FORT GORDON, Ga. -- Chaplain Col. John Read is working to shift how health care providers address Soldiers returning home with injuries that can't be seen before their injuries become Post Traumatic Stress (PTS) or PTSD.
Most healthcare for behavior health or mental health issues focus on PTS but according to Read, there is a surge in advocacy to identify that moral injury does exist on a spectrum with PTS.
"We know that when someone suffers from moral injury and nothing is done to address that, at some point in time it will become PTS or PTSD. So the compelling question is what are we doing to address this collaboratively on the continuum of care?"
While the answer previously was that not much was being done, Read feels that through his and the U.S. Army Medical Command's efforts we are beginning to look at moral injury and see what can be done for our Soldiers.
Read describes moral injury as a significant betrayal of trust associated with someone you trust to be a competent moral authority.
Moral injury can result from a Soldier questioning his actions during combat that conflict with their own morals or it can be about a romantic relationship where there is infidelity by someone that was trusted deeply.
"There is a lot of energy focused on the VA and the Department of Defense on moral injury as well as behavior health, but the problem is that we still tend to look at [moral injury] in terms of the operational construct of war when it's soul damage."
Moral injury is a sense of loss, grief, guilt, shame, and remorse from experiences that have shook your core values so what happens is that individuals tend to withdraw from relationships and communities that have mattered to them.
"Parts of this are personal to me. I saw and did things from January 2004 to January 2005 that troubled me and I recognized my own degree of moral injury. I find it kind of fascinating the kinds of things that I withdrew from early on, were the things that always had the most promise to help me," said Read.
Read references information from the Brite Divinity School in Texas that recovery groups help patients by getting people reconnected to people who support them so that they can effectively process their experiences verbally and bond with others who have had similar experiences.
"There has been some great work done in the Boston VA and the Palo Alto VA by Jonathan Shay and Brett Litz, one's a psychiatrist and ones a psychologist, mostly in the behavior health arena, identifying and measuring the disconnectedness. It just seems to be kind of intuitive that it is something that chaplains and spiritual advisors ought to be looking at doing collaboratively with behavior health."
There are a few evidence based surveys that look at moral injury but none have been commissioned by the DOD and moral injury is not in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, but Read feels there is no reason to think it won't be included someday.
"The question is, do we wait for that to happen or do things now? I have encouraged all the chaplains in the Southern Region to incorporate moral injury in their treatment. Pete Robinson at the Eisenhower Army Medical Center Residential Treatment Facility has done a great job of collaborating that into the RTF."
"Substance abuse is an area where people are in a recovery process, they can't be cured, so when you look at the moral injury constructs and it seems like you have an environment rich with the possibility to do something constructive."
Read describes how he conducted training at Fort Leavenworth where roughly 70 percent of the inmates were incarcerated for sex crimes and most would say that at one time in their life their trust was significantly betrayed.
One inmate had been sexually molested by someone in a leadership role and that violation affected his adult life by causing him to violate other's boundaries and do inappropriate things.
"To me it is not rocket science, it's simple behavior, if we don't wade into [moral injury] and find a way to make people as healthy and resilient as they can be, it's a connected issue."
"One of the leading causes of completed suicides in the DoD are relationship failures, so if someone is already withdrawing from relationships that have meant a lot to them, then they are already at a greater risk. So if we address the moral injury that causes someone to withdraw from relationships, others and community, it may give us the capacity to drive down the number of completed suicides annually."
When asked about how to treat an Soldier who doesn't have a religious background or may be atheist, Read says "we all have values, whether it be the Army core values, our national values, patriotic values, or those you were raised with in a family. I would be very careful with a person who is an atheist to not impose religious or spiritual values but address their disconnectivity and what values have been called into question."
I would look at where they have noticed the withdrawal in their lives and who has been a source of encouragement. For someone who is spiritual or religious, that could be the mosque, the temple, or the church but for someone who isn't religious it could be their platoon or a group of friends.
"The point is, where are the contact points and where do they no longer exist. What do we need to do to help them process out loud how their life has changed by what they have seen and done?"
"I don't know if there is any Soldier regardless of their belief or non-belief that couldn't benefit from treatment for their moral injury, if it is done appropriately.
In the future Read sees a heightened collaboration between behavior health and the Chaplain's Corps that would allow psychologists to recognize when someone is suffering from a moral injury and to incorporate a clinically trained chaplain to assist with cooperative counseling and possibly facilitating recovery groups together.
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