Identity & Moral Injury

1. Identity & Moral Injury Psych 190: Warriors at Home Dr. Elena Klaw

2. Goals for Today Identity changes in warriors Sense of self Sense of purpose Relationships Moral injury Effects Self forgiveness Posttraumatic growth

3. Identity Change What aspects of a military member’s sense of self may change as a result of participating on war?

4. Possible Changes in Sense of Self Safety & trust in the world Sense of control may be gone Feeling of indestructability May feel like a “bad” person Effects: May try to exert control: give orders May feel hopeless & helpless: depressed May feel that they deserve special treatment and disappointed

5. Sense of Purpose May have foreshortened sense of future May have anxiety about redeployment May feel like damaged goods May feel that they have failed if they lost buddies in the war May miss a sense of mission May question spiritual beliefs, feel abandoned or unloved by higher power

6. Relationships Redployment anxiety may affect whole family May feel unworthy of love and care May feel weak May feel useless especially with a physical disability May feel others would hate them if they knew what they did in service May feel out of place, like misfits or loners May feel hardened May feel abandoned by the gov’t Effects: May self isolate

7. Moral Injury Litz et al. (2009) “Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional guerilla wars amplify these challenges. “ “Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially.” “Warriors may also bear witness to intense human suffering and cruelty that shakes their core beliefs about humanity. “

8. OIF/OEF and Moral Injury (Litz et al., 2009) Service members deployed to Iraq or Afghanistan have been exposed to high levels of violence and its aftermath. 27% surveyed had experienced ethical dilemmas, possibly because of ambiguity of the enemy. In 2003, 52% of soldiers and Marines surveyed reported shooting or directing fire at the enemy. 32% reported being directly responsible for the death of an enemy combatant (Hoge et al., 2004). 65% reported seeing dead bodies or human remains, 31% reported handling or uncovering human remains, 60% reported having seen ill/wounded women and children who they were unable to help. 2003, 20% of soldiers & Marines surveyed endorsed responsibility for the death of a non-combatant.

9. Effects(Litz et al., 2009) After controlling for combat exposure, taking a life was a significant predictor of PTSD symptoms, alcohol abuse, anger, and relationship problems. Especially associated with chronic PTSD and depression. May have long lasting psycho-social impact including guilt and shame. This sense of shame may lead to a negative attributional style, withdrawal, and avoidance behavior

10. Self Forgiveness(Litz et al., 2009) Veterans who have experienced atrocities and/or killing as part of war need professional support to accommodate their experiences into their own moral schemas. Self forgiveness challenges internal, stable, and global attributions. Correlated with reduced PTSD severity. Increasing feelings of worth reduces isolation and increase social support. Reduces both avoidance symptoms and self punishing behaviors. Allows traumatized veterans to develop adaptive ways of relating, and new meanings as they integrate into civilian world.

11. Posttraumatic Growth See self as more capable and self reliant Appreciate family and friends more Can practice acceptance of changes