The recruits came at a trot down the Boulevard de France at the storied Marine Corps boot camp at Parris Island, S.C., shouting cadence from their precise parade ranks. Parents gathered on the sidewalks pressed forward, brandishing cameras and flags, yelling the names of the sons and daughters they hadn’t seen in three months.
“He said he lost 25 pounds!” cried a younger brother of Kenneth Karpenko of Corry, Pa. Now, Kenneth and hundreds of other recruits were about to graduate and folks had come from all over the country for Family Day, which opened with this recruit formation run. “There he is!” someone shrieked as a blur of olive drab streamed past. Kenneth’s mom, Pam Karpenko, dabbed tears from her cheeks and managed to say, “We are so proud!”
Is she comfortable with her son becoming a warfighter, with American troops still being killed in Afghanistan and trouble brewing elsewhere in the world? “Oh, we prayed about it and he prayed about it – he knew it was what God wanted,” she said. “We are good with that.”
It’s a proud and painful scene to watch, for it’s clear that there will be more wars, and that there will always be young Americans eager to sign up to fight. In three months, these recruits have earned the right to be called Marines. More training will come later. But there is no way, really, to prepare them for the emotional extremes of war: trauma for some, including moral injury, a violation of the sense of right and wrong that leaves a wound on the soul.
“You just can’t communicate the knowledge of war to somebody else. It’s something that you know or don’t know, and once you know it you can’t un-know it.”
Stephen Canty, former Marine
“You just can’t communicate the knowledge of war to somebody else. It’s something that you know or don’t know, and once you know it you can’t un-know it and you have to deal with that knowledge,” explained Stephen Canty, a thoughtful 24-year-old who went through boot camp here in 2007, before his two combat deployments to Afghanistan.
Army basic and Marine boot camp are rigorous preparation, of course. Recruits become lean and hard. They learn to work in teams, to obey orders without hesitation or question, to shout “AYE SIR!” in unison, to fire an assault rifle at human-silhouette targets. They march in close-order drill, navigate overland at night with a compass, demonstrate how to treat a sucking chest wound and fight each other with pugil sticks and boxing gloves. They memorize the Marine core values or the seven Army values.
But can they be trained to make life-altering decisions in conditions of moral ambiguity, and to live comfortably with their actions? Can anyone really be inoculated against moral injury? Can it be prevented? The experiences of some recent combat veterans, at least, suggest not.
“We have come back, we have had brothers die in our arms, we’ve picked up parts of other people,” 28-year-old Marine Sgt. Sendio Martz told me one day at Camp Lejeune, N.C., last fall, shortly before his medical discharge from the Marine Corps. He spoke haltingly, searching for the words. “And you are completely angry at the situation you were put into … not angry because you signed up but … what happened you weren’t fully prepared for.”
The physical and technical training at Parris Island is laced with lessons on morality and values. Drill instructors hammer into recruits a rigid moral code of honor, courage and commitment with the goal, according to the Marine Corps, of producing young Marines “thoroughly indoctrinated in love of Corps and Country … the epitome of personal character, selflessness, and military virtue.” The code is unyielding. “There is no room in the Marine Corps for either situational ethics or situational morality,” declares a standing order issued in 1996 by the then-commandant, Gen. Charles Krulak.
The Army’s moral codes are similar, demanding loyalty, respect (“Treat others with dignity and respect while expecting others to do the same”), honor and selfless service.
All this may sound like the moral ideals by which most Americans strive to live. But the military’s moral codes are different: They are issued to each recruit along with a weapon and the training, and eventually the authorization, to kill. Success on the battlefield may call for the suspension of basic notions of civilian morality in order to accomplish the mission. Thus the military codes add dimensions of loyalty, duty and personal courage, and back up those values with a requirement of rigid and unquestioning discipline and obedience to lawful orders. The Army’s Soldier’s Creed demands that troops “always place the mission first.”
“The moral power of an army is so great that it can motivate men to get up out of a trench and step into enemy machine-gun fire.”
Dr. Jonathan Shay, in his book Achilles in Vietnam
The entire military is “a moral construct,” said retired VA psychiatrist and author Jonathan Shay. In his ground-breaking 1994 study of combat trauma among Vietnam veterans, Achilles in Vietnam, he writes: “The moral power of an army is so great that it can motivate men to get up out of a trench and step into enemy machine-gun fire.”
The military’s moral structure is intended to help guide troops through “morally ambiguous situations,” said Marine Col. Daniel J. Haas, who commands the recruit training regiment here.
“We think about this all the time,” he said. In morally tricky situations where you have to make a split-second decision, “ultimately, the answer you come up with is the one you will have to live with. You’ll be more likely to live with your decision if you make it a considered, values-based decision.”
But in war, asking troops to meet the ideals and values they carry into battle – always be honorable, always be courageous, always treat civilians with respect, never harm a non-combatant – may itself cause moral injury when these ideals collide with the reality of combat. Accomplishing the mission may mean placing innocent civilians at risk. Duty, honor and discipline may mean obeying an order you know to be misguided – and later cause a feeling of having been betrayed by your leader.
The great moral power of an army, as Shay puts it, makes its participants more vulnerable to violation, and to a sense of guilt or betrayal when things go wrong. It was his work with Vietnam combat vets, in fact, that led him to recognize that their trauma often came from a deep sense of betrayal. He recognized that the official definition of PTSD failed to describe their mental anguish, leading him to coin the term “moral injury.”
The ideals taught at Parris Island “are the best of what human beings can do,” said William P. Nash, a retired Navy psychiatrist who deployed with Marines to Iraq as a combat therapist. “It’s these values that give you some chance of doing something good in a war, and limiting collateral damage, however right or wrong” the war itself is. The problem, he said, is that “war will break these values.
“There is an inherent contradiction between the warrior code, how these guys define themselves, what they expect of themselves – to be heroes, the selfless servants who fight for the rest of us – and the impossibility in war of ever living up to those ideals. It cannot be done. Not by anybody there,” Nash said. “So how do they forgive themselves, forgive others, for failing to live up to the ideals without abandoning the ideals?”
Warriors come home “and something is damaged, broken. They feel betrayed; they don’t trust in these values and ideals any more.”
As Stephen Canty, the former Marine, put it, “We spent two deployments where you couldn’t trust a single person except the guys next to you.” Back in civilian society now, Canty said, “We have trouble trusting people.”
‘Bad Things Still Happened’
Even when armed with a set of rigid values and discipline, warriors in combat can be caught in situations where they have no opportunity to choose between right and wrong. In the often chaotic fighting in Iraq and Afghanistan, where there was no clear distinction between enemy insurgent and innocent civilian, young Americans could act in good conscience, and in accordance with a strict moral code, and still suffer moral injury.
During a gun battle outside Marjah, Afghanistan, in early spring of 2010, a Marine squad of Charlie Company, 1st Battalion 6th Marines (“Charlie One-Six”), was pinned down in a gully, taking intense fire from an adobe compound. Unable to move forward or to retreat, the squad leader OK’d an attack and Lance Cpl. Joseph Schiano, a 22-year-old on his second combat tour, lifted a rocket launcher to his shoulder, took aim and fired.
The blast blew apart much of the adobe building. As the dust settled, the Marines could hear shouting and wailing. Their interpreter said, “They want to bring out the wounded.” And as the torn and bleeding bodies were dragged out, it became clear that the Taliban had herded women and children into the building as human shields.
“And Schiano is leaning against wall, just sobbing,” recalled Canty, who was Schiano’s squadmate at the time. “The thing is, you couldn’t have known.”
But as Canty himself often says, once you know the truth of war, you can’t un-know it. After that tour in Afghanistan, Schiano left the Marine Corps and went home to Connecticut. The war still weighed heavily on him. He couldn’t fit back. Daytimes, he felt he didn’t belong. At night, he had screaming nightmares.
One Sunday afternoon several weeks after he returned, Schiano went off the road in his 2003 Volkswagen Jetta and rammed a utility pole. At his funeral in Riverside, Conn., Marines of One-Six carried the casket. He was 23 years old.
Their ability to make split-second moral assessments, a function of the prefrontal cortex of the brain, may not be fully developed, researchers say, a fact that may be familiar to any parent of teenagers.
In other combat situations, where the kind of “considered, values-based decision” that Col. Haas advises is theoretically possible, young troops have two handicaps. Their ability to make split-second moral assessments, a function of the prefrontal cortex of the brain, may not be fully developed, researchers say, a fact that may be familiar to any parent of teenagers. But in war, when 20-year-olds are licensed to kill, the stakes are far higher. And they may not be getting enough sleep, another critical factor in making moral judgments, according to Shay, the VA psychologist. A 2008 Army study reported that combat troops were averaging less than six hours of sleep a night, month after month.
“The problem for a lot of these kids is that psychologically, morally and neurologically they are not fully developed by any stretch of the imagination,” Nash said. That makes it impossible “for the people pulling the triggers, impossible for the medics and corpsmen and doctors who are treating people … you want to try to live up to the ideal of protecting people, and you fail to protect them.”
Challenges to live up to a moral code are precisely what young Americans have been encountering in Iraq and Afghanistan. In his account of a 2003 combat deployment in Iraq, Soft Spots, Marine Sgt. Clint Van Winkle writes of such an incident: A car carrying two Iraqi men approached a Marine unit and a Marine opened fire, putting two bullet holes in the windshield and leaving the driver mortally wounded and his passenger torn open but alive, blood-drenched and writhing in pain. The two Iraqis may have been innocent civilians. The Marines may have been obeying the strict rules of engagement, which govern when deadly force can be used (normally, in cases where the approaching car is a threat to American life and the driver refuses several warning signals to stop). But the damage was still done.
The only way to absorb such experiences, Van Winkle writes, was to “make it impersonal and tell yourself you didn’t give a shit one way or another, even though you really did. It would eventually catch up to you. Sooner or later you’d have to contend with those sights and sounds, the blood and flies, but that wasn’t the place for remorse. There was too much war left. We still had a lot of killing to do.”
In a recent phone interview, Van Winkle said the decade since his combat tour has given him a slightly different perspective. “I tried to make myself and my Marines live up to those moral standards,” he said. “I mean, we weren’t pushing people around. We weren’t doing things we shouldn’t have been doing, although things happened by accident.
“The bright line between murder and legitimate killing is something that our most junior enlisted person cares deeply about. When they kill somebody who didn’t need to be killed, they are really wounded themselves.”
Dr. Jonathan Shay, retired VA psychiatrist
“I was doing what I was supposed to be doing, and bad things still happened.”
His moral injury is not unique. “The bright line between murder and legitimate killing is something that our most junior enlisted person cares deeply about,” said Shay. “When they kill somebody who didn’t need to be killed, they are really wounded themselves.”
Not all those who deploy to a war zone experience killing or direct combat, and some troops never get to war at all. But moral injury can occur anywhere. Certainly the technicians working in mortuary affairs at Dover Air Force Base, Del., who handle the remains of Americans killed in combat are exposed to moral trauma.
For many other U.S. troops, exposure to killing and other traumas is common. In 2004, even before multiple combat deployments became routine, a study of 3,671 combat Marines returning from Iraq found that 65 percent had killed an enemy combatant, and 28 percent said they were responsible for the death of a civilian. Eighty-three percent had seen ill or injured women or children whom they were unable to help. More than half – 57 percent – had handled or uncovered human remains.
The intense kinship forged among small-unit combat troops can enable them to endure hardship, loneliness and peril. But such close relationships also put them at risk of excruciating grief at the sudden, violent death of a loved comrade, something that happens all too frequently. In a 2013 Wounded Warrior Project survey of its members, all severely wounded combat veterans, 80 percent said they had a friend seriously wounded or killed in action.
In a similar finding, an extensive 2008 field survey of combat and support troops in Iraq and Afghanistan found that two-thirds knew someone seriously injured or killed. Fifty-six percent had a member of their unit wounded or killed.
‘The Right Thing To Do Could Get You Killed’
In retrospect, signs of the resulting moral confusion are difficult to miss. The rate at which troops were hospitalized for mental illnesses has risen 87 percent since 2000, according to a July 2013 study by the Armed Forces Health Surveillance Center. The center also reported in June of last year that mental complaints, not physical injury, were the leading cause of medical evacuations from the battlefields of Iraq and Afghanistan between 2001 and 2012.
Michael Castellana, a psychotherapist at the U.S. Naval Medical Center in San Diego, sees the damage among dozens of his Marine patients: an erosion of moral certainty, or the confidence in their sense of right and wrong. “We are beginning,” he told me, “to venture into what I think is the kernel of combat trauma: the transformative capacity of what happens when we send our children into a war zone and say, ‘Kill like a champion.’”
Nash, the retired Navy psychiatrist, said veterans looking back on their time in Iraq or Afghanistan are prone to wonder, “In my little sphere of influence, how well did I or didn’t I live up to the ideals?” Often, he said, the answer “is what kills them.”
The inability to consistently achieve the highest levels of moral behavior in the shambles and chaos of war can produce varying degrees of “shame and guilt and anger – the primary emotional consequences of this moral injury,” Castellana said. “And if you read the suicide notes, the poems and writings of service members and veterans, it’s the killing; it’s failing to protect those we’re supposed to protect, whether that’s peers or innocent civilians; it’s sending people to their death if you’re a leader; failing to save the lives of those injured if you’re a medical professional. … Nothing to do with the rightness or wrongness of war.”
In recent years, the military has tried to build what it calls “resiliency” into its young warriors. In one Army program, Comprehensive Soldier Fitness, soldiers at every level get annual training in physical and psychological strengthening. The key to absorbing stress and moral challenges is to “own what you can control, and think before you take on negative thoughts and start blaming yourself,” said Sgt. 1st Class Eric Tobin, a master resilience trainer.
If women and children are inadvertently killed in battle, he said, “feeling bad about that is normal. Not to minimize the loss of life, but you can also focus on the positive outcomes of that battle, that you are still alive, that you protected yourself and your team, that you helped the military achieve its objective.”
The Army is also producing a series of videos to get troops to think about moral injury before they are sent into battle. In four of these 30-minute videos, to be completed later this spring, combat veterans talk about their experiences and how they dealt with the psychological damage, said Lt. Col. Stephen W. Austin, an Army chaplain with the Comprehensive Soldier Fitness program. One of the videos focuses on killing.
“There are no answers – we just want to start the conversation, getting the troops comfortable talking about these things,” said Austin. “That’s the most important thing of all, that people feel they can talk about these issues with their buddies.”
The Marines have taken a slightly different approach, focused on identifying and helping Marines with all forms of combat stress right on the battlefield.
Nash developed a comprehensive approach to combat stress called OSCAR (Operational Stress Control and Readiness) concepts. Under the program, the Marines have embedded mental health professionals like himself directly into combat battalions. And leaders, officers and noncommissioned officers alike, were trained to recognize Marines under severe stress and to intervene, removing them from battle if necessary, getting them calmed down and getting them peer support so they wouldn’t isolate themselves, and getting higher-level help if needed.
“This is relevant to moral injury big-time,” said Nash. It’s on-the-spot help from compassionate and wise mentors, the people who know Marines the best. A good platoon sergeant or squad leader is “better than I ever could be, listening to a Marine’s story, saying, ‘I’ve been there and done that and I made sense of it by saying this part was my responsibility but all that other stuff I couldn’t help.’”
The best military leaders do this instinctively. In Iraq, Nash once watched a battle commander lean over a wounded Marine being carried off on a gurney; like most of the wounded, he was not only in extreme pain and fear, but tormented with shame for having been wounded, and guilt at having to leave his buddies. “You did your job,” the commander said, “and I am proud of you.”
The military’s efforts to build “resiliency” in its troops has drawn criticism from the Institute of Medicine, the independent, nongovernmental health arm of the National Academies. In a new report published in February, the IOM said there is an “urgent need” to prevent psychological health problems in the military, but that the Pentagon’s prevention programs are “not consistently based on evidence” and there is “no systematic use of national performance standards” to assess their effectiveness.
A more focused effort to help troops think through ethical and moral problems is a virtual reality (VR) prototype designed by Albert “Skip” Rizzo, a University of Southern California psychologist and specialist in virtual reality at the school’s Institute for Creative Technologies.
In one VR scenario, troops on a routine patrol halt their convoy, confronting a man drawn up in a fetal position on the road. As they watch, he moves slightly – he’s alive. Young soldiers are saying, “Hey! Let’s go help!” But they are silenced by the sergeant, who warns them that this may be an ambush.
“That guy may be innocent,” the sergeant says, “Or he may have a pound of C4 [explosive] on him. Maybe he’s just lyin’ there waitin’ for us to get near, and he or one of his buddies in that village hits the switch and boom! You’re dead – or if you’re lucky, you’re laying in the ditch with no arms or legs. … I’ve seen it happen. Sometimes, life sucks.”
The soldiers call for a robot to investigate, but while they wait, a friendly and wise mentor appears on the screen. “I’m Capt. Branch. My job is to turn up at key moments to help you develop the resilience you will experience in and around combat,” he says in an avuncular tone. “Today you stood by and did nothing while a man bled to death on the roadway. How’d that feel? Wrong? Frustrating? Overwhelming? It sucked, didn’t it? This kind of twisted crap happens all the time here. Your natural impulses are going to be challenged at every turn.”
The scenarios are intended not to provide specific answers, but to introduce troops to morally ambiguous situations and to get them thinking and talking about how to deal with them. But the bottom line is that morality, in war, is different.
“What you’ve learned from every good and decent person in your life is sometimes going to have to go on the back burner,” says the Capt. Branch character. “The right thing to do in San Diego or Charlotte … could get you killed here.”
Whether or not the VR scenarios help troops prepare for combat is unclear. But some answers may come from a pilot project Rizzo is running with a Colorado National Guard special operations team scheduled to deploy to Afghanistan later this year. The project is underwritten by the U.S. Army Research Lab, the Defense Advanced Research Projects Agency (DARPA) and the Infinite Hero Foundation, which supports troops and veterans with physical and mental health issues.
Rizzo and his team are using the virtual reality scenarios to study soldiers’ reactions to moral challenges, monitoring each participant’s heart rate, respiration and skin conductivity, and drawing blood to check for stress biomarkers.
“The problem we’re trying to understand is, can we detect people who may have more difficulties with moral and ethical quandaries that happen every day in combat,” Rizzo said. “And whether exposure to these scenarios has an impact” on how soldiers absorb combat trauma.
Such work may begin to provide critical insights into the nature of moral injury and help identify individuals who are more vulnerable to it. But for now, young troops will go to war not fully prepared for what they’ll find.
“None of us really knows what it’s like until we go over there, and we go two, three, four, five times before we ever pause to think about what we’re doing,” said Canty, who is now out of the Marine Corps.
“There’s always going to be people like me who are smiling the first time they get on the bus [to boot camp] – they don’t want to miss the war,” he said. “There will always be kids willing to fight, and they’re always going to pay this price, and there are always going to be guys like me who are saying, ‘Hey man, you don’t wanna do it, no, no, no, you don’t want to. It seems like fun, and I can’t tell you not to do it.’ But there’s no talking a kid out of it.”
Only after troops get back, he said, “do we start to look at the mental effects of killing other human beings.”
Canty’s little brother, Joe, joined the Marines in 2010 and recently deployed to Afghanistan. “I know what he’s getting into; he’s going back to Helmand Province less than 20 miles from where I was, and he’s got a grin ear to ear,” Stephen said. “And there’s nothing I can do to wipe that grin off his face because, that was me, you know? Three years earlier. Nobody could have told me.”
Stephen’s grandfather tried. He’d been a Marine in the Pacific in World War II. “Don’t do it,” he told Stephen before he enlisted at 17. “You’re too goddamn smart, boy.”
For help with moral injury or other mental health issues
The Pentagon website Military OneSource for short-term, non-medical counseling.
Veterans can call, text or chat with the Veterans Crisis Line. Dial 800-273-8255.