PLEASE all of attachments... Because its a long paper, you still have the BOOK as well.

Chapter Eight Moral Injury Of the many questions arising from a warrior’s participation in armed conflict one of the most common arises from seeing humanity at its absolute worst. “What happened to the good?

Where did it go?” The question takes many different forms but the essence is universal. How can human beings inflict the type of carnage and destruction upon one another that warfare demands? There is no doubt that war in the twenty -first century is unlike war in any previous century. To be sure there are similarities in the bas ic nature of warfare but the forms, venues, and means have evolved beyond the levels of our moral and philosophical reasoning and understanding. Warfare in American history has always been evolutionary, especially from the standpoint of technology. Perha ps no war has shown the tragic reality of technology exceeding both military tactics and strategy more clearly than World War I. The advent of the machine gun made Napoleonic Squares and cavalry charges obsolete and resulted in what can only be described a s the mass slaughter of millions of young men on the European fields of battle. However, the armies continued to collide on specific geographic spaces known as the battlefield. In fact, those battle spaces often lent their names to the battles themselves u p to and through the Vietnam War. Names such as Bunker Hill, Cowpens, and Yorktown; Gettysburg, Manassas, and Vicksburg; Belleau Wood, the Somme, and the Meuse -Argon; Normandy, Sicily, Guadalcanal, and Iwo Jima; Inchon and Chosen Reservoir; Khe San, Ira Dr ang Valley, and Hue City help to define engagements in which opposing armies met en masse upon the fields of battle. These battles involved significant movements of troops and engagements lasting from days to several weeks in duration, followed by relati vely long periods in which little or no kinetic action occurred. Ante –twenty -first -century warfare could be described as having armies that were clearly identified as combatants, where war was waged largely on open battlefields with relatively well -defined front lines, and engagements were typically brief with lengthy periods of relative calm wedged in between them during which troops could replenish, rest, and regroup. This pattern is no longer descriptive of twenty -first -century warfare. The latter few ye ars of the twentieth century saw the advent of terrorist bombings in 1993 by an attack on the World Trade Towers in New York City followed in 1998 with attacks on the US Embassies in Kenya and Tanzania. The second attack upon the World Trade Center in 2001 moved the whole world into twenty -first -century warfare in which the phrase “Shock and Awe” became part of the common vocabulary. Speed, increased lethality, network -centric platforms, the loss of noncombatant exclusions, urban settings, and remotely pi loted vehicles have become the standard for a new way of waging war. There are no longer clearly discernible front lines, no rear echelons, and what is now twelve years of war in which kinetic engagement has been near constant has become the new face of wa r. Broken bodies and broken lives manifest the damage in increased incidents of post - traumatic stress, and suicides occurring among active soldiers and veterans in near battalion numbers each month, not to mention the spouses and other family members of service men and women, are all too common. Sexual assaults on both women and men by green on green, and moral failures of senior officers, have increased at a disturbing rate. Beyond the physical and psychological wounds experienced by our warriors there has arisen a new class of injuries called “spiritual, soul, or moral.” While there are many different definitions of moral injuries the following is taken from the US Department of Veterans Affairs and aptly describes the essence of a moral injury. Like psychological trauma, moral injury is a construct that describes extreme and unprecedented life experience including the harmful aftermath of exposure to such events. Events are considered morally injurious if they “transgress deeply held moral beliefs an d expectations” (1). Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture -based, organizational, and group -based rules about fair ness, the value of life, and so forth. 64 Rita Nakashima Brock and Gabriella Lettini in their book on moral injury speak of those who have suffered such injury as feeling “they no longer live in a reliable, meaningful world and can no longer be regarded a s decent human beings.” 65 Jonathan Shay says that moral injury is the persistence of adaptive behaviors to survive in a combat situation that cause a warrior to have complications in the process of readapting to a civilian environment. Moral injury to t he warrior is not simply the result of experiencing the awful things that warriors are exposed to in combat. Moral injury according to Dr. Shay is the result of three parts, each of which must be present in order for a moral injury to occur. First, there m ust be a betrayal of what is morally correct. Second, someone who is in a legitimate position of authority must commit the betrayal of what is morally correct. Third, the betrayal must occur in a high -stakes situation. 66 Moral injury is often not readil y apparent either to the injured or to others. Not unlike post -traumatic stress or traumatic brain injury the symptoms of moral injury do not just suddenly and dramatically appear. It is more like they just emerge, coming out of the murky mist of one’s inn er core. Shay’s three -part definition is an important contribution but a broader statement seems preferable: moral injuries are wounds from having done something, or failed to stop something, that violates a person’s moral code. By this definition moral in juries are not the same as PTS with nightmares and flashbacks along with other symptoms. Moral injuries torture the soul of an individual. Moral injuries plague the conscience and are manifest by a sense of deep shame, guilt, and rage. Retired Col. Elspeth Ritchie, a former psychiatry consultant to the Army Surgeon General, asserts that “The concept of moral injury is an existentialist one. You may not have actually done something wrong by the law of war, but by your own humanity you feel that it’s wrong.” 67 Col. Ritchie’s observations can be illustrated by a recently published interview with a veteran of the war in Iraq who served as an Army nurse. In the wake of a bombing he took charge of those who had little chance of survival. Among them was a little girl of perhaps six years old whose chest was blown apart. He recounts that he could not let her suffer and so he injected dose after dose of painkillers into her IV. She died then and he is sure that he killed her. Even though subsequent medical evaluation an d toxicology reports showed that she died of her injuries, not his injection of pain medication, he still blames himself for her death. Now he seeks therapy with other “souls in anguish,” including an Army staff sergeant who was unable to aid a comrade who se legs were severed in an explosion in Afghanistan, a Marine Iraq vet whose junior comrade was killed after he had persuaded him to switch posts, and a Navy man who beat an Iraqi civilian in anger. 68 The notion of moral injury does not necessarily incl ude the loss or taking of human life. Consider the following anecdote taken from WBUR 90.9, Boston’s NPR station, entitled “Moral =njury: When Soldiers Betray Their Sense of Right and Wrong.” “Tom” is an Army Veteran who deployed twice to =raq. :e lives in the suburbs of Boston and asked that we not use his real name. Tom tells a story of moral injury where nobody dies. Still, it gets at another way of defining moral injury, one in which you stand in for the person of legitimate authority, betraying you r own sense of right and wrong. “With the dogs = always laugh, because people could not possibly understand. = love dogs. I grew up with dogs. But in Iraq you have to shoot the dogs. One of our staff sergeants got bit early on, and he had to have these r abies shots — like, the old -school ones with the six -inch needles. After that it was like a mandatory rule: You will shoot every dog. So we were clearing this whole village, nobody getting shot or dying, but it was chaos. Things were burning, yada, yada. W e came to this last house and this dog was going crazy. Can I just shoot it? Oh yeah, absolutely. So I went over to the dog and shot next to it, just to scare it. The dog started to shake so uncontrollably, I thought it was going to die of a heart att ack. Maybe I was too soft at the time . . . but I just had this feeling, like, what are we doing? This dog was barking because a bunch of soldiers just went through its house and grabbed its owner and now they’re breaking things. What am I doing here ? =t was not a good feeling.” 69 Johnathan Shay provides the additional important insight that moral injury is best healed by veterans themselves with professionals providing a safe space in which the veterans can engage in telling their narratives to one another. It is the process of the veterans telling their stories that is the essence of their healing. Members of the healing professions can serve as trustworthy guides through the process and be empathetic listeners . provided they listen with heart a nd head; make the process about the veteran; and are humble enough to understand that the veterans who have experienced the moral injuries have much to teach the professionals. In other words, it is the veterans themselves who are the agents of their own healing. 70 In addition to the safe space, there must also be a sacred space to affect healing of moral injuries. Shame, guilt, alienation, and despair, that often attends to the first three, are profoundly spiritual or soul -related injuries and not simply psychologic al. What is a sacred space? Sacred means to be set aside for a holy or single purpose usually having to do with a religious use. Veterans often feel that what they have participated in as combatants is so morally reprehensible that there is no possibility for reconciliation and therefore they feel alienated from the divinity due to their moral failures. In order for there to be forgiveness or reconciliation there must be both a sacred space in which to confront the divinity and some means by which communica tion with the divinity is possible. We will discuss this vital matter of a safe and sacred space further in the final chapter. Retired Navy Captain William Nash, a psychiatrist who headed the Marine Corps combat stress programs, says, “Forgiveness, more than anything, is key to helping troops who feel they have transgressed.” 71 Moral wounds or injuries require something more than emotional or physical healing. Moral wounds are not medical issues, though they may manifest medical needs if left unattended. They are profoundly religious issues. Military chaplains see troops struggling with moral injury at the basic level of troops in the trenches. Soldiers wrestle with the notion of forgiveness even if they don’t possess the religious language to describe th eir struggle. Soldiers will frequently ask if they need to confess an action -or an inaction. All too frequently they come to their own conclusion that they have gone past the point of possible redemption and cannot accept the notion that God could or would forgive them. They adopt language that reflects their sense of alienation like: “=’m a monster.” “=t should have been me and not those good guys who died.” “=’m not a hero. The guys who were killed are the real heroes.” “=f there is a God, he couldn’t for give what =’ve done.” These are profoundly religious questions though they certainly are not limited to any single faith tradition. The challenge facing faith communities and chaplains in uniform in particular is in finding a way to address the issue of moral wounds in a constructive fashion. There are many roadblocks in the way. =t goes against the grain of a warrior’s self -image to think that one cannot carry the weight of one’s duty in combat. Ergo PTS is seen as a weakness, a failure on the part of th e warrior. Likewise, moral injury implies an ethical failure by the warrior who serves in a force whose motto stresses honor, duty, and country. Equally problematic is the daunting challenge of determining how to help someone who believes that he or she ca nnot say what’s bothering them for fear of losing one’s security clearance or being declared unfit for duty. Military chaplains must not only respond to and care for those warriors who have experienced moral injuries; they are also people who have suffer ed moral injuries themselves. The double challenge of experiencing personal moral injury combined with the demand to be a caregiver for others who have experienced moral injuries places a significant burden upon military chaplains and their families. In pa rt due to the atmosphere of antireligious sentiment common in today’s cultural milieu military chaplains have frequently adopted a medical model of responding to the moral injuries of others. That is to say, military chaplains have moved to seeing themselv es as therapists, counselors, or healers who diagnose and treat “clients” in much the same manner as psychologists or clinical social workers. This tendency is one filled with potential problems for the military chaplain. In order to stay true to a vocatio nal calling to tend to the spiritual well -being of themselves and others, chaplains must be well trained, grounded in their own faith traditions with well -honed skills in understanding the spiritual nature not only of the injuries experienced by themselves and others, but of the need to be well trained and deeply committed to their own spiritual core. We do not suggest that there ought not be a relationship between the religious and the medical or other helping communities. Indeed, each community brings r ichness and essential aspects to the treating of both the physical, spiritual, and moral injuries incurred by warriors.

Military chaplains must be able to possess and demonstrate a mature and well -developed personal spirituality that is deeply informed and shaped by the religious and theological tenets of their faith traditions. Warren Kinghorn, who is both a professor of psychiatry and pastoral and moral theology at Duke University Divinity School, has analyzed and criticized the medical model that has c ome to predominate in the treatment of moral injury. Though insightful and clinically useful, psychological theories of moral injury are limited by their empirical suppositions. This makes them unable to treat the problem as anything other than a technical one. Thus, their empiricism makes for an inability to evaluate the moral suppositions and rules under attack in cases of moral injury. They are unable to distinguish between meaningful and non -meaningful moral suffering. “Communities and meaning -structure s [religious communities and faith convictions] can be instrumental, but only instrumental” to the process of healing in moral injury. For Kinghorn, who sees moral injury in terms of moral and penitential theology, Christian communities need to make room f or combat veterans to experience confession and absolution. They need a community that can walk with them on an honest path toward reconciliation, recognizing that we are all implicated in the violence of our world. 72 Brock and Lettini tell the story of Herm, a chaplain during the Vietnam War. Herm witnessed the terrible impact of the war’s atrocities upon the soldiers he served. “= was amazed,” he said, “at their personal shame — not guilt — but profound, searing shame. Many felt that they had committed a p ersonal affront against God.” This sense of shame emerged especially when he had them read the Psalms, Psalm 51 in particular. At a time when moral injury was not yet named, Herm was drawn by these experiences to the conclusion that something far more prof ound than PTS was going on in the lives of these soldiers. 73 The power of this penitential psalm and the salutary effects of :erm’s regular practice of serving communion with its promise of forgiveness and mercy and Hesus’ solidarity in human suffering are surely lessons for today’s growing awareness of moral injury. Theological Reflections The problem of evil is as familiar as it is seemingly insoluble. If God is gracious, just, and omnipotent, why is there evil? In theological terms it seems totally plausible to say that moral injury is an encounter with evil so radical that it evokes the problem of evil as a deeply existential reality rather than simply a theological conundrum. We are all familiar with the reality of evil within in us and around us. Given the webbed interconnectedness of all things, we cannot escape being touched by the manifestations of evil that permeate our world. The Law of God, says Helmut Thielicke, keeps reminding us of this truth of our worldly existence. It compels us to rea lize that, so long as we are here below, we are implicated in innumerable, suprapersonal webs of guilt . . . that we are actors in a thousand plays which we individually have not staged, which we might wish never be enacted, but in which we have to appear and play our parts. 74 For Thielicke, then, ethics is not a matter of competing philosophical theories. It is a theological matter of how we cope morally and with hope in this in -between time, the time between the eschatological fulfillment of Christ’s re demptive work and the lingering reality of terrible evil. 75 =n other words it is life in the tension of the interplay between the accusation of God’s Law, innately present in the brokenness of life, and the hope and promise of the gospel. It is humanity ’s lot in general to live in this tension, to be caught in webs of suprapersonal guilt and placed on stage in tragic dramas not of our choosing. Recognizing this should place the faith community in a position of solidarity with those suffering moral injury . However, for the victims of moral injury their drama is a counsel of despair; there is only the accusing Law and no hint of gospel hope. Providing help for those locked in the grip of despair is a pastoral task involving the chaplain along with the pastoral ministry of the community of fellow sufferers and of the caring congregation for those who have returned from battle struggling to reen ter civilian life. It is important to provide a safe and welcome place in the church. Providing safe and sacred space for returning warriors to find healing for their wounds is an obligation of the churches and their congregations. No matter what their pos ition on war may be, the unconditional demand of Christian love, which is the cornerstone of the Christian ethic, reaches out to all. In terms of the just war tradition, which has been observed inside and outside the churches, the principle that a war to be just must be declared by a legitimate authority, means for a democratic society that the citizenry take ownership for that declaration and responsibility for its casualties, whether physical or spiritual, including all who share in the losses of war. T he Christian church along with other faiths have a vocational obligation to lead the way in their own witness of caring. In her recent book in which she relates stories of the morally injured with whom she has been embedded, Nancy Sherman is insistent th roughout on the duty of society to take responsibility for the well -being of their returning service men and women. The nation and its noncombatant citizens have been in some measure responsible for the war by their political involvement, their taxes, and in various ways supporting the war. Thus she states emphatically, We have a sacred moral obligation to those who serve, whether or not we agree with the causes of those wars and whether or not those who serve agree with them. Those moral obligations are institutional, both governmental and nongovernmental: veterans are morally owed the best possible resources across the widest swath of medical psychiatric, social, legal, and technical services. But the obligations are also interpersonal, one -on -one. We ha ve duties to each other for care and concern: normative expectations and aspirations that we can count on each other, we can trust and hope in each other, and we can be lifted by each other’s support. 76 Clearly, no mere ethical reflection on right and w rong will avail in and of itself. The awful encounter with evil, as Thielicke observed, is always for the Christian a deep theological question. A common theological response to the problem of evil is to posit that God in creating needed to allow for freed om if the creation is to have its own integrity. Out of love of creation the all -powerful God freely limits God’s self. Characteristic of God’s love for the creation is that willingness to be open to its rejection and, instead of coercing obedience, to suf fer with the creation in order to redeem it. This argument from love and freedom popular though it may be does not stop the nagging questions of why evil should emerge in the wake of freedom or even how much freedom for evil an omnipotent God can allow t o go on. “:ow long, O Lord, :ow long?” This is the lament of the psalmist: How long, O Lord? Will you forget me forever? How long will you hide your face from me? How long must I bear pain in my soul, And have sorrow in my heart all day long?

How long sha ll my enemy be exalted over me? (P s 13:1 –2) The mystery persists. For this reason many theologians would have us look not to the mystery of evil’s origin. (“Universal sin” for example has largely replaced “original sin”; the former describes a fact whil e origin remains a mystery.) Instead of looking to origins, some call us to consider what God in love for the troubled world is doing to redeem it from itself. Taking that advice we can begin to see some theological resources that can provide sustenance an d a compass for those seeking to walk with the morally injured on the path to healing. The Beatitudes with which Matthew begins Hesus’ Sermon on the Mount give expression to characteristics of agape love’s character and disposition. As “blessings” they a re capacities born of that grace of God in Christ that engenders love. 77 In the second of the Beatitudes (Matt 5:4) we read, “Blessed are those who mourn for they shall be comforted.” Mourning, the deep sense of loss and grief in the face of death, gives expression to love’s profound relationality. This may be a response to the loss of someone near and dear but it may also be an empathetic response to the tragic loss of life in the world around us through acts of violence, the fury of natural disaster, or the terrors of war. The onset of mourning when confronted with such loss of life or, more broadly, with all manner of human suffering, tells us of our inherent connectedness with all in the community of life. Our grief and our empathic capacity to feel the pain of others is a testimony to that connectedness. It is a readiness to be in solidarity with the suffering. It is love reaching out to affirm those relationships with the hurting in a desire to comfort and heal. Even as it is Jesus who announces and bestows these blessings of love’s disposition, it is Jesus who embodies them in his life and work of self -giving love for all people. Hesus’ solidarity with the suffering of our sad world comes to its most complete revelation in the event of the crucifixio n. We understand that in the mystery of the cross Jesus took upon himself the sinful brokenness of our world and even death itself. However, we must insist that, contrary to some traditional views, it was not simply the human Jesus who endured the burden o f human sin and our death; it was an event in the very life of the Triune God. For Luther the unity of human and divine in the Christ and the unity of the Son with the Father and the Spirit made it clear that Christ’s passion was indeed God’s passion. Luth er is quoted thus in the Formula of Concord , one of Lutheranism’s confessional documents, “if it cannot be said that God died for us, but only a man, we are lost.” 78 While the Formula makes clear that it is not in the nature of divinity to die, it is cle ar from Luther that the suffering and death of humanity as embodied in the suffering and death of the Christ is taken into the divine life of the Trinity united as the persons are in the mutual indwelling of one another in the bonds of love. This theopas sionism is central to Hürgen Moltmann’s theology of the Trinity. These are his profound reflections on Hesus’ cry from the cross, “My God, my God, why have you forsaken me!” =f we take the relinquishment of the Father’s name in Hesus’ death cry seriously, then this is even the breakdown of the relationship that constitutes the very life of the Trinity: if the Father forsakes the Son, the Son does not merely lose his sonship. The Father loses his fatherhood as well. The love that binds the one to the other is transformed into a dividing curse. . . . Communicating love and responding love are alike transformed into infinite pain and into the suffering and endurance of death. . . . The Father “delivers” up the Son in order through him to become the Father of t hose who have been delivered up (Rom. 1:18ff.). The Son is given over to this death in order that he may become the brother and savior of the condemned and the cursed. . . . What happens on Golgotha reaches into the innermost depths of the Godhead, putting its impress on the trinitarian life in eternity. 79 =n Moltmann’s account we begin to grasp the depth of divine solidarity with human suffering. There is no pain of human suffering — not even the pain of moral injury — that is not comprehended in God’s expe rience of the cross. If the broken souls of the morally injured feel as though a meaningful universe has crumbled beneath their feet and left them bereft of hope, God has experienced this very thing in the rending of the relational unity of the divine life in whom the very world has its ground and sustenance. Sin itself is estrangement from God and one another. Moral injury is that estrangement brought to an extreme level of intensity. God has taken that estrangement into God’s very life and suffered its te rrors that in the power of divine love it may be overcome. In the final analysis, the almighty power of God is best understood as infinite and unfailing, steadfast love. For the morally injured and those who seek to minister to them the vital truth of God’s solidarity in our suffering is of central importance to the possibility that the healing of the spirit can occur. Moreover, the victory of the resurrection stands as th e ultimate triumph of God’s suffering love. This is the comfort promised in the Beatitude for those wounded ones who mourn the loss of their soul’s vitality and it is the “comfort” in the sense of God’s gracious support and strength for those who are calle d to serve the morally injured. All of these things we are saying are there in the means of grace, the sacraments, and the rite of repentance and absolution but they must be brought to life with pastoral sensitivity not only grounded in theological depth b ut also in a deeper understanding of the guilt and shame that are deeply a part of the morally injured. Moral injury involves guilt and/or shame depending on the situation. 80 Brock and Lettini , quoted above, emphasize shame. Guilt may be understood in terms of experiencing the contradiction between who we are and what we should do. Shame can be understood as the contradiction between who we are and what we want to be. 81 The themes of lost trus t and betrayal, of being cut off from one’s self and one’s relationships surface in the accounts of moral injury. “People often describe moments of intense shame with the words, ‘= wanted to die,’ as if to say that shame is so painfully confusing to one’s existence that non -existence would be preferable.” 82 Guilt and shame are rooted in our innate relationality as human beings. (Recall our previous discussion of creation in the image of God.) That is, their power is in their capacity to damage or virtually destroy our capacity for relationship and, thus, rob us of our very selves. “Our pastoral task concerning persons suffering from shame is to assist them to return from isolation to relationship.” 83 Again, the means of grace are there to take pastoral car e beyond the capacity of those who minister. They are an assurance of God’s radical and unconditional acceptance and one’s unquestionable place in God’s beloved human community.

The mutual support of that community, we reiterate, must be sustained. Notwith standing the unique aspects of combat traumas that bring on shame and guilt, it is possible for those who have not gone to war to relate at least at some level; most if not all of us have had experiences that cause feelings of guilt and shame. We may find renewal in divine grace and are able to move on. However, the memories of the events and the sense of guilt and shame that goes with them remain to haunt us, often on a sleepless night, when they come upon us unawares, triggered by some unbidden thought. T he prodigal son of Luke 15:11 –24 was restored to life by his father’s gracious acceptance because he was restored to family, the locus of his true self, from the alienation of a life gone bad. No longer in thrall to a Gentile pig farmer and isolated from h is authentic community, he nonetheless must still live with the lingering consequences of his wasted inheritance and the regrets of his actions. The challenge of this ministry to the morally injured requires the kind pastoral and theological discernment that brings us back to the vital importance of critical thinking. The ability to think critically about each of the varied circumstances military chaplains find themselves confronting is an essential skill. While critical thinking is frequently implicit in theological education and training, it must become more explicit in the theological and spiritual formation of military chaplains. Just as other professional skills such as preaching, the interpretation of sacred texts, and worship practices are taught as subjects within the core curriculum of clergy, so must critical thinking be taught to clergy. Like the skills of surgical incision or diagnostic examinations for physicians, the skill of thinking critically for chaplains must also be developed in their pr eparatory training to function as professionals within their vocational areas. Nowhere is this more in demand than for the ministry to the morally injured. 64 . National Center for PTSD, “PTSD.” 65 . Brock and Lettini, Soul Repair, xv. 66 . Shay, “Casu alties.” 67 . Quoted in Helinek, “Some Casualties are ‘Wounded Souls,”’ A22. 68 . Watson, “Souls in Anguish Tortured by War Memories.” 69 . Bebinger, Freemark, and Guntzel, “Moral =njury.” 70 . Shay, “Casualties.” 71 . See Nash et al., “Psychometric E valuation of Moral =njury Events Scale.” 72 . Kinghorn, “Combat Trauma and Moral Fragmentation,” 67 –69. 73 . Brock and Lettini, Soul Repair, 26 –27. 74 . Thielicke, Theological Ethics , 436. 75 . Ibid., 44. 76 . Sherman, Afterwar , 3. 77 . See Childs, Ethics in the Community of Promise, 46. 78 . Formula of Concord, Article VIII, 44. 79 . Moltmann, The Trinity and the Kingdom , 80 –81. 80 . Sherman, Afterwar , 81 –86. 81 . Binau, “Shame and the :uman Predicament,” 132. 82 . Ibid, 137. 83 . Ibid, 143 .