Category Archives: Good Books

War-related moral injury: what is it? What helps? 

I’m reading David Wood’s What Have We Done: The Moral Injury of Our Longest Wars (2016, Little, Brown and Company). David is a journalist and has experiences embedded in military operations in Iraq and Afghanistan. PTSD is well-known and discussed, especially in the context of war. If you have listened to the news, you know that many veterans struggle with it and struggle with return to civilian life. Suicide rates of current and former military members should grab your attention and tell you that we have a serious problem on our hands. If you have read further, you probably have heard about treatments such as Prolonged Exposure and Cognitive Processing Therapy being used by VA mental health practitioners. 

This book, however, introduces readers to the concept of moral injury, a cousin to PTSD. While the features may look similar to PTSD, moral injury may better account for some of the experiences, especially where terror (the emotion, not behaviors) may not have been the main experience. 

The book opens with a story of a Nik, a Marine whose position came under fire from a small boy with an assault rifle. 

“According to the military’s exacting legal principles and rules, it was a justifiable kill, even laudable, an action taken against an enemy combatant in defense of Nik himself and his fellow marines. But now Nik is back home in civilian life, where killing a child violates the bedrock moral ideals we all hold. His action that day, righteous in combat, nonetheless is a bruise on his soul, a painful violation of the simple understanding of right and wrong that he and all of us carry subconsciously through life. 

… At home strangers thank him for his service, and politicians celebrate him and other combat veterans as heroes. And Nik carries on his conscience a child’s death.” (8)

The author goes on to argue with illustration after illustration that to go to war is to suffer moral injury, to suffer the disconnect between deeply held values and the experiences during war. While it is easy to see moral injury in the forced choice to kill a child vs. save one’s own life, moral injury can also result from being sent on a fool’s errand–political reasons sent to war vs. need to protect or defend freedoms. 

PTSD v. Moral Injury? 

Post-traumatic stress disorder is biology. It is the body’s involuntary physical reaction as we relive the intense fear of a life-threatening event and the scalding emotional responses that follow: terror and a debilitating sense of helplessness. (15)

He goes on for paragraphs to depict the experience of PTSD and its cascade of symptoms–“fear-circuitry dysregulation.” But then listen to how he talks about Nik

…Nik doesn’t have PTSD. What Nik struggles with is not the involuntary recurrence of fear. He’s okay with the crowds at Walmart. He doesn’t startle at loud noises. In contrast with veterans who’ve experienced PTSD, Nik didn’t feel the pain of his moral injury at the moment of the incident…. [But] he is bothered by the memory of that Afghan boy and with questions about what he did that day. Like all of us, Nik had always thought of himself as a good person. But does a good person kill a child? …No, a good person doesn’t kill a child, therefore I must be a bad person. …The symptoms can be similar to those of PTSD: anxiety, depression, sleeplessness, anger. But sorrow, remorse, grief, shame, bitterness, and moral confusion–what is right?–signal moral injury while flashbacks, loss of memory, fear, and startle complex seem to characterize PTSD. (17)

PTSD has little to do with sin. It is a psychological wound caused by something done to you. Someone with PTSD is a victim. A moral injury is a self-accusation, prompted by something you did, something you failed to do, as well as something done to you. (18)

Guilt and shame are key characteristics. Not being able to save a buddy, making a quick decision that also included losses of civilian life, betrayal by leaders but being forced to carry out orders, or not being protected by buddies–all can create a moral injury. Add a mega dose of grief/loss from death and loss of companionship after the unit breaks up and you have a serious problem. (Don’t forget once home and safe, the loss of adrenaline, the loss of status, the replacement of dullness and the rebuilding of old relationships without your friends and without purpose will enhance all painful feelings including nagging guilt and shame.)

Definition offered

The lasting psychological, biological, spiritual, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. (250)

Spiritual community interventions? 

Despite their attractiveness, short-term interventions like CISD aren’t effective (chapter 6 details this). In addition, straight up attempts to challenge distorted thoughts are likely to fail. So, what might work? The book details some listening and validating activities by chaplains, including the burning of cards listing their “sins” as they leave the battlefront symbolizing their remorse and reception of God’s forgiveness. Talking about guilt, confessing failures and shame seem central. Note that confessing and validating do not necessarily mean that others agree that sins have been committed or that perceptions of self are accurate. They merely acknowledge the burden the veteran carries. Even the secular therapy models validate feelings of guilt while finding acceptance and forgiveness. Saying, “don’t blame yourself, you couldn’t help it” to Nik aren’t helpful. Finding a path that doesn’t blame or excuse (237) allows for a different path between all or nothing shame responses. 

It seems that what spiritual mentors and Christian practitioners have to offer in light of these themes are central to recovery from moral injury. 

The reality, says the author, our current therapies are only marginally helpful and sometimes harmful. Near the end of the book he concludes with this conviction,

True healing of veterans with war-related moral injuries will only come from community, however we and they define community–peers, neighborhoods, faith congregations, service organizations, individuals. That means it is up to us. (260)

And thus, YOU have a job to do

Listen. I highly recommend you read his last chapter (“Listen” begins on page 261). He will tell you how to engage a conversation in order to learn. No matter your personal beliefs about war, this is something you can do. Don’t look for the government to do the job, be the one to listen and learn yourself. Be the one to bear witness, as silently as you can. Your presence (more than your words) will convey compassion, understanding, and God’s presence.

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Filed under christian psychology, Good Books, Post-Traumatic Stress Disorder, trauma

New Book on Forgiveness by Bryan Maier

Bryan Maier, colleague with me here at BTS Graduate School of Counseling, has just published, Forgiveness and Justice: A Christian Approach (Kregel, 2017).  Over the last 11 years I have enjoyed listening to and debating with Bryan regarding matters pertaining to individual and corporate forgiveness. I now commend this fine book to you for your reading! It is good to see his work in print.

As you likely know, forgiveness is a pretty popular topic these days, even outsid4161leu-lnl-_sx331_bo1204203200_e of Christian circles. Bryan describes some of these approaches to forgiveness (do it because it is good for your health, do it to restore relationships, do it following a prescribed set of steps, etc.) and lays out a clearer definition of forgiveness and related concepts (justice, empathy, grace, repentance, and more). Without being overly methodical, Bryan examines the processes needed to move to active, other-centered forgiveness. However, along the way he spends a good deal of time talking about things such as the imprecatory Psalms (asking God for justice)–something not often found in literature encouraging us to forgive.

Here’s what I said in my book blurb (inside cover),

Dr. Maier makes a persuasive and entirely readable case that biblical forgiveness happens only in response to authentic repentance. You will find this book clear, logical, and pastoral in its treatment of the concepts of forgiveness, repentance, and justice. Though forgiveness is a popular topic in mainstream literature, Dr. Maier gives a rare treat: cogent definitions and illustrations of God’s view of forgiveness from Genesis to Revelation. Using case studies, the reader experiences not only a better definition of the final acts of forgiveness, but also the necessary pre-forgiveness activities of healing and repentance. Victims of injustice will find comfort and relief in knowing that the focus of the forgiveness process falls squarely on the shoulders of the offender.


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Filed under counseling, Forgiveness, Good Books

Treating a whole population with suspicion always ends badly

I’m currently reading Spectacle, the telling of the story of Ota Benga, a Congolese man held captive in 1906 at the Bronx Zoo and placed on display in the zoo’s monkey house. This tragic story reveals our ugly history where Americans, by-in-large, believed in the superiority of the White races. But in chapter five, the author talks about another incident, The Brownsville Affair, during that same year. It is this affair that I wish to highlight.

The Brownsville Affair

In late July of that year, there was an altercation between a black member of the infantry division and a white man. The white man was killed. A mob ensued and when it was over, three more lay dead. Fast forward a few weeks into August and suddenly a bartender (white) is killed. The suspicion is instantly laid on the infantry, despite their white officers reporting that every infantry member was in his bed at the time. Evidence was planted to try to incriminate the men. When the men were interrogated, they denied any involvement and of course could not say who had killed the bartender.

But the people of Brownsville continued to accuse the men. And the decision was made to castigate them all for a so-called “conspiracy of silence.” The decision went all the way to President Theodore Roosevelt who signed the order having 167 men dishonorably discharged as punishment for a crime they did not and could not have committed. Here Pamela Newkirk recount Roosevelt’s comments

Despite pleas from black leaders, including Booker T. Washington, Roosevelt would sign the order denying the men–who had been deprived of legal counsel or a hearing–back pay, pensions, and eligibility to serve in the future. Roosevelt, considered a racial moderate for his time, unapologetically defamed the innocent men, saying, “Some of the men were bloody butchers; they ought to be hung.”

Not until Nixon, did this injustice be made right (and then the “justice” did not include any form of restitution.

The Trajectory When We Dehumanize others

Notice the trajectory:

  • One person of a group (a minority group) does something wrong.
  • Later, another ambiguous thing happens and blame is laid at the feed of an entire population.
  • Facts are not sought out but evidence is created and “justice” delivered because “these people” are butchers.

Is it any wonder that such minorities don’t feel particularly warm feelings when thinking about national pride. How could they? We’d like to think we are well beyond the years that we would place a human in a zoo to be gawked at. Indeed, we are. We’d also like to believe we are well beyond the years where we would demonize and be suspicious of an entire population of people. We are not there yet. There might be people who are butchers among the innocent. So, let’s ensure they don’t remain among us and accuse them of a conspiracy of silence for not pointing the guilty out. Let’s keep them all out just to be sure.

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Filed under Christianity, Civil Rights, Good Books, Historical events, Justice, News and politics, Race

The “End of Worry” in a dangerous world?

In light of the recent bombing in Boston, I thought I would use today’s post as a timely book note. Will van der Hart (Anglican vicar) and Rob Waller (Psychiatrist) have written a small but helpful book entitled, The End of Worry: Why We Worry and How to Stop (2011, Howard Books). What makes this book interesting is the fact that Will freely discusses his own struggle with worry, made more evident after the 2005 bombings in his city of London. While the bombings were the final straw to panic attacks, Will also explores some of the early roots of worry in his life.

If you struggle with worry, there are several reasons why this little book might be a comfort to you.

  1. The authors write as if they know worry and fear.
  2. It is not, as they say, “triumphalistic.” Meaning, they do not believe the right beliefs/prayers/faith will automatically solve the problem
  3. Worry is portrayed not only as a spiritual problem but also explored through lenses of psychology, biology, and habit formation.
  4. It is written to the worrier, not about the worrier
  5. Each chapter gives you opportunity to engage in a few key exercises
  6. They differentiate between solvable worry and floating worry (and the tyranny of the “what ifs…”)
  7. Their solutions are practical but do not pretend to be simplistic. In fact, they devote some space to the notion that you should “stop trying not to worry.” Sound radical?
  8. A number of their solutions are helpful for those who ruminate (OCD, scrupulosity)

The book sits firmly in the cognitive behavioral model of intervention. Therefore, much of it encourages readers to explore belief systems about self and world and to begin challenging faulty thinking and to work to replace with more appropriate cognitions, meditations, and self-talk. CBT is not the only therapeutic model but offers anxious people something to do.

If you would like to work through a book that describes the process of worry and perfectionism and then gives you some ideas to examine and change your own struggle, this might be the book for you.

*I received a free copy of this book without any obligation to write this post.


Filed under Anxiety, christian counseling, Cognitive biases, Good Books, Uncategorized

Desensitized to Justice Matters?

This week marks time when the 2013 Justice Conference comes to Philadelphia. If you have time, come for a visit and see what many of the well-known advocates for justice have to say ( and say hi to us at Global Trauma Recovery Institute/Biblical Seminary located at #237 in the exhibit hall). At our church, one of the adult Sunday School classes has been considering What God thinks about justice. I had the pleasure of leading it this Sunday as we explored the matter of injustice within our own walls. You see, too often we think about injustice as an “over there” problem. But wherever humans exist, injustice does also.

Gregory of Nyssa says that injustice is rooted in…greed. Greed propels us to take what is not rightfully our own. While outright theft is one form of greed, so also is being unwilling to speak up when others are being mistreated (we don’t want to give up our comfort and power).

Sensitivity to Injustice?

In today’s class, we considered those in our midst that might have less of a voice, thereby being more vulnerable to systemic injustice. Some of the populations named included children, women, ethnic/language/ideological minorities, singles, single parents, technologically dis-advantaged individuals, lower socioeconomic status individuals, same-sex orientation individuals, etc. In small groups, we considered how we might sensitize ourselves to the potential for systemic sin inside the church. Across all groups, the main answer was given that relationships must be formed with “the other” if we are going to learn of latent forms of injustice. There is little that will help us outside of learning through relationship.

Desensitizing ourselves?

However, there are times when we are in proximity to injustice and we turn a blind eye to it. How does this happen? Over time, we lose our sensitivity and begin to accept the dominant paradigm. If you want an excellent description of this process, I encourage you to read The Eye of the Leopard, by Henning Mankell. The main character, Lars Hakansson, arrives in Zambia as a young man. He is shocked and embarrassed by the overt racism by white farm owners who mistreat their “employees” and imagine that Africa would fall apart without their superior work wisdom and work ethic. But over the next 18 years he finds himself owning a farm and being in charge of 200 employees and their families. As the book progresses, he ends up becoming as paranoid as those who have lived their entire lives in Zambia. To be fair, both Black and white Africans help perpetuate the division. Lars tries to shed the “bwana” moniker (akin to “our father” in Swahili). Once he accepts the position, Lars imagines he will be different. He will build schools. He will treat others with dignity. He will raise salaries. Despite keeping these promises, the social fabric continues to fray and Lars starts to sound like the other racist owners.

Only in the end does Lars come to realize the truth,

A White man can never help Africans develop their own country from a superior position, he thinks. From below, from inside, one can contribute to expertise and new working patterns. But never as a bwana. Never as someone who holds all power in his hands.

Being in a system that promotes a dominant group’s power and maintains another group subservient will inevitably rub off on you if you try to work within the current system’s power structures. The challenge is this: if you don’t work in the current system, you probably can’t get much accomplished and will have little voice against “the machine.” If you do try to work within the accepted power structures, you will likely have some positive effect, even as you yourself may become accepting to some of the injustices.


Filed under Africa, Good Books

Good trauma telling?

In preparation for the start of our introductory Global Trauma Recovery course here at Biblical I re-read Richard Mollica’s Healing Invisible Wounds book (see previous posts about the book here and here). Mollica reminds us that there is a healing way to tell one’s trauma story…and there are destructive forms of telling the story.

Destructive forms of storytelling?

Trauma victims do need to tell their story. They need to be heard. But some forms of telling do more damage than good. Signs that the telling may not be helpful?

  • Puts victim/teller into high emotions (reliving the experience versus telling about it)
  • Overwhelms the hearer (who then disconnects thereby leaving the victim feeling more alone)
  • Focuses solely on the trauma or trauma symptoms (e.g., the degradation, shame, etc. thus maximizing paralysis and minimizing survival skills, resiliencies, and other important parts of the person’s life)

Facets of healthy trauma telling?

Mollica suggests 4 facets of good story telling

  • Factual re-telling of trauma (however not every graphic detail)
  • Identifying the cultural significance of the trauma experience
  • Gaining existential or spiritual perspective (reframe from larger perspective on self and world)
  • Identifying the teller/listener relationship forming

Notice that the storytelling is not just about what happened. It is also about the significance, looking from God’s perspective (on self, other, world, etc.) and identifying new connections, skills, resiliencies, etc.

Mollica gives these questions for counselors, family, and pastors to help guide a better story. I find them very helpful if one accepts the caveat that they are not all asked in one sitting nor would we demand articulate answers from victims:

  1. What traumatic events have happened?
  2. How are your body and mind repairing the injuries sustained from those events?
  3. What have you done in your daily life to help yourself recover?
  4. What justice do you require from society to support your personal healing?


Filed under Abuse, counseling, counseling science, counseling skills, Good Books, Post-Traumatic Stress Disorder, teaching counseling, trauma, Uncategorized

Book Note: A brief window into Palestinian life

English: Personal photo of Poet and Author Mou...

English: Personal photo of Poet and Author Mourid Barghouti, taken by Dia Saleh (Photo credit: Wikipedia)

Just finished Mourid Barghouti’s I Was Born There, I Was Born Here (2011, Walker & Co.; first published in Arabic, 2009). It is a set of short stories about the author’s experiences as a Palestinian making trips from Jordan back to his homeland in occupied territories (Ramallah). No matter your political leanings or support for Israel and/or a two state solution, you will find his descriptions of road blocks, walls, difficulties moving around, etc. a reminder of the fact that trauma can result not just from shocking and unexpected experiences (e.g., assaults, rape, domestic violence) but also from the daily grind of living in a police state without the right status. And lest you think he is only talking about living under Israel’s thumb, he also describes living under intimidation in Cairo as well,

No matter the differences in terms and methods from one Arab country to another, such people [those who had just taken his adult son] are always gracious when inviting their prey to be their guests and they will always be bringing them back in an hour or so at the most. Men and women have spent decades in the cells of the Arab regimes without ever finishing that damned cup of coffee.

We got the message.

The message of fear or, rather, of intimidation….

Thuggish authority is the same, whether Arab or Israeli. Cruelty is cruelty and abuse abuse, whoever is the perpetrator (p. 199)

His son was forced to leave the country of his birth (Egypt) since he was not Egyptian. Here’s what the author said,

What has stayed with me from this incident was my inability to protect my son. (p. 200)

Besides the descriptions of interminable waits at checkpoints, rude interrogations, refused entry to home villages for no apparent reason, Barghouti also describes the experience of being seen by others as a criminal, a possible thief, a terrorist instead of the poet that he is.

A worthy read to see life from another perspective.

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Filed under Good Books, Great Quotes, trauma

Booknote: Broken Memory

Just posted a short book review over at Global Trauma Recovery Institute. It is a novella about a child survivor of the 1994 genocide in Rwanda. If you are interested in getting an inside look at life after a trauma, dealing with memories and spaces in memories, and a common recovery process, I commend the book to you.  Quite moving, easy to read (not triggering for most), and gives some good illustrations of actions of the survivor and other caring individuals that help the young woman regain control over her internal world.

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Filed under Africa, counseling, Good Books, Rwanda, trauma

Why we lie

Just finishing up Karl Marlantes’ What it is Like to go to War (New York, Atlantic Monthly Press). It is not an easy book even as it is a quick read. There are many psychological frailties brought to the surface that should unnerve any reader, and not just those who want to know about war changes a person. One such human foible, lying, gets a whole chapter. After describing types of lies we tell, he has this to say about why we lie,

We lie because we find ourselves in positions where it appears the truth will hurt us. But a truth isn’t a thing like a flying rock. So by “hurt us” we must mean it will hurt some goal toward which we strive. And we’ve managed to confuse that goal with a definition of ourselves. “Hurt our ability to achieve our ends” equates to “hurt us.” Worse, we have such a large number of goals to use to define ourselves that we rarely know which to apply at any particular time. I want to be a hero. I want to stay alive. I want to be a good officer. I want my troops to like me. I want to defend my commanding officer. I want his job. I want to tell the whole world how incredibly difficult a time I have just had. I don’t want to look like a crybaby. I want to uphold the honor of my service. I want to get even. (p. 132)

I think Marlantes nails us all here. We might not struggle with the same wants but surely we can find ourselves in the same sort of struggle between hero and self, between getting what we want and doing the right thing. And we get confused as to what will get hurt if we tell the truth. Though we lie to ourseves that our lies are to protect others, mostly we lie to protect our own self.


Filed under Good Books, Great Quotes

Book note: Unbroken, the story of Louis Zamperini’s traumatic WWII experiences and survival

Just finished Laura Hillenbrand’s Unbroken: A World War II Story of Survival, Resilience, and Redemption (Random House, 2010). She tells the story of Louis Zamperini’s early life (which depicts the miracle of his surviving childhood and his own juvenile delinquency) leading up to his Olympic experiences in Berlin and then his airmen experiences in the Pacific. In May, 1943, while looking for another plane that didn’t return to base, Zamperini’s plane goes down in the middle of the South Pacific. Against the odds, he and 2 others survived.

Actually, the miracle that he survived could be said about his entire life: impoverished immigrant family, juvenile delinquency, being an Airmen, surviving a plane crash in the middle of the Pacific, surviving on a flimsy raft for 47 days without any food or water other than rain or raw fish here and there, surviving torture by the Japanese for a couple of years and then, finally, surviving PTSD and accompanying alcoholism.

Read the book of you are interested in the life of airmen in WWII (it is amazing how many died in noncombat crashes). Read the book if you are interested in hearing how psychological trauma from war and torture often impacts a person. Read the book if you like surprising endings.

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Filed under Good Books, ptsd, trauma, Uncategorized