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How Vietnam vets help others define and understand ‘Moral Injury'

University of Montana/ Emily Senkosky

Reporting by Emily Senkosky, University of Montana School of Journalism

After veterans returned from the Vietnam War, which wound down 50 years ago, they struggled to adjust. That’s been true for combat vets before that war and since. For Vietnam vets, a diagnosis of Post Traumatic Stress Disorder wasn’t possible until the 1980s. More recently – around 2009 – psychological experts further refined PTSD with the term “moral injury.”

John Philip Garrity, 76, is a Vietnam War veteran who now lives in Missoula. As a psych tech in a high casualty base camp, he talked daily to soldiers after they returned from combat. When he wasn't talking to his fellow soldiers, he'd care for the wounded or carry the dead to an evacuation helicopter.

"I think that any person as close to combat or in combat as I was has PTSD. But I think it's worse than that. I think PTSD is simply a bunch of symptoms descriptive of something that is deeper. And it's now being called, in recent years, moral injury," Garrity said.

Today, many experts define moral injury as a type of invisible scar, or soul wound. It happens when people face situations that deeply violate their conscience or threaten their core values. The guilt and hopelessness build up.

Rachel Williamson is a clinical psychologist and assistant professor at the University of Montana who has applied this term in her practice and teaching. Williamson said, "Moral injury is usually nested within trauma disorders and conceptualizations. And it's kind of from this observation, specifically from Vietnam War vets, they came in with PTSD or PTSD-like symptoms, but when you inquire about, "what is that tied to?" It was, "I did this thing that contradicts my moral code," she said.

Garrity was 19 when he went into the Army and he grew up in a religious family. "I am basically Montana-Irish Catholic all the way," he said.

He was in seminary before Vietnam. At the base camp, he knew a priest, but that priest didn't see what he saw. "They had a tent that was the chapel and the priest talked about peace and quoted some things from the Bible without ever mentioning war and the insanity we were in and that priest never, ever showed up when all these wounded were coming.

After the war, Garrity went further into psychology at the University of Montana rather than finishing seminary. In some ways, he recognized himself. "I think I have so much moral injury in me that it's just an overwhelming component of who I am," said Garrity.

In Missoula, where Garrity's lived since returning from Vietnam, there's at least one support group focused on moral injury.

Paul Tiede, a U. S. Marines veteran, runs a moral injury workshop through the Volunteers of America. His father served in Vietnam and stayed in the Army. Tiede says that his dad had pretty high standards for how to be, but he didn't talk a lot about what he went through. Now Tiede is getting his Ph.D. remotely in clinical depth psychology from Pacifica Graduate Institute in Carpentina, California. He spends a lot of time trying to open a wider conversation around moral injury, even beyond PTSD.

"You can have PTSD, but not moral injury. You can have moral injury, but not PTSD. And here you're talking about a soul injury, which is impossible to measure and difficult to define," Tiede said.

Nearly 75 percent of veterans report that they feel disconnected from their faith or ethical code when they return home from war.

"I don't know if we've ever had a moral injury component within a military unit. These are the people who have been damaged or injured, so then we've come up to a whole wall of, 'this is how things are done in the military'. I mean, it's a different world over here," said Tiede.

The specific challenges that came from the Vietnam War for moral injury are twofold. It was a war supported by a highly disputed draft. Many of the soldiers didn't volunteer, but were rather forced to go to war, and the ones who did enlist often did so out of fear that they would be drafted anyways. The other prong was public opinion. As it went on, people increasingly disapproved of what soldiers were doing and being asked to do there.

Tiede said, "Atrocities happen in war. This is not new. But what was new is that this news was being filmed and brought into your very living room. That was new. You're eating your supper, and here's Marine tactical jets dropping Napalm."

The war, and coverage of the war, eroded trust. When Vietnam veterans returned to this tense social climate, they were often seen as part of the problem.

Williamson said, "With the Vietnam War, not having that kind of social validation is a major contributor to it. Add to that as well, not only is it something you're maybe personally wrestling with, but then you are coming home to a country that's saying, "yes, what you did was wrong and wasn't justified."

Both Williamson and Tiede say moral injury is not isolated to veterans. When a person has felt harm or inflicted harm on someone, it disrupts a person's moral understanding of life and leaves behind a scar they carry from then on. But often, combat veterans experience this on another level, simply because they have faced the violence of war, as well as the challenges of re-assimilating back into society after a life altering event.

"The goal is not to abolish you of your sins or whatever, but it's to move from this really extreme place that really prevents movement in a positive direction," said Williamson.

For John Garrity, that's meant, in part, talking about the lessons from Vietnam since he came home. "I've been speaking up for 54 years," he said.

For Teide and Williamson, they're both pushing to make moral injury a term more of us know about.

Fifty years ago, the Vietnam War wound down and soldiers who survived it returned home. More than 36,000 Montanans served in the war. For the 50th anniversary of its end, students at the University of Montana School of Journalism spoke with Vietnam vets across the state. YPR will be sharing their stories throughout the month. This series on the Vietnam War is supported, in part, by the Greater Montana Foundation.