In San Diego streets, runners are a common sight. On Monday, two of those runners were extraordinarily uncommon.

Tomorrow, we express our gratitude to the 22 million men and women who have served and sacrificed in the name of America and our way of life. We have sent them to faraway places, sometimes into the most arduous circumstances, with a duty to carry out missions that the average citizen cannot comprehend. And we often send them home broken.

While we rightly address the impact of post traumatic stress disorder on veterans, as a society, we must also consider another invisible wound of service and war: moral injury, defined as “damage done to one’s conscience or moral compass when that person perpetrates, witnesses or fails to prevent acts that transgress their own moral and ethical values and codes of conduct.”


The men and women in our military often find themselves facing an array of moral decisions and compromises they may be unprepared to address, and in the chaos of the moment, they may take — or witness — actions that will later haunt them. War’s inherent destructiveness can corrode the spirit and the moral fiber of our warriors, who might return home with feelings of guilt and shame based on certain choices, preventing them from successfully reintegrating into their communities.

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To prevent the downward slide of our veterans, we must recognize and acknowledge that such moral and spiritual injuries exist and are the result of shattered expectations rooted in religious and spiritual beliefs and in cultural norms on fairness and the value of life.

As critical as any somatic injury, these wounds are the root of suffering and can be the cause of permanent debilitation. Common problems among our combat veterans include depression, anger, alcohol abuse, relationship problems and suicide — all symptoms that could be related to or caused by unresolved moral injuries. Acknowledging moral injury and recognizing both its existence and potential for harm is the first step toward understanding, reconciling and healing. Identifying moral injury and rendering aid, however, presents serious challenges since many veterans may feel too ashamed to talk about the moral infractions that grate against their personal values and codes of conduct.

“In a world where anything goes, people have a hard time deciding what is right and what is wrong,” says Larry Kent Graham, a professor emeritus of pastoral theology in Denver who has taught Air Force Chaplains. “The core issue of our time is how to embrace with grace and care the dissonance and diverse assessments of the moral issues calling for our guidance and healing.”

This has become a foundational message for all care providers who serve veterans struggling with moral injuries. Precision and certainty in recovery are not attainable goals; the best we can hope for is to help guide our veterans to a place where they can feel inclusiveness, community and camaraderie with others.

At the VA Maryland Health Care System, we see it as our moral obligation to treat the mind, body and spirit of our veterans. We understand that the dimensions of the human spirit and the healing that returns us to contentment resides in our ability to know and acknowledge that we injure others, we are injured by others and that we must become resilient in the face of these injuries in order to stay balanced and productive. This is the way to healing and wholeness. This is the way back for all of us — veterans and civilians alike — from the shadow world into one of light.

Dr. Adam M. Robinson Jr. is director of the VA Maryland Health Care System; he served as the 36th surgeon general of the United States Navy, overseeing both the U.S. navy and Marine Corps health care systems. He can be reached at vamhcspublicrelations@va.gov.