Moral injuries need more consideration

March 1, 2016 by Sharon Adams

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As a society, we’ve set high expectations on our members of the military to live and work on the moral high ground. Their code of values and ethics, compiled in the 2003 manual Duty with Honour: The Profession of Arms in Canada, was developed so those serving will “consistently perform their duties to the highest ethical standards.”

They are required to act with dignity, loyalty and courage, to be respectful and obey lawful authority. Society expects them to be the best examples of Canadian values.

What has this to do with veterans’ health? Well, war is a dirty business, and warriors too often are put in situations that shatter their code of ethics, resulting in a moral injury.

Moral injury is recognized by the Canadian Armed Forces as one of four causes of operational stress injuries, along with events that provoke terror, horror or hopelessness, accumulated stress and grief.

Research into moral injury is in its infancy, according to presenters at the Military and Veterans Health Research Forum in Quebec City in November.

“Values regarding right and wrong, evil and good, are at the heart of the military profession,” said Megan Thompson of Defence Research and Development Canada. “[Codes, training, rules of engagement and the chain of command] are not always enough.” They are of little help to those trained to kill the enemy and sworn to protect civilians, when they witness women and children being massacred and are under orders not to intervene or are confronted by a child or a pregnant woman with a grenade.

What about those caught in an ethical no man’s land, ordered to do something they think is immoral or unethical, but obliged to obey orders and respect the chain of command?

Moral injury can destroy deeply held personal beliefs about right and wrong, profoundly damage the ability to trust, make some see evil everywhere or feel hopeless about the human condition. Some develop severe guilt, shame and anxiety. Codes, training and orders don’t help them live with themselves once they get back home. Some commit suicide.

 

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“They are equipped to confront ethical situations on deployment, but less prepared for moral injuries,” said Lieutenant (Navy) Michelle Moore of the Royal Military College of Canada. “Many think because they have been trained to kill, they should be able to handle the aftermath.” This belief prevents them from even seeking help, and hampers their ability to reintegrate into society.

So moral injury is a concern for us all.

 

Is it possible
to make troops more resilient
to moral injury?


Moral injury is the impact of witnessing or taking part or being victimized by actions that violate an individual’s or the military’s moral code. Syracuse University’s Moral Injury Project gives these examples: causing harm to civilians either accidentally or having no alternative; not providing medical aid to comrades or civilians; hearing of executions of co-operating local nationals; living with knowledge of failure to report a sexual assault or rape; following illegal 
or immoral orders; and a change in belief about the necessity or justification for war.

“There are real legal and political considerations for the Canadian Armed Forces” regarding research, said Thompson. Answers to questions about events in which personnel witnessed or participated in events involving violations of the code of ethics or the laws of armed conflict could reverberate up the chain of command to senior leaders.

Yet there are many questions only further investigation and research can answer.

First, how prevalent is moral injury? Are some occupations more exposed to it than others, and under what circumstances? Are there some deployment experiences that increase the risk? Are some people more vulnerable, others more resilient, and why?

What is the role of leaders in preventing moral injury? Research shows troops are more vulnerable to moral injury when their leaders let attitudes or behaviours that deviate from the code slide by.

Some traumas that cause post-traumatic stress disorder also cause moral injury, but there is disagreement whether PTSD treatments, which largely address fear and horror, adequately address shame, guilt and the broken sense of self associated with moral injury. While repeatedly recalling the incident helps lessen pain for some PTSD sufferers, it drives it deeper for some with moral injury.

Do mental health programs and treatment need tweaking? Is there special stigma around moral injury? Some believe moral injury is best treated in the family circle and larger community.

Do education and training programs need updating to reflect the ethical questions raised by the complexity of modern military operations? A good beginning could be a discussion about conditions that raise the risk of moral injury.

Is it possible to make troops more resilient to moral injury, or harden them to it? And is that a good thing, since many believe the symptoms of moral injury that prove a person is moral is evidence of empathy.

The nature of modern conflict means “moral complexity and ambiguity are likely to continue and increase,” said Thompson.

So…what are we all going to do about it?

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  • Mfanawemkosi Fakudze

    Excuse the use of my African praise name. I am a Canadian who has served in the Canadian militia but never in a conflict zone, although I have spent 30 years in international development and have been in situation where moral injury was present, such as my time working with the Palestinians in the West Bank and Gaza Strip where I witnessed moral breeches by the Palestinians and by Israelis.

    I think dealing with the issue of moral injury is important because it is certainly different than PTSD. I had several close calls with black and green mamba snakes and developed a state of anxiety when heading out into the bush. I eventually got over it. However, moral injury is something else and it is possible that some may experience it more deeply than others. For example, I was brought up as a Christian in a very religious family. My moral framework was defined by my Christian beliefs and values, which crossed many lines dealing with violence, human sexuality, the practice of forgiveness and turning the other cheek. If I observed behaviour which I felt was not right in my mind I was conditioned to speak up and/or take action to prevent the wrong. Failure to do so might lead to a sense of moral injury. Being brought believing that it is a sin to kill someone (one of the Ten Commandments) as a soldier would immediately have led to moral injury the moment I killed someone or prevented others from killing someone.

    The one great outlet for a true Christian believer is the right to ask for complete forgiveness, no matter how great the sin. Now asking for forgiveness will not necessarily guarantee relief because the memories of an event may be so horrific and opposite the way one is expected to behave. But often forgiveness from others can eventually lead to forgiveness of one’s self. Yet some see holy forgiveness as a get out of jail card…one that is not earned, one that a person is not worthy of receiving. But in the Christian framework that is what one receives…total absolution if you bring the sin to God and ask for forgiveness.

    In my adult life, I developed lasting and at times deep feelings of depression and anxiety, which was accompanied by feelings of rage and blaming others for my condition. I was suicidal and murderous at the same time. My thinking ran counter to my Christian upbringing but no amount of prayer, help of friends, therapeutic treatment by doctors, psychologists and psychiatrists solved my troubles for 30 years. I hated myself. I feared I would kill myself and others. It was a living hell. Then a miracle happened when I my suffering was at its worst, I met a psychiatrist who was simple and direct, who convinced me to take anti-depressant medication. The first pill turned me into a person like a joyous evangelist but I wasn’t safe to drive and I couldn’t concentrate at work. The next medication worked without any side-effects. It fixed the nuerochemical disfunctioning in my brain. I was changed overnight. It made me mentally healthy and in doing so it gave me the right to forgive myself for my behaviour and thinking, something which had been beyond my control. I learned to accept that part of my life and see it for what it was. It also gave me the courage to speak out and to help others who were suffering.

    Dealing with moral injury has to be a combination of compassion, forgiveness, psychiatric help, spiritual help, treatment centres that help rebuild the spirit through gardening and working with animals. I think that proper therapeutic modalities should be developed to help a person to review the moral injury events to deal with those injuries, similar to the Truth and Reconciliation events that have helped.

    The answers are not easy.

  • Legion Magazine

    Thank you for sharing your story with us Mfanawemkosi Fakudze and it is a great thing you are doing by speaking out and helping others who are suffering.

  • Mike Bell

    It should be called CPTSMI – Chronic post traumatic stress and moral injury – I was diagnosed after a claim, not for war, but for racism. I was forced out of the military at the height of my career. It was a Master Warrant Officer. He didn’t have the authority but I didn’t know it at the time. I had morals and values at the time and when I was betrayed it harmed me. They saved my life as a teen, trained me, made me believe then took it all away…it was shattering inside. They should consider how to deal with shame and broken sense of self. I think group sessions help heal that more than one to one. You need the family to help you, even if its military members. This is a very good article! I like it, it explains a lot, thanks

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