A 2021 study by the United Service Institution of India (USI) revealed that more than half of Indian Army personnel are under severe stress. This alarming finding highlights that the Indian Army has been losing more personnel to suicides, fratricides, and untoward incidents than to enemy actions. Factors contributing to this stress include prolonged exposure to counter-insurgency and counter-terrorism operations, emphasising the urgent need for enhanced mental health support and stress management initiatives within the armed forces. This is also being observed within the Central Armed Police Forces (CAPFS), with such cases emerging from within the Central Reserve Police Force (CRPF) and Border Security Force (BSF), among other paramilitary forces in the country.
Reflecting on this study brought me back to a conversation I had with a soldier who shared his profound moral dilemma a few years ago.
On a foggy morning in Kashmir, the young soldier stood guard at a checkpoint, his mind heavy with the memory of a recent encounter. He had to make a split-second decision that resulted in unintended civilian casualties. This decision haunted him, not as a flashback, but as a profound sense of guilt and betrayal of his moral code. His story, while personal, is not entirely isolated. It highlights a crucial yet often overlooked aspect of mental health in conflict zones: moral injury.
Anyone who joins military service is recruited in an absolutely fit medical condition. The service conditions are unique, and they live a regimented lifestyle under strict military laws. However, prolonged exposure to situations of extreme violence during sustained military action, involving constant threats to one’s own life, and a sense of isolation and deprivation due to lack of regular access to family and friends impact the psyche of a soldier over time.
This peculiar stress exacerbates regular diseases and ailments. In such circumstances, soldiers have a tendency to suffer from Post-Traumatic Stress Disorder (PTSD), not just in India but in any army deployed in a combat situation. While some manage to cope, others succumb to the stress, developing psychiatric disorders.
Understanding PTSD and Moral Injury
Post-Traumatic Stress Disorder (PTSD) is a well-known mental health condition characterised by symptoms like flashbacks, nightmares, hypervigilance, and avoidance behaviours following exposure to traumatic events. It encompasses a broad spectrum of reactions to various forms of trauma, from natural disasters to personal assaults.
Moral injury, however, delves deeper into the psyche. It arises from actions that transgress one’s moral or ethical beliefs, resulting in intense feelings of shame, guilt, and anger. This violation fundamentally shakes one’s core values and sense of trust in oneself and others.
Security Forces in Kashmir and the Northeast
Indian soldiers and security personnel face unique psychological challenges in regions like Kashmir and the Northeast. These areas are fraught with prolonged conflicts, frequent violence, and complex socio-political dynamics. Soldiers often confront situations that starkly conflict with their moral and ethical beliefs, leading to profound psychological impacts.
Kashmir Conflict: The Kashmir conflict has embroiled Indian security forces in prolonged counter-insurgency operations. Soldiers often find themselves in morally ambiguous situations, such as engaging insurgents in populated areas or dealing with the collateral damage of civilian lives. These situations can lead to moral injury as soldiers grapple with the emotional aftermath of their actions. A Rashtriya Rifles (RR) soldier recounted, “Every decision feels like a no-win situation, and the faces of innocent people caught in the crossfire stay with you.”
Insurgencies in the Northeast: The insurgencies present a different but equally complex set of moral and ethical dilemmas. The region’s ethnic diversity and numerous insurgent groups create a volatile environment. Soldiers must balance combat operations with efforts to win the hearts and minds of local populations, often finding themselves in morally compromising positions. For example, a soldier might witness or participate in actions perceived as unjust, leading to a deep-seated sense of guilt and betrayal.
Distinguishing PTSD from Moral Injury
While PTSD and moral injury share overlapping symptoms, their root causes differ significantly. PTSD is a reaction to trauma broadly, while moral injury specifically stems from the violation of one’s moral or ethical beliefs. This distinction is critical for understanding the psychological experiences of Indian soldiers and security personnel.
Research indicates that moral injury often co-occurs with PTSD, exacerbating mental health conditions. However, moral injury involves more profound ethical and spiritual distress, necessitating different therapeutic approaches.
Implications for Mental Health Support
Recognising moral injury among Indian forces has significant implications for mental health support. Traditional PTSD treatments may not fully address the profound moral violations characteristic of moral injury. Adequate support should include acknowledging moral injury, providing specialised support, fostering open communication, and rebuilding trust and meaning.
Moving Forward
As awareness of moral injury grows, tailored mental health programs within the security forces are urgently needed. These programs should provide comprehensive education on moral injury, offer specialised therapeutic interventions, create supportive environments for open discussion, and focus on rebuilding trust and restoring a sense of purpose.
In the context of security forces, especially those deployed in Kashmir and the Northeast, moral injury may be a more accurate and encompassing term for many cases traditionally labelled as PTSD. By recognising and addressing moral injury, we can provide more effective and compassionate support to those who serve in these challenging environments, ensuring their mental health and well-being are appropriately safeguarded.