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Interfaith Veterans' Workgroup

helping vets come home

moral injury

Come Ye Disconsolate

May 8, 2019 by Rx0puqi Leave a Comment

A Meditation on Moral Injury and Forgiveness

Preached at the Presbyterian Church of the Covenant

On May 5th, 2019

By the Rev. Thomas C. Davis

Irish poet Thomas Moore and American hymnist, Thomas Hastings, gave Christians a beautiful hymn that isn’t in our Presbyterian hymnal. In the 70s my wife and I belonged to a racially diverse congregation in Pittsburgh called the Community of Reconciliation. It was there, sung by African Americans, that I first heard this pre-Civil War hymn, “Come Ye Disconsolate.” The first verse goes like this:

Come to the mercy-seat, fervently kneel;

Here bring your wounded hearts,

here tell your anguish,

Earth has no sorrow that heaven cannot heal.

We don’t use the word, “disconsolate,” much these days. It means inconsolable, hopelessly unhappy. Someone who has endured that sorry state of heart and mind for too long may feel that suicide is the only way out. But the hymn says no! For earth has no sorrow that heaven cannot heal.

Al Mills is an Iraq War veteran. He and his brother, Nnamdi, are the current Twin Poets Laureate of Delaware. Over coffee a couple years ago I learned that Al was struggling with anger and hyper vigilance, symptoms of post traumatic stress. And what bothered him even more was a deep sense of shame, on account of something he had participated in during his tour in Iraq. He belonged to an artillery unit. Soldiers in artillery units rarely see the damage they inflict. But things changed quickly for Al when his unit had to convoy through an urban area. Suddenly he experienced what it’s like to be an infantryman, to kill close up. Duty and fear carried him through a terrible episode, but afterwards, after he had had time to think, what he had done made him terribly ashamed, so ashamed that he was beginning to feel inconsolable, disconsolate.

I would not be sharing these personal details about Al’s experience, were it not for the fact that he has already done so himself in public, by means of a very moving poem which he read for the first time at the St. Stephens Lutheran Church. He worked up to writing that poem after sharing memories with fellow combat veterans in the Interfaith Veterans Workgroup. I was present on both occasions.

Al’s poem was a soul dump. With his pen he let go of so much pent up anger, so much horror, so much moral indignation, and yes, so much shame! Reading the poem among civilians took a lot of courage, because veterans don’t know whether civilians can understand what they’ve been through. A veteran with moral injury has already heaped so much shame on himself or herself, it’s difficult to risk having even more piled on by folks who don’t understand. Al took that risk, and now he was exhausted. I invited him to walk around the block with me

Neither of us said much for a while. Then, finally, to console him I said, “You know, Al, with this moral injury stuff you’re in good company. The Apostle Paul had moral injury, big time.”

I think the Spirit put that idea into my head. I hadn’t worked out the details yet. The elements of an argument were floating around in my unconscious. I just rushed to the conclusion that night to assure Al that he wasn’t a bad person for having done a bad thing.

Now that I have had time to ponder the truth of my intuition that Paul had moral injury too , here’s why I think so.

Moral injury was a term coined by Jonathan Shay, a therapist who was treating Vietnam veterans with post traumatic stress. He observed that some of their symptoms derived from a hyped up nervous system that couldn’t be quieted. But other symptoms related to a deeper level of the self. You could say they are spiritual afflictions. Shay observed that moral injury is a very deep wound to the conscience. As researchers caught on to this term, moral injury, they understandably linked it to an event, a trigger, something that a veteran had done or failed to do in the line of duty which led to grievous harm, often the loss of life.

More than two years of research about moral injury have convinced me, however, that we won’t understand moral injury adequately if we focus just on an event that triggered moral pain. There are high suicide rates among doctors, among police officers, among correctional officers, and small farmers. Researchers are beginning to use the term, moral injury, to refer to the psychological pain among people in these professions too. In many instances their moral injury did not derive from a particular trigger, but rather, from severe moral frustration. Many people choose such professions out of a deep desire to serve, to be helpful to others. Then, they find that they cannot help as they had wanted because the working environment makes this impossible. When they fail, sometimes they don’t blame a system, they blame themselves. A soldier doesn’t blame the craziness of war for his bullet which was meant to kill an enemy but stuck a civilian instead. He blames himself. A doctor doesn’t blame a health system that puts more emphasis on saving money than saving lives. She takes the blame herself. She thinks, “I just didn’t work hard enough.” A farmer doesn’t blame big agriculture and increasing urbanization for losing the family farm. He blames himself.

The most common denominator among sufferers of moral injury doesn’t seem to be a similar trigger, but rather, a quality of personality, namely, a very high dedication to service. People with very high ideals about serving others may be more prone to moral injury than others who are less altruistically inclined.

This brings me back to the story of Saul. He had very high ideals of service. He was a Pharisee, a protector of the sanctity of religious law. Pharisees get a bad rap in the New Testament. They generally were people with very high standards of behavior. I see Saul that way. He was a crusader for the right way of doing things, and he saw followers of Jesus as dangerous underminers of that long tradition. So, when the story in Acts 9 opens he is carrying letters from high priests in Jerusalem bearing the names of followers of Jesus who have fled persecution in Jerusalem to seek refuge in far away Damascus. He is carrying hit lists. He is out to arrest and imprison the enemies of religious rectitude.

But, I don’t think Saul is of one mind. I think he has doubts. Saul was present during the stoning of Stephen, and scripture says he approved of it. But I think there was a growing part of Saul that didn’t approve. Stephen’s bloody clothing was dropped at Saul’s feet. To dispose of it he had to get blood on his hands, and killing up close can change a person. Besides that, scripture notes that Saul was a student of the highly respected Rabbi Gamaliel. And Gamaliel recommended that angry crowds not pursue annoying Christians, because if they were truly doing God’s work, then nothing could stop them. So we notice that Saul’s own rabbi was not of one mind regarding the followers of the Way.

Neither, I think, was Saul. As he rode on to Damascus to take prisoners I submit there was an inner war going on in him. He was beginning to experience an extreme inner tension brought about by a conscience pulling him in opposite directions.

Saul astride his horse was a prime candidate for what mental health practitioners call “conversion disorder.” According to the Diagnostic and Statistical Manual of Mental Disorders, conversion disorder occurs when a person experiences neurological symptoms that are not attributable to any medical condition. The symptoms are real, not imaginary, and they can affect motor functions and one’s senses.

Conversion disorder tends to be manifest in persons who, like Saul, have endured extreme tension. A symptom of their disorder can sometimes be understood as their body’s way of releasing the tension. For instance, a woman who is afraid of showing strong emotion might develop temporary paralysis of her arm when anger motivates her to strike someone. Typical symptoms of conversion disorder are temporary paralysis, weakness loss of balance, and temporary blindness. The story about Saul falling off his horse, needing help to move about, and becoming blind, suggest to me that his body was relieving part of his inner stress by temporarily relieving him of the capacities necessary to carry out a mission about which he had growing misgivings. He was ready to meet Jesus, but didn’t know it yet.

Saul recovers his sight when blindness is no longer necessary to relieve his inner tension. He can see again when he no longer fears that being able to see will enable him to do something against which his conscience has been crying out no, no, no! Notice that he doesn’t receive this assurance until he is forgiven.

And it is Ananias who is the transmitter of a forgiveness coming from the risen Jesus. He says to Saul, “Jesus, who appeared to you on the road as you were coming here—has sent me so that you may see again and be filled with the Holy Spirit.”

Thus it is that Saul, tormented by conscience, is assured by another human being that the old is over and done with. Saul is forgiven and given a new and right spirit for moving ahead. A man who might have taken his own life from agony of soul is saved by the laying on of hands and a declaration of pardon.

This story is very precious to me, a veteran who was once plagued by moral injury, a veteran who fell into a deep depression almost two decades after combat. That’s how long a conscience can stew. The men and women suffering from moral injury are often the morally most sensitive. They blame themselves for failing to clear a high bar that they have set for themselves. I speak from experience. We need an Ananias, another human being, to assure us that there is indeed a balm in Gilead.

Maybe you are presently wrestling with some moral quandary, as Saul did. Maybe you are a mystic and will see Jesus in your own way on your own road, as I did in Vietnam. Maybe you will see Jesus in some modern Ananias who declares to you what you may have learned in Sunday school, or maybe from the Reverend Mr. Fred Rogers, that you are loved just as you are.

Come, ye disconsolate, where’er ye languish;

Come to the mercy-seat, fervently kneel;

Here bring your wounded hearts,

here tell your anguish,

Earth has no sorrow that heaven cannot heal.

Filed Under: moral injury, post traumatic stress, repercussions of killing, Uncategorized, writing to heal

Annotated Bibliography of Books and Web Resources About Moral Injury

September 7, 2018 by Rx0puqi Leave a Comment

 

Books About Moral Injury and Resilience After Moral Injury

Boudreau, Tyler E. Packing Inferno: The Unmaking of a Marine. An autobiographical account of an Iraq veteran’s growing awareness of his own moral injury and what he did about it. Boudreau’s superb prose will give you a visceral taste of combat and its moral ambiguities.

Burke-Harris, Nadine. The Deepest Well. This book is about the long term health damage caused by ACES, adverse childhood experiences. I include it in this bibliography for two reasons: 1) because some researchers suspect that the veterans who have the most difficulty adjusting with resilience to PTS were already severely traumatized as children. (In the brain and body, injury inflicted by trauma is cumulative.) 2) In a late chapter the author makes six recommendations for resiliency which may prove useful for returning veterans.

Chivers, C.J. The Fighters. Stories about six U.S. veterans of the wars in Iraq and Afghanistan. They are: an F-14 pilot, a Green Beret sergeant, a Navy corpsman, a helicopter pilot, an Army infantryman and a Marine lieutenant. Their stories cover the 18 year history of these wars.

Davis, Thomas C. Double Exposure: A Veteran Returns to Vietnam. In this Kindle ebook the author recalls his own moral injury which wasn’t apparent to him until after the end of the war. Religious faith was important in his recovery.

Dean, Chuck. Nam Vet: Making Peace With Your Past. This is a self-help guide from one vet to another, written in simple language.

Grossman, Dave. On Killing: The Psychological Cost of Learning to Kill in War and Society, by Lt. Col. Dave Grossman. The author spends considerable ink proving that in past wars many riflemen refused to shoot at the enemy, because they couldn’t bear taking another’s life. This is a challenge to military trainers, but good news about human nature! Grossman examines how training can desensitize soldiers to killing, and how the act of killing can plague them afterwards.

Kingston, Maxine Hong. Veterans of War, Veterans of Peace, a collection of excellent short stories authored by veteran writers, mostly from the Vietnam and Korean wars.  The stories are largely hopeful and inspirational.

Marlantes, Karl. What It’s Like to Go to War. Marlantes was a Marine captain in Vietnam. He wrote a fictional best seller called Matterhorn which was informed by his combat experience. This book gives the factual details of that experience.

Meagher, Emmet and Jonathan Shay. Killing from the Inside Out. This author digs deeply into western history to dispute the moral validity of just war theory.

Moon, Zachary. Coming Home: Ministry That Matters With Veterans and Military Families. Guidance for Christian churches who want to help veterans and their families.

Nakashima Brock, Rita. Soul Repair: Recovering From Moral Injury After War.  Professor Nakashima Brock has established a Center for Soul Repair at the Brite Theological Seminary, dedicated to research and public education about recovery from moral injury.

Sackett, John G., Major USAF. Guilt Free War: Post Traumatic Stress Disorder and An Ethical Framework for Battlefield Decisions.  Moral injury is a challenge to military trainers, he writes. If human beings have an inborn reticence to kill, how can they be trained to perform the job of killing without morally injuring themselves? Major Sackett proposes guidelines for preparing soldiers ahead of time to not hold themselves morally culpable for battlefield decisions they may be forced to make. His book is based on just war theory, which other authors in this bibliography reject.

Sheehan, Dan. Continuing Actions: A Warrior’s Guide to Coming Home. A former combatant who experienced moral injury describes his own road to recovery in a style that will appeal to other warriors.

Sherman, Nancy. Afterwar: Healing the Moral Wounds of Our Soldiers.

Sites, Keven. The Things They Cannot Say. Stories about moral injury told by grunts.

Tick, Edward. Warrior’s Return: Restoring the Soul After War. An early author in the field of moral injury, Tick’s book is based on clinical work with many combatants.

Van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body Healing of Trauma. Not just about moral injury, but trauma in general, and not just trauma experienced in combat. Van der Kolk explains that all trauma injures the body and the brain, so treatments must address both. He also explains that trauma is cumulative. It is stored in the body, and each new trauma is added to the sum of previous ones. Soldiers who experienced traumas as children have injuries to their bodies and brains which may make it more difficult to recover from more recent traumas. This is a seminal book in the field of PTSD research.

Wood, David. What Have We Done: The Moral Injury of Our Longest Wars, by war correspondent, David Wood. Chronicles his considerations of “moral costs” of the wars in Iraq and Afghanistan.

Yocum, Cecilia. Help for Moral Injury: Strategies and Interventions. A fairly short book with concise descriptions of evidence based treatments helpful for treating veterans with moral injury. It is written for professional psychiatric and medical practitioners, and it involves mainly one-on-one techniques.

Yunger, Sabastian. War. A war correspondent’s deeply honest account of the harrowing experiences of the 2nd Platoon, Battle Company of the 173rd Airborne Brigade in Afghanistan. Yunger organizes his book in three long chapters: Fear, Killing, and Love.

Web Resources On Moral Injury and Resilience After Moral Injury

The very best of these web resources are the last listed, the three articles by war correspondent, David Wood.  You might do best to start there.

Arrow, Holly; and Schumacher, William M. “What is moral injury in veterans?” published in The Conversation.  A good, brief introduction to moral injury.

Barno, David; and Bensahel, Nora. “How to Talk to a Veteran,” Published by the University of Texas.  “Thank you for your service!” may not be a helpful greeting for a veteran troubled by moral injury, because he/she is not proud of what he/she did, and therefore shouldn’t be thanked for it. This article provides guide for what is most helpful in talking with a veteran.

Clear, James “Make More Art: The Health Benefits of Creativity.” Moral injury arises in the top and front of the human brain, the pre-frontal cortex. The non-conscious part of the brain, at the bottom and back, is where trauma hypes-up the fight-or-flight mode of consciousness for self-protection, and the nervous system gets stuck in high gear. That non-conscious part of the brain can be calmed by deep breathing meditation, but also, it seems to this veteran, by making art. Making art is a partly reflective process, but it’s also a not totally conscious one, an intuitive one, we say. So, like deep breathing, making art can be a bridge between the reflective part of the brain and the non-conscious part. This integration brings a peace which neurologically is not yet fully understood.

Cramer, Tom. “Can Spiritual Therapy Heal Your PTSD Symptoms?” Published through the Veterans’ Administration in Virginia. Mentions Dr. Nagy Youssef who is researching how faith communities can help veterans with moral injury.

Dickerson, Caitlin. “On Family Separation, Federal Workers Often Agonized Over Enforcement“, Published in the New York Times. Often moral injury occurs when one feels personally responsible for the death of another human being, or more than one. This author writes that when some I.C.E. employees were ordered to separate migrant children from their parents they suffered moral injury. This is an instance where there was no evident loss of life involved, yet the responsible officials felt morally trapped between a call to follow orders and their own consciences.

Gessler, Paul. “PTSD and Moral Injury Are the Hidden Wounds of Veterans,” a letter to veterans on the campus of Rocky Mountain College.  Published under the auspice of Veterans for Peace and the Adult Learning and Veteran Services Office of the college.

Jones, Diana Nelson. “‘Veterans’ Breakfast Club’ offers help to heal from moral injuries.” Published by the Pittsburgh Post Gazette. In her six recommendations for promoting resilience after trauma, author Dr. Nadine Burke-Harris notes (#6) that getting connected to a supportive community is essential. This article illustrates her point.

Kniggendorf, Anne. “Kansas City Veteran and Physician Treats the ‘Moral Injury’ of War Through Poetry.” From an interview at WCUR 89.3 FM.

Mighty Visual (a blogger at Vimeo), video entitled “Hunter in the Blackness: Veterans, Hope and Recovery,” Vietnam vets and younger veterans from the Iraq and Afghanistan Wars talk about their post traumatic stress and moral injury and what’s been helpful to them in recovery.

Press, Eyal. “Wounds of the Drone Warrior,” published in the New York Times Magazine.  In his book on the psychological effects of killing David Grossman observes that distance from the enemy tends to decrease a combatant’s moral sensitivity to killing. However, the visual preciseness of recently developed aerial cameras has made it possible for attack drone pilots to see what’s happening to their human targets quite clearly. Some are suffering extreme stress and moral injury in this line of duty.

Talbot, Simon G. and Dean, Wendy. “Physicians Are’t ‘Burning Out’. They’re Suffering From Moral Injury.” Many physicians enter that profession because they have high ideals and want to save lives. But the complicated demands of modern medicine frustrate that desire, and leave some feeling deep moral failure.

Turner, Jon Michael. YouTube video of him testifying at Iraq Veterans Against the War’s Winter Soldier gathering.

Woolston, Chris. “Writing for Therapy Helps Erase Effects of Trauma.” Perhaps the title of this article exaggerates. While writing for most veterans will not erase the effects of trauma, it does help to remove much of the emotional power of troubling memories.

Wood, David. Moral Injury: “The Grunts: Damned If They Kill, Damned If They Don’t.” This is the first of a 3-part series published in the Huffington Post. War correspondent Wood has authored some of most poignant short articles on moral injury available on the web. The second in this series is entitled, “The Recruits: When Right and Wrong Are Hard To Tell Apart.” The final article is “Healing, Can We Treat Moral Wounds?“

Filed Under: moral injury

Grief, Post Traumatic Stress, and Moral Injury

August 4, 2018 by Rx0puqi Leave a Comment

An Interfaith Veterans’ Workgroup member who works in the field of mental health observed that some experts recommend that people who are grieving not resist sadness, but rather, allow themselves to feel it and work through it. She asked whether a similar recommendation has been made for veterans suffering from post traumatic stress and moral injury. Here was my answer:

Regarding your excellent question: Grief is a normal response to a profound loss, felt as deep sadness. Cultures have developed ritualistic responses to the death of a loved one. These help people express their sadness in conventional ways, and the rituals provide a way for people to support each other in their grieving. Typically there are not similar rituals for other kinds of deep losses, such as loss of employment or loss of face. It’s good advice, I think, to counsel people to allow themselves to feel the normal sadness of a profound loss. If one tries to avoid feeling this normal sadness one’s grief may turn into the numbness of a severe depression, and that is a condition more difficult to weather.

Warriors experience post traumatic stress because the primitive part of their brains, (the back and bottom), have been on high alert for an extended period, so they are programmed to respond automatically and instantaneously and aggressively to threats. While they are in a theater of war this ramped-up condition of their nervous systems protects them. Therefore, this condition is not experienced as dysfunctional then. But when warriors return home and try to cope with daily life in a very different set of circumstances the behaviors that protected them are experienced both by themselves and others as highly dysfunctional, e.g. hypervigilance, automatic and oddly aggressive responses to even minor threats, odd reactions to noises, unconscious behaviors such as crossing a street to walk on the inside of a curve, or always choosing a seat in a restaurant that faces the entrance. I have discovered that it isn’t easy to de-program the primitive, non-reflective part of the brain with reflective methods. To bring down a ramped-up nervous system, talk therapy isn’t very useful. The body must be involved. Breathing meditation is one treatment that is working well on the unconscious part of the brain. Other treatments are working too. We’re in an exciting time of trauma treatment research.

Moral injury is a deep wound to one’s conscience due to something one did or failed to do in a line of duty which violated one or more of one’s core values. Many of the instances of moral injury involve loss of life. One holds oneself responsible for someone dying, or being put in life-threatening circumstances, and this grieves one very deeply. Warriors often don’t experience moral injury until they have had time to reflect on what happened in a life-or-death situation. Their warrior training programmed them to react automatically and aggressively, causing them to fire immediately, without thinking, upon a perceived threat. Later, remembering the incident in detail and thinking about its consequences, they may or may not forgive themselves for what they did.

Moral injury may be experienced even when there is no loss of life. (I have changed my view on this. In an earlier post I called killing the root of moral injury, but it isn’t always). In 1975, when Saigon fell to North Vietnamese troops I began to have nightmares, not about battle, but about betraying my South Vietnamese comrades in arms, abandoning them to this fate. I was experiencing moral injury. Some members of ICE experienced moral injury when they were compelled by duty to separate children from their parents. Some doctors are experiencing moral injury because they have very high standards for saving lives, but they feel complicit in a system that is dysfunctional and is not protecting the lives of all patients equally and fairly. Some farmers, I would say, are experiencing moral injury because, try as hard as they may, they are losing at a business that is very much more than a business. It’s a precious way of life that has been in their families for generations. And they hold themselves personally responsible for losing the battle to sustain that way of life. I have cited populations where the rate of suicide is rising. Not just military veterans, but also police and correctional officers and doctors and small farmers are taking their own lives at increasing rates. I am not the only researcher who feels that moral injury is a primary engine of suicide.Post traumatic stress and moral injury are often co-present. I feel that mental health practitioners need to deal with the ramped up nervous system before much can be done about moral injury. Otherwise, it’s like trying to treat a patient with an active addiction. Once there is some evidence that a patient is gaining ground dealing with unconscious behaviors, then it becomes possible to deal with wounds to the conscience. Here’s where talk therapy comes in, and also — an under-represented line of inquiry in my opinion — the effectiveness of spiritual disciplines and religious rituals of forgiveness and personal transformation.

You may find the following books helpful:

On Chronic Stress and Its Long Term Damages to Health:

The Body Keeps the Score, by Bessel Van der Kolb
The Deepest Well, by Nadine Burke-Harris

On Moral Injury in Veterans, and Treating It:

The Things They Cannot Say, by Kevin Sites
Afterwar: Healing the Moral Wounds of Our Soldiers, by Nancy Sherman
Killing from the Inside Out, by Emmet Meagher and Jonathan Shay
Soul Repair, by Rita Nakashima Brock
On Killing, by Lt. Col. Grossman
Help for Moral Injury: Strategies and Interventions, by Cecilia Yocum

— TCDavis

Filed Under: moral injury, post traumatic stress

Getting to the Root of Moral Injury: Killing

April 6, 2018 by Rx0puqi 3 Comments

What if we all have a pacifist gene and just refuse to recognize it? That’s the question that Jane Yoder raises in this recent article published by the Iowa City Press-Citizen.

Human beings are social creatures. Our ancestors had to cooperate in order to hunt large and powerful prey. Humans can function solo, of course, but we are hard wired to cooperate with and protect other members of our species. The innate human propensity not to kill another human being leaves some combat veterans wondering why they sometimes feel strange compunction after close encounters with the enemy. Strange, I say, because military trainers strive to desensitize recruits to killing. They strive to dehumanize the enemy in order to prevent warriors from recognizing themselves in the enemy. The U.S. military has come to recognize that moral injury is a valid psychological affliction, one which fuels depression and increases the rate of suicide among veterans. However, when explaining what kinds of memories trigger moral injury, only very rarely do military analysts mention that killing per se can do it. Killing an innocent bi-stander is frequently mentioned as a trigger. Failing to save the life of a buddy? Yes, of course, that too. But killing an enemy? Our violent culture has conditioned us to laud such an act, not call it into question. If military recruiters and trainers were to admit that there is something fundamentally unnatural about killing members of our own species, that we all share as it were a pacifist gene, their job would be much more difficult.

Ex-Marine Karl Marlantes, in his book, What It’s Like to Go to War, recounts a combat experience where he encountered a young enemy soldier suddenly, face to face and almost within an arm’s length. He shot him dead even as he felt a strange compassion that no amount of training or combat experience could eradicate. Killing, he declares, is wrong, but it may sometimes be necessary. It seems to me that we will not get to the root of veterans’ moral injury without grappling with the irony of that observation. Instead, a culture wedded to the myth of redemptive violence depicts military service as unquestionably heroic.

Filed Under: moral injury, repercussions of killing

Understanding Post Traumatic Stress and Moral Injury

October 25, 2017 by Rx0puqi Leave a Comment

About two years ago I founded the Interfaith Veterans’ Workgroup, to see what could be done to keep veterans from killing themselves. They were doing that at more than twenty a day. After two years of research I understand better the role of post traumatic stress and moral injury in veterans’ depression, and I’m coming to see that there are some non-clinical ways of helping warriors come home. Please read on:

Post Traumatic Stress is in the Body

A good book to understand the treatment of trauma is The Body Keeps the Score, by Bessel Van der Kolk.  PTSD affects the bottom and back of the brain.  That’s the primitive part that takes care of automatic functions, like breathing, the heart’s beating, etc.  Living under ongoing threat, as in a war zone, conditions that part of the brain to react aggressively without thinking.  PTS is in the entire body.  Warring creates muscle memory for self-preservation.  When warriors come home, and this can be done these days in a matter of hours, the muscle memory continues.  The whole body is still on combat alert.  One is hyper vigilant.  Sleep is difficult.  And when even a slight provocation occurs, like being cut off in traffic, the body reacts aggressively, automatically.  No thinking is involved.  The primitive brain is still doing its thing.  This condition can endure for many years.

Moral Injury is Felt After You’ve Had Time to Think

War is not heroic, as in the movies.  In war you do things merely to stay alive. You do them automatically, without thinking.  After a firefight you may not be proud of your conduct.  Maybe you killed a civilian who got in the way.  Maybe you failed to save a buddy.  Maybe out of anger you abused a prisoner, killed a prisoner, desecrated a corpse. Maybe in a strange moment you got in touch with the humanity of your enemy and you feel bad about shooting him down in an ambush instead of in the give and take of a fair firefight.  After you’ve had time to think there are so many ways to feel rotten about yourself for doing what you did, or failing to do what you think you should have done.  Such nagging reflections happen in the top and front of the brain, the pre-frontal lobes. PTS and moral injury are often co-present.  Both contribute to depression, but I think moral injury is probably the stronger factor in veteran suicide.

Returning Veterans and Returning Citizens from Prison Face Some Similar Challenges

Here’s a piece I shared with IVW and some friends who are working with men and women returning from prison:
For about two years I have been leading a group devoted to helping combat veterans transition successfully to civilian life (the Interfaith Veterans Workgroup).  Concurrently I have been sitting weekly with New Beginnings-Next Step, which helps former inmates transition from prison to society.  I have noticed that some veterans and many returning citizens from prison face similar emotional and behavioral challenges: managing anger, maintaining close relationships, and dealing with depression without self-medicating with substances that often lead to addiction.
One could say that these similarities stem from habits formed for self-protection in persons who have had to cope for a rather long time in dangerous and violent circumstances.  The CDC study done in Wilmington indicates that most young men who end up in prison for gun crimes experienced trauma as children. They were desensitized to violence not only by what they saw on TV or in video games, but much more so by witnessing maimings and killings where they lived, and sometimes in their own families.  Furthermore, they resorted to guns not only as a means of self-protection, but also as a means to assert themselves, to gain and keep respect; and in the long run respect “in the hood” is needed for survival, or so I’m told.  Thus, a habit of responding quickly and violently to even apparent challenges to the self becomes ingrained in the nervous system. Violent aggression becomes a habit of the body.  One doesn’t think anymore before pulling the trigger.

Lieutenant Davis driving boat in Vietnam
author, driving the “skimmer” in Mekong Delta, 1970

In 1970 I had accompanied South Vietnamese sailors to a village in enemy territory where we distributed medicines to “win hearts and minds.”  On the way back to our base we were ambushed.  We couldn’t see who was shooting at us, but every man in our boat sprayed the dense rushes on the canal bank immediately, without thinking.  Our rapid violent response suppressed enemy fire and got us out of that tight spot.  Our military training had desensitized us to killing and had ingrained in our very bodies an automatic response.  In an ambush there is no time to think.  One shoots to survive, and if one does survive, then one has the time afterwards to sort out what one did.  When there was no target, as in this case, one may wonder whether anyone got hit, and if so, was it a shooter or an innocent bystander?

 I know from personal experience that a habit of violent aggression gets ingrained in persons who have had to cope with living under constant threat.  That habit can be unlearned, but it takes time and dedication. Up to now our military hasn’t recognized a need to de-program warriors. You fly out of a war zone and presto, you’re back in the civilized world.  But your body is still on combat alert. Anger, may I suggest, is a natural self-protective human response. In a war zone it can indeed preserve your life.  But when you try to transition to civilization, what saved your life in war is likely to destroy it back home. Your body, not just your mind but your body too, needs to develop new habits for dealing with perceived challenges to the self.
That’s where mind-body disciplines like the martial arts, yoga, and mindfulness based stress reduction come in, and also the Alternative to Violence Project invented by Quakers.  The military deliberately trains people to not be anguished by killing, and to react immediately and violently to a perceived attack.  Those habits of the mind and body are needed in a theater of war, but they must be unlearned upon return, else former warriors may harm others or themselves.

Filed Under: moral injury, post traumatic stress

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@kengrantde The production of the Wilm. Veterans' Freedom Mural has begun: bit.ly/1T0of9j

About 3 weeks ago from InterfaithReflection's Twitter via TweetDeck

The production of the Wilm. Veterans' Freedom Mural has begun: bit.ly/1T0of9j

About 3 weeks ago from InterfaithReflection's Twitter via TweetDeck

Veterans Freedom Mural: youtu.be/Pq9fuS7snVU?a via @YouTube

About 3 weeks ago from InterfaithReflection's Twitter via Google

Wilmington VA Medical Center host town hall in Dover | WMDT.com Maryland-Delaware wmdt.com/news/more-loca…

About 2 months ago from InterfaithReflection's Twitter via Twitter Web Client

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