The Trauma of Moral Injury (featuring a military chaplain)

Way back in April, I spent four days at Mount Hermon, CA, attending a missions conference put on by the same organization I'm a summer missionary with this year. I got to visit a private beach, live under the redwoods, and grab ice cream down in Santa Cruz. But I think the best part was a conversation I got to have with a special OPs military chaplain we'll call Chaps.

Chaps was one of the morning speakers during the conference. He gave a fascinating presentation on the trauma of moral injury, not just in our soldiers but everywhere. And this isn't a new thing, though the term is very recent. Chaps offered the idea that King Saul (yes, that King Saul) battled moral injury - and lost.

Now, anytime I hear the word "trauma" I prick up my ears. Anyone who's a writer knows how much trauma comes in to (or should come in to) stories. Especially high fantasy, which is mostly what I write. Wars and death and pain surround that genre, and it is realistic for the majority of those characters to have to deal with trauma of some sort or another.

So after the presentation, I asked Chaps if I could ask him some questions about moral injury, and he agreed. We talked the next day for over an hour, almost missed supper, and I ended up with a free book out of it and an interest in and burden for military chaplaincy.

Of course I asked Chaps if I could share his answers on my blog so other young writers could learn the same information. He agreed on the condition that I don't use his real name or any pictures or anything for security reasons, which is why we're calling him Chaps. :P

Which brings me to the meat of this post: a paraphrasing of our Q&A, coupled with my notes from his session, to introduce y'all to the idea that we're writing trauma wrong.

(Mostly in that we all try and use PTSD when in reality PTSD isn't nearly so prevalent of an issue as moral injury. *coughs*)

What is moral injury?

According to that lovely book Chaps gave me (it's called The Bible and Moral Injury by Brad E. Kelle, by the way), moral injury is "a nonphysical wound that results from the violation of a person's core moral beliefs (by oneself or others)." It's "the wrecking of a person's fundamental assumptions about 'what's right'" that may result from "a sense of having violated one's core moral identity and lost any reliable, meaningful world in which to live".

Moral injury often has its roots in failure. Failure to live up to an archetype, or failure to make the right choice. It can even result from the failure of a personal hero. The results can span anywhere from a bit of personal wrestling and a few tears shed all the way up to lost marriages, addictions, and suicide.

One example Chaps gave during his presentation came from a war movie (American Sniper, I think? I'm not entirely sure though XD). The main character, a sniper, is charged with protecting a ship full of his guys from an enemy soldier who's trying to carry bombs on board. He sees the guy with the bombs running toward the ship and shoots him. Not exactly easy - but it gets worse.

A kid runs out of the shadows, picks up the explosives, and continues the mission.

Now the MC is faced with a choice: shoot a child to save his guys, or don't shoot a child and let his guys get blown to high heaven.

It's those kind of deep, ethical decisions that have to be made in a split second that wreck people. Even after the deed is done, even if they do what everyone around them thinks is the right choice... they have to live with it. Live with knowing they killed a child. Or with knowing they didn't kill a child and their friends are dead because of it.

Most people try to hide the pain, or numb it. But we'll get to that in a second.

Moral Injury vs. PTSD

Everyone has seen what is labeled as PTSD in books and movies. One prime example is Katniss Everdeen, the main character from Suzanne Collins' The Hunger Games. By the end of the story she's basically defined by her trauma (which I strongly disagree with, but that's a rant for another time). She suffers nightmares, hallucinations, terror, insomnia, etc. The other Victors deal with the same trauma in other ways: drugs and alcohol, suicide, pretending everything is fine while they crumble on the inside.

But, while I'm no expert, I'm not sure Katniss just has PTSD (though I think she does have that as well). She also has moral injury because of what she did in the arena. Because she killed people and she saw people killed and she can't forget.

See, that's one of the most tell-tale signs of moral injury. You can't forget. In PTSD, your memories have gaps. But with moral injury, you remember every detail. The sights and sounds and tastes and smells and what you felt, inside and out. Tiny details are carved into your memory, taunting you, and try as you might you can't get them to just go away.

So a lot of people turn to drugs and alcohol. If you dull your senses enough, you can forget for a little while.

Okay, enough of my rambling. Have a handy-dandy Venn diagram of moral injury vs. PTSD from Chaps' presentation. :)

Alright, now that we've got that jazz clear, on to the Q&A!

1. What conflicting desires come with moral injury (i.e. the desire to tell someone, but also wanting to hide)?

Wanting help but being afraid to ask for it is definitely an issue. What a lot of guys really want is trust. They'll start doing little things - little tests here and there - to build up enough trust with a person for them to open up and admit they're struggling. Trust is absolutely necessary for healing. And on the flip side, broken trust is incredibly destructive. (Joelle's note: Chaps couldn't even find words to describe how destructive broken trust could be. Eventually he said it could result in someone never opening up again and never finding healing.)

2. Does moral injury always stem from a very difficult moral decision? Is it always a decision you made or can you get it from a situation you have no control over?

Typically, yes. It can also occur as a loss of trust in leadership (for example, Saul's betrayal of his tribe and people in 1 Samuel 22, where he orders the slaughter of the innocent priests of Nob). So a little bit of both.

3. What lengths are people willing to go to to heal/escape/get rid of it?

People who experience it often turn to the tactics of numbing and forgetting. (Going back to that concept of PTSD losing memory, and moral injury remembering everything). A lot of guys in the military who struggle with moral injury end up struggling with relationships (especially marriage). And they're willing to let those relationships die over it. Part of the issue is that the other person in the relationship doesn't know what's wrong or how to help. Since PTSD is so marketed in our culture, most people think their husband/friend/brother/whatever has PTSD and they start looking stuff up and trying to help. The problem is that most of these guys don't have PTSD (at least, not as much as moral injury), and so the partner is treating the wrong disease. Often that makes things worse. The best thing for them to do is give the morally injured person time and a safe space.

4. What lengths are people not willing to go to?

In the military, it's hands-down getting kicked off of the team. The military is a soldier's life. Often he has better relationships with the other guys in his team than he does with his wife and kids and other friends and family just because of the amount of time they spend together. They spend years and years together in training, living together, and going through the hard stuff together. Trauma bonding also happens a lot and is very important to these guys. Understanding is a critical need they seek, and they find it in the other guys who went through the exact same situation.

Once a guy gets kicked off the team (usually because he's using drugs or alcohol to dull the pain and it's affecting his performance), not only does he have to face up to the reality that he doesn't have the people or job he built his life around anymore, but he also has to grapple with the perceived failure he committed. He broke the warrior archetype (strong, whole, able to carry yourself and the team). And often that creates even more moral injury as it shakes his world.

Side question: How hard is it to get into another "brothership" once you leave one (whether because you got kicked out or you got assigned to something new or whatever), and do guys want to?

It's pretty easy, but once you get kicked off the team you have to go back down the totem pole, and no one wants to do that. In terms of departure trauma, officers actually deal with more of that because they move around more.

5. What are some defense/deflecting tactics people use?

The biggest is dark humor and general joking. No one wants to talk about this because it breaks the warrior archetype. If you show that you're bothered by stuff, that you're struggling, you're seen as weak. And you're a soldier. You can't be weak. Guys generally do everything in their power to keep the moral injury to themselves until they reach the breaking point (i.e. your commander tells you to either shape up or you're getting kicked off the team). That dramatic shutting down you see in movies is rare (the angry leaving of the room kind of deal). It works much better to just deflect questions with jokes and dark humor, or guide the conversation elsewhere, than to draw attention to yourself by shutting down and/or leaving. It's usually a slow release of "pressure" here and there to continue coping. (I.e. talk about one memory with the chaplain, then you're good to go for another long while.) Either that, or the guy explodes and whoever is listening is there for a few hours while they unload their life story.

6. Obviously healing depends on how big of an injury people have, but is there a general timeframe from seeking healing to essentially healed (i.e. 6 months-10 years)?

Not really. It all depends on the individual.

7. Are there treatments for moral injury? If so, what are they?

Moral injury is a fairly recent type of trauma to be accepted by psychologists and whatnot, so most treatments are still in the experimental and developmental stages. But some proven treatments include spiritual orientation cognitive stuff (God, basically), forgiveness, community, storytelling (through art or talking it out or writing it down - just get your story out of you), and rituals. It's important to try and bring closure. A lot of rituals (like writing your story down and then burning it kind of a deal) help guys to start moving forward again.

8. Is there anything you suggest avoiding in writing about this? (i.e. PTSD has been dramatized and glorified to the point where it becomes a character's identity.)

Definitely don't dramatize and glorify it, or let it become an identity. That's a very big one. Otherwise, I'll turn the question around and say what you should do is remember that redemption is key. Give your character (and reader) sense of completion. An end. And don't let their trauma define them.

Random Takeaways

"Failure + loss + trauma = moral injury."

Trust, understanding, and forgiveness (toward yourself and others) are essential to healing.

"Moral injury results in loneliness and isolation."

Further Resources

(FYI... take these with a grain of salt and probably run them by your parents first if you're still under their care. Chaps said most of these books and movies have language and violence, as is realistic but definitely not for all eyes. And they're also emotionally hard. Really hard. I have yet to read or watch them (I started The Bible & Moral Injury), so I don't have a personal opinion. But he said if you want good examples of what it's like being in the army and dealing with moral injury, these are some good ones to look at.)

Books:

Alone at Dawn by Dan Schilling

The Guardian by Joshua Hood

The Bible & Moral Injury by Dr. Brad E. Kelle

The Body Keeps the Score by Bessel van der Kolk (Chaps didn't mention this one, but a therapist who works with extreme trauma cases said this is a good book to look at if you want to see how trauma affects you physically, not just emotionally and mentally)

Movie:

American Sniper

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"Killing hurts the killer, too, even in self-defense or in the line of duty and ... no justification, legal, political, religious, or otherwise, can heal those wounds." -Boudreau, "The Morally Injured"

"Moral injury results when soldiers violate their core moral beliefs [or have those beliefs betrayed by others], and in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human beings." -Rita Nakashima Brock & Gabriella Lettini, "Soul Repair: Recovering from Moral Injury after War"

"I fear I am no longer alien to this horror. I am, I am, I am the horror. I have lost my humanity.... The monster and I are one." -Camillo (Mac) Bica, "Beyond PTSD: The Moral Casualties of War"

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Something that really bugs me about how modern writers present trauma is how glorified it is. It's cool to have trauma. You get attention if you have trauma. Your life is interesting if you have trauma. All of those lies not only damage the reputations of those who actually deal with trauma, but it gives people the idea that they should have some. It seems like I'm running into more and more people who are proud of the trauma they have (or think they have).

Guys. Trauma isn't pretty. It wrecks your life. And without God... it's almost impossible to heal.

So let's stop writing books that glorify trauma, that make it seem cool and desirable. Let's write trauma that is real. Trauma that hurts, trauma that kills, trauma that isn't the endgame. Let's show that you can heal from trauma. You don't have to be a victim. There is a God out there who knows you better than you know yourself and can heal every wound, seen or unseen. It's time to write about the beauty of an untraumatized life. It's time to write positive stories that showcase redemption and salvation and completion for those who actually are traumatized.

It's time to write hope.

Until next time,

Take courage, pursue Christ, and smile while you still have teeth!! ^_^

-Joelle

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