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        Almost Sunrise | Lesson Plan: Moral Injury and the Moral Ambiguities of War

        Post-traumatic stress disorder (PTSD) is a term many students may know. It is a psychological diagnosis associated with individuals who have experienced trauma, such as assault, natural disaster, abuse and war, either as civilians or as combatants. Less familiar is the term moral injury, or a wound to the soul, caused by participation in events that violate one’s deeply held sense of right and wrong. Both PTSD and moral injury affect veterans and contribute significantly to the alarming 20 veteran suicides that occur every day in the United States on average according to the most recent study from the U.S. Department of Veterans Affairs. Yet, moral injury is less well-known than PTSD, and appropriate treatment for it is not well understood.

        This lesson invites student to gain a deeper understanding of moral injury and develop greater empathy for the challenges returning veterans face. Using video segments from the documentary film Almost Sunrise, students will learn about moral injury through the experiences of Tom and Anthony, two young Iraq war veterans struggling to heal their own moral injuries while raising awareness of veteran suicide as they complete a walking journey from Wisconsin to California. Students will conduct independent research, analyze the conditions and contexts in which moral injury occurs and explore effective mental health therapies and treatments.

        Lesson Summary

        [Moral injury] is the raw primitive feeling I did something terribly wrong and I just don't know whether I was justified or whether I can be forgiven. The cure has to involve the honesty to acknowledge, yes, I did this.

        - Father Thomas Keating, Almost Sunrise

        Post-traumatic stress disorder (PTSD) is a term many students may know. It is a psychological diagnosis associated with individuals who have experienced trauma, such as assault, natural disaster, abuse and war, either as civilians or as combatants. Less familiar is the term moral injury, or a wound to the soul, caused by participation in events that violate one’s deeply held sense of right and wrong. Both PTSD and moral injury affect veterans and contribute significantly to the alarming 20 veteran suicides that occur every day in the United States on average according to the most recent study from the U.S. Department of Veterans Affairs. Yet, moral injury is less well-known than PTSD, and appropriate treatment for it is not well understood.

        This lesson invites student to gain a deeper understanding of moral injury and develop greater empathy for the challenges returning veterans face. Using video segments from the documentary film Almost Sunrise, students will learn about moral injury through the experiences of Tom and Anthony, two young Iraq war veterans struggling to heal their own moral injuries while raising awareness of veteran suicide as they complete a walking journey from Wisconsin to California. Students will conduct independent research, analyze the conditions and contexts in which moral injury occurs and explore effective mental health therapies and treatments.

        Time Allotment

        Two 50-minute class periods with a homework assignment.

        Learning Objectives

        By the end of this lesson, student will: 

        • Be able to define moral injury and understand how it differs from post-traumatic stress disorder (PTSD)
        • Analyze the psychological and physical impact of moral injury, including its ability to cause suicide, on the lives of individual veterans
        • Participate in a Socratic seminar discussing the relationship between moral injury and just war theory
        • Write a one-page letter to a veteran, veteran’s family, elected official, or mental health professional/administrator in the U.S. Department of Veterans Affairs explaining moral injury and providing recommendations for effective treatment 

        Supplies

        Film clips from Almost Sunrise and equipment on which to show them

        Computers with access to the Internet for student research.

        Introductory Activity

        Understanding Moral Injury

        Share with students this part of the U.S. Department of Veterans Affairs definition of moral injury: “The key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational and group-based rules about fairness [and] the value of life.” 

        View clips 1 and 2. Discuss reactions and collect any questions that may have arisen.

        Have students independently do a close reading of this article, “Why Distinguishing a Moral Injury from PTSD Is Important” from the online publication Stars and Stripes, an independent newspaper published by the U.S. Department of Defense. 

        In small groups, have students share their understanding of moral injury and be prepared to discuss in a large group these questions:

        • What is moral injury? 
        • What are the differences between moral injury and PTSD?
        • Why is it important to understand the difference between PTSD and moral injury? 

        If students would like to research moral injury further, we recommend exploring the Moral Injury Project at Syracuse University.

        Homework: Read President Obama’s Nobel Peace Prize acceptance speech “A Just and Lasting Peace.” Underline key sentences that further clarify your understanding of a just war and write responses to these prompts in preparation for tomorrow’s Socratic seminar:

        • In your own words, explain your understanding of the phrase “just war.”
        • What is your argument in favor or against a “just war”?

        Learning Activities

        “Just War” and Moral Injury 

        Begin class by asking each student to share with a peer their response to President Obama’s Nobel speech. 

        Watch clip 3. Have students spend a few minutes reflecting on what Tom, Anthony and their friend Emmet share about engaging in combat in Iraq and its relationship with moral injury. 

        If time permits, conduct a Socratic seminar using the text of President Obama’s speech, the film segments from Almost Sunrise and students’ independent research on “just war” theory. 

        Central questions for discussion: 

        • How does the rationale for why a nation goes to war affect or influence the way a soldier may understand their actions in combat as right or wrong? 
        • Does this have any relationship to moral injury? Why or why not?

        Culminating Activity

        EXTENSIONS 

        Share this quote from Katinka in Almost Sunrise. Katinka is a cultural anthropologist with a specialty in combat PTSD and veterans’ experiences with this condition. She is also Tom’s girlfriend. 

        These stories have generated a growing empathy within me. Certainly I will never know what it feels like to be at war in Iraq or Afghanistan, but I know what it feels like to lose someone. I am humbled by these veterans, not because they served and protected our country or spread democratic ideals, but because they are not giving up. They inspire me. 

        Watch clip 4 or clip 5 from Almost Sunrise and have each student write a one-page letter to either a veteran, a veteran’s family, an elected official, or a mental health professional/administrator in the U.S. Department of Veterans Affairs explaining their understanding of moral injury and providing recommendations for effective treatment. 

        Focus on veterans’ relationships. Listen to a portion of This American Life Episode 603, “Once More, With Feeling,” from minute 29:45 to 36:22. The story features veteran Michael Pitre talking about how he changed his personal narrative about fighting in the war so that it took a form he thought would make his friends and family more comfortable, but doing so ended up damaging him and his relationships. After listening, discuss what made him feel distant from others and the effect it had on him. Then talk about his shift and how his loved ones made him feel more settled. 

        Have students read and explore the embedded videos in the three-part Huffington Post project, “A Warrior’s Moral Dilemma” on moral injury by journalist and author David Wood. 

        RESOURCES 

        POV Resources

        POV: Almost Sunrise — The POV site for the film has many features, including an interview with the filmmakers, a general discussion guide with additional information, resources and activity ideas and a reading list of suggested books. 

        POV: Media Literacy Questions for Analyzing POV Films — This list of questions provides a useful starting point for leading rich discussions that challenge students to think critically about documentaries. 

        Film Related Websites

        Almost Sunrise — The film’s official website offers information about the film and ways to get involved. 

        Moral Injury and Hidden War Wounds 

        The Atlantic: “Healing a Wounded Sense of Morality”  

        Huffington Post: “A Warrior’s Moral Dilemma” 

        The New York Times: “War Wounds That Time Alone Can’t Heal” 

        The New York Times “What We’re Fighting For”  

        U.S. Department of Veterans Affairs: “Talking Spiritual About Moral Injury”  

        Organizations Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury — This website includes clinical research and resources on health issues related to military service. 

        Project Welcome Home Troops — This organization’s website provides quality-of-life support for returning veterans and their families, including techniques for stress relief, health and wellbeing and empowerment. 

        Stop Soldier Suicide — This is the website of a group that works to support active military and veterans and create a network of resources and solutions. 

        U.S. Department of Veterans Affairs — This website provides research, information and resources related to veterans. 

        Immediate Assistance Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury — A 24/7 live chat outreach center can be reached at 866-966-1020 or by emailing resources@dcoeoutreach.org. 

        Veterans Crisis Line — For immediate assistance, veterans can call, text or chat with the Veterans Crisis Line. Dial 800-273-8255 or visit https://www.veteranscrisisline.net/.

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