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Moral Injury in Combat: Holistic and Community Healing | STEVE GUNN | TEDxLehighRiver


I am very happy to be here today to talk

I am very happy to be here today to talk with you about a very serious subject I

with you about a very serious subject I

with you about a very serious subject I invite you to go on a journey with me

invite you to go on a journey with me

invite you to go on a journey with me we’ll be going to Vietnam we’ll be going

we’ll be going to Vietnam we’ll be going

we’ll be going to Vietnam we’ll be going to some places deep in the heart some

to some places deep in the heart some

to some places deep in the heart some dark places some academic places some

dark places some academic places some

dark places some academic places some intriguing places and then to

intriguing places and then to

intriguing places and then to possibility and hope so

possibility and hope so

possibility and hope so come along last December I was in

come along last December I was in

come along last December I was in Vietnam with a group of fellow veterans

Vietnam with a group of fellow veterans

Vietnam with a group of fellow veterans on a journey of healing and

on a journey of healing and

on a journey of healing and reconciliation there I learned about a

reconciliation there I learned about a

reconciliation there I learned about a very important concept moral injury I

very important concept moral injury I

very important concept moral injury I learned about one pathway to healing

learned about one pathway to healing

learned about one pathway to healing this injury and I discovered that I had

this injury and I discovered that I had

this injury and I discovered that I had incurred a moral injury during my

incurred a moral injury during my

incurred a moral injury during my service in the Vietnam War I’m sharing

service in the Vietnam War I’m sharing

service in the Vietnam War I’m sharing this with you today for two reasons to

this with you today for two reasons to

this with you today for two reasons to help expand our understanding of the

help expand our understanding of the

help expand our understanding of the challenges that many veterans experience

challenges that many veterans experience

challenges that many veterans experience as they return home from war and to help

as they return home from war and to help

as they return home from war and to help fellow veterans who may be experiencing

fellow veterans who may be experiencing

fellow veterans who may be experiencing moral injury to see it to understand it

moral injury to see it to understand it

moral injury to see it to understand it and to find some of the peace and the

and to find some of the peace and the

and to find some of the peace and the healing that I’m finding as I tend this

healing that I’m finding as I tend this

healing that I’m finding as I tend this wound

when I was with my fellow veterans in

when I was with my fellow veterans in Vietnam we were walking in the district

Vietnam we were walking in the district

Vietnam we were walking in the district of coochie when we encountered madam kee

she was sweeping her courtyard she

she was sweeping her courtyard she welcomed us into her home we sat at her

welcomed us into her home we sat at her

welcomed us into her home we sat at her dining room table and in front of her

dining room table and in front of her

dining room table and in front of her family altar and she shared some of her

family altar and she shared some of her

family altar and she shared some of her story with us her brother had been

story with us her brother had been

story with us her brother had been killed in a napalm attack during the war

killed in a napalm attack during the war

killed in a napalm attack during the war I said I feel bad about what we did in

I said I feel bad about what we did in

I said I feel bad about what we did in your country no madam kee said don’t

your country no madam kee said don’t

your country no madam kee said don’t feel that way you were just doing what

feel that way you were just doing what

feel that way you were just doing what you were told to do I had a surprisingly

you were told to do I had a surprisingly

you were told to do I had a surprisingly intense emotional response to Madame

intense emotional response to Madame

intense emotional response to Madame Kees forgiveness

Kees forgiveness

Kees forgiveness tears of joy and grief and relief welled

tears of joy and grief and relief welled

tears of joy and grief and relief welled up frequently during the rest of the

up frequently during the rest of the

up frequently during the rest of the journey and at times I tears still well

journey and at times I tears still well

journey and at times I tears still well up when when I speak of Madame Kees

up when when I speak of Madame Kees

up when when I speak of Madame Kees forgiveness those tears were my clue

forgiveness those tears were my clue

forgiveness those tears were my clue that I had incurred a moral injury but I

that I had incurred a moral injury but I

that I had incurred a moral injury but I didn’t realize that at that time and my

didn’t realize that at that time and my

didn’t realize that at that time and my emotions didn’t make sense to me let me

emotions didn’t make sense to me let me

emotions didn’t make sense to me let me tell you why I was in Social Work school

tell you why I was in Social Work school

tell you why I was in Social Work school in 1969 when I received my draft notice

in 1969 when I received my draft notice

in 1969 when I received my draft notice I believed that the war was morally

I believed that the war was morally

I believed that the war was morally wrong and I applied for conscientious

wrong and I applied for conscientious

wrong and I applied for conscientious objector status because I did not want

objector status because I did not want

objector status because I did not want blood on my hands for killing in a war

blood on my hands for killing in a war

blood on my hands for killing in a war that I felt was morally wrong I served

that I felt was morally wrong I served

that I felt was morally wrong I served as a combat medic with a hundred and

as a combat medic with a hundred and

as a combat medic with a hundred and first Airborne Division in the last

first Airborne Division in the last

first Airborne Division in the last major battle of the Vietnam War after I

major battle of the Vietnam War after I

major battle of the Vietnam War after I left a combat role I provided medical

left a combat role I provided medical

left a combat role I provided medical care in the local villages so here’s

care in the local villages so here’s

care in the local villages so here’s what puzzled me

what puzzled me

what puzzled me I carried no weapon I killed no one I

I carried no weapon I killed no one I

I carried no weapon I killed no one I helped my fellow soldiers and I helped

helped my fellow soldiers and I helped

helped my fellow soldiers and I helped the local villages so what was the

the local villages so what was the

the local villages so what was the source of my moral injury and guilt as I

source of my moral injury and guilt as I

source of my moral injury and guilt as I have discovered I was morally injured

have discovered I was morally injured

have discovered I was morally injured when I was compelled to witness and to

when I was compelled to witness and to

when I was compelled to witness and to support killing in a war that I felt was

support killing in a war that I felt was

support killing in a war that I felt was morally wrong and what was the source of

morally wrong and what was the source of

morally wrong and what was the source of my intense emotional response to Madame

my intense emotional response to Madame

my intense emotional response to Madame Kees forgiveness when madam key said

Kees forgiveness when madam key said

Kees forgiveness when madam key said don’t feel that way you were just doing

don’t feel that way you were just doing

don’t feel that way you were just doing what you were told to do she was

what you were told to do she was

what you were told to do she was directly acknowledging my moral injury

directly acknowledging my moral injury

directly acknowledging my moral injury and guilt and she was doing so with care

and guilt and she was doing so with care

and guilt and she was doing so with care and kindness Madame key was

and kindness Madame key was

and kindness Madame key was demonstrating the Vietnamese community

demonstrating the Vietnamese community

demonstrating the Vietnamese community approach to addressing veteran trauma

Bret lits is a psychologist with the

Bret lits is a psychologist with the United States Department of Veterans

United States Department of Veterans

United States Department of Veterans Affairs the VA brett describes the

Affairs the VA brett describes the

Affairs the VA brett describes the causes of moral injury this way it’s

causes of moral injury this way it’s

causes of moral injury this way it’s perpetrating failing to prevent bearing

perpetrating failing to prevent bearing

perpetrating failing to prevent bearing witness to or learning about acts that

witness to or learning about acts that

witness to or learning about acts that transgress deeply held moral beliefs and

transgress deeply held moral beliefs and

transgress deeply held moral beliefs and expectations dr. Jonathan Shea also

expectations dr. Jonathan Shea also

expectations dr. Jonathan Shea also indicates that moral injury can result

indicates that moral injury can result

indicates that moral injury can result from betrayal of what’s right by someone

from betrayal of what’s right by someone

from betrayal of what’s right by someone who holds legitimate authority in a

who holds legitimate authority in a

who holds legitimate authority in a high-stakes situation but one soldier

high-stakes situation but one soldier

high-stakes situation but one soldier described the source of his moral injury

described the source of his moral injury

described the source of his moral injury very simply it’s when the head says to

very simply it’s when the head says to

very simply it’s when the head says to do what the heart says is wrong David

do what the heart says is wrong David

do what the heart says is wrong David Wood is author of what we have done the

Wood is author of what we have done the

Wood is author of what we have done the moral injury of our longest Wars David

moral injury of our longest Wars David

moral injury of our longest Wars David describes a story of moral injury in

describes a story of moral injury in

describes a story of moral injury in Afghanistan a young marine was in a

Afghanistan a young marine was in a

Afghanistan a young marine was in a bad firefight there were casualties on

bad firefight there were casualties on

bad firefight there were casualties on both sides Marines and Taliban out of

both sides Marines and Taliban out of

both sides Marines and Taliban out of the corner of his eye he saw a figure

the corner of his eye he saw a figure

the corner of his eye he saw a figure spraying bullets from an assault rifle

spraying bullets from an assault rifle

spraying bullets from an assault rifle when he got the figure in his sights he

when he got the figure in his sights he

when he got the figure in his sights he saw that it was a boy 12 or 13 he took

saw that it was a boy 12 or 13 he took

saw that it was a boy 12 or 13 he took aim and fired according to military

aim and fired according to military

aim and fired according to military rules of engagement it was a justifiable

rules of engagement it was a justifiable

rules of engagement it was a justifiable kill he was accomplishing his mission he

kill he was accomplishing his mission he

kill he was accomplishing his mission he was protecting his fellow Marines and he

was protecting his fellow Marines and he

was protecting his fellow Marines and he was protecting himself but when the

was protecting himself but when the

was protecting himself but when the young marine returned home to civilian

young marine returned home to civilian

young marine returned home to civilian life he found that he had a bruise on

life he found that he had a bruise on

life he found that he had a bruise on his soul

his soul

his soul a painful violation of the civilian

a painful violation of the civilian

a painful violation of the civilian rules of right and wrong since 1980

rules of right and wrong since 1980

rules of right and wrong since 1980 post-traumatic stress disorder PTSD has

post-traumatic stress disorder PTSD has

post-traumatic stress disorder PTSD has been the major tool that we have used to

been the major tool that we have used to

been the major tool that we have used to understand the impact of battle trauma

understand the impact of battle trauma

understand the impact of battle trauma on veterans the specific term moral

on veterans the specific term moral

on veterans the specific term moral injury first appeared in a research

injury first appeared in a research

injury first appeared in a research article in 2009 and it appeared there

article in 2009 and it appeared there

article in 2009 and it appeared there because there are problems that PTSD

because there are problems that PTSD

because there are problems that PTSD cannot address it can’t explain these

cannot address it can’t explain these

cannot address it can’t explain these these problems doctor Jonathan Shay is a

these problems doctor Jonathan Shay is a

these problems doctor Jonathan Shay is a psychiatrist who devoted his career to

psychiatrist who devoted his career to

psychiatrist who devoted his career to serving veterans in the VA who were

serving veterans in the VA who were

serving veterans in the VA who were diagnosed with PTSD dr. Jonathan Shea

diagnosed with PTSD dr. Jonathan Shea

diagnosed with PTSD dr. Jonathan Shea describes powerfully and simply why it

describes powerfully and simply why it

describes powerfully and simply why it is so crucial for us to look at moral

is so crucial for us to look at moral

is so crucial for us to look at moral injury and I’ll get to that later but

injury and I’ll get to that later but

injury and I’ll get to that later but right now I’m going to talk to you about

right now I’m going to talk to you about

right now I’m going to talk to you about the experience of moral injury the VA

the experience of moral injury the VA

the experience of moral injury the VA describes the experience of moral injury

describes the experience of moral injury

describes the experience of moral injury this way

this way

this way highly aversive and haunting states of

highly aversive and haunting states of

highly aversive and haunting states of inner conflict and

inner conflict and

inner conflict and turmoil shame guilt anxiety anger

turmoil shame guilt anxiety anger

turmoil shame guilt anxiety anger alienation withdrawal and self

alienation withdrawal and self

alienation withdrawal and self condemnation alcohol or drug use

condemnation alcohol or drug use

condemnation alcohol or drug use emotional numbing underemployment or

emotional numbing underemployment or

emotional numbing underemployment or unemployment failed or harmed

unemployment failed or harmed

unemployment failed or harmed relationships and self harming including

relationships and self harming including

relationships and self harming including suicide research shows that there’s a

suicide research shows that there’s a

suicide research shows that there’s a direct link between moral injury and

direct link between moral injury and

direct link between moral injury and suicide because guilt is a major trigger

suicide because guilt is a major trigger

suicide because guilt is a major trigger for suicide so this is quite a list and

for suicide so this is quite a list and

for suicide so this is quite a list and I think you can see by looking at this

I think you can see by looking at this

I think you can see by looking at this list why it is so crucial for us to give

list why it is so crucial for us to give

list why it is so crucial for us to give moral injury close scrutiny so as I said

moral injury close scrutiny so as I said

moral injury close scrutiny so as I said in since 1980 PTSD has been the major

in since 1980 PTSD has been the major

in since 1980 PTSD has been the major tool that we’ve utilized and moral

tool that we’ve utilized and moral

tool that we’ve utilized and moral injury appeared in 2009 because it’s fit

injury appeared in 2009 because it’s fit

injury appeared in 2009 because it’s fit filled in the gaps where there were

filled in the gaps where there were

filled in the gaps where there were problems that PTSD cannot explain

problems that PTSD cannot explain

problems that PTSD cannot explain so dr. Jonathan Shea describes very

so dr. Jonathan Shea describes very

so dr. Jonathan Shea describes very simply why it’s so crucial for us to

simply why it’s so crucial for us to

simply why it’s so crucial for us to look at moral injury PTSD is rarely what

look at moral injury PTSD is rarely what

look at moral injury PTSD is rarely what wrecks veterans lives or crushes them to

wrecks veterans lives or crushes them to

wrecks veterans lives or crushes them to suicide moral injury does both

I discovered some intriguing information

I discovered some intriguing information while I was in Vietnam and I want to

while I was in Vietnam and I want to

while I was in Vietnam and I want to share this with you because I think it

share this with you because I think it

share this with you because I think it can help us as we seek to help our

can help us as we seek to help our

can help us as we seek to help our veterans with moral injury the

veterans with moral injury the

veterans with moral injury the vietnamese experienced staggering levels

vietnamese experienced staggering levels

vietnamese experienced staggering levels of death destruction and privation

of death destruction and privation

of death destruction and privation during what they call the american war

during what they call the american war

during what they call the american war for example three million Vietnamese

for example three million Vietnamese

for example three million Vietnamese died versus 58,000 Americans but despite

died versus 58,000 Americans but despite

died versus 58,000 Americans but despite this great disparity in levels of trauma

this great disparity in levels of trauma

this great disparity in levels of trauma dr. Levin how of the Institute of

dr. Levin how of the Institute of

dr. Levin how of the Institute of psychology in Hanoi states that the

psychology in Hanoi states that the

psychology in Hanoi states that the chronic and comprehensive breakdown

chronic and comprehensive breakdown

chronic and comprehensive breakdown often seen among American veterans is

often seen among American veterans is

often seen among American veterans is absent among Vietnamese veterans dr. Lee

absent among Vietnamese veterans dr. Lee

absent among Vietnamese veterans dr. Lee describes protective factors in Vietnam

describes protective factors in Vietnam

describes protective factors in Vietnam that affect the way the Vietnamese

that affect the way the Vietnamese

that affect the way the Vietnamese responded to the war let’s take a look

responded to the war let’s take a look

responded to the war let’s take a look at one of these protective factors

at one of these protective factors

at one of these protective factors Vietnamese communities have a different

Vietnamese communities have a different

Vietnamese communities have a different relationship with their veterans than we

relationship with their veterans than we

relationship with their veterans than we do here in the u.s. in the u.s. veterans

do here in the u.s. in the u.s. veterans

do here in the u.s. in the u.s. veterans often feel that they must bear the

often feel that they must bear the

often feel that they must bear the burden of their invisible wounds on

burden of their invisible wounds on

burden of their invisible wounds on their own and they feel reluctant to

their own and they feel reluctant to

their own and they feel reluctant to share their stories in a civilian

share their stories in a civilian

share their stories in a civilian community dr. edy tick is author of

community dr. edy tick is author of

community dr. edy tick is author of warriors warriors return restoring the

warriors warriors return restoring the

warriors warriors return restoring the soul after war dr. tick describes the

soul after war dr. tick describes the

soul after war dr. tick describes the relationship of Vietnamese communities

relationship of Vietnamese communities

relationship of Vietnamese communities to their veterans in Vietnam communities

to their veterans in Vietnam communities

to their veterans in Vietnam communities have been traditionally witnessing their

have been traditionally witnessing their

have been traditionally witnessing their warriors stories and they’ve been doing

warriors stories and they’ve been doing

warriors stories and they’ve been doing it in homes and pagodas and community

it in homes and pagodas and community

it in homes and pagodas and community centers they’ve been doing this on a

centers they’ve been doing this on a

centers they’ve been doing this on a spontaneous basis for hundreds of years

spontaneous basis for hundreds of years

spontaneous basis for hundreds of years Vietnamese communities feel that the

Vietnamese communities feel that the

Vietnamese communities feel that the stories soldiers the stories

stories soldiers the stories

stories soldiers the stories soldier’s stories feel that they feel

soldier’s stories feel that they feel

soldier’s stories feel that they feel that they

that they

that they are belong to the community as a whole

are belong to the community as a whole

are belong to the community as a whole and that they share they have the

and that they share they have the

and that they share they have the responsibility to carry these stories in

responsibility to carry these stories in

responsibility to carry these stories in their hearts Vietnamese communities feel

their hearts Vietnamese communities feel

their hearts Vietnamese communities feel a shared responsibility for the decision

a shared responsibility for the decision

a shared responsibility for the decision to go to war so how can we apply this in

to go to war so how can we apply this in

to go to war so how can we apply this in the u.s. first morale injuries not a

the u.s. first morale injuries not a

the u.s. first morale injuries not a medical diagnosis this is a wound that’s

medical diagnosis this is a wound that’s

medical diagnosis this is a wound that’s in the moral spiritual and social arenas

in the moral spiritual and social arenas

in the moral spiritual and social arenas therefore Medical Care might be helpful

therefore Medical Care might be helpful

therefore Medical Care might be helpful at times but in order to truly address

at times but in order to truly address

at times but in order to truly address this wound holistic care is required

this wound holistic care is required

this wound holistic care is required doctor EdTech describes the components

doctor EdTech describes the components

doctor EdTech describes the components of holistic care

of holistic care

of holistic care it addresses mind body heart and spirit

it addresses mind body heart and spirit

it addresses mind body heart and spirit in community guided with transcendent

in community guided with transcendent

in community guided with transcendent meaning there are places in the VA where

meaning there are places in the VA where

meaning there are places in the VA where such holistic care is being provided in

such holistic care is being provided in

such holistic care is being provided in addition to the work of these skilled

addition to the work of these skilled

addition to the work of these skilled professionals the involvement of the

professionals the involvement of the

professionals the involvement of the community is required in order to

community is required in order to

community is required in order to complete holistic care let me let me

complete holistic care let me let me

complete holistic care let me let me describe one approach to involving our

describe one approach to involving our

describe one approach to involving our communities with our veterans there are

communities with our veterans there are

communities with our veterans there are community listening circles where

community listening circles where

community listening circles where veterans and civilians can gather in a

veterans and civilians can gather in a

veterans and civilians can gather in a small group where veterans can share

small group where veterans can share

small group where veterans can share their stories as a part of their healing

their stories as a part of their healing

their stories as a part of their healing there’s several requirements for such a

there’s several requirements for such a

there’s several requirements for such a circle first a group of veterans who are

circle first a group of veterans who are

circle first a group of veterans who are willing to share their stories in a

willing to share their stories in a

willing to share their stories in a civilian circle and a group of civilians

civilian circle and a group of civilians

civilian circle and a group of civilians who are trained and committed to this

who are trained and committed to this

who are trained and committed to this work who are willing to listen to

work who are willing to listen to

work who are willing to listen to difficult stories with open

difficult stories with open

difficult stories with open compassionate and with strong hearts

compassionate and with strong hearts

compassionate and with strong hearts they need to be willing to own their

they need to be willing to own their

they need to be willing to own their part of the responsibility for sending

part of the responsibility for sending

part of the responsibility for sending the soldiers to war and in order to true

the soldiers to war and in order to true

the soldiers to war and in order to true we honor these life and death stories a

we honor these life and death stories a

we honor these life and death stories a sacred space is required it’s a sacred

sacred space is required it’s a sacred

sacred space is required it’s a sacred space not a religious space so what are

space not a religious space so what are

space not a religious space so what are the consequences if we do not take

the consequences if we do not take

the consequences if we do not take action to expand our understanding of

action to expand our understanding of

action to expand our understanding of moral injury and how to attend this

moral injury and how to attend this

moral injury and how to attend this wound recent research shows that 25% of

wound recent research shows that 25% of

wound recent research shows that 25% of veterans who are at risk for moral

veterans who are at risk for moral

veterans who are at risk for moral injury upon returning home from war so

injury upon returning home from war so

injury upon returning home from war so if we take that 25% and we look at

if we take that 25% and we look at

if we take that 25% and we look at veterans who served in Vietnam Iraq

veterans who served in Vietnam Iraq

veterans who served in Vietnam Iraq Afghanistan I calculate that at least

Afghanistan I calculate that at least

Afghanistan I calculate that at least 1.2 million veterans are at risk for

1.2 million veterans are at risk for

1.2 million veterans are at risk for moral injury if we do not take action to

moral injury if we do not take action to

moral injury if we do not take action to expand our understanding of the injury

expand our understanding of the injury

expand our understanding of the injury and and how to address it 1.2 million

and and how to address it 1.2 million

and and how to address it 1.2 million veterans may not receive the help that

veterans may not receive the help that

veterans may not receive the help that they need to deal with this crushing and

they need to deal with this crushing and

they need to deal with this crushing and life-threatening wound so how can we as

life-threatening wound so how can we as

life-threatening wound so how can we as a community gather together to address

a community gather together to address

a community gather together to address this problem I have some recommendations

this problem I have some recommendations

this problem I have some recommendations we can support public dialogue like

we can support public dialogue like

we can support public dialogue like we’re doing today to heighten awareness

we’re doing today to heighten awareness

we’re doing today to heighten awareness of moral injury support research to

of moral injury support research to

of moral injury support research to increase our understanding of this

increase our understanding of this

increase our understanding of this injury and support community-based and

injury and support community-based and

injury and support community-based and holistic programs for our veterans more

holistic programs for our veterans more

holistic programs for our veterans more specifically you can find one of these

specifically you can find one of these

specifically you can find one of these community listening circles and

community listening circles and

community listening circles and participate if there’s not one in your

participate if there’s not one in your

participate if there’s not one in your area I suggest that you seek out

area I suggest that you seek out

area I suggest that you seek out guidance and support if you’re

guidance and support if you’re

guidance and support if you’re interested in creating such a circle I

interested in creating such a circle I

interested in creating such a circle I invite our communities to follow the

invite our communities to follow the

invite our communities to follow the example of madam key to acknowledge

example of madam key to acknowledge

example of madam key to acknowledge moral injury in community and to do so

moral injury in community and to do so

moral injury in community and to do so with care

with care

with care and with kindness and finally have you

and with kindness and finally have you

and with kindness and finally have you ever felt awkward or uncomfortable in

ever felt awkward or uncomfortable in

ever felt awkward or uncomfortable in the presence of a veteran I have some of

the presence of a veteran I have some of

the presence of a veteran I have some of us veterans can have a pretty rough

us veterans can have a pretty rough

us veterans can have a pretty rough exterior if you find yourself feeling

exterior if you find yourself feeling

exterior if you find yourself feeling awkward or uncomfortable in the presence

awkward or uncomfortable in the presence

awkward or uncomfortable in the presence of a veteran consider this the person in

of a veteran consider this the person in

of a veteran consider this the person in front of you may be experiencing moral

front of you may be experiencing moral

front of you may be experiencing moral injury and that fact guarantees that

injury and that fact guarantees that

injury and that fact guarantees that you’re standing in the presence of a

you’re standing in the presence of a

you’re standing in the presence of a kind compassionate heart thank you

kind compassionate heart thank you

kind compassionate heart thank you [Applause]

”

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