Pastoral Care for Veterans Experiencing Moral Injury: A Brief Resource

This resource was created in August 2021 in the wake of the US withdrawal from Afghanistan. To download this resource as a PDF, click here.

Veterans from all eras are reacting to the events in Afghanistan, such as the U.S withdrawal and the takeover by the Taliban. Veterans may question the meaning of their service or whether it was worth the sacrifices they made. They may feel distress about experiences they had during their service. 

Some veterans may even be experiencing moral injury. They may have already experienced moral injury, whether or not they have a name for it. Not all service people experience moral injury, but it’s important to look for signs so you can know how to respond and suggest other professional help when necessary. Moral injury and Post-Traumatic Stress Disorder are related and can co-occur, but are not the same.

 

What is moral injury? 

Moral injury is the “distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to” traumatic or extremely stressful events where a person

  1. Does something against their beliefs
  2. Fails to do something in line with their beliefs
  3. Witnesses behaviors that go against their beliefs 

Moral injury often occurs when someone experiences one of the above things at the command of someone who is an authority figure, i.e. someone does something against their beliefs because they were following orders of a superior officer.

It is particularly important for pastors to be able to recognize moral injury because you may be the first person a veteran reaches out to, and often moral injury causes spiritual distress, leading people to (a) question how God could let this happen, (b) feel shame about what they have done, and/or (c) wonder if they are capable or worthy of being loved by God. 

 

Signs of moral injury: 

Veterans may question the meaning of their service or whether it was worth the sacrifices they made. They may feel like they need to expect and/or prepare for the worst. For example, they may:

  • Become overly protective, vigilant, and guarded
  • Become preoccupied by danger
  • Feel a need to avoid being shocked by, or unprepared for, what may happen in the future

Regardless of whether they have moral injury, veterans may exhibit the following behaviors in reaction to current events in Afghanistan and pastoral care can help people name and begin to process what they’re going through:

  • Feel frustrated, sad, helpless, grief or distressed
  • Feel angry or betrayed
  • Experience an increase in mental health symptoms like symptoms of PTSD or depression
  • Sleep poorly, drink more or use more drugs
  • Try to avoid all reminders or media or shy away from social situations
  • Have more military and homecoming memories

 

Providing spiritual care to people who (may) have moral injury: 

It’s important to emphasize that feeling distress is a normal reaction to negative events, especially ones that feel personal. Some things you could communicate: 

  • It can be helpful to let yourself feel those strong feelings rather than try to avoid them 
  • I am not judging you, I am here to listen to what you need to share
  • You deserve to feel better
  • You are loved and lovable; God loves you

Someone may feel they need to ask for God and/or another person’s forgiveness. Try not to judge whether or not what they’re asking forgiveness for is right or wrong, and do not tell them there is no need to ask forgiveness. Make space for them to make amends, and, as they are ready to hear it, assure them that God loves and forgives them no matter what they understand themselves to have done wrong

Sometimes it’s not spiritually and psychologically safe for someone to share “the whole story,” which they may not even remember. Try to mirror the language they use when sharing. You can also check-in by saying something like “what’s it like to share this with me?” or “how are you feeling as we talk about this?” especially if it seems like they’re flooded with memories or emotions or appear distressed or anxious. 

If someone is searching for faith resources, Psalms of lament can help connect people in distress to their faith, showing that the Bible has these expressions of deep lament and anguish without immediate resolution (i.e. Psalm 130, Psalm 6:3, Psalm 10)

 

Other things to keep in mind

  • Often when people remember or recount traumatic experiences, the “timeline” is not linear; this is normal. As you listen, do not try to piece together a timeline of events that makes sense to you; rather, listen to what someone is telling you and affirm the feeling you hear, i.e. “I can see that you are in pain as you remember that experience” or “I can hear how angry/sad/afraid it makes you to remember this” or “I can hear how painful it is for you to talk about this experience. I’m here to listen if you want to share more. We can also sit together in silence or pray together if you’ve shared enough for today.”
  • Don’t try to convince people that their service “was worth it,” even if it’s what you believe; rather, affirm that their feelings–whatever they are–are normal
  • There are not many narratives or public examples of veterans experiencing this kind of psychic, moral, and spiritual pain, so even talking about the contradictions they feel is an act of deep courage and faith.
  • Veterans may not know they can come to you to talk about what they’re going through; try to incorporate something into your sermons or prayers that indicate the moral complexity veterans may be feeling right now and/or reach out to veterans individually in your congregation to acknowledge they may be going through a lot and ask “would you like to talk? I’m available these times” 
  • If you mention Afghanistan and/or veterans in worship, it’s best not to thank service people publicly because many veterans share that it can feel incongruous to be thanked when they may not be proud of–and may actually feel trauma associated with–the things they did; instead, pray for healing and for the struggles that many veterans feel as they return from war or remember what they’ve experienced, even if it was a long time ago
  • Make it as easy and low-pressure as possible for veterans to come to you, and try not to feel offended if they don’t take you up on it or back out at the last minute

 

When to suggest additional support & resources for support

  • If you think that someone is at risk of suicide or harming others:
    • a veterans’ hotline is 1-800-273-8255, then PRESS 1 or visit http://www.veteranscrisisline.net/
    • Encourage them to go (or take them if they agree) to the local VA medical center, where they can go regardless of discharge status or enrollment in other VA healthcare; if there isn’t one nearby, encourage them to go to a hospital Emergency Room (and call their therapist if they have one)
  • Indications of depression, such as withdrawing from family or community when someone had previously been more engaged, outbursts of anger or irritability, increased use of alcohol, etc.

 

Resources: