Moral Injury and US Army Social Work Officers
Main Article Content
Keywords
Moral injury, military social work officers, post-traumatic stress, spirituality, moral injurious events, deployment
Abstract
Uniformed social work officers, serving as healthcare providers and soldiers, are frequently confronted with the complex and conflicting responsibilities to uphold loyalty, duty, respect, and commitment to their unit’s mission while also upholding their professional and personal values, principles, and duties as social work professionals and servants of humanity. As Army social work officers return home, many carry spiritual and emotional wounds as warriors and healthcare providers. This paper discusses the results of a qualitative study that examined the occurrence of potential moral injurious events that social work officers experienced during their deployment in support of Operation Iraqi Freedom from 2007- 2009. The authors also examine the challenges that these healthcare professionals experienced, resulting in a potential existential crisis that was caused by the wounding of their soul.
References
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Barnes, H.A., Hurley, R.A., & Taber, K.H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. Journal of neuropsychiatry, 31(2)98-103. Doi: 10.1176/appi.neuropsych.19020036
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James, W. (1968). The self. In C. Gordon & K. J. Gergen, (Eds.). The self in social interaction (Vol. 1, pp. 41–49). Wiley & Sons.
Jung, C. G. (1990). The archetypes and the collective unconscious. Princeton University Press.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war Veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695-706. https://icds.uoregon.edu/wp-content/uploads/2015/03/Litz-et-al-2009-Moral-Injury-and-Moral-Repair-in-War-Veterans.pdf
MacNair, R. (2002). Perpetration-induced traumatic stress in combat veterans. Peace & Conflict, 5(1), 63–73. https://doi.org/10.1207/S15327949PAC0801_6
Mental Health Advisory Team (MHAT-V). (2008) Operation Iraqi Freedom 06-08: Iraq: Operation Enduring Freedom 8: Afghanistan. Retrieved from http://www. armymedicine .army.mil/reports/mhat/mhat_v/mhat-v.cfm.
Nasarov, A., Jetly, R., McNeely, H., Kiang, M., Lanius, R., & McKinnon, M. C. (2015). Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatrica Scandinavia, 1-16. DOI: 10.1111/acps.12406
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652. DOI: 10.7205/MILMED-D-13-00017
Padgett, D. K. (1998). Qualitative methods in social work research: Challenges and reward. Sage.
Pearson, C. (1991). Awakening the heroes within: Twelve archetypes to help us find ourselves and transform our world. HarperCollins.
Pearson, C., & Marr, H. (2003). A guide to interpreting the Pearson-Marr Archetypal
Indicator instrument. CAPT Publishing.
Platoni, K. (2018). The moral injuries of war. The American Institute of Stress Combat Stress, 9(3), 4-6. www.stress.org/wp-content/uploads/Newsletter/Combat%20Stress%20Fall%202018/content/Combat%20Stress_Fall%202018_rvFNL-pages.pdf
Sayer, N. A., Noorbaloochi, S., Frazier, P., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving medical care. Psychiatric Services, 61, 589-597. https://doi.org/10.1176/ps.2010.61.6.589
Shay, J. (2011). Casualties. Daedalus: The Journal of the American Academy of Arts and Sciences, 140(3), 179-188. https://doi.org/10.1162/DAED_a_00107
Sherman, W. T. (2015). Memoirs of General William T. Sherman. Digireads.com Publishing
Simmons, C. A., & DeCoster, V. (2007). Military social workers at war: Their experiences and their educational content that helped them. Journal of Social Work Education, 43(3), 497-512. https://doi.org/10.5175/JSWE.2007.200600054
Simmons, C.A., & Rycraft, J.R. (2010). Ethical challenges of military social workers serving in a combat zone. Social Work, 55(1), 9-18. https://doi.org/10.1093/sw/55.1.9
Sokolik, J. (2015). Moral Injury and the military veteran: DePaul’s multi-faith veterans support project. DePaul Magazine: 1 (1). https://via.library.depaul.edu/cgi/viewcontent.cgi?article=1001&context=depaul-magazine
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Van Hook, P. M. (2016). Spirituality as a potential resource for coping with trauma. Social Work & Christianity, 43(1), 7-25. https://www.nacsw.org/sw/onlineceutraining/spirituality-potential-resource-coping-trauma
Wisco, B. E., Marx, B.P., May, C.L, Martini, B., Krystal, J.H., Southwick, S.M., Pietrzak. (2017). Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depress Anxiety, 34, 340-347. https://doi.org/10.1002/da.22614
Wood, D. (2014). The grunts: Damned if they kill, damned if they don’t. The Huffington Post. https://projects.huffingtonpost.com/moral-injury/the-grunts.
Yan, G. W. (2016). The invisible wound: Moral injury and its impact on the health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 181, 451-458. DOI: 10.7205/MILMED-D-15-00103
Antonelli, M. (2017). Moral injury. The American Journal of Psychoanalysis, 77: 406-416. doi: 10.1057/s11231-017-9107-4.
Barnes, H.A., Hurley, R.A., & Taber, K.H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. Journal of neuropsychiatry, 31(2)98-103. Doi: 10.1176/appi.neuropsych.19020036
Beard, M. T. (2015). Distinguishing PTSD from moral injury: Conceptual and experiential approaches [Unpublished manuscript]. https://www.academia.edu/13862065/Distinguishing_PTSD_from_Moral_Injury
Blinka, D, & Harris, H.W. (2016). Moral injury in warriors and veterans: The challenge to social work. Social Work & Christianity, 43(3), 7-27
Bollinger, A., Riggs, D., Blake, D., & Ruzek, J. (2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 255–270. doi: 10.1023/A:1007706727869.
Bremault-Phillips, S., Pike, A., Scarcella, F., & Cherwick, T. (2019). Spirituality and moral injury among military personnel: A mini-review. Frontiers in Psychiatry, 10, 1-9. Doi:10.3389/fpsyt.2019.00276
Brock, R. N. & Lettini, G. (2012). Soul repair: Recovering from moral injury after war. Beacon Press.
Bryan, C. J., Bryan, A. O., Anestis, M. D, Anestis, J. C., Green, B. A., Etienne, N, Morrow, C. E., & Ray-Sannerud, B. (2016) Measuring moral injury: Psychometric properties of the moral injury events scale in two military samples. Assessment, 23(5), 557-570. Doi:10:1177/1073191115590855
Bryant, A. N. (2007). Gender differences in spiritual struggle during the college years. Sex Roles, 56, 835-846. DOI:10.1007/s11199-007-9240-2.
Currier, J., Holland, J., Drescher, K., & Foy, D. (2015). Initial psychometric evaluation of the Moral Injury Questionnaire-Military version. Clinical Psychology & Psychotherapy, 22, 54-63. DOI: 10.1002/cpp.1866
Daley, J. G. (Ed.). (1999). Social work practice in the military. Haworth Press.
Davis, D. E., Worthington, E. I., Hook, J. N., & Hill, P. C. (2013). Research on religion/spirituality and forgiveness. Psychology of Religion and Spirituality, 5, 233-241. https://doi.org/10.1037/a0033638
Dekel, R., Solomon, Z., Elklit, A., & Ginzburg, K. (2004). World assumptions and combat-related posttraumatic stress disorder. The Journal of Social Psychology,144, 407–420. https://doi.org/10.3200/SOCP.144.4.407-420
Freeman, D. R. (2015). Archetypal identification: An alternative for spiritual well-being assessment. Journal of Religion & Spirituality in Social Work: Social Though, 34: 158-176. https://doi.org/10.1080/15426432.2014.973987
Freeman, D.R. (2007). Spirituality and the calling of social work students. Social Work & Christianity, 34(3), 277-297.
Fontana, A., & Rosenheck, R. (1999). A model of war zone stressors and posttraumatic stress disorder. Journal of Traumatic Stress, 12, 111–127. https://doi.org/10.1023/A:1024750417154
Gilbertson, A. (Fall 2008).The life and lonely death of Noah Pierce. VQR Online, 84(4). https://www.vqronline .org/vqr-portfolio/life-and-death-noah-pierce
Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Little Brown.
Harris, J.I., Erbes, C.R., Engdahl, B.E., Thuras, P., Murray-Swank, N., Grace, D., … & Le, T.V. (2011). The effectiveness of a trauma-focused spiritually integrated intervention for veterans exposed to trauma. Journal of Clinical Psychology, 67, 425-438. DOI: 10.1002/jclp.20777
Held, P., Klassen, B. J., Hall, J. M., Friese, T. R, Bertsch-Gout, M. M., Zalta, A. K., & Pollack, M. H. (2019). “I knew it was wrong the moment I got the order”: A narrative thematic analysis of moral injury in combat veterans. Psychological Trauma Theory, Research, and Policy, 11(4), 396-405. https://doi.org/10.1037/tra0000364
Hodgson, T. J. & Carey, L. B. (2017). Moral injury and definitional clarity: Betrayal, spirituality and the role of chaplains. Journal of Religion & Health, 56, 1212-1228. https://doi.org/10.1007/s10943-017-0407-
Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.
James, W. (1968). The self. In C. Gordon & K. J. Gergen, (Eds.). The self in social interaction (Vol. 1, pp. 41–49). Wiley & Sons.
Jung, C. G. (1990). The archetypes and the collective unconscious. Princeton University Press.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war Veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695-706. https://icds.uoregon.edu/wp-content/uploads/2015/03/Litz-et-al-2009-Moral-Injury-and-Moral-Repair-in-War-Veterans.pdf
MacNair, R. (2002). Perpetration-induced traumatic stress in combat veterans. Peace & Conflict, 5(1), 63–73. https://doi.org/10.1207/S15327949PAC0801_6
Mental Health Advisory Team (MHAT-V). (2008) Operation Iraqi Freedom 06-08: Iraq: Operation Enduring Freedom 8: Afghanistan. Retrieved from http://www. armymedicine .army.mil/reports/mhat/mhat_v/mhat-v.cfm.
Nasarov, A., Jetly, R., McNeely, H., Kiang, M., Lanius, R., & McKinnon, M. C. (2015). Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatrica Scandinavia, 1-16. DOI: 10.1111/acps.12406
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652. DOI: 10.7205/MILMED-D-13-00017
Padgett, D. K. (1998). Qualitative methods in social work research: Challenges and reward. Sage.
Pearson, C. (1991). Awakening the heroes within: Twelve archetypes to help us find ourselves and transform our world. HarperCollins.
Pearson, C., & Marr, H. (2003). A guide to interpreting the Pearson-Marr Archetypal
Indicator instrument. CAPT Publishing.
Platoni, K. (2018). The moral injuries of war. The American Institute of Stress Combat Stress, 9(3), 4-6. www.stress.org/wp-content/uploads/Newsletter/Combat%20Stress%20Fall%202018/content/Combat%20Stress_Fall%202018_rvFNL-pages.pdf
Sayer, N. A., Noorbaloochi, S., Frazier, P., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving medical care. Psychiatric Services, 61, 589-597. https://doi.org/10.1176/ps.2010.61.6.589
Shay, J. (2011). Casualties. Daedalus: The Journal of the American Academy of Arts and Sciences, 140(3), 179-188. https://doi.org/10.1162/DAED_a_00107
Sherman, W. T. (2015). Memoirs of General William T. Sherman. Digireads.com Publishing
Simmons, C. A., & DeCoster, V. (2007). Military social workers at war: Their experiences and their educational content that helped them. Journal of Social Work Education, 43(3), 497-512. https://doi.org/10.5175/JSWE.2007.200600054
Simmons, C.A., & Rycraft, J.R. (2010). Ethical challenges of military social workers serving in a combat zone. Social Work, 55(1), 9-18. https://doi.org/10.1093/sw/55.1.9
Sokolik, J. (2015). Moral Injury and the military veteran: DePaul’s multi-faith veterans support project. DePaul Magazine: 1 (1). https://via.library.depaul.edu/cgi/viewcontent.cgi?article=1001&context=depaul-magazine
Tanielian, T., Jaycox, T., Schell, T., Marshall, G., Burnam, M., Eibner, C., Karney, B.R., Meredith, L.S., Ringel, J. S., Vaiana, M.E., & The Invisible Wounds Study Team. (2008). Invisible wounds of war. RAND. Retrieved from http://www.rand.org
U.S. Department of Defense. (2013). U.S. casualty status. Retrieved from http://www.defense.gov /news/ casualty.pdf
Van Hook, P. M. (2016). Spirituality as a potential resource for coping with trauma. Social Work & Christianity, 43(1), 7-25. https://www.nacsw.org/sw/onlineceutraining/spirituality-potential-resource-coping-trauma
Wisco, B. E., Marx, B.P., May, C.L, Martini, B., Krystal, J.H., Southwick, S.M., Pietrzak. (2017). Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depress Anxiety, 34, 340-347. https://doi.org/10.1002/da.22614
Wood, D. (2014). The grunts: Damned if they kill, damned if they don’t. The Huffington Post. https://projects.huffingtonpost.com/moral-injury/the-grunts.
Yan, G. W. (2016). The invisible wound: Moral injury and its impact on the health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 181, 451-458. DOI: 10.7205/MILMED-D-15-00103