Moral Injury May be Most Important Factor in Military Suicides

Child cries after surviving a vehicle checkpoint shooting by American soldiers in Iraq that killed most of her family. Many doctors are suggesting a condition known as ‘moral injury’ may be increasingly a factor in the rising rate of military suicide. (Chris Hondros)

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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“Blood Makes the Green Grass Grow”

Inside his house shortly before taking his own life, Noah Pierce hung a defaced Iraq flag he took from an Iraq military base in 2003. While training for the war at Fort Stewart Georgia in 2002, Noah wrote home, “The drill sergeant would ask, ‘What makes the green grass grow?’ We would yell, ‘blood, blood, blood makes the green grass grow.’” From Iraq in 2003, Noah wrote home, “a stray bullet caught this kid in the head. Oh well one less motherfucker that won’t grow up and continue this shit.” Redeployed to Iraq in 2005 he wrote, “I hate life. If I died here, I would be young and it would be an honorable way to go. Let’s face it, I have no future when I get back.”

The Life & Lonely Death of Noah Pierce

by Ashley Gilbertson
Virginia Quarterly Review, Fall 2008

Noah Pierce’s headstone gives his date of death as July 26, 2007, though his family feels certain he died the night before, when, at age 23, he took a handgun and shot himself in the head.

No one is sure what pushed him to it. He said in his suicide note it was impotence—a common side effect of post-traumatic stress disorder (PTSD). It was “the snowflake that toppled the iceberg,” he wrote.

But it could have been the memory of the Iraqi child he crushed under his Bradley. “It must have been a dog,” he told his commanders.

Noah Pierce, Dec. 23, 1982 — July 26, 2007 (family photo)

It could have been the unarmed man he shot point-blank in the forehead during a house-to-house raid, or the friend he tried madly to gather into a plastic bag after he had been blown to bits by a roadside bomb, or—as the fragments of Noah’s poetry might lead you to believe—it could have been the doctor he killed at a checkpoint.

Noah Pierce grew up in Sparta, Minnesota, a town of fewer than one thousand on the outskirts of the Quad Cities—Mountain Iron, Virginia, Eveleth, and Gilbert—on the Mesabi Iron Range. Discovered on the heels of the Civil War, the range’s ore deposit is the largest in the United States. These were the mines that made the Second Industrial Revolution.

It’s a stigma.

It’s not like if Noah had of come home with his arm blown off. They would have fixed it with an artificial arm, and he would have gone through therapy to learn how to use it and therapy to accept the loss of the arm. And nobody would have looked down on him for that. They would have patted him on the back and told him how proud they were.

But once people hear he has PTSD, then he’s a person with leprosy. He’s got a disease and he’s looked down upon and frowned on, and not trustworthy. It’s just not right — Cheryl Softich, Noah’s mother

Range steel became the tracks of railroads, the wires of suspension bridges, the girders of skyscrapers. It became the weapons and artillery of the World Wars. welcome to mountain iron, the taconite capital of the world reads a sign greeting visitors along the highway. There are so many open pit mines that the cities seem perched on tiny outcrops, overlooking gaping holes ready to engulf them.

Around the clock, deep metallic groans come out of the ground, and freight trains barrel through, horns screeching. Blasting takes place so close to people’s houses, residents open their front doors so the pressure doesn’t blow out their windows.

Locals are proud of their hardworking, hard-drinking heritage. There are more than twenty bars on Eveleth’s half-mile-long main street. On a typical night last May, when I was there, loudspeakers affixed to lampposts blared John Denver’s “Take Me Home, Country Roads,” and Harleys thundered through town.

One bar closed early, when a drunk got thrown through the front window.

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New Report Cites Continued Stigma, VA Benefits Backlog, Among Significant Barriers to Veterans Mental Health Care

According to a new report published June 28, 2012 by The National Alliance on Mental Illness (NAMI) titled, “Parity for Patriots – The Mental Health Needs of Military Personnel, Veterans and their Families,” troops coming home from multiple combat zone tours are experiencing record levels of psychiatric injuries such as PTSD and depression. The report lists barriers to care, such as stigma and a growing backlog of VA disability claims, as serious problems awaiting service members when they come home from war. Above, Marine Corps Sgt. Jesse E. Leach assists Lance Cpl. Juan Valdez-Castillo after he was shot by a sniper in Anbar Province, Iraq on October 31, 2006. (Joao Silva/NYT)

Mental Wounds Plague Veterans

by Alan Johnson
The Columbus Dispatch, June 28, 2012

America’s wars are winding down, but America’s warriors are coming home with hidden wounds: post-traumatic stress disorder, chronic depression and other serious mental-health problems.

As a result, alcohol and drug problems, family violence and suicide are plaguing veterans and their loved ones, according to a National Alliance on Mental Illness report released today. A veteran commits suicide every 80 minutes in the U.S., while someone on active duty takes his or her life every 36 hours, the NAMI report says.

The national report, “Parity for Patriots,” provides detailed statistics on growing mental illness affecting many of the 2.2 million active-duty personnel in the U.S. and millions more veterans and families members.

– One in five active duty military personnel have experienced symptoms of PTSD, depression or other mental health conditions

– One active duty soldier dies by suicide every 36 hours and one veteran every 80 minutes

– Suicides have increased within National Guard and Reserve forces, even among those who have never been activated and are not eligible for care through the Department of Veterans Affairs (VA)

– More than one third of military spouses live with at least one mental disorder

– One third of children with at least one deployed parent have had psychological problems such as depression, anxiety and acute stress reaction — NAMI 2012 Report: Parity for Patriots – The Mental Health Needs of Military Personnel, Veterans and their Families

Quoting a 911 call-center counselor, the report says, “He just said he thinks he should walk out into traffic on Interstate 5 and end it all. That life is not worth living.”

NAMI concluded that the Veterans Affairs medical system is “hard to penetrate” for those seeking mental-health treatment. Half wait 50 days for their initial assessment. The agency has a backlog of nearly 900,000 cases awaiting disability benefits.

At the same time, barriers remain to parity between physical and mental-heath care — despite a 2008 law aimed at fixing the problem.

Attitudes also play a big role, NAMI reported. Active military personnel and many veterans are reluctant to seek treatment for fear of the stigma.

Mental-health problems are prevalent in family members, too: Thirty-seven percent of spouses were diagnosed with various disorders, and one-third of the 776,000 children of active military personnel have acute stress reaction, depression, anxiety or behavior disorders, the report said.

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