Military sexual trauma (MST) comprises a range of harmful experiences, including rape, sexual coercion, attempts at forcible sexual contact, and sexual harassment (Conrad et al., 2014). Estimates vary across studies and the definitions that the Veterans Administration (VA) has used over the years have changed, as well as the Department of Defense’s reporting requirements. Conservative estimates state that 20% of women veterans have experienced military sexual trauma, but that does not fully account for the 80-90% of assaults that go unreported (Conrad et al., 2014). In the moral injury study for women veterans I am co-leading, 80% of participants interviewed so far experienced some form of sexual trauma. One participant, who works to help other veteran women said that pretty much everyone she knows is a sexual assault survivor. 

MST is so prevalent among women who served that it is common for people to equate moral injury in women to MST. They are not synonymous terms. Moral injury refers to the psychological injury that occurs when a traumatic event clashes with a person’s deeply held moral values (Nash et al., 2013). Moral injury research is still in its early stages and there is no agreed-upon list of potentially moral injurious events (MIEs). Currier et al. (2015) identified 20 MIEs in six categories: acts of betrayal, acts of disproportionate violence inflicted on others, incidents involving death or harm to civilians, violence within military ranks, inability to prevent death or suffering, and ethical dilemmas/moral conflicts. Nash et al. (2013) developed a scale that included nine items — six of which involved perceived transgressions by self or others and three items related to betrayal by others. Currier et al.’s (2015) scale included the item, “I was sexually assaulted,” but the instrument by Nash et al. (2013) stuck to more general categories. 

The point is that while many women experience moral injury as a result of a sexual assault, MST is not the only event that causes psychological harm. Our research is generating a new theory of moral injury as it relates to women veterans. We encourage all women who meet the study qualifications to apply. More information can be found on our study website. To participate, you must be a woman between the age of 25 and 70; a retired or discharged uniformed service member with at least five years of service; of the grade of E-5 or above as an enlisted person, W-2 or above as a warrant officer, or O-3 or above as an officer at the time you left the service; not currently working for the Department of Defense as a civilian or contractor; and a witness to, participant in, or the target of any activities by military personnel that created inner conflict or violated your personal moral values.

To generate a complete theory, we need to interview a broad spectrum of women who have experienced a wide array of emotional and psychological traumas. In operations that the U.S. has been involved in in the last 20 years, women have been involved in direct combat action, so we need to gather data from those women who have killed in combat or witnessed combat death or injury. We need to find women who were not sexually assaulted but were the subject of other types of humiliation or attacks by fellow service members. Many women have been outright rejected and disrespected by colleagues or treated as pariahs in their units. I do not know the full extent of the injuries that are out there in the woman veteran population, but that is why we are conducting this study. We need to fill in many gaps in the knowledge base of the moral injury field. If you think you qualify, or know someone who does, please contact me at 910-690-5964 or droberts@chaplainconsultants.com. Sharing your experiences can be difficult, but many women find that the act of sharing is cathartic. 

Dr. Daniel Roberts is an author, consultant, and teacher who conducts world-class education and research in military chaplaincy. He has over 15 years of experience in providing emotional and spiritual support to the men and women in the armed forces. Daniel also provides training and mentorship to thousands of military chaplains through conferences, classroom instruction, and one-on-one coaching. His students include chaplains from the US Army, Air Force, and Canadian Armed Forces (CAF). Dr. Roberts also helped the CAF develop military doctrine for the deployment of chaplains as religious advisers.

References

Conrad, P. L., Young, C., Hogan, L., Armstrong, M. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50(4), 280-286.

Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2013). Initial Psychometric Evaluation of the Moral Injury Questionnaire-Military Version. Clinical Psychology & Psychotherapy, 22(1), 54–63.

Nash, William P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646-652. 

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8 Comments

  1. I was an E5-E6 for a total of 5 years. I’m 70 years old. I was verbally harrased and assaulted once. While in Basic Training I was subjected to an attempted kidnapping by a taxi cab driver. I made rank ahead of my peers and was constantly harrased, accused of “sleeping” my way up the chain of command to get promoted early. The assault was by my Senior Non-commissioned officer in charge and the worst part was how I was treated when I tried to get help. Told I was just having flights of fantasy and failure to adjust to adult life.

    1. Linda, I’m so sorry that happened to you. I hope you have received some help and support since that time. I’m middle-aged and over 20 years your junior, but I can relate to what you shared. I’m a MST survivor, too. You’re not alone.

  2. I would love to participate in hopes that I can finally release myself from the demons that cling to me. Unfortunately, I will not retire until December 31st. Please let me know if I can be a candidate.

  3. I am a MST survivor. After 20+ years of silence, I was referred to seek VA compensation. I applied on my own – without any assistance. I filled out the paperwork online, submitted 20 years’ worth of civilian mental health, medical, and occupational records. About six months later, I was awarded with 100% service-connected for MST PTSD.

    The reason why I never sought care at the VA for over 20 years is due to my fear of being retraumatized. I feared worsening flashbacks, being revictimized, being disbelieved, having my honorable discharge rescinded for disclosing my MST, being raped, being emotionally abused, and experiencing what I believe to be moral injuries.

    This long silence was a moral injury to me. When I attempted to participate in a MST group at the VA twice, I looked around the room at both uniformed mililitary personnel (still in their youth) as well as us older veterans. Us older veterans had the same look of sadness on our faces, and some of us cried. I admitted to my therapist in a private session that I couldn’t return to that group because the pain was too deep. I explained further that I felt morally injured – a term I had learned as an undergrad years ago studying psychology, and a term that I researched on my own for the past year. I explained that I felt horrible for considering that MST ensued because I didn’t tell years ago. I was too afraid that I will be brutally beaten, apart from dishonorably discharged, had I told. I feared being sexually assaulted again. I feared many things. I felt like all my training meant nothing if I felt all this fear. I was physically injured, so my honorable discharge remained intact. However, I never reported MST.

    What somewhat corroborated my story when I applied for compensation some 20 years later was another Marine who did report MST. I have no idea what happened to her, since I never saw her after she reported. When I was asked questions about the incident, I honestly couldn’t remember. I dissociated at a time when I didn’t even know what dissociation meant. I only recalled bits and pieces of memory of what happened to me, but I couldn’t recall what may or may not have happened to someone else. I don’t even remember being in the same area. I blanked most of the stuff out.

    About a decade prior to my applying for VA compensation, I was diagnosed with a dissociative disorder. It was the first time I had learned about the reasons why I lost time for no apparent reason, and why I couldn’t recall important events. My reactions to the traumas I had experienced in service were many, and I felt ashamed upon homecoming. A few VA therapists helped me to understand the importance of homecoming, and why for many years I felt this weight on my shoulders – a weight caused by silence. I didn’t feel like a hero; instead, I felt like a coward.

    Today, I still feel like a coward. It is as if all the training I received was wiped away after my experiencing MST. What made matters worse was when I suffered year after year with feelings of guilt and shame for not disclosing. I didn’t think I was allowed to disclose to civilian therapists let alone any of my close friends about my MST experiences. In fact, when I sought treatment with civilian therapists for nearly two decades prior to my seeking help through the VA, I attributed my feelings to childhood maltreatment, especially since that was the focus of most therapists in the civilian world. Many of my veteran friends who sought civilian care for their mental health issues agreed that their focus became solely on their childhood traumas, not their military ones. Such reinforcements worsened my guilt, shame, moral injuries, and silence. I pretended that my emotional reactions and mental suffering were due to childhood trauma, but the treatments for childhood trauma weren’t working. I could only assume that it is because there’s something vastly different about the betrayal wounds felt from MST when compared to childhood traumas.

    I was resilient to any childhood traumas prior to my enlisting in the military. I worked high-stress jobs such as security, attended college for a brief time, and completed ROTC. I often worked multiple jobs to pay the bills, and I had many friends, including military friends.

    After MST, my life went downhill. I felt like I couldn’t trust anyone, including myself. I was so confused about my hiding MST because it went against all the leadership training I had received while in service. For some reason, I was confused about why I was a victim of MST. Was this a test? I thought. Stay silent, remain strong, ignore my feelings, I answered myself. Don’t let them see your “weak” pain, and don’t betray your brethren, even if you think they betrayed you, I told myself silently. Confused, afraid, and ashamed, I remained silent.

    When I was honorably discharged, my guilt and shame increased. Year after year, my silence reminded me of how much of a coward I was. I wasn’t a leader for not telling, and because I didn’t report MST, I may have allowed those guys to further harm others and repeat that tradition – all the way to now. I felt responsible for the uniformed soldiers in the MST group because I never told. I wasn’t the leader they trained me to be; I should have known that MST was anything but “a test of my courage.” I should have known that the perpetrators were wrong.

    And even though I was aware that retaliation would likely ensue if I did report, I felt like that was not a good enough excuse for me. I felt ashamed for being “selfish” in preserving my rank and honor by not telling. I felt guilty and ashamed for returning home a coward.

    Every year the weight of MST’s moral injury grew on me. How dare I even call myself a veteran, I told myself. I spent many years alone, and many years in and out of psychiatric facilities, even during times I had worked prior to my becoming disabled through SSDI.

    There were times I couldn’t function at all, so I wound up homeless. I never lived on the streets per se, but I have lived in homeless shelters and, at one time, in my car. I couldn’t shower everyday, so that reinforced my sense of being filty, less than, undeserving, etc. I hated myself for remaining silent.

    Even today I struggle with these thoughts. I’m scared of seeking care at the VA many days, and I’m scared about coming in contact with one of my offenders at the VA one day. I’ve moved a few times to hopefully prevent that. But my records are visible to any veteran or VA personnel who works at the VA. I feel even more exposed, especially when some of the therapists’ notes are recorded on my record where even I can see when I choose to download my information from the VA health website.

    What keeps me stuck is my fear of expressing emotion. I feel emotion, but expressing tears or anything other emotion scares me. My guilt and shame tell me that I don’t deserve to be supported through emotional expression. The moral injuries had confused me so much over the years that I feel lost and trapped. Even though I told a sliver of my story, it still wasn’t good enough to stop MST. To this day, about 25% of women and about 10% of men at the VA have reportedly experienced MST. Those are recent estimates today! And those don’t even count the many people who don’t report for whatever reason. It’s that silence and that not reporting that seems immoral, even when systemic pressures within the military and outside in mainstream society reinforce the idea that telling about sexual offenses (especially if told days, months, or years later) will cause even more harm, shame, and guilt. Why didn’t you report this sooner? What are you leaving out? Are you telling the truth? How can you forget some details but remember others? –All this victim-blaming and victim-shaming have worsened my moral injuries. I deal enough with flashbacks, intrusive thoughts, and hypervigilence from MST, but adding insult to those post-traumatic injuries meant that the moral injuries embedded within silence were “true.” Could society be wrong? Nah, I told myself. I blamed myself again and again for the silence.

    I don’t plan on joining any studies as a participant, but I do wish you all well on your research endeavors. I hope that you are able to find some answers that could help us veterans. Betrayal traumas and moral injuries seem to go hand in hand.

    On the flip side of all this, I wonder about the brothers whom I would have felt honored to serve with had they not had committed MST against my person. I wonder if they ever felt moral injuries themselves for what they did to me, or what they may have been “trained” or “influenced” to do by other (predominantly male) service members. I also wonder about the female bystanders who may never have been victimized by MST, but may have encouraged the silence to ensue. Do they feel moral injuries, too?

    And then I return to myself and many other MST survivors. Our moral injuries related to silence seem like all responsibility has fallen on the victims’ shoulders, as opposed to the perpetrators of MST as well as the bystanders being held responsible. If I were a leader, I’d clearly see that MST is wrong, and that condoning “rape culture” in the military does a disservice to our country. If we are to defend our Nation and our Constitution, how does allowing MST support the defense of our Nation and our Constitution? How does MST factor into leadership, combat training, and other training? It sure seems like MST detracts from the defense.

    Knowing this, however, I still feel guilty and ashamed for not telling and therefore not defending my own self. How can I be a trained soldier and a trained leader who is defending our country if I cannot even defend myself against my own brothers-in-arms? This moral injury comprising an inability to fight back (apart from remaining silent about it) brought more shame and guilt to my conscience. If I cannot fight back, then I don’t deserve to be here, and I certainly don’t deserve to be called a hero or a veteran, I thought to myself. I don’t deserve to celebrate Veterans Day, I tell myself, and I certainly don’t deserve to be thanked for my service. What service? My failure at fighting off MST before it became a trauma? I’ve hated myself for being weak that way, for being an immoral coward. I should have fought back harder, I told myself, I should not have frozen or dissociated. I should have remained vigilant and alert, strong and defensive.

    My depression, anxiety, PTSD, insomnia, isolation, guilt, and shame increased year after year. I swear that moral injuries worsen PTSD and prolong healing. Until rape culture and victim-blaming decrease, my PTSD and moral injury traumas will remain.

    1. I thank you for sharing your story. I hope it helped a little to take the time to do that. Unfortunately, for far too many people, your story is similar. You do not deserve the shame and guilt you feel and you did not deserve for any of this to happen to you. You deserve to be happy and free. My organization and others will continue to work towards seeing that everyone is healed from moral injury.

      On another note, I think it would be an interesting study to ask perpetrators of MST if they feel moral injury because of what they did. I suspect that many of them do.

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