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[Moral injury] is the raw primitive feeling I did something terribly wrong and I just don't know whether I was justified or whether I can be forgiven. The cure has to involve the honesty to acknowledge, yes, I did this.
- Father Thomas Keating, Almost Sunrise
Post-traumatic stress disorder (PTSD) is a term many students may know. It is a psychological diagnosis associated with individuals who have experienced trauma, such as assault, natural disaster, abuse and war, either as civilians or as combatants. Less familiar is the term moral injury, or a wound to the soul, caused by participation in events that violate one's deeply held sense of right and wrong. Both PTSD and moral injury affect veterans and contribute significantly to the alarming 20 veteran suicides that occur every day in the United States on average according to the most recent study from the U.S. Department of Veterans Affairs. Yet, moral injury is less well-known than PTSD, and appropriate treatment for it is not well understood.
This lesson invites student to gain a deeper understanding of moral injury and develop greater empathy for the challenges returning veterans face. Using video segments from the documentary film Almost Sunrise, students will learn about moral injury through the experiences of Tom and Anthony, two young Iraq war veterans struggling to heal their own moral injuries while raising awareness of veteran suicide as they complete a walking journey from Wisconsin to California. Students will conduct independent research, analyze the conditions and contexts in which moral injury occurs and explore effective mental health therapies and treatments.
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Note to teachers: This lesson asks students to learn about the psychological trauma of war from the experiences of real veterans. Some of the film clips contain graphic scenes of violence from war. You may want to solicit permission from parents and/or administrators ahead of time by explaining how the lesson relates to your curriculum (and the school's) goals.
OBJECTIVES
By the end of this lesson, student will:
- Be able to define moral injury and understand how it differs from post-traumatic stress disorder (PTSD)
- Analyze the psychological and physical impact of moral injury, including its ability to cause suicide, on the lives of individual veterans
- Participate in a Socratic seminar discussing the relationship between moral injury and just war theory
- Write a one-page letter to a veteran, veteran's family, elected official, or mental health professional/administrator in the U.S. Department of Veterans Affairs explaining moral injury and providing recommendations for effective treatment
GRADE LEVELS: 10-12, University Level
SUBJECT AREAS
U.S. History, World History, Social Studies, Health, Psychology, Current Events, Philosophy, Sociology
MATERIALS
Film clips from Almost Sunrise and equipment on which to show them
Computers with access to the Internet for student research
ESTIMATED TIME NEEDED
Two 50-minute class periods with a homework assignment.
FILM CLIPS
Film clips provided with this lesson are from Almost Sunrise.
Clip 1: "What Is Moral Injury?" (3:47 min.)
This clip begins at 0:00 with a definition of moral injury as a "wound to the soul, caused by participation in events that violate one's deeply held sense of right and wrong." It leads into a conversation between Tom, one of the veterans featured in the film, and a monk discussing the way in which Tom's actions in the military haunt him, and how his pain might be treated. It concludes at 3:47.
Clip 2: "Diagnosing Moral Injury" (3:42 min.)
At 21:30, Tom and Anthony meet a policeman who shares that police officers have suicide rates similar to those of vets. He explains how he has learned to cope with his emotions. The clip ends at 25:12, when Katinka, Tom's girlfriend, describes how the military measures and defines PTSD and how it differs from moral injury.
Clip 3: "'Just War' and Its Relationship to Moral Injury" (4:20 min.)
From 34:30 to 38:50, Tom, Anthony and their friend Emmet describe their perspectives on the purpose of the Iraq war and how the government's changing story about it influenced their perception of the actions they took there on their country's behalf.
Clip 4: "Wolf Walker" (5:10 min.)
Starting at 51:10, Tom and Anthony meet Wolf Walker, one of the members of a Native American tribe they visit on their journey across the country. The clip concludes at 56:20, when Wolf Walker shares his family's experience with war and his tribe's perspective that a person's power to heal comes from within.
Clip 5: "Treating Moral Injury" (2:58 min.)
In this clip beginning at 1:20:16, Tom talks about attending a "power breath" training, where he practiced meditation and deep breathing to make space for deep reflection., He talks about how that experience allowed him to begin to forgive himself and heal. The clip ends at 1:23:14 with a quote from journalist and author David Wood: "It is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans."
ACTIVITY
Understanding Moral Injury
Share with students this part of the U.S. Department of Veterans Affairs definition of moral injury: "The key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational and group-based rules about fairness [and] the value of life."
View clips 1 and 2. Discuss reactions and collect any questions that may have arisen.
Have students independently do a close reading of this article, "Why Distinguishing a Moral Injury from PTSD Is Important" from the online publication Stars and Stripes, an independent newspaper published by the U.S. Department of Defense.
In small groups, have students share their understanding of moral injury and be prepared to discuss in a large group these questions:
If students would like to research moral injury further, we recommend exploring the Moral Injury Project at Syracuse University.
Homework: Read President Obama's Nobel Peace Prize acceptance speech "A Just and Lasting Peace." Underline key sentences that further clarify your understanding of a just war and write responses to these prompts in preparation for tomorrow's Socratic seminar:
- In your own words, explain your understanding of the phrase "just war."
- What is your argument in favor or against a "just war"?
"Just War" and Moral Injury
Begin class by asking each student to share with a peer their response to President Obama's Nobel speech.
Watch clip 3. Have students spend a few minutes reflecting on what Tom, Anthony and their friend Emmet share about engaging in combat in Iraq and its relationship with moral injury.
If time permits, conduct a Socratic seminar using the text of President Obama's speech, the film segments from Almost Sunrise and students' independent research on "just war" theory.
Central questions for discussion:
- How does the rationale for why a nation goes to war affect or influence the way a soldier may understand their actions in combat as right or wrong?
- Does this have any relationship to moral injury? Why or why not?
EXTENSIONS
Share this quote from Katinka in Almost Sunrise. Katinka is a cultural anthropologist with a specialty in combat PTSD and veterans' experiences with this condition. She is also Tom's girlfriend.
These stories have generated a growing empathy within me. Certainly I will never know what it feels like to be at war in Iraq or Afghanistan, but I know what it feels like to lose someone. I am humbled by these veterans, not because they served and protected our country or spread democratic ideals, but because they are not giving up. They inspire me.
Watch clip 4 or clip 5 from Almost Sunrise and have each student write a one-page letter to either a veteran, a veteran's family, an elected official, or a mental health professional/administrator in the U.S. Department of Veterans Affairs explaining their understanding of moral injury and providing recommendations for effective treatment.
Focus on veterans' relationships. Listen to a portion of This American Life episode 603, "Once More, With Feeling," from minute 29:45 to 36:22. The story features veteran Michael Pitre talking about how he changed his personal narrative about fighting in the war so that it took a form he thought would make his friends and family more comfortable, but doing so ended up damaging him and his relationships. After listening, discuss what made him feel distant from others and the effect it had on him. Then talk about his shift and how his loved ones made him feel more settled.
Have students read and explore the embedded videos in the three-part Huffington Post project, "A Warrior's Moral Dilemma" on moral injury by journalist and author David Wood.
POV Resources
POV: Almost Sunrise
http://www.pbs.org/pov/almostsunrise/ - The POV site for the film has many features, including an interview with the filmmakers, a general discussion guide with additional information, resources and activity ideas and a reading list of suggested books.
POV: Media Literacy Questions for Analyzing POV Films http://www.pbs.org/pov/educators/media-literacy.php - This list of questions provides a useful starting point for leading rich discussions that challenge students to think critically about documentaries.
Film Related Websites
Almost Sunrise
http://www.sunrisedocumentary.com/ - The film's official website offers information about the film and ways to get involved.
Moral Injury and Hidden War Wounds
The Atlantic: "Healing a Wounded Sense of Morality"
http://www.theatlantic.com/health/archive/2015/07/healing-a-wounded-sense-of-morality/396770/
Huffington Post: "A Warrior's Moral Dilemma"
http://projects.huffingtonpost.com/projects/moral-injury
The New York Times: "War Wounds That Time Alone Can't Heal"
https://well.blogs.nytimes.com/2016/06/06/war-wounds-that-time-alone-cant-heal/
The New York Times "What We're Fighting For"
https://www.nytimes.com/2017/02/10/opinion/sunday/what-were-fighting-for.html
U.S. Department of Veterans Affairs: "Talking Spiritual About Moral Injury" https://www.va.gov/health/NewsFeatures/2016/July/Talking_Spiritual_about_Moral_Injury.asp
Organizations
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
http://dcoe.mil/ - This website includes clinical research and resources on health issues related to military service.
Project Welcome Home Troops
http://www.projectwelcomehometroops.org/ - This organization's website provides quality-of-life support for returning veterans and their families, including techniques for stress relief, health and wellbeing and empowerment.
Stop Soldier Suicide
http://stopsoldiersuicide.org/ - This is the website of a group that works to support active military and veterans and create a network of resources and solutions.
U.S. Department of Veterans Affairs
www.va.gov - This website provides research, information and resources related to veterans.
Immediate Assistance
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
http://dcoe.mil/ - A 24/7 live chat outreach center can be reached at 866-966-1020 or by emailing resources@dcoeoutreach.org.
Veterans Crisis Line
https://www.veteranscrisisline.net/ - For immediate assistance, veterans can call, text or chat with the Veterans Crisis Line. Dial 800-273-8255 or visit https://www.veteranscrisisline.net/.
STANDARDS
Common Core State Standards for English Language Arts & Literacy in History/Social Studies, Science, and Technical Subjects (http://www.corestandards.org/assets/CCSSI_ELA%20Standards.pdf)
SL.11-12.1 Initiate and participate effectively in a range of collaborative discussions (one-on-one, in groups and teacher-led) with diverse partners on grades 11-12 topics, texts and issues, building on others' ideas and expressing their own clearly and persuasively.
SL.11-12.2 Integrate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, orally) in order to make informed decisions and solve problems, evaluating the credibility and accuracy of each source and noting any discrepancies among the data.
SL.11-12.3 Evaluate a speaker's point of view, reasoning and use of evidence and rhetoric, assessing the stance, premises, links among ideas, word choice, points of emphasis and tone used.
W.9-10.1, 11-12.1 Write arguments to support claims in an analysis of substantive topics or texts, using valid reasoning and relevant and sufficient evidence.
W.9-10.2d Use precise language and domain-specific vocabulary to manage the complexity of the topic.
W.11-12.2d Use precise language, domain-specific vocabulary and techniques such as metaphor, simile and analogy to manage the complexity of the topic.
W.9-10.4, 11-12.4 Produce clear and coherent writing in which the development, organization and style are appropriate to task, purpose and audience.
Content Knowledge: (http://www2.mcrel.org/compendium/browse.asp) a compilation of content standards and benchmarks for K-12 curriculum by McREL (Mid-continent Research for Education and Learning).
Language Arts, Standard 1: Uses the general skills and strategies of the writing process.
Language Arts, Standard 2: Uses the stylistic and rhetorical aspects of writing.
Language Arts, Standard 8: Uses listening and speaking strategies for different purposes.
Language Arts, Standard 9: Uses viewing skills and strategies to understand and interpret visual media.
ABOUT THE AUTHOR
Blueshift is a team of education specialists with background in environmental and social impact work. The team recognizes and builds on the power of documentary film in reaching broad audiences to spark energy for deep and lasting social change. The team works with filmmakers, photographers and writers to develop innovative educational strategies, experiences, tools and resources that bring stories off the screen and into viewers' lives.