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Levy A, Gross ML. From active duty to activism: how moral injury and combat trauma drive political activism and societal reintegration among Israeli veterans. Front Public Health 2024; 12:1336406. [PMID: 38932767 PMCID: PMC11200126 DOI: 10.3389/fpubh.2024.1336406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
Trigger warning This article deals with combat experiences and their consequences and could be potentially disturbing. Introduction Moral injury (MI) is a severe form of combat trauma that shatters soldiers' moral bearings as the result of killing in war. Among the myriad ways that moral injury affects veterans' reintegration into civilian life, its impact on political and societal reintegration remains largely unstudied but crucial for personal, community, and national health. Methods 13 in-depth interviews examine combat soldiers' exposure to potentially morally injurious events (PMIEs) that include killing enemy combatants, harming civilians, and betrayal by commanders, the military system, and society. Interviewees also described their political activities (e.g., voting, fundraising, advocacy, protest) and social activism (e.g., volunteering, teaching, charitable work). Interviewees also completed the Moral Injury Symptom Scale. Results Two distinct narratives process PMIEs. In a humanitarian narrative, soldiers hold themselves or their in-group morally responsible for perpetrating, witnessing, or failing to prevent a morally transgressive act such as killing or injuring civilians or placing others at unnecessary risk. In contrast, a national security perspective blames an out-group for leaving soldiers with no choice but to act in ways that trigger moral distress. Associated with shame and guilt, the humanitarian perspective triggered amends-making and social activism after discharge. In contrast, a national security perspective associated with anger and frustration fostered protest and intense political activism. Discussion Despite its harmful health effects, moral trauma and injury can drive intense political and social activism, depending upon the narrative veterans adopt to interpret PMIEs. Aside from moral injury's personal, familial, and social effects, moral injury drives veterans' return to the political arena of civil society. As such, veterans play a central role in politics and dramatically affect post-war policy in democratic nations following conflict.
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Affiliation(s)
- Adi Levy
- Department of Jewish Studies and Political Science, Florida Atlantic University, Boca Raton, FL, United States
- Israel Institute and Florida Atlantic University, Boca Raton, FL, United States
| | - Michael L. Gross
- School of Political Science, The University of Haifa, Haifa, Israel
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Houle SA, Abidi CB, Birch M, Reeves K, Younger W, Conradi C, Patten S, Bélanger S, Richardson JD, Nazarov A, Wells S. The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis. Eur J Psychotraumatol 2024; 15:2353534. [PMID: 38832673 DOI: 10.1080/20008066.2024.2353534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one's experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.
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Affiliation(s)
- Stephanie A Houle
- MacDonald Franklin OSI Research Centre, London, Canada
- Veterans Affairs Canada, Charlottetown, Canada
| | - Catherine Baillie Abidi
- Department of Child and Youth Study, Mount Saint Vincent University, Mount Saint Vincent University, Halifax, Canada
| | | | - Kathryn Reeves
- Department of Child and Youth Study, Mount Saint Vincent University, Mount Saint Vincent University, Halifax, Canada
| | | | - Carl Conradi
- Centre for Addiction and Mental Health, Toronto, Canada
| | - San Patten
- Dallaire Institute for Children, Peace and Security, Dalhousie University, Halifax, Canada
| | | | - J Don Richardson
- MacDonald Franklin OSI Research Centre, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
- St. Joseph's OSI Clinic, St. Joseph's Health Care London, London, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, London, Canada
- Department of Psychiatry, Western University, London, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada
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Ford CG, Smigelsky MA, Yi JY, Trimm VM, Wortmann JH, Meador KG, Nieuwsma JA. Measuring morality: Analyzing the factor structure of the moral foundations questionnaire in veterans. J Clin Psychol 2023; 79:954-968. [PMID: 36269895 DOI: 10.1002/jclp.23448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Moral reasoning is an underexamined and potentially useful area of research relative to the care of moral injury in veterans. However, the most widely used measure of moral reasoning, the moral foundations questionnaire (MFQ), has not been validated in this population. METHODS Post-9/11 veterans (N = 311) completed questionnaires which included the MFQ. Veterans' scores were compared to the general US population. Confirmatory factor analysis was used to test existing models of the MFQ in the sample. Exploratory factor analysis (EFA) was also used to examine potentially improved model fits. RESULTS The two leading, preexisting MFQ models were both poor fits for the data. EFA results produced a four-factor model for the veteran sample using 25 of the original 30 items of the MFQ. CONCLUSIONS Measuring moral reasoning among veterans may be important in understanding the experience of moral injury. However, the most widely used scale (MFQ) performs poorly among a sample of post-9/11 veterans, indicating that veterans may respond differently to the measure than the general US population. Military culture may uniquely influence veterans' moral reasoning, suggesting the need for military specific measures for this construct.
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Affiliation(s)
- Christopher Graham Ford
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Melissa A Smigelsky
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Jennifer Y Yi
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Victoria M Trimm
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Jennifer H Wortmann
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA
| | - Keith G Meador
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA.,Departments of Psychiatry and Health Policy, Center for Biomedical Ethics and Society, Nashville, Tennessee, USA.,Graduate Department of Religion, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason A Nieuwsma
- Department of Veterans Affairs, Integrative Mental Health, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Ein N, Houle SA, Liu JJ, Easterbrook B, Baker C, Fuertes M, Turner RB, MacDonald C, Reeves K, Deda E, Hoffer K, Abidi CB, Nazarov A, Richardson JD. The potentially morally injurious nature of encountering children during military deployments: A call for research. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual’s deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.
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Affiliation(s)
- Natalie Ein
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Stephanie A. Houle
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Jenny J.W. Liu
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Bethany Easterbrook
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Clara Baker
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Marianela Fuertes
- The Dallaire Institute for Children, Peace and Security, Halifax, Nova Scotia, Canada
| | | | - Caleb MacDonald
- The Dallaire Institute for Children, Peace and Security, Halifax, Nova Scotia, Canada
| | - Kathryn Reeves
- Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Erisa Deda
- St. Joseph’s Operational Stress Injury Clinic, London, Ontario, Canada
| | - Ken Hoffer
- The Dallaire Institute for Children, Peace and Security, Halifax, Nova Scotia, Canada
| | | | - Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - J. Don Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, London, Ontario, Canada
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