WASHINGTON, DC - MARCH 27: U.S. military veterans set up 1,892 American flags on the National Mall March 27, 2014 in Washington, DC. The Iraq and Afghanistan Veterans of America installed the flags to represent the 1,892 veterans and service members who committed suicide this year as part of the 'We've Got Your Back: IAVA's Campaign to Combat Suicide.'
Long before the number of suicides in the US military exceeded the number of combat deaths, Drs. Rita Nakashima Brock and Gabriella Lettini were working together to help veterans recover from the “moral injuries” they received during service. Cofounders of the Soul Repair Center at Brite Divinity School, they’ve run workshops, lectured widely on the topic, and coauthored the book Soul Repair: Recovering from Moral Injury after War. Now, as President Obama prepares to again increase the number of troops in Iraq, the lessons in “soul repair” developed by Brock and Lettini may be more critical than ever. “Moral injury,” they write in the book’s introduction, “results when soldiers violate their core moral beliefs, and in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human beings.” It is, according to Brock and Lettini, a state of despair particular to soldiers, and one that can have dire consequences. “When the consequences become overwhelming,” they warn, “the only relief may seem to be to leave this life behind.” In a longer passage, they outline exactly how this moral suffering plays out in a soldier’s life:
Rita Nakashima Brock, Ph. D. is Founding Co-Director of the Soul Repair Center at Brite Divinity School.(www.britesoulrepair.org). She was a professor for twenty years, directed the Fellowship Program at the Radcliffe Institute for Advanced Study, Harvard University, a prominent advanced research institute, and from 2001-2002, was a Fellow at the Harvard Divinity School Center for Values in Public Life. Her latest book is Soul Repair: Recovering from Moral Injury After War, co-authored with Gabriella Lettini.
The killing of Iraq veteran and national figure Chris Kyle prompted media queries and questions for the three of us who run the Soul Repair Center at Brite Divinity School. Our Center is dedicated to recovery from moral injury in veterans. Rev. Dr. Coleman Baker, Chaplain (Col.) Herman Keizer, Jr. (ret.) and I spent a day reflecting together on what went wrong when Kyle tried to help a fellow vet. Here are some of our reflections.
Chris Kyle, a well-decorated Navy SEAL sniper, completed four tours in Iraq with an extraordinary record of kills. Kyle's book about his experiences in the clandestine fraternity gained him much admiration. Then, a week ago on a firing range in Texas, Eric Routh, a Marine reservist who served in Iraq, killed him and his fellow veteran Chad Littlefield.
Kyle was beloved by many because he tried to support his fellow vets in returning to civilian life, but it seems clear that Kyle himself never really left the military. He overcame his own struggles with alcohol and a fear of leaving his house by re-building a military cocoon as a means of therapy. Kyle's idea of what worked best for returning veterans was the military espirt de corps of an active unit. He used the tools of his military experience at his Fitco Care Foundation, designing treatments built on exercise, counseling and veteran camaraderie. And he kept a live-fire range open and invited others to shoot for therapy.
In trying to treat Eric Routh by echoing his war experience, Kyle, who sought to stay in war, may have provoked a desperate Routh to seek escape from such "help." By not questioning whether military values can simply be relived in civilian life, Kyle failed to understand difficulties some returning vets might have with a "HOOHA" model of counseling and training, especially those with traumatic brain injuries, PTSD, and moral injury. For veterans who feel betrayed by the government, have serious trauma, or experience a collapse of moral meaning after war, more exposure to military life can compound the difficulty of adjusting to the civilian world.
It was hard trying to wrap my mind around "Well, how can I shoot another human being?" And even the first time I had to do it, they're yelling at me. "You have to do it! Take it! Take it!" And it's still trying to get over the fact that, well, I'm fixin' to have to kill someone.
And then you do it, and you have to think of it differently. You're not killing a person, you're killing an enemy that if you don't do it, they're gonna kill your guys. ... You have to de-humanize it, so you don't go crazy.
In his civilian life, Kyle continued this strategy of de-humanizing his enemies. He referred to people in Iraq as "savages." He also dismissed civilians as shallow and selfish.
We think Kyle had a good point about civilian society. The care for each other unto death and the willingness to die in service to others bonds a combat unit in ways that are rare in civilian life. During the Iraq War, civilians were shielded from images of coffins returning home and were advised to shop, rather than make personal sacrifices to support the troops. The narcissism, personal ambitions, and self-obsessions with consumerism and celebrity culture have prompted some veterans to ask, "I fought for this?"
Without a new social, emotional, spiritual system that can help veterans of war move from a military system to civilian life, we sentence many of them to military cocoons or lonely states of limbo from which transition is nigh impossible.
Few institutions in our culture ask people to commit to each other over the whole life course, from birth to death. Few organizations welcome strangers and include them in a community of care; attend to those who need help, feel hurt or are troubled in their souls; and hold each other accountable for living into their best selves in circles of generosity and reciprocity. These commitments of lifelong weekly activities describe congregational life. Though no congregation does them perfectly, most try their best, and many do them well.
We believe that congregations are one place that should be welcoming veterans home, but few have committed to this work. It should not be undertaken with just simple good intentions, though good intentions matter a great deal. To welcome veterans into a community's life, we need to understand how to assist the transition from the values of military life to religious life. We must advocate for better services for treating PTSD, and we must support veterans' families and all they go through to welcome veterans home.
We mourn the deaths of Chris Kyle and Chad Littlefield. They are tragic, senseless killings that have left their families and friends with unimaginable loss. We may never know why they were killed. However, we hope their deaths can help us all better understand the complicated and difficult return to civilian life for combat veterans and see this as an important responsibility of us all.
Without adequate ways for veterans to process their war experience, reflect on its moral and psychological impact, and restore them to civilian life, we fail as a society to bring them all the way home. Tragically, just before he died, Kyle hinted he might be ready to come home. He wanted to slow down and just take care of his family, saying he was tired: "I'm just trying to be the me that I am and not all of this other crap."
The first book to explore the idea and effect of moral injury on veterans, their families, and their communities
Although veterans make up only 7 percent of the U.S. population, they account for an alarming 20 percent of all suicides. And though treatment of post-traumatic stress disorder has undoubtedly alleviated suffering and allowed many service members returning from combat to transition to civilian life, the suicide rate for veterans under thirty has been increasing. Research by Veterans Administration health professionals and veterans' own experiences now suggest an ancient but unaddressed wound of war may be a factor: moral injury. This deep-seated sense of transgression includes feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs.
Rita Nakashima Brock and Gabriella Lettini, who both grew up in families deeply affected by war, have been working closely with vets on what moral injury looks like, how vets cope with it, and what can be done to heal the damage inflicted on soldiers' consciences. In Soul Repair, the authors tell the stories of four veterans of wars from Vietnam to our current conflicts in Iraq and Afghanistan—Camillo "Mac" Bica, Herman Keizer Jr., Pamela Lightsey, and Camilo Mejía—who reveal their experiences of moral injury from war and how they have learned to live with it. Brock and Lettini also explore its effect on families and communities, and the community processes that have gradually helped soldiers with their moral injuries.
Soul Repair will help veterans, their families, members of their communities, and clergy understand the impact of war on the consciences of healthy people, support the recovery of moral conscience in society, and restore veterans to civilian life. When a society sends people off to war, it must accept responsibility for returning them home to peace.
Click here to read an excerpt of Soul Repair on Beliefnet.com
Click here to read an excerpt of Soul Repair on Scribd.
"Soul Repair is an eloquent, deeply human reminder that war is not just what takes place on a distant battlefield. It is something that casts a shadow over the lives of those who took part for decades afterwards. The stories told by Lettini and Brock are deepened by what the authors reveal about the way the tragic thread of war's aftermath has run through their own families."—Adam Hochschild, author of To End All Wars
"Those you send to war may come home with souls unclean and hearts drowning in bitter mistrust. But the need for purification after battle has vanished into the blind spot of our culture. We neither offer it to returning veterans, nor remember that we-for whose sake, in whose name, our soldiers went to war-need purification with them. Potent challengers of conventional thinking, rich in heart, those who speak here are voices you will not forget." —Jonathan Shay, MD, PhD, author of Odysseus in America: Combat Trauma and the Trials of Homecoming
"Very important and deeply moving. I strongly recommend it."—James H. Cone, author of The Cross and the Lynching Tree
"Soul Repair is stunning, just beautiful. Riveting. This is not just a breakthrough book, it is a breakthrough moment, the kind of work that makes history shift and emotions adjust. It restores balance and reclaims life." —Amir Soltani, author of Zahra's Paradise
"Eloquent and unflinching discourse on war's problematic moral core."—Publishers Weekly
Rita Nakashima Brock is Founding Co-Director of the Soul Repair Center at Brite Divinity School. She was a professor for twenty years, directed the Fellowship Program at the Radcliffe Institute for Advanced Study, Harvard University, a prominent advanced research institute, and from 2001-2002, was a Fellow at the Harvard Divinity School Center for Values in Public Life. 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 with Brock of Soul Repair: Recovering from Moral Injury After War.
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. 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.
While the Army has long provided protective training for soldiers sent to war, this is clearly now inadequate. Battles with insurgencies make violence against civilians commonplace and acceptable in ways that violate international standards for the conduct of war and the moral code of conduct for soldiers. For example, "Sniper Wonderland," a military drill chant says:
See the little girl with the puppy; Lock and load a hollow pointed round... Take the shot and maybe if you're lucky; You'll watch their lifeless bodies hit the ground....
The most recent Army attempt to prepare troops for battle appears to have failed miserably. Its "Comprehensive Soldier Fitness" (CSF) program, begun in 2009 with a $125 million investment and lauded in a New York Times Magazine article in March 2012, has been widely criticized. It bypasses the difficult ethical questions that many healthy human beings ask about war, and its spiritual fitness component has no moral content. It suggests that a soldier's commitment to a higher purpose—mission first—makes for resiliency. But most people capable of such a commitment also have empathy for others and deep moral values.
The Army's "spiritual fitness" encourages soldiers to see events in a neutral light, rather than labeling them as good or bad, and to create a nightly list of positive things that happened that day. The lack of awareness is startling regarding what it might mean to ask someone to think of killing a child, losing a close friend or torturing detainees as neutral or positive.
Proving a direct cause-effect relationship between such training and suicides is difficult, of course. However, there are certain moral reactions to war and the experience of combat training that indicate a violation of moral conscience in war can have devastating inner consequences in soldiers. A larger proportion of soldiers and veterans who serve in combat seek the counseling help of a chaplain over the help of a clinician. This choice has two likely reasons. First, speaking to a chaplain does not create a negative psychological record in a military career. Second, psychological training does not require knowledge of theological issues, moral discussions of good and evil, or religious meaning. In fact, when soldiers raise moral questions about conscience in therapy, they are often referred to clergy.
The reporting on military and veteran suicides mostly fails to explore the role of moral injury. When a suicide occurs years after a soldier returns from war, combat experience is often disregarded as a primary cause of the suicide. Yet, as Karl Marlantes, a Vietnam veteran, reports in "What It Is Like to Go to War," he was fine for a decade, and then, he crashed. Often, such delays are used to deny VA services or are regarded as a family problem, rather than as a consequence of service in combat.
The alarming rates of reported suicides are squishy statistics and do not reflect the true numbers of soldiers who take their own lives. Many combat veterans tell stories of comrades who shot themselves, but who were reported as "non-combat" or "accidental" casualties. Soldiers who deliberately place themselves in harm's way in hopes of dying are reported as casualties, not suicides. Since many life-insurance policies will not pay benefits to families if suicide is the cause of death, the need to disguise suicide may mean some apparently accidental deaths were, in actuality, planned. We will never know the true suicide numbers, but we do know moral injury causes intense inner anguish.
Moral injury is not a clinical condition that can be medicated or cured by psychology. It requires the reconstruction of a moral identity and meaning system with the support of a caring, nonjudgmental community that can provide a way for veterans to learn to forgive themselves. But any community that wants to offer such support must have the moral courage to examine its own responsibility for war. With such a small percentage of Americans (1 percent) serving in the military, and the escalating unpopularity of the wars in Iraq and Afghanistan, too few people or communities remember the initial popularity of the wars or care about the cost to the men and women we send to fight on our behalf.
We care, and we believe our whole society bears responsibility for addressing moral injury. Whether or not we supported the wars, they do not end when soldiers come home. Instead, they continue in the souls of those who fought and in their families and communities when they return to civilian life. That is why we believe one right response of moral conscience to military and veteran suicides is to study and address moral injury as a hidden wound of war.