At the end of a maze of cubicles on the top floor of the VFW headquarters in Kansas City, Nick Lopez read from a script for a veterans event he has been working on for months. The theme was “heroism in service.”
“The classical hero’s journey involves, above all, sacrifice,” Lopez began. The Marine veteran and VFW youth programs coordinator read what characterizes that journey: a call to adventure, a refusal to go, crossing a threshold, or battling internal and external monsters.
The event Lopez was planning – The Veteran Reader’s Theater – is in its fourth year. This summer, the current group of participants began working to smooth the wrinkles out of their personal stories about battling those monsters. Many are trying to heal from moral injury, a sort of cousin to the better-known post-traumatic stress disorder (PTSD). They wrote about their experiences and read their poems and stories at a virtual event in November.
Lopez leads the Kansas City Vet Writing team, part of the Moral Injury Association of America and sponsored by the Missouri Humanities Council.
“Probably the biggest struggle with veterans is sharing those experiences with their loved ones,” he said. “They believe that it’s hard for other people to relate to what they’ve experienced”
At the end of his script, which introduced the online event, Lopez said that when the adventurer returns home, “perhaps he’ll have a story to tell.” That’s the cue for the procession of nine readers to begin.
One of the readers was Air Force veteran Heather Smoot, who wrote about suffering at the hands of fellow service members:
My enemies wore the same clothes;
My career they managed to dispose.
It was a most disappointing tale
and though I often felt frail,
I coped with inner strength,
despite the extravagant lengths
they went to ruin my life.
The poem is streaked with anger, depression, and shame, but by the end, the voice is in a place of power:
I never set out to be an unsung hero
but, enduring my trials, I did grow.
I vowed to never sign my life away.
With my destiny; I’d have the last say.
PTSD and moral injury share some characteristics: anger, depression, anxiety, nightmares, and insomnia.
“At the worst, it’s self-medication with alcohol or drugs,” said Cindy McDermott, a Navy veteran and co-founder of the Moral Injury Association of America, based in Kansas City.
However, McDermott said that those with PTSD experience startle reflex, memory loss, fears, and flashbacks.
“When you look at moral injury, that’s when you’re seeing the conscience, the empathy coming forward, and that’s when the veteran would suffer from sorrow, grief, regret, shame, and the alienation as well,” she said.
Also unlike PTSD, moral injury isn’t an easily diagnosable disorder, or a disorder at all. It’s caused by an action, or lack of action, that goes against a person’s core moral values and results in great guilt or shame.
Rita Nakashima Brock, Senior Vice President and Director of the Shay Moral Injury Center of Volunteers of America in Virginia, worked with McDermott to start the Kansas City writers group.
Brock gave the example of a young man she knew who enlisted in the Army. While in Iraq, the man and several of his teammates were ordered to shoot an Iraqi who was threatening to throw a grenade.
“He doesn’t remember actually shooting, but he remembers seeing this young man with a grenade in his hand, and then seeing him lie in a pool of blood clearly dead,” Brock said.
Later, when the soldier looked at his magazine, he saw that he had fewer bullets than the last time he’d checked. Brock said the soldier was suddenly certain he’d killed the man.
“He just was devastated,” Brock said. “He realized he had crossed some moral line in his life he could never get back across.”
Moral injury also happens to civilians, such as medical professionals during the pandemic. Doctors and nurses have been in battlefield-type situations deciding who will receive ventilators or other equipment, and who will die.
“They’re not prepared for this in medical school,” Brock said. “And they can feel like they’re failing as doctors because they’re not saving anybody.”
Because moral injury isn’t a medical condition and can go unrecognized for years, it can’t be solved by filling a prescription. But Brock said writing helps because once the story is on paper, it’s externalized.
“When they write it down, or they speak it, or they depict it, they could see it for the first time in a way that makes it something they could actually manipulate and work with,” Brock said. “And that’s the moment at which recovery is possible.”
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans.Funding comes from the Corporation for Public Broadcasting.