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War psychology research expands, troops found to suffer 'moral injuries'

As researchers and psychologists have come to a better understanding of post traumatic stress disorder a different kind of suffering among veterans has surfaced, a feeling of guilt or inner conflict called 'moral injury.'

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Boudreau resigned his commission after having questions of conscience. He wrote in the Massachusetts Review, a literary magazine, that being diagnosed with PTSD doesn't account for nontraumatic events that are morally troubling: "It's far too easy for people at home, particularly those not directly affected by war ... to shed a disingenuous tear for the veterans, donate a few bucks and whisk them off to the closest shrink ... out of sight and out of mind" and leaving "no incentive in the community or in the household to engage them."

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So what should be done?

"I don't think we know," Ritchie says.

Troops who express ethical or spiritual problems have long been told to see the chaplain. Chaplains see troops struggling with moral injury "at the micro level, down in the trenches," says Lt. Col. Jeffrey L. Voyles, licensed counselor and supervisor at the Army chaplain training program in Fort Benning, Ga. A soldier wrestling with the right or wrong of a particular war zone event might ask: "Do I need to confess this?" Or, Voyles says, a soldier will say he's "gone past the point of being redeemed, the point where "God could forgive him" — and he uses language like this:

"I'm a monster."

"I let somebody down."

"I didn't do as much as I could do."

Some chaplains and civilian church organizations have been organizing community events where troops tell their stories, hoping that will help them re-integrate into society.

Some soldiers report being helped by Army programs like yoga or art therapy. The Army also has a program to promote resilience and another called Comprehensive Soldier Fitness to promote mental as well as physical wellness; some clinicians say the latter program may help reduce risk of moral injury but doesn't help troops recognize when they or a buddy have the problem.

Nash says the Marines are using "psychological first aid techniques" to help service members deal with moral injury, loss and other traumatic events. But it's a young program, not uniformly implemented and just now undergoing outside evaluation for its effectiveness, he says.

At Camp Pendleton, the therapy trial will be tailored to each Marine's war experiences; troops with fear-based problems might use a standard PTSD approach; those with moral injury may have an imaginary conversation with the lost person.

Forgiveness, more than anything, is key to helping troops who feel they have transgressed, Nash says.

But the issue is so much more complicated that wholesale solutions across the military, if there are any, will likely be some time coming.

Many in the armed forces view PTSD as weakness. Similarly, they feel the term "moral injury" is insulting, implying an ethical failing in a force whose motto stresses honor, duty and country.

At the same time, lawyers don't like the idea of someone asking troops to incriminate themselves in war crimes — real or imagined.

That leaves a question for troops, doctors, chaplains, lawyers and the military brass: How do you help people if they don't feel they can say what's bothering them?

AP Broadcast correspondents Joseph Frederick and Sagar Meghani contributed to this report.

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