“Thank you for your service.”

Caleb looked up from his breakfast plate to see a gray-haired man in a plaid shirt, about his father’s age, extending his hand. The man was smiling broadly. Caleb knew that the man must have seen his gray, black-lettered “ARMY” t-shirt and had correctly assumed that he was a veteran. Caleb returned his gaze, respectfully and without smiling.

“Thanks,” he said.

As Caleb drove away from the diner a few minutes later, he felt uneasy; a storm of mixed emotions swirled and churned in his stomach. The man was friendly and clearly meant well. He may have been a vet himself — though Caleb doubted that, by his casual tone of voice. He had clearly meant to honor Caleb — so why did he not feel honored?

Caleb’s thoughts soon turned, as they did every day, to his two, 15-month combat tours. As an infantryman — “eleven-bravo”— his job was to carry a weapon, to follow orders and to look out for his fellow soldiers.

Most of his days were filled with sweltering summer days and cold winter nights in which little, if anything, happened. But these periods of mind-numbing boredom had been unpredictably interspersed with violence and fighting that was simultaneously exhilarating and sickening.

It was these memories that flooded him at night.

He remembered the nighttime patrol in which there had been an ambush and a terrible loss. Caleb felt somehow responsible for it. The captain and staff sergeant arranged a debriefing, but no one wanted to talk for long. Things were too fresh and they needed to move on, to stay on guard, and to be ready for the next mission. When he returned home and was soon honorably discharged from the military, he figured that he would be able to leave Afghanistan behind.

But that didn’t happen. For some reason, things got worse.

He was unable to fall asleep, and would wake with a startle at the slightest noise. Kate, his wife of five years, told him that he would thrash around and shout in his sleep. But more than that, she told him that he had changed. He wasn’t as affectionate with her or with their 3-year-old daughter, Grace. He was less joyful, more sullen, more prone to losing his temper and snapping about little things.

The first Sunday that Caleb returned to the church where he and Kate had met six years beforehand, the pastor had asked him to stand, called him a hero, and told him that the country and the church were proud of him and grateful for his service.

Caleb received an instant, rousing standing ovation. Afterward, he was serenaded with handshakes and slaps on the back. But he felt unsettled. He appreciated people’s welcome, and he was proud of his service and of his fellow soldiers, but he wasn’t sure about the word hero.

He had only been doing his job — and besides, he still felt responsible for so much loss. He decided that he couldn’t talk to his pastor about this. His pastor was a nice person, but not a veteran. He probably wouldn’t understand. And besides, his pastor and everyone else was proud of him. They called him a hero. After about a month, Caleb stopped going to church.

Facing PTSD

Though he didn’t trust civilians, including Kate, Caleb decided that he could talk to other veterans about what he was going through.

Kevin, a fellow soldier from his first tour who lived in the same city, met him one day and told Caleb that he was going through similar things and had found a mental health counselor at his local VA hospital to be surprisingly helpful. Reluctantly, Caleb made an appointment at the same clinic. He met for an hour with a young psychologist who asked a lot of questions about his war experiences, his home life, family life, his sleep and irritability, and whether he was thinking of harming himself. At the end of the hour, the psychologist told Caleb, “You have PTSD — post-traumatic stress disorder.”

Over the next couple of months, Caleb learned a lot more about PTSD and began to understand his experiences in the light of that diagnosis. PTSD, he was told, happens when a person experiences or witnesses a profound threat either to his or her own life or safety, or to the life or safety of others. The memories of these experiences don’t fade away as most memories do, but remain painfully intact just under the surface of consciousness, and are triggered at unwanted and inopportune times, often by cues that are reminders of the trauma. Sometimes, these memories return as nightmares. Caleb identified with this. He remembered swerving three lanes on an interstate once after he thought a piece of trash was a roadside bomb.

After a few months of working with a psychologist and psychiatrist at the VA, Caleb was feeling a little better. New medication was causing him to feel calmer and to sleep more soundly at night. Talking with the psychologist helped him to understand his responses, and he began to go out in public more. But there was still something missing. He didn’t understand why he felt so uneasy when told “thank you for your service” by the man in the diner. He didn’t understand why he couldn’t pray, why he didn’t enjoy church, why he couldn’t talk to Kate about everything that had happened in Afghanistan.

New Strength from All

A week later, Kevin called again. He invited Caleb and Kate to a church that he had just started attending. The pastor there, he said, was a veteran and was leading a Bible study group for veterans and their spouses. Caleb attended the following week, and for the first time since he had returned home, he felt at home, surrounded by Christians who understood him and who knew how to encourage him. Many of the fifteen veterans in the room had PTSD, and they all understood how the terrifying realities of war could follow a service-member home and cause tension and edginess. But they spoke not just of fear, but also of guilt and shame. Some- times, explained the pastor, soldiers suffer not just from what happens to them in war, but also from what they do or participate in while at war (he called this “moral injury”). War is terrible and messy, he said, and sometimes veterans carry around huge weights of shame or guilt, even if they never violated any law. Sometimes that shame comes from not having done more to protect or save a comrade. Sometimes it comes from witnessing people being mistreated. And sometimes it comes from the tough duties they are expected to perform. When veterans carry these weights, calling them heroes in an attempt to honor them may not help. It might even make things worse.

As Caleb sat in that room, with Kate beside him, he began to feel a mixture of sadness, relief, and joy that he hadn’t known since returning home. He knew that he had a long way to go. But surrounded by fellow vets, and studying Scripture, Caleb knew without a doubt that God loved him. He began to see that God’s love was stronger than war’s hatred, and that the God who “makes wars cease through- out the earth” (Psalm 46:9) might also heal his own broken places. With Kate at his side, he began to envision a life beyond war. He realized that he needed to grieve and to mourn. But beyond grief, he glimpsed grace — and found the beginning of peace.

5 Ways to Welcome Veterans Into Your Church

1. Receive veterans.

Sometimes people don’t know what to say to veterans who have just returned from war. The best response is, simply, “Welcome home.”

2. Don’t assign labels.

Though well intentioned, labels like “hero” and “patriot” may not resonate with veterans who are struggling with what they witnessed or did in war. At worst, these labels can make it harder for veterans to open up about their experiences. So, don’t use them.

3. Listen.

Listen to veterans, but understand if they don’t want to talk. Many veterans will rarely want to talk about painful war experiences except in the context of a trusting relationship. So focus on cultivating trust, and don’t worry if vets don’t want to talk.

But if they do, be ready to listen openly and nonjudgmentally.

4. Connect veterans with other veterans.

Veterans can understand other veterans like no one else can. So connect veterans to each other, or refer veterans to ministries that do this.

5. Invite veterans into work and service.

Veterans have a lot to offer their churches and communities, and need to be called to exercise their gifts and skills. Look for opportunities to ask veterans to contribute!

What is Moral Injury?

Moral injury is a relatively new term that mental health clinicians and researchers are using to account for why some veterans suffer after war. For a long time, researchers assumed that PTSD (post-traumatic stress disorder) was primarily driven by fear, as veterans encountered terrifying situations in war and then brought that fear home with them, in ways that result in emotional numbing, avoidance, constant tension and stress, and nightmares.

More recently, though, researchers have increasingly realized that some traumatic war experiences lead not only to fear but also to guilt and shame, particularly if a soldier acts (or witnesses others act) in a way that violates his or her most deeply held moral commitments. This guilt-and- shame-based suffering, which may or may not be associated with PTSD, is referred to as moral injury. Because it touches closely on questions of sin and forgiveness, moral injury has spiritual significance. Christians should be aware of moral injury and should be prepared to minister to morally injured veterans.

Warren Kinghorn, MD, ThD is a psychiatrist and theologian at Duke University. He is co-director of the Theology, Medicine and Culture Initiative at Duke Divinity School. Growing up at Edwards Road Baptist Church in Greenville, S.C., Warren now lives in Durham, N.C., with his wife, Susan, and their two young children.