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Injury runs deep for veterans

By JULIE SHERWOOD | Daily Messenger | Published: June 9, 2019

CANANDAIGUA, N.Y. (Tribune News Service) — Navy veteran Walter Wilhelm worked in weapons aboard the USS Coral Sea off the coast of Vietnam during the war.

What happened after he returned home from military service in 1976 turned into a living hell for him -- a litany of painful episodes over the years tied to an addiction to alcohol and pain medication and an internal battle with anger and feelings of shame. He lost his marriage and lost his children, among other traumatic events.

"It's so grievous, so deep. You never forgive yourself," said Wilhelm, who struggled for decades with forces he once thought he could never overcome let alone open up about and begin to heal.

Wilhelm said he had no idea about the significance of mental health until years after his military service and his treatment through the VA.

"It plays such a big role," said Wilhelm, a resident at the Canandaigua VA Medical Center where he receives treatment for physical and mental health conditions. He attributes those services, along with another treatment through the VA -- much newer and still being explored -- to strides he has made so far.

Healing inner wounds

Post-traumatic stress disorder has been around since the beginning and long before it had that name. Anger, anxiety, flashbacks, nightmares and self-destructive behavior are some of the symptoms of PTSD that in previous generations was called a number of things -- shell shock, soldier's heart and combat fatigue, to name a few. But it wasn't until after the Vietnam War that PTSD was recognized as an official mental health condition, to be diagnosed and treated.

Like the long road to recognition for PTSD, some are working on official recognition and diagnosis for two, interconnected conditions being called moral and spiritual injury. Chaplain Robert Searle at the Canandaigua VA provides a support group focused on the concept that is part of ongoing research at the Center of Excellence for Suicide Prevention at the Canandaigua VA campus.

"Those who write about moral and spiritual injury use similar words to describe their inner wounds: guilt, shame, meaninglessness, and hopelessness," said Searle, who provides a spiritual injury group attended by Wilhelm and other veterans at the Canandaigua VA.

Wilhelm described how, over many weeks, he painstakingly wrote 42 pages about his experiences and feelings as part of this spiritual therapy. Wilhelm said he read every word to the chaplain and they talked. The spiritual injury group has helped him more than he would have imagined, he said.

Wilhelm said he learned to forgive himself, let go of the shame, and reconnect with a spiritual part of himself he had lost years ago.

Searle explained it as "a spiritual quest to find love and forgiveness and a new life, which once again can have significance and value." Searle went on to say that veterans "who find themselves on this quest discover their inner wounds transformed into an oasis of deep faith."

What about moral injury?

Dr. Marek Kopacz told an audience in Livonia this spring how research on moral injury is shedding light on the struggles veterans face and playing a role in suicide prevention. Kopacz, with the VA Center of Excellence for Suicide Prevention at the Canandaigua campus, was a guest speaker at the event sponsored by the Livingston County Suicide Prevention Task Force, Genesee Valley Health Partnership and Livingston County Veteran Service Agency.

While moral injury is "a relatively new construct," the "experience has been there forever," he said.
"Since the dawn of military conflict there has been that ambiguity, that struggle, that sense of what happened, what did I do, what did I see? And having to carry those experiences and carry that weight. That weight affects a person," he said.

It isn't just veterans who have seen combat who may suffer from moral injury. Kopacz gave an example of an Army cook whose job is to feed fighter pilots. The cook didn't participate directly in war.

"But providing food to individuals who were assigned to kill as many people as possible," that disturbed him, Kopacz said. The impact of those feelings and the conflict they present between right and wrong can hurt deeply, he said. He gave other examples: A soldier who wants to help a distressed woman and child, but cannot help because it would violate orders and jeopardize the lives of others.

Such experiences result in "a struggle for meaning" and "form a disconnect between what happened and what should have happened," Kopacz said.

"For some, they will get to a point of recovery," the doctor said. "They will be able to connect those halves. Some, however, are stuck. They stop trying to connect those two halves. They live in a state worse off with each day."

Kopacz said there is no diagnostic code right now for moral injury, and no set way to define cases.
"Research is growing by leaps and bounds," Kopacz said, adding he sees the day when this will "translate into care for veterans."
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