After veterans returned from the Vietnam War, which wound down 50 years ago, they struggled to adjust. That’s been true for combat vets before that war and since. For Vietnam vets, a diagnosis of Post Traumatic Stress Disorder wasn’t possible until the 1980s. More recently – around 2009 – psychological experts further refined PTSD with the term “moral injury.”
John Philip Garrity, 76, is a Vietnam War veteran who now lives in Missoula. As a psych tech in a high casualty base camp, he talked daily to soldiers after they returned from combat. When he wasn't talking to his fellow soldiers, he'd care for the wounded or carry the dead to an evacuation helicopter.
"I think that any person as close to combat or in combat as I was has PTSD. But I think it's worse than that. I think PTSD is simply a bunch of symptoms descriptive of something that is deeper. And it's now being called, in recent years, moral injury," said Garrity.
Today, many experts define moral injury as a type of invisible scar, or soul wound. It happens when people face situations that deeply violate their conscience or threaten their core values. The guilt and hopelessness build up. Rachel Williamson is a clinical psychologist and assistant professor at the University of Montana who has applied this term in her practice and teaching.
"Moral injury is usually nested within trauma disorders and conceptualizations. And it's kind of from this observation, specifically actually from Vietnam War vets, like they came in with PTSD or PTSD like symptoms, but when you inquire about, you know, what is that tied to? It was, I did this thing that contradicts kind of my moral code," said Williamson.
Garrity was 19 when he went into the Army. He grew up in a religious family.
"I am basically Montana-Irish Catholic all the way," said Garrity.
He was in seminary before Vietnam. At the base camp, he knew a priest, but that priest didn't see what he saw.
"They had a tent that was the chapel and the priest talked about peace and quoted some things from the Bible without ever mentioning war and the insanity we were within and that priest never, ever showed up where all these wounded were coming," said Garrity.
After the war, Garrity went further into psychology at the University of Montana rather than finishing seminary. In some ways, he recognized himself.
"And I think I have so much moral injury in me that it's just an overwhelming component of who I am," Garrity said.
In Missoula, where Garrity's lived since returning from Vietnam, there's at least one support group focused on moral injury. Paul Tiede, a U. S. Marines veteran, runs a moral injury workshop through the Volunteers of America. His father served in Vietnam and stayed in the Army. Tiede says that his dad had pretty high standards for how to be, but he didn't talk a lot about what he went through. Now Tiede is getting his Ph.D. remotely in clinical depth psychology from Pacifica Graduate Institute in Carpentina, California. He spends a lot of time trying to open a wider conversation around moral injury, even beyond PTSD.
"You can have PTSD, but not moral injury. You can have moral injury, but not PTSD. And here you're talking about a soul injury, which is impossible to measure, difficult to define," said Tiede.
Nearly 75 percent of veterans report that they feel disconnected from their faith or ethical code when they return home from war.
"I don't know if we've ever had a moral injury component within a military unit. Like, these are the people who have been damaged or injured, you know, so then we've come up to a whole wall of, this is how things are done in the military. I mean, it's a different world over here," Tiede said.
The specific challenges that came from the Vietnam War for moral injury are twofold. It was a war supported by a highly disputed draft. Many of the soldiers didn't volunteer, but were rather forced to go to war, and the ones who did enlist often did so out of fear that they would be drafted anyways. The other prong was public opinion. As it went on, people increasingly disapproved of what soldiers were doing and being asked to do there.
"Atrocities happen in war. This is not new. But what was new is that this news was being filmed and brought into your very living room. That was new. You're eating your supper, and here's, you know, Marine tactical jets dropping Napalm," said Tiede.
So the war, and coverage of the war, eroded trust. When Vietnam veterans returned to this tense social climate, they were often seen as part of the problem.
"And particularly with the Vietnam War, not having that kind of social validation, I think, is a major contributor to it," said Williamson. "Add to that as well, because not only is it like something you're maybe personally wrestling with, but you are coming home to a country that's saying, like, yes, what you did was wrong and wasn't justified."
Both Williamson and Tiede say moral injury is not isolated to veterans. When a person has felt harm or inflicted harm on someone, it disrupts a person's moral understanding of life and leaves behind a scar they carry from then on. But often, combat veterans experience this on another level, simply because they have faced the violence of war, as well as the challenges of re-assimilating back into society after a life altering event.
"The goal is not to like, you know, abolish you of your sins or whatever, um, but it's to move from this really extreme place that really prevents movement in a positive direction," Williamson said.
For John Garrity, that's meant, in part, talking about the lessons from Vietnam since he came home.
"I've been speaking up for 54 years," said Garrity.
For Teide and Williamson, they're both pushing to make moral injury a term more of us know about.
