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  • Very good topic for discussion and action in therapy with combat trauma. My experience as a combat vet and as a psychotherapist working with combat vets both have shown me starting in the mid 70s that many of us were experiencing a major shift in our thinking and processing information regarding trust. There was a major breach of trust, a betrayal of our beliefs, of our ideas about government, religion, education, and family. For many of us this was about almost getting killed, seeing many of our fellow soldiers killed, seeing civilians killed by major air strikes and at some level not feeling that we were protecting our country from anything that was a threat to them. It was only a threat to us because we were sent to Vietnam to hunt and kill people who were not a threat to the US or the world. The physiological reactivity of PTSD can be managed to some degree with cognitive behavioral training over time. This moral injury from betrayal by the society and most of its institutions seems to stay under the radar. One of the reasons is because many believe that it is a political, non-therapeutic issue to get involved in this gigantic elephant in the room, and to focus on the obvious PTSD symptoms instead. After I had been working as a clinician with the Vet Center program for a few years, they renamed it the Readjustment Counseling Service. I have a problem with this name. It implies that the mission was to get these ex-soldiers readjusted back to the society that they left. Not gonna happen. One does not readjust to those who were involved in the ignorance, deception, and betrayal that caused so much death and destruction. So without addressing this aspect of the "Moral Injury", many of my fellow combat vets will go on confused in emotional and cognitive dissonance with, at best, some relief from PTSD symptoms or physiological reactivity through behavioral intervention in conventional CB therapy, or get inappropriately medicated for it. This problem continues today with the current wars in Iraq and Afghanistan, Syria and elsewhere, with so much of the society and even its healers afraid to take on this elephant in the room.

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