Moral injury, Afghanistan, path toward recovery Analysis by War On The Rocks

War on the Rocks has published an article claiming that while Afghanistan continues to fade from America’s collective memory, the war looms large for tens of thousands of America’s veterans. Caliber.Az reprints the article.

On Aug. 31, 2021, the last American plane departed Hamid Karzai International Airport in Kabul, bringing America’s latest, longest war to an ignominious end. Since that day, Afghanistan has quickly faded from America’s rearview mirror.

Over the last 20 years, the United States spent two trillion dollars and lost 2,439 servicemembers there. 3,500 military widows were left without their spouses, 6,000 children without at least one parent, and 14,000 parents without their sons or daughters. But despite this grim toll, the United States has only just begun to bear the brunt of its two-decade-long war. In fact, for countless Afghanistan veterans, the trauma from the war continues unabated.

The fall of Afghanistan, specifically the chaotic nature of the Noncombatant Evacuation Operations and the abandonment of tens of thousands of Afghan allies, left thousands of Afghanistan veterans to face an old but largely forgotten mental health condition: moral injury. This diagnosis refers to the damage done to a person’s conscience when witnessing or participating in an event that violates their moral or ethical code. And it is currently wreaking havoc on America’s Afghanistan veterans. If steps are not taken to address this problem, the result will be a disgruntled veteran population more prone to mental health problems, substance abuse, incarceration, and radicalization.

The three elements of a more effective response are simple but difficult. First, there should be more research and funding for moral injury. Second, the American government and the Department of Defense should be more candid in acknowledging the failure of America’s war in Afghanistan and in addressing the plight of Afghan allies still at risk. Third, the Department of Defense should provide institutional heft by encouraging the creation of structured spaces, like commander’s calls or down days, in which veterans, active-duty personnel, and others can discuss the war, its ending, and its consequences. Senior military leaders can lead the way by discussing these topics virtually in order to help lower-echelon commanders follow in their footsteps. 

Moral Injury

The study of moral injury as a psychological condition began when Vietnam veterans reported feeling distress as a result of violating their core beliefs during combat. According to the U.S. Department of Veteran’s Affairs, moral injury occurs when people, usually in traumatic or unusually stressful circumstances, “fail to prevent, or witness events that contradict deeply held beliefs and expectations.” Although studies have increased over the past decades, there is still no commonly accepted definition of moral injury, in part because of its overlap with post-traumatic stress disorder. Both conditions often negatively impact a person’s well-being and mental health and are associated with an increased risk of suicide, depression, and anxiety. Some research also suggests that moral injury may be present in up to 90 percent of post-traumatic stress cases, and acts as an obstacle to successful treatment.

That said, there are notable differences between the two conditions. According to Jonathan Shay, who coined the term, moral injury emphasizes the specific role of the servicemember involved. It features a betrayal of what’s right over a critical issue by someone in a position of authority. As a result, moral injury often leads to a profound questioning of one’s life, along with a prolonged period of shame or guilt. This condition, when not addressed, can also become “the story” that veterans use to describe their entire military experience and transition.

America’s chaotic withdrawal exacerbated moral injury diagnoses among Afghanistan veterans, 41 per cent of whom now display symptoms of it according to one study. The withdrawal left many veterans humiliated, betrayed, angered, and deeply dissatisfied with the outcome of the war. And it may partly explain why nearly 76 per cent of Afghanistan veterans report feeling like strangers in their own country.

Moral injury issues associated with the Afghanistan withdrawal exacerbate the range of other, better-known mental health and substance abuse problems stemming from America’s “War on Terror.” Moreover, the betrayal associated with moral injury makes veterans susceptible to targeting by extremist groups. The modern white power movement targeted Vietnam War veterans with a call to “bring the war home,” that emphasized “the elite’s betrayal of servicemembers” following the fall of Saigon. Today, the Proud Boys and Oath Keepers are making similar pitches to disaffected veterans following another lost war. While the rate of extremism in the military and veteran population is still small, a sizable portion of the defendants connected with the Jan. 6 attack on the Capitol are veterans. Moreover, this problem may worsen as more Iraq and Afghan veterans leave the services in the coming decade.

Increased Research and Funding

The first step in mitigating the impact of moral injury is better understanding the condition. First and foremost, researchers should address the lack of consensus over defining moral injury and develop consistent and trusted standards for measuring it.

After this, more should be done toward understanding the relationship between moral injury and post-traumatic stress disorder, so as to better develop specific treatments for moral injury. Promising approaches that deserve more study prioritize moral repair and spiritual well-being.

Finally, it is important for bureaucratic reasons that treatment can be measured and outcomes tracked. In this vein, the challenge of classifying moral injury according to the Diagnostic and Statistical Manual of the American Psychological Association should be overcome, as this will drive training and reimbursement for treatment.

The U.S. government can play its role in addressing these gaps by providing the necessary funding. Direct support would help to compensate for the lack of community-based, organized, and funded efforts to complement the limited work of the Veterans Affairs Administration. After two decades, some critical services still do not have sufficient staff with cultural competency to help veterans deal with a wide range of conditions, much less moral injury. Finally, partnerships between U.S. government entities, corporations, foundations, and community-based veteran service organizations  can enhance best practices and better direct funding, while also building stronger community and regional networks to support veterans and families.

Validating Conversation

After the fall of Kabul, Secretary of Defense Lloyd Austin told Congress that it was time to accept some uncomfortable truths about America’s war in Afghanistan. On the first anniversary of the fall, Austin stated that “many people have hard questions about the costs of the war and what their sacrifices meant. These are important discussions, and I hope we will keep having them with thoughtfulness and respect.” Similarly, articles in this publication have urged senior leaders to help guide the all-volunteer force through its first lost war. But despite this, nearly two years on, the silence remains deafening. The lack of frank, open discussions about America’s war in Afghanistan exacerbates many veterans’ moral injury. Rather than validating their sense that something went wrong, refusing to acknowledge it contributes to a sense of betrayal.

Accordingly, senior defence leaders should begin talking frankly about America’s failure in Afghanistan. First, government officials should admit that the Taliban defeated the United States and that the United States abandoned its Afghan allies. Countless journalists and foreign policy intellectuals have dubbed America’s withdrawal from Afghanistan a devastating defeat. They have noted that forces aligned with the perpetrators of the Sept. 11 attacks not only drove American troops out of Afghanistan, but now possess more advanced military equipment and control more territory than they did in 2001.

But in the face of this consensus, U.S. military and civilian leaders refuse to admit defeat. Instead, they use euphemistic language to soften the blow. While this is understandable considering the delicate nature of the subject, the lack of frank, honest language robs veterans of the validation they deserve. America’s war in Afghanistan was more than a “strategic failure,” it did not simply “conclude,” and it did not just “wind down . . without all the goals satisfactorily completed.”

Senior American military officials should also discuss the abandonment of America’s Afghan allies on the battlefield. Tragically, the United States did not uphold its sacred principle of leaving no man behind. Between 200,000 and 300,000 special immigrant visa applicants are still waiting for their applications to be processed. While they wait, they face constant threats from the Taliban. Furthermore, there are countless Afghan allies who do not qualify for the special immigrant visa and remain underground because of their association with the former government and the United States. These include, but are not limited to, Afghan Special Operation Forces, Afghan Air Force personnel, and civil society members, particularly female rights activists.

Speaking the truth should also be followed by concrete action. The Department of Defense can take specific steps to hold itself accountable for not only the evacuation of Kabul but for the entire 20-year war. In this regard, the department’s release of a classified after-action report on the Noncombatant Evacuation Operations is a welcome first step. The bipartisan Afghan War Commission can also take a lesson in candour from the Dutch government’s recent report on Afghanistan. If it does so, this will provide the Department of Defense with a non-partisan blueprint for accountability.

Importantly, speaking the truth about America’s longest war will only reach the intended audiences if structured spaces are created for such dialogue. This means providing the institutional heft for these discussions to be effective. For example, the Air Force has a Bridge Chat program, which is designed to initiate and guide discussions on important topics in the service and society. Furthermore, numerous services have used Bryan Doerries’ Theater of War. These productions employ Greek tragedies to discuss sensitive topics with civilians and could also be used to help service members and veterans discuss their experiences in Afghanistan.

Whatever venue is chosen, senior military leaders should lead by example on this subject. Following the murder of George Floyd, former Air Force Chief of Staff Gen. David Goldfein and former Chief Master Sgt. Kaleth Wright filmed a series of videos entitled “A Conversation: CSAF & CMSAF.” The videos featured Goldfein, who is Jewish, and Wright, who is black, having a candid dialogue on some of the most sensitive issues in America. Both leaders were praised for their frank discussion, which only boosted Wright’s sterling reputation among airmen.

In a similar spirit, even a simple speech by high-ranking officials on Afghanistan would pay dividends. Chairman of the Joint Chiefs of Staff Gen. Mark Milley’s widely lauded apology for his role in responding to the Lafayette Square protests stands out as an example that could be emulated. Senior military leaders played a central role in creating moral injury. By leading these conversations, they can also play a pivotal part in moral recovery.

Conclusion

While Afghanistan continues to fade from America’s collective memory, the war looms large for tens of thousands of America’s veterans. For 20 years, U.S. soldiers were ordered to rebuild Afghanistan and, following the mantras of population-centric counterinsurgency, they grew close with their Afghan allies. Then, in the blink of an eye, the war ended disastrously, with their allies trapped behind enemy lines. While Americans, by and large, have moved on, far fewer veterans have turned the proverbial page.

American society and its government, including senior military officers, should take concrete steps to mitigate the resulting moral injury. This means providing veterans with the resources, the honesty, and the opportunities for conversations that they deserve. While these three steps alone will not ameliorate two decades’ worth of damage, they will begin a necessary reckoning.