The Cost of Moral Injury (originally published in 2012)

I've been thinking about my dad a lot today.  He was a member of the 10th Mountain Division ski troops during WWII.  He was one of the very few in his regiment to come home alive.  He returned with a Silver Star, a Purple Heart, and a broken soul.  He became a life long advocate for peace.  He also never spoke about his experiences during the war.

He'd tell funny stories about training at Camp Hale, located in the heart of the Rocky Mountains - elevation 9,300 feet.  How the men, already elite skiers, were taught mountain climbing and snow survival skills.  How they burned so many calories during training that they were each given half a pie for dessert.  They were also given free cigarettes and since my father didn't smoke, he'd trade his for more pie.  He said one night he ate 3 whole pies and he was still hungry.  I believe it.

One of the few photographs I have of him from that time shows a very handsome, lean man standing on the side of a snow covered mountain with his wooden skis slung over one shoulder.  He was smiling widely and looked relaxed and carefree.  The photograph was made at Camp Hale before he shipped out.

Once these men arrived in Northern Italy, they did things I have difficulty imagining.  Scaling the 2,000 foot vertical sides of Riva Ridge in the Apennines mountains in the dark of night... while carrying all their gear, skis, and guns with only strap on metal crampons attached to their boots.  I learned that from an old 10th Mountain Division newsletter.  I didn't learn it from my dad because my dad couldn't talk about the war.  Once, when I told him I was going to an anti-war protest in 2003 prior to the beginning of the Iraq War, he quietly said - "that's a really good thing you all are doing.  If only everyone understood that war is the hardest on women and children..."  his voice trailed off and when I asked what he meant - he changed the subject.

The men of WWII were in a tough place when they came home.  They were heroes of "the Good War" and culturally conditioned not to talk about feelings.  So they kept them inside.  They didn't talk about PTSD then.  There wasn't a lot of information available about coping with the horrors of war when they returned home.  So they stayed silent and in my father's case, busy.  He threw himself into his work and his hobbies.   He didn't allow himself time to reflect or remember.

By the time he met my mom, he had gotten pretty good at doing the things that society said a man must do.  He had a good job.  He drove a nice car.  He even got his pilot's license.  He also came home from the war with a temper and you never knew when he would yell.  He was obsessive about security when we were home alone without him.  He installed many locks and would get very upset if he came home and discovered we had missed one.  I remember one time I overheard him yell at my mom "You don't have any god damn idea what they could do to you and Suzi do you?!?"  I didn't really know what he meant, but it scared me - I could tell whatever it was, it was very bad.

I knew something was wrong with my dad, I just never really knew what it was.  Now I do.  My dad was suffering from moral injury.  What is moral injury?  Dr. Gabriella Lettini and Dr. Rita Nakashima Brock, authors of the recently released book "Soul Repair: Recovering from Moral Injury after War" define moral injury as "a negative self-judgment based on having transgressed core moral beliefs and values or on feeling betrayed by authorities. It is reflected in the destruction of a moral identity and loss of meaning. Its symptoms include shame, survivor guilt, depression, despair, addiction, distrust, anger, a need to make amends and the loss of a desire to live."

Dr. Brett Litz, a clinical psychologist with the Department of Veterans Affairs defines a moral injury experience as "perpetrating, failing to prevent, bearing witness to or learning about acts that transgress deeply held moral beliefs and expectations."
Litz and his colleagues are advocating for an increase of research into the issue of moral injury.  They argue that "service members who don't talk to loved ones, clergy or some other confidant will become convinced what they did is unforgivable, leading to recognized symptoms of withdrawal, self-condemnation and avoidance."

My father, like many men who came home from WWII, didn't talk to anyone.  His unrecognized injury destroyed my parent's marriage.  They divorced when I was 4.

When I was 6, my father married my beloved step-mom Cynthia.  For the first time in my life, I saw glimpses of the man my dad must have been before the war.  They were never apart from the time they got married until her death decades later.   Even so, with the exception of Cynthia, he was still emotionally distant and even though we would do things together, I always felt like there was a barrier between my dad and the rest of the world.

Decades later, I took care of Cynthia when she was in hospice and we had many deep conversations.  One day I finally got up the courage to ask her about my dad- why he was distant.  She grew quiet and then said "First, you need to know your dad loves you very much.  When we met, we were both carrying very heavy burdens.  We were able to share them with each other.  He knows I love and see ALL of him.  I know he loves and sees ALL of me."  She then told me that the war had come close to completely breaking him and before they met, only his incredible will and strength kept him together.

After Cynthia died, my dad and I spent a lot of time together.  He still didn't talk about the war.  When he was 90 I went to visit him and he suddenly started to cry.  I had only seen my dad cry once before-- when Cynthia died.  I just held him while he cried and he finally cried out "I'm so glad you do what you do.  I wish I'd had the courage to go throw my medals in Bush's face!"  That was all he said.  But it was in that moment that I realized just how much the war had cost him.

We all count the deaths.  We all count the injured.  We all can calculate the dollars spent.  I wonder if we have ever calculated all that has been lost among the living?  How many men (and now women) return with parts of them missing - invisible parts that they cannot file a claim for?  How many men like my father lose their connection with those they love and the rest of society?  How many families never get to welcome home the person that left?  Never get to see their parent care free and smiling?  These are some of the costs of moral injury.  A deeper and more final cost is that many of those suffering from moral injury ultimately commit suicide.

I am grateful that my dad did not choose this path.  I am grateful he had moments free from anguish thanks to Cynthia's wisdom and love.  I recognize that many do not have those anguish free moments and my heart aches for them...and my heart aches for all the families who will never again know their loved ones without injured souls.  I  continue to do what I can to actively oppose war but now I do it with the image of my care-free and smiling dad firmly attached inside my heart.