Episode 279: Scott DeLuzio Understanding Moral Injury and its Impact on Veterans Transcript
This transcript is from episode 279, Understanding Moral Injury and its Impact on Veterans.
Scott DeLuzio: [00:00:00] Thanks for tuning in to the Drive On Podcast where we are focused on giving hope and strength to the entire military community. Whether you’re a veteran, active duty, guard, reserve, or a family member, this podcast will share inspirational stories and resources that are useful to you. I’m your host, Scott DeLuzio, and now let’s get on with the show.
Hey everybody. Welcome back to the Drive On Podcast. So in last week’s episode, we talked about how to deal with guilt and shame. And the concept of moral injury came up. And I had only recently become aware of the term moral injury. Maybe within the last few years. And I figured that maybe some of the listeners out there may not be familiar with that term either.
And I wanted to dive into the topic a little bit more.
And so I wanted to highlight moral injuries in its own episode. Because understanding what it is, may help some people. [00:01:00] Who might be suffering from a moral injury and may not even realize it, deal with it. A little bit more effectively. So. First off before we get into any further, we’ve talked about.
Moral injury. In the last episode, we briefly touched on it. We said it a few times here. So what is a moral injury? The term moral injury describes a variety of things. Different symptoms, similar to those associated with PTSD. And they result from experiences that. Violate a person’s deepest and most closely hold value held values.
It may violate trust or their principles, things along those lines. And we all have our own sets of principles. And values that define us. You might think of yourself as a protector or as a Christian who follows. The commandment thou shall not kill, but [00:02:00] when you’re faced with a situation where you’re the aggressor and not the protector.
Or you have to violate that commandment and kill somebody. You may be faced with this internal conflict of who am I? What type of person have I become this isn’t who I thought I was. And there is some overlap between moral injury and PTSD. Both start. Usually from some form of traumatic events, some sort of.
Catalyst’s something that sparks this. Injury in people. And in some cases, there may be an actual loss of life. Or there may just be a threat of harm to people. PTSD tends to have additional symptoms like hyper arousal or flashbacks nightmares, those types of things. But this episode, isn’t about PTSD.
But just know that there are some similarities between moral [00:03:00] injuries and PTSD. And I wanted to make that distinction there because it’s especially important. If you have tried to get a diagnosis for PTSD gone to a therapist and they said, no, you don’t have PTSD. It may be that you don’t actually have PTSD. They may actually be correct.
But really you may be suffering from. And moral injury. Because there’s so many similarities between the two. So this is something to talk about with the therapist. But again, I don’t want to get too far into PTSD what PTSD is and in all those differences. Just know that if you’ve gone to a therapist and they’ve talked to you, doesn’t seem like they think that you have PTSD. It may very well be that you don’t have PTSD, but it may be more likely that you have something like a moral injury or it could be something else entirely. But this is just a way to.
Eliminate some of the possibilities just kind of inform you of what some of these things [00:04:00] are. So while we’re serving in the military. There’s a lot of ways that a moral injury can occur. And obviously I can’t cover every single possible scenario because. What’s moral to one person.
Differs from me and from another person there’s so many different variations out there, but. I’ll try to give some general high level overview. Of what. Can occur during your military service that may lead to a moral injury. And maybe some of this will apply or at least you can maybe tweak it to your own situation too.
Better understand what a moral injury might be. Or how it occurs. You know, so.
All the time, especially during a deployment, we may face situations where.
We may end up with a moral injury. So for example, a drone pilot. May suffer from a moral injury after they drop a bomb on [00:05:00] a house, knowing that they’ve likely killed people who were inside. They may not be there on the ground physically to see this happening in real time. But they know that their actions by pressing that button.
It’s causing the death, the destruction of a home. Probably injuries of other people who may be nearby. That might have some conflict with themselves on a moral level, right? Someone who has been on the ground though, who, and has had to kill people in direct combat can also suffer from moral injuries in very much the same way.
Knowing that you are responsible for ending somebody’s life. That very well could. Lead to a moral injury. All right. We talked about the commandment thou shall not kill if you are a Christian person that very easily could cause some sort of conflict. And am I really a good Christian? Am I really this.
You know, Religious person that I thought I was, or is there something else going on or you [00:06:00] start to call them the question, these things.
Someone else like a medic. Could. Be faced with a moral injury when they have a situation where they couldn’t save everybody. Who was on this mission? So multiple people were injured. And the medic tries to help. One person over another person and somebody passes away, maybe both of the people pass away. I mean,
Is there their job to be the healer, the protector of these people who they’re serving with, and the team depends on the medics ability to be able to provide. Care for the wounded. And when the medic is unable to do that. And again, this is not me. Blaming the medic or pointing fingers and saying you should, you haven’t done your job.
You suck at your job or anything like that? That’s not what I’m trying to do here. I’m just trying to get into the mind of this person. And that medic maybe. Felt like they should be able to save everybody. Like that’s their job. They need to be able to [00:07:00] do this. And so when they weren’t able to, now they have this inner conflict with themselves and it may make them feel like.
Maybe they’re not the person that they once thought that they were. Or maybe there was somebody else who froze when they should’ve taken action. Maybe they saw the enemy. Take out their friends and they couldn’t move to prevent it. It was the fight flight or freeze. Thing going on with them. And in this situation they froze. I mean, it’s a normal human reaction. It happens to people but they may blame themselves or they may feel like they’re not.
A good soldier because they weren’t able to do the things that they needed to do. They froze when the time came. And you may actually experience a moral injury when you haven’t done anything immoral. Or against your own beliefs. You personally, haven’t done anything. Two causes moral injury. For example, you may have had [00:08:00] a certain view of what leadership is or isn’t supposed to do. And if you find yourself working for an incompetent leader or someone who’s dishonest or.
Untrust trustworthy. You may feel. Powerless or hopeless, like, how am I supposed to do this job? If I don’t have the leadership there to support me? I’m like, you. I may not be able to live up to the values that you hold for yourself because of the situation that you’re in and the people who are leaving you are preventing you from being the person who you feel like you should be able to be.
All of this. I mean, again, these are just a few examples, but all of these examples and others like them, Can create this emotional or psychological or even spiritual impact on the people who are experiencing them. The emotional impact of a moral injury. Can we talked about this in the last [00:09:00] episode, can create feelings of guilt or shame?
Even anger and remorse are some others that, that may happen. Veterans may struggle to even come to terms with the actions that they took or didn’t take. Or things that they witness during their. Their time in uniform. It can create this emotional pain and distress inside of them that prevents them from moving on from this.
They may feel betrayed like we were talking about with the leadership. And their experience may just challenge their own moral beliefs or expectations of themselves or others. And so that. Creates a lot of emotions in there. The guilt, the shame, the anger, the remorse, the distrust. All of these things are.
You know, pretty intense, emotional. Behaviors or emotional. Outcomes. From this. And there’s a psychological factor to all of this as well. And moral injury can [00:10:00] lead to depression. Anxiety. Can be combined with post-traumatic stress disorder, PTSD. Veterans. With moral injuries can struggle with.
Sleep. Not being able to sleep at all. They may actually have the nightmares and intrusive thoughts that the flashbacks and hallucination type things that we’re talking about with PTSD, because very often PTSD and moral injuries are. Are linked. And I’ll talk about that in just a minute, but
They may have difficulty trusting other people, especially in a case where. Somebody who they trusted. Their leadership, for example. They put their trust in those people and they let them down. They may have difficulty trusting. Other people in the future. Because of situations like that, where I was hurt once and I’m not going to be hurt again. So I don’t want that.
Pop back up. And then I’m a spiritual side of religious side of things. The moral injury can just [00:11:00] challenge. Veterans. Core spiritual beliefs. It can challenge there. Sense of meaning their purpose, their. Identity of who they are.
They may even question their values and beliefs. They may struggle with. A feeling of disconnection.
And experienced even a loss of faith. Altogether. They may feel like. They’re not worthy to be. You know, part of this. Religion or the spirituality that they may have.
They may just end up feeling lost and not know where to turn. How could you. Go to your priest and tell them that. You killed somebody. And expect them to believe that you’re. Still a good Christian.
And I’m picking on the Christians here. Because I’m one. And it’s something that I’m familiar with, but a lot of other [00:12:00] religions have very similar beliefs. You know, how could you go to your religious leader? Whether it’s Christian or any other faith. How could you go to that religious leader and.
Talk about this. You know, go to confession and. Confess these sins, right? How could you do that? And then expect. Them to not. Hold judgment. Against you. That’s a lot to take on, right.
And there’s that stigma that veterans may feel stigmatized or even ashamed about the experiences that led to this moral injury that they are experiencing. And it may cause them to be hesitant to even go out and seek help. They might feel like. Other people are judging them, whether it’s a therapist or a priest or a
Friend or a family member or anybody really, that those people are going to be judging. Them. And fear. They may fear that [00:13:00] admitting. To what happened that, that surrounded this moral injury could impact their reputation could impact their career. Their relationships because of the stigma associated with what’s going on with them.
And quite honestly, Like I said in the beginning of this episode, I. Was not really familiar with the term moral injury until just a few years ago. And it’s not really. Widely understood. Bye even some Mental health professionals. There’s very limited research and studies that have gone on with moral injuries. And so when you’re talking to people about moral injuries,
They. They may. People may struggle to find a professional who is knowledgeable and understands. What. Is involved with a moral injury. And like we were saying before PTSD and moral injury share some very similar traits. [00:14:00] And so it’s possible that there may be a misdiagnosis or in an underdiagnosis in the case of you know, being treated for PTSD and maybe you don’t actually have PTSD, but
The person who’s treating you, maybe doesn’t understand moral injuries and thinks that maybe there isn’t anything wrong. And so this could. Be a setback as far as treatment is concerned because you know, if you don’t understand what it is that you’re trying to treat, it’s really difficult to treat that.
Thing. So. You know, A lot of. A lot of more research needs to be done in order to understand. Moral injuries and what’s effective in treating them what causes them and all that type of stuff too.
And again, these emotions that we’re talking about. The guilt and the shame, the anger, the. Feelings of not being able to trust people. Those things make it really difficult to communicate with other people. These emotions. Are difficult to [00:15:00] express and get out there, especially when you’re talking to a loved one. And you may feel like.
You’re going to be judged for something that you’re. That you either did or didn’t do or something that happened. You may feel the same way with a. Therapist, a healthcare mental health provider. You don’t know. What their background is, and you don’t know how they’re going to react when you open up and tell them your story and this concept of the moral injury that’s coming up here. Like.
You don’t know how. They’re going to react. And so it’s going to make it a little bit more difficult for you to open up and be able to receive the care that you actually need. And another thing that may. Be a setback here too. Veterans is that moral injury? I may not come up until gears after. You.
Even left the military or got back from deployment. And so that makes it really challenging to connect the symptoms that you may be [00:16:00] experiencing. Two. The experience that took place because you may all of a sudden start having these symptoms. It may be five, 10 years later. And you might be thinking to yourself, okay. What happened now? What happened in the last few weeks months? Maybe?
That is causing me to have this reaction. And it may not be anything that happened right now. And maybe something that happened years ago. And so it’s difficult to connect the symptoms to that experience. When there is that delayed. Effect. That delayed onset of these symptoms. And it may be.
Difficult, especially when you’re dealing with a provider, a mental health provider who isn’t familiar with. Moral injuries. And the fact that there could be this delay. It could be difficult for them to diagnose and treat it. Because.
They just don’t know. How much time may have passed or may not have passed. [00:17:00] And they may not look that far back. You know, they may just say, okay, well what’s going on with you now? So it’s important to understand this. I think it’s important for everybody to be their own advocate as far as their own.
Their mental health, their physical health, their. You know, overall wellbeing, be your own advocate and knowing that there could be this delay of. The symptoms coming up I think is. Really important thing because.
When your provider may not understand. You’re able to maybe bring this up to them and tell them, Hey, I. Feel like this thing that was happening years ago, maybe the reason why I’m feeling, what I’m feeling right now. And that might help them to figure out what’s going on with you and help to treat you.
And unfortunately though, A lot of the.
Treatment options that are available are. Somewhat. Unproven. At this point, since it is a relatively new [00:18:00] concept. I don’t want to say that. Totally unproven, because they’ve been used effectively for other treatments. Just specifically with regards to the moral injury side of things. There aren’t a ton of treatment options available.
And it can result in veterans receiving either inadequate care or just ineffective care. Which isn’t helpful. In my case.
Where I first heard about moral injuries. I was talking about time when I was deployed to Afghanistan and. I was faced with a decision. Of whether or not to shoot a child. And that child was standing up on the back of one of the jingle trucks. And he, I was standing maybe 50 to 75 yards away. From where the truck was and the truck was driving past a group of.
American soldiers that I was serving with. And this kid stood up on the back. There must spend some. [00:19:00] Bags or boxes or something in the back of his truck. So he was able to stand up over the side of it. Up above the soldiers that he was driving by. And he pointed what? To me, looked like a rifle at the soldiers.
And. I knew right then and there. My job is. To protect those soldiers. They can’t protect themselves right now. They couldn’t even see it unless they’re looking straight up. They couldn’t see what was happening or about to happen. And so I felt like it was my job to protect them. And so. Raised my rifle.
Flip the safety off.
Aimed. I was ready to shoot, but something just didn’t feel quite right.
And I took a second look. This time I was looking through. The site on my rifle. It’s magnified just a little bit. So I was able to see just a little bit better than when my naked eye. And I noticed that the rifle had this kid was holding, was all the same color. [00:20:00] Everything from the tip of the barrel all the way through the end of the stock. And it all was the color of a piece of wood.
That you might pick up at home Depot or Lowe’s or wherever.
And as I was looking at it, I realized it was just a piece of wood. That was carved in the shape of a rifle. Like an AK 47 style rifle. Which is why I thought it was an AK 47 to begin with. It was because the majority of AK 47s that I’ve seen are all, they have like a Woodstock. And so to me,
It sort of looked like. It was one of those.
And so I almost pulled the trigger. I almost killed this kid. It wouldn’t have been a tremendously difficult shot from that close. Yeah, it was moving a moving target, but it wasn’t moving very fast. It was maybe going. Just five, 10 miles an hour. And it was relatively close. Like I said, about 50 some odd yards away.
And I’ve hit targets at close before. [00:21:00] With.
Relative ease. So I really had. No doubt that I would have been able to make that shot. And kill that child.
But as I put the safety back on my. Weapon and lowered it.
I started thinking to myself, like, what the hell kind of person am I. Who have I become? I’m the type of person who just seconds earlier. If you were to tell me, I be pointing my rifle. A person. At a child. Ready to kill them. With my finger on the trigger. I would’ve told you you’re nuts. I’m the type of person who protects children.
That’s. One of my core beliefs about myself is that’s what I do. I protect people or innocent people who Need protecting and children certainly fall in that category. And so.
For the longest time. I didn’t understand why I felt the way I felt or [00:22:00] what it wasn’t until I was able to understand what a moral injury was. Someone had told me about moral injuries, explained what they were. That’s when I was able to kind of better process it and it’s still a trouble point for me. I’m not going to lie.
It’s not like I, now I understand what moral injuries and all of a sudden I’m better know, like it’s still a struggle and an internal struggle for me. Like I, once a person who was pointing a rifle at a child ready to kill him. And. Really, it was just a few pounds of pressure on the trigger. Between me.
Killing him and not killing him. That was it. That was the only difference I was aimed right where I needed to be aimed.
Easy shot. Like I was saying
So it, it took me awhile to kind of better understand why I felt the way I felt. And in this case,
It’s still a struggle for me. But it’s something that I’m able to now identify and then work at. And get [00:23:00] better at, and I’ve done this in several different ways. But I’m not alone. And if you’re out there and you’re listening to this, and this sounds like something like. Maybe that happened to you, or one of the other examples that I gave maybe is something.
That resonates with you. You’re not alone. There was a study done that surveyed about 1300 combat veterans. Us combat veterans. And it found that most veterans with PTSD depression, or a combination of the two. Experienced. A moral injury of some sort. Seven to be exact 72% of those with PTSD experience, a moral injury, 72% with depression experience moral injury.
And 68% with a combination of the two. Say that they experienced a moral injury as well. And about a third of those participants. Say that they. Participated in the actual event. So they were the person who. Was doing the shooting or they [00:24:00] were the one who was participating in this event that caused the moral injury.
About half of them witness other people doing things. So it would have been in a situation where if I had shot that child, somebody else would have watched me do that. Maybe. And they witnessed that happening.
And then a little over half say that they experienced a betrayal. So similar to like the leadership. Example that I gave earlier. That they experienced. Sort of a trail. And in that study the existence of moral injuries in veterans without PTSD or depression. Or any combination thereof?
Was. About a third of the participants, so significantly less. So we’re talking about, about roughly 70, some odd percent of people with PTSD or depression, experiencing moral injuries down to a third of people without PTSD or depression. Who are. Experiencing a moral injury. So. There’s a big gap there and there’s a lot of.
It seems to me like correlation there. About 8% of [00:25:00] those. People who did not have PTSD or depression, but experienced. A moral injury. Participated in the event that caused the moral injury. About 20% witnessed the event. And another 20 or 20% or so of those people experienced a betrayal.
And that study indicates that moral injuries are. More prevalent amongst veterans with PTSD or depression. Relative to those without PTSD or depression. The study. Was the first one to examine. The correlation between veterans with PTSD or depression and moral injuries. And it was only done late last year. I think it was October of 2022 that this study was done.
And so. Not a whole lot of work has been done in this area. You know, we’re talking just a few months here. Since that first study was done. I don’t know how many more studies have been done in the meantime. Hopefully there’s been a bunch. But [00:26:00] still it’s only been recent that these types of studies and.
Trying to identify these correlations have even started taking place. So a lot more work probably needs to be done. To be able to understand it better and understand the correlations and the causes and everything like that. But there are treatment options that are available. For veterans who are dealing with moral injury.
And there are things, different therapy, options, different treatments for veterans who are struggling with this moral injury. And w well, I’m going to name a few of them here. Just know that this is not a comprehensive west. It’s important to work with a therapist who is knowledgeable about more moral injuries and their treatment.
And you may need to work through several of these options too, in order to see the benefits. So you may try one, it doesn’t work at all for you. And. It doesn’t mean just give up all hope. It means keep trying until you find something that does work or you may [00:27:00] need a combination of things in order for it to really be effective for you.
Again, talk to a therapist, they’re going to be able to help. Guide you in the right direction and make the right. Choice here. But there’s cognitive behavioral therapy. CBT is a type. Of therapy. That tries to change the negative thought patterns and behaviors that are associated with the moral injury.
Can I help you reframe the experiences and manage your emotions better. And develop coping strategies for times when you are dealing with these negative emotions and try to help you. Deal with some of those symptoms. This is a new one that I haven’t heard of before, but I through doing some research, I came up with this one acceptance and commitment therapy.
It focuses on accepting. Difficult emotions and experiences. Instead of just avoiding them. Or suppressing them. I don’t know the silence sort of like prolonged exposure. Therapy. But [00:28:00] the name that I came across with this acceptance and commitment therapy. So maybe it’s the same thing as prolonged exposure. Maybe it’s different.
But it can help.
Take action towards
Dealing with the emotions and the experiences that you’ve dealt with rather than avoiding them altogether. The EMDR eye movement, desensitization and reprocessing. And that’s a type of therapy that involves like a visual stimulation or. Or sometimes it could be. Auditory as well. I think while.
The individual is recalling this traumatic or difficult emotion or difficult experience and it can help process and desensitize those emotions associated with the moral injury. Without. Avoiding it all together.
And there’s group therapy. Which provides an environment where there’s a bunch of other people there who maybe have experienced something similar to what you’ve experienced and you can [00:29:00] share in a.
Group environment To help you. Process through some of these things and maybe listen to other people’s stories too, which might help you. Deal with your own. Emotional situation, the things that you’re going through. You can practice. Mindfulness like meditation, breathing exercises, yoga.
Those things can help you. Reduce stress. And create a sense of calm in situations where you may be. Panicked or you may be just dealing with this, the anger, the guilt of the shame, or the frustrations that come along with this. You can also deal with going through some sort of spiritual or faith-based.
Intervention. Each. Religion might have different ways of dealing with these things. Different ways of thinking about some of these moral injuries. But they can provide you with a sense of meaning, a sense of purpose. And connection and belonging. To the group, the religious group that you may have been a part of and these things can help you process.
These [00:30:00] experiences in the context of your spiritual or religious beliefs? And so that way. You may. Come to terms with the fact that you may have had to kill somebody. As again, I’m going to pick on the Christians here. You may have had to kill somebody, but the Bible. Talks about these commandments, but.
Thou shall not kill. Is actually. More accurately thou shall not murder. And. When you think about it, that way, if you’re killing somebody in self-defense, that’s not murder. That’s you’re defending yourself or you’re defending others. You’re doing the things that you’ve been asked to do to defend your country.
Right. And so that’s not murder. Now.
When you try to wrap your head around this. You may see that line between murder and self-defense is a very gray line and it may be difficult to understand it. But part of [00:31:00] these. Interventions these religious. Interventions, maybe it’s with a religious leader, like a priest or somebody that represents your religion.
Maybe they’re able to help you wrap your head around it in a way that makes sense to you.
And a lot of these treatments that I mentioned are also used for PTSD as well. I’ve used some of them, myself for PTSD. So it’s important to recognize that. Moral injury and PTSD are separate issues. So if you’re going for treatment you may be able to treat both at the same time, especially if they occurred simultaneously, that may be something that you may be able to do, but
Especially if there is a separate events you may need to address each one separately. And again, each case is different. So I would suggest talking to a therapist to get the best advice as far as what you might need to do. But. At the end [00:32:00] of the day.
I want to. Just impress upon everybody that there is. Something out there for you to help. Cope with the moral injury. And hopefully this episode gave you a better understanding of what a moral injury is. Different examples that I gave obviously are not comprehensive. They don’t include every single example that’s out there. Couldn’t possibly fit them all into an episode, but.
And hopefully these examples gave you a better understanding. Maybe that triggered something in your mind that said, Hey, maybe this is what I’m dealing with. Maybe it’s not PTSD necessarily. Although it very well could be. But maybe there’s something else going on. So I want to thank you first off for taking the time to listen to this episode.
My understanding of this has increased over the last few years. And hopefully your understanding has increased as well by listening to this episode You know, talking about moral injury and its impact on veterans. You know, we’ve discussed the emotional, the [00:33:00] psychological, the spiritual impact of moral injury.
As well as some of the challenges that veterans. May face when dealing with. Moral injuries. We’ve also talked about potential treatment options that can help veterans address their moral injury and find healing and meaning in their lives.
But again, if someone that you know is struggling with a moral injury, or you may be struggling with yourself, I want to encourage you or the person that you know, to go and seek out professional, help and support. Just remember that you’re not alone. And that there is hope. For. Healing for recovery.
And understanding of this injury that has occurred. So thank you for listening. We’ll see you in the next episode.
Thanks for listening to the Drive On Podcast. If you want to support the show, please check out Scott’s book, Surviving [00:34:00] Son on Amazon. All of the sales from that book go directly back into this podcast and work to help veterans in need. You can also follow the Drive On Podcast on Instagram, Facebook, Twitter, LinkedIn, YouTube, and wherever you listen to podcasts.
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