Moral injury is a term that should be on the radar screen of any clinician who treats military veterans.
It was the subject of the National Association of Social Workers Suffolk Division program at Molloy College’s Sustainability Institute in Farmingdale on Nov. 17.
The highlight was a presentation by Camillo Mac Bica, a Marine who served in Vietnam. Bica is a member of Veterans for Peace, which disavows all wars, and a professor of philosophy and arts at Manhattan’s School of Visual Arts.
Bica said he teaches a course called The Mythology of War in which he describes dehumanizing tactics used in basic training to indoctrinate recruits and teach them to obey commands on the battlefield without questioning.
This can result in a soldier taking actions that are against their own moral code, and overlook actions by others. That, in turn, can result in guilt, shame, loss of self-esteem, despair, depression and possibly suicide.
Bica said he wrote a paper about moral injury in the 1980s but couldn’t get it published. Now, the Department of Veterans Affairs recognizes it as a treatable condition.
The VA says “moral injury is a construct that describes extreme and unprecedented life experience…which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs.”
It says the condition “may stem from direct participation in acts of combat, such as killing or harming others…or giving or receiving orders that are perceived as gross moral violations.”
The military, Bica said, has paid lip service to moral injury, stigmatized mental illness, looked for quick fixes and emphasized prescribing medication rather than long-term therapy. “All wars yield moral casualties,” he said. “Human beings are not killers by nature. Killers have to be created…Moral injuries are the result of manipulation during basic training.”
He said training teaches recruits to view the enemy as inferior and demonic so soldiers do not confront the enemy’s humanity. He said when soldiers seek treatment through the VA, they sometimes are convinced to ignore their trauma and told they are not truly responsible for their actions, which are but a natural outcome of war.
“Such ‘treatment’ tends to worsen the condition,” he said, “and doesn’t alleviate the vet’s moral injury…So [committing] an atrocity becomes a primal response to an overwhelming threat…it’s [said to be] commonplace, intrinsic to war.”
Bica urged more than 100 attendees to take different steps in treating veterans with PEMs (psychological, emotional and moral injuries). He suggested that they encourage veterans to self-forgive and try to eliminate the stigma of mental illness, which he said should not be viewed as a sign of weakness or a source of shame.
He said veterans should be shown that they are products of the warrior mentality drilled into them. He feels veterans with PEMs should be designated as combat wounded and be eligible to receive a Purple Heart.
These veterans must be deprogrammed, Bica said, have their moral identity shorn up and be prepared to re-enter a non-military environment. They must be asked to review and reevaluate their own personal responsibility for war actions and understand the impact their experiences can have on their sense of correct behavior.
They must consider whether their behavior was justifiable, understandable and excusable. Their guilt must be communalized – shared with the community and with those who trained and sent them to war, he said.
“We open our guts up to you,” Bica said, “and try to make you understand, and hope you will be able to help others and do it right…Being silent about the [war] experience is not curative, nor is it patriotic. It must be unpacked, examined and discussed.”
Northport VA Medical Center social worker Beth Brittman said the largest group of returning veterans from Iraq and Afghanistan is 20-29 years old, that 92 percent of them know somebody who was killed or seriously wounded and 47 percent have uncovered or handled human remains.
Bica said studies show 55 percent of Korean War troops never fired a shot at the enemy and 95 percent of troops in Vietnam never fired a shot, because human beings have a natural predisposition not to kill other human beings.
Brittman said war invades the fabric of a soldier’s life, resulting in a change of personality. “Working with vets, we’re grief counsellors,” she said. “We must honor and heal the emotional scars of war.”
Brittman said a veteran she treated is haunted by having killed an enemy soldier and then finding a photo of the man’s wife or girlfriend in his pocket. “He’s me,” the veteran told her.
Another veteran told her his job was to check people off when they left or arrived home from a deployment.
“He came to feel he was sending people to their deaths,” she said.
Veteran presenter Sarah Mess said she has experienced moral injury, PTSD, insomnia, chronic pain, exhaustion, difficulty concentrating and confusion since an incident on July 12, 1993 in Mogadishu, Somalia, where she says she witnessed U.S. Cobra helicopters firing rockets at a building in which dozens of Somalis were killed, including women and children.
Mess said she also feels she was poisoned by the anti-malaria drug Lariam she was given. “I continue to be humiliated by my providers,” she said. “Nobody understands.”
She urged clinicians to be sensitive when treating veterans. “Don’t push pills,” she said, adding, “Our identities are shaped by the words [diagnoses] that are put out there in the aftermath of service.”
