Following orders that may result in civilian deaths, or deciding whether to save or to abandon a fellow soldier are just some of the life-altering choices soldiers must make while deployed.

Retired Army Col. Herman Keizer Jr., founding co-director of the Brite Divinity School Soul Repair Center, said these types of decisions often violate soldiers’ core values, resulting in a lost sense of identity and a skewed world view.

The Soul Repair Center conducts research to better understand this developing concept, which is called “moral injury.”

Keizer, who served as a chaplain in the Army for 34 years, described one veteran’s experience with moral injury.

“While on a rooftop guarding, he saw a guy dialing a cell phone near a homemade bomb that was being diffused,” Keizer said. “He ended up killing the man out of suspicion that the phone would detonate the bomb. He found out later that it could only have been exploded by pressure.”

Keizer said this man is now plagued with feelings of guilt over killing an innocent person.

“He’s having a deep moral crisis,” Keizer said. “He’s ashamed of what he’s done.”

Moral injury, which is not to be confused with post-traumatic stress disorder, is a concept that has only been around since 2009, Keizer said. 

PTSD is a basic reaction to stress that manifests as a startle or panic response and affects the limbic system, he said, while moral injury affects the frontal lobe and the more advanced parts of the brain that control empathy and moral reasoning.

Symptoms of moral injury were previously lumped into the PTSD category. However, following a spike in veteran suicides, Keizer and the Rev. Dr. Rita Nakashima Brock, the other founding co-director of the Soul Repair Center, decided to dig deeper to find a solution.

According to estimates from the U.S. Department of Veterans Affairs, approximately 22 veterans took their own lives each day during 2010.

“War is not hell, coming home is hell,” Keizer said.

In order to open the center, Keizer and Brock applied for funding from Lilly Endowment, Inc. and received a $650,000 two-year grant. Keizer said the foundation was so enthusiastic about the idea that they granted the money the day they received the center’s proposal. 

The Soul Repair Center, which opened in the spring of 2013, conducts research and works to educate and train civilians to support veterans recovering from moral injury. 

Shawn Keane, administrator for the sociology and anthropology departments, said veterans transitioning into life at the university face many challenges.

“A lot of veterans on this campus spent their whole young adult life in military, where everything was on a strict schedule,” she said. “Now they are at TCU, and no one tells them when to eat or when to wake up – that takes adjusting to.”

Keane, who volunteers her time as liaison between veterans and the university, helps veterans cope with the adjustment by helping organize a week of events around Sept. 11. She said it brings the veteran community together so they can support one another.

“It’s helpful when veterans can meet other veterans while also making other students aware of the tremendous costs of war,” she said.

Keizer said being informed and sharing their stories are more than half the battle for veterans.

But solutions for coping with moral injury remain elusive because the concept is still so new, and there are few statistics on the subject.

Keizer said out of the several million individuals who have served in Afghanistan, about 30 percent returned with PTSD. However, he said the number of soldiers who show signs of moral injury is unknown.

Former Marine captain and Iraq veteran Tyler Boudreau wrote in the Massachusetts, a literary magazine, that those who suffer from moral injury have “wounded souls” rather than mental issues, making research difficult.

Despite this, the center is moving forward and will seek additional grant money to fund retreat programs for veterans. Keizer said the first week-long retreat is scheduled for March. The event will connect veterans with counselors who will help them with physical and mental treatment, he said.

In the meantime, the center seeks to train individuals to inform veterans about moral injury and other hardships.

According to a story by the Associated Press, some Army programs, including one called Comprehensive Soldier Fitness that is designed to promote both mental and physical well-being, have reportedly had positive preventative effects with regard to moral injury. 

According to the Soul Repair Center’s website, while the organization’s current focus is on veterans and current members of the military, they also hope to expand the scope of their research to address law enforcement, medicine, prisons and international post-conflict situations.