"Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress their own moral and ethical values or codes of conduct. Within the context of military service, particularly regarding the experience of war, “moral injury” refers to the emotional and spiritual impact of participating in, witnessing, and/or being victimized by actions and behaviors which violate a service member’s core moral values and behavioral expectations of self or others. Moral injury almost always pivots with the dimension of time: moral codes evolve alongside identities, and transitions inform perspectives that form new conclusions about old events." [http://moralinjuryproject.syr.edu/about-moral-injury/]

The notion of moral injury, including betrayal have been around for many decades but it is only recently that serious efforts have been made to understand their impacts on military veterans. It goes well beyond the traditional idea that military PTSD is only the result of seeing something awful in war to refer to something deeper and more insidious. As many veterans tell me, it feels like something that just crept into their souls over time. When it comes to betrayal, it often leaves a crushing blow making a mockery of military values and one's military identity. Betrayal comes in many forms - starting with the persistent reports of sexual violence, harassment, and indifference, to instances where official reports are inconsistent with event facts to personal instances of being promised postings or promotions for doing special things only to be ignored and forgotten.  Among these men and women, these types of things seem to create the most serious and lingering damage of all.  As difficult as it may be to accept, there is a way to move beyond this blackness .... It begins with the full, unedited story.

Most soldiers remember the Green Zone designation from the Iraq War. Compared to being outside the wire, it was a protected area where it was relatively safe to lower one's guard, rest and recoup, and mentally decompress for a time. Why is this analogy important when it comes to mental health? Despite all the efforts over the past 20 years to develop mental heath programs to deal with operational stressors in military and most first response organizations, many people still do not risk coming forward. From my perspective, the glaring answer to this problem is that it is still not safe. While we can pretend that members will not be judged, that formal mental health will always help, or that they will be able to resume their careers, we know that a tremendous amount of work is yet to be done to humanize many of these workplaces. Reputation is everything to most first responders, including military, police, fire, paramedics, and correctional officers so they remain stoically silent. But, we also know that social isolation is the breeding ground for routine stress and emotional distress to grow into unmanageable reactions. So how do we protect their 'psychological safety' (only jargon, I promise) as they try to mentally decompress without fears of being judged, misunderstood, or sent to the head shop on their way out of employment?
 
People need to have safe places and safe people within their organizations and within their communities where they can begin to air out things spinning around in their heads or emotional reactions that they can't shake. This means considering designating particular places within units, shifts, or watches where lowering one's guard does not come with the risk of being 'outed' or tagged as crazy. Places and specific people where anything can be said or explored without requiring them to give up control. I recently attended a mental health day organized by paramedics - their level of openness and honesty with each other was inspiring to watch - In mind my they get it. First responders of all types have to start being honest with each other about the benefits and the true costs of doing the job.  This is where it has to start because some people will never seek out formal mental health because of the risks of losing one's reputation or employment unless these organizations change fundamentally.  And, the reality is that there are not enough qualified mental helpers to go around.
   
In the meantime, I wonder about the usefulness of a term like 'Operation Green Zone' to think about an initiative aimed at creating practical ways and forums for first responders to connect honestly with each other. To create an environment of psychological safety despite any bureaucratic shortcomings or outdated workplace practices. This is not to say that all workpalces are inadequate or that supervisory practices are oppressive; they just have different priorities - getting the job done with an eye on liabilities and fiscal limitations. Designating areas, particular supervisors/co-workers, or groups as a green zone would be a great place to start; at least in my mind.

I am quite interested in hearing feedback or thoughts about the usefulness of moving this type of initiative forward. It would not be a formal mental health 'program' and it would not rule out a role for formal mental health, if needed. 


  

Public attention is focused sharply on the lives of military personnel and first responders because of ongoing reports of suicide among these men and women. Politicians and bureaucrats of various stripes have been forced to take action while a plethora of theories have been offered to explain the plight of these men and women. Theories about pre-existing conditions (e.g., childhood abuse or neglect), concurrent stressors (family pressures and financial distress), disordered brains, and even self-stigma (self critique and denial of problems) have all been advanced as the ‘cause’ and even though these factors may contribute to distress among first responders, they offer only a partial explanation. But, what about the workplace itself? We do not appear to be courageous enough or mature enough to look honestly at the actual day-to-day context of these workplaces, including the value systems, the consequences of basic training models, unspoken but shared codes of ‘manly’ conduct, and supervisory practices as major sources of distress among these men and women.

Emotional suppression, bravado, pride, self-reliance, and dependability are among the most sacred values steeped within these organizations and handed down to young trainees. While these values and codes of conduct may well be necessary to get difficult jobs done, the cost is that these work places can become inhuman and these very values run counter to the requirements of good mental health. I think we are faced with a fundamental dilemma – we either will continue to try to train first responders to become tougher and even less human or the nature and organization of these workplaces may require substantial and fundamental changes. We may need to humanize these places again.
  
In the increasingly demanding workplaces for first responders and the military, there is considerable attention on professionalism which ironically can turn these places into ‘soul-less’, rationalized places where the focus is on one’s ability to do the job. There is not much leniency or time to treat co-workers as human beings. There is not much room for people to have a bad day or to be emotionally upset following a bad call because of organizational pressures and paranoia over public scrutiny and possible legal actions. Workplaces can turn into emotional pressure cookers – a working wasteland.

Maybe a little less focus on ‘what’s his/her problem’ and a little attention to ‘what’s our problem’ could go a long way in reminding everyone that at the end of the day we are all just human beings – nothing more, nothing less. 

​The message in the dream was so strong that it woke me – hard to ignore a realization that feels heavy in my body. I am struck by the sophisticated and yet paradoxically simplistic efforts to link trauma among soldiers to personal or biological vulnerabilities that produce distress from scenes of human suffering and devastation or experiences of betrayal and institutional neglect. A focus on individual susceptibility. I believe that an alternative social-relational understanding of military trauma could lead us in an entirely different direction. It accounts for the importance of military identity and values in understanding trauma. Namely, that once a soldier has a direct experience of failures to meet codes and values or physical deterioration, he is faced with fundamental questions of what it was all about. She is often forced to face the hollowness of pride and specialness and the limits of comradeship. He may realize that nobody else wants to hear from him and the simple and painful truth is that he often has to keep quiet or he has to go.

Concerns about unit morale and operational priorities means that there can no space for ‘negative nellies’; there can be no conversation about the impacts of contradictions, dilemmas, and other realities of military life itself which may be injurious to its members. Training, perfectionistic standards amid silence and emotional suppression can erode one’s mental stamina especially when faced with the realities of deployments or domestic catastrophes. The 110% ones and the ‘go to’ guys seem to suffer the biggest fall from grace; pride is often replaced with disheartenment and bitterness.

These members can witness or experience things which are intimately personal and yet unseen by the person standing next to them. Their worlds can be immediately altered – they take a hit and the mirrors shatter. Values, beliefs, and expectations can come crashing down in an instant and they realize that they stand alone in an empty room. I have heard many times that in these moments of unwelcome clarity - which can happen in the blink of an eye - everything suddenly changes. It is this unchangeable moment, that soldiers try to ignore or deny, that can create the basis of trauma. And, in many cases these situations contain some unsolvable moral dilemma. They try to think their way through what is essentially an emotionally-centred problem – shame or outrage - that has no outlet. These men and women remain stuck with fragmented memories and bodily felt reminders of these internal struggles.
​
What if the negative ones, the ones who move to the fringes were treated as the valued social conscience of the military? I wonder about the need for safe places where these other voices and experiences can be heard and respected by others in uniform? We might come to a better place of taking care of each other and not leave it to the civilian world to try and figure out. Instead of occupying our efforts exclusively on individual vulnerabilities, we might be better off by also uprooting the basic nature of military training and culture and the inherent contradictions, including the downside of stoicism and individual secrecy. After all, we developed as a highly social species out of necessity – we are cannot survive physically or mentally on our own.  

​Serving in uniform on behalf of the country is a special life in many ways. It means taking on a new identity and adopting a set of values that few people in everyday life understand or fully appreciate. We develop confidence, pride, and self-worth linked intimately with our ability to carry out our military roles; the people we are at home is usually of secondary importance. We have very little in common with everyday people who seem undisciplined, lack focus, and occupy themselves with trivial things compared to the adrenaline-soaked military world. It also means that soldiers, sailors, and air force men and women live compartmentalized lives. One’s military life and civilian roles are easily divorced from each other – they have nothing in common. And, it is important to compartmentalize these roles. After all, it is not cool to act like an RSM when teaching one’s son or daughter how the dishwasher works and for those who do, strained marriages and parent-child relationships are often the lingering results.

When men and women leave the military either voluntarily or because of injury, the price to be paid for a lifetime of compartmentalization shocks many of us: “It was like leaving a huge part of myself behind.” It can feel like a profound loss and disorientation. Part of the way forward, or making the transition through no man’s land, if you will, means integrating one’s military and civilian worlds. One of the hardest things to face is having to do an honest values checklist – figuring out our true values which may or may not be the same as the ones we adopted to serve. It may mean giving up some of these values and remembering the other ones that had to be packed away. One of the biggest challenges comes down to the issue of emotional suppression – having to keep our true thoughts and emotions bottled up. The very things that make us human. Being stoic and focused were of primary importance. Having to face loneliness, uncertainty, or lack of confidence in managing day-to-day relationships and waiting for permission to be oneself have to be overcome in order to move forward. Admitting to anxiety but giving new things a shot anyway, taking time to say good-bye to the uniform on your own terms, talking honestly with family and friends about losses, irritations, or confusion, figuring out who you want to be as a good man or woman are all necessary parts of making the mental transition back to ourselves as people. It means learning to truly speak up.     

To view Global TV interview, follow link below.

Soldiers and first responders of all types are trained to lock things down in order to get the job done. Whether it is shutting off reactions from things seen and done overseas or steeling oneself to tell a parent about a fatal accident. They are trained to compartmentalize events and to suppress emotions. Events get packed away and forgotten for years, maybe even decades.

But this mental skillset required to live and work in ‘adrenaline mode’ comes with a cost that most people do not realize. People get a little rougher and toughened up mentally which can feel great at the time regardless of comments from co-workers, spouses, or family members. Just put the event in a little mental box and hide it away, that seems to be the practical thing to do. It is important to keep one’s image intact; this is a reality for many people I know despite public campaigns that admitting to mental / emotional wounds from the job is an honourable thing.  We seem to be moving in that direction but we are not there yet. Organizational leaders still have to come to terms with their worries about degrading operational effectiveness by having members openly discuss their emotional lives and the true costs of doing the job.

When people pack events away and ignore what is going on with them emotionally, they tend to move towards machine mode - increasingly impersonal and task-focused -  and less involved with people who care about them; lone wolves. Let’s face it, most organizations reward and want these 120 per centers – the no-nonsense, go-getters. But if you ask many of these men and women how they are doing emotionally, they have no idea. In fact, I know a lot of people who don’t know what that question even means. They don’t set out for things to go this way; most of them are simply following their training and values.  After all, if everyone has to stop and do a mental self-check after every event, it could end up being a part-time job in itself. I think it has to be built into the training from day one, re-enforced, and practiced by everyone from top brass to the newbies. It will certainly change the way we do business at present. Otherwise, these efforts may end up being seen as window dressing.
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In the meantime, it is imperative to stay connected with biological families, parents, and spouses. Find some community cause to connect with to buffer work negatives, join a veteran’s group, write down your story, draw, paint, sing – things that move you out of lock-down adrenaline mode. Now the hardest of all, be honest with the people who care when they ask: How are you?     

​[Presentation to Academics, Community members, and Veterans on the challenge of re-integrating into civil society: Mount St. Vincent University, 20 April 2016]  

How has the community you work with been impacted by war?
It has been said that Canada’s national identity was born on the European battlefields of the First Great War. This history and those heroes are revered within our military institution. When we talk about war; there is generally a view of it as a unitary experience with clearly defined start and finish, winning-losing, and where good and evil are clearly demarcated. But War is our word, it is not their word. Instead, pre-deployment training, brotherhood and heroic deeds during named operations and missions, and post-deployment adjustment form the realities for military personnel. Deployment to a warzone is often the culmination of training over many years; it is focused on tactics, mission objectives, time-limited deployments – it is a fragmented experience focussed on tasks, doing one’s job, battle buddies, and AORs. Even the things that happen in another unit close by are often unknown to them.

Over the past 25 years, our military has deployed to many conflict areas, from Somalia, Rwanda, Bosnia, Afghanistan, Iraq and other places. The CAF also deployed to warzones in the 1970s-80s during the so-called Cold War when we were a different military - watchers and guardians tasked with keeping the peace and protecting people.

To understand the impact of serving in armed conflict zones, I think we need to understand aspects of military psyche. Military personnel undergo rigorous training that transforms and unites them under basic values of loyalty, courage, honour and the responsibilities that comes with wearing the maple leaf on one’s shoulder.

Military life also hinges on emotional suppression, compartmentalization, and having an internal shield so that experiences do not overwhelm them. These qualities form an essential skillset to allow them to manage adrenaline, stay focussed, and not freeze in dangerous situations. It allows them to fully commit to one another even in nightmarish realties – the grotesque, indecent, and sometimes inhuman things happening around them. It exposes them to cultural and political realities that have to be ignored even as these things chew into their fundamental beliefs and value systems.   
 
In terms of impact – warzones are a surreal, life altering experience both good and bad. Soldiers describe deployments to a warzone as an ultimate test of training and proving oneself. It centers on rules and ethics, staying focused, missing family, and about reconstituting a new intimate family in faraway places. There are many who see their particular deployment as a positive, life affirming experience – they made a difference or they have better appreciation of life at home. For soldiers who served in places like Rwanda, Somalia or the Balkans; restrictive ROEs meant that they could not help in the ways and to the extent that they were trained to do and expected by the Canadian public. Often, they were forced to be helpless observers to atrocities.
 
  
Training and military values meant that they had to bottle up reactions to the terrible things happening around them. They were left in a type of emotional pressure cooker that exhausted many of them. Over 20 years later, we continue to grapple with the after-effects of these places. Our military institution will likely grapple with the after-effects of Afghanistan for many years to come.
 
For veterans, war is a complex moral testing ground – it is the place where the highest espoused values are met and sometimes fail which can leave them in a moral quagmire. It is the place where inhumanity occurs and at other times where the best of us is enacted through compassion and caring and protecting the innocent.
 
Upon return home, many of them are disoriented and ‘feel changed’ by a loss of military bonds; their experiences further separate them from civil society. Many resent how average Canadians occupy themselves with trivialities unaware of their efforts to protect us from harsh realities. Their service is invisible and has little meaning back home among the rest of us.
 
The people I see have personal secrets based in shame/guilt or even outrage with leadership for not being able to do the right thing. They are separated through silence and are skeptical of civil society – they are set apart (reverse culture shock). Veterans end up being a sub-culture onto themselves.
 
For many, WAR is an incredible source of pride for passing the ultimate test and it also forces them to contend with inevitable failures to help, to assist. It is about the failed promises of specialness (hero to zero) and returning home to mediocrity, isolation, and anonymity.
 
For those who are medically released because of mental injuries, they are recast as victim heroes who feel broken and discarded by their military family and divorced from civil society. They exist in an interpersonal vacuum. Many of the people I know search to repeat specialness through sacrifice or heroic acts as they contend with profound emptiness and separateness. They live with the loss of bonds forged by combat. These people are held in a nebulas place in general society.

What stories need to be told?
The war narrative is usually left to politicians and official reports. A second narrative in Canada - the medical narrative – reduces war to physical and mental injuries from specific events as a set of symptoms, exposing possible biological weaknesses among some members. These narratives are often sanitized and organized for public consumption that hinge on the mandates of national security and sensitivity of personal information. The stories from soldiers on the ground often reflect the impossibility of holding up espoused military values, moral complexities and contradictions, hidden operational errors, lack of support in the field, and about maintaining silence over events that outraged them and wore them out emotionally. They walk as ghosts among the rest of us.

Their stories, especially among those deemed mentally wounded, are not heard since they are considered to be compromised and hence unreliable witnesses to their own experiences. While their stories need to be witnessed I am not sure if the rest of us are up to the task of listening without judgment:

1. Stories of men and women living with the memory of obscenity and inhumanity.
2. The true costs to them of living behind a mask of toughness and having to keep secrets.
3. Stories about frustration, shame, and betrayal when hearing official accounts that exclude their sacrifices and contributions.
4. The disorientation of the unmet promise of specialness and returning home to emptiness.
5. Stories about moral dilemmas and lasting effects on them as people.
6. The disjuncture between military values, and Canadian expectations, and the actual reality of life in these places.
7. The consequences of social bifurcation of military versus civilian (us-them) and the absence of social space and real opportunities for military veterans to reset themselves and truly decompress in respectful and safe settings. 

Whose voices need to be heard?
The prevailing narrative of war is that of aging, stoic WWII veterans ‘the greatest generation’ and images of the Highway of Heroes which creates a seamless story honouring our war dead. But, we have no story for our modern-day mentally-injured veterans. We are not sure what to do about them – we can’t understand why they take their own lives.
This story has been constructed as a medical story about compromised warriors and mental aftermaths like anger, addiction, sleeplessness, depression, or lingering PTSD and a focus on technologies and interventions to resolve mental injury/degradation.
 
I think veteran stories need to be heard for what they are outside of diagnostic considerations. We need to understand the things they take on mentally or give up of themselves to assume a military identity and fulfill their roles. Stories of bewilderment, disheartenment and the loss of themselves on behalf of the country. Again, I am not sure if we are up to the task of listening because of our own compartmentalization, vested interests, and our anxieties.  
 
In Canada, we seem to hold a polite indifference towards our military. We are not sure about the place of the institution as it relates to our reputation as ‘nice people’. I believe that this unspoken tension and disconnection further alienates veterans – young men and women - from social re-integration. Our media often reduces post-war concerns to governmental contests with veterans over money and supports. We are not sure how to respond to the injured - these failed warriors.
 
We do not have conversations over the responsibilities of Canadian society to help bring them home mentally. Instead, we leave it to our politicians and federal institutions to manage them. We do not grapple with questions about how young men and women serve to quell our confusion and anxiety over questions about national identity and our role in the world.
The stories of family members, friends, and parents of soldiers need to be included in a full accounting of fundamental changes in their sons and daughters.

The voices of the thousands of counselors and therapists across the country who hold many secrets but are held to confidentiality also need to be heard.

War encompasses a vague notion of protecting Canadians and exerting influence in the world by helping other societies even as geopolitical and economic complexities raise unsettling questions that can not be addressed. Many veterans wonder whether their efforts in faraway places were worth it.

In terms of military veterans, I think we have to face a harsh reality in Canada: Namely, that upwards of one third of the men and women we send to warzones will struggle to come home mentally and some will never be able to make that journey even with well-meaning efforts. There seems to be a fundamental question to be answered: Are they a necessary sacrifice?
 

 
 
 
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​Ghost in the Ranks

​Operational Stress Injuries and Post-Traumatic Stress Disorder (PTSD) are among the possible consequences facing members of the Canadian military. Unlike the potential physical consequences of dangerous deployments, psychological injuries are not always apparent. Military members are taught a mental skillset to help them manage their internal emotional worlds allowing them to do extraordinary things. Unfortunately, while ingrained military training prepares our men and women for action as capable soldiers, this same training may also require them to trade aspects of their humanness—sowing the seeds for lingering mental distress. As a result, those most affected are left in a limbo, disconnected from their military roles and yet unable to relate to their former civilian lives. They become ghosts of their former selves, haunting the ranks until, more often than not, they find themselves on the outside looking in, with unacknowledged scars, anger, and regret. We ask a great deal of our men and women in uniform; if a shift in culture can help members of our military with mental distress, we owe it to them to make that shift possible.