Rapid Ascent: Moral Injury Published Aug. 8, 2024 By Dr. Heather Venable Wild Blue Yonder--Maxwell AFB -- In 1948, the AFM 35-15 Air Force Leadership set out principles and techniques for early Cold War commanders to build cohesive and efficient organization to face the challenges of the post World War II security landscape. Its values are timeless, but it was aimed at an audience familiar with references and examples that no longer reflect the experiences of a 21st century Department of the Air Force. Its preface, by CSAF General Hoyt Vandenburg, insists “leadership techniques must change as the habits and thinking of the people comprising our units change,” so we created an updated resource with our contemporary context in mind. At the suggestion of Air University leadership, we drew upon the expertise of AU faculty to offer a quick primer on six foundational concepts of the Human Domain. This is the fifth in a six part series. Having flown and fortuitously survived 22 bombing runs over Germany in World War II, a B-17 bombardier began having startling nightmares after dropping his bombs over a city rather than the designated target. Subsequently hospitalized for a knee injury, his trauma only worsened as he experienced the mockery of soldiers seemingly cognizant and critical of the city bombing carried out by the Allies, calling him “D.D” for “Death and Destruction.” Rather than fearing losing his own life–the source of what we recognize today as post-traumatic stress disorder–this Airman suffered a different and perhaps even deeper wound: that of moral injury, or the feeling that he had trespassed his deeply-held spiritual beliefs. In a similar case, a bombardier flying over France in World War II erroneously misaimed his bombs at a point six miles away from the target. As he watched the bombs strike farmhouses, he became increasingly agitated, and he subsequently avoided firing at some German fighters attacking his bomber. Wrestling with inadvertently having possibly killed French civilians, the bombardier could not bring himself to fire at a legitimate German target even when his entire crew was at risk. These two examples from World War II exemplify the immense moral injury that some Airmen have experienced in the past. One of the more challenging CGOs I had to mentor didn’t always grasp the balance of morale/mission. There is a way to do both – after all this is a warfighting organization and we ask people to do almost impossible things at a near routine basis...and for the most part, they do it and will often keep asking for more. But they are also all volunteers, and we need as many of them to stay/keep providing inspiration others to serve. My basic lesson I tried to drive home with this particular CGO: You can always get compliance in the Air Force...it’s the law…But you have to earn enthusiasm. A leader gets both…a person in charge will only ever get compliance (and usually at the minimum level). – CMSgt Christopher Almeria These Airmen’s moral injuries were not really understood at the time but increasing attention has been devoted to moral injury since 2001 given the range of dilemmas resulting from a sometimes-diffuse battlefield characterized by a range of threats, misunderstandings, and firepower. One study suggests that 40 to 60 percent of Army and Marine Corps veterans believed they had killed an enemy combatant during the Global War on Terror while 10 to 30 percent believed they had killed a civilian, suggesting the significant numbers that might be suffering from moral injury. Moral trauma occurs in cases that exist along a spectrum of both the “avoidable and the unavoidable.” One researcher, for example, cites a Marine who found himself killing a child armed with an assault rifle yet doing so within the rules of engagement given the situation.[1] Although technically the Marine did not err, that did not keep him from wondering if he had acted correctly. Even more precise technology or more stringent rules of engagement do not make moral trauma a moot point for Airmen. Indeed, those piloting and operating the sensors of remotely piloted vehicles have found themselves simultaneously at great physical distance from killing yet in places of great emotional closeness that can cause moral trauma or injury. Moral injury can be understood as resulting from numerous scenarios that frequently occur in combat ranging from seeing one's comrades being killed or injured to believing one has transgressed one’s deeply held moral beliefs. According to the National Center for PTSD [posttraumatic stress disorder], moral injury occurs when in “traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations.”[2] One night at Balad, during the heat of OIF one of our senior officers (an AF colonel) reported to the ER with a bullet wound. Turned out fortunately to be a minor injury and the bullet was removed; he was returned to duty the next day. When the paperwork for the Purple Heart came across my desk it seemed straight-forward until I noticed in the medical report that the attending surgeon (a firearms kind of guy) indicated that it appeared the bullet had never been fired from a gun. After a CDI it was revealed that the officer had found the bullet on the ground, cut himself, inserted the bullet, and then called for help to be taken to the ER. The point I make when telling this story is not just how sad it is than an officer would violate his integrity to gain false honor—it’s that when word spread of this the stories didn’t start with ‘did you hear about Colonel X’ but rather ‘did you hear about that AF colonel?’ As an officer and leader, it’s not about you—what you say and do will reflect on the institution, for better or for worse. --Commander (Anonymous by request) This definition helps illuminate those emotions and thoughts that rise to the surface during the “dark night of the soul.” As philosophy professor Dr. Lisa Tessman further explains, moral trauma can result when one must consider the “unthinkability” of an action one has to perform.” They are the “kinds of wounds we inflict on ourselves that come inherently from the wounds we inflict on others.”[3] Moral trauma can occur not only from individuals perpetrating violence but as receivers of violence or what can be understood as “within-ranks violence,” not just meaning friendly fire but being fired at by an opponent. Thus, moral injury can occur from a wide range of circumstances. Dr. Jonathan Shay adds a different layer by stressing how moral injury can result from one’s leadership violating one’s trust. For Shay, the “violator is a powerholder” whereas for most researchers the “violator” is the “self.”[4] Both, of course, are correct, with Shay’s work in particular serving as a powerful reminder of the sacred nature of trust within the military. Non-combat related moral injury, for example, may result when one’s leadership does not take proper action regarding the sexual harassment of someone in an individual’s chain of command.[5] Trust is especially important in an institution seeking to enable mission command. In empowering lower-level decision making, an institution bears responsibility for carefully ensuring leaders are equipped to make sound decisions in challenging circumstances even when a lack of communications permits them from having full situational awareness. To help military personnel to deal with a range of potential challenges in an environment characterized by mission command, character training--sometimes seen as a “nice to do”—merits increased attention. You set the tone by being the standard. You choose if it is going to be a very high standard or a mediocre one. One of my favorite quotes is “You live with what you tolerate” and that absolutely holds true in your organization. If you see something wrong or less than best and you don't say something, you just set your standard. You maintain it by remembering your why…remembering why the tone of an organization is impacted by your actions and why that mattered to you as a young Airman. You think back on the leaders that had the biggest impact on you and emulate the things they did that held weight.--SMSgt Ashley T. Strong The analogy of “bad apples” is instructive here. It is of limited utility to consign the moral failings of the US military to only a few “bad apples” when anyone can experience moral trauma even from the best of intentions, especially if not properly prepared for the moral challenges of warfare.[6] For example, one Marine found himself shooting a child who darted into his line of sight only at the last minute, with the child being in the act of firing bullets from his assault rifle. The Marine fired back in self-defense of himself and his fellow Marines. While he most likely acted instinctually, he still had to live with the dilemma of either shooting a child or letting one of his own Marines potentially die.[7] The result of moral trauma can be very difficult to deal with in terms of “debilitating symptoms and self-destructive behaviors.” The overarching feeling for those experiencing post- traumatic stress is fear whereas for those experiencing moral trauma it is shame or guilt. Perhaps most importantly for those suffering from the experience, moral injury perhaps more so than PTSD tends to be what “wrecks” individuals’ lives.[8] It is important to note that moral injury can overlap with but also differs from posttraumatic stress, which manifests more as hyperarousal caused by the experience of combat in a wide range of symptoms from flashbacks and dreams to anger and increased alertness. In essence, post-traumatic stress is characterized by emotions of “fear, horror, and helplessness” whereas moral injury tends to cause different feelings of “guilt, shame, and anger,” Again, those in the military, whether or not they experience combat, can be subject to post-traumatic stress or moral injury, as can civilians. But what differs in those experiencing post-traumatic stress from moral injury is notable: the former have far greater physiological arousal–or stress factors stimulated by fear of one dying–and the essence of a sense of what one has “lost.” For those experiencing post-traumatic stress, it is “safety.” For those with moral injury, it is “trust,” whether in oneself or in others. Importantly, suffering from moral injury does not necessarily require one to be religious, especially given how deeply embedded moral concepts of right and wrong regarding killing are embedded in societies. For those who do hold to religious beliefs, however, moral trauma can result in a “diminishment or total abandonment” of their religious beliefs. Clearly and concisely, with as little ambiguity or ethical relativism as possible. The team should understand their structure, their left and right limits, the resources allocated to them, and where they should be taking it all. Furthermore, the why should be clearly articulated; not only why the unit is working towards a specific goal or mission, but also reference to applicable policy and regulation that govern why the mission must be accomplished in the specified fashion. Explaining to people what you want from them and why you want it will create a transparent culture. -- CMSgt Evan Serpa In some cases, the service member errs in judgement and must live with the consequences. Some disagreement exists as to whether one should help the person deal with the reality of what he or she did or seek to help the person understand that it was not their responsibility. Being able to “justify” one’s actions is, in such cases, not enough to prevent the onset of moral injury as the individual questions whether he or she acted morally. As such, one should expect that even the most moral of combatants may find themselves in extremely morally challenging situations where they may act according to doctrine, or rules of engagement yet still reasonably feel as if they have undermined their own value judgments. Despite the increased attention paid to moral injury in the last decade, researchers still have much to learn about how best to heal those experiencing the spiritual wound of moral injury. There is an enormous challenge for psychologists and other supportive bystanders seeking to help those suffering from moral injury given that the central problem of those they are seeking to counsel is precisely the loss of trust. There is also a role for chaplains in facilitating healing, regardless of whether the military member ascribes to a religious belief or not.[9] Those seeking to establish a connection with those wrestling with moral injury have their odds quite understandably staked against them: can they be trusted? Are they similarly victimized and, if so, how will that aid the injured, among a myriad of other questions? In such cases, healing can often be aided by bringing together those affected by moral trauma precisely by having them empower each other.[10] Seventy-four percent of Vietnam veterans surveyed at PTSD centers agreed that they had “difficulty reconciling” their spiritual beliefs with the “traumatic events” they endured in Vietnam. Vietnam veteran Karl Marlantes writes forthrightly of his own combat experience, including situations likely having caused his own moral trauma. He stresses how the Marine Corps taught him how to kill but not how to “deal with killing.” The importance of a kind of warrior identity in terms of great respect for one’s enemy (even if one greatly questions one’s opponents’ values) in terms of the sacred nature of all human life is virtually impossible when one dehumanizes the enemy. Deploying “meaning” to the battlefield can help inoculate military personnel against moral and psychological injury while also helping them do “no more harm than they need to do.”[11] Dr. Heather P. Venable is an Associate Professor of Military and Security Studies in the Department of Airpower and the Course Director of the Airpower Strategy and Operations Course at Air Command and Staff College. As a visiting professor at the US Naval Academy, she taught naval and Marine Corps history. She was a non-resident fellow at Marine Corps University’s Krulak Center from 2021 to 2023 and is currently a Research Fellow at West Point’s Modern War Institute. Textbox quotes from individual Air Force personnel collected and edited by Dr. Paul J. Springer as part of his study of leadership during the tenure of General David L. Goldfein. Many thanks to the volunteer participants whose comments and experiences helped to shape the contours of this project: Air University’s ACTS “Disciples” Lt. Col. Lyndsey Banks, CMSgt Jason Blair, TSgt Zachary Bennett, Col. Stephanie Boger, Lt. Col. Jose Crespo, Lt. Col. Christy Cruz Peeler, Col. Jerry Davisson, MSgt Ashley Evans, Lt. Col. Mitchell Foy, Maj. Ray Funke, CMSgt Steven Hart, Dr. Robert Hinck, Dr. John Hinck, CMSgt Joshua Lackey, Mr. Mark Logan, Lt. Col. William Mendel, Capt. Denny Miller, Ms. Rhonda Miller, TSgt Israel Navarro, Lt. Col. Amber Ortiz, SMSgt Joshua Penery, Lt. Col. Don Salvatore, Col. Eltressa Spencer, Dr. Susan Steen and the AY24 AU Resilience Research Task Force, Maj. Jonathan Tolman [1] Lisa Tessman, “Moral Injury and Moral Failure,” in How to End a War: Essays on Justice, Peace and Repair, ed. Graham Parsons and Mark Wilson (Cambridge: Cambridge University Press, 2023): 37. [2] Sonya B. Norman and Shira Maguen, U.S. Department of Veterans Affairs, National Center for PTSD, “Moral Injury” [3] Grace W. Yan, “The Invisible Wound: Moral Injury and Its Impact on the Health of Operation Enduring Freedom/Operation Iraqi Freedom Veterans,” Military Medicine, Vol. 181, (May 2016): 451. [4] Jonathan Shay, “Moral Injury,” Psychoanalytic Psychology, vol. 31, no. 2 (2014): 184. [5] Shay, “Moral Injury,” 185. [6] Lt. Col. Michael A. Haack, “The Orchard: How AFSOC Should Grow Leaders of Character,” Strategic Studies Paper, Air War College, February 2019. [7] Tessman, “Moral Injury and Moral Failure,” 37-38. [8] Shay, “Moral Injury,” 184. [9] Lindsay B. Carey and Timothy J. Hodgson, “Chaplaincy, Spiritual Care and Moral Injury: Considerations Regarding Screening and Treatment,” Frontiers, 5 December 2018. [10] Shay, “Moral Injury,” 188-9. [11] Karl Marlantes, What It is Like to Go to War (New York: Grove Atlantic, 2011), 8.