By CHRIS VAUGHN Fort Worth Star-Telegram Published: June 5, 2012
FORT WORTH — War changes people. That is indisputable.
The changes differ infinitely, depending on the individuals, their background, age and maturity, their war, when they served, the place they served. It is counterproductive to stereotype.
But amid all the discussion in recent years of post-traumatic stress disorder and its effects on Iraq and Afghanistan veterans, a small group of mental-health professionals, military chaplains and civilian ministers now says some of the symptoms are what they call “moral injuries” that can involve guilt, shame, grief and betrayal.
“In the medical model, all the bad mental-health things that can happen come from PTSD,” said Brett Litz, a clinical psychologist and professor in Boston who is conducting research funded by the Defense and Veterans Affairs departments. “That’s simplistic thinking. It says that the only harmful aspects of war are about life threats. That’s too narrow. Even though it’s controversial, it is critically important that we think about other ways that war affects people psychologically, biologically, spiritually and morally.”
Fort Worth is now on the front line of trying to understand, research and treat moral injuries. At the Brite Divinity School at Texas Christian University, an Indianapolis-based philanthropic foundation has funded the opening of the Soul Repair Center.
Although the Soul Repair Center won’t officially open until Veterans Day, Brite is already ramping up the program, naming the Rev. Rita Nakashima Brock and retired Army chaplain Herman Keizer Jr. co-directors and making contacts nationally in the mental-health field and the faith community.
Brite President D. Newell Williams promised that this is no academic exercise.
“The people setting the tone for this conversation will be veterans, not faculty,” Williams said. “Like any good program of repair and recovery, those who have suffered the injury bring the critical perspective. We expect that to be the case from the beginning of this to the end.”
The program is not limited to Iraq or Afghanistan veterans since there is a considerable population of Vietnam veterans still grappling with their combat experience. But at no time in U.S. history has there been more focus on the mental health of troops returning from war.
More than 2 million men and women have served in Iraq or Afghanistan, including hundreds of thousands of National Guardsmen and reservists. Most of them have served multiple tours in a muddled combat situation, where the enemy is often indistinguishable from innocent civilians — or can’t be seen at all.
Many veterans have no lingering problems from their combat tours.
But others do. Since 2002, the VA has treated almost 224,000 Iraq and Afghanistan veterans for post-traumatic stress, according to its records. The Army has been accused of pushing soldiers with mental-health problems out of the service on disciplinary issues; civilian employment for many young veterans remains elusive; and, most alarmingly, suicides have been stubbornly high among active service members and veterans.
The VA recently said that 18 veterans commit suicide every day and that hundreds more, even those receiving care, are attempting suicide every month.
Post-traumatic stress disorder is a medically defined anxiety problem caused by a life-threatening event, experts say. The symptoms include flashbacks, nightmares, hypervigilance and emotional withdrawal.
Moral injuries are different in that they are brought about by “perpetrating, failing to prevent or bearing witness to acts that transgress deeply held moral beliefs and expectations,” according to the VA. While an individual can have both PTSD and moral injuries, experts said, the symptoms of moral injuries are often different: depression, insomnia, reliance on alcohol or drugs, or suicidal thoughts.
Perhaps a veteran is struggling with having ordered an airstrike on the wrong location and killing innocent people. Perhaps a veteran is struggling with survivor’s guilt, grief at the loss of a close friend. Or perhaps a veteran is struggling with having taken the life of another person, militarily justified or not.
Medical and counseling treatments are available for PTSD, but there is a recognition that moral injuries need to be treated differently, experts said.
“The VA can’t do anything for someone who says, ‘I have sinned,’” Williams said. “Religious communities have answers to confessions of sin.”
‘He came back a different human being’
Brock, one of the directors of the Soul Repair Center, is an author, professor and well-known leader in the Christian Church (Disciples of Christ). She lives in Oakland, Calif., but intends to commute to Fort Worth as needed. The idea at Brite is more hers than anyone else’s.
She is the daughter of a career soldier who served 29 years, from World War II to Vietnam, where he supervised a small medical aid station on a combat outpost. He retired immediately after returning from Vietnam and died in 1976 as a middle-aged man — largely, she believes, of a broken heart from what happened there.
He never talked to her about it, so she is left guessing.
“He came back a different human being than the one who left,” she said. “Knowing what I know now, I think he came back with moral injuries.”
The other director, Keizer, is a retired colonel in the chaplain’s corps who served in Vietnam in 1969-70, earned a Purple Heart and stayed in the service through the Army’s “hollow” years in the 1970s.
He participated in the writing of a leadership manual in the late ’70s and early ’80s to try to return honor, ethics and loyalty to Army leadership.
Not everyone likes the term “moral injury”; some say it suggests that a service member obeying an order or conducting justified military action is acting “immorally.” Litz, a professor in the psychiatry and psychology departments at Boston University and a mental-health researcher at the VA Boston Healthcare System, said “that is an understandable reaction.”
“But from my vantage point, someone, by virtue of their beliefs, could be affected by what they see or do,” he said. “There are some very painful and difficult decisions that get made about life and death in war. That, fundamentally, is about morality.”
A nationwide vision
Brock acknowledges that she is a strong opponent of the war in Iraq but said that is not relevant when it comes to helping veterans.
“Our position isn’t to take moral or political positions,” she said. “We all have them as people, of course. But moral injury doesn’t come from supporting war or not. It comes from the experience of war.”
Brite intends to develop a curriculum to teach divinity students how to work with veterans; conduct research and publish papers; work with other divinity schools nationwide; reach out to military chaplains; and build a website for clergy to consult when someone in their congregation is struggling.
Williams said the school intends to make the curriculum and training work for people of all faiths.
“We are confident that there are remedies within the Christian faith to address moral injury, but we don’t think that’s the only place,” he said. “This is not meant to be exclusively Christian.”
The school also intends to form a “think tank” of scientists, clergy, mental-health professionals and combat veterans to drive all of its missions.
“Five years from now, what we’d like to see is, if you are a veteran who lives on the West Coast or in the Northeast, that there would be a trained clergyperson you could go to within a day’s drive and talk to,” Williams said. “If, after five years, all there is is a center at TCU that helps veterans in this area, we will have failed.”