Those we send into war return forever changed.
Many wander for years in a state of isolation and misery. Without understanding how war changes people, we will continue to fail as a public to do what is required to return soldiers to civilian life.The devastating suicide rate among veterans exposes that failure. Since 2005, the rates have been climbing among those younger than 30. Reported suicides total around 6,500 a year out of 23 million veterans, triple the civilian rate, with female veterans' rates higher than men's. We commit enormous resources to turn recruits into soldiers. Military training teaches them to perform acts regarded as criminal or unnatural in civilian life. Then, we send them into the maws of battle: the anxiety, horror, violence, fatigue, noise and constant death of war, which is the most heinous process humans have designed to wreck moral conscience. We neither spend equivalent resources to train them to return to civilian life nor support them in recovering their moral character.While intense national focus has been turned on post-traumatic stress disorder, little attention has been paid to moral injury in war. They are not the same.PTSD is a reaction to terror that inhibits the brain's abilities to calm fear and integrate feeling and memory. Brain injuries and previous trauma create greater vulnerability to PTSD. Moral injury can occur in a healthy, well-functioning prefrontal cortex, which governs our understanding of moral values, evaluates our behavior, creates a coherent memory narrative, makes moral judgments and organizes perception and feeling into an empathetic response to others.Moral injury occurs when a war combatant violates deeply held moral beliefs and can no longer make sense out of the world. Vietnam veteran and philosopher Camillo "Mac" Bica describes it as the destruction of moral identity. Psychiatrist Jonathan Shay, who worked with Vietnam veterans, explains it as an unmaking of character. It happens in many ways: killing; failing to stop an atrocity or committing one; having to fight a war one thinks is unjust; or treating human remains disrespectfully.It comes also as survivor guilt and feeling betrayed by officers, national leaders or members of one's unit. It results in shame, guilt, a desire to make amends, a sense of futility about life, rejection of faith, depression, addiction and profound inner anguish that includes feelings of worthlessness, anger, mistrust and despair.Moral injury afflicts healthy people; it is not a psychological disorder that can be adequately treated clinically. Psychological training does not require knowledge of theological ideas or an ability to discuss evil and morality. When veterans in therapy raise moral questions or ask about God or evil, they are usually referred to clergy, and a greater number initially choose to talk to a chaplain over a therapist.But not all religious advice or counseling helps those who struggle with moral injury. Clergy and religious communities that impose judgments or punitive ideas of divinity can make it worse; so can those who simply treat vets as heroes.Religious people need to offer instead friendship: a capacity to listen deeply and empathetically; attitudes of respect and care; a willingness to engage in deep moral exploration; and consistent, reliable support for rebuilding a moral identity over a lifetime. While we cannot forgive veterans for harm done to others, we can accompany former combatants as they come to a time when they can forgive themselves.There must be research and public education about moral injury, and resources and training programs for clergy, nonprofit leaders, clinicians, chaplains and communities that want to support recovery from it.By engaging a wider public, we will enable many more people to succeed at bringing veterans all the way home.Rita Nakashima Brock, a theologian, and Herman Keizer Jr., a former military chaplain, are co-directors of the Soul Repair Center of Brite Divinity School at Texas Christian University. The center is scheduled to open Nov. 12.Have more to add? News tip? Tell us
