moral injury

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

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