What is Moral Injury and How Can VOA Help?

Have you ever considered what it is like to bear soul wounds; to go through life with your moral centers disrupted by what others have done to you, or by what you have done to others?

Or perhaps you witnessed a depraved act, and were unable to prevent the resulting traumatic damage to others. Imagine what it must be like to go through daily life with your core beliefs shattered by such events; to realize over time that you are changed, unable to anchor yourself to what was your most basic moral character.

Please reflect on this excerpt from a soldier’s story in the military periodical, Stars and Stripes:

Even on the short overnight ops, sometimes we talked about things we knew we’d carry home. On a cold night in March 2010, Jeff brought up the kid he’d shot a month earlier, when the battle for the Afghan city of Marjah was hot and there was no shortage of 15-year-olds picking up AK47’s off the ground. Jeff had killed one of them with four shots from a heavy-caliber semi-auto that made a soft thud when the bolt released. The kid had a rifle, and even kids with rifles can kill Marines, Jeff had figured. A few weeks later, we were on the side of the road watching for Taliban fighters digging bombs into the ground, and Jeff was telling me about it. He described the way the kid fell and how he wasn’t sure he’d done the right thing.

That was five years ago. Jeff doesn’t bring up that story anymore. I know he thinks about it though; because a couple of years back he put a Remington 700 short action in his mouth and didn’t pull the trigger. Rather than remaining in the flooded poppy fields of Afghanistan, the story of the kid Jeff shot stuck with him. It grew and matured just as Jeff had, until one day Jeff sat on his bed with a loaded rifle across his lap, staring at a part of his life he could no longer understand. “I’m not crazy,” he told me, and I knew he wasn’t. Ten years ago we would have just called it post-traumatic stress disorder. Sixty years ago, it would have been combat fatigue. And in the shell-raked trenches of the Western Front, it would have been shell shock. But Jeff’s dead kid was none of those things. Jeff’s weight was something else — a moral injury.

By: Thomas Gibbons-Neff

What is Moral Injury?
Unlike PTSD, moral injury is not a fear-based disorder. It has no diagnostic threshold, and its social and behavioral impact reflects an inner struggle to integrate experiences that challenge “personal interpretations of right and wrong” (Kopacz, 2016). Moral injury indicates damage to core belief systems, and manifests with unique psycho-spiritual negative moral emotions such as guilt, shame, despair, grief, remorse, alienation, betrayal, blame, self-condemnation, and outrage against leaders or self (Graham, 2017).

It undermines the individual’s ability to navigate personal application of fundamental spiritual truths and blurs the line between good and evil. The moral injury sufferer turns this anguish inward, resulting in self-destructive behavior such as substance abuse or anti-social behavior like isolation, acting out or self-harm. Combined with PTSD or other debilitating conditions, moral injury can accelerate the erosion of basic coping skills and a downward spiral to hopelessness. The resulting dysfunction leads to loss of relationships, employment, motivation, confidence, and can result in severe depression or suicide. Many veterans have described the experience as “feeling a total loss of identity.”

In Jeff’s story, his battle buddy points out that the memory of the kid Jeff shot stuck with him, and that “it grew and matured just as Jeff had, until one day Jeff sat on his bed with a loaded rifle across his lap, staring at a part of his life he could no longer understand.” At that point Jeff correctly recognized that he wasn’t crazy, but determined that something was very wrong – so wrong in fact, that the only option he could navigate was killing himself. He didn’t know it at the time, but the moral injury he suffered three years prior in Afghanistan was growing, consuming his moral centers – or what many refer to as the soul – to the point of elimination.

Moral injury is a normal human response to perpetrating, failing to prevent, witnessing, or hearing about acts or events that violate conscience and challenge an individual’s core moral foundations and codes of conduct. It can also come from losing beloved comrades, handling human remains, or failing to prevent harm to others.

How Volunteers of America Can Help
Treatment for moral injury is both spiritual and emotional in its technique and coincides with Volunteers of America's Ministry of Service. Recovery strategies are currently being developed, and Volunteers of America (VOA) is on the forefront of the effort to combat this soul disruption. Currently, VOA is the lead agency on a research project funded by Bristol Meyers Squibb to develop an Evidenced-Based Model for treating moral injury. The project is also co-led by the Veterans Administration (Dr. Jonathan Shay) and researchers from Texas Christian University – Brite Divinity School (Dr. Rita Brock). In the summer of 2017, Dr. Brock was hired by Volunteers of America as the Senior Vice President of Moral Injury Programs. She has selected Volunteers of America-Greater New York (VOA-GNY) as one of two affiliates in which to conduct the research efforts.

Over the next two years, the teams at VOA-GNY and VOA-Los Angeles will work with Dr. Brock, Dr. Shay, and 120 veterans (60 in each city) on this project, which will be known as Spiritual Resiliency Training (SRT). Our approach is a peer leadership system, a military squad model of trust and bonding, and complimentary alternative therapy strategies such as mindfulness and the arts. The SRT strategies focus on confronting moral suffering, exploring forgiveness and gratitude, restoring meaning or faith and purpose to life, increasing self-acceptance and awareness of each person’s core humanity, and civic engagement through public service. SRT will help strengthen the spiritual, relational, and emotional resiliency of veteran participants and lower indicators of moral injury distress such as suicidal ideation, substance abuse and homelessness.

One final note – moral injury is not limited to soldiers and veterans of the United States Armed Services; it can happen to anyone, anytime. It is pervasive in our society and is often misdiagnosed as a personality disorder or mental illness. VOA is committed to leading the way in finding solutions for moral injury, and over time we will have more information to share on the progress we are making.

For more information on the subject, visit the Volunteers of America website, watch this video featuring Dr. Brock or purchase the book Moral Injury-Restoring Wounded Souls by Larry Kent Graham.

Learn more about the Veteran Peer Support Programs offered by VOA-Greater New York.

By Brian Bardell, Vice President, Business Development & Program Services