Researchers at the Minneapolis VA probe whether killing in combat leaves lasting spiritual wounds.
The two soldiers followed standard rules of engagement as a suspicious truck rolled toward their convoy in Iraq.
First, they fired a warning flare. But the truck kept coming. Then, a warning shot with live ammunition. The truck kept coming.
Then, they took aim at the driver, shooting and killing him.
Yet when they searched the vehicle, they found no weapons or bombs around the dead man.
Soon, they were sitting with Minnesota National Guard chaplain Steve Timm, anguishing over whether they had committed an unforgivable sin that violated their Christian beliefs.
“It’s really, really tough,” Timm said, “to believe that God hates you.”
Those kinds of deadly wartime encounters — and their imprints on soldiers’ consciences — are the focus of a new movement among military medical researchers to study “moral injuries,” the invisible scars on soldiers who believe they have committed condemnable acts.
Psychologists at the VA Medical Center in Minneapolis are at the forefront of the work, helping to define moral injury, examining how it aggravates mental disorders, and testing whether an experimental form of group therapy can heal such wounds of the spirit.
A study of survey results for 814 Minnesota National Guard members who served in Iraq over the past decade showed that those who experienced moral injury had higher levels of depression and post-traumatic stress disorder (PTSD).
Moral injury generally refers to any type of guilt, shame, or depression that arises from actions that may have violated deeply held beliefs. But for this study, which was presented at the Minneapolis VA Medical Center last month, soldiers met the criteria if they killed in combat, felt their actions were unforgivable, and believed that God had abandoned them.
The lack of resiliency among soldiers who met this definition was alarming, said Dr. Irene Harris, the VA psychologist leading the research. “Basically, [they feel] at my spiritual functioning level, I don’t think I belong here in the world. I’m not worth it. I have a sense that I should not be here.’’
The moral consequences of war on the individual psyche have been examined for centuries; the ancient Indian poem Mahabharata and the 4th-century writings of St. Augustine asked when warriors were justified in killing and warfare.
The term moral injury wasn’t outlined until 2009, though, when researchers at the VA’s National Center for PTSD in Boston found evidence of long-lasting impairment in soldiers who had used lethal force or participated in wartime atrocities.
Moral injury doesn’t always result from acts committed, Harris said. In some cases, inaction can leave equally deep scars.
Timothy Doble is a peer support volunteer at the Minneapolis VA who uses his experience as a Vietnam vet to support other veterans experiencing mental health challenges. Doble served in the Marines, often wielding a hand-held grenade launcher on three-man patrols in and around the fire bases near the Laotian border.
Among the memories that haunted him, Doble said, is the time one Marine in his company threw rocks at the dead body of a Vietnamese soldier. “I should have said something,” he said. “I should have stopped him.”
Doble, 66, suppressed feelings of guilt and shame after being injured by mortar fire and returning home in 1969. He worked as a public school math teacher for three decades, and many colleagues had no inkling of his struggles. But gradually nightmares and visions of Vietnamese soldiers coming to kill him grew strong, and — at his wife’s prompting — he sought treatment in recent years.
Often, he said, it was religious moments that brought out feelings of anguish, as when his church congregation applauded a speaker who, while serving in the military, had refused to launch a missile, or when his pastor prayed for peace at the time of Desert Storm, but not for the soldiers going into combat.