Healing the wounds of war

Helicopter propellers whirled above Glen Martin’s head as he skimmed the jungle treetops. He had been in Vietnam less than a month, but it was already time to start shooting at the enemy. He gripped the machine gun with sweaty palms, pulled out the pin, and squeezed the trigger. 

Martin’s training had prepared him for this moment of combat. But only this moment. Over the course of the next five decades, he grappled with the weight of what he’d done while in uniform—a constant reminder that he never trained for the aftermath of war. The conflict’s unpopularity back home and its messy ending only compounded his struggle. 

“In Vietnam, we never had an exit,” said Martin, who at 77 walks with a small, gradual gait, but has yet to let age slow him down. “We had an entrance. We’re gonna go over and we’re gonna do all these things. We didn’t accomplish what we wanted to accomplish. All these 55,000 kids got killed, young men, young women, whatever, and for no reason.” 

Over the years, Martin battled a mixture of guilt, shame, disgust, and even anger—typical responses to what doctors increasingly diagnose as moral injury. Symptoms occur when people feel they did something, or failed to do something, that violates their deeply held moral or religious beliefs. Symptoms can also occur when they see another person doing something and they fail to stop it.

Combat veterans from every war experience moral injury, but due to the lack of support for the Vietnam War back home, its veterans were especially susceptible.

The last American troops left Vietnam with the fall of Saigon on April 30, 1975. Fifty years later, 5 million Americans who served during the conflict are still alive. Many continue to suffer from feelings of guilt and shame for what they did, didn’t do, or saw. Now, thanks to an increasing awareness of moral injury’s effects and the benefits of faith-based therapy, veterans from Vietnam and more recent conflicts are finding healing for their deepest wounds.

Troops of the U.S. 173rd Airborne Brigade encounter sniper fire on a mission in Vietnam in 1965. Associated Press / Photo by Horst Faas

MORAL INJURY is not new. The human struggle to reconcile with God after moral transgressions is described often in the Bible: Regret followed when Adam and Eve disobeyed God, Cain killed Abel, and David took Bathsheba as his wife after murdering her husband. In 416 B.C., Greek author Euripides described an internal reaction he called “miasma” that afflicted the perpetrator, victim, or observer of an unjust killing. And in A.D. 401, Augustine wrote about the anxiety and fear that results from separation from God in his autobiographical Confessions.

Harold Koenig, a psychiatrist who has studied the effects of religion and spirituality on health, notes the problem boils down to sin: “The anguish, the moral injury that people experience, in some respects, that’s a good thing. Because part of the repentance involves having some level of conscience that says, ‘I’ve done something wrong. I should feel guilty.’”

It’s natural for people to feel remorse when they hurt someone or do something wrong. But without a framework for seeking forgiveness, those feelings of guilt may become toxic.

Most Vietnam vets are now in their 70s and 80s, which means many are still struggling with the effects of moral injury in their final years of life.

Larry Brown is a palliative care hospice chaplain at the Department of Veterans Affairs (VA) hospital in San Antonio, Texas. When he walks into a patient’s room, he looks for the telltale signs: anger, isolation, and even ignoring his questions. After much probing and patience, he often gets veterans to open up. The questions he hears usually follow a pattern: “Am I going to hell? Can I be forgiven? Does God love me? Why me? Why did I have to go through this?”

In 2024, about 2.3 million Vietnam veterans received care through VA facilities across the country. Nearly half a million received mental health treatment. Nearly 90% of veterans who self-identify moral injuries describe their symptoms as severe, according to a study of more than 400 veterans and active-duty service members.

Taking off the uniform doesn’t solve the problem. In some cases, it can make it worse. Veterans lose the shared sense of mission and acceptance of doing something regrettable in combat when they leave the military and return to family or have new co-workers unfamiliar with their experiences.

“That’s when the guilt and shame comes in,” said Koenig, a professor of psychiatry and behavioral sciences at Duke University. People who haven’t experienced war don’t understand how someone could violate their moral values in battle. “They don’t understand the circumstances that often drive one, in some respect, to do this.”

A Vietnam veteran visits the Vietnam Veterans Memorial to pay respects to men he served with. Tom Williams / CQ-Roll Call, Inc via Getty Images

RECOGNITION AND TREATMENT of moral injury is catching on at the VA, especially as service members from the wars in Iraq and Afghanistan grapple with their own wounds. After the disastrous pullout from Afghanistan in August 2021, phone counselors at the VA crisis line received more calls than usual from veterans seeking mental health help, according to the military-­focused newspaper Stars and Stripes.

Veterans can participate in individual or group therapy programs with chaplains and psychologists who help them understand how moral injury differs from the better-understood post-­traumatic stress disorder (PTSD), discuss their shared experiences, evaluate their beliefs, apportion blame, make amends, and seek forgiveness.

Group participants learn to trust each other, Brown said. “As they bond and tell their stories, the others in the group say, ‘No; you’re not responsible for that. You need to let that go. You’re responsible for this,’ and they need to hear it from others that are going through the moral injury, and in that fashion, that’s when they start to let go.”

Transgressions are particularly harmful because those affected tend to question their foundational beliefs. The resulting guilt, grief, and shame can lead to questioning faith, forgiveness, God’s goodness, or even His existence. Veterans who are struggling often leave their church or religious community, which can be one of the most effective resources for dealing with moral injury, according to a study of more than 1,600 active and former service members.

“Someone with moral injury doesn’t feel that they’re worthy of being forgiven, but yet Christ went on the cross for that forgiveness,” Brown said. “And it always, always goes back to that, believer or not.”

Numerous studies show lower rates of PTSD in people with active religious beliefs and practices. Studies of active duty military and veterans who self-­report combat-related moral transgressions show similar results. The vast majority of more than 300 peer-reviewed research studies show religious beliefs and practices significantly increase life satisfaction and emotional well-being across all demographics. Studies that included active duty and veterans support these findings and show decreased symptoms of PTSD, depression, and ­suicidal thoughts.

Christianity’s prescription of admitting guilt, confessing, and repenting provides more effective healing than justifying sin as ignorance, prescribing medications, or encouraging veterans in secular therapy to stop blaming themselves, according to Koenig.

“Most of the time it takes a trauma and suffering that brings a person to that point where they have no other option,” Koenig said. “So they have to turn to God, make Him first, and then love their neighbor.”

GLEN MARTIN hasn’t participated in any moral injury programs through the VA, but he has done therapy for PTSD. And he’s created his own form of weekly group therapy.

Every Thursday, he meets a few other veterans at a restaurant near his home in Woodstock, Ga. The men provide each other a lifeline of support, brought together by the secrets they carry from their time in combat. The conversations stay casual: cars, football games, vacations, and grandkids. But under the surface runs the current of their shared experiences.

“You still remember,” said Martin, who served six months in Vietnam. “You say ‘Why? Why?’ but I was in the military. It wasn’t like I wanted to go out and shoot somebody.”

Martin has gone to church ever since he was a little boy and says faith has always been an important part of his life. Although his manner is reserved when discussing his beliefs, he has a quiet confidence when he speaks about God’s presence through life’s trials.

In 2004, Martin decided to file claims for VA benefits after a diagnosis of prostate cancer likely caused by exposure to Agent Orange. He found the paperwork and process to file claims confusing, but another veteran helped him through it. After he beat cancer, he wanted to help others in similar situations.

“So I said to the person that helped me, ‘I’ve got a lot of friends that were in Vietnam. What can I do to help someone else that didn’t know?’ So the guy says, ‘I want you to make me a promise: Pass it on.’ So I’ve been passing it on ever since.”

Martin now volunteers with Disabled American Veterans, supporting people through the process of filing their own VA claims. He says talking about Vietnam with other veterans and helping them has aided his own recovery from the things he did and saw while in the Army.

“Most people aren’t going to tell you,” he said of his fellow veterans. “They want to leave it alone. But when we talk about it, it’s better for us than leaving it alone.”