Philly-area veterans find that healing ‘moral injury’ helps with recovery from PTSD, depression, addiction

When Leroy Enck enlisted in the Marines at age 18, he had the misfortune to begin training on Sept. 11, 2001. He was among the first ground forces to push into Baghdad.

Enck, now 37, was deployed three times and witnessed horrors that a Marine might expect, and others he could never have imagined, such as a starving puppy feasting on a dead soldier. Several months after he returned home, Enck’s neighbors got a puppy. “And I’m seeing this person with his face eaten off,” the South Philly resident recalled.

When his unit reached Fallujah, Iraq, Enck’s commander directed Enck and his fellow Marines to stand on rooftops to announce their presence, even though they were surrounded by enemy snipers. “It’s a miracle more people didn’t get killed,” said Enck, whose profound sense of helplessness haunted him long after he got home.

He suffered from PTSD and substance use disorder. Last year, Enck entered eight months of inpatient treatment at the Philadelphia VA Medical Center, which offered him some relief and coping tools. But it was the moral injury group led by VA psychologist Peter Yeomans and VA chaplain Chris Antal that steered Enck onto a path to healing.

“Moral injury” refers to the impact of feeling “either betrayed when trying to uphold or expecting certain moral values to be in place,” Yeomans explained. Another source of moral injury comes from violating your own values or seeing others do that.

“And importantly, it’s not a clinical diagnosis,” he said, explaining that it’s not something that’s wrong with the soldier. Rather, it’s about the burden of having to shoulder far too much, and suffering the results physically, emotionally, and spiritually.

The concept of moral injury — first developed by former VA psychiatrist Jonathan Shay, is about the unfair distribution of appropriate moral pain.

“The veterans who are morally serious and morally sensitive are holding something that often the society wants to ignore, avoid, and that exacerbates the pain of the veteran community,” Antal said.

In the group, Antal said, “veterans can speak honestly and feel some sense of assurance that they won’t be judged, that they will be heard, and that the community will accept their fair share of responsibility for sending these people into harm’s way, for training them to do the difficult work of killing.”

Yeomans and Antal run the 12-week program for about seven veterans at a time. At a community healing ceremony in the 10th week, veterans testify about their experiences at war before willing members of the public, gathered in the VA’s chapel. Community members are drawn to the ceremonies through word-of-mouth from past attendees, pastors bringing congregants, clinical professionals observing Yeomans and Antal, along with family members and friends of the veterans.

After the veterans speak about what moral injury means to them and tell their stories, the community makes a circle around the veterans, laying hands on their backs as a way of showing support. A water cleansing ritual and the lighting of candles to signify hope are also part of the ceremony. Then veterans meet twice more in their 90-minute group to process how the ceremony affected them.

During his testimony at the ceremony in December, Herbert Campbell, 72, who served as an infantryman in the Army, said he could remember only 18 months of the 28 months he fought in Vietnam. The rest of it he blocked out. But he does recall plenty of horrors, as well as a prayer he said while serving.

“I asked God not to be part of my life because I enjoyed the fighting and the killing,” said Campbell, of West Philly, who suffers from PTSD and depression.

That was his moral injury, he told the audience. “What I did not know was that there was a life I would have to lead after Vietnam and that my actions would haunt me for the rest of my life.”

When the group met the week after the ceremony, Campbell seemed less depressed, Antal said.

Veterans often use the word “deliverance” to describe how they feel in the weeks after the ceremony, a deliverance from the shame that had isolated them, Antal said. Yeomans added that “unburdening” is a common word he hears.

“People are brighter, happier,” Yeomans said. “They’re looser. There’s a sense of a weight being lifted … and we always hear about openings in relationships with their family members.”

James Dixon, who served in 1967 and 1968 as an infantryman in Vietnam, said he was able to speak about memories at the December ceremony that he had never before told his wife, who was in the audience.

Dixon was 23 when he was drafted, newly married, and a devout Christian.

“While in Vietnam, I asked a chaplain, ‘How do I deal with morals in combat?’” recalled Dixon, of Columbus, N.J. “His answer was, ‘There are no morals in combat.’ I did not fully believe his answer because I knew I still had my own personal morals.”

Dixon witnessed and heard secondhand about atrocities that still haunt him today. He saw pictures other soldiers had taken of the corpses they had mutilated and heard about enemy combatants being shoved alive out of flying helicopters.

“In combat, you’re often wracked with revenge and rage, often believing you are justified to act the way you have to, to take orders and things that I know I would never have done on my own,” Dixon testified at the ceremony. “The public has to understand I was sent to war by military leaders, politicians, and even you, the voting citizens. … I served our country fighting for freedom and now deal with combat experiences for the rest of my life.”

Back then, fellow soldiers warned him that he would be killed if he spoke up. Yet today, what still tortures him is that he didn’t do anything to stop the monstrous behavior he witnessed.

“That’s where the guilt comes in,” he said.

The moral injury group “let me express some things, but that doesn’t mean it’s over,” Dixon said. “Even though my family, friends, religious leaders, and definitely God have forgiven me, I haven’t yet forgiven myself.”

Enck recalled a memorable moment during his community healing ceremony before Dixon’s. When community members came up on stage and circled the veterans, it was, he said, “the first time I let people behind [me] like that” since he entered the service.

Enck, who is part of an alumni gathering called the Moral Injury Leadership group, which meets regularly for support, said he felt an “unburdening” at the healing ceremony.

“The veteran community, for all our positive attributes, we’re our own echo chamber of false narratives, that civilians can’t relate to us,” Enck said. But he found it both powerful and healing to “have a group of civilians there saying, ‘We want to be better. Show us how. Teach us. Share your story with us.’”