Just as PTSD sprang out of the post-Vietnam era, today’s generation of veterans return home to face an invisible wound known as “moral injury” — a new name for a condition that is as old as the dawn of battle. Moral Injury, coined by Dr. Jonathan Shay, refers to the painful inner conflict that results from having violated one’s own code of what’s right and wrong in the line of duty. To some, moral injury is the unacknowledged specter looming over the current U.S. veteran suicide crisis, which claims the lives of 20 individuals every day. Some of the country’s top experts on moral injury, and well-known champions of veterans issues, share their deepest insights into the nature of this wound, why it’s so pervasive and universally stress the responsibility each of us must bear in helping those who have seen war make meaning of their experience. Voices of Resilience follows the struggles of a diverse group of veterans, that of a young man from Colorado, and a young couple in Saipan, one of many remote islands in the Pacific, where enlistment rates tend to soar higher than any other community in the U.S. population. Ultimately, Voices offers inspirational examples of veterans who…
The film is lovely and its portrayal of returning Veterans heart felt. My experience working clinically with Veterans is often brutal as we resonate with the brutality of their own experience. If we, as providers, can bring our Veterans even minimal relief, it is worth our discomfort; any effort on our part considering the enormous sacrifices they have made for us by fighting our ugly wars is our responsibility as providers and as a nation. That said, I prefer not to attend “Military” movies, especially those made in Hollywood. My work is so very important to me and the only way I can continue to serve our Veterans is by preserving myself. Managing my own fatigue and burn out is crucial to taking hold of the task at hand. So, when Michael called the Resilience Center to offer us tickets to his film, I declined initially. After-hours for me, are for non-war related activities, not an artistic rendition of my daily life. Michael, however, convinced me that this film was different so I agreed to attend. His film, “Almost Sunrise,” was playing at the Human Rights Watch Film Festival at Lincoln Center, also a significant film festival for me. And…
A few years ago, as part of a video project I’d volunteered for, I had the opportunity to interview veterans and hear about their lives and struggles. One particular day, my interview subject casually mentioned, “Twenty-two veterans kill themselves every day.” It stopped me dead in my tracks. I thought I had misheard. I didn’t. That was a pivotal moment for me in this journey to make this film. I realized right then and there that there was a crisis in this country, taking place right in front of our eyes, one to which many of us, including myself, were blind. In some deep silent corner of that realization, I felt utterly compelled to do something, to act, to serve, to help these people who had sacrificed so much.
Once I had passed the “sniff test” with them, these vets opened up and shared with me some of their most intimate, harrowing experiences, usually those found on the extreme end of the human spectrum. The connection we shared through these exchanges was of an intensity that would knock me off my feet. It often felt as if time itself had stopped. At some fundamental level, I wanted to create a film that would give others a chance to experience that stunning reciprocity, that unbelievable, profound connection. I believe that hearing stories can lead to empathy, which can lead to action.
There’s tremendous work yet to be done to help properly care for our returning warriors and all servicemen and women. One of the most important and, indeed, hopeful aspects of the story is the wider acknowledgement that there is such a thing as a “moral injury,” a wound that has no outward physical traits but yet can act as the primary unseen force that can destroy a person’s life. Veterans and their families are sometimes all too familiar with some of the possible symptoms; substance abuse, alcohol addiction, estrangement, failed marriages, low self esteem, depression, rage, helplessness and botched suicide attempts. But just by identifying the nature of this injury, we can take the seminal steps toward healing it in appropriate and effective ways. It’s clear; we cannot merely medicate our way out of a pain stemming from inner conflict. The only remedy that makes sense is to treat it at the source, which requires one to turn within.
My sincere hope is that, in the midst of this urgent crisis, the film will stir people to consider the significance of including holistic practices, such as proven ancient breath techniques and meditation, in the overall approach to our veterans’ wellness. One vet whom I had encountered had reluctantly, skeptically tried a powerful breathing exercise. After a period of time, he was able to come off of his regimen of numbing meds. He says it was like waking up for the first time in 40 years. He advised other younger veterans not to wait so long.
The making of the film has created a tremendous opening for me. I can more deeply appreciate and, hopefully, as a consequence, more deeply convey an understanding: that in embracing the struggles of these men and women, and their families—these very human pillars who endeavor to keep the home together—we are not only helping to lift whole communities, but, in essence, we are lifting ourselves.
Truly, there is no “other.”
A rare, hopeful look at the life of a veteran, beyond his demons.
Almost Sunrise tells the inspiring story of two young men, Tom Voss and Anthony Anderson, who, in an attempt to put their haunting Iraq combat experiences behind them, embark on an extraordinary journey – a 2,700 mile trek on foot across America. Will this epic pilgrimage be enough to release them from their self-destructive impulses and give them the chance to begin life anew?
While the film exposes some of the brutality of war, it doesn’t dwell there. It’s ultimately a story of hope and potential solutions. Most importantly, the film reveals the promise of holistic practices for healing. When Tom signs up for a special breathing workshop for veterans, he must confront his deepest spiritual identity. He encounters Father Thomas Keating, a renowned Trappist monk who has counseled veterans for decades, who gently illuminates the need to turn inward to achieve true peace – and gives guidance that culminates in a remarkable inner transformation rarely depicted on screen.
Where the stereotypes of “the broken veteran” or “homecoming hero” leave off, the film continues onward, offering an unprecedented portrait of those who return from war; rich, complex, far more hopeful. Almost Sunrise allows us to connect with a universal human aspiration for happiness and through Tom and Anthony’s genuine search for it, be reminded of our common soaring possibilities.
The film also acts as an urgent call for communities to better understand these deep-seated psychic wounds, and for the government to acknowledge and finally treat moral pain by using methods other than pills. Almost Sunrise deftly and movingly demonstrates the promise of holistic healing practices is on the horizon in a way that we cannot afford to ignore.
What is Moral Injury?
Moral injury is a relatively new concept and “involves psychological and spiritual wounds that result from experiences that conflict with one’s deeply held beliefs of right and wrong. This is not a mental disorder”, says Katinka Hooyer, PhD, also a character in Almost Sunrise.
Dr. Brett Litz, a pioneer in the study of moral injury, points out that, “The key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life…” The injury can arise in a variety of forms ranging from “….perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
Recently, researchers and therapists on the frontlines of veterans’ care have started to identify what may be a critical factor in the overall suicide crisis – a sort of “missing link” – a condition called “moral injury”.
I would bet anything, that if we had the wherewithal to do this kind of research we’d find that moral injury underlies veteran homelessness and suicide.
– Dr. William Nash, Director of Psychological Health for the United States Marine Corps
“Moral Injury Panel at AFI Docs”
Moral injury in the context of war
The actions that war requires, whether committed or witnessed, often violate the core cultural beliefs Veterans learned from their families and communities.
Moral injuries surface when a Veteran begins to reflect on the memories of war, judging their own behavior or that of their friends or leaders. The memories that define a moral injury are about sorrow, shame, and deception, not so much fear or anger. Fear and anger are more representative of PTSD.
The consequences of violating one’s moral code, even if the act was necessary and unavoidable in that moment, can be very destructive. In these instances, self-judgment is at the core of moral injury. The killing of children and women, not being there for a battle buddy who lost their life or the incapacity to help injured civilians are common sources of moral pain that Veterans talk about.
Witnessing leaders and respected peers violate core values is a different form of moral conflict. Feelings of betrayal are at the root of these types of moral injury. Examples include being raped by fellow service members or witnessing the inhumane treatment of prisoners.
The stories that may provide a clue to moral injury are linked more to what service members have done or failed to do, not what was done to them. Feelings of guilt and shame, related to not living up to their military charge or failing to fulfill their own standards of right and wrong, are a strong sign of moral injury.
The emergence of moral injury has no particular timeline. There are life experiences that may trigger awareness of moral injuries. These experiences include changes in life stages, marriage, the birth of a child, and the loss of a relationship, the empathy of a stranger, the death of a loved one or even experiencing unconditional love.
Moral Injury vs PTSD
“The diagnosis of PTSD has been defined and officially endorsed since 1980 by the mental health community, and those suffering from it have earned broad public sympathy and understanding. Moral injury is not officially recognized by the Defense Department. But it is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans: a bruise on the soul, akin to grief or sorrow, with lasting impact on the individuals and on their families.”
– David Wood, A Warrior’s Moral Dilemma, Huffington Post (http://projects.huffingtonpost.com/projects/moral-injury)
Moral injury can be expressed through
• Overwhelming depression
• Guilt or shame
• Loss of meaning in life
• Feelings of worthlessness, despair and remorse
• Feeling like “I’ve lost a part of myself”
• Feeling like “I do not know who I am anymore”
• Feeling intense distrust
• Difficulty connecting emotionally to others
• Abandonment of core values
What to do with Moral Injury?
Veterans carry moral injuries with them because often they are too ashamed to tell anyone. One of the most healing things Veterans can do is share these experiences with other Veterans that have similar stories. Receiving acknowledgement from other Veterans is important to know they are not alone in their moral conflicts. Sharing with a trusted loved one can also be comforting and relieve some of the burden.
Sometimes, connections to religious communities can offer some grace and assist Veterans in coming to terms with their internal moral conflicts. For others, serving humanity in a manner that can help them “right the wrongs” they believe they committed, is also healing.
Civilians and veteran families:
It is VERY important not to pass judgment, good or bad, and just LISTEN and say, “I hear you.” The Veteran is already judging themself in a very damaging way. They may have had other people make excuses for them and say, “You did what you had to” or “It was either them or you.” It can be hard to hear Vets describe their pain and it is crucial to remember that your role is not to “fix” the pain. Just listen in a way that shows respect, acceptance and continuing support. That is a huge gift to someone – it lets the person know, without words, that they are worthy.
ALMOST SUNRISE is the first feature documentary film to identify Moral Injury and explore the veterans experience through the lens of this timely condition.
“Almost Sunrise is a timely and groundbreaking look at what could be a missing piece of the puzzle—the true nature of the psychological wounds of returning soldiers known as ‘moral injury,’ and the undeniable potential power of meditation and nature therapy in helping veterans to reclaim their lives.” – Hollywood Glee
Moral Injury Books
Warrior’s Return: Restoring the Soul After War, by Edward Tick
Tribe: On Homecoming and Belonging by Sebastian Junger
For Families and Healthcare providers:
Thank You for Your Service by David Finkel
Soul Repair: Recovering from Moral Injury after War by Rita Nakashima Brock and Gabriella Lettini
Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury by by Brett T. Litz PhD, Leslie Lebowitz PhD, Matt J. Gray PhD, William P. Nash M.D.
What Have We Done: The Moral Injury of Our Longest Wars by David Wood
Afterwar: Healing the Moral Wounds of Our Soldiers by Nancy Sherman
The Things They Cannot Say: Stories Soldiers Won’t Tell You About What They’ve Seen, Done or Failed to Do in War by Kevin Sites
Moral Injury Project: http://moralinjuryproject.syr.edu/
Veterans Affairs: http://www.ptsd.va.gov/professional/co-occurring/moral_injury_at_war.asp
A Warrior’s Moral Dilemma by David Wood: http://projects.huffingtonpost.com/moral-injury
The Morally Injured by Tyler Boudreau http://www.massreview.org/sites/default/files/Boudreau.pdf
Project Welcome Home Troops
Stop Soldier Suicide
One of the main goals of Almost Sunrise Impact Campaign is to create more access to the kinds of non-medicalized therapies that seem to be one of the only or effective ways – so far – to address the complexity of a condition like Moral Injury.
The traditional medicalization approach
Mental health professionals are concerned by the failure of traditional institutional efforts to make a dent in the suicide rate, including the failure of psychiatric drugs to reach the core of the problem. Whereas PTSD is a diagnosable fear disorder in response to specific trauma, Moral Injury is not a mental illness. While governments and policy makers are slowly acknowledging this complex condition, it remains an uphill battle for recognition because it doesn’t fit neatly into the medical diagnostic and treatment model.
From 2005 to 2011, as suicide rates rose, the Department of Defense increased its prescription of psychiatric drugs by nearly seven times (a rate 30 times faster than the increase among the civilian population).
Although the realities of post-traumatic stress disorder are better understood than ever before, experts say some war veterans are misdiagnosed and may instead be suffering from a complex spiritual wound – a “Moral Injury”.
Hope in natural-based treatments
Since standard drug-based treatment has failed to promote healing for those suffering from traumas experienced in the war, several studies are pointing to the effectiveness of natural and alternative methods as a form of therapy.
Among the non-institutional approaches to healing that are quietly emerging as beacons of hope for veterans is the breathing meditation, a practice that is on the rise, and which we explore in ALMOST SUNRISE through the story of our main characters, who learn to meditate while on their cross-country search for healing.
“Warriors are extraordinary human beings. After a long deployment of holding their breath in combat, they no longer know how to breathe with ease in their civilian life. Trained for war, they were never trained for peace.” – Tom Voss (veteranstrek.org)
Yoga-based breathing exercises have been shown to decrease stress, boost immune function (probably as a result of decreased stress), reduce anxiety, depression and blood pressure, and benefit pain and post-traumatic stress disorder. In particular, breathing practices such as Power Breath, by relaxing the body, may help with the processing of traumatic experiences.
Read More about Project Welcome Home Troops and the Power Breath Meditation Workshop http://www.projectwelcomehometroops.org/
Can the positive effects of breathing meditation last?
According to Stanford research published in the Journal of Traumatic Stress, breathing meditation is a powerful ally for military veterans recovering from Post Traumatic Stress Disorder (PTSD). Emma Seppala, associate director of Stanford’s Center for Compassion and Altruism Research and Education, is the lead author of the article. Seppala says, “This is the first randomized controlled study on a form of meditation or yoga for veterans with PTSD, that has shown such long-term, lasting effects.”
Seppala and her colleagues examined 21 American veterans from the wars in Iraq and Afghanistan as they participated in a breathing-based meditation practice known as Sudarshan Kriya (Power Breath). The 21 participants met for three-hour sessions over seven days. Researchers measured eye-blink responses to loud noises, respiration rates and self-reported descriptions of participants’ PTSD symptoms. Assessments were taken at four intervals—before, during, on month later and one year after treatment. One year after the study, the participants PTSD scores still remained low, suggesting that there had been long-lasting improvement. “It’s unusual to find the benefits of a very short intervention (still) lasting one year later,” she said.
Stanford scholar helps veterans recover from war trauma: http://news.stanford.edu/news/2014/september/meditation-helps-ptsd-090514.html
The science of breathing:
The Scientific Benefits of Breathing (Infographic):
The power of nature
The power of being in contact with nature is another holistic health care approach that has gained recognition from both “empirical research and individuals who are realizing the importance of nature’s contact in their lives” (Stephanie Westlund, Author of Field Exercises).
For veterans and active duty soldiers, “any kind of nature exposure will be helpful”, says Edward Tick in War and Soul: Healing our nation’s veterans from Post-Traumatic Stress Disorder.
Almost Sunrise emerged from the idea of Anthony Anderson and Tom Voss to walk from Milwaukee, WI to Los Angeles, CA. Rather than the goal to walk the 2,700 mile distance, they wanted to use the time in the trek to reflect on their lives, changes, and issues that have developed since their experiences in Iraq.
“Being out in nature, feeling the breeze, listening to the sounds… it gives you perspective. And I think that is the one thing veterans lose that time in nature can bring back very easily.” – Anthony Anderson
Read more: www.veteranstrek.org
The power of community and compassion
Hope is also increasingly being found in the efforts that emphasize the role of community and its potential for healing power in helping vets re-connect with themselves and their loved ones. Throughout the trek, Anderson and Voss met hundreds of people across the country who reached out and cared for them as they passed through their communities. They celebrated their arrival, invited them for food and a comfortable place to sleep; opening their homes and their lives to them.
“When you’re at war, you can’t really trust a lot of people. Meeting all these new people on the trek, has helped me restore my faith in people.” – Anthony Anderson
Many veterans are also finding other alternative therapies to be effective in their healing process. Moving from more traditional treatments such as pharmaceutical and psychotherapy, to a more holistic approach including martial arts, physical exercise, writing, volunteering, farming, equine-therapy, music and arts, and caring for animals.
A comprehensive list of resources for veterans, family-member and civilians is forthcoming.
Mindfulness, Meditation and Mind fitness: Joel Levey and Michelle Levey
Yoga For Warriors: Basic Training in Strength, Resilience and Peace of Mind by Beryl Bender Birch (Give Back Yoga Foundation).
Field Exercises: How Veterans Are Healing Themselves through Farming and Outdoor Activities by Stephanie Westlund
Warrior Writers: A Collection of Writing & Artwork by Veterans Paperback – 2014 by Aaron Hughes
Project Welcome Home Troops
Stop Soldier Suicide
With our Impact Campaign, we will seek to challenge stereotypes and promote active community support for veterans reintegration.
Through a countrywide community screening tour and public education initiatives, our mission is to bring the film into diverse communities of veterans and civilians alike.
Our screenings are followed by structured immersion activities that provide opportunities for civilians and veterans to connect their own healing journeys with one another.
Some of our Immersion Activities that focus on community building are:
“Tracing of Trauma” Participatory Performance
Written and facilitated by Katinka Hooyer
This evocative participatory performance highlights Veterans’ unique perspectives of military service, going to war and returning home. Through reciting excerpts from interviews Katinka conducted with Iraq and Afghanistan Veterans, the audience gains a more profound understanding of Vets’ lives, moral injury and the transformative effects of war work. In this way, audiences, including civilians, have the opportunity to delve more deeply into the issues that Almost Sunrise raises and discover common values and deeper connections with all those who serve. The performance challenges popular stereotypes that the media perpetuates while offering moments to reflect on the personal costs of war.
“Dear Veteran” Community Art Project
Designed by Katinka Hooyer, sponsored by Cards of Wood
This public art project gives civilians an opportunity to acknowledge and speak to Veterans in their lives and communities, in some cases for the first time. Inspired by the prayer trees of Tibet, and Shinto shrines of Japan where devotees write their wishes and prayers on small wooden plaques, Dear Veteran cards are placed on trees in public places as gestures of appreciation and hope. The cards live on through a digital archive and are shared with Veterans through social media.