Moral Injury Poses Hidden Risks for Service Members

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By Beth Schwinn, DCoE Public Affairs, March 11, 2015

Dr. William Nash addresses the Mental Health Integration for Chaplain Services program.

 

 

About 30 years ago, two Navy ships were approached by refugees begging for rescue who had escaped Vietnam in underequipped boats. At the time, so-called “boat people” rescues had become so frequent that they were taking Navy ships from their missions. Officers were directed to rescue refugees only when their crafts were not seaworthy.

Capt. Corwin Bell, in command of the USS Morton, a 415-foot Navy destroyer, decided to pick up the refugees since a storm was approaching. He was later reprimanded.

Capt. Alexander Balian of the USS Dubuque, a 16,500-ton amphibious transport vessel, decided the refugees’ wooden junk was seaworthy, gave them ample food and water and sent them on their way. Crew members reported pushing the desperate refugees off the lines as they attempted to climb aboard the Dubuque, the only ship that had stopped to help during their weeks at sea. When the junk’s survivors finally reached the Philippines, newspapers there reported that some had resorted to cannibalism after again running out of food. Balian was court-martialed and resigned his commission.

Decisions like these have a lasting impact on everyone involved and can affect the brain in the same way as posttraumatic stress disorder (PTSD), causing physiological and psychological damage, a phenomenon known as moral injury, says Dr. William Nash, a retired Navy psychiatrist. Moral injury likely affected many of those aboard the Dubuque or the junk that day, he said.

“Think about all of the people who were scarred for life or lost their lives because of this moral choice,” Nash told some 300 military chaplains and psychological health providers during a meeting of the chaplains working group, hosted by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. “It’s tragic, but it’s not unique. I’m sure we all know of choices that seem small at the time but end up having huge moral consequences.”

The term moral injury was coined in the aftermath of the Vietnam War, when psychiatrist Jonathan Shay, then with the Department of Veterans Affairs, used it to describe the reactions of Vietnam veterans to atrocities committed or condoned by their superiors. Nash and others have since extended the term to describe what service members experience when they themselves commit an act that violates their own beliefs—for example, when a service member kills a child who is shooting at him. Working group attendees offered other examples: cutting off the ears of fallen enemy combatants as souvenirs; not stopping to give food or water to civilians who may be concealing an improvised explosive.

Moral injury is not clinically defined nor captured as a formal diagnosis, and no clinical practice guidelines are available for it. However, health care providers in the military often address moral injury when treating a psychiatric disorder. Chaplains, frequently the first resort for service members struggling with moral issues, also counsel service members who experience moral injury.

Nash offered tips for treating and counseling service members with moral injury. It’s important to understand that the emotion underlying the injury is not fear, but shame, guilt, or outrage, he said.

Psychiatry defines PTSD as a fear-based reaction that can occur after a life-threatening event such as battle or rape. Exposure therapy, in which patients repeatedly relive the event to lessen the fear reaction, has been clinically shown to be effective for PTSD.

But exposure therapy can actually worsen moral injury, Nash said. Moral injury patients need to experience not safety, but forgiveness. Chaplains and behavioral health counselors can assist by helping them understand how much blame to bear (patients may either deny all blame or exaggerate their responsibility for an event), learn to tolerate their intense negative emotions, and figure out how to become useful members of their communities or make some other form of restitution. Other techniques used in treating PTSD, such as improving physical health, group therapy, or religious practice, can also be helpful, he said.

Moral injury has become a loaded term, in part because some see it as a judgment on the person who experiences the injury. In fact, Nash said, patients who experience moral injury are likely to be highly moral.

“Psychopaths don’t experience moral injury,” he said. Service members, with their ideals of duty and honor, may be especially vulnerable to this kind of injury, Nash said.

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We Bid Farewell to Al Russell, Director of Chaplaincy

[vc_row][vc_column width=”1/1″][text_output]193Al Russell will be retiring later this year, but it was decided to celebrate his 21 years of service to CBAmerica ministries and chaplaincy at the upcoming CBNW Annual Enrichment Conference. This is one of the largest gatherings of Conservative Baptists and you are invited to attend. The convention is March 9-11, and the retirement ceremony will take place during the evening session on Tuesday, March 10, 2015, at the Convention Center in Seaside Oregon. (See article below)

GO HERE for details and to register for the conference.

We plan to present them with gifts that they will find meaningful; one a framed painting, “The Way to Emmaus,” that will come with an engraved brass plaque honoring their service. Another gift we would like to present is a check for $6,800 towards the purchase of a three-wheeled vehicle. With changes in Carol’s health, Al had to give up the motorcycle they used to ride for pleasure. Al believes this will be a safe and fun way for them to travel in retirement, as it is light, economical, and easily towed behind their RV.

The CBA Board has authorized a special offering for the purchase of these gifts totaling $7,000. You are invited to participate in this “love offering.” We would also like to present a memory book with letters and photos of the Russells’ ministry over the years.

Please send checks payable to CBA or items for inclusion in the memory book to the CBAmerica office at 3686 Stagecoach Rd Unit F, Longmont CO 80504. Please mark everything “Russell Retirement.”[/text_output][/vc_column][/vc_row]

Chaplain Spotlight

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Chaplain Dave Lundell is the Supervisory/Lead Chaplain for the Veteran’s Health Administration in Tucson, Arizona. He is dedicated to providing chaplain support as a spiritual resource for Veterans.

He retired from active-duty military (Air Force and Army) as an Army chaplain with combat, prison and medical trauma experience. He has a background in social work and has over 30 years of military service including unit and pastoral ministry experience. The VA is committed to holistic care of our veterans, attending to their medical, psychiatric, social and spiritual well-being. Having Dave on board as a hospital inter-disciplinary clinical chaplain reflects this commitment.

Dave’s background helps him relate to what our veterans are experiencing when re-entering civilian and family life. His goal is to help them “glean the spiritual wisdom needed for successful post-military living, even with a past involving trauma.” From his experience, many veterans are open to “considering spirituality as part of their post-service quality-of-life, either personally or as part of a family.”

According to Dave, “(t)raumatic events associated with military service often raise questions about God and challenge one’s long-held beliefs. Spiritual distress may be experienced as anger, guilt, loss of intimacy, loss of joy, loss of a sense of purpose, sadness and a need for forgiveness.”

Dave invests much of his time doing in-patient visitation. But he is also available for out-patient consultation in his office. He wants to encourage and guide veterans so they can find spiritual and religious support. In addition to his consultation practice, he supports OEF (Operation Enduring Freedom-Afghanistan), OIF (Operation Iraqi Freedom), OND (Operation New Dawn) and PTSD (Post-traumatic Stress Disorder) patients and leads introductory PTSD & Spirituality groups as well as Attribute Meditation to build faith. He also leads a variety of topical Bible studies.

If you would like more information on how to contact Dave, please contact the CBA office.[/text_output][/vc_column][/vc_row]

CBAmerica Board of Directors Appoint New Director of Chaplaincy

At the 2014 January Board meeting, Rev. Allen Russell informed the CBAmerica Board of Directors of his plans to retire from his position as the Director of Chaplaincy in mid-2015. A search team was selected with a goal of appointing a new Director by January 1, 2015.  This would allow Chaplain Russell the opportunity to train and mentor his replacement. By early summer Chaplain Andrew Meverden was unanimously approved by the board as the new Director of Chaplaincy.

Chaplain Meverden’s experience dates back over 40 years of military and 35 years missionary, parachurch, and church involvement. He worked as a missionary in Portugal planting churches with the Conservative Baptist Foreign Mission Society (WorldVenture). He assumed the leadership of Santo Antonio dos Cavaleiros mission, developing national leaders, organizing churches and securing original church meeting facilities.

Reverend Meverden then worked as Director of Church Relations for Partners International in San Jose, California. When he became a Chaplain in the US Army Reserve.  Following this experience, he served as Assistant Pastor of Ministry Development at Calvary (Baptist) Church in Los Gatos, California, and then as Senior Pastor of Galilee Baptist Church in Denver, Colorado. While pastoring this 106 year old congregation, Chaplain Meverden was called to active duty in Afghanistan, as chaplain of the Colorado Army National Guard Green Berets.

After serving in Kabul, Afghanistan as Chaplain of US Army Special Forces, Chaplain Meverden became a management and program analyst at Joint Forces Headquarters in Centennial, Colorado, while continuing his part-time Guard Chaplaincy. He has served since 2007 as Command and Fulltime support Chaplain at Joint Forces Headquarters, Colorado. It is from this position that Chaplain Meverden will retire on December 31, 2014.

Col. Meverden and his wife, Myra, live in Aurora Colorado. They have been married 8 years and have 7 children and 8 grandchildren. Chaplain Meverden’s broad military, parachurch, and pastoral experience will be a great compliment to the CBAmerica program that Al Russell has built over the last 21 years.Andy and Myra Meverden