disorder, or PTSD, but fewer know about the diagnosis of moral injury.
“The suffering when things go wrong, and stakes are high, these are invisible wounds but, nonetheless, harm from something seen or done or from something done to us,” Dr. Kari Thyne, an Air Force veteran and associate professor at the Joint Special Operations University, said. “Moral injuries result in emotions such as anger, guilt, shame, self-blame, and sorrow. The effects can remain dormant for weeks, months, years, or even decades; they will not remain dormant forever.”
The topic is gaining traction with mental health care providers and the special forces community. At this year’s Special Operations Forces week in Tampa, a panel spoke on the subject and how it is being addressed.
A Venn diagram of PTSD and moral injury demonstrates part of the problem. The chart shows how the symptoms of one or the other can overlap.
Dr. Erin McFee, a professor of practice at the Perry Center for Hemispheric Defense Studies, said that can make diagnosing an issue even more difficult.
“It’s not a binary, oh, wait, yes, I have moral injury or no, I don’t have moral injury, it’s very difficult to sort of suss out what is and what isn’t,” McFee said. “That confusion can sort of add to the distressing nature of it. And that is also part of the phenomenon.”
Researchers on the topic say a combination of training before entering a combat zone and making additional resources available after returning home. The most important tool to address and manage moral injury is understanding an individual’s ownership of their experiences.
“Individual perception is key, you cannot tell an individual how they feel or what the traumatic experience means to them,” Dr. John Edgar Caterson, a master faculty instructor at the Joint Special Operations University, said. “It is their experience. And they are the own expert of their own individual soul root wounds, invisible wounds, whatever label you want to put on it, but they are the experts of that.”
For all that is known about moral injury, suicides among those that have served, continue at alarming rates. Depending on the factors considered, annual numbers of veterans committing suicide can vary from 17 to 44 lives lost every day. According to the National Institutes for Health, peer mentorship is one avenue for prevention.
Ultimately there are no easy answers when it comes to treating moral injury. However, experts say it starts with information and access to resources.
Crisis Resources
Suicide and Crisis Lifeline: Dial 988, then press 1 or text 838255.
Weapons and Warfare
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