For Veteran Women, Military Sexual Trauma and Moral Injury are not the Same

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. 

Old Memories, Fresh Wounds

Photo by Milada Vigerova on Unsplash

For the last several months, I have been working with a partner to conduct a moral injury study for women veterans. (We are still looking for participants. If you are a female veteran and experienced something while serving that caused inner conflict or went against your moral values, consider signing up: https://chaplainconsultants.com/projects/). Although military sexual trauma is not synonymous with moral injury, rape was a common experience among the women I interviewed. That is very disturbing. What is even more disturbing is that 30 years later, that deep wounding is every bit as sore and fresh as it was when it first happened.

While the men who committed these crimes went unpunished, the women who were their victims spent the rest of their lives in pain. Some of them cannot have the children they desperately wanted due to the physical damage they suffered. Others lost their ability to have an intimate relationship with another person. One woman’s family members disowned her when they found out that she reported the rape to authorities.

It is hard for me to hear these stories. As a caregiver, I want to believe that anything can be healed. But after many years of therapy, some women have experienced little in the way of recovery. True, they are no longer suicidal, but life is not what others would consider normal. 

That is not to say that these women are completely powerless. Many have pursued education as a means of taking back their power. Some are heavily involved in advocacy and social change programs. These survivors want to take their pain and use it to help others. I have profound respect for that.

I cannot give up on the healing process or on these survivors. They have come too far. They have suffered too much for me to stop trying. But I cannot do it alone. More caregivers, especially men, need to come to their aid. Women continue to fight for their freedom from oppression and victimization, but until more male leaders, preachers, and support providers take up their cause, more tragedies will occur. 

One way we are taking on the problem is through the Women Veterans and Clergy Conferences, that will be held in Richmond, VA and Charleson, SC. These meetings will gather women veterans, clergy and caregivers from a wide variety of religious and spiritual perspectives, both men and women, to discuss ways of bringing about change and healing. One important aspect of the events will be veteran storytelling. From behind a protective screen, women will tell their stories so that attendees can get a true sense of how big the problem really is and get motivated to work for change. Also, women told me that voicing their stories was cathartic for them. 

This is not an attempt to commercialize a problem. The conferences are free to attend and are merely a starting point to find new ways to collaborate and build relationships between women veterans and support providers. To find out more, go to: https://chaplainconsultants.com/products-and-services/wvc-conference/.

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.

Why Male Clergy Need to Understand Moral Injury in Women

Introduction

In the United States, most clergy are male. Approximately 95% of U.S. Army chaplains are men (U.S. Army, 2014) and only 12% of churches have a woman in the senior leadership role (Hartford Institute for Religion Research, 2006). There are many women in institutional ministry (e.g. prison and hospital chaplaincy), but for most women who experience a potentially moral injurious event, their formal religious leader will be a man.

What is Moral Injury?

Moral injury, as it is currently defined, refers to the inner conflict a person feels when his or her sense of moral rightness is violated (Currier, Holland, Drescher, & Foy, 2015a; Currier, McCormick, & Drescher, 2015b; Nash, Carper, Mills, Au, Goldsmith, & Litz, 2013). Moral injury is commonly spoke about in reference to killing in combat, but there are other ways that moral injury can occur. Nash et al. (2013) found that witnessing others’ immoral acts, failing to do something that one feels is right, and experiencing betrayal can all lead to moral injury.

Moral Injury in Women

Much of the research conducted on moral injury has focused on men. Dr. Daniel Roberts of Roberts Research and Consulting and Joann Kovacich, Ph.D. of the University of Phoenix are conducting a study of moral injury in women. They plan to administer 20 or more in-depth interviews with women who served in the Armed Forces. The purpose of the study is to generate a theory of moral injury in women veterans. So far, eight participants have provided over 10 hours of qualitative data.

Preliminary results suggest that military sexual trauma (MST) may be a common context in which moral injury occurs in women. Women also talked about moral injurious events (MIEs) that included witnessing atrocities, betrayal by leaders, being disrespected by subordinates and superior officers, lack of support, and killing in combat. Some of these MIEs were also found by Nash et al. (2013), but MST, disrespect, and lack of support were common themes among women that might not occur as regularly with men.

Women described military experiences that run counter to military ideals. Participants were raped by their commanders, treated with disdain by co-workers, openly disrespected by subordinates, and bullied by leaders. Despite their pain, half of the women stayed in the military and completed full careers. The other half left after a few years and for some of them, their moral injurious experience was a significant factor. For those who stayed in the service, helping other women was a motivator.

What Male Clergy Should Do

Male clergy should be open to the idea that for women, moral injury might entail a different set of circumstances than for men. MST is a common theme among women and the Department of Defense estimates that female service members are seven times more likely to experience sexual assault than men (Department of Defense [DoD], 2018). Gender harassment, disrespect, and bullying were also common themes among participants. Women are four times more likely to experience a hostile work environment related to their gender than men (DoD, 2017).

Male chaplains should examine their own perspectives on equality for women in the military. The role of women in the armed forces continues to be debated in Christian circles. Some denominations reject the notion that women should be allowed to serve in combat jobs (The Lutheran Church — Missouri Synod, 2017). As more and more women pour into fields that were previously closed to them, harassment from those who are against such integration could increase. Regardless of how a chaplain feels about combat integration, he or she should be able to provide compassionate care. Understanding one’s own bias related to equality can help prevent weak support if one is inclined towards a more conservative view of women in the military.

Finally, all chaplains should consider additional opportunities for training and dialogue on issues related to women’s experience in military service. One such opportunity is the Women Veterans and Clergy Conferences, being held in April of 2020 in Charleston, SC, and Richmond, VA (https://chaplainconsultants.com/products-and-services/wvc-conference/). These conferences will include both male and female clergy from the military, VA, and civilian circles. The purpose of the conferences is to discuss the latest research on moral injury, learn about healing modalities from a wide variety of perspectives, hear from women veterans who experienced moral injurious events and develop collaborative relationships. Registration is now open for these events and there is no cost to attend (https://forms.gle/eV1epBWrSyYQTPf17). Moral injury research is ongoing. To find out more about the current study, go to: https://chaplainconsultants.com/projects/, or call Daniel Roberts at 910-690-5964.

Roberts Research and Consulting (RRC) is a company that specializes in education, research, and advocacy in military chaplaincy and soldier care. RRC’s research focus is on pastoral support to female service members. Women are an underserved population when it comes to spiritual leadership and support. By conducting studies with female service members as the primary population, RRC is able to develop theories and practices that will enhance the lives of women in the military.

References

Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2015a). Initial psychometric evaluation of the Moral Injury Questionnaire-Military Version. Clinical Psychology and Psychotherapy, 22(1), 54-63. doi:10.1002/cpp.1886

Currier, J. M., McCormick, W., & Drescher, K. D. (2015b). How do morally injurious events occur? A qualitative analysis of perspectives of veterans with PTSD. Traumatology, 21(2), 106-116. doi:10.1037/trm0000027

Department of Defense. (2017). 2016 Workplace and Gender Relations Survey of Active Duty Members. Retrieved from https://www.sapr.mil/public/docs/reports/FY16_Annual/Annex_1_2016_WGRA_Report.pdf.

Department of Defense. (2018). Appendix B: Statistical Data on Sexual Assault. Retrieved from https://sapr.mil/public/docs/reports/FY17_Annual/Appendix_B_Statistical_Data_on_Sexual_Assault.pdf.

Hartford Institute for Religion Research. (2006). “A quick question: What percentage of pastors are female?” Retrieved from http://hirr.hartsem.edu/research/quick_question3.html.

The Lutheran Church — Missouri Synod. (2017). Women and Military Service: A Lutheran Perspective. Retrieved from https://blogs.lcms.org/2018/ctcr-report-women-and-military-service-a-lutheran-perspective/.

Nash, W. P., Carper, T. L. M., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646-652. doi:10.7205/MILMED-D-13-00017

Roberts, D. L., Kovacich, J., & Rivers, M. (2017). The Comprehensive female soldier support model: A Delphi study. Journal of Health Care Chaplaincy. doi:10.1080/08854726.2017.1312817

Roberts, D. L., & Kovacich, J. (2019). Military Male Chaplains’ Pastoral Support and Female Soldiers: A Descriptive Case Study. Submitted for publication.

United States Army. (2014). “Women in the U.S. Army Chaplain Corps.” Retrieved from http://www.army.mil/ article/122458/Women_in_the_U_S__Army_Chaplain_Corps/. 

New Conferences will Bring Chaplains and Women Veterans Together for Soul Care

Roberts Research and Consulting today announced it will host two Women Veterans and Clergy Conferences in April of 2020. One event will take place in Charleston, South Carolina and the other in Richmond, Virginia. The conferences will bring together women veterans, male and female military chaplains, VA chaplains, and civilian clergy to learn about moral injury in women veterans, discuss healing modalities, engage in healing practices, and talk about ways to bring about positive change.

Moral injury is a term that refers to the inner conflict military service members feel when their sense of moral rightness is violated during their time in the service. Initial findings of a current study underway on moral injury for women veterans conducted by Dr. Daniel Roberts of Roberts Research and Consulting and Joann Kovacich, Ph.D. of the University of Phoenix suggest military sexual trauma is one common cause of moral injury, as well as witnessing atrocities, killing in combat, and being forced to do things that are against one’s moral values.

Both military chaplains and civilian clergy have a special role to play in the well-being of service personnel. Military chaplains are often the first person a soldier talks to when he or she experiences difficult circumstances. Once service members leave the military, civilian clergy and Veterans Administration (VA) chaplains can provide care, but civilian clergy often do not know how to “speak the veteran’s language.” Veterans are often hesitant to reach out to people they do not know.

The conferences aim to address these problems by putting military chaplains, civilian clergy, and women veterans in the same room. Veterans will get a chance to tell their stories. Researchers who specialize in moral injury, soul care, PTSD, and mental health will share their latest findings, and clergy and mind/body/soul practitioners will describe healing modalities. The conference leaders hope to create an environment for positive relationships and future collaboration. Registration for attendees and presenters is open at: https://chaplainconsultants.com/products-and-services/wvc-conference/.  

To make the conference affordable for veterans who are on limited budgets, there is no charge to attend. Roberts Research and Consulting is seeking sponsors to defray the cost of the event and provide travel scholarships for those veterans who are short on funds. Sponsors will receive an exhibitor space at one of the conferences, a full-page ad in the conference book, premium advertising space on the website for three months, and a place in the welcome bags for their brochures or other items.

To find out more, contact Dr. Daniel Roberts, droberts@chaplainconsultants.com or 910-690-5964.

Roberts Research and Consulting (RRC) is a company that specializes in education, research, and advocacy in military chaplaincy and soldier care. RRC’s research focus is on pastoral support to female service members. Women are an underserved population when it comes to spiritual leadership and support. By conducting studies with female service members as the primary population, RRC is able to develop theories and practices that will enhance the lives of women in the military.

What’s Missing in Moral Injury Research

Image by Gerd Altmann from Pixabay

Moral injury (MI) is a term that refers to the emotional trauma a military service member feels when his or her sense of moral rightness is violated during the course of war (Currier, Holland, Drescher, & Foy, 2015a; Currier, McCormick, & Drescher, 2015b; Nash, Carper, Mills, Au, Goldsmith, & Litz, 2013). MI addresses a gap in PTSD formulations. Various research efforts have been made to establish an MI construct and instruments for measuring moral injurious events. Both the MI framework and its associated scales were developed using a low percentage of women as participants.

Moral Injury Constructs

The extant literature uses multiple definitions for moral injury. The most narrow version, offered by Shay (2014), states that moral injury might occur when a leader in a high stakes situation violates a moral law. All three elements — moral violation, by a person in a position of authority, in a high stakes situation — must be present for moral injury to occur. Much like the Great Man leadership theories from centuries ago, in which the leader has a “duty of care” for his or her subordinates and the followers have a “duty of loyalty,” Shay casts military leaders as shepherds to their flocks. Shay does not provide definitions of what he considers to be a moral violation or a high stakes situation, but the examples he uses are generally combat related.

Others have expanded the description of the causes of moral injury. Litz et al. (2009) stated that “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (p. 700) could cause MI. Nash et al. (2013) used the same description in their research related to moral injury. In Jinkerson’s (2016) assessment of potentially moral injurious events (MIEs), he states that a MIE may occur “when one violates his or her moral beliefs, is betrayed, or witnesses trusted individuals committing atrocities” (p. 122).

Drescher, Foy, Kelly, Leshner, Schutz, and Litz (2011) approached the development of a moral injury construct by gathering data from a select group of care providers. Qualitative interviews were conducted with 11 chaplains, 11 mental health workers, and one educator. Eight of the participants worked in the Department of Defense (DoD), and nine were from the Veterans Affairs (VA) department. Four of the participants were women. Participants were asked to help define moral injury, whether PTSD formulations adequately covered the long term effects of MIEs, the types of events that might contribute to MI, and what might be the long term effects of moral injury.

The results suggested that the moral injury construct needs improvement. All of the participants agreed that the MI term is needed because PTSD does not adequately capture the trauma experienced in a war zone. There was also unanimous agreement that the provided definition of moral injury — “disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner” — was inadequate. Participants suggested that the list of events that could cause moral injury should include betrayal, disproportionate violence, harm to civilians, and in-ranks violence (such as sexual assault).

Moral Injury Instruments

Moral Injury Questionnaire — Military Version

The two most common instruments for measuring moral injurious events are the Moral Injury Questionnaire — Military version (MIQ-M; Currier et al., 2015a) and the Moral Injury Event Scale (MIES; Nash et al., 2013). The MIQ-M contains 20 items and is designed to measure MIEs for military personnel. Items are divided into six categories: acts of betrayal, disproportionate violence perpetrated on others, harm to civilians, in-rank violence, inability to prevent suffering, and ethical/moral dilemmas. The MIQ-M measures the frequency of each item on a four-point scale: 1-Never, 2-Seldom, 3-Sometimes, and 4-Often.

Currier et al. (2015a) conducted an initial psychometric evaluation of MIQ-M. The first sample included 131 veterans from the wars in Iraq and Afghanistan, 13% of whom were female. The second sample consisted of 82 male veterans who were in a rehabilitation program for those with PTSD. Second sample participants also completed the Combat Experiences Scale (CES), the Work and Social Adjustment Scale (WSAS) to measure impairment in social and occupational functioning, and the Suicidal Behaviors Questionnaire (SBQ-R) to determine suicide risk. The Posttraumatic Stress Disorder — Civilian (PCL-C) was used to assess PTSD symptoms, and depression was measured using the Patient Health Questionnaire (PHQ-9). Results showed that greater MIQ-M scores were associated with greater combat exposure, lower work and social adjustment, greater PTSD symptoms, and increased depression.

Moral Injury Events Scales

The Moral Injury Events Scale (MIES) was developed and evaluated by Nash et al. (2013). MIES is an eleven item instrument created by “a team of experts”, but the composition of the experts was not described in the research article. The MIES is designed to measure traumatic events that violate deeply held moral/religious views and that might lead to PTSD. The scale addresses two categories of events: violations of moral beliefs by self or others and issues of trust. To validate the scale, researchers used male-only Marine Corps infantry battalions who deployed to Iraq and Afghanistan. The authors acknowledged that further testing with female service members needed to be done.

Bryan et al. (2016) conducted a psychometric evaluation of MIES using participants from the Air Force and Army National Guard. The first sample consisted of 151 active Air Force personnel who were getting outpatient mental health treatment. Just over one third of the sample was female. The second sample was made up of 935 Army National guard members who were demobilizing after an Afghanistan deployment. Eighteen percent of this sample were female.

Results varied somewhat from those obtained by the original evaluation by Nash et al. (2013). Rather than the two-factor solution, Bryan et al. (2016) found three factors: moral violations committed by self, violations committed by others, and betrayal by others. Based on item intercorrelation scores, the authors suggested that the number of Transgression-Self items and Transgression-Others items should be increased to capture a broader range of events. No significant difference between mean scores for men and women were found in either sample. Authors suggested that diagnostic interviews could further evaluate the instrument’s construct validity.

Neither the MIQ-M or MIES were developed or tested using a significant number of women. While the military population is approximately 15% female (2011 Demographics profile of the military community, 2012), oversampling for women might be necessary to discover the entire range of women’s military experiences that may contribute to MI. Women encounter a variety of stressors in disproportion to men. According to the Congressional Research Service (2017), women account for approximately 2% of the wounded and killed in action from Operations Enduring Freedom and Iraqi Freedom. On the other hand, up to 84% of military women experienced sexual harassment, and one third experienced rape or attempted rape while serving in the military (Turchik & Wilson, 2010). In-service sexual assault rates for men were reported at 4% or lower and the reported rate of sexual harassment for military men was as high as 74% (Turchik & Wilson, 2010). Ruiz-Cantero et al. (2007) explained the importance of considering gender and class, as well as power inequalities between men and women in health research. Not adequately considering gender in research is likely to lead to biased results (Ruiz-Cantero, 2007). MIQ-M and MIES were validated using female sample sizes of 20% or less.

Conclusion

What’s missing is that current concepts of moral injury do not adequately account for the social and institutional context in which military women work while serving as members of the U.S. warfighting community. A review of contemporary MI descriptions and instruments showed that not enough women were included in the research. Another study showed that women experience the military differently than men (Roberts, Kovacich, & Rivers, 2017).

To correct this problem, we are conducting a study entitled, “Moral Injury for Women Veterans: A Grounded Theory Study” (see Current Projects page). We are seeking U.S. women veterans who served in the Army, Navy, Air Force, Marines, or Coast Guard, either on active duty, in the reserves, or National Guard. To qualify, you must be 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 take part in the study or request additional information, please contact: 
Dr. Daniel Roberts, 910-690-5964, droberts@chaplainconsultants.com

References

Berg, Susan H. (2002). ‘The PTSD Diagnosis: Is It Good for Women? Affilia, 17(1): 55-68.

Bryan, Craig J., Bryan, AnnaBelle O., Anestis, Michael D., … Ray-Sannerud, Bobbie (2016). ‘Measuring Moral Injury: Psychometric Properties of the Moral Injury Events Scale in Two Military Samples’. Assessment, 23(5): 557-570.

Congressional Research Service (2017). American War and Military Operations Casualties: Lists and Statistics (CRS Publication No. RL32492). Available at: https://fas.org/sgp/crs/natsec/RL32492.pdf (accessed 26 March 2018).

Currier, Joseph M., Holland, Jason M., Drescher, Kent, & Foy, David (2015a). ‘Initial Psychometric Evaluation of the Moral Injury Questionnaire—Military version’. Clinical Psychology and Psychotherapy, 22(1): 54-63.

Currier, Joseph M., McCormick, Wesley, & Drescher, Kent D. (2015b). ‘How Do Morally Injurious Events Occur? A Qualitative Analysis of Perspectives of Veterans with PTSD’. Traumatology, 21(2): 106-116.

Department of Defense (DoD) (2012). 2011 Demographics Profile of the Military Community. Available at: http://www.militaryonesource.mil/12038/MOS/Reports/2011_Demographics_Report.pdf (accessed 26 March 2018).

Drescher, Kent D., Foy, David W., Kelly, Caroline, … Litz, Brett (2011). ‘An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans’. Traumatology, 17(1): 8-13.

Jinkerson, Jeremy D. (2016). ‘Defining and assessing moral injury: A syndrome perspective’. Traumatology, 22(2): 122-130.

Litz, Brett T., Stein, Nathan, Delaney, Eileen, … Maguen, Shira (2009). ‘Moral injury and moral repair in war veterans: A preliminary model and intervention strategy’. Clinical Psychological Review, 29(8): 695-706.

Nash, William P., Carper, Teresa L. Marino, Mills, Mary Alice, … and Litz, Brett T. (2013). ‘Psychometric evaluation of the Moral Injury Events Scale’. Military Medicine, 178(6): 646-652.

Roberts, D. L., Kovacich, J., & Rivers, M. (2017). The Comprehensive female soldier support model: A Delphi study. Journal of Health Care Chaplaincy. doi:10.1080/08854726.2017.1312817

Ruiz-Cantero, Maria Teresa, Vives-Cases, Carmen, Artazcoz, Lucia … Valls, Carme (2007). ‘A framework to analyse gender bias in epidemiological research’. Journal of Epidemiology & Community Health, 61(Supplement 2): ii46–ii53.

Shay, Jonathan (2014). ‘Moral Injury’. Psychoanalytic Psychology, 31(2): 182-191.

Turchik, Jessica A. and Wilson, Susan M. (2010). ‘Sexual assault in the U.S. military: A review of the literature and recommendations for the future’. Aggression and Violent Behavior, 15(4): 267-277.

Raped, Bullied, and Neglected

So far, I have only conducted a small number of interviews for the study entitled, “Moral Injury in Women Veterans: A Grounded Theory,” but some common themes are quickly emerging. The first is, that all of the women were raped by someone in a position of authority over them, like their commanders. Some were raped multiple times or forced into a sex ring. This is betrayal on an ultimate level.

These things happened to them when they first entered the military, so they had no rank or capacity to resist. In basic training, you are taught to keep your mouth shut and do what you are told. Even though the military teaches people to report these things, it is unrealistic to ask a scared, brand new recruit to report something so devastating and shameful as being raped by a superior officer or sergeant.

Hazing and bullying was also a common theme. Women were subjected to cruel harassment and emotional torture. This bullying included punching, name calling, isolation, and neglect of all kinds from their supervisors and fellow service members. These are the people who were supposed to watch out for them, mentor and support them. Instead, they abused the people who were entrusted to their care. Women put up with this because they wanted to serve their country and fulfill their own dreams. Also, they did not feel that there was anyone they could go to for help.

The effects of their moral injuries have been devastating. Even now, years later, women still feel isolated, emotionally crippled, and distrustful. Some struggle to maintain intimate relationships, and others experience extreme emotional swings. For their troubles, women received administrative or medical discharges, rather than honorable ones. They joined to serve their country and got shit on by organizations that claim to be the bastion of integrity, courage, and moral strength.

These and other stories need to be told. My team is working hard to capture the realities of military women’s lives and use those stories to demand change. We need more women to come forward. Women experience many things in the military that feel like a violation of their personal values. You do not need to have been raped to qualify for this study. If you were a witness to, a participant in, or the target of any activities by military personnel that created inner conflict or violated your personal moral values, you could qualify for this study. Click this link to get more information and find out how to volunteer: Moral Injury Study.

Caring Deeply about the Underserved

Sixteen years ago, I began a journey that would transform the rest of my life. In February of 2002, I entered the military chaplaincy as a member of the dominant group – a White, male, conservative Christian. In my prior service as an infantryman, I had never worked with female soldiers. I assumed, like many of my fellow troopers that when it came to the military, women were the weaker sex. I also assumed that everyone is able to get the care they need. Both assumptions turned out to be wrong.

The military is full of strong women. Since the beginning of our nation, women have served as fighting troops, spies, medics, and support personnel (Devilbiss, 1990; Monahan & Neidel-Greenlee, 2010; Sherrow, 1996). In addition to their full-time jobs as warriors and leaders, they are mothers, spouses, confidants, and chefs. Many female soldiers are single mothers. “More than 30,000 single mothers have deployed to Iraq and Afghanistan” (Mattocks et al., 2012, p. 538). 

My first assignment as a unit minister was in a drill sergeant unit. These great professionals were responsible for introducing civilians to the military way of life. The female drill sergeants in the unit were every bit as capable and competent as the males. They cut no slack, expected none, and fully earned my respect. Now, women continue to prove their strength by passing some of the toughest schools in the military – Army Ranger school and Marine Corps Infantry Officer training. These women always knew they were powerful, it’s just that some of us, like me, were slow to come to that realization.

The stress on military women is immense, but they handle it well. One study found that men exit the military at a significantly higher rate than women (Finestone et al., 2014). Another study showed no significant difference between male and female soldiers in burnout levels, commitment, or constructive coping strategies during infantry training (Tarrasch et al., 2011).

Not long after I transitioned from the infantry to the chaplaincy, I learned to love, admire, and respect the women who put on the uniform in the active and reserve forces. However, I was disturbed to learn that they did not always get the spiritual and religious support they needed. As I went about my ministerial work, many women told me stories about how they sought chaplain support but were ignored, treated lightly, or quickly referred to someone else.

One woman told a horrific story about how she tried to stop a fellow soldier from committing suicide. Despite her best efforts, the man shot himself with his own rifle. She was greatly disturbed, but the chaplain never stopped in to see how she was doing. I am sure that that chaplain does not represent most clergy, but he certainly failed in that instance.

I also found that some male chaplains were overly cautious when dealing with female soldiers. These men seemed to be more concerned about avoiding false accusations and inappropriate relationships than caring for the women in their ranks. It smacks of an underlying assumption in the untrustworthiness of women. I know that false accusations do happen in life, but I find it laughable that this is a major concern given that chaplains have no command authority and there is no evidence of widespread accusations against military chaplains. What would a soldier have to gain by accusing a chaplain? Chaplains have no influence on soldiers’ careers.

I now see women as an underserved population when it comes to chaplain support. I am not suggesting that most male chaplains are doing a poor job. But as a whole, men are not working hard enough to understand the needs of women service members and provide adequate emotional and spiritual support. In my dissertation study, only 30% of women I interviewed received sufficient support from military chaplains (Roberts, Kovacich, & Rivers, 2017).

Because of the additional stress, prejudice, and harassment women still face, they experience the military differently than men (Roberts et al., 2017). As a member of the dominant group, I have never experienced the kind of minimization and emotional assault women in society face on a daily basis. One woman I interviewed, who had been in the military for a decade or so, said that this interview was the first time that anyone had truly asked her opinion on anything. The first women to graduate from Ranger school received death threats online (Myers, 2018). The Department of Defense does not tolerate harassment and discrimination, but there are still some military men and women who quite frankly do not belong in the service because they cannot lay down their own prejudices.

Because of my work, I developed a deep desire to see that our female service members receive the kind of spiritual and religious support that they truly deserve. I used my research to develop the Comprehensive Female Soldier Support Model. It is a framework for providing emotional and spiritual assistance based on research with women soldiers, expert advice from female chaplains, and my own experience in working with rape and trauma survivors.

The model calls for empathetic listening, trauma mitigation skills, self-awareness, and counseling techniques. It also calls on male chaplains to become fully aware of the unique ways in which women cope with the stressors of military life. Treating all service members the same misses the boat because it fails to address the realities of male-dominated cultures. Most women, LGBTQ, and non-White service members have experienced a lifetime of harassment and discrimination.

The skills and attitudes needed to be an effective religious support provider of women soldiers can be learned by anyone. I deliver seminars and workshops that teach clergy, religious organizations, and seminary students effective techniques. Contact me to learn more. I guarantee your knowledge and capabilities will grow after just one seminar.

Dr. Daniel Roberts is an author, consultant, and teacher who conducts world-class education and research in military chaplaincy. He has over 16 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

Devilbiss, M. C. (1990). Women and military service: A history, analysis, and overview of key issues. Maxwell Air Force Base, AL: Air University Press.

Finestone, A. S., Milgrom, C., Yanovich, R., Evans, R., Constantini, N., & Moran, D. S. (2014). Evaluation of the performance of females as light infantry soldiers. BioMed Research International, 2014, 1-7. doi: 10.1155/2014/572953

Mattocks, K. M., Haskell, S. G., Krebs, E. E., Justice, A. C., & Yano, E. M. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science & Medicine, 74(4), 537-545.

Monahan, E. M., & Neidel-Greenlee (2010). A few good women: America’s military women from World War I to the wars in Iraq and Afghanistan. New York: Alfred A. Knopf.

Myers, M. (2018). First female Ranger grads open up about the aftermath and joining the infantry. https://www.armytimes.com/news/your-army/2018/03/13/first-female-ranger-grads-open-up-about-the-aftermath-and-joining-the-infantry/.

Roberts, D. L., Kovacich, J. & Rivers, M. J. (2017). The comprehensive female soldier support model. Journal of Health Care Chaplaincy, 24(1), 1–19.

Sherrow, V. (1996). Women and the military: An encyclopedia. Santa Barbara, CA: ABC- CLIO, Inc.

Tarrasch, R., Lurie, O., Yanovich, R., & Moran, D. (2011). Psychological aspects of the integration of women into combat roles. Personality and Individual Differences, 50(2), 305-309. doi:10.1016/j.paid.2010.10.014

Narrative Counseling: Helping Women and Minority Service Members Navigate Trauma

Even though the Department of Defense continues to promote equality through training and policy, minority groups, including women, non-Whites, and LGBT service members continue to experience a higher level of emotional trauma, bias, and discrimination than men, Whites, and heterosexuals. Military women are sexually assault at seven times the rate of men (Davis, Grifka, Williams, & Coffee, 2017). Based on 2016 statistics, the Marine Corps was the most dangerous for women with an 8% sexual prevalence rate and the Air Force was the safest with a 3% rate. Men experienced sexual assault at a far lower rate than women. The Navy had the highest rate for sexual assault on males at 1%. The rest of the services hovered around one half percent for men.

Women experienced sexually hostile work environments in the military at four times the rate of men. Approximately one in four women in the Navy and Marine Corps faced repeated sexual jokes, innuendos, or unwanted contact, even after perpetrators were asked to stop (Davis et al., 2017). This rate was slightly less for the Army, but the rate for women in the Air Force was half that of the Navy and Marine Corps. Only about one in 16 men suffered the same sorts of humiliation. 

In a study published by the Defense Equal Opportunity Management Institute (DEOMI, n.d.), American Indians/Alaskan Natives, Asians, Blacks/African Americans, and Native Hawaiians/Pacific Islanders were all more likely to hear racioethnic jokes than Whites. Compared to Whites, races/ethnicities with higher representation in the military were less likely to hear such jokes than lower represented ethnicities. Thus, Blacks were less likely to hear racioethnic jokes than American Indians. Enlisted personnel were significantly more likely to hear racioethnic jokes than officers. Other studies reported lower promotion rates, unequal justice, and lower access to health care for Black than White service members (Burk & Espinoza, 2012). 

LGBT veterans are more likely to experience PTSD, depression and alcohol misuse than heterosexual veterans (Goldbach & Castro, 2016). Non-heterosexual veterans also have higher lifetime rates of suicidal ideation than heterosexual veterans. Previous policies that excluded LGBT people from military service might have resulted in increased sexual victimization of non-heterosexual people while preventing reporting of assaults over fear of being discharged for their sexual orientation. Even though Don’t Ask Don’t Tell has been repealed and LGB service members (but not transgender persons) are able to serve openly in the military, a significant percentage of lesbian and gay soldiers do not feel comfortable discussing their sexual orientation with their medical service providers. LGB members who do not want to be identified also fear that their sexual orientations will be discussed outside of medical circles.

Sexism, racism, and heterosexism can combine in the life of one person such that a Black female lesbian might experience more stress than a White female. While the military continues to work towards eliminating bias and discrimination, in a quick snapshot, the previous paragraphs show that minority service members continue to experience emotional distress at a greater rate than members of dominant groups. Even if the Department of Defense was a perfect organization, many minorities have experienced a lifetime of trauma and abuse, and they bring these experiences with them when they join the military. 

Chaplains need to not only be aware of the realities that minorities face, but also have a counseling approach that takes these things into account. Narrative counseling is such a philosophy. 

Narrative counseling theory is grounded in a constructionist set of assumptions. This means that people construct meaning and that it is the meaning that people attribute to themselves and their experiences that constitute both identity and the development of resources for living. We make meaning and live our life through the stories we have created to give our lives coherence. (Neuger, 2001, loc. 1186). 

We decide who we are by the stories our parents, society, and others tell about us. The narratives that we accept are the ones that become truth for us. For minorities, many of these narratives are demeaning, minimizing, and disempowering. Women are told that they are too soft or too “bitchy” for leadership. Asians are smart but passive. Blacks are violent and less intelligent. These false narratives are spread and fertilized by the media, the internet, and social encounters. Even if one is aware of popular stereotypes and seeks to avoid them, he or she can still fall victim to biases. 

Narrative counseling is a way to help clients discover the disempowering stories that they have accepted for themselves and develop new narratives to counter them (Neuger, 2001). The pastoral counselor become a mirror and a guide to the counselee. As a mirror, the chaplain reflects the person’s story back to the client so that he or she sees how the story has been disempowering. For instance, a female soldier once came to me because she was unhappy in her marriage. At one point, she said, “I am unhappy, but I know that being happy in marriage is not the point.” 

To which I responded, “You don’t think happiness in your relationship is important?” 

She replied, “My mother told me that you don’t have to be happy to stay married.”

I asked, “Was your mother in an unhappy marriage?”

“Oh yes,” she said. “I never saw her happy with Dad.”

“What do you think is the point of marriage?” I asked.

“I don’t know,” she said, “but Mom said I have to stay with my husband no matter what. God does not like divorce.”

In this instance, narratives about God and marriage passed down by her mother had prevented the person from considering alternatives other than staying married to a husband who was mistreating her. He was not physically abusive, but he neglected her emotionally. The above dialogue showed how I acted as a mirror.

Next, I guided her into developing a new story for herself. Through several counseling sessions, we discovered that she had contributed to the problem because she was afraid to tell her husband what she wanted and needed. She always just acquiesced to his wants. I asked her to think about the possibility that happiness is important in marriage and that she had a right to expect her husband to respect her wishes. She resolved to begin working on a new story for herself — one of strength, confidence, and self-actualization. 

We discussed several options going forward. She decided to seek marriage counseling with her husband and work on being more outspoken with him about what she wanted. The couple did not use me for counseling because I was in the same military unit as the wife and he wanted a “neutral” counselor. She later told me that the counselor was completely disempowering by blaming her for all the relationship problems. Eventually, she divorced the man because he refused to change. I continued to help her work through the challenges of being a single mother, standing up for herself in relationships, and being happy. She was quite confident as a soldier, but needed to learn how to feel worthy of happiness and self-confidence in marriage. Much of her problem was due to the ideas passed on through her own family experience growing up. When I last saw her, she was quite pleased with her life and was taking on many new experiences.

There are many aspects to narrative counseling, but it is well suited for the disempowered and disenfranchised. Through webinars, case studies, vignettes, and on-site seminars, Roberts Research and Consulting (RRC) can help religious professionals and organizations add this style of counseling to their inventory. RRC seminars are a great option for continuing education needs.

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

Burk, J., & Espinoza, E. (2012). Race Relations Within the U.S. Military. Annual Review of Sociology, 38, 401-422.

Davis, L., Grifka, A., Williams, K., & Coffee M. (Eds.). (2017). 2016 Workplace and Gender Relations Survey of Active Duty Members

Defense Equal Opportunity Management Institute. (n.d.). No Laughing Matter: Interracial and Intra-Ethnic Patterns in “Off Color” Jokes (Technical Report No. 11-13). Patrick AFB, FL: DEOMI. 

Neuger, C. C. (2001). Counseling Women: A Narrative, Pastoral Approach. Minneapolis, MN: Fortress Press [Kindle].