Staff Perspective: Moral Injury and Society – “Thank you for your service.”

Staff Perspective: Moral Injury and Society – “Thank you for your service.”

As we have looked at the concept of moral injury we have predominantly looked at it as a condition of the individual. However, every disorder exists within a social context. In this entry, I’d like to examine the role of American society in moral injury. Previously, I had discussed the treatment options that have evolved. These methods focus on the service members developing some form of peace with what had happened in a variety of ways. What I am hoping to examine is the aspects of our culture and society that may contribute to the burden that our service members bear in the prosecution of a war or conflict.

First, a bit of history. The first widespread, near real time, images of war occurred during the Vietnam war. The ranks of American journalists in the region grew from just a few dozen in 1964 to at least 600 by 1968 (1). There continues to be much controversy about the coverage of the war and it’s impact on the outcome, but what cannot be disputed was the “pulling back of the curtain” regarding the unavoidable brutality of the war. One of the most iconic images of the era was of Phan Thi Kim Phuc also known as “Napalm Girl” (2). I would not venture to say that Americans were not aware of the brutality of war, but images like these brought it to the front of mind, made it real and involved us. We understood with more clarity the consequences of sending troops into battle. But how we processed that knowledge was another thing entirely. At a training I provided several years ago, I had a chance to speak to several Vietnam Veterans and what they had to say has stayed with me. “I always say ‘welcome home’ when I meet another vet, because no one said it to us.” As President O’Bama remarked in 2009, the Vietnam veterans were often "shunned and neglected, even demonized" when they came home from the war (3). There is a great deal of controversy about what actually occurred at anti-war protests, but the national sentiment which emerged was that soldiers who violated our national sense of morality would not be respected or honored. In many ways I agree with that sentiment, but I also understand that war is not clean. It presents impossible choices. What is one supposed to do when driving in a convoy and a child stands in the middle of the road? When this has been a method to get convoys to stop and be attacked? What is one supposed to do after firing on an enemy combatant and his wife or child picks up the weapons and starts firing?

I raise these issues because these are versions of events that service members have recounted again and again in treatment. They struggle to tell me about it, they are terrified what there spouses or children will think if they learn of it. When we ask our Service members to fight, these situations or similar ones are impossible to avoid. It is here where the national sense of morality creates problems. As much as Laws of Armed Conflict (LOAC) and Rules of Engagement (ROE) are essential, they cannot fully account for the realities of war. Some of the self-characterizations I’ve heard from service members include: “there’s a special place in hell for people like me”, “I couldn’t even tell my priest”, “Only a monster would do something like that”, “I’d lost so many brothers, I didn’t care. It almost felt good. Now I can barely look at myself in the mirror”, “I’m not safe to be around.” These statements are coming from loyal, patriotic and dedicated services members and it forced me to ask, what causes them to see there experience this way?

Of course there are individual factors that contribute to these beliefs, but examining the social/cultural influences is what this article is about. A variety of models have been proposed for the individual mechanisms that contribute to moral injury, but not the social mechanisms. Based on my clinical experience I would propose there are at least two social factors that contribute:

Social avoidance/ignorance of disturbing aspects of war – On many occasions I would hear service members say “We went to war and America went to the mall.” Recent conflicts have been far away and the stories that make the news rarely capture the realities of what our service members experience. Idealism of service members and the belief that our values prevent us from engaging in the brutality of war – There is a great deal of pride in the values we hold dear, but these cannot prevent the violent realities of war that our Service members face.

The hope I have in writing this article is that those of us who do not step into the role of combat Service member or Veteran can begin to create space for the unimaginable situations they may be asked to cope with. The common phrase that is offered to Service members is “Thank you for your service.” I believe it’s our responsibility to understand more clearly what that service entails, the good, the bad and the ugly. I don’t have all the answers, but I hope to start a conversation. What do you think? Please provide comments or suggestions. We can only make a difference together!

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Jeff Mann, Psy.D. is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland.