Resolving moral injury: dealing with fallout from the war in Afghanistan

By CH (Maj.) Stephan BuchananOctober 4, 2021

CH (Maj.) Stephan Buchanan, a chaplain and the deputy chief of the Department of Ministry & Pastoral Care at Madigan Army Medical Center, is part of a team that is ready to welcome anyone seeking support. The DMPC office is in the hallway behind...
CH (Maj.) Stephan Buchanan, a chaplain and the deputy chief of the Department of Ministry & Pastoral Care at Madigan Army Medical Center, is part of a team that is ready to welcome anyone seeking support. The DMPC office is in the hallway behind the chapel on the first floor of the hospital tower. Buchanan deployed to both Afghanistan and Iraq in the late 2000’s. Like all chaplains who work in a hospital, he has completed the year-long training called clinical pastoral education. U.S. Army photo taken September 9, by Kirstin Grace-Simons. (Photo Credit: U.S. Army) VIEW ORIGINAL

MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – I deployed for 15 months in 2008 and 2009. While there, traveling throughout the battle space, I relied on local nationals and interpreters to get me in; I don’t speak Pashto or Dari. In exchange for that, we told them – not just me – we told them, that after doing this, you can come to America. Fast forward over a decade later, we withdraw. No one that I know personally, but nonetheless, local nationals who helped Americans, who were given that same promise, are left behind. You hear stories of the Taliban executing them. So, with that, many service members, me included, feel a sense of guilt with that and what do we call that? We call that moral injury.

What is moral injury? The damage done to one’s conscience or moral compass when a person perpetrates or witnesses or fails to prevent acts that transgress against one’s own moral fiber or ethical code of conduct or values. So, we make a promise – we will make your life better, you can come to America – and not only is that broken, but you and your family very well could die for doing this.

What are some examples of things that can cause moral injury?

- Using deadly force in combat or while in combat causing the harm or death of civilians or women and children.

- Giving orders in combat that result in the death of a service member, someone that’s under your charge.

- Freezing with fear, because combat is a scary place and you never know what you’re going to do – no one does. Freezing with fear and failing to provide medical help to a person to the left or right and maybe they die.

- Returning home from a deployment and hearing of executions of those who cooperated with you – local nationals – whether it’s right away or, in this case, a decade later, much like what’s happening now.

What are the consequences of moral injury?

A moral injury can lead to serious distress, depression and suicidality. It can take the life of those who are suffering from it, both literally and figuratively. It can debilitate people, preventing them from living a full and healthy life. Moral injury is damage done to one’s soul. So, you can’t see it. But, you can see signs of it.

What does it look like?

It often looks like grief, shame and outrage. People lose trust in themselves and their moral foundations, their relationships might be disrupted. They can’t trust others not to judge them. People might self-isolate or self-medicate with drugs or alcohol, causing both physical and relational issues that very well can quickly lead to depression and suicide ideation/suicidality.

What should we do about moral injury?

First, is to acknowledge it in the same way, much like we acknowledge physical and mental trauma. Then, what do we do? In the military, chaplains and counselors are often the front line in addressing moral injury. The Madigan Department of Ministry and Pastoral Care is here to serve you. When you talk to a military chaplain, your session is privileged and confidential. This level of privileged communication and confidentiality is only afforded to military chaplains. Anything and everything you say as a matter of conscience is confidential. Chaplains are the only profession that are not mandated reporters – the whole hospital is, we are not. That is true regardless of what is said. Military chaplains are the only ones who can have that kind of communication, and that is all military chaplains.

Help and recovery start with acknowledging you need help and then asking for help. And then we’re here to help you.

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