COLUMBUS, Ohio —Moral injury is “an injury of the soul,” as Army veteran Matt Zeller tells it.
Zeller, 40, served in Afghanistan and said the United States gave the Taliban power when it left behind Afghans who had been promised safety for helping soldiers during the military withdrawal from there in August 2021, following 20 years of war.
“It’s an injury that the Taliban gets to keep killing Americans with,” he said during a visit to Ohio to meet with the staff of retiring GOP Sen. Rob Portman and advocate for the Afghan Adjustment Act, which would help Afghans who fled here for safety reasons stay permanently.
Zeller, of Fairfax, Virginia, knows of five veterans who died by suicide during the evacuation of Afghanistan following the fall of Kabul.
About 41% of veterans are morally injured, according to statistics from Iraq and Afghanistan Veterans of America, where Zeller is a senior adviser.
“It’s pretty insidious,” he said.
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It can manifest in veterans feeling as if they failed in their mission because Afghans who served alongside them were left behind, said Zeller and James Powers, a fellow Army veteran, who lives in Canton, Ohio.
Here’s more information on moral injury and how it can impact veterans:
What is ‘moral injury’?
Moral injury is defined by the Department of Veterans Affairs as stemming from participating in killing or harming others in warfare, witnessing deaths or failing to prevent immoral acts.
It can result from traumatic or unusually stressful situations where people may carry out, fail to prevent, or witness events that contradict their deeply held moral beliefs and expectations, according to Sonya Norman, director of the post-traumatic stress disorder consultation program at the National Center for PTSD. It manifests as guilt, shame, disgust, anger, loss of trust and sense of self as well as difficulty forgiving oneself, she told The Dispatch, a part of the USA TODAY Network.
It can occur at the same time as PTSD due to the same originating event, but can also be present with anxiety and depression, Norman said.
How common is it?
Studies show that it affects between 37% and 65% of combat veterans, Norman said.
Does it only impact veterans?
Though it has been most extensively studied in veterans, Norman said there is growing recognition that other populations can experience it, too. This includes frontline health care workers, such as those who experienced morally distressing situations during the COVID-19 pandemic.
It can also impact veterans who were not deployed, said Nicole Jackson, clinical director of whole health at the Veterans Affairs Central Ohio Healthcare System. Those who served as medics, in food service or human resources roles in the military can also be impacted.
Norman has talked to one veteran who had to get to a bunker quickly and tried to make sure everyone else got to safety along the way. The person couldn’t save everyone and, though they weren’t in an infantry role, still suffered from that experience.
Kaitlynne Yancy, associate director of government affairs with Iraq and Afghanistan Veterans of America, didn’t deploy and served in the Navy in Virginia. Sometimes, she said she feels moral injury in the form of imposter syndrome or not feeling like a “real veteran” because she wasn’t deployed.
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How is it treated?
PTSD treatments are effective with moral injury. If someone has moral injury in addition to a mental health condition like PTSD or depression, treating the mental health problem may also help with the moral injury, Norman said.
The U.S. Department of Veterans Affairs is also studying interventions for it, said Norman.
“The VA has invested resources and continues to do so to create spaces that are more safe for all,” Jackson said. “All veterans are important. All veterans deserve high-quality health care.”
Empowering veterans to make their own choices as they transition out of service, where they were often told what to do, can help as well, she said. That may include trauma-focused therapy and evidence-based treatment.
“Veterans can get better,” Jackson said. “People can manage mental health in ways that make them stronger.”
What are examples of moral injury?
A common cause of moral injury can occur with someone goes against a religious value like “thou shalt not kill” by being ordered to kill someone in the line of duty, Yancy said.
“It comes from you having a set of values and being put in a situation where you might have to compromise those values,” she said of moral injury. “You are forced to compromise so you don’t lose any of your other brothers and sisters. … While you think you’re prepared for that type of decision, we’re not always prepared for what comes after and we don’t always have access to resources to deal with that after.”
Moral injury can also stem from witnessing an act someone might believe is immoral or knowing about something and not doing anything or being able to do something to stop it, experts say.
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Jackson, of the VA Central Ohio Healthcare System, said that it can happen in instances when a person might have done everything they could but still feels there should have been a different outcome. Or they could be torn about what they were ordered to do.
“A lot of times it’s about how unpredictable life can be,” she said.
It can also come from a sense of betrayal about orders, Jackson said, or a sense of betrayal by one’s fellow armed services members. For instance, when one might experience racism, sexism, sexual assault or homophobia from their brothers and sisters and feel as if they are not seen as equal.
Follow Danae King on Twitter: @DanaeKing.