MORAL INJURY: The Crucial Missing Piece in Understanding Soldier Suicides
by Rita Nakashima Brock
Huffington Post, July 23, 2012
Note: This piece was co-authored by Col. Herman Keizer, Jr. (ret.), Co-Director of the Soul Repair Center, who served for 34 years as a military chaplain, and Dr. Gabriella Lettini, co-author of ‘Soul Repair: Recovering from Moral Injury After War,’ Beacon, forthcoming November 2012.
The crisis of military suicides, averaging one a day, has captured national attention. The July 23 cover story in Time magazine summarizes much of this coverage. Unfortunately, it is misleading.
The article presents the suicides of two officers — a helicopter pilot who served in Iraq and a medical doctor who did not serve in Iraq or Afghanistan. This example skews the article in two ways. First, in focusing on officers, it selects a group that tends to see less direct combat than the enlisted men who both do more direct fighting and commit suicide at higher rates than officers. Second, in contrasting the two officers’ deaths, it suggests that suicide rates are the same for those who serve and those who do not serve in combat.
Soldiers are trained to kill, which is regarded as criminal behavior in civilian life, and they are trained to be lethal without even thinking about it, a method of training called reflexive fire training — Dr. Rita Nakashima Brock, founding co-director of the Soul Repair Center at Brite Divinity School
However, the medical doctor first was an enlisted soldier who worked on a bomb squad and served in Bosnia. He was also in Oklahoma City just after the federal building was attacked — years before he decided to become a doctor.
It’s likely he saw war conditions during his earlier service.
We need to remember that the U.S. has sent its forces into violent conflicts every year since World War II, except one, so Iraq and Afghanistan are not the only ways a soldier may have experienced combat.
The most serious blind spot in the reporting on military suicides is an absence of discussions about the moral impact of military training and its implementation in combat. Soldiers are trained to kill, which is regarded as criminal behavior in civilian life, and they are trained to be lethal without even thinking about it, a method of training called reflexive fire training.
We suggest that moral injury is likely one of the most important factors in military suicide rates.
Moral injury is not PTSD. The latter is a dysfunction of brain areas that suppress fear and integrate feeling with coherent memory; symptoms include flashbacks, nightmares, dissociative episodes and hyper-vigilance. PTSD is an immediate injury of trauma.
Moral injury has a slow burn quality that often takes time to sink in. To be morally injured requires a healthy brain that can experience empathy, create a coherent memory narrative, understand moral reasoning and evaluate behavior.
Moral injury is a negative self-judgment based on having transgressed core moral beliefs and values or on feeling betrayed by authorities. It is reflected in the destruction of a moral identity and loss of meaning. Its symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live.
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