Beyond “Good Guys and Bad Guys”: Helping Veterans Deal with Moral Injuries
A Snapshot of Moral Injury
Imagine you’re a private in the military and you’re on deployment to Afghanistan. You’re with your unit in the mountains, stationed a short distance away from a group of small huts where local Afghan people live. You’re sweltering in the heat of the midday sun, when you suddenly receive an order to start firing into the huts. The order is given because nearby allied soldiers are taking fire from those huts — it is likely the case that Taliban members have planted themselves there in order to use Afghan civilians as a shield. Your fellow soldiers need your support or they could be killed. You follow the order and fire into the area. You later learn that along with Taliban members, several civilians were killed including a child. How would you feel? How would you even process what has happened?
This type of scenario and many others that involve negative outcomes from military action are often at the heart of PTSD and moral injury for military veterans. The shame and guilt can be so immense and overwhelming that many soldiers will never even discuss these experiences with their closest loved ones — including their spouse. The fear is that no one would understand, and even worse, they would be judged and have relationships irreparably damaged.
Many people tend to think of PTSD (Post Traumatic Stress Disorder) as resulting from a scenario where you get attacked and have your safety and life threatened in some way — indeed, this is typically the case. However, trauma and moral injury (see below) can also come from violence enacted toward others.
So, what can we as a society do to help veterans who are suffering from actions they’ve taken and things they’ve seen from past combat? The foundation of any help must be proper understanding of the factors that affect how soldiers think and behave in combat situations.
What Is a Moral Injury?
First, let’s define a few things. PTSD is a rather commonplace term that most readers will be familiar with. Briefly, it refers to the presence of a number of symptoms (ex: nightmares; avoidance of people and places; flashbacks) that occur in response to a trauma and last for at least one month.
Moral Injury is a lesser known term, but is receiving more attention from mental health care providers and researchers. Definitions vary somewhat, but it is generally defined as a negative psychological response to events that challenge our morals and values. What you previously believed about yourself or others gets changed in some significant way. You may no longer trust or respect yourself or others as moral beings because of what happened in combat. It can happen when a soldier kills or harms another person, or when they see another person (especially someone they respect) act in an immoral way.
Moral injuries can leave you feeling as though you’re a different person, that people are inherently flawed and immoral, and perhaps that the world itself is a terrible place, devoid of meaning.
Many cases of PTSD will involve moral injuries, although not all, as PTSD and moral injury are not the same thing. It is possible for someone not to have PTSD and yet to have their mental health greatly affected by a moral injury. Common emotional responses to moral injury include depression, shame, guilt, and anger.
Veterans’ concerns over how civilians might view them are not entirely wrong. There are civilians who have negative reactions to stories involving soldiers harming others or acting in ways that many would view as immoral outside of a combat setting. Negative responses from the general population can be public (ex: the response to soldiers in the US returning from Vietnam), but nowadays tend to be private. I know that some military veterans do get occasional, negative comments from people over the role of our military involvement. For example, some people disagree with the decision to enter the war in Afghanistan. Fortunately, civilians in the West tend to have a positive attitude toward military members and show respect for their efforts.
However, much of the public have not heard the personal stories of veterans who’ve returned from Afghanistan and other deployments, as there tends to be two types of stories the media report — those involving the tragic loss of life at the hands of the enemy and those involving acts of bravery. Such stories are important to report and discuss, but also have the undesirable consequence of viewing combat experiences in black and white terms — situations where there were “good guys” and “bad guys.” Less common are the stories where one’s moral understanding of what transpired is muddy and grey.
Part of the motivation for writing this article is an attempt to frame this issue of moral muddiness in a way that allows for more clarity, understanding and empathy for all involved. To be clear, there are bad soldiers — those who act in ways that are not explainable by the elements of war experience and other military factors. These individuals were just as likely to harm people before and after their combat experiences as they were during combat. Every profession has its bad apples and the military is not exempt from this truth. This article is not about those individuals.
Rather, when we discuss moral injury we are often referring to people who have a moral compass, values and principles. They are no different than the rest of us, and because of their similarity to most of us, we should be able to imagine how we might have responded if we were in the same situations that our veterans were in — what would we think, feel, and do in their shoes?
But our thinking about this issue goes beyond simply having empathy. There needs to be a proper appreciation of the factors that affect their thinking and behaviour in many of these experiences. It is only with this improved understanding that anyone could start to evaluate the moral actions of military members. This is something that could benefit both civilians and veterans.
Understanding the Context Where Moral Decisions Get Made
There are several key factors that should be considered when hearing such stories — whether you’re a mental health provider working with veterans or a friend, spouse or general civilian. First, everyone needs to appreciate the commonality of Morally Impossible Situations (MIS) in combat scenarios. MIS experiences are those where no possible action could produce a morally perfect or completely satisfactory outcome. Think back to the scenario presented at the start of this article — your options are to fire into huts knowing that civilians could be hurt or killed (a morally undesirable outcome) or you could disobey the order and increase the likelihood of your fellow soldiers (the ones taking fire from the village) being harmed or killed (a morally undesirable outcome).
There is nothing you can do that will result in everyone being protected and safe. Such is the nature of war (and life) and it is something that everyone — veterans and civilians — need to consider. As a psychologist who frequently works with veterans I often have to present such scenarios to ensure that the patient recognizes and appreciates that there was nothing they could do to protect everyone (“If you had decided to do action Y instead of X, you’d likely be sitting across from me with a moral injury in therapy anyway”).
Another factor that needs to be appreciated are the inherent limitations imposed on veterans in combat situations. Such limitations on soldiers’ ability to act or not act include rules of engagement and the chain of command. Rules of engagement generally refer to the circumstances under which a soldier can use force. These rules are not always the same across deployments. For example, the rules of engagement on deployment with the UN in Somalia might be different from the rules under NATO in Bosnia.
One example of a rule of engagement is the need for positive identification of threat. In other words, you cannot fire at someone or use force unless you can see that they are carrying a weapon. In Afghanistan, not only were there no clear enemy combatants (i.e., enemies didn’t wear uniforms), but what could be considered a weapon or threat was very unclear at times.
For example, many IEDs were detonated remotely using a cell phone. This makes for a very unsettling situation — you could be driving on a section of road known for IEDs, see someone using a cell phone on the side of the road, and yet cannot take any action. Indeed, there are soldiers who witnessed their friends die via IED explosion and can see in hindsight how they perhaps could have prevented it by taking action. But is it reasonable for soldiers to take action against all Afghan civilians for using cell phones? This is not possible nor practical, and would not fall within the rules of engagement.
It becomes apparent when working with military veterans that many war experiences are ambiguous, and it is not at all clear as to what someone should do. The rules of engagement add an extra layer of complexity to these scenarios.
Likewise, soldiers’s thinking and behaviour are shaped by the requirement to follow their chain of command. Disobeying an order from a superior puts the solider at risk of being charged with a crime, being ostracized from their troop and perhaps even unwittingly putting innocent people at risk. Soldiers on the front line don’t always have access to the information that senior military members have, and therefore are limited in terms of all the factors to consider in situations where morals and values could be at play. As such, you could cause harm by ignoring chain of command as well as by following chain of command — another example of a MIS.
A final factor to consider is the degree to which a soldier’s ability to think and make decisions is significantly compromised in combat settings. In terms of understanding basic human thinking, it is helpful to use the analogy of the brain as a computer. Most people know that your computer can only process a finite amount of information at a time, and so if you have many programs open at once it will make your computer slow down. Likewise, there is only so much that the brain can handle and process, and there are a number of factors that affect its performance.
Things like sleep, hunger, and stressors (ex: workload) tend to affect civilians in daily life in negative ways. Consider how simply having a poor night’s sleep affects your ability to function at work the next day as an example of how your decision-making ability can be compromised. Now imagine how your thinking and overall mental health would respond in an environment where you’re:
- Exposed to unimaginable heat (some soldiers working inside tanks need to wear cooling vests because the heat is so unbearable)
- Working 12–18 hour shifts,
- Getting little sleep (ex: because you’re sleeping in the desert with snakes and camel spiders),
- Driving on roads known to be packed with IEDs,
- Seeing friends and locals killed in gruesome ways,
- Being occasionally or regularly fired upon with mortars or bullets
- Living on military rations for months on end
These are living conditions where one’s brain is not always functionally optimal, not to mention how the emotional response to such scenarios can produce skewed thinking and responses. A common response to trauma is to become emotionally numb, or to feel chronic anxiety and be on guard at all times. These responses can be useful for survival, but they come at a cost — you’re not thinking or responding the way you normally would. This fact can be easily missed or dismissed by veterans in hindsight, or by civilians who lack a proper understanding of how combat stress affects the brain.
Balancing Guilt, Regret and Compassion
Before anyone (civilian or veteran) can judge another or even themselves for actions taken in combat, they must properly consider the aforementioned factors when weighing their judgments. The vast majority of veterans that I’ve worked with did not act in ways that I would consider outright immoral, and those who suffer moral injuries were intending to do the right thing — even if the outcome was undesired. When it comes to moral judgments, it is the intention of the person that must carry most weight — an idea recognized by philosophers (ex: Immanual Kant) and in law (the concept of mens rea).
Because we are dealing here with complex, emotionally charged circumstances, there will be situations where soldiers act in regrettable ways that are out of character. For instance, someone who is a genuinely good person might engage in actions that do betray their own principles. For such cases, it is important that both the soldier and anyone hearing their story have a measured and nuanced way of thinking of these actions (bearing in mind the above mentioned factors, for example). Having a balanced view of moral actions can mean that the person is not all bad or completely guilty/responsible, but may mean that some of their actions require some bearing of responsibility. It is not reasonable or necessary to fully excuse all actions in combat. Rather, the goal is to achieve healthy responsibility.
Healthy responsibility refers to being accountable for the proportion of an outcome that is due to you, taking into consideration the relevant contextual factors. In the example used at the start of the article, a healthy sense of responsibility might lead to the conclusion that one is not a murderer (there was no intent; the intention was to protect innocent Canadians and harm the Taliban who are trying to kill those fellow soldiers — indeed, it is the Taliban members using the villagers as a shield who should bear most of the responsibility). Furthermore, a healthy sense of responsibility should lead one to feel regret instead of guilt. Regret is when we wish the outcome could have been different, whereas guilt occurs when we believe we acted immorally.
Some veterans may need to feel and process guilt. They may have acted out of character and harmed others in a way that was not acceptable. This is a very human experience and one that need not be avoided. Indeed, it is not only soldiers that I help deal with guilt in therapy, but civilians from all walks of life. Even in such situations, compassion for the person and the victims tends to produce better outcomes that trying to induce guilt and shame. In fact, effective treatments for PTSD and moral injuries, such as Cognitive Processing Therapy and Adaptive Disclosure, will help veterans process guilt in a healthy way so they can move forward and not get stuck in their emotions and symptoms.
I am hopeful that in the future, veterans will be able to more regularly tell their stories and that the general public and media respond in a healthy and productive way. When a country sends its soldiers on deployments, whether we agree or disagree with the political decision, there must be a collective sense of duty and responsibility for the outcomes. The burden of trauma and moral injury should be collectively shared and not placed on the shoulders of individuals.
