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Battlefield’s Burden: The Impact of Moral Injury in the Military

Updated: Mar 30

When it comes to the warrior psyche, Dr. Barton Buechner speaks from experience—from several angles. He served in the U.S. Navy, including deployment to conflict zones, and has spent years with various veterans’ organizations and agencies listening to the stories of veterans going all the way back to World War I. He is now a founding faculty member and past program director of the Military Psychology Program at Adler University, delving into the complex intersection between mental health and social dynamics for the sake of supporting our nation’s service members.

 

I met Dr. Buechner back in September 2023 at the John P. Mayhugh Foundation’s Hero’s Journey Symposium in Washington, D.C., an annual event dedicated to holistically addressing mental health issues through diverse leadership initiatives. Keynote speakers included Members of Congress and the former White House Drug Czar Honorable James Carroll. As a volunteer supporting the symposium, I managed the logistics for the moral injury panel where I got to meet famed journalist Kathleen Koch, the executive director of the Moral Compass Federation, and several psychologists from the Veterans Affairs Office. Also sitting on the panel was Dr. Buechner, whose depth of insight into the phenomenon of moral injury clearly came from years of experience, interactions, and research.


After the panel, we wound up getting into an unexpected discussion about the role that moral injury played during Israel’s disengagement from the Gaza Strip back in 2005. At the time of the event, I was a student in Tel Aviv. I’ll never forget the thousands of Israelis who poured onto the highways, protesting either in favor or against the disengagement plan, and the impact this near-civil war had on the psychological fabric of our society. I’ll also never forget the haunted looks of my friends who returned from Gaza after forcibly evacuating thousands of Israeli citizens from their homes.

 

Our discussion also helped me realize the common humanity of the military experience across the globe. As Dr. Buechner put it on the panel, “Moral injuries have been part of the warrior culture throughout human history. There is a perilous journey into war and a perilous journey back.” Clearly, this malady isn’t going away any time soon. In the spirit of healing our warriors, let’s take the time to learn more.



Jessica: Tell me a bit about your background and what led to the work you do today in military psychology?

 

Barton: I spent 30 years in the U.S. Navy in a variety of roles and locations, both active duty and reserve. My first operational tour was during the Iranian hostage crisis on a destroyer up in the Gulf region in 1980. After that, I served as a public affairs officer and had several Navy and joint-service assignments.

 

Along the way, I had the opportunity to go to Yountville, California as the communication director and later deputy administrator of a large Veterans Home with about 800 vets, including about 70 World War I veterans. I got to listen to their amazing stories, which got me interested in trauma and moral injury. We usually talk about moral injury as a disruption, but there are also people who have really grown as a result of those exposures.


I started asking myself, What’s the difference? Why do some people get stuck after a challenging experience while others grow and blossom and become inspirational people?

 

I was at the Veterans Home for 20 years total, but during that time I was also recalled to active duty in the Navy from 2000 to 2005, which put me in Washington, DC when the 9/11 attacks occurred. It became a focal point for me in terms of how do we fit on this continuum as we try to make the world a safer place while also enacting our values during complex, high-stakes situations.

 

After earning my doctorate at Fielding Graduate University, I made my way to Adler University as a founding member of the faculty of the military psychology program. I was surprised to find that there aren’t a lot of psychology programs that focus on the military in higher education. Over the years I’ve discovered that there are many, many areas of the military that the field of psychology touches upon. Some of these areas are fairly controversial, but they are all essential.

 

Jessica: What aspects do you find controversial?

 

Barton: There is a duality of war that is uncomfortable for some to admit—that war is a terrible thing, while also at times being necessary. War causes death and destruction, so we want to avoid it at all costs. Yet, throughout human history, there have been moments where the only choice for survival is to wage war.

 

So when we talk about moral injury, we’re bringing the military experience into a more focused light. We’re honing in on the personal experience of the people who have come into contact directly with war and now have to come to grips with difficult, existential questions.

 

We can use the current conflict taking place in Israel as an example [referring to the recent October 7th massacres and resulting Israel-Gaza War]. Israel has taken center stage in the world’s eye. We’re watching closely how Israel handles itself after being attacked. We’re watching how Israel handles hostage negotiations.


In military operations there is also the phenomenon of an adversary trying to force you to do something that compromises your integrity. Hamas certainly tries to force Israel into those situations. Israel, for its part, strives to differentiate itself from its enemies by following international law and treating people humanely.

 

* Author’s Note: To learn more about Israel’s navigation of conflicting values during war, read former Israeli ambassador Michael Oren’s op-ed piece titled “Israel’s Choice: Body or Soul” here.

 

Jessica: How exactly do you define moral injury? And can you share a specific story example that illustrates moral injury? 

 

Barton: The classical thinking about moral injury in terms of a deeply disturbing or disorienting experience has its roots in either sensing or being part of a betrayal by someone in authority. Another aspect of moral injury would be having a sense of failing to live up to your own values, or coming to grips with the knowledge that you’ve been part of something that is deeply disturbing at a fundamental level. Something that challenges essential human values and makes you question the meaning of life.

 

At the John P. Mayhugh Foundation’s Hero’s Journey Symposium in Washington, D.C. where Dr. Buechner and I first met (far right). Photo Credit: Bobby Ross

 

I’ll give you an example from a story collected during my dissertation research. Everyone I interviewed for that study had a clinical diagnosis of post-traumatic stress. But what I found as I started digging into their stories was that there was almost always an underlying moral conflict or injury that haunted them more than the trauma itself. My specific example here is an infantryman artilleryman who served in the U.S. Army in the recent war in Afghanistan. He survived enemy explosions at close range in 37 separate incidents. He had traumatic brain injuries (TBI), he had seen a lot of death, but interestingly he was left relatively unscathed by those experiences.

 

What eventually got him out the army with a medical psychological discharge was what happened to him after an incident while he was on patrol. His vehicle was blown up by an enemy explosive device and one of his best friends was killed in front of him. He returned to his compound and it turned out that another patrol had picked up a group of locals who were believed to have been planting IEDs (improvised explosive devices) in the area where his vehicle had just been blown up.

 

One of the men in particular was loudly claiming he was innocent and being generally uncooperative. The soldier witnessed this scene and went into a fit of rage and completely lost control; he nearly beat this captured local to death. His colleagues had to restrain him as a result. They wound up chaining him to a light post in the middle of the compound clearing. It was deeply humiliating for him. It also messed up his frame of reference. Like, wait, who is the perpetrator here? Who is the victim? After all of the combat experience he had navigated successfully, this is what ended his service.

 

Jessica: My heart goes out to this guy. I can only imagine how many other similar stories exist as a result of this war. Do you know if there was anything that was helpful for this particular veteran’s healing process?

 

Barton: Pursuing a university degree at a school with a solid veteran support program. Probably not what you were going to guess, right? Higher education is commonly overlooked in the healing process when it comes to moral injury. The GI Bill after World War II was transformative because it made higher education more accessible to veterans who can now more easily enter the re-socialization process and direct their energies toward a meaningful second career. The Post-9-11 GI Bill is following in that tradition

 

Also having some form of mentorship has helped many transitioning veterans reground after being profoundly ungrounded by their experiences. There’s no one path that works, but there are definitely conditions we can create where growth is more likely to take place.

 

Jessica: The military psychology program you’re helping spearhead today is known for analysis through an Adlerian lens, based on the teachings of Austrian psychotherapist Alfred Adler. Can you explain his theories in a nutshell?

 

Barton: Alfred Adler was a protégé of Sigmund Freud, the father of psychoanalysis. But Adler came to the conclusion that Freud was looking too deeply inside the individual without spending enough time looking at the social dimension of mental health. And so he coined the German term, “Gemeinschaftsgefuhl,” which is the notion that connection with others, or “social feeling” is essential to our human health.

 

Adler is also considered one of the first positive psychologists, along with Abraham Maslow. In the school of positive psychology, instead of delving into the negative side of an experience, we should aim to highlight and analyze the positive. This is another area where Adler diverged from Freud. While Freud’s focus was on finding underlying disease or pathology by analyzing disorder, Adler was exploring how to build better social structures so that we can have healthier individuals.

 

If you interview POWs who have spent time in isolation, they will tell you that nothing takes the place of human connection. It’s essential to wellbeing. That was also basically Adler’s realization. He concluded that a major impediment to positive social connection is a sense of inferiority that drives people to certain actions that are not conducive to mental wellbeing. But this sense of “inferiority” is ultimately a construct. It’s a social world created by the individual, in response to certain experiences and interactions.

 

Jessica: How is Adlerian theory integrated into the psychology work you do today?

 

Barton: Uncharacteristically, I entered the field of psychology from a career in communications. In my first career, the classical belief is that communication is about a sender trying to reach a receiver of a message. In this paradigm, we craft our message in a way that is effective to convey our meaning and intent.


Later thinking in the field is more interactive, recognizing that communication is the product of complex dynamics that ultimately constitute reality. This “constructionist” view of communication aligns well with Adlerian theory, which gives us more tools in terms of creating healthier forms of communication, along with personal empowerment through the realization that we co-construct our reality.

 

Put another way, both communication and mental health is not just one person creating a reality and transmitting it into an abyss. In a healthy society, by virtue of our back-and-forth interactions, we co-construct a reality and a system of meaning. There is reciprocity and mutuality. But contemporary American society doesn’t necessarily emphasize this framework, and does not see the world in the same way that the military does, so as a result a lot of service members have a hard time transitioning back into the civilian world.

 

Dr. Buechner discusses moral injury on a panel with Veteran Affairs Psychologist Dr. Melissa Smigelsky at the Hero’s Journey Symposium in Washington, D.C. Photo Credit: Bobby Ross

 

Keep in mind that the culture in the military is very well-defined. Members have their missions, responsibilities, and purpose in life, and they interact with people who are like-minded, at least in the sense of shared values and mission focus. The civilian world is multipolar, and if you don’t know how to integrate back into this environment and create meaning for yourself—especially in light of the difficult experiences or morally complex choices you made back in the military—you can easily find yourself lost.

 

Jessica: Moral injury isn't just relevant to the military theater, by the way. In the aftermath of the COVID-19 pandemic, we know that our healthcare workers are suffering from this phenomenon as well. First responders and police officers are dealing with morally complex situations, as are journalists reporting from disaster zones, and so on.


What do you believe are the key lessons that our members of the military can teach the rest of society about moral injury and the way forward?

 

Barton: When you go into any front-line service profession, you understand that your purpose is to protect others and save lives. But what do you do during a situation such as COVID-19 when you’re physically unable to save everyone? It can translate as a felt sense of failure, even if in reality you did your best.


The pandemic forced health workers into unknown territory, where they did not always have the information, training, and resources they needed. This is something people in the military can relate to. In these type of situations, you have to count on your peers and comrades to “have your back.”


You know they are dedicated to the mission like you are, and would if necessary lay down their own lives to protect you. There is also a need to know that leadership is behind you when you have to make tough calls in the heat of the action – but sometimes they don’t always support you the way you expect. Maybe it’s due to competing priorities or pressure from the outside, but that trust is essential, and it’s also fragile. So, I think there are lessons here from the military about balancing the forces of group cohesiveness with supportive leadership, within the context of embracing higher values.

 

When service members come back to rejoin their civilian communities, They often look for a place where they can maintain a sense of purpose and find a peer support network of people who can understand who they are and what they’ve experienced.


I think the same thing applies to medical professionals and others in fields with similar variables. Ultimately, the power of belongingness within these social connections, as well as confidence in supportive and ethical leadership, can mitigate the impact of moral injury.

 

Jessica: Knowing the difficulties that our service members are likely to face when they enter the field, what can we do to prepare them psychologically? In other words, are there preventative treatments we can administer to mitigate the impacts of moral injury?

 

Barton: Military training should include preparation for difficult situations and a range of actions, along with tools for resilience so that service members can bounce back. Obviously we can’t plan for everything, but we can at least expand our range of possible actions to psychologically prepare our members for what they might face in the conflict zone.

 

There’s a phenomenon called “unwanted repetitive patterns,” or “URP”s, that applies here. These are strong contextual forces that come up repeatedly in an environment where, even with the best of intentions, we feel powerless to make the right decision. We may go into the situation thinking that we will respond one way, but something pushes our button or triggers something deep inside, and then afterwards we’re uncomfortable with how we responded.

 

One of the ways to prevent these URPs is to expand the range of potential actions that we know we have at our disposal, and to increase ability to reflect on possible outcomes in the moment, so that we can act into the situation more wisely. This kind of training and preparation can help our service members build resilience so that they won’t be immobilized when they have to confront inevitably hard choices.

 

Jessica: This concept of including psychological preparation for morally complex or traumatic incidents among new recruits in police departments is starting to gain traction in recent years as well. I think ultimately people just don’t want to feel alone or abnormal when they’re struggling with these issues.

 

* Author’s Note: See previous blog piece titled “On a Mission to Protect Police Mental Health” to learn more.

 

Barton: Absolutely. I think another area we can touch upon is intercultural competency, which means recognizing that when training new members, no one shows up as a blank state. Rather, each person has a whole cultural or religious history that shapes how they see the world. America has a very diverse society and that’s reflected in our military. So, we need flexibility in recognizing how people form their value systems and how they can have different psychological reactions to the same situation.

 

Jessica: In some of your past research, you've expressed concern about the untold stories of service members and veterans, as well as the loss to society from not being able to learn from their experiences. What do you believe is stopping our service members or veterans from telling their stories and what can be done to improve this capacity?

 

Barton: There are the stories we tell and the stories we have lived, and they don’t always match up. There are also the stories that are unheard or untellable, so we have to break down the barriers to allow veterans to share their experiences in an authentic way. Some veterans may not even consider the therapeutic power of storytelling in the first place and remain in isolation.

 

Setting the stage or setting the environment appropriately to be receptive to these stories is half the work. We need facilitators who ask the right questions to get veterans to open up. As an example, I recently participated in a program at the holistic retreat Omega Center in New York. It included pairing veterans with embodied practices, such as yoga and Tai Chi meditation, as well as a peaceful natural setting that made it easier for people to open up. They try to get rid of as many artificial barriers as possible that might be included in more traditional therapies.

 

For some people, connecting spiritually through a higher power provides a transcendent sense that forgiveness is available. And when it comes to interacting with others, people want to know that rather than be judged, their stories will be received and witnessed.


Dr. Buechner speaks at the American Psychological Association (APA) Division 19 Military Psychology Research Conference (c. 2023)

 

Jessica: What are the most successful treatments or therapies available today to treat moral injury?

 

Barton: For starters, we have to increase awareness of moral injury. A few weeks ago, I was in a room full of members of the military and when I asked who had even heard of “moral injury” only three people raised their hands. The wider public is probably even less aware of the term. Even though most members of the military probably haven’t heard of the term,  if you speak to chaplains they almost automatically recognize it. They see moral injury as a soul wound, an existential guilt – something they have worked with for a long time.

 

Instead of focusing on a single treatment, we should make a variety of integrated treatments available to suit different individuals. Acceptance and commitment therapy has shown promise in helping people shift their attention from the past, perhaps through mindfulness techniques, then accept what they experienced, and then commit to bringing something good about as a result of that experience.

 

Self-regulation therapies, such as Yoga Tai Chi and Horse Therapy, have been shown to be useful, but ultimately people have to renegotiate the meaning of their experience. They have to find a new purpose and figure out a way to move forward instead of self-destructing.

 

I know that that some veterans dealing with moral injury have had issues with therapies based on prolonged exposure, in which a client may be forced to go through a troubling incident in detail over and over again. The wrong therapy can be rejected, or do more harm than good.


This is also why it’s important to differentiate moral injury from PTSD, since what works well therapeutically for treating PTSD might backfire for an individual struggling with a moral injury. Unfortunately, many veterans will not even try, or will not stick with existing therapies, because it was easier to just get the PTSD diagnosis and then get on with their lives.

 

Many veterans don’t want to bring their stories home for fear of “poisoning” their friends and families with their ugly war experiences. But if they don’t share these stories with our wider society, then society misses out on knowing the sacrifices that were made on their behalf—sacrifices made to protect our lives and our value system.

 

* Author’s note: Police officers and first responders struggle with a similar dilemma. To learn more, check out this interview with Police Sergeant Michael Sugrue.

 

It's important for veterans to know that they’re not alone. There are other people like them who have experienced morally complex situations, but they wouldn’t know that unless they’re put in the right environment with the right people where they can share their stories. Our social structures have changed over the years, but our essential human nature has not. Moral injury has been around for as long as wars have existed. 

 

Recommended additional resources from Dr. Barton Buechner:

 

 

 


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About Jessica Lauren Walton: Jessica is a communications strategist, video producer, and writer in the U.S. defense sector. She has written articles on a range of security and mental health topics and conducted interviews with military leadership, CIA officers, law enforcement, psychologists, filmmakers, and more. Jessica recently completed her memoir about her experience as an American woman struggling with mental illness while trying to get into Israeli intelligence.


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