Breaking the backbone: Moral injury among noncommissioned officers

Abstract:Moral injury, defined as the result of a betrayal of what is right by a legitimate authority in a high stakes situation, is a significant concern facing military personnel that contributes to damaged trust (Litz et al., 2009; Shay, 2009) and worsened mental health outcomes, notably increased suicidality (Battles et al., 2018; Currier et al., 2019; Houtsma et al., 2017; Kelley et al., 2019; Maguen et al., 2020). Moral injury literature focuses largely on the individual moral transgressions committed by self and others (perpetration), or the experience of being betrayed (victimization). Research that examines the role of legitimate authority, a key characteristic of the military institution’s hierarchical structure, and the influence of the military total institution itself is limited. Noncommissioned officers (NCOs) are the lowest-level powerholders amongst military leadership and as the “backbone of the Armed Forces” (National Defense University, 2014, p. 2), they are in a unique position to both experience moral injury from their leaders’ betrayals, as well as perpetrate betrayals, potentially causing moral injury to their own subordinates and themselves in the process. In this constructivist grounded theory study, I conducted in-depth interviews with 20 Army and Marine Corps NCO veterans who had a combat-related deployment history, recruited from Save A Warrior (SAW), a veteran service organization. This predominantly male sample (19 men, 1 woman) was characterized by very high rates of adverse childhood experiences (ACEs), with all participants reporting a history of suicidality; notably, all had experienced a degree of healing related to their moral injury. My findings indicate that NCOs’ experience of moral injury is a multi-determined, complex phenomenon, influenced by the military as a total institution, the power of legitimate authority (both theirs and that of the leaders above them in the military hierarchy), and ACEs. ACEs made participants particularly vulnerable to the military total institution’s re-creation of their abusive family dynamic, in which the institution stated that it was protective and caring, but ultimately committed betrayals against participants, who were dependent upon the institution for their survival and well-being. Additionally, military norms and indoctrination processes encouraged participants’ perception of leaders with legitimate authority as “father figures,” which evoked and reinforced participants’ institutionallybeneficial “childhood survival strategies,” such as people-pleasing, an over-inflated sense of personal responsibility, and aggression. By the time participants became leaders and obtained legitimate authority as NCOs, their moral injury-related decision-making was influenced by previous institutional and leadership betrayals, the pressure to utilize institutionally-reinforced childhood survival strategies, and their need to prioritize the protection of their subordinates, at times from other leaders or the institution itself. Post-discharge, the shifting experience of moral injury for participants was heavily influenced by additional betrayals perpetrated by the institution (e.g., negative experiences with the VA), as well as larger political betrayals such as foreign policy decisions that rendered their previous combat missions pointless. All of these experiences exacerbated participants’ moral injury, resulting in broken trust with the self and with others, and over time, worsening substance abuse, isolation, and suicidality. However, participants found healing through the SAW peer community, which facilitated their recognition of the harmful influence of the institution, meaningfully addressed their childhood trauma, and restored their trust in others and themselves. These findings illustrate how the total institution, legitimate authority, and ACEs work together to influence NCOs’ decision-making and shape their experiences of moral injury. This insight adds integration and complexity to the empirical literature on military personnel and veterans’ moral injury experiences, while offering new directions for research, practice, and policy.