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THE DAILY ASTORIAN • MONDAY, AUGUST 17, 2015
Soldier’s journey to heal spotlights war ‘soul wounds’
By JULIE WATSON
Associated Press
SAN DIEGO — “It was just
another day in Mosul,” the sol-
dier began, his voice shaking.
Sgt. 1st Class Marshall Powell
took a deep breath. He couldn’t
look at the other three service-
men in the group therapy ses-
sion.
He’d rarely spoken about
his secret, the story of the little
girl who wound up in his hospi-
tal during the war in Iraq, where
he served as an Army nurse.
Her chest had been blown
apart, and her brown eyes im-
plored him for help. Whenever
he’d thought of her since, “I
killed the girl,” echoed in his
head.
Powell kept his eyes glued
to the pages he’d written.
He recalled the chaos after
a bombing that August day in
2007, the vehicles roaring up
with Iraqi civilians covered in
blood. Around midnight, Pow-
ell took charge of the area hous-
ing those with little chance of
survival. There, amid the man-
gled bodies, he saw her.
She was tiny, maybe 6 years
old, lying on the Àoor. Her an-
gelic face reminded him of his
niece back home in Oklahoma.
Back in the therapy room,
saying it all out loud, Powell’s
eyes began to ¿ll just at the
memory of her. “I couldn’t let
her lay there and suffer,” he said.
A doctor had ¿lled a syringe
with painkillers. Powell pushed
dose after dose into her IV.
“She smiled at me,” he told
the others in the room, “and I
smiled back. Then she took her
last gasp of air.”
• • •
Before the war, Sgt. Powell’s
very core was built on God and
faith and saving lives, not doing
anything that could end one.
He lost his purpose when the
girl died, and he found himself
in a nondescript room on a San
Diego naval base trying desper-
ately to save his own crumbling
existence.
Surrounding him that day
were veterans who had suffered
as he suffered: An Army staff
sergeant who stood frozen in
shock, unable to offer aid to a
fellow soldier whose legs were
severed in an explosion in Af-
ghanistan. A Marine whose ju-
nior comrade was fatally shot
after he convinced him to switch
posts in Iraq. A Navy man who
beat an Iraqi citizen in anger.
Like Powell, they’d spent
years torturing themselves over
acts that tortured their con-
science. “Souls in anguish” is
how some experts describe this
psychological scar of war now
being identi¿ed as “moral inju-
ry.”
Unlike post-traumatic stress
disorder, which is based on fear
from feeling one’s life threat-
ened, moral injury produces
guilt and shame from something
done or witnessed that goes
against one’s values or may
even be a crime.
While the idea of warriors
feeling remorse over battle¿eld
horrors is not new, moral inju-
ry has gained more attention
following the wars in Iraq and
Afghanistan as mental health
providers point to it as a reason
why veterans aren’t improving
with PTSD treatments.
The Navy now runs one of
the military’s ¿rst residential
treatment programs that ad-
dresses the problem — the one
that Powell found.
Still, debate persists over
whether moral injury is a part of
PTSD or its own separate condi-
tion. There is no formal medical
diagnosis for it.
Psychiatrists who treat moral
injury believe it has contributed
to the suicide rate among vet-
erans, who account for 1 out of
every 5 suicides in the United
States. And they see danger in
ignoring it because its treatment
is distinct.
PTSD sufferers can ¿nd re-
lief with medication and coun-
seling that encourages reliving
the triggering incident to work
through fear. But if the person
considers what happened to be
morally wrong, reliving it may
only reaf¿rm that belief.
Counselors have found the
self-punishment stops when
veterans learn the deed does not
de¿ne who they are. Veterans,
the experts said, ¿nd comfort in
sharing with each other, because
only those who’ve experienced
war can truly understand the
complexity of morality on the
battle¿eld.
“The pain brings everyone
together and creates a bond that
Brennan Linsley/AP Photo
Retired U.S. Army Sgt. 1st Class Marshall Powell sits at
the dining room table and pauses while talking about his
emotionally traumatic experiences serving as a military
nurse in northern Iraq in 2007.
Brennan Linsley/AP Photo
Retired U.S. Army Sgt. 1st Class Marshall Powell sits in his home in Crescent, Okla., in
March, looking at snapshots from his emotionally traumatic time serving as a nurse in
northern Iraq in 2007, during one of the bloodiest years of the conflict. One night after
bombing attack, Powell oversaw a hospital room designated for those with little chance
of survival. There, amid the patients, he saw a wounded girl that reminded him of his
niece back home. Maybe 6 years old, the Iraqi girl’s body was riddled with shrapnel, and
her brown eyes implored him for help. Unable to save her, he gave her painkillers, and
until recently could not forgive himself, or God, for her death. More photos online.
‘The pain brings everyone together and
creates a bond that no one can break.’
— Elvin Carey of Murrieta, Calif.,
whose fellow Marine died after the two switched posts
no one can break,” said Elvin
Carey of Murrieta, Calif., whose
fellow Marine died after the two
switched posts.
• • •
Sgt. Powell is a friendly man
who ¿nds peace working on his
family’s farmland outside Cres-
cent, Okla. He said he wanted to
share his story because it might
prompt others to seek help.
And while Powell always
blamed himself for the girl’s
death, three toxicology experts
interviewed by The Associated
Press said her injuries, not the
drugs, likely caused her death.
By the time he arrived in San
Diego in February 2014, Pow-
ell, then 56, was on therapist No.
5 and contemplating suicide. He
had never heard of moral injury;
he just knew that the beliefs that
had shaped his life were shat-
tered.
He was raised on the idea
that God has a reason for ev-
erything. It was the mantra his
family drew strength from in the
face of poverty and racism in ru-
ral Crescent.
“When a man’s down, if he
stays down, he done lay down,”
Powell’s older brother, Bob,
said once when young Marshall
Àopped down on the porch, up-
set over being called a racial slur
at school. “You need to get on
up from there.”
He learned to pick himself
up from even the darkest depths.
After Bob died in a car accident,
Powell, then in the Air Force,
started using drugs, quit the ser-
vice and wound up sleeping on
the streets of Dayton, Ohio. He
returned to Crescent and to Sun-
day services, apologizing to the
pastor for having only a dime to
drop in the basket. The reverend
gave it back, along with $43 in
donations, and told him to keep
his faith. “God hears you,” said
the pastor.
The next day, Powell joined
the Army.
• • •
But the girl was something
he couldn’t get back up from.
Months after her death, Powell
was sent back stateside to Ha-
waii. Soon, she was appearing
in his dreams.
Her death left him question-
ing God, and himself most of all.
Powell started drinking heavily
and sought help for PTSD. He
was prescribed pills for insom-
nia, depression and anxiety. But,
he says, “I couldn’t beat it.” Af-
ter six years, a therapist recom-
mended the program at Naval
Medical Center San Diego.
Called Overcoming Adver-
sity and Stress Injury Support,
or OASIS, the program started
in 2010 with the aim to help
service members not ¿nding
success with PTSD treatments.
Three years later, therapies ad-
dressing moral injury were add-
ed.
Seven other servicemen
were part of Powell’s 10-week
session. After the second week,
the veterans were asked to put in
writing what had triggered their
moral injuries. After a month,
the men were divided into two
groups to share their stories.
When Powell was ¿nished,
the men in the room were silent
at ¿rst. Among them was Carey,
who, listening to Powell, felt a
connection to someone for the
¿rst time in years. Steven Velez
was there, too, Àashing back to
his time as an Army staff ser-
geant in Afghanistan, when he
was too traumatized to help his
comrade. He stood and shook
Powell’s hand.
“You did your best,” he
said. “You didn’t do anything
wrong.”
In the program’s ¿nal weeks,
Powell and the other men were
told to write a letter of apolo-
gy or reconciliation as a way
to ¿nally ¿nd self-forgiveness.
Powell addressed his to the little
girl’s parents. He’d never met
the couple or knew if they sur-
vived the bombing, so the letter
went nowhere. But it helped to
put down the words and read
them aloud to his fellow veter-
ans.
“I want you to know,” he
wrote, “your daughter has been
in my heart each day since that
night.”
• • •
A year ago April, Powell
left OASIS with new tools and
hope and friends he could lean
on.
He was honorably dis-
charged from the Army last
August, and found work as a
nurse at a home for the elderly
in Crescent, but he realized he
no longer had it in him to do the
job he once loved. He quit and
is pursuing a degree in industrial
engineering.
He spends much of his time
on his farmland, in his family
since his great-great-grand-
mother arrived in Oklahoma to
start a new life after being freed
as a slave. Sometimes, he talks
to God as he clears the brush
around the walnut trees.
“I feel peace, redemption
Brennan Linsley/AP Photo
A photograph shows now-retired U.S. Army Sgt. 1st Class
Marshall Powell standing with a U.S. Army MEDEVAC heli-
copter in Iraq during his last tour to the country, at Powell’s
brother’s house in Crescent, Okla. Powell, who served as a
military nurse in Iraq and Afghanistan, was deeply haunted
by his experiences, and nearly lost his own internal war
with depression before finding meaningful help.
when I talk to him out there,” he
says. “I know he forgives me.”
Powell has ¿nally forgiven
himself, too, but he knows he’s
not entirely healed.
He still takes medication for
anxiety, depression and insom-
nia. But more than anything,
he leans on the seven veterans.
Their cellphones have become a
lifeline, with daily texts.
Often Powell, the group’s
oldest member, is the one giving
the advice. Helping them helps
him, because he sees that he can
still heal others.
The AP shared with Powell
the medical experts’ opinions
that the girl’s injuries likely
caused her death. Said one,
Bruce Goldberger, professor of
toxicology at the University of
Florida College of Medicine:
“What he did probably was
relieve the pain like they do in
hospice care.”
Hearing that brought relief
for Powell. “It’s something I’ve
been carrying on my back for so
many years, that guilty feeling,”
he says.
The girl still comes to him
in his dreams. Not long ago, he
envisioned her running through
a pasture, and he yelled at her
not to leave.
But he can put a distance be-
tween who he is now, and what
happened then. And when his
heart races and the anxiety re-
turns, he stops to remind himself
that he’s not a bad person; it was
just a bad situation.
“It will never go away,” he
says. “Now, I know how to deal
with it.”