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Subscribe to RSSA veteran of the wars in Iraq and Afghanistan, former Marine Capt. Timothy Kudo thinks of himself as a killer — and he carries the guilt every day.
"I can't forgive myself," he says. "And the people who can forgive me are dead."
With American troops at war for more than a decade, there's been an unprecedented number of studies into war zone psychology and an evolving understanding of post-traumatic stress disorder. Clinicians suspect some troops are suffering from what they call "moral injuries" — wounds from having done something, or failed to stop something, that violates their moral code.
Though there may be some overlap in symptoms, moral injuries aren't what most people think of as PTSD, the nightmares and flashbacks of terrifying, life-threatening combat events. A moral injury tortures the conscience; symptoms include deep shame, guilt and rage. It's not a medical problem, and it's unclear how to treat it, says retired Col. Elspeth Ritchie, former psychiatry consultant to the Army surgeon general.
"The concept ... is more an existentialist one," she says.
The Marines, who prefer to call moral injuries "inner conflict," started a few years ago teaching unit leaders to identify the problem. And the Defense Department has approved funding for a study among Marines at California's Camp Pendleton to test a therapy that doctors hope will ease guilt.
But a solution could be a long time off.
"PTSD is a complex issue," says Navy Cmdr. Leslie Hull-Ryde, a Pentagon spokeswoman.
Killing in war is the issue for some troops who believe they have a moral injury, but Ritchie says it also can come from a range of experiences, such as guarding prisoners or watching Iraqis kill Iraqis as they did during the sectarian violence in 2006-07.
"You may not have actually done something wrong by the law of war, but by your own humanity you feel that it's wrong," says Ritchie, now chief clinical officer at the District of Columbia's Department of Mental Health.
Kudo's remorse stems in part from the 2010 accidental killing of two Afghan teenagers on a motorcycle. His unit was fighting insurgents when the pair approached from a distance and appeared to be shooting as well.
Kudo says what Marines mistook for guns were actually "sticks and bundles, like you'd seen in old cartoons with hobos." What Marines thought were muzzle flashes were likely glints of light bouncing off the motorcycle's chrome.
"There's no day — whether it's in the shower or whether it's walking down the street ... that I don't think about things that happened over there," says Kudo, now a graduate student at New York University.
"Human beings aren't just turn-on, turn-off switches," Veterans of Foreign Wars spokesman Joe Davis says, noting that moral injury is just a different name for a familiar military problem. "You're raised 'Thou shalt not kill,' but you do it for self-preservation or for your buddies."
Kudo never personally shot anyone. But he feels responsible for the deaths of the teens on the motorcycle. Like other officers who've spoken about moral injuries, he also feels responsible for deaths that resulted from orders he gave in other missions.
The hardest part, Kudo says, is that "nobody talks about it."
As executive officer of a Marine company, Kudo also felt inadequate when he had to comfort a subordinate grieving over the death of another Marine.
Dr. Brett Litz, a clinical psychologist with the Department of Veterans Affairs in Boston, sees moral injury, the loss of comrades and the terror associated with PTSD as a "three-legged stool" of troop suffering. Though there's little data on moral injury, he says a study asked soldiers seeking counseling for PTSD in Texas what their main problem was; it broke down to "roughly a third, a third and a third" among those with fear, those with loss issues and those with moral injury.
The raw number of people who have moral injuries also isn't known. It's not an official diagnosis for purposes of getting veteran benefits, though it's believed by some doctors that many vets with moral injuries are getting care on a diagnosis of PTSD — care that wouldn't specifically fit their problem.
Like PTSD, which could affect an estimated 20 percent of troops who served in Iraq and Afghanistan, moral injury is not experienced by all troops.
"It's in the eye of the beholder," says retired Navy Capt. William Nash, a psychiatrist who headed Marine Corps combat stress programs and has partnered with Litz on research. The vast majority of ground combat fighters may be able to pull the trigger without feeling they did something wrong, he says.
As the military has focused on fear-based PTSD, it hasn't paid enough attention to loss and moral injury, Litz and others believe. And that has hampered the development of strategies to help troops with those other problems and train them to avoid the problems in the first place, he says.
Lumping people into the PTSD category "renders soldiers automatically into mental patients instead of wounded souls," writes Iraq vet Tyler Boudreau, a former Marine captain and assistant operations officer to an infantry battalion.
Boudreau resigned his commission after having questions of conscience. He wrote in the Massachusetts Review, a literary magazine, that being diagnosed with PTSD doesn't account for nontraumatic events that are morally troubling: "It's far too easy for people at home, particularly those not directly affected by war ... to shed a disingenuous tear for the veterans, donate a few bucks and whisk them off to the closest shrink ... out of sight and out of mind" and leaving "no incentive in the community or in the household to engage them."
So what should be done?
"I don't think we know," Ritchie says.
Troops who express ethical or spiritual problems have long been told to see the chaplain. Chaplains see troops struggling with moral injury "at the micro level, down in the trenches," says Lt. Col. Jeffrey L. Voyles, licensed counselor and supervisor at the Army chaplain training program in Fort Benning, Ga. A soldier wrestling with the right or wrong of a particular war zone event might ask: "Do I need to confess this?" Or, Voyles says, a soldier will say he's "gone past the point of being redeemed, (the point where) God could forgive him" — and he uses language like this:
"I'm a monster."
"I let somebody down."
"I didn't do as much as I could do."
Some chaplains and civilian church organizations have been organizing community events where troops tell their stories, hoping that will help them re-integrate into society.
Some soldiers report being helped by Army programs like yoga or art therapy. The Army also has a program to promote resilience and another called Comprehensive Soldier Fitness to promote mental as well as physical wellness; some clinicians say the latter program may help reduce risk of moral injury but doesn't help troops recognize when they or a buddy have the problem.
Nash says the Marines are using "psychological first aid techniques" to help service members deal with moral injury, loss and other traumatic events. But it's a young program, not uniformly implemented and just now undergoing outside evaluation for its effectiveness, he says.
At Camp Pendleton, the therapy trial will be tailored to each Marine's war experiences; troops with fear-based problems might use a standard PTSD approach; those with moral injury may have an imaginary conversation with the lost person.
Forgiveness, more than anything, is key to helping troops who feel they have transgressed, Nash says.
But the issue is so much more complicated that wholesale solutions across the military, if there are any, will likely be some time coming.
Many in the armed forces view PTSD as weakness. Similarly, they feel the term "moral injury" is insulting, implying an ethical failing in a force whose motto stresses honor, duty and country.
At the same time, lawyers don't like the idea of someone asking troops to incriminate themselves in war crimes — real or imagined.
That leaves a question for troops, doctors, chaplains, lawyers and the military brass: How do you help someone if they don't feel they can say what's bothering them?
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can say something
, just if you can put in this kind of prospective , if you have some pet geese they your freind they dont really like to many people but you , but a bobcat wants to eat them ,
do i not shoot the bobcat that is looking at me a real nice looking cat , but i say you no if i dont kill that cat,
its going to kill my geese, so i shoot um,
i didnt like i had to kill the cat really i didnt really want to, but i did , then i had a hen pet hen size of a pidgen really cool called her mini pearl, she was with me and i saw the other birds fling from below and mini was not beside me, i called mini , now where she was gone, so i wait the next day and i killed that bobcat ,
and i dont fill bad at all,
ok be safe
im out
Well, Sir it only makes sense to protect your friends and those in your charge because failing to do so is a fate worse than death. When in doubt lay them out, because it's easier to justify why you neutralized a potential threat then it is to explain why you allow your follow troops/friends/family/whatever to die. Often in life it's easier to ask forgiveness for what you needed to do than ask permission to do what must be done.
People amaze me sometimes. Did they not know when they joined the military (especially those who joined after the wars started) that the potential they would be in combat was pretty good? Face it, that is what the military is for, to kill people your government tells you are your enemy. If you can't stomach that, you shouldn't join. I'm glad they have morals, but I wonder about their common sense.
Of course there is moral injury. Because we need to follow a higher calling than our government. How a religion or a chaplain can do anything other than advise people to NOT go to war is inconceivable. It's "Do Not Kill" not "Do Not Kill unless your government says it's ok." This is more of the mess that Bush/Cheney have left as their legacy. Not only was the Iraq war a lie, it has been known to be a lie for some time. Soldiers who participated in that war should not be looked up to by our society. Refusing to participate would have been the heroic thing to do. You wouldn't have a guilty conscience for refusing.
Well, Sir it only makes sense to protect your friends and those in your charge because failing to do so is a fate worse than death. When in doubt lay them out, because it's easier to justify why you neutralized a potential threat then it is to explain why you allow your follow troops/friends/family/whatever to die. Often in life it's easier to ask forgiveness for what you needed to do than ask permission to do what must be done.
Raincheck: "Soldiers who participated in that war should not be looked up to by our society. Refusing to participate would have been the heroic thing to do". REALLY???? I was once a man known as "Trigger Mike" I was an instrument of the people just as a carpenter's hammer feels no pain when used to drive a nail nor any shame when used to crack a skull for it's the carpenter that decides and as such so is the guilt all upon the carpenter and in this case the ones that used the military as their hammer and the ones that allowed it to happen.
I signed up to serve my country it mattered little how I served, where I served, or the reasons for the need of my service. My country told me how to serve, the American people told me where to serve by ALLOWING IT. For if the AMERICAN PEOPLE did not support the, who, what, when , and where of my service THEY SHOULD HAVE STOPPED IT. But, they by reelecting mostly the same people to public office and not demanding a change of direction reaffirmed that I was fulfilling the wishes OF THE PEOPLE OF THE UNITED STATES for I was but just their instrument. For we service men & woman may have been holding the rifle BUT IT WAS THE AMERICAN PEOPLE THAT PULLED THE TRIGGER. Now if any of you feel regret for what has happened than look no farther than your own mirror for where to place the blame and you and all like you alone should feel the shame.
BULL@!$%#! The people that are THE MOST TRAINED to use a gun, is being told they cannot have a gun? This is ridiculous!
This is the ultimate war wound. War is an ugly thing. When you serve, you believe you serve for a moral reason. Yet you find that war has no true morality. It is human beings killing other human beings. Every single person who dies had a reason to live. And in the end, you are stuck with the realization that no matter what the cause or the rightness of that cause, you have still had to kill people to advance that cause.
The ultimate immorality is the taking of another human life. Yet we send young men and women off to war and tell them that the injunction against killing is temporarily on hold. The rules have been changed. It is a tribute to these veterans that they feel guilt. It affirms their innate decency and humanity.
War is not a glorious adventure. It is an ugly, destructive and ultimately damaging experience. I worry far more for those who do not question themselves, do not question what they have been called upon to do.
Someday, in some distant Utopia, I hope we find a way to resolve conflict without killing one another. Because the price our brave men and women pay is always too high, not just in physical death and injury, but in emotional pain and injury. It is a lifetime of regret and second guessing. Do we really have the right to inflict that pain on anyone? Do we have the right to ask that of anyone?
"We don't know..." how to deal with it? D'oh? Are "we" stupid? Are "we" suffering from some sort of selective amnesia?
There are known ways of dealing with guilt. Confession for some, therapy for others, working to help other people in order to find some expiation, seeking forgiveness spiritually or from others, just talking about the incidents that have caused the feelings of moral failure, and then talking about them some more, each telling defusing some of the intensity.
The problem isn't that the VA or whoever is dealing with these sorts of problems don't know how to help. The problem is that they refuse to do it. It is taking up to two years for some veterans' claims for disability or assistance to be dealt with. With luck (I say this with irony), they'll kill themselves before the VA has to spend any money on these men and women who fought under our flag and had promises made to them about their compensation for doing so.
We, the people, can all help our returning veterans by giving them jobs, offering them friendship and paying attention to what is going on with them -- or what is NOT. If we forgive them for doing what soldiers are trained and ostensibly paid to do, and making it clear that our forgiveness comes with no strings, maybe they will choose a method to help them to find their own forgiveness .
This is not just a problem for individuals. Waving flags and yelling, "Wooo hoooo!" and "Welcome home!" isn't enough. We need to acknowledge what has happened to those who fight our foreign wars while we're at home watching TV, going to the mall, worrying about who's going to be voted off the island or why Lilo just can't seem to get it together.
Helping our men and women of the armed services re-integrate into their dropped lives and our society is everyone's problem -- not just the VA's, not just their families' or neighbors' problems.
"No man is an island.
Each is a piece of the continent,
A part of the main. ...
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee."
(John Donne, 1624)
Evidently, the writer has trouble counting past 10 when he writes: "With American troops at war for more than a decade". We have been constantly at war, somewhere in the world, for OVER HALF A CENTURY!!! Yet we haven't been attacked by any COUNTRY since WW2. We are the only country that has its military stationed all over the world in other countries.
And people have trouble understanding why some of us have moral issues with that? My question is: Why don't all Americans have trouble with that? We don't like to have foreign military stationed in our country, yet it is perfectly alright for us to put our military in other countries - talk about a double standard.
This is an issue that will never be resolved. We want the men who enter our armed forces to have a conscious. However, for certain individuals to have moral issues with death , be it an enemy or a fellow soldier , cannot be solved. I am chilled by the thought of one ' solution: to only have individuals who have no qualms over killing become soldiers. But, we may be getting closer to that possibility with research being done on armed drones capable of independent action. Research is actually looking into this.
Seems to me that this guilt problem is bound to be more pronounced if a soldier fights in a war that, in retrospect, was totally unnecessary...like most of America's wars.
I will grant you that, Leroy. It may have been easier for the soldiers to sleep easier from World War II then say our latest conflicts, but killing and seeing other killed in combat, friend or foe, I never thought of as easy.
Agreed Steve, that's why I specifically referenced the guilt problem and not the other two legs.
An excellent overview of the topic. In my daily work with combat veterans, I do find that some have come to some peace with their actions; some, anything but. For most of them, though, they can still be so blown away by the arbitrariness of War, the decisions that had to be made so quickly, often by those who are so young. And some come to "peace" with their decisions while still being troubled by them, over and over, for years.
"Moral injury" shows so well what, I believe, standard treatments for PTSD show less well: recovery from the wounds of War is always interpersonal. Combat veterans need to feel that they have been brought back into a community, understood as well as possible, listened to. As a society, whether religious or not, we inculcated values into these men and women. In my opinion, we owe it to them to take responsibility for those values ourselves--and listen and stay with them as long as is necessary.
Rodney Deaton, MD, JD
www.ptsdandcombat.com
The horrible things veterans can go though have been well documented for generations. Don't want to risk it? Then don't join the military. But don't expect to live off taxpayer dime for the rest of your life because you got PTSD. Last time I checked it's an all volunteer force so nobody made you sign up.
Paul: what I can tell from what you said to me is that you are smug
you have little idea about what Cpt Kudo is dealing with nor what most striken vets go through- you have no idea about nightmares- you never saw intense, unrelenting combat and spent night after night under threat of execution- you have no idea of what DMZ was like in 1960s
I can easily tell who lives w hell
There are just too many smug commentors here
war is just an abstraction to the majority of you and you have your ways of being facetious and sarcastic
and Joe Scatone, just because it is a volunteer force DOES NOT mean that these young men and women should be tossed into immoral wars
I got nothing out of the comments here because few have any idea what Cpt Kudo is talking about- same story- most Americans are superficial- go back to your television sets and NASCAR and sitcoms
and I no longer care what "my fellow Americans" have to say because most of you are clueless ; hard striken vets know it; so go ahead Paul- insult me more
one of my closest buds in Corps was Jewish and I am sitting here w Jewish friend and Irish friend sipping a few beers so take your devious mind and direct it elsewhere and go learn a little about PNAC
The Brady bill issue would only come up if you were found incompetent by VA standards. Which means that a doctor has to find that you are not competent to handle your own affairs, because of physical or mental issues. Very few veterans are found incompetent and if you are found incompetent you can supply other medical opinions to counter the finding. At the point that you are determined incompetent, the Brady bill provisions regarding firearms is applicable but you can also ask for a waiver to it. This is a provision of the law that was passed into law by congress that the VA must abide by. A finding of service connection for PTSD does NOT automatically result in a finding of incompetency. As a matter of fact, the VA would only propose to find a vet incompentent if a doctor told them that the vet was. You have to read this law in context or be left with erroneous beliefs regarding the issues it addresses.
This is only one of the sacrifices our brave soldiers make for their country. We can pray we can offer comfort we can show them the love they need. Our soldiers have been holding at bay an insane evil that threatens the entire world. It is very disheartening when they are used by our government for purposes other than to defend the innocent. Pray for them.
A war conceived on utter lies by Dick Cheney, Paul wolfowitz cabal , fanned by hate mongerers like Right wingers tea partyer,s and Zionist lobby and fought by armchair quarterbacks was going to extoll a heavy pric eon our beloved and heroic field fighters. I pray for them to stay mentally and physically healthy .
thanks Milton
How many americans have heard of PNAC and that cabal that started 2003 Iraq War
I served 10 years in the US ARMY, and saw combat in Desert Storm. I have a completely clear conscience asshould any other soldier that honorably serves their country. This is a s*** story about people with no backbone who should noy have been accepted into the service in the first place...US ARMY 1982-1992, Desert Storm Vet, 1/41 Inf 2AD(fwd)..Proud to have killed Iraqis that were slaughtering innocent civilians in Kuwait..
Bill if you were never be put in a situation where you watched innocents die and ordered to do nothing then you were fortunate. Even worse would be to be ordered to shoot an innocent civilian. It has happen. I would agree with you that it does take a special strength to deal with the horrors of war and not everyone has that kind of strength. Those who lack this type of strength would better off not being accepted into the armed services. This strength is probably more rare than we realize. Our brave soldiers have been fighting an insane evil for decades and deserve to be honored and loved for their sacrifice.
Bill the way things are going in the US you may have to defend civilians again. I pray it never comes to that.
Will I get better parking places if I can get a sticker stating that I'm morally handicapped?
I feel for all the brave men and women who were in afgan. but my Late Husband was in nam and when they came home they were called Baby Killers Were you?
Were you called baby killers when you got off the plane when you came home, well the men were who went to nam.
Sharrron, the baby killer, spat on story that is continually repeated as if that happened to every Vietnam vet when he returned is largely a proven myth. Google "The Spitting Image " I for one can tell you that after I returned from Iraq and Afghanistan, had I been spat on or even seen someone spit on a fellow service member I would have knocked their teeth out of there head and happily spent the next week or 2 in the county jail with a smile on my face. It has become accepted as common knowledge by the population that it actually happened and was the norm because it has been told so often that it has to be true....doesn't it ? Its just not credible that a guy who just spent 12 months at war facing the brutally sadistic Viet Cong would suddenly become timid at the mere sight of a Tye dye t shirt wearing, hygiene challenged pot smoking Hippie ! Really......
Hey Marine when you go to war you go under orders and those that give the orders and start these wars are the guilty brother not you. Marine if you find foregiveness in your heart for others then you should be able to find foregiveness for you Sir. War changes people for the rest of their days, the idea is to use it to make things better for those coming behind you Sir and you being a Marine there is no doubt in mind that you can get it done. I and many like me thank you for your service to your country and her citizens, you Sir are a good Marine and we love you and care about you and your family.
Dave Johnson: Great comments. The "Chicken Hawks" don't want Chuck Hagle as Sec. of Defense, because he might know too much about the real costs of war. He knows that wounds and death, while necessary in war, are real and individual. He knows that "ground troops" are more than red or blue blocks being moved around the map from the comfort of politician's comfortable leather chairs. He knows that our country should use WAR as a last resort. He knows that politicians do not fight the war, they too often benefit from it both politically and financially. He understands that as a civilized society we should have advanced from the Middle Ages, when the combat soldier, the front line soldier, the grunt, were considered only as "Cannon Fodder" to achieve a country's political and economic ends. We, after all, are appointing a Secretary of Defense, not a Secretary of WAR. War is hell, unless you don't have to risk your life and benefit from its spoils.
Republicans and conservatives don't have a moral capacity and enjoy sending people into war to kill other people.