Moral Injury in the Lives of Aging Veterans: Spiritual

Needs and Supports Anne M. Pott

Professor Kathy Bonnar

Spirituality

“One’s sense of self and purpose through a set of beliefs, principles or values.”

Manning et al., 2019

Abraham Lincoln, 16th President of the United States.

HONOR THE SOLDIER AND SAILOR EVERYWHERE

who bravely bears his country’s cause. Honor, also,

the citizen who cares for his brother in the field and

serves, as best as he can, the same cause.

An ethical trauma that results from:Ø “perpetrating,

Ø failing to prevent,

Ø bearing witness to, or

Ø learning about acts that transgress deeply held moral beliefs.”

Moral Injury

Litz et al., 2009

German WWI veteran describes killing a French soldier in a bayonet charge(https://youtu.be/XruYsAmKLyU)

“Startle” Reflex

-Memory

Loss-

Flashbacks-

Fear

Anger-

Depression-

Anxiety-

Insomnia-

Nightmares-

Self-medication with Alcohol or

Drugs

Sorrow-

Grief-

Shame-

Alienation-

Regret

BothNash & Litz, 2013

Recognizing Moral Injury

Post-Traumatic Stress

Moral Injury

Moral Injury in Aging VeteransØ May resurface decades later during times of great

transition and lossØ Common symptoms are:

Ø Often overlooked and misunderstood

• Insecurity • Shame• Betrayal • Depression• Bitterness • Unforgiveness for self and others• Suicidal

Unresolved Religious Struggles:Ø Lower Immune Functioning

Ø Raise Emotional Distress

Ø Cause Depression

Ø Increase Mortality Risk

Doehring, 2019

Veterans representing different countries, cohorts, actions, deployments, and homecomings need a safe space to share their stories.

Claiming Voice:

Old Soldier Meets Young Soldier| The Gap |@ LADbible TV(https://youtu.be/uSTdUqgIdyk)

Evidence-Based Intercultural Approaches to Spiritual Care

Ø Recognize the influences of family, culture, political systems on one’s religion and spirituality.

Ø Begin with activities that promote self-compassion such music, art, and poetry and mind-body exercises.

Ø Facilitate lamentation as a context for Graham’s (2017) “sharing anguish, interrogating causes, and reinvesting hope” (p. 24).

Ø Support the wounded veteran on the journey to spiritual healing. Doehring, 2019

Dear Veteran

Inspired by the Shinto shrines of Japan where devotees write their wishes and prayers on small wooden plaques, and the prayer trees of Tibet, Dear Veteran cards are placed on trees in public places as gestures of tribute and hope.

(dearveteran.com)

Dear Veteran is a public art project that gives civilians an opportunity to acknowledge Veterans in their lives and communities.

Power Breath Mediation Workshop

“The POWER BREATH MEDITATION WORKSHOP is a mind-body resilience-building program for returning veterans. It offers practical breath-based tools that decrease the stress, anxiety and sleep problems that many returning veteran’s experience.

(https://projectwelcomehometroops.org/power-breath-workshop/)

Helping aging veterans begin to communicate their spiritual struggle with moral injury.

Communicate:

Potential Barriers to Spiritual CareØ Access to wounded veterans as many do not attend church or

participate in faith-related activities.

Ø Some veterans only want to speak to someone with personal combat experience.

Ø A struggle with the conflicting messages of independence and strength versus dependence on God.

Ø Behaviors related to moral injury such as shame, anger, depression and social isolation.

Pyne et al, 2019

“Communities of faith provide a structure of social support, establish traditions, and practice rituals stemming from a rich history of healing, forgiveness, witness, repentance, and reconciliation.”

Soul Care Initiative, 2014

Soul Care

Communion:

Helping aging veterans to find healing and hope through communion with others who share similar pain, doubt, and shame.

REBOOT Recovery: Overcoming Trauma Together

“The war against trauma doesn't end when the deployment is over. REBOOT COMBAT RECOVERY is a 12-week, faith-based, peer-led course that helps veterans, active-duty military and their families heal from service-related trauma.”

Murphy, J., 2015

Community:

Helping aging veterans to build vital connections within their community.

5 Things Veterans Want You to Know:Ø We are not all soldiers.

Ø We did not all kill someone (and those who did usually don’t want to talk about it).

Ø Our military service changed us.

Ø Some of us have invisible wounds.

Ø It is hard to ask for help.Bravo Zulu: Achieving Excellence in Relationship-Centered Dementia Care.

Promote Healthy Listening

(compassionatelistening.org)(ListentoaVeteran.org)

LISTEN TO A VETERAN Project: Open your ears. Open a heart.

COMPASSIONATE LISTENINGProject International

“Reduces the common chasms between veterans and non-veterans through the simple act of one non-veteran listening to a veteran from any era.”

“To access our deepest wisdom to transform separation and conflict into an opportunity for connection, healing, and peace.”

Key Moral Injury ResourcesØ Shay Moral Injury Center of Volunteers of America

(https://www.voa.org/moral-injury-war-inside)

Ø Soul Repair Center of Brite Divinity School(https://brite.edu/programs/soul-repair/WhatisMoralInjury/)

Ø Soul Care Initiative(http://www.soulcareinitiative.org )

ØThe National Center for PTSD of VA Health Care(https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp)

Key Moral Injury Resources• Chaplain, J.S., Blumenshine, A.,Tubesing, D. A., Yancey, V. (2009). Welcome Them

Home: Help Them Heal: Pastoral care and ministry with service members returning from war. Wheat Ridge Ministries, Whole Person Associates, Inc.

• Gambone, M. D. (2017). Long Journeys Home: American Veterans of World War II, Korea, & Vietnam. Texas A & M University Press.

• Meagher, R. E., & Pryer, D. A. (2018). War and Moral Injury a Reader, Cascade.• Peace & Justice Support Network. Returning Veterans Book Resources. Mennonite

Mission Network. • https://www.pjsn.org/resources/militarism/returning-veterans/Returning-Veterans-Book-

Resources• Sunday School Curriculum• https://assets.mennonites.org/Downloads/PJSNRetVets_SSMaterialBookBW_C15-105.pdf

• Spiro, A., Settersten, J., & Adwin, C. M. (2018). Long-Term Outcomes of Military Service: The Health and Well-Being of Aging Veterans. APA.

References (1 of 2)

Doehring, C. (2019). Military moral injury: An evidence-based and intercultural approach to spiritual care. Pastoral Psychology, 68, (15-30). https://doi.org/10.1007/s11089-018-0813-5

Edmonds, B. (2018). God is not here. (2018). In R. E. Meagher & D.A. Pryer (Eds.), War and moral injury: A reader (pp. 37-50). Cascade.

Knobloch, L. K., Owens, J. L., Gobin, R. L. (2021, April 5). Soul wounds among combat trauma trauma survivors: Experience, effects, and advise. Traumatology. Advanced online publication. http://dx.doi.org/10.1037/trm0000307

Kudo, T. (2018). On war and redemption. (2018). In R. E. Meagher & D.A. Pryer (Eds.), War and moral injury: A reader (pp. 79-82). Cascade.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706. https://doi.org/10.1016/j.cpr.2009.07.003

Manning, L., Ferris, M., Rosario, C. N., Prues, M., & Bouchard, L. (2019). Spiritual resilience: Understanding the protection and promotion of well-being in the later life. Journal of Religion, Spirituality, and Aging, 31(2), 168-186. https://doi.org/10.1080/15528030.2018.1532859

Meagher, R. E., & Pryer, D. A. (2018). War and moral injury: A reader. Cascade.Murphy, J. (2015). Jesus is better than war: The testimony of a former anti-Muslim combat junkie.

Christianity Today. https://www.christianitytoday.com/ct/2015/june/jesus-is-better-than-war.html

Nash, W. P. & Litz, B. T. (2013). Moral injury: A mechanism for war-related psychological trauma in military family members. Clinical Child Family Psych Review, 16, 365-375. https://doi.org/10.1007/s10567-013-0146-y

References (2 of 2)

Purcell, N., Burkman, K., Keyser, J., Fucella, P., & Maguen, S. (2018). Healing from moral injury: A qualitative evaluation of the impact of killing treatment for combat veterans. Journal of Aggression, Maltreatment, and Trauma, 27(6), 645-673. https://doi.org/10.1080/10926771.2018.1463582

Pyne, J. M., Rabalais, A., Sullivan, S., (2019). Mental health clinician and community clergy collaboration to address moral injury in veterans and the role of Veterans Affairs chaplain. Journal of Health Care Chaplaincy, 25, 19. https://doi.org/10.1080/08854726.2018.1474997

Shay, J. (2018). Moral Leadership Prevents Moral Injury. In R. E. Meagher & D.A. Pryer (Eds.), War and moral injury: A reader (pp. 301-306). Cascade.

Schorr, Y., Stein, N. R., Maguen, S., Barnes, J. B., Bosch, J., & Litz, B. T. (2017). Sources of moral injury among war veterans: A qualitative evaluation. Journal of Clinical Psychology, 74, 2203-2218. https://doi.org/10.1002/jclp.22660

Smith, B., Parsons, M., & Hand, J. (2014). War leaves and enduring legacy in combatants’ lives. Journal of Gerontological Social Work. 57(8), 790-809. https://doi.org/10.1080/01634372.2014.898006

Quartana, P. J., Wilk, J. E., Thomas, J. L., Kim, P. Y., Clark-Walper, K., & Hoge, C. W. (2014). Trends in mental health services utilization and stigma in U.S. soldiers from 2002-2011.American Journal of Public Health, 104(9), 1671-1679. https://doi.org/10.2105/AJPH.2014.301971

Questions?

• Anne M. Pott• 775-848-6954• anne@pottfamily.net• crf_pottam@cuchicago.edu (until 8/25/21)