WACO, Texas (KWTX) Have you ever heard of something called "moral injury?"
It's a problem that isn't widely recognized but many veterans are dealing with it.
In fact Central Texas has become a hub for research into the issue.
In this edition of Hearing the Veteran's Voice we hear from one veteran who experienced it and is now working to treat it.
Veterans have a world of emotions and experiences to grapple with after leaving active duty.
Many people have post traumatic stress disorder.
But that's not the diagnosis for everyone.
Michael Russell is the director of the Center of Excellence for Research on Returning War Veterans.
He said, "you have to be put in fear of imminent injury and react in fear or horror to that life threatening situation. To get PTSD you have to have that."
Russell explained the idea of moral injury.
"You have guilt over something that you did, or something that you failed to do. So you did some wrong or you failed to do some right in a military situation. And as a result you're suffering trauma from that or problems from that," he said.
As veteran who served in Iraq, Russell has grappled with these concepts himself, namely the removal of Saddam Hussein and onset of ISIS.
"They destroyed everything. We created that monster," Russell said, "he kept those people at bay and we took that away, and we didn't put anything in its place that protected those people and a lot of people died. Three quarters of a million Iraqis died because of that."
And it can be difficult to overcome.
"With moral injury it's hard to feel like you fit back into society. You're carrying this guilt. You don't feel like you belong in polite society," he said.
Russell gave the example of drone pilots, many times working remotely from the United States, hitting targets overseas, and sometimes making deadly mistakes.
"They think it's a terrorist hideout and they blow up a wedding or a birthday party or a hospital. This has happened," he explained, "it's an accident, you make your best judgement, but you find out later that it's a bad call."
But because the individual's life was never directly in danger they don't fit the PTSD diagnosis.
Because moral injury is not a diagnosis accepted by the VA many people may not be getting treated for it.
"Either we need to change the definition of PTSD and broaden it to include moral injury, or we need to make a new diagnosis called moral injury and let these people have services," Russell said.
Now the center under his leadership is trying to change that.
Russell said, "my intention is to make this a moral injury center of excellence, to be the leaders in bringing this idea out."
Among their initiatives they're developing an assessment tool for moral injury.
"So we can better classify people, prescribe the right therapy for them, bring them in and test them and say is it PTSD mainly in which case we're going to give this treatment to you, or moral injury mainly in which case we're going to give this treatment to you," he said.
They're also trying group therapy, intense outpatient therapy, and ACT therapy, that stands for acceptance and commitment therapy.
"The best way when I'm working with people is this idea of the scales being unbalanced. You did something wrong. The scale is unbalanced and now it's time to balance the scales," Russell explained,"and sometimes what you have to do is give back something to balance those scales. So sometimes it's a call to action to do something good to make up for the bad."
Russell hopes through this research and treatment people can get the help they need.
He said, "it is my hope that we can get some good data to either make a war-related trauma diagnosis separate from PTSD or add moral injury or just broaden the definition."