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Veterans Moral Injury: Another Kind of Grief

Post Traumatic Stress Experiential Programs with Companion Dogs

Post Traumatic Stress Experiential Programs with Companion Dogs


Does serving in war have potential to cause “moral injury” to our soul?  As our nation grapples with the escalating suicides of over 22 military men and women each day, this is a question both troubled veterans and a growing group of PTSD counselors are seeking to understand.  I had never heard of “moral injury” as one of the potential causes of veteran’s Post Traumatic Stress Disorder until recently.


Rather than grief over what happened to them, they live with grief over what they did to other human beings.  At the core, it addresses the enormous pain men and women in the military feel when their fundamental understanding of right and wrong is violated.  They live, often for years, with grief, numbness, guilt and shame over their actions.

Daily Heartbreak


Emerging as a relatively new term, it’s as old an experience as war itself.  Soldiers from every war speak of this.  Memories abound.   A World War II 17-year-old submarine sailor lives his entire life recalling the day they destroyed an enemy carrier and weren’t allowed to pick up the screaming survivors drifting at sea; a Vietnam veteran continues having visual images of entire villages destroyed, knowing civilian casualties were inevitable; a Marine in Afghanistan continues to lament a split-second decision to kill an armed 13-year-old child during a firefight; or a platoon leader in Iraq suffers survivor guilt after a roadside blast kills comrades under his protection .



“Moral injuries,” explains former Army psychiatrist Elspeth Ritcher in a three-part Huffinton-Post series by Pulitzer Prize winning journalist David Wood, “are caused by a tortured conscience.  You may not have done anything wrong by the law of war, but by your own humanity you feel that it’s wrong.”





This past week, I met with Larry Shook, a former editor of mine and highly respected journalist in Spokane, Washington.  We sat in front of the comforting fireplace of the elegant Davenport Hotel, but the suffering from moral injury this Vietnam veteran describes is far from comforting.  He articulates the sources of his PTSD so vividly, he helps you feel the external and internal violence and horror that erodes one’s soul.  Larry, who entered the military with high enthusiasm to serve our country, fought in Vietnam during 1967-68 as a door gunner and crew chief on a helicopter gunship.  In nine months, he logged 1200 combat hours, engaged in the Tet Offensive, and was shot down three times. “I saw and caused a lot of death.  There’s a lot of imagery in 1200 hours.  Imagine sitting in a darkened movie theater around the clock for eight weeks watching the most violent movie imaginable.”



He also found his heart captivated by the beauty of the land and the special innocence and spirit of the Vietnamese children.  I understand since we have an adopted seven-year-old Vietnamese granddaughter who seems magical in spirit. But within months, his gung-ho enthusiasm took a radical shift.  “Six months into the war, I was so haunted to know we were destroying their lives, their families, and their villages.  I felt more like a war criminal.  But I had to wall off these emotions and continue in our destruction every day.”  His heart also harbored a competing emotion: his love for his fellow warriors. “I also felt immense loyalty and protection for those I served alongside.”



Last year, he gave a presentation at Spokane’s Unitarian church because he wants others to understand the full dimensions of PTSD with returning vets who need help.   He said, “I saw Eden carpet-bombed by B-52s; Eden scorched with napalm; Eden seared with white phosphorous.  I saw three little girls murdered in cold blood and why I didn’t kill their killers God will have to some day explain to me.  So many times I heard men screaming at me in my headset to save their lives.  So many times I saw them turned into bodies plastic wrapped in their own ponchos.  I saw…oh, I saw so much.”



Such experiences gave him nightmares for years, all the while masking what he felt through his successful outward life as a loving husband, father, and creative journalist.  “I put a mask on after returning from Vietnam.  I pretended I didn’t hurt, pretended I was whole, pretended I was like everyone else.  I hid, because I thought no one would want me in their life, not even my own family, if they knew who I had been in Vietnam.  I thought I had no place else to go.”



But  a couple of years ago, when a deer jumped in front of his car and her body parts exploded violently before him, his PTSD came roaring back.   “I finally understood where my terror came from.  It was a combination of shame and fear of being found out.”  Now actively seeking healing and wholeness, he finds the writing of Dr. Edward Tick, a psycho-therapist who wrote about moral injury in War and the Soul especially insightful. He also finds deep meaning in helping other veterans in their journey to wellness.


Read  One Veteran’s Story from Larry Shook here.




Over 8000 vets commit suicide each year in America, far more than those killed in combat.  The morally ambiguous attitudes towards recent wars adds to the complexity, compared to clear national support for World War II.  Multiple deployments compound the pain.  The diagnosis of PTSD has been defined and endorsed since 1980 by the mental health community. Though they share many similar symptoms of PTSD, veterans expressing moral injury add elements of profound sorrow and regret.  The Defense Department doesn’t officially recognize moral injury; however, in light of the alarming number of suicides, interest appears to be growing within segments of the military.  At the United States Naval Medical Center in San Diego, Amy Amidon, a staff psychologist, oversees its moral injury/moral repair therapy group. “They have seen the darkness within them and within the world, and it weighs heavily upon them.”




According to Woods, the Pentagon has quietly funded a $2 million clinical trial to explore ways to adapt PTSD therapies for Marines suffering from moral injury.  William P. Nash, a retired Navy psychiatrist and a pioneer in stress control and moral injury believes many returning veterans bear this pain. “I would bet anything that if we had the wherewithal to do this kind of research we’d find that moral injury underlies veteran homelessness, criminal behavior, suicide.”  He sees it akin to grief and sorrow, with lasting impact on individuals and their families that affects intimacy, trust in life, and sense of purpose.   But he also believes that, in time, with awareness and intentional treatment that nurtures a positive identity infused with compassion and forgiveness, healing is possible.


His hope is that all veterans are treated as humans with souls, and not just drugged with antidepressants.





For each of you who love a veteran, plus clergy and counselors who hear their stories, I hope knowing more of this potential source of inner anguish will add insight to help in their healing.  I’d really encourage you to read Doug Wood’s series in the Huffington-Post mentioned above and Larry Shook’s One Veteran’s Story for far more in-depth understanding.  They deserve our best.
















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Remembrance and “Book of Life” Film




Do you long for “built-in” ways of remembrance for someone you love?   The most common lament I hear from families is frustration over the subtle, and not-so-subtle silencing that emerges after the death of a loved one.  “Don’t talk about your sorrow,” counseled a widow in a letter to my mom after the death of my father. “People don’t want to hear it.”  Believing her, she privately grieved the end of a sixty-year marriage.


Also, in America’s mourning-avoidant culture, family and friends often hesitate to mention a deceased loved one for fear they will upset us.  Yet, most families long to feel more freedom to speak openly about the one they love.


Perhaps that is why I found the new film The Book of Life so enchanting.  Drawn from the Hispanic tradition of remembering loved ones during the Day of the Dead celebrations, Mexican director Jorge Gutierrez creates a dazzling animated musical comedy and adventure film.  With gorgeous visuals, the plot encourages the importance of “The Land of the Remembered” where spirits live on as long as loved ones preserve their memory.  In contrast, great sadness awaits those relegated to the Land of the Forgotten.  Through an explosion of color and movement, it shows children growing in understanding that death is a part of life, and that remembering loved ones strengthens family bonds.



I recall the first time I saw the strange sugar skulls, skeletons, and Pan de Muerto bread in bakeries while traveling in Mexico City.  “What in the world are these?” I wondered.  Then I learned of the Day of the Dead, which originated in Mexico and is now celebrated throughout the world on October 31, and Nov 1 and 2.  This tradition gives Hispanics a yearly “built in” cultural ritual to recognize family members and friends who have died. Usually, although these vary by villages and countries, the 1st of November is the Dia de los Inocentes or Dia de los Angelitos. This day is given to remember deceased infants and children, the little angels. This also parallels All Saints Day in the Catholic tradition.  November 2 parallels All Souls Day  and celebrates adults who are deceased.






Families plan far ahead on how to decorate graves and build ofrendas (altars) in preparation for a gathering of family and friends coming to remember and pray for those who have died.  Vibrant Mexican marigolds, candles, memorabilia from the deceased, sugar skulls, favorite candies, drinks,photographs and breads all add a festive personal touch.  Toys often decorate the children’s graves.  It gives families a time to reminisce, picnic, party, tell anecdotes, laugh, and pray.  One hope is that the deceased’s spirit will come back to visit and continue the spiritual bond in the family.


I was fascinated to see a big display of colorful Day of the Dead house decor in our local World Market this year as Halloween and Day of the Dead dates merge.  My hunch and hope is that the conversations emerging from persons seeing the Book of Life will encourage all Americans to ask, “Don’t we all need more rituals that create ways of remembrance?”  Learning from the natural expressions around life and death within Hispanic communities just might break the silence surrounding families that live with loss and love.


Films often shape cultural change; could this be the enduring legacy of the Book of Life?  


For a joyful time of exuberant yet thoughtful entertainment, considering going to this kid-friendly film!  Then, I’d love to hear your thoughts.






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Condolence Letters in an Online World

A condolence note from a friend I've kept for years

A condolence note I’ve kept for years


A favorite condolence note included only nine words. “Heart shattered lives….by no means escape God’s notice.”   After our daughter died in Bolivia, Suzette wrote this contemporary translation of Psalm 51 on a simple ecru card with her beautiful personal handwriting and signed it.  For years, I propped this treasured card on my desk, a visual assurance that we don’t walk on this pilgrimage alone.  Often such notes from friends help us heal along our journey in grief.


Parents I interviewed for Pilgrimage through Loss also shared how they’ve kept condolence notes for years.  “I am a private person,” said Lorie, the mother I mentioned in my post Helping Siblings Face Sorrow who had lost premature twins shortly after birth.  “I didn’t want a lot of visitors, but I loved each note sent to me.  They let me know the world cared.”   Many years later, she still has them in a basket at home.


But as the folk song says, “Times, they are a’changing.”


In an increasingly on-line world, people are turning to Facebook, texting, and on-line funeral memorial sites to offer another way of expressing one’s feelings.  It’s also the natural way of daily communication for many, especially young people.   For others, often older and accustomed to believing in the power of written notes, the thought of sending condolences to a grieving person via instant technology is often seen as heartless and lazy. “I’d hate it,” expressed one 70-year-old who values the courtesy of the written word.


But I saw another picture this week when a dear friend’s husband died suddenly of a stroke.  When Mary Beth left her home in the morning, her husband had enjoyed breakfast and was in his favorite chair reading the newspaper and listening to NPR.  By time she came home in the afternoon, she found him almost comatose.  When he didn’t revive, she called 911 and he died in the ambulance on the way to the hospital.  As you can imagine, the shock after 52 years of marriage is profound.


While I visited the next morning, amidst her tears she mentioned “I can hardly believe all the tributes to Dick coming in on Facebook. It’s how all the young people communicate these days.”  Many came from friends of her daughter Jeanne and late son Stephen. Her face lit up briefly as she said, “They are writing about how much they say our marriage has meant to them.”  Within less than 18 hours, because of Facebook, friends of their family living across the nation were pouring in their thoughts and feelings.  She clearly felt the gift of their compassion and remembrances.


“Our on-line world offers the immediacy of response,” said Jerry Sittser, author of A Grace Disguised: How the Soul Grows through Grief that explores the loss of his wife, daughter, and mother all in one car accident. “I know this immediacy can be meaningful.”   Because his family died before the onset of our virtual age, all the hundreds of condolences he and his three remaining children received came through personal letters.    “However, a heartfelt thoughtfulness emerges when someone takes the time to really sit down and discern what they hope will convey the depth of their love and memories and care for you.  I hope families still receive such gifts.  Notes and letters are also so tactile….you can hold them in your hand and reread and reread if desired.”


Not an Either-Or Choice


As customs change, it doesn’t have to be an ‘either-or’ choice.   We can give a genuine response to a Memorial Site on-line or to a Facebook tribute or text.  But later, we can also take the time to compose a heartfelt letter, or find a card that symbolizes what we want to convey to a family in grief.  Either way, what grieving persons often say they most appreciate are the anecdotal stories that friends share.  Such a collection of memories ease a broken-heart.  Long after the intensity of the memorial service and early weeks abate, a family is left with the emptiness of a loved one gone.  Receiving a written note offers a tangible way for families to linger and dwell in the love that surrounds them.  It’s a worthy investment of time and thoughtfulness.  Who knows, the letter you thoughtfully write…even if only nine words long…may be the gift a person treasures for years!


What do you think? 








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Helping Siblings Face Sorrow

Remembering Baby Ryan Courtesy of Ashlee Hammar

Remembering Baby Ryan
Courtesy of Ashlee Hammac


Are there healing ways for all in the family to remember an infant who dies?  


This was Ashlee Hammac’s question last October when their baby Ryan died just five days after his birth from Hypox-Ischemic Encephopathy.  Though in shock and heartbroken, this mom  also recognized her three-year-old son Tucker’s heartbreak at losing his little brother. He had shared months of the family’s joyful anticipation during her pregnancy.  He also met Ryan in the hospital NICU room.  He knew his mother and father spent day and night reading children’s books to Ryan as a way to bond with their dying child.   Realizing Tucker needed a natural way to mourn, she decided to add a sandbox to Ryan’s gravesite so his feelings could be expressed too.  “Tucker loves trucks and was always going to the gravesite with me,” said Hammac in an interview with People magazine.  “I wanted to make it special for him too.  Now he goes out and sings lullabies to him and talks to him just like he was there, almost like they are playing together.”


Tucker meeting baby brother, Ryan. courtesy of Ashlee Hammac

Tucker meeting baby brother, Ryan.
courtesy of Ashlee Hammac


A National Response


When the photograph above was published, it went viral to over 220,000 users.  Hammac received so much virtual support because other parents recognized her unusual thoughtfulness in our mourning-avoidant culture.  This also led their family to start a non-profit called “Pages to Memories.”  Part of their mission is to collect books for families to read to children in the NICU units in hospitals.  “I wanted to feel like Ryan was helping still.  In those five days he changed our family.”


Other Ways of Remembrance


Other parents I interviewed for Pilgrimage through Loss mentioned creative ways they found for siblings to remember and talk about their feelings of confusion and loss.  When Lorie Sawyer entered unexpected labor and gave birth to premature twins, her daughter and son died within minutes of birth. “I first saw Lori in bed with a baby in each arm, wrapped in the pink and blue blanket I’d brought,” remembers Shelly, Lori’s mother. “Memories of this are still heart-wrenching years later.”  But what Lori and Shelly appreciate deeply was the humane and sensitive way the hospital helped their family through such a profound loss.  For a brief period, the nurses took the babies to bathe and then brought them back dressed in tiny baby clothes kept on hand for such infants.  “What I remember vividly was there was no sense of hurry in the hospital.  We could hold and rock the babies as long as we needed,” said this grateful grandmother.


Including Their Other Children


Lori and her husband, Ben, have two older sons who were five and eight and their family wanted to have the babies baptized.  Their friend, a female pastor, came to to the hospital to conduct this significant religious ritual, and they named their children Molly and Joseph.  They believe this bonding time with their babies have helped Joseph and Molly to always be a part of their family story, important to their older sons.  Even their daughter, Annie, born after the twin’s death, gets involved in remembering.  “They died shortly before Halloween, so on the first-year anniversary, we released balloons with messages from the boys to their baby brother and sister,” said Lori. “Then, when their father took the boys to get pumpkins, they asked to add two very small ones for the babies.  Now it is a tradition to have five pumpkins on the porch each year in memory.  Annie, seven, continues this custom now.”  She also feels that family rituals need to be natural, not forced, and recognizes that they will change over the years.


In their shock, they hadn’t thought to take pictures, but the nurses took little Polaroids.  “These became magically recreated into beautiful photographs through a group of professional volunteer photographers in the Seattle area called Soulumination,” appreciates Lori.  “They take life-affirming pictures of terminally ill children to give the family an enduring legacy.”  These also help provide a natural way for siblings to talk about baby Molly and Joseph.


These healthy expressions of forever love inevitably help siblings.  It’s an important change from earlier times when sorrow often stayed buried in silence.


Do you know of other creative ways families have helped siblings living with a brother or sister’s death?








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About Linda
For everyone, life sometimes brings shipwreck moments.

Ours happened when four friends woke us one beautiful May dawn to break the news that our 25-year-old married daughter Krista had died 7000 miles away while volunteering in Bolivia. Our hearts shattered, much like the shards of her bus that plunged over a mountain cliff.
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Desperate. Determined. Unwaveringly confident. In 1896, a Norwegian immigrant named Helga Estby dares to cross 3500 miles of the American continent to win a $10,000 wager. On Foot. BOLD SPIRIT: Helga Estby’s Forgotten Walk across Victorian America introduces readers to this fascinating journey of an audacious act of courage and love of a mother trying to save a family farm.

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Support for Parents

+ Alliance of Hope for Suicide Survivors On-line forum and website

+ American Childhood Cancer Organization (ACCO) (Formerly Candlelighters Childhood Cancer)

+ Compassionate Friends

+ First Candle: Support for Stillborn and SIDS deaths

+ Loving Outreach to Survivors of Suicide (LOSS)

+ MISS Foundation (also in Spanish) On-line support groups : Infant & toddler death and advocacy

+Parents of Murdered Children

+ TAPS: Tragedy Assistance Program for Survivors: 1-800-959 3277 for survivors of military deaths