Lee was a platoon sergeant serving in Afghanistan. He was an older non-com who had been an E-7 for a while, but he took seriously his responsibility to train and care for the soldiers in his unit. Most of them were young enough to be his sons. He was also committed to helping his lieutenant achieve excellence in command, offering both advice and support as necessary. When Lee received word that a close family member had died in the States, he was offered compassionate leave. He struggled with the decision to go home, but eventually took two weeks to return for the funeral and to help his family. While he was absent from his unit, the platoon came under a rocket barrage. Three of Lee’s soldiers were killed. Lee felt as if these deaths were his fault: if he had been present, he might have been able to protect his soldiers. The sense of having failed in his duty cut to the core of Lee’s identity. Not only did he feel overwhelming guilt and shame, but he also saw himself as less of a soldier and less of a man. Assurances from his chaplain and even from the families of the deceased did nothing to diminish these feelings.
Sarah was an emergency physician practicing in a remote rural hospital. She was the only ER doc on staff. While she usually had a nurse available, Sarah had to do triage herself. It was rarely a problem until COVID struck. Suddenly, the hospital was overwhelmed. Sarah found herself working long days with little sleep. She felt as if she was barely able to manage. Then one night four patients were rushed in simultaneously from a multi-car crash. One had sprains and a broken arm. The other three were all much more seriously injured. While any of the three could be saved, Sarah knew that she didn’t have the resources to save them all. The patient with the worst injuries was going to consume so much time that the other two would be neglected and might die. Sarah made the choice to focus on the other two, and her choice resulted in the death of the one. Rationally, Sarah knew that she had made the right choice, but the patient who died was the mother of the two who survived. Sarah began to see the woman in her dreams, always with an accusing expression. She felt acute guilt at a choice that had allowed the woman to die. She wondered whether there was any point in becoming a doctor if she was not going at least to try to save all her patients.
Eddie was a Marine sniper, and he was very good at his job. With his finely tuned rifle, he could consistently deliver precision shots to targets over a mile away. One shot, however, lingered in his memory. Eddie was occupying an overwatch position to cover troop movements. From a nearby building emerged a child carrying a grenade. The child walked purposefully in a direction to intercept a fire team. The marines could not see the child from their position. Under the rules of engagement, this child was armed and presenting an imminent threat to the troops. Eddie watched the child through his scope, and at the last possible moment he took the shot and eliminated the threat. Eddie’s first, visceral reaction was to think, “I’ve killed a child.” That thought haunted him afterward. He kept replaying the situation in his mind, wondering whether he could have done something else. While he could think of no good alternative, his sense of guilt and shame continued to grow until it was overwhelming. He saw himself taking that shot over and over again in his nightmares. When he woke up from those dreams, he could barely breathe. When his enlistment was up, Eddie left the Marines, but he could not find peace.
While their situations differed, Lee, Sarah, and Eddie had much in common. All made choices that seemed justifiable under the circumstances. Afterward, however, all felt that the results of their choices were morally unacceptable. No amount of reasoning or justification removed the sense of having done wrong, of having violated some fundamental moral obligation. All felt themselves to be diminished as persons: each suffered some loss of identity. All of them became less able to function as professionals and as humans because of the guilt and shame that they carried.
What these people experienced is now being described under the label Moral Injury. This is a relatively new label that tries to distinguish a particular combination of responses from the older category of Post Traumatic Stress Syndrome. The current consensus seems to be that these are overlapping but not identical problems. The effects of Moral Injury are often experienced among people who work in the military, in emergency services, and in health care, but they can occur as the result of any circumstance in which people make choices that they feel are contrary to their moral commitments.
Moral Injury is an old problem with a new label—so new that it is not even listed in the current edition of the Diagnostic and Statistical Manual, the authoritative work for mental health professionals. Nor has it been much described or discussed within the biblical counseling movement. It is a topic that most pastors know very little about. That is unfortunate, because almost every church has at least one Lee, Sarah, or Eddie.
We at Central Seminary want to provide our students and our pastor friends with an introduction to the category and an initial look at one possible Christian response. We have invited Chaplain (Col) Chris Melvin, State Chaplain for the Arizona National Guard, to lecture on this topic. Chaplain Melvin has the academic qualifications: his doctoral studies focused on Moral Injury. He also has the practical experience, with two tours in Afghanistan and one in the Horn of Africa, besides his ongoing ministry in the National Guard.
You can hear Chaplain Melvin at Central Seminary’s Fall Conference on Tuesday, October 15. The first session begins at 0830. There is a small charge if you attend in person, but breaks and lunch are included. You can register for the conference here. We would love to welcome you to this event.
For a Soldier in a Camp
Anonymous
Be thou my safeguard, O my God!
My refuge, tow’r and shield;
The tents of war are my abode,
Set in this martial field.
Am I protected by the Lord,
Amidst the loud alarm;
And wreathings of the bloody sword,
My life is kept from harm.
Should thousands drop on ev’ry side,
And strangle in their gore;
Yet thou my God canst still provide,
That I may be secure.
Make thine almighty arm my trust,
Let me on thee depend,
Whilst I’m in duty bound and must:
My country’s cause defend.
Make me resign’d unto my fate,
And patiently to bear,
With all the trials, I may meet,
And hardships of a war.
For Jesus’s sake my sins forgive:
Cause me thy love to know;
Teach me a Christian life to live,
As Christian soldiers do.
I trust unto thy providence,
Thy promises I plead;
My life is safe in thy defense,
In ev’ry time of need.
And should it be my lot and fate,
Here to resign my breath;
May I be in that happy state:
To die with living faith.
