Broken Compass: Moral Injury's Devastation

Discover the profound impacts of moral injury on veterans and their families with insights from Dr. Daniel Roberts, president and CEO of the Moral Injury Support Network for Service Women Incorporated. Explore how feelings of shame, guilt, and self-blame can lead to serious challenges such as homelessness, substance abuse, and social isolation. We promise you'll gain a deeper understanding of moral injury as we differentiate it from PTSD, and learn why this distinction is crucial for effective support and recovery. Through the compelling story of Faith, a Hispanic woman dealing with racism-induced moral injury, we illustrate the real-life consequences and encourage a compassionate approach to healing.

Join us as we offer a sneak peek into our upcoming book, which provides an extensive exploration of moral injury—from definitions and concepts to recovery strategies and spiritual support. This episode is essential for chaplains, mental health professionals, and anyone eager to grasp the intricacies of moral injury. We delve into empirically validated tools to assess moral injury and highlight critical research gaps, preparing the ground for future discussions on its impact on military families. Don't miss this enlightening conversation that promises to shed light on the psychological and emotional abuse nuances within these contexts, equipping you with immediate care guidance for those affected.

Chapters

• 0:00 Effects of Moral Injury
• 22:35 Impact of Moral Injury on Veterans

Transcript

Speaker 1: 0:34

Good day, dr Daniel Roberts, president and CEO of Moral Injury Support Network for Service Women Incorporated. Welcome to the Moral Injury Support Network podcast. On today's episode we're going to talk about the effects of moral injury. Last podcast we talked about sources or roots of moral injury and triggers. So I highly suggest that you take a listen to that podcast episode three of season three and today is the next episode. We'll be talking about the effects of moral injury. So a lot of this information is coming from our book that we're in the process of publishing. It's in draft form right now and if you'd like to get an advanced copy of this book, you can make a quick donation to Moral Injury Support Network and we will send you an advanced copy of this book in draft and you'll see the notes in the notes for this episode how to do a donation.

Speaker 1: 1:47

But in this book we talk about, you know we kind of cover moral injury from one end to the other as far as what's available in research and some of the research we've done ourselves and the training and information we have provided Moral Injury Support Network about moral injury, and we've also synthesized a bunch of research from others who have done work on moral injury. In the book we talk about moral injury definitions and concepts, sources of moral injury, how moral injury affects people. We delve into different moral injury instruments. You know survey tools that have been empirically validated that can help care providers determine if someone has been morally injured and to what extent. Maybe there's still lots and lots of gaps in the research on moral injury and lots of areas that need to be explored about moral injury. Also in the book we cover recovery programs. There's a lot of multi-week programs out there that are being done by great practitioners, some within the VA, some provided by the VA, others not provided by the VA, others not. But in the book we talk about different recovery programs and how they work to help people who are suffering from moral injury. And then we have a couple of chapters on immediate spiritual aid and trauma care for people who have been morally injured. So that's, if you're a chaplain, someone comes into your office you identify as being morally injured, what can you immediately do to help them? And then, from a mental health care perspective, from the perspective of a counselor psychologist, of a counselor psychologist, other mental health practitioner like social worker if someone presents with moral injury, what is immediate care that you can do to help them be safe, begin to work through the moral injury and then either refer them to a program or get them into a multi-week program, et cetera. So all that is in the book and, like I said, we can send you a draft copy If you make a donation and just let us know that you would like the draft copy.

Speaker 1: 4:36

You can do that on our website at missionsorg slash donation, the donation page. So you can also send an email to droberts at misnsorg and let me know that you'd love to get an advanced copy draft copy of the book, and I'll be happy to send that to you once you make a donation of any amount. And the reason why we want to send the draft copy to you is just to give you a chance to. What we'd like to hear from you is is this book meeting the needs? Does it address moral injury in a helpful way? So we'll send you this advanced copy and give you an opportunity to comment on the book to help make the book better before we put it out in print. So I want to let you know about that Before we get into the effects of moral injury.

Speaker 1: 5:37

I do want to cover really quick some basics of moral injury. If this is the first episode you're listening to and you aren't familiar with moral injury, we'll cover those basics here for a few minutes and then we'll get into moral injury's effects and moral injuries effects. So if you aren't familiar with the term moral injury, let's talk about it just a little bit. First of all, there are no uniformly agreed upon definitions of moral injury. There's some useful definitions out there and ones that are commonly used. Jonathan Shea defined moral injury as perpetrating, failing to prevent, bearing witness to or learning about acts that transgress deeply held moral beliefs and expectations.

Speaker 1: 6:52

So what I tend to think of moral injury of in layman's terms, or, you know, to conceptualize it in a way that is easy to remember, moral injury is when something traumatic happens to someone that violates their deeply held moral beliefs, and it could be something that happens to them, something they participate in, or it can be something they just witness. You can see something traumatic, see trauma, witness trauma, and have it violate your deeply held moral beliefs, and you can be morally injured from it, especially if what you're witnessing you're not able to do anything about. In fact, you can actually be morally injured by hearing about something that is really terrible and that violates your deeply held moral beliefs. By way of a regular example now, let me say moral injury was first conceptualized as a military problem, things that happen to people in a military setting. But really moral injury is something that can happen to anyone.

Speaker 1: 8:16

Oral injury is something that could happen to anyone. It could happen to someone who works at IBM or it certainly can happen to first responders. First responders are prone to it. But even going back to my IBM example, if you know of a leader in IBM and I'm sure IBM is an outstanding company doing great work so IBM is just an example, a company that came to my head. But someone at your workplace is doing something very unethical, is deeply bothering you and it's harming other people in some way. That could be a moral injury. You could.

Speaker 1: 9:12

If someone is in a bad car accident but everybody understands it was an accident maybe the roads were bad or something happened beyond someone's control you could end up with PTSD from that accident because of the extreme trauma involved. But not moral injury, because there wasn't a moral violation. But, on the other hand, tragic accident someone dies, say, for example, and the driver was a drunk driver then that could also include moral injury because of the moral violation of getting drunk and getting behind the wheel. So think about moral injury that way. In the medical field, what used to be called burnout is now being more associated with moral injury, and there could be a lot of other cases where moral injury can happen. So how does moral injury affect people? That's really what we want to get to today, and it can affect people in a lot of ways. People in a lot of ways. Moral injury is closely tied to PTSD, and often folks with PTSD also have moral injury. So the two phenomenon are not the same, but they often are found together.

Speaker 1: 10:56

By far most of the research into moral injury has been on veteran populations, and so that's where most of this information is coming from. What we've seen the effects of moral injury on veterans. We also have some data about how it affects military spouses, and if you look at some other research related to the healthcare industry, so on and so forth. But there are a lot of commonalities with how moral injury can affect people. Regardless of whether we're talking about military veterans, spouses or people in the medical care field, it's often the effects are very similar. It's just that the context or the sources of moral injury are different, so let's talk about some of those effects. So let's talk about some of those effects In military veterans.

Speaker 1: 11:59

Myself and Dr Kovacic conducted a study where we interviewed about 50 women veterans and they described their moral injury, how it affected them, how it happened and so on and so forth. And within that data set, emotional and mental health problems were by far the most common. More than 40 women identify symptoms in these two categories emotional and mental health problems. Most women experience fear, anger, rage, hatred and grief. Then later, many of those same women experienced a sense of hopelessness or lost their ability to feel at all after they did not receive the help, support, justice or counseling that they needed. For many women, this diminished emotional capacity never returned to them and it affected their relationship from then on. So it was so devastating that every relationship afterwards was affected by their moral injury.

Speaker 1: 13:08

And for most women over 50% of them the moral injury came from a sexual assault, but not everyone. There were all kinds of other things that caused moral injury. We covered that much more of that in the previous episode, so take a listen to that. Some of the women completely lost the ability to have an intimate relationship with another person and remain single and isolated to this day. Some even don't even talk to their family. So it, you know it created not only problems for, you know, intimate sexual relationships, but even friends and family. They lost the ability to be bonded to those people. Kayla was sexually assaulted.

Speaker 1: 14:12

When she was asked about the emotional after effects she said well, it's really hard, I don't really have emotions because when you get into that fight, flight or freeze, I froze and that kind of froze everything. I have a really hard time with emotions. Mary was forced by her supervisor to get an abortion and she had this to say about it it was a mixture of fear and resentment of my leadership, you know, resentment for what they were able to do at the time and a fear of their control over me. But the hazing and bullying continued for the rest of my time there. So afterward I also had regrets that this didn't stop anything. Really, I had a very difficult time with respect. Everything became very robotic and obsessive and my therapist to this day is still trying to dig up memories. I have very little recollection of a lot of my time stationed there, so you can hear the devastating effects to her.

Speaker 1: 15:21

But also, interestingly enough, it's this loss of memory and some of you in the audience, many people, have had adverse childhood experiences and due to those adverse childhood experiences there are maybe parts of your childhood you just can't remember unless somebody really helps dig them up for you. And I understand that, because I've had that same experience where I just can't remember major parts of my childhood and somebody has to like a therapist has to really help me. You know, remember those things depression, suicidal ideation, diminished memory capacity and confusion and I don't have the research to back it up yet. I don't know that there's been very strong correlation between moral injury and a lot of other issues with veterans, like homelessness, substance abuse, all that. There's some research that would point to that, but we definitely need more research in that area. But if you think about it, somebody's been morally injured due to their time in service and they have all this and because of that they have PTSD, anxiety, depression, suicidal ideation, etc. You know it's going to be very hard to work and some of our participants said I'm totally disabled because of it and it's hard for me to work Now. Currently, moral injury is not recognized in the DSM for psychologists and so there are groups of people that are working to get that put in the DSM so that it can be a diagnosis. And once it's a diagnosis then I think it's also a chance that people can get disability because of it. But it's not really diagnosable in that sense yet. There are survey instruments you can determine if somebody's morally injured, but there's not a way to then be compensated because of it.

Speaker 1: 18:07

Sherry said that the effects of her sexual assault were long-term and while it started me on this huge spiral, I think I'm still in it Right now. I'm 100% disabled. So just mentioned her, the total disability. Lena went through her traumatic experiences but was able to keep working. Years later her experience hit her and just out of the blue it ambushed her and she said something happened at the job I had. I worked with kids and that just totally knocked me down. I couldn't work anymore. Depression, anxiety, a lot of nightmares I couldn't name what was going on and got into drinking and all that. So it can. It can be where you you have this experience, you bury it. It can be where you have this experience, you bury it and then years later something can trigger it and then you begin to feel these effects, sometimes even worse years later than shortly afterwards.

Speaker 1: 19:17

Loss of self-worth was the second most common symptom for women. In our study, women who experienced sexual assault, gender harassment, retaliation for reporting or not giving into sexual advances and toxic leadership led to a loss of self-value self-value and some women violated their own morals. And because they didn't stand up for themselves or they didn't stand up for other people or um things they were forced to do that they felt like you know they. They should have stopped or not done whatever it was, you know. They felt this tremendous loss of self-worth, like now they're just garbage, they're not redeemable as a human, so on and so forth. Many, many veterans who have been in combat have experienced that same kind of thing. Been in combat have experienced that same kind of thing. If they've had to do some very nasty things in combat, let's say, you know, in the Middle East, where they maybe had to shoot a child because the child was carrying explosives or whatever, or they violated the rules of engagement, even if it was unknowingly until later, and then they began to feel this guilt and that they're unredeemable, their self-worth, self-value plummets and it's very hard to help someone recover who has lost their self-value.

Speaker 1: 20:58

Over half of the women lost their ability to trust others due to their moral injury experience and this showed up in sexual assault, gender harassment, retaliation incidences. Often the assault was a result of the assault was from someone they knew or someone they considered a friend. Women also talked about how they lost trust in the military institutions when those institutions, those organizations, failed to believe them or support survivors. And again, many of these women remain sort of isolated and alone. And again, going back to this is not just a phenomenon for women, but men can experience these same kind of things. Not only can men be sexually assaulted, but just men can be betrayed, and betrayal is a huge component of moral injury, often so that betrayal can lead to total loss of trust. Many marriages were lost. And here's a startling statistic Nearly half of the women that we interviewed 50 women who we interviewed or completed anonymous surveys surveys said they seriously considered taking their own lives or they actually did make a suicide attempt. So again, that goes back to suicidal ideation.

Speaker 1: 22:35

Homelessness, substance abuse All this can be tied to moral injury and can be an effect of a moral injury. Shame, guilt and self-blame figured prominently in the lives of moral injury survivors, even when an observer might determine that the survivor had no reason to think that they were somehow to blame, like in the case of a rape, survivors often still found themselves feeling guilty for what happened to them. They could not seem to shake the feeling that it was somehow their fault. Other times, perpetrators and their co-conspirators, supervisors and other blamed women were gaslighted them. Okay, so let's hear the story of Faith, a Hispanic woman who experienced shame and guilt due to racism. And she said who experienced shame and guilt due to racism? And she said well, initially I wasn't an equal opportunity specialist, I was military intelligence and I was one of the few women of minorities that were within that.

Speaker 1: 23:50

Most of the people that I got with early on were, there was a white environment, and so I got lonely at times. I didn't know how to describe it, but I felt lonely. It was because of who I was. I was made to feel ashamed of being Hispanic because I was the only one at a time being in a room. There was only me. So I became lonely but at the same time I kind of tried to assimilate with that and not my culture, kind of leave my culture behind. So loneliness and shame, I think were the biggest things in the beginning Low self-esteem and shame of who I was and who I was born to.

Speaker 1: 24:44

There are other symptoms or effects that moral injury can have on people, including physical sickness, inability to sleep, lost interest in sex. So, what's interesting, some women lost interest in sex completely, others turned to promiscuity. So moral injury can affect different people in different way, but in simple terms, people often become someone that they no longer recognize themselves or someone they no longer. Another study conducted by VA, when chaplains were asked the kind of complaints they got from morally injured veterans and MI's moral injuries impact on social functioning, community and integration and integration. They identified several problems that veterans presented with, including chronic pain, sleep problems, depression, self-medicating with alcohol and drugs, isolation and social withdrawal from everyone, including family members Talked about that Suicidal ideation associated with social isolation. So much of what is there. We've already discussed Much of what is there. We've already discussed.

Speaker 1: 26:01

So now, in our study with military spouses, which is still ongoing, but we have interviewed 20 military spouses who are either the partner or ex-partner of a service member with PTSD and we talked about, you know, we asked them about what it's like being married to or a partner of someone with PTSD and how that relates to moral injury. Their experiences relate to moral injury and we found some interesting results and some very, very difficult stories. So some of the just to give you an idea of some of the experiences they had. Some service members disappeared without warning, leaving spouses to worry if they were dead, on a spending spree or lost. So the service member would just disappear and then reappear days later.

Speaker 1: 27:16

Sometimes Many veterans were physically present but avoided any interactions with spouse or children that might trigger an emotional response, a typical kind of thing with PTSD. Other service members were bodily abusive to their spouses or the walls and furniture when triggered. Some spouses endured insults, criticisms and accusations from their spouse, from their service member. Dora said it's a battle every day, not a battle, but it's walking on eggshells every day trying to figure out what the mood is. Edith said I learned that some of the things we did go through in those early days are considered abuse and I'm not going to tolerate that again. I mean I had things thrown at me. There's holes in the walls, tiles broken. I've had to call law enforcement, you know, just to protect myself. Mostly so. And these spouses also experienced depression, anxiety, weariness, the low self-esteem we talked about before and they so they're dealing with not only trying to care for the service member, trying to care for children and then dealing with their own mental health. So I won't get too much into spouses because we actually our next episode in February.

Speaker 1: 28:55

We will cover moral injury in military spouses and how moral injury affects families. So I'm going to save that for then, but I will just say that we covered what I talked about mostly was how the women veterans that we interviewed talked about the effects of moral injury. But these effects can not just happen to veterans, they can happen to anybody men, women, any kind of race. There are many different kinds of experiences that can lead to moral injury, and so you can see how the effects of moral injury could mean that moral injury is correlated to suicidal ideation, homelessness, substance abuse, all kinds of other veteran problems that we're trying to help with and fix in the world, but without an understanding that moral injury could be behind it. You know you're missing a really key issue.

Speaker 1: 30:04

And just as a closing kind of comment on that, a friend of mine had PTSD. He was being treated for PTSD, he also had moral injury, but he didn't know he did and he had never heard that term. When a chaplain introduced him to the term moral injury, it made total sense to him and the chaplain began helping him work through that moral injury and because of that he began to feel a lot better, grow through that trauma and was much better when, prior to understanding about moral injury, he was being treated for PTSD. He was getting medication for PTSD and it wasn't helping that much because really at the heart of it was something deeper than that and that's moral injury. That's all we're going to do for this episode. Like I said, next episode we are going to be talking about moral injury in military families, so tune into that and then after that we'll be talking about psychological and emotional abuse in military families where moral injury and PTSD is concerned. So actually, to be honest with you, the next several episodes will be dealing with military spouses and that works. So really want to tune in. You can download our podcast and all the main podcast streaming platforms and we'd love to have you donate to us.

Speaker 1: 31:49

Moral Injury Support Network for Service Women Incorporated. We not only do this podcast, we do all kinds of training and education events for care providers to help them understand what moral injury is, how they can help people with it. We do moral injury research. Our current study is looking at moral injury in military spouses, like I mentioned, and we're doing another study where we're looking at how moral injury correlates to adverse childhood experiences. So research and then, course, we do provide direct support to women veterans who need help. So through our partners and our partnership program, we provide psychological counseling, chaplain support. Not only those things, but also if veterans need help with their finances, if they need help with food, shelter, all those sorts of things, we will help them.

Speaker 1: 32:56

Through our partners we can help women significantly help with those issues, and we do a lot of follow-up with the women veterans that reach out to us to support to make sure they're getting the help they need. And we're always looking for ways to expand our partnership with organizations who are looking to help veterans. Many women veterans start their own nonprofit groups because they want to help people that have suffered like them and we are looking to partner with them. So you can contact us by calling us at 910-701-0306, emailing me at droberts at misnsorg, or go to our website, misnsorg, and there's a big Donate button on that page. We'd love to have a donation in any amount, and that helps us keep moving forward. We also have sponsorship opportunities for organizations that want to even do more to help us and are looking to get some brand recognition, looking for us to help them connect with more veterans, and so all that's on our website. Hope you'll check us out and we'll talk to you next session.