Veteran Suicide, Moral Injury and Five Promises

Nov 07, 2015

Based on a speech delivered by Dr. Kahn to Veterans in Politics, International Las Vegas, Nevada 8/27/2015     

How do we begin to have the conversations that will lead us in the direction of fulfilling the promises we have made to our soldiers and veterans? We have heard the facts and read the personal stories:

  • 22 American veterans commit suicide every day
  • Estimates of post-traumatic stress are quite variable or fuzzy since definitions and tracking methods vary; one respected study found 20% of veterans who served in Iraq or Afghanistan have post-traumatic stress
  • 19% of our veterans have Traumatic Brain Injury (TBI) which may be combined with depression
  • A survey of veterans found over 73% do not believe our soldiers and veterans are getting the healthcare and benefits they need; only 37% of female respondents felt positive or very positive about the VA’s care and treatment of women veterans
  • Sexual assault in the military may be experienced by 25% of active-duty women even though only 5% of those assaulted or harassed file reports
  • The Pentagon still does not have combat boots designed for women’s feet even though studies have shown putting women in men’s boots leads to stress fractures – pain and damage they simply cannot walk off

I recently published a comprehensive plan to transform the Department of Veterans Affairs so this deeply flawed agency may truly provide world-class services and a world-class delivery system of promised benefits. This plan requires more than turning around one federal department. The issues touch the very nature of how we as a nation approach war and peacebuilding in the 21st century.

These conversations about our veterans are more difficult than we may imagine since less than 1% of Americans age 18-55 are currently active-duty military. Adding in members of the Reserves, we still have only slightly more than 1% of the American population in the armed services. Compare this to World War II when about 15% of the adult population served in the military.

Many call these differences the “civilian-military gap” which is I believe is more than just numbers. We the American public are disconnected from the soldiers and veterans who go to war in our name and we are disconnected from the violence of warfare. And so we are not having national conversations about warfare and peace in the 21st century and America’s role around the world.

Significantly reducing veteran suicide and depression begins with an increase in the number and quality of mental health services and includes financial support for non-profit organizations run by veterans for veterans. Just as important as more services is recognizing the social and moral dilemmas of warfare – challenges that affect us all not just soldiers, veterans and their families.

We the American people must better understand what service and warfare means in the 21st century.  We must have the courage to talk about the real costs of war and stop the fantasy – the lie – that combat is morally safe. Putting the burden on our soldiers and veterans and their families to deal with the brutality of warfare is the coward’s way out for the rest of us.

Moral Injury

Most recently a new concept regarding combat trauma has gained traction:

moral injury is defined as the ethical damage done when we train our sons and daughters to kill others and deploy them to ambiguous combat situations. Moral injury is not the trauma of violent events; it is not post-traumatic stress. It is the psychological damage done when we as a nation force our soldiers to violate the code of ethics by which we raise our children.

Dr. Jonathan Shay, a psychiatrist who worked for more than two decades at the Veterans Hospital in Boston, is credited with coining the term moral injury. It is the psychological damage that occurs when battleground actions conflict with a soldier’s internal moral code. Shay has also written about his opposition to the term “post-traumatic stress disorder” or PTSD. He believes that combat stress is not a disorder or psychiatric illness; psychological trauma in battle is an injury with a range of symptoms. I fully agree with his views. When we train people to kill another human being we make moral demands. Combat is not morally safe.

From this perspective, moral injury is the social reality we all share when we do not as a nation acknowledge the ethical conflicts of warfare. This will only change when political and military leaders are more honest about the true hazards of war. Integrity in the White House means gut-wrenching honesty about all our national decisions and the unintended consequences we all face.

Jonathan Shay also writes about the importance of homecoming for our soldiers and better ways to welcome them home. We think we honor our veterans with parades and naming roads the Veterans Memorial Highway; this is lovely but not enough. Even veteran events hosted by and for veterans are not enough. We as a nation need to better connect with the people we send off to fight our wars and learn to listen without judgment to their stories of combat.

Many have written that Native American traditions for welcoming home tribal members from battle are more connected to the community and go deeper into both the trauma of warfare and the healing powers of community. There is much we can learn from these traditions and ceremonies for healing the warriors heart.  Perhaps the most important aspect of Native American ceremonies for returning warriors is that the whole community would listen to the stories of what had happened in battle. They would share in the burden of that knowledge, and communicate that what happened to you happened to all of us.

When we the American people separate ourselves from our veterans we do more damage. I have called for Conversations with America about war and peacebuilding in the 21st century for two reasons – to gather citizen input into foreign policy decisions and to bridge the gap that separates civilians from our soldiers and veterans. And those conversations have to include military leaders. The Pentagon has kept in place a culture that bullies soldiers who have concerns about combat or that humiliates soldiers who ask for help such as calling suicide prevention hotlines. We need to teach soldiers and military leaders at all levels to recognize the symptoms of combat stress – insomnia, depression, panic attacks and flashes of violent anger. We all need to recognize that asking for help is a sign of strength and an act of courage. We need to understand that feeling bad about what you did or saw in combat is not a personality disorder or a discipline problem; it is a normal reaction to an impossible task. As we work harder to welcome our veterans home, we must find ways to share the burden of memory.

Five Promises

From 2006 to 2011, I gave one lecture once a semester on “The Science of Peacemaking” at the National Defense University at Fort McNair in Washington D.C. in Ambassador John W. McDonald’s course on Conflict Resolution and Multi-Track Diplomacy. My respect and admiration for the commitment and courage of our soldiers and veterans remained steadfast (my dad was a Marine). Over those years, my understanding of the military culture evolved. The Ambassador had invited me back to the last two classes of the course to listen to the group presentations as the class applied their new learning to conflict situations around the world. Listening, I saw more than fighter pilots, engineers, physicians, physicists, intelligence specialists and other military experts. I saw young military leaders who were also extraordinary strategic planners and brilliant system thinkers. I came to believe we do not use their expertise very well (especially after they leave military service) and that we must employ our military leaders (young and more senior) across all government agencies.

I closed my comments at the Veterans in Politics, International meeting with this:

Tonight as an independent candidate for President of the United States, with a platform that states we will Transform America by Transforming Government, with a 7-track plan to re-boot all our agencies and build peace here at home and around the world, and as a candidate with a vision of ONE America that works for everyone with no one left out, I make these five promises to you:

My 5 Promises:

  • I will not send soldiers off to wars that do not have to be fought
  • I will bring veterans into my administration in leadership roles across all agencies
  • I will hold the VA accountable for change; I will use the Iraq and Afghanistan Veterans of America (IAVA) 2014 Policy Agenda as the federal blueprint for change; I will put in place every VA recommendation made by General Accountability Office; and I will demand weekly progress reports
  • I will talk about the true costs of war – the moral burden we place on all our soldiers – and I will ask our communities to truly bring our soldiers home, to welcome then into community activities – not just parades – to tell their stories in schools, churches, synagogues, mosques, senior citizen and recreation centers – to tell their stories so they understand their burden is our burden
  • I will call for our veterans to run for public office; we need your skills and we need your point of view

To call the Veterans Crisis Hotline dial 1-800-273-8255 and Press 1.

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