They Don’t Receive Purple Hearts A Guide to an Understanding and Resolution of the Invisible Wound of War Known as Moral Injury Written by: Joseph M. Palmer Edited by: James H. Mukoyama, Jr. They Don’t Receive Purple Hearts A Guide to an Understanding and Resolution of the Invisible Wound of War Known as Moral Injury JOSEPH M. PALMER This book is not intended as a substitute for therapeutic or medical advice. The reader should regularly consult a medical professional in matters relating to their health and particularly with respect to any symptom that may require diagnosis or medical attention of any kind. Note to Readers: This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is based upon sources believed to be ac‐ curate and reliable and is intended to be current as of the time it is written. It is provided with the understanding that the publisher is not engaged in rendering professional services of any type. If advice or other expert assistance is required, the services of a competent professional person should be sought. Also, to confirm that the information has not been affected or changed by recent developments, traditional research techniques should be used, including checking alternate primary sources where available. All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Copyright © 2015 Military Outreach USA Editor: James H. Mukoyama, Jr. First Printing: 2015 ISBN: 978‐0‐9962985‐0‐6 (Paperback) Acknowledgements Military Outreach USA would like to express our thanks to those who have provided valuable input into the creation of this publication. Particular thanks to Professor Amos Guiora who provided insight into the training of Israeli Defense Forces. His book, Legitimate Target, provided invaluable information concerning the legal and moral aspects of the use of drones in today’s world. Thanks are given to Leah Fostick, PhD, Department of Communication Disorders, Ariel University, Israel, for providing direction on studies conducted concerning IDF soldiers and PTSD. To Dr. Roland Weierstall of the University of Konstanz, Germany, whose work on Appetitive Aggression has proven invaluable, thank you. Military Outreach USA has relied on research, studies, and personal interviews to develop this publication. Every attempt has been made to accurately cite those sources or individuals who contributed to the information contained. It was not possible to use or include all of the resource information identified for inclusion in this publication. That information, however, is extremely valuable and added to a deeper understanding of moral injury. i Preface “The award known as the Purple Heart has a history that reaches back to the waning days of the American Revolution. The Continental Congress had forbidden General George Washington from granting commissions and promotions in rank to recognize merit. Yet Washington wanted to honor merit, particularly among the enlisted soldiers. On August 7, 1782, his general orders established the Badge of Military Merit: "... The General ever desirous to cherish virtuous ambition in his soldiers, as well as to foster and encourage every species of Military merit directs whenever any singularly meritorious action is performed, the author of it shall be permitted to wear on his facings, over his left breast, the figure of a heart in purple cloth or silk edged with narrow lace or binding." This award was open only to enlisted men and granted them the distinction of being permitted to pass all guards and sentinels as could commissioned officers. The names of the recipients were to have been kept in a "Book of Merit" (which has never been recovered). At the present time there are three known recipients of the Badge of Military Merit: Sergeant Elijah Churchill, 2nd Continental Dragoons; Sergeant William Brown, 5th and Sergeant Daniel Bissel, 2nd Connecticut Continental Line Infantry. Washington stated that the award was to be a permanent one, but once the Revolution ended, the Badge of Merit was all but forgotten until the 20th century. General John J. "Blackjack" Pershing suggested a need for an award for merit in 1918, but it was not until 1932 that the Purple Heart was created in recognition of Washington's ideals and for the bicentennial of his birth. General Order No.3 announced the establishment of the award. On May 28, 1932, 138 World War I veterans were conferred their Purple Hearts at Temple Hill, in New Windsor, NY. Temple Hill was the site of the New Windsor Cantonment, which was the final encampment of the Continental Army in the winter of 1782‐1783. Today, the National Purple Heart Foundation continues the tradition begun here in 1932, of honoring veterans who have earned the Purple Heart. The Purple Heart has undergone many changes with respect to the criteria for being awarded. At first, the Purple Heart was exclusively awarded to Army and Army Air Corps personnel and could not be awarded posthumously to the next of kin. In 1942, President Franklin Roosevelt signed an executive order allowing the Navy to award the Purple Heart to Sailors, Marines, and Coast Guard personnel. Also in that year, the Purple Heart was made available for posthumous award to any member of the military killed on or after December 7, 1941. Originally the Purple Heart was awarded for meritorious service. Being wounded was one portion of consideration for merit. With the creation of the Legion of Merit in 1942, the award of the Purple Heart for meritorious service became unnecessary and was therefore discontinued. The Purple Heart, per regulation is awarded in the name of the President of the United States to any member of the Armed Forces of the United States who, while serving under competent authority in any capacity with one of the U.S. Armed Services after April 5, 1917 has been wounded, killed, or has died after being wounded (thepurpleheart.com). ii Moral injury, often called an invisible wound of war, is an injury that affects the spirit and soul of a person. It is like a bullet wound that if left untreated will continue to bleed, ultimately affecting the entire body, until, in the worst of cases, death results. As with any wound, a basic understanding of how to treat it is necessary. Consider this publication an opportunity to learn about some of the causes of moral injury and potential treatments for a moral wound. Moral injury, spiritual injury, or as the Marines refer to it, inner conflict, is in the simplest of terms, a personal harm stemming from a violation of one’s moral code. It can, though not always, occur by doing or seeing something that is traumatic. It can occur to anyone, at any time, in any profession. In this publication attention is given to those who serve or have served in the military. While some address moral injury as being the consequence of a traumatic event, Military Outreach USA believes that it is much more complicated and is the result of the total military experience…from recruit training to the battlefield and afterwards. Military Outreach USA contends that while moral injury can be the result of a singular traumatic event that there are also other contributors that accumulate over time leading to a moral injury. Those are the physical and moral distresses that can eventually bring an individual to the breaking point with the consequence resulting in a moral injury. In each chapter, topics or issues are addressed that contribute to or provide an understanding of moral injury. Each chapter stands alone in either providing a historical perspective or in addressing contributors to moral injury. Attention is provided to what other militaries, such as Israel’s Defense Forces (IDF) does through their training to reduce the risks of moral injury. The Soviet incursion into Afghanistan is explored to provide a background to U.S. forces experiences in that country. One chapter deals with the use of drones and the legal, ethical and moral problems that arise from their continued use. In sum, the contributors to moral injury are addressed with possible suggestions and approaches to resolution. During Military Outreach USA’s research conducted for this publication it was noted that the medical community, particularly in the field of moral psychology, is increasing its efforts in research concerning emotions and/or the psychological effects of moral injury. While Military Outreach USA applauds this research it does not address the immediate problem of one who is suffering from a moral injury. While the research continues, there are organizations in every city or town in the nation that are currently available to serve those who suffer from a moral injury. These are the nation’s community of houses of worship and caring organizations. It is the responsibility of those caring houses of worship and organizations to learn about and then help heal the invisible wound of war known as moral injury. As moral injury is a wound to the spirit and soul, attention must be given to houses of worship as the place for healing. Perhaps it is the psalmist who speaks for those who suffer from moral injury when he cries out: “My soul is full of troubles and my life draws near to Scheol [the world of the dead]…Thou has put me in the depths of the pit, in the regions of the dark and deep.” (Ps. 88:3 and 6 ESV) There are no medals or ribbons for those who suffer from the invisible wound of war. There is only the torment and struggle carried within the darkness of the soul.