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I’ll never forget a commercial I saw on the Armed Forces Network while I was in Iraq. It was a warning about the dangers of PTSD, and it showed a man washing his hands, the water running with blood, as he recalled some traumatic scene that was reflected in the bathroom mirror, mangled bodies stretched out into the distance behind him. Despite its graphic nature, the commercial didn’t surprise me—when it comes to serving in the military, we rally around those who saw friends killed beside them, who huddled in the dirt while bombs fell around them.

But the research shows that for many who are diagnosed with PTSD, the condition arises not from what was done to us but what we did—or what we failed to prevent. This mechanism, known as moral injury, can be sympathetic (“I couldn’t save them”) but is often not sympathetic at all (“I killed them”). For people carrying this factor in PTSD, the task of integration, of sitting with and holding what we’ve done, is far more challenging.

We are, once again, engaged in a war, despite the fact that Donald Trump campaigned on stopping American involvement in foreign wars. At the time of this writing, he has involved us in three to five separate armed conflicts, depending on how you count them. With Iran, Trump may be gesturing at ending the conflict for the cameras (and the stock markets), but Defense Secretary Pete Hegseth quickly cast doubt on the idea that there will be a quick end to the fighting. And just a few days ago, the president intimated the potential for violent action against Cuba.

Whether or not you view these military commitments as righteous, what cannot be denied is that we are clearly in the midst of an era of heightened U.S. intervention across the world. This joins wildly spiking levels of demonstrations, civil unrest, and political violence domestically. This means that the people we arm and train and ask to use violence on our behalf are having to do so at an unprecedented rate.

The one thing notably absent in these scraps are large-scale ground commitments. While 13 American service members have died in the war so far, there is a temptation to believe that our troops will be mostly spared. We are not seeing image after image of flag-draped coffins. And so the hope follows that PTSD won’t dog our active military members because they are fighting largely at a clean distance—flying planes, dropping bombs, firing missiles and drones from a safe remove.

For some, this may indeed be true. For many, it won’t be. Because, for veterans of modern warfare, the question isn’t how to come to grips with something that befell us in the manner of a natural disaster. It’s how to reconcile what we see in the mirror. We know we are not monsters, but we are equally sure that we have done monstrous things. The justification of authority and mission, in my experience, props you up for a while, but it fades fast, and in the end you’re left with the bald fact that you could have said “I will not do this,” damn the consequences. You could have looked at the possible outcomes of the duty you were agreeing to, and turned away from it. We are a volunteer force that hasn’t seen a draft in over 50 years. Many of us were private contractors. Nobody made us sign up.

For me, the moment I felt this most directly happened years after I returned from Iraq, where I had worked as a targeting officer. I was strolling through a beautiful spring Manhattan night when my friend called me “a good guy.” I was suddenly overwhelmed, turning to her with a cold anger I didn’t know was in me. Our peaceful evening suddenly went sour as I argued for the next 15 minutes, asking her if she thought the mothers of the Iraqis would look at my comfortable life in New York City, at the amazing meal we’d just shared in peace and comfort, at the well-appointed apartment I would be returning to, and tell me I was a good guy. If they would, I would accept it, I told her, but I knew that they wouldn’t.

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This is moral injury: the bone-deep understanding that you are not a good guy. Not because of anything dramatic, not because of some special flaw within you, but because you are guilty of the most common tic in how humans navigate existence—turning others into objects. This kind of basic human cruelty is as common as the grass. In nonviolent settings, it leads to mean-girl-style ostracism or political backstabbing around the corporate watercooler. But that same impulse, unfolding on a battlefield or a police encounter gone pear-shaped, gives us Abu Ghraib or the recent killings in Minnesota.

When it comes to people who end up as targets, we have heard the label domestic terrorist quite a bit lately. For targeting officers like me, the most common label was the enemy. In my time in law enforcement, we called them EDPs (Emotionally Disturbed Persons), individuals, and, very often in my experience, idiots. This systematic stripping away of humanity is the critical tool that empowers us to access what we need to pull a trigger, swing a baton, or produce the package necessary to “action a target.” The result is final. Once it is done, there is no taking it back. The refrain “I was just doing my job” wears thin awfully fast. In the end, you’re left with who you thought you were and the emerging picture of who you actually are.

That picture is complex, but ruminating on your actions can quickly become torturous. And we live in an age of outrage cycles, call-out culture, and social media condemnation. In our intensely public lives, we have never been more exposed to those who are angered by our actions. No past, it seems, is ever far enough in the rearview mirror. The internet’s general advice for those who wish to atone, blaring across X and Reddit and beyond is the shorthand KYS (“kill yourself”). Too many heed that call.

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Pilots, missile and drone operators, targeting officers, fire control technicians, artillery officers, and tactical mission planners may not be what we called “pipe-hitters” when I was in Iraq—those direct-action combat operators who kill up close and personal. But the phenomenon of moral injury means they don’t have to do that to still be in real danger of carrying home the kinds of invisible wounds that will dog them for the rest of their lives. Moral injury is a major contributing factor in many cases of PTSD and, in one study, its strongest predictor. I think about whoever carried out the mission two weeks ago that wound up striking the girls’ school in Iran, an attack that killed roughly 175 people, mostly children. Maybe I’m naive, but I cannot picture anyone involved in that mission walking away, shrugging their shoulders, and just getting on with their life.

We have so far not committed any real numbers of ground troops to our expanding number of foreign interventions. But whether or not we see it, we are surely hurting the ones we are asking to fight for us. We must be aware of this, plan for it, and be ready to help them when their symptoms inevitably emerge. In my experience, the blaring questions will be Why did I do this? What did I think would happen? Given the administration’s shifting narratives for attacking Iran, those will be difficult questions to confront.

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