Soldier spot­lights se­vere ‘soul wounds’ of war


“It was just another day in Mo­sul,” the soldier be­gan, his voice shak­ing. Sgt. 1st Class Mar­shall Pow­ell took a deep breath. He couldn’t look at the other three ser­vice­men in the group ther­apy ses­sion.

He’d rarely spo­ken about his se­cret, the story of the lit­tle girl who wound up in his hos­pi­tal dur­ing the war in Iraq, where he served as a U.S. Army nurse. Her chest had been blown apart, and her brown eyes im­plored him for help. When­ever he’d thought of her since, “I killed the girl,” echoed in his head.

Pow­ell kept his eyes glued to the pages he’d writ­ten.

He re­called the chaos af­ter a bomb­ing that Au­gust day in 2007, the ve­hi­cles roar­ing up with Iraqi civil­ians cov­ered in blood. Around mid­night, Pow­ell took charge of the area hous­ing those with lit­tle chance of sur­vival. There, amid the man­gled bod­ies, he saw her.

‘Last gasp of air’

She was tiny, maybe 6 years old, ly­ing on the floor. Her an­gelic face re­minded him of his niece back home in Ok­la­homa.

Back in the ther­apy room, say­ing it all out loud, Pow­ell’s eyes be­gan to fill just at the mem­ory of her. “I couldn’t let her lay there and suf­fer,” he said.

A doc­tor had filled a sy­ringe with painkillers. Pow­ell pushed dose af­ter dose into her IV.

“She smiled at me,” he told the oth­ers in the room, “and I smiled back. Then she took her last gasp of air.”

Be­fore the war, Sgt. Pow­ell’s very core was built on God and faith and sav­ing lives, not do­ing any­thing that could end one. He lost his pur­pose when the girl died, and he found him­self in a non­de­script room on a San Diego naval base try­ing des­per­ately to save his own crum­bling ex­is­tence.

Sur­round­ing him that day were vet­er­ans who had suf­fered as he suf­fered: An Army staff sergeant who stood frozen in shock, un­able to of­fer aid to a fel­low soldier whose legs were sev­ered in an ex­plo­sion in Afghanistan. A U.S. Marine whose ju­nior com­rade was fa­tally shot af­ter he con­vinced him to switch posts in Iraq. A U.S. Navy man who beat an Iraqi citizen in anger.

Like Pow­ell, they’d spent years tor­tur­ing them­selves over acts that tor­tured their con­science. “Souls in an­guish” is how some ex­perts de­scribe this psy­cho­log­i­cal scar of war now be­ing iden­ti­fied as “moral in­jury.”

Un­like post-trau­matic stress dis­or­der, which is based on fear from feel­ing one’s life threat­ened, moral in­jury pro­duces guilt and shame from some­thing done or wit­nessed that goes against one’s val­ues or may even be a crime.

While the idea of war­riors feel­ing re­morse over bat­tle­field hor­rors is not new, moral in­jury has gained more at­ten­tion fol­low­ing the wars in Iraq and Afghanistan as men­tal health providers point to it as a rea­son why vet­er­ans aren’t im­prov­ing with PTSD treat­ments.

The Navy now runs one of the mil­i­tary’s first residential treat­ment pro­grams that ad­dresses the prob­lem — the one that Pow­ell found.

Moral In­jury

Still, de­bate per­sists over whether moral in­jury is a part of PTSD or its own sep­a­rate con­di­tion. There is no for­mal med­i­cal di­ag­no­sis for it.

Psy­chi­a­trists who treat moral in­jury be­lieve it has con­trib­uted to the sui­cide rate among vet­er­ans, who ac­count for 1 out of ev­ery 5 sui­cides in the United States. And they see dan­ger in ig­nor­ing it be­cause its treat­ment is dis­tinct.

PTSD suf­fer­ers can find re­lief with med­i­ca­tion and coun­sel­ing that en­cour­ages re­liv­ing the trig­ger­ing in­ci­dent to work through fear. But if the per­son con­sid­ers what hap­pened to be morally wrong, re­liv­ing it may only reaf­firm that belief.

Coun­selors have found the self­pun­ish­ment stops when vet­er­ans learn the deed does not de­fine who they are. Vet­er­ans, the ex­perts said, find com­fort in shar­ing with each other, be­cause only those who’ve ex­pe­ri­enced war can truly un­der­stand the com­plex­ity of moral­ity on the bat­tle­field.

“The pain brings ev­ery­one to­gether and cre­ates a bond that no one can break,” said Elvin Carey of Mur­ri­eta, Cal­i­for­nia, whose fel­low Marine died af­ter the two switched posts.

Sgt. Pow­ell is a friendly man who finds peace work­ing on his fam­ily’s farm­land out­side Cres­cent, Ok­la­homa. He said he wanted to share his story be­cause it might prompt oth­ers to seek help.

And while Pow­ell al­ways blamed him­self for the girl’s death, three tox­i­col­ogy ex­perts in­ter­viewed by The As­so­ci­ated Press said her in­juries, not the drugs, likely caused her death.

By the time he ar­rived in San Diego in Fe­bru­ary 2014, Pow­ell, then 56, was on ther­a­pist No. 5 and con­tem­plat­ing sui­cide. He had never heard of moral in­jury; he just knew that the be­liefs that had shaped his life were shat­tered.

He was raised on the idea that God has a rea­son for ev­ery­thing. It was the mantra his fam­ily drew strength from in the face of poverty and racism in ru­ral Cres­cent.

He learned to pick him­self up from even the dark­est depths. Af­ter his older brother Bob died in a car ac­ci­dent, Pow­ell, then in the U.S. Air Force, started us­ing drugs, quit the ser­vice and wound up sleep­ing on the streets of Day­ton, Ohio. He re­turned to Cres­cent and to Sun­day ser­vices, apol­o­giz­ing to the pas­tor for hav­ing only a dime to drop in the bas­ket. The rev­erend gave it back, along with US$43 in do­na­tions, and told him to keep his faith. “God hears you,” said the pas­tor.

The next day, Pow­ell joined the Army.

But the girl was some­thing he couldn’t get back up from. Months af­ter her death, Pow­ell was sent back state­side to Hawaii. Soon, she was ap­pear­ing in his dreams.

Her death left him ques­tion­ing God, and him­self most of all. Pow­ell started drink­ing heav­ily and sought help for PTSD. He was pre­scribed pills for in­som­nia, de­pres­sion and anx­i­ety. But, he says, “I couldn’t beat it.” Af­ter six years, a ther­a­pist rec­om­mended the pro­gram at Naval Med­i­cal Cen­ter San Diego.

Called Over­com­ing Ad­ver­sity and Stress In­jury Sup­port, or OA­SIS, the pro­gram started in 2010 with the aim to help ser­vice mem­bers not find­ing suc­cess with PTSD treat­ments. Three years later, ther­a­pies ad­dress­ing moral in­jury were added.

Seven other ser­vice­men were part of Pow­ell’s 10-week ses­sion. Af­ter the sec­ond week, the vet­er­ans were asked to put in writ­ing what had trig­gered their moral in­juries. Af­ter a month, the men were di­vided into two groups to share their sto­ries.

When Pow­ell was fin­ished, the men in the room were silent at first. Among them was Carey, who, lis­ten­ing to Pow­ell, felt a con­nec­tion to some­one for the first time in years. Steven Velez was there, too, flash­ing back to his time as an Army staff sergeant in Afghanistan, when he was too trau­ma­tized to help his com­rade. He stood and shook Pow­ell’s hand.

“You did your best,” he said. “You didn’t do any­thing wrong.”

In the pro­gram’s fi­nal weeks, Pow­ell and the other men were told to write a let­ter of apol­ogy or rec­on­cil­i­a­tion as a way to fi­nally find self-for­give­ness. Pow­ell ad­dressed his to the lit­tle girl’s par­ents. He’d never met the cou­ple or knew if they sur­vived the bomb­ing, so the let­ter went nowhere. But it helped to put down the words on pa­per and read them aloud to his fel­low vet­er­ans.

“I want you to know,” he wrote, “your daugh­ter has been in my heart each day since that night.”

In April 2014, Pow­ell left OA­SIS with new tools and hope and friends he could lean on.

He was hon­or­ably dis­charged from the Army last Au­gust, and found work as a nurse at a home for the el­derly in Cres­cent, but he re­al­ized he no longer had it in him to do the job he once loved. He quit and is pur­su­ing a de­gree in in­dus­trial en­gi­neer­ing.

‘He for­gives me’

He spends much of his time on his farm­land, in his fam­ily since his great-great-grand­mother ar­rived in Ok­la­homa to start a new life af­ter be­ing freed as a slave. Some­times, he talks to God as he clears the brush around the wal­nut trees.

“I feel peace, re­demp­tion when I talk to him out there,” he says. “I know he for­gives me.”

Pow­ell has fi­nally for­given him­self, too, but he knows he’s not en­tirely healed.

He still takes med­i­ca­tion for anx­i­ety, de­pres­sion and in­som­nia. But more than any­thing, he leans on the seven vet­er­ans. Their cell­phones have be­come a life­line, with daily texts.

Of­ten Pow­ell, the group’s

old- est mem­ber, is the one giv­ing the ad­vice. Help­ing them helps him, be­cause he sees that he can still heal oth­ers.

The AP shared with Pow­ell the med­i­cal ex­perts’ opin­ions that the girl’s in­juries likely caused her death. Said one, Bruce Gold­berger, pro­fes­sor of tox­i­col­ogy at the Univer­sity of Florida Col­lege of Medicine: “What he did prob­a­bly was re­lieve the pain like they do in hos­pice care.”

Hear­ing that brought re­lief for Pow­ell. “It’s some­thing I’ve been car­ry­ing on my back for so many years, that guilty feel­ing,” he says.

The girl still comes to him in his dreams. Not long ago, he en­vi­sioned her run­ning through a pas­ture, and he yelled at her not to leave.

But he can put a dis­tance be­tween who he is now, and what hap­pened then. And when his heart races and the anx­i­ety re­turns, he stops to re­mind him­self that he’s not a bad per­son; it was just a bad sit­u­a­tion.

“It will never go away,” he says. “Now, I know how to deal with it.”


1. In this March 16 photo, re­tired U.S. Army Sgt. 1st Class Mar­shall Pow­ell sits at the din­ing room ta­ble and pauses while talk­ing about his emo­tion­ally trau­matic ex­pe­ri­ences serv­ing as a mil­i­tary nurse in north­ern Iraq in 2007, dur­ing one of the blood­i­est years of the con­flict, at Pow­ell’s home in Cres­cent, Ok­la­homa. 2. In this March 17 photo, re­tired U.S. Army Sgt. 1st Class Mar­shall Pow­ell straight­ens a photo of his mother on a wall at his brother’s house in Cres­cent.

3. In this March 17 photo, re­tired U.S. Army Sgt. 1st Class Mar­shall Pow­ell leaves Zion Ceme­tery, a pri­mar­ily African-Amer­i­can burial place with the gravesites of freed slaves, out­side Cres­cent.

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