Moral Injury: The Psychological Wounds Of War

Guests

Tyler Boudreau, author, Packing Inferno: The Unmaking of a Marine
Dr. Jonathan Shay, clinical psychiatrist who coined the term 'moral injury'
Rev. Rita Brock, co-director, Soul Repair Center at Brite Divinity School

"Moral injury" is a term used in the mental health community to describe the psychological damage service members face when their actions in battle contradict their moral beliefs. Thought it isn't diagnosable, doctors and veterans are searching for ways to support those who have experienced this inner conflict.

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NEAL CONAN, HOST:

This is TALK OF THE NATION. I'm Neal Conan, in Washington. Whether you call it battle fatigue or shell shock or PTSD, we've come to accept that the trauma of combat can leave profound psychological scars. But how do you describe the damage from actions that violate one's values, but don't involve trauma, injury from horrific scenes that betray core moral beliefs?

Some mental health experts have adopted a relatively new term: moral injury. It's not accepted as a psychiatric diagnosis, there's no real treatment, but more and more veterans believe it finally puts a name to their condition and an explanation to their symptoms.

We want to hear from those of you who served in uniform. Does the term moral injury resonate with your experience? Our phone number: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, the latest from the Turkey-Syria border, where NATO missile batteries may soon be in place. But first, moral injury. And we begin with a 12-year veteran of the Marine Corps, Tyler Boudreau, who commanded an infantry company in Iraq. He joins us by phone from Amherst, Massachusetts.

Good to have you with us today.

TYLER BOUDREAU: Hi, thanks for having me.

CONAN: When did you first hear the term moral injury?

BOUDREAU: Well, you threw me, there. I think it's been a couple of years now, but it was after - I think the important time for me was that it was after I had written my book, because I wrote a memoir called "Packing Inferno." And at that time, I was thinking of guilt quite a lot, and I was talking about guilt, but I knew that I didn't hear of the term moral injury at the time.

And so I was - you know, I was categorizing that guilt under post-traumatic stress, and for a long time that was giving me a lot of trouble. And then someone said, hey, we have this term moral injury, and for me, that immediately resonated. I said, ah, this term can work, I can understand this. Because as you were just pointing out, some of the things that I feel, you know, angst about were not necessarily traumatic. And so now, you know, this new category really opened things up.

CONAN: What kind of things are you talking about?

BOUDREAU: Well, I think that particularly in a counterinsurgency or an occupation environment, there's a lot of more benign scenarios that are not necessarily highly violent, not necessarily a lot of killing going on, but there's a lot of things that people might feel, you know, that violated their moral codes.

And so, for instance, for me, an example might be authorizing snipers to shoot, you know, an Iraqi man over the radio. So, you know, there is violence actually happening there, but I'm not personally involved in it. I'm disconnected from that action, and I'm, in fact, miles away, and yet I still - I know that I played a role in that scenario. And so, yes, I feel some guilt about that, but I can't really call that traumatic. There was no trauma for me.

CONAN: And similarly, as a commander of an infantry company, you sent guys on patrol who did things that, well, may not have been pretty.

BOUDREAU: Yeah, well, let me just correct you there. I'm sorry. I took command of a company after Iraq. So in Iraq, I was an assistant operations officer, and - but I did, in fact, dispatch patrols frequently. That is - that part is accurate. And so, yeah, sure, there would be times where they would go on patrol, and they would be involved in situations.

And sometimes, it was situations where they had inflicted violence sometimes, and violence had been inflicted upon them. Either way, I am dispatching them, and I feel some responsibility for that, and there is, you know, once again, there's a sense of, you know, there's a sense of remorse or guilt or something where your morals are being challenged. And this term moral injury kind of gives - it opens up space for a conversation to be had about that.

CONAN: A conversation, but it's more than a philosophical debate - real effects.

BOUDREAU: Yeah, it does have real effects, although that's not the area where I'm most expert in. I mean, I am aware that the VA has studied it, and the military has kind of gotten involved in it. And I know that you're going to be talking to Dr. Jonathan Shay, and he knows, you know, quite a lot about that side of it.

I actually have focused more on the social function of this term and that conversation. That's been sort of the area where I have spent of my time thinking.

CONAN: But you did have effects from this, and you, as you say, were struggling to, well, when you wrote your book, compare it with PTSD.

BOUDREAU: That's right, yeah, for sure. This, you know, reflection of my own, without a doubt, emerged from my own experiences and it made me - you know, it made me think very hard about it. And once I started thinking about it, I mean, the - one of the main points that I make, and this connects to the individual, is that the conversation for post-traumatic stress is almost exclusively in a medical or mental health environment.

So, you know, if someone says, OK, you've been diagnosed with post-traumatic stress, right away you're going to go see a therapist or a psychologist or wherever they're going to send you. They're going to send you, you know, to the doctor. And that's where your conversation is going to happen.

And it's very easy for the public, the American public, to say, hey, yeah, let's take care of those veterans. Let's get them to doctors. Now, with moral injury, the - kind of the distinction that I think is so important is now, it's not necessarily a medical issue anymore. Now it's a social issue. Now, when a veteran says, hey, I have a moral injury or I have something more that's challenging my moral code, that means it's challenging society's moral code.

And that means that it's a discussion for everyone, not just the medical community, and it's not something to just, you know, whisk the soldier or the veteran off to the doctor. It's, hey, we all need to be in this conversation. And we are all, by the way, responsible for whatever transgression that he or she is involved in. That's our transgression, too.

CONAN: Tyler Boudreau mentioned Dr. Jonathan Shay, who spent two years at the - excuse me, two decades at the Department of Veteran Affairs outpatient clinic in Boston. And he's on the line with us, joining us from member station WBEZ in Chicago.

Dr. Shay, nice to have you with us.

JONATHAN SHAY: Great to be here. And hi, Tyler. Good to hear your voice.

BOUDREAU: Hi, Tom. Thank you.

CONAN: How did you come up with this term, moral injury? What were the parameters that you were trying to describe?

SHAY: Well, this just fell into my lap from the story that the great ancient poet Homer tells of Achilles in "The Iliad." That is the story of moral injury and the terrible consequences of it.

CONAN: The death of Patroclus and his horrible revenge.

SHAY: Well, yes, I mean, the - and in particular it's all triggered by his boss Agamemnon's violating the moral consensus of the forces that he commanded. And the text is very clear that he really was off-base.

CONAN: And how did you come to apply this Homeric message to, well, experiences like Tyler Boudreau's in Iraq?

SHAY: Well, when I was working at the VA, it took me about a year to figure out that I was hearing the story of Achilles over and over again, sometimes as fragments and sometimes as the whole sequence exactly as Homer told it. And that was a piece of dumb luck for me, because I got the chance to write a book that has since had real legs to it.

CONAN: The book is "Achilles in Vietnam." Another one: "Odysseus in America." As you came to come up with this term, how did you apply it to veterans? And did they, as soon as they heard the term, like Tyler Boudreau said, ah-ha?

SHAY: Well, it's more than just the term, because Tyler I think is totally on-target when he says that to medicalize this - what's the pill for this? Uh-uh. In my view, recovery happens only in community. And typically, the first community in which that is going to work is the community of fellow veterans. And I - as far as I'm concerned, people with all the alphabet soup after his name have no business on center stage in this. It's other veterans.

CONAN: We want to hear from those other veterans. Does the term moral injury resonate with your experience? 800-989-8255. Email us: talk@npr.org. We'll start with Ben, and Ben's on the line with us from Oswego, New York.

BEN: Yes, sir. Thank you.

CONAN: Go ahead, please.

BEN: Yeah, this would be the very first time I've heard the phrase moral injury, but I'm certainly one of those combat vets where it just kind of - it just - it falls into place very easily. I was in a light infantry Army unit in the Iraqi theater, and needless to say, we had to track down our fair share of HBTs and handle our business.

And the process that we went through doing that, a lot of the times, you didn't really have the ability to concern yourself too much with moral obligation. It's more about the mission. And upon my return here in the States, and now that I have a young child and - you start to look at life in a bit of a different way, and this is whenever you first, you know, see the - what could be this moral injury.

I do have - I'm categorized and rated PTSD, but this is something that just kind of struck me, because just recently, I've been struggling very much so. And I happened to turn to the church community for assistance with this, mostly because my remaining friends that I associate with are still active-duty, and I don't believe it's my place to speak with them too heavy on the subject, because they have to go back over, and they need to be of a certain state of mind.

So it's double-edged, in a manner of speaking. But there was, specifically, just to give an example, I need to be mindful, I suppose, if you can forgive me for doing so, but I don't want to paint anyone or any particular establishment or institution in a negative light as much as possible in doing so. So we did have an insurgent who tried to drive a VBIED, a vehicle-borne IED into our FOB.

CONAN: A car bomb, yeah.

BEN: Yes, sir, but this was actually a dump truck. They were going all out, and they had some aircraft payload munitions and whatnot inside. And we fired upon the individual driving the vehicle. He was struck, but survived, and then we pulled him out of the vehicle and kind of got to work on him, trying to figure out what's going on. We deduced that he was kind of intoxicated by some form of a substance or another, and, you know, his face was drawn on.

We'd keep our HBTs in an exterior kind of tent, away from the FOB building, and just a general treatment. Again, I just - I want to be mindful, but I also want this conversation to be real. And, you know, I mean, those are human beings. They had to - you know, they had to use the facilities, if you will, and whatnot. And a lot of times, the soldier who would be watching over him may not be very - may not be very mindful to certain things like that. And I mean, I'm sure your imagination can take it just a bit, although I want to - I wanted to say that, you know, I just...

CONAN: Ben, we're going to leave you at that forward operating base just for a moment. We're going to take a short break. Can you stay on hold for a minute?

BEN: Sure.

CONAN: All right, we'll pick up the conversation after we get back. We're talking about the relatively new term moral injury to describe experiences in combat and the effects afterwards and the conversations afterwards that we all need to have. Stay with us. You're listening to TALK OF THE NATION, from NPR News.

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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. This hour we're talking about moral injury, a relatively new term used to characterize emotional scars that members of the armed forces bring back from the battlefield after doing and witnessing things that violate core beliefs.

Though the term is new, the problem is as old as war itself. So if you've served in uniform, tell us: Does this term moral injury resonate with your experience? 800-989-8255. Email talk@npr.org. You can also join the conversation online. That's at npr.org. Click on TALK OF THE NATION.

Dr. Jonathan Shay coined the term moral injury. He's our guest, along with Tyler Boudreau, a 12-year veteran of the United States Marine Corps. Ben is also on the line with us from Oswego, New York, who's been describing his experiences there at a forward operating base where the driver of a man who attempted to blow up a dump truck full of explosive materials was - Ben is it fair to say handled roughly?

BEN: Yeah, I mean, that's definitely one way you can certainly coin it. He was no friend of ours, and we certainly were not coming towards him. I mean, within the constraints of the Geneva Conventions and so on and so forth, we acted appropriately, but then again there's definitely a gray area, I suppose, that takes place whenever you're boots on the ground, and it's just you and then.

Their comfort really wasn't much of a concern of ours at the time.

CONAN: And Tyler Boudreau, I wanted to ask you: When Ben talked about the distinction between mission and morals, does that resonate with you?

BOUDREAU: Well, I think this is sort of a standard dilemma where you get in a situation where you feel, you know, you have to - you know, you have to get things done. You have to survive, or you have to accomplish the mission. And that struggle between, you know, if it becomes a struggle, if soldiers start to feel a struggle between their personal morality and the mission, what that reflects is the larger, you know, operation, you know, that the society, you know, that the country has put them, you know, in this situation. So that's one of the reasons that you come back to this is a social issue. It's not a clinical issue.

Hopefully you're not going to have, you know, a lot of people feeling that their personal, core beliefs have been violated if the mission is good, and when things start to get gray, you have probably more moral injury problems.

CONAN: And that conversation, Ben, you say you don't talk to your fellow soldiers about it.

BEN: No sir, I was just with one of them the other day, and I started to get into the subject because it has been something that started to bother me recently, just for whatever reasons. And I told him just outright that I wasn't going to get involved with it. He was more than welcome for me to discuss some things with him, but I know that while you're in the gray even, you - in that particular environment you have to be calloused and sometimes exceedingly so.

You have to be - you have to shut off the emotion 100 percent, but unfortunately whenever you do something like that, you're shutting off some other, you know, core parts of your personality, and that allows you to really start crossing that line, I believe. And I don't want him - I do not want my fellow active-duty soldier friends to have to get this kernel, this thought in their mind that's maybe going to cause them to second-guess themselves whenever they're in a situation where they must stay on point.

CONAN: And Dr. Shay, I wanted to bring you in here. There's a lot to talk about. Obviously you can't do any kind of diagnosis on the radio. But the - one of the things that seemed to me interesting that Ben talked about is that he does have a PTSD diagnosis. These two things are not mutually exclusive.

SHAY: No, they're not mutually exclusive at all. Moral injury can lead to PTSD, moral injury can come after PTSD. I mean, the simplest way to understand PTSD is the persistence into civilian life of absolutely valid survival adaptations, adaptations that let you survive when other human beings really are trying to kill you and doing a damn good job of it.

CONAN: Ben, thank you so much for the call, and I hope you get a chance to talk about this.

BEN: Yes, sir, thank you, I appreciate it. Thank you.

CONAN: Let's see if we can go next to - this is Mike(ph), and Mike's calling us from the big island on Hawaii.

MIKE: Hi, how are you?

CONAN: Good, thanks.

MIKE: Yeah, I mean I - the two calls and just a shout out to Dr. Shay. He does a great job. He's brilliant. And I use a lot of his materials. But, you know, my experience is - was hard to quantify, obviously diagnosed with PTSD, two tours in Iraq, two tours in Afghanistan, and my youngest son just out from his first tour to Afghanistan as a young Army officer.

But it really puts into perspective. Had a car bomb incident, a lot of body parts, just sensory overload. And I like what the last two callers have talked about, you know, the focus on the mission, you know, fundamental failing of your training if you just can't get your head stuck into the game and get things going and process and produce and accomplish.

It's just after the fact. And I am a PTSD sufferer, working on five years. I'm darn near normal. But that moral compass changes, and it changes at that point when you go through sensory overload, when you stack body parts, when you try to match one with the other, when you deal with concussion blasts and other issues. There's a darkness that descends. It's almost as if you lose heart and faith in humanity itself, and it's - it's horrific once you come to that realization. It's a tough road back.

CONAN: And how do you - you say you're darn near normal, a condition many of us would aspire to, but how do you get that back? How do you get that faith back?

MIKE: You know, I think it's - for me, I'm an avid reader. So it's looking at these sort of different philosophical constructs and trying to find one that, you know, has been mined previously that matches this experience. You know, you've been horribly scarred and traumatized, and in my outreach work with the VA, I just saw young guys who were so traumatized not only by their physical or other emotional injuries but by this moral compass shift that they couldn't get out of bed.

And I think it's a matter of time. It's a matter of love, appreciation. It's a sense of can do, finding a comfortable place. I had one very old but wise psychiatrist at the VA in Seattle tell me, you know, you live in a clay jar, and it's the height of courage to fly towards that one crack, that one fissure that shows the light. It's hard to get up there, but it's the courage to try. And I think that's the solution.

CONAN: Mike, thanks very much for the call.

MIKE: You bet.

CONAN: Keep working. Here's an email we have from Jack(ph) in Ohio: A moral injury here, I suffered it in April in 1967 on the Bong Son River when an unarmed prisoner escaped and hit the water. I begged him to come back, but he didn't understand. He was probably just a farmer we'd evacuated from the An Lao Valley like many of the others.

Finally when he was way out in the river, several of us began to fire at him. He seemed to realize he was in trouble and was hit once. He came up holding his arms out of the water, and my bullet hit him in the head. He sank, and we swam out and got his body.

This tragedy has haunted me for many years since. I wrote a song about it, and that seemed to help my moral guilt and injury for killing an unarmed, innocent man. Lord, forgive me. That's Jack in Athens, Ohio. Dr. Shay, there is no pill, you say. So how do you get that conversation going? What helps?

SHAY: Well, I want to say, Neal, that I've been twisting arms all over the place, pointing out that our society lacks any real understanding of what's needed for purification after battle. We need rituals, we need liturgies, we need narratives, we need artworks that - and the point here is that it's not something you say to a veteran.

You, Mr. Veteran, you need to clean yourself up. It's that we all need to clean ourselves up after war. These people went on our behalf and in our name, and we need to purify as a community, not just as just say to this returning veteran you need purification, uh-uh.

CONAN: Purification rites, we know them best perhaps from Native American experiences.

SHAY: That's one culture that certainly had a lot of understanding of it, but you find footprints of it in the Bible. Ancient Rome had a way of purifying the legions when they came back from the campaigning season. Just about every society but ours has had such a thing, and a parade isn't it. Nor is what happened to one of the veterans I treated, who was met at his front door in South Boston by his father when he returned from Vietnam. And he plopped a $50 bill into his hand and said, here, get drunk, get laid and I'll see you in the union hall on Monday morning. Whatever that was, it wasn't purification.

CONAN: We turn now to the Reverend Rita Brock. She's the founding co-director of the Soul Repair Center at Texas Christian University's Brite Divinity School. She's the author of "Soul Repair: Recovering from Moral Injury after War." And good to have you with us today.

REVEREND RITA BROCK: Thank you. It's a pleasure to be on, especially with Tyler and Jonathan, whose work I so respect.

CONAN: Well, you work on recovery from moral injury conversation, the societal conversation. If that's what we need to recover, we have a long way to go.

BROCK: We certainly do. We spend months, weeks and months, training ordinary people who grew up with us and teaching them to kill, and then we send them off to war, which is a horrible experience for any person with a conscience. And then we bring them home, and with a little bit of interviewing and a few hours maybe of talking to, we put them back in civilian society. And the rest of us just think, well, they'll just get over it and go on with their lives and be the same. And they're never the same.

CONAN: Never the same. So how do you get them back to some reasonable facsimile thereof?

BROCK: I think it really is a process of befriending veterans. It's - and facing into our own moral culpability. I look at someone like Tyler - who has incredible moral core, who's been fierce about facing into the things that he regrets and things that he did - and I think that the rest of us need to have the same kind of moral courage if we're going to help veterans recover.

But we can't - we're not there to be their therapists. We're not there to fix them. We're there to befriend them in a long process of coming to terms with what it meant for us to send other human beings into war and what it's required now for us to bring them home.

CONAN: And, Tyler Boudreau, this seems to me to be outside the conversation about whether it was worth it in one place or another about the cause. But the fact is we sent you there. We have to come to terms with what we all did.

BOUDREAU: Yes. I think that's exactly right, and I thank Rita for her kind words. And one of the reasons that I always kind of want to pull the conversation back to the social is because I think it's very instinctive for veterans and soldiers themselves to want to deal with it themselves. I think that it's sort of a natural reaction to society.

And, in fact, Dr. Shay even pointed out to me recently that the military is preferring now the term inner conflict over moral injury, and you can see the implications right there where, OK, this is a personal - this is personal work. You may get help, you may get a - you may get, you know, clinical support, but this is still personal work.

And I really disagree with that idea because, you know, the problem is, is that as soon as you turn it into a social problem, moral injury, even if it is an individual experience, it calls into question the entire policy. And, you know, maybe the policy needs to be called into question, and maybe it doesn't, but it should be on the table. And the morality of any policy, particularly that involves military force, should be on the table.

And I think that in our country - and maybe all countries - people are afraid of that conversation because of how it may look as far as their support for the troops or their support for the cause or their patriotism or whatever it is. But we have to as a society be able to discuss morality because this is what you get. You get soldiers who come home and who are wrangled, and we need to be able to deal with that as a society, not just as individuals who knew to do inner work. That's not good enough.

CONAN: Tyler Boudreau, a retired Marine Corps officer. Also with us, Dr. Jonathan Shay, a clinical psychiatrist and former psychiatrist at the Department of Veterans Affairs Outpatient Clinic Hospital in Boston, coiner of the term moral injury; and the Reverend Rita Brock, the founding co-director of the Soul Repair Center at Brite Divinity School. You're listening to TALK OF THE NATION from NPR News.

And here's an email question from Noah in Tucson: Can you explain how moral injury is differentiated from cognitive dissonance? Moral injury seems to simply define the effect of cognitive dissonance, but I'm certainly no expert.

Dr. Shay, can you help us?

SHAY: Certainly, the dissonance in both versions of moral injury that are currently circulating, the dissonance is between what someone experienced and believes they have to do or have done. And the code in - as they understand it and as their local community and culture understands it, the code of what is praiseworthy and blameworthy, what I call what's right, a simple turn of phrase.

So you have three elements in moral injury, as both lines of research on it understand it. A betrayal of what's right, number one, and in one version - mine - by someone who holds legitimate authority. But in the other version, which is very important - and I'm not saying that it's not important, and it can coexist with the first kind - is where it is my - I do it. I betray what's right, not somebody in authority.

And then the third element is in common, and that is that the stakes are high. Nobody's ever morally injured in a penny ante poker game because the stakes just aren't high enough.

CONAN: Here's an email from Steven(ph) in San Francisco: I'm a veteran of the first Gulf War. The very nature of the military - war and killing - creates a moral dilemma. The first time you kill or injure an individual, there is a profound change in one's values and morals. Everyone who serves in combat suffers moral injury. Some are able to reconcile this more than others.

While I believe the VA should provide services to address this, VA disability payments regarding this would-be syndrome creates an unlimited liability for the nation's taxpayers. If one feels that one's morals and values will be compromised, they should not sign up for the military. First, quickly, Dr. Shay, is this a syndrome, a would-be syndrome?

SHAY: Well, first of all, I do not actually believe that there is an inherent injury to a human being or any other mammal or fish from killing another of one's own species. This is an idea that was put forth by Dave Grossman, and unfortunately, it just isn't well-founded. But the - Dave Grossman's very famous book on killing. I think that a lot of people do suffer very much when they believe they have killed the wrong people for the wrong reason.

In the lingo of the people who are currently there, somebody who didn't need to be killed. I get terribly angry at people, civilians, who say, oh, there are no rules in war. Well, I can tell you that soldiers, Marines care deeply about the things that keep them clean, and the rules of war are that keep them clean.

CONAN: We're going to continue this conversation for a couple of minutes after we come back from a short break. We'll also speak with NPR's Deb Amos, who joins us with the latest on Syria and how the recently announced cease-fire between Israel and Hamas may change things; certainly put more attention on the Syrian Civil War. Stay with us. It's the TALK OF THE NATION from NPR News.

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CONAN: In just a moment, we'll go to the border between Syria and Turkey to talk about the Syrian Civil War and how things are developing since the formation of a national coalition, a new national coalition that's been winning friends in foreign capitals, getting mixed reception thus far inside Syria. But we wanted to continue our conversation for just a couple of minutes on moral injury.

Still with us is Tyler Boudreau, a retired Marine Corps officer; Dr. Jonathan Shay, a clinical psychiatrist; and the Rev. Rita Brock, co-founding, co-director of the Soul Repair Center at the Brite Divinity School. Just to follow up on that email question. Tyler Boudreau, from your point of view, is moral injury something that's seeking to be defined as an injury that - as a syndrome, rather, that would require extensive treatment?

BOUDREAU: I definitely wouldn't deny treatment. You know what I mean? Like, I would think that that would be an, you know, inherent component if that's what's an individual, you know, wanted to be. I'm not, you know, into the medical world so I couldn't answer it like in a professional way as far as whether it's a syndrome or not a syndrome. But in terms of having counseling, you know, put it that way, and having some personal help, I think that's perfectly great. It's OK. I just want to include, you know, the larger conversation.

And let me just also add this, because this is a piece of moral injury that gets ignored again and again, and that is the victims of those - the victims, you know, if you are - if you have done some transgression, if you've killed somebody, if you've hurt somebody, there's a victim there. You have a moral injury. But if you don't have included in that conversation the people who you have hurt, then you can't have the moral injury.

And so, you know, and particularly in the conflicts that we're talking about today, Iraq and Afghanistan, where a big piece of those operations are, you know, helping the Iraqi people, helping the Afghanis, well, you know, we tend to not pay much attention to those people in this conversation and they've got to get into the conversation. They need to be acknowledged in order for us to have that moral injury.

CONAN: All right. Here's...

BROCK: Neal, this is Rita. I agree with Tyler on that. And I wanted to add a response to the idea that some people are unfit to serve in the military if they're going to have moral injury because I think it misunderstands even the nature of military training, in which anyone who goes through military training is taught moral values. They're taught just war principles, the Geneva conventions. There are all of these codes of honor around what is a soldier to do and not do. And shooting innocent civilians is not something a soldier does.

But when you throw people into a war where there's no army and no military there fighting and they're only fighting civilians, you get - the moral ambiguities become quite fierce and horrible. And you have soldiers having to kill children, pregnant women, dogs. It becomes a terribly morally compromising situation even for people who feel good about being in the war and wanting to be there and wanting to serve their country. It doesn't mean that they don't come home with their moral consciences wrecked.

And I actually think that - I agree that there are certain forms of treatment that might be needed. But this is a problem for the whole society. To try to slide it into just something that the VA can take care of, I think, is the wrong approach. The reason we started the Soul Repair Center in Texas is because our mission is not to treat veterans individually. Our mission is to train the public on understanding what moral injury is and being willing to help veterans recover - not as a disorder, but to support them for the rest of their lives and learning to live with what happened to them in war because it's not something you're ever going to forget.

CONAN: Is it something that you can manage though?

BROCK: Yes. And I think that's part of it. You just have - you - what happens is that you have to support people in all the moral questions and the struggle they're in to try to understand what happened to them, and to help them reconstruct a moral identity that can integrate what happened to them in war, but will allow them to want to live and even perhaps to thrive for the rest of their lives.

CONAN: Let's leave it there. Reverend Brock, thank you very much for your time today.

BROCK: You're welcome. It's a pleasure to be with you.

CONAN: Rita Brock, co-director of the Soul Repair Center at Brite Divinity School, author of the recent book "Soul Repair: Recovering from Moral Injury after War." Our thanks as well to Dr. Jonathan Shay, clinical psychiatrist, formerly with the Department of Veterans Affairs in Boston, with us from WBEZ, our member in Chicago. Dr. Shay, thanks very much.

SHAY: You're welcome. It's great to be here.

CONAN: And Tyler Boudreau, thank you for your time there in Amherst.

BOUDREAU: Thank you very much for having me.

CONAN: We'll come back and talk about Syria and Turkey in just a moment.

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