Imagine you are in charge of air operations on a military installation during a conflict. The runway is narrow, flights are limited, and the weather is not cooperative. During the height of engagement, one plane is carrying blood for transfusions, the other a shipment of munitions sorely needed by your fighters on the frontlines. The bad weather is a limiting factor. Which plane do you allow to fly first?
Remember: Whatever choice you make will result in a fellow service member’s death.
This is not a hypothetical situation, but the type of scenario that our military faces every day. In the “heat of battle,” service members often find themselves having to make decisions that are unthinkable in civil society. Such decisions leave our service members trapped between the demands of duty and their internal sense of right and wrong. Conflict zones then become an arena of moral complexity where our military must grapple with choices that challenge their ethical boundaries, potentially resulting in moral injury.
Moral injury is the psychological distress that arises when an individual witnesses or participates in events that conflict with their moral compass. The term was popularized in the mid-1990s by Dr. Jonathan Shay, a staff psychiatrist at a Department of Veterans Affairs outpatient clinic who treated veterans suffering from psychological trauma. The nature of soldiers’ work often exposes them to complex situations that test the limits of their morality. Hostile environments, family separations, civilian casualties, and orders that contradict personal values can lead to an inner turmoil that leaves soldiers struggling for years after the completion of their service.
The 2021 military withdrawal from Afghanistan spurred a new rash of moral injury diagnoses, as service members and veterans questioned the meaning of what they’d fought for and grappled with the reality of the comrades left behind, according to Military Times. The withdrawal generated a resurgence of interest, as evidenced by the VA’s announcement that it would be initiating the first major nationwide survey studying moral injury in veterans. Based on the findings of the survey, the VA will promote relevant interventions to treat moral injury as part of a comprehensive veteran care package. The study will focus on veterans of the post-911 wars.
As philosopher and military ethicist Nancy Sherman and several military reporters have pointed out, there is a problematic disconnect between the American public and its military and veteran community. Most Americans do not come into direct contact with war or hostile operations and, as a result, are either uninterested or struggle to relate to those who have returned from conflict zones with wounds to bear. Considering the fact that our service members are called upon to make hard decisions so that we can preserve our way of life, recognizing moral injury should be our moral obligation as a society.
With this in mind, what can we do to help our service members and veterans who are undergoing a crisis of conscience?
This was one of the key topics of discussion at the recent Hero’s Journey Symposium in Washington, D.C. The symposium was hosted by the John P. Mayhugh Foundation, a non-profit organization established in 2017 as part of a national effort to holistically address mental health issues through diverse leadership initiatives. The annual symposium brings together members of Congress, military veterans, psychologists, academics, and industry leaders to discuss strategies and solutions for better mental health outcomes. While the emphasis of the discussions is on veterans and their families, the symposium aims to spearhead approaches that benefit all communities across the United States.
This year’s symposium included panel discussions on improving mental wellbeing for children and families, improving the clinical experience, community wellness and resiliency, and moral injury. In attendance were military veterans Rep. Mariannette Miller-Meeks, Iowa 1st District and Rep. Seth Moulton, Massachusetts. Other speakers included Dr. Barbara Van Dahlen, the co-founder and CEO of WeBe Life, and former White House “Drug Czar” the Honorable James Carroll. From losing a mother to schizophrenia to grappling with a child’s drug addiction, each speaker had a personal connection to the greater mission to untangling the complex dynamics of mental health and improving access to resources.
The panel on moral injury was moderated by award-winning journalist and former CNN correspondent Kathleen Koch, who shared her own brush with moral injury as a result of covering the destruction of Hurricane Katrina in her hometown in 2005. As Koch aptly put it, “PTSD is a racing heart, moral injury is a broken heart.”
At the Hero's Journey Symposium, from left to right: Kathleen Koch, Dr. Jason Nieuwsma, Timothy "Tito" Torres, Dr. Melissa Smigelsky, Mary Mayhugh, Dr. Barton Buechner, Jessica Walton
(Photo Credit: Bobby Ross)
Representing the veterans' perspective, Timothy "Tito" Torres, who served in the 75th Ranger Regiment as an Airborne Ranger, completed nine out of his eleven combat deployments in Afghanistan and was personally devastated by the 2021 withdrawal. Getting involved with the Moral Compass Federation, which Torres currently supports as the executive director, helped him focus his energy on the psychological needs of the veteran community while continuing to help Afghan allies. Today, the organization empowers veterans to address moral injury through education, advocacy, and action.
As Drs. Jason Nieuwsma and Melissa Smigelsky from the Veteran Affairs Center for Integrative Mental Health pointed out on the panel, there is currently no official diagnosis or threshold for moral injury. PTSD and moral injury often co-occur, but treating moral injury the same way therapists treat PTSD can be counterproductive. Furthermore, many veterans struggling with PTSD are unable to process their moral injury until after the symptoms of their post-traumatic stress are first treated—leaving veterans to unexpectedly deal with a second wave of shock. Unfortunately, the treatment programs available for moral injury are scarce.
Dr. Smigelsky further explained that when PTSD was first established as a diagnosis in 1980, it focused on anxiety, fear, triggers, and avoidance. But the moral dimension of trauma, which was known about at the time, was not included in this diagnosis.
When Koch questioned why moral injury wasn’t considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorder (DSM), Dr. Nieuwsma clarified the potential downside of attaching certain medical terms to moral injury, which might result in limiting who could treat suffering veterans, among other bureaucratic hurdles. He also pointed out that when we consider the usual disorders included in the DSM—depression, anxiety, and so on—descriptions are focused on the disorder within the individual alone. Moral injury, on the other hand, “points to profound social questions that we should all be asking, such as, ‘Did we do the right thing? What was the right thing to do in that circumstance?’”
In other words, moral injuries may be pointing to wider societal issues. Sharing and studying stories of moral injury encourage public discourse on important issues related to national defense. We must sometimes have uncomfortable conversations about the ethics of warfare and the full cost of conflict. These discussions are critical for shaping informed policies and decisions that affect our nation’s security and the long-term well-being of our citizens.
Difficult moral decisions during hostile operations are not confined to the battlefield alone; conflicts rife with moral dilemmas exist in everyday life as well. Our service members and veterans carry with them a wealth of experiences and stories that can provide invaluable insights for our contemporary world, ranging from the complexities of heroism and sacrifice to self-forgiveness. The act of sharing these stories is not just a means of therapy or preserving history, but a powerful tool for collective growth and resilience.
Military stories also highlight personal challenges and the lessons learned in the face of adversity. How could any other theme be so important to explore in the aftermath of the COVID-19 pandemic and the rising rates of mental illness and suicide among our younger population? The stories of service members who have persevered through unimaginable circumstances and physical hardship serve as a testament to the strength of the human spirit. If communicated in a relatable fashion, narratives culled from these environments can inspire individuals from all walks of life to overcome their own challenges.
Dr. Barton Buechner from Adler University discusses moral injury on a panel with Veteran Affairs Psychologist Dr. Melissa Smigelsky
(Photo Credit: Bobby Ross)
Moral injury is not a sign that something is wrong with our society. It is a sign that we still have a conscience; it is a sign that, as a society, we want to do what is right, even when faced with conflicting choices. This struggle is a symbol of the moral compass preserved within the human spirit.
We all walk through life with a certain aperture of what we experience; war flings open that aperture, exposing soldiers to the extremes of human depravity along with the most noble, heroic acts that man is capable of. As a result, the personal stories of those who have served our country contribute to our understanding of the human dimension in the overwhelmingly complex dynamics of conflicts. It is our duty to honor our service members and veterans’ stories, and in doing so, we honor the very essence of our nations’ values and principles. The hope is that by listening to these stories, our society benefits from gaining empathy, understanding, and inspiration that ultimately creates a more enlightened community.
At the conclusion of the Hero’s Journey panel, Dr. Barton Buechner, the program director of the Adler University Military Psychology MA Program and a veteran himself, summed it up as such: “Moral injuries have been part of the warrior culture for years back. There is a perilous journey into war and a perilous journey back. But there is also a gift that veterans have to share with the rest of society and that is their stories.”
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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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