This collection of testimonies from both veterans and nonveterans alike shares personal reflections on very difficult times in each of their lives when violent and traumatic experiences changed them forever. We hope it gives our readers insight on how our contributors survived these most difficult times and gives hope to those suffering the consequences of post-traumatic stress disorder (PTSD) and moral injury.

PTSD has been widely discussed in our culture over many decades, particularly after Vietnam. The term PTSD is relatively new; however, the aftermath and symptoms are not. Literature, going back hundreds of years, has revealed traumatic experiences and the symptom’s effects on their characters’ lives.

Our country’s history has long recognized the psychological effects of trauma and terminology evolved as the medical community learned more about the aftereffects upon veterans. In the mid to late 19th century, the term “nostalgia” was embraced to describe soldiers experiencing mental trauma such as sadness, homesickness, sleep problems, and anxiety. This became the model of psychological trauma in the Civil War.

With the advent of World War I, “shell shock” became the term adopted to describe the effects constant artillery bombardment had on soldiers. It was believed that brain damage resulted from shelling. Panic and sleep problems were widely recorded among soldiers being treated. Thinking changed when more soldiers who were not experienced to shelling were also having the same symptoms, which then described as “war neuroses.”

During World War II, shell shock was replaced with the term “battle fatigue.” Exhausted soldiers were constantly on the go and fighting in unimaginable conditions which took an inevitable toll on them. Many of our military commanders did not recognize battle fatigue as a real problem, General George Patton being prominent among them.

The present-day terminology of PTSD came to existence in 1980 when the American Psychiatric Association (APA) added this to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The inclusion of this term resulted from studies involving returned Vietnam veterans and others. The links between war trauma and the trauma survivors was finally established.

Moral injury is closely intertwined but distinct from PTSD. The Moral Injury Project at Syracuse University describes it as follows:

Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.

Moral injury is not new as a concept. Basically it is as old as war itself. Literature and history have many recorded instances of moral injury and the ethical dilemmas which our warriors experienced and endured. Examples of moral injury in wartime are typically:

• using deadly force in combat and causing the harm or death of civilians knowingly but without alternatives or accidentally;
• giving orders in combat that result in the injury or death of a fellow service member;
• failing to provide medical aid to an injured civilian or service member;
• returning home from deployment and hearing of the executions of cooperating local nationals;
• failing to report knowledge of a sexual assault or rape committed against oneself, a fellow service member, or civilians;
• following orders that were illegal, immoral, and against the rules of engagement (ROE) or Geneva convention;
  and
• a change in belief about the necessity or justification for war during or after one’s service.

Coping with moral injury is challenging because of its profound and deep effects on those who experienced it. Moral injury must be recognized across our nation, and caregivers need to be aware of its effects. Communities are encouraged to listen and encourage those suffering from moral injury. Numerous avenues are available to aid in comforting and confronting moral injury victims. Common therapies and activities can include art, writing or journaling, religious dialogue, and peer discussion groups as examples. Further discussion follows in this guidebook. As we go forward, it’s okay to not be okay!

Richard Dorn
Editor