(17 Aug 2015) Visiting the remote Oklahoma cemetery where his parents are buried helps Marshall Powell find an inner peace that he once feared was lost to him forever.
Powell, a former US Army Nurse, was profoundly affected by his experiences while serving as a medic in Mosul, Iraq, in 2007.
Witnessing the horrors of war, including numerous civilian deaths, shook his deeply held religious beliefs.
The loss of a little Iraqi girl was to have a particularly devastating impact.
She had been brought into his field hospital with terrible injuries, after a bombing in August 2007.
Powell did what he could to ease her pain, but there was nothing he could do to save her life.
Blaming himself for her death, Powell went into a downward spiral, which culminated in severe depression and heavy drinking.
Six years of therapy, medication, and treatment for Post Traumatic Stress Disorder, or PTSD, proved unsuccessful.
Hope eventually came when he learned his condition had a name – moral injury – and that he wasn’t the only sufferer.
He got help at a group counselling programme called OASIS (Overcoming Adversity and Stress Injury Support), which is based at a naval base in San Diego, California.
OASIS was started in 2010 to help service members who, like Powell, were not responding to traditional PTSD treatments.
Clinicians determined moral injury needed a different kind of treatment, and specific therapies were added in 2013.
At OASIS, Powell was urged to write about his moral injury, a process that took him two weeks.
Sharing the experience with other sufferers was the first step towards recovery.
As another exercise, Powell wrote a moving letter of apology to the Iraqi girl’s family.
The letter was never sent but helped him on the road to self forgiveness.
After an honourable discharge from the army, Powell is now pursuing a degree in industrial engineering.
He helps others with similar problems and, while not fully free of self-doubt, he has finally forgiven himself.
The term moral injury was first defined in the 1990s by clinical psychologist Jonathan Shay, who recognised the condition in Vietnam war veterans he was treating.
Shay and others psychiatrists believe it has contributed to the high suicide rate among veterans.
Unlike PTSD, which is based on fear from feeling one’s life threatened, moral injury is said to be marked by extreme guilt and shame for something done or witnessed, which goes against one’s values, and may even be a crime.
Moral injury has gained more attention following the wars in Afghanistan and Iraq, as mental health providers increasingly point to it as a reason why veterans aren’t improving with PTSD treatments.
However, experts are divided over whether moral injury should be regarded as a separate condition, or part of the PTSD syndrome.
There is no formal diagnosis for it by medical professionals, and no one knows how many veterans may suffer from it.
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