Proefschrift 'Soldiers in conflict, moral injury, political practices and public perceptions.

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Moral Injury, Political Practices and Public Perceptions

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Typography and design: Merel de Hart, Multimedia NLDA, Breda :fm\i`ccljkiXk`fe: Mei-Li Nieuwland Illustration (Lonomo), Amsterdam

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ISBN/EAN: 978-94-93124-04-2

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Jfc[`\ij`e:feÐ`Zk

Moral Injury, Political Practices and Public Perceptions

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ter verkrijging van de graad van doctor aan de Radboud Universiteit Nijmegen

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volgens besluit van het college van decanen in het openbaar te verdedigen op dinsdag 7 januari 2020

om 10:30 uur precies door Tine Molendijk

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Contents

DfiXc@ealip1Cèbè^k_\DfiXcXe[k_\GjpZ_fcf^`ZXc%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/ Research Objectives and Questions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 20 Relevance%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 22 JkilZkli\f]k_\;`jj\ikXk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 23 ŚĂƉƚĞƌϮ͘dŽǁĂƌĚĂƌŽĂĚĞƌdŚĞŽƌĞƟĐĂůƉƉƌŽĂĐŚƚŽDŽƌĂůŝƐƚƌĞƐƐ ... Ϯϳ @ekif[lZk`fe1ÅKiXldXXe[]Xidfi\Æ%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 27 GKJ;Xe[DfiXc@ealip%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% )/ K_\Fi`^èXe[I`j\f]GKJ;%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% )/ C`d`kXk`fejf]GKJ;Le[\ijkXe[è^j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 30 DfiXc@ealip1Gifd`j\jXe[C`d`kXk`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 32 Toward a Broader Theoretical Approach to Moral Distress%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 35 @jjl\(1K_\:fdgc\oEXkli\f]DfiXc9\c`\]j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 35 Issue 2: Political and Societal Dimensions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% */ ŚĂƉƚĞƌϯ͘DĞƚŚŽĚŽůŽŐŝĐĂůŚŽŝĐĞƐĂŶĚŽŶƐŝĚĞƌĂƟŽŶƐ ... 43 Epistemological Underpinnings%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 43 I\j\XiZ_JkiXk\^p%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 44 :Xj\J\c\Zk`fe1;lkZ_YXkXe[K=L%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 45 JXdgcè^Xe[;XkX:fcc\Zk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 47 Sample Selection %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 47

;XkX:fcc\Zk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 47

<o`jk`e^@e]fidXk`fe`eC`k\iXkli\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% +/ Interviews%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% +/

J\c]$:fe[lZk\[@ek\im`\nj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% +/

@ek\im`\nj:fe[lZk\[Ypk_\E\k_\icXe[jM\k\iXej@ejk`klk\%%%%%%%%%%%%%%%%%%%%%%%%%%% 50 Participant Observation and Other Sources%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 51 The Research Participants%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 51

;XkX8eXcpj`j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 52 :i\[`Y`c`kpXe[>\e\iXc`qXY`c`kp%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 54 I\j\XiZ_\iIfc\Xe[@jjl\jf]@ek\igi\kXk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 54

<k_`ZXc:fej`[\iXk`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 56

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Contents

WĂƌƚdǁŽ͘^ŽůĚŝĞƌƐŝŶŽŶŇŝĐƚ ... 57

ŚĂƉƚĞƌϰ͘dŚĞDŝƐƐŝŽŶƐ ... 61

;lkZ_YXk#LEGIF=FI%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 61 KXjb=fiZ\Lilq^Xe#@J8=%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 64

ŚĂƉƚĞƌϱ͚͘dŚĂƚ͛ƐũƵƐƚƚŚĞǁĂǇŝƚŝƐ͛͗hŶĐŽŵƉůŝĐĂƚĞĚ^ŽůĚŝĞƌŝŶŐ ... 69 Introduction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 69 K_\D`c`kXipGif]\jj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 70 :_Xcc\e^\j[li`e^;\gcfpd\ek%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 72

K_\Afpjf]D`c`kXipGiXZk`Z\1EfAljk`ÏZXk`feE\\[\[6%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 72

Aljk`ÏZXk`fejXe[IXk`feXc`qXk`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 74

;f`e^>ff[%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 74 Rules and Instructions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 75

I\Z`gifZ`kp%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 76 Distancing and Numbing%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 77 K_\D`c`kXipGif]\jj`fe`eI\cXk`fekf:`m`cC`]\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ./

Maneuvering Through Tensions%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /'

:feZclj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /)

ŚĂƉƚĞƌϲ͘DŽƌĂůŝƐŽƌŝĞŶƚĂƟŽŶĂŶĚƚŚŝĐĂů^ƚƌƵŐŐůĞƐ͗

DŽƌĂůŝƐƚƌĞƐƐĂƚƚŚĞ/ŶĚŝǀŝĚƵĂů>ĞǀĞů ... 85 Introduction %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /, KnfJkfi`\jf]DfiXc;`jki\jj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /-

9fYÆjJkfip1Ji\Yi\e`ZX%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /.

E`\cjÆJkfip1Lilq^Xe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 91 DfiXccp;`jki\jj`e^<og\i`\eZ\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 94

MXcl\:feÐ`Zk%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 94 Moral Overwhelmedness/Detachment%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 95 Senselessness%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 96 DfiXc=X`cli\Xe[DfiXc;`jfi`\ekXk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 0/

Ethical Struggle%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 101 :feZclj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 103

ŚĂƉƚĞƌϳ͘WŽůŝƟĐĂůĞƚƌĂǇĂůĂŶĚZĞƉĂƌĂƟŽŶƐ͗

DŽƌĂůŝƐƚƌĞƐƐŝŶZĞůĂƟŽŶƚŽWŽůŝƟĐĂůWƌĂĐƟĐĞƐ... 107 Introduction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 107 Jfd\>\e\iXc:_XiXZk\i`jk`Zjf]k_\D`jj`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ('/

;lkZ_YXkXe[K=L%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 111

;lkZ_YXk#LEGIF=FI1Fek_\>ifle[%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 111

ÅGi\k\e[gcXpÆ1Gfn\ic\jje\jjXe[J\ej\c\jje\jj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 112

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Contents

ÅC\ɘkffli]Xk\jÆ18YXe[fe`e^Xe[9\`e^8YXe[fe\[%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 113

Å8be`]\èk_\YXZbÆ1=\\cè^JlZb\i\[èk_\D`jj`feÆj8ɘ\idXk_%%%%%%%%%%%%%%%%%%%% 115

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;\dXe[`e^Kilk_Xe[:fdg\ejXk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 116

;lkZ_YXk#LEGIF=FI1Gfc`k`ZXcGiXZk`Z\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 117

K_\D`jj`fe1:feÐ`ZkjXe[:fdgifd`j\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ((/

K_\8ɘ\idXk_1Fɕ\i`e^:cfjli\fi:cfj`e^Fɕ6%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 120

K=L#@J8=1Fek_\>ifle[%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 122

EfG\id`jj`fekf=`i\#ÅAljkdXb\jli\k_\ÐX^`jgcXek\[Æ%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 122

Å@jk_`jnèeè^_\XikjXe[dè[j6Æ%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 124

ÅK_\Y`^^\ig`Zkli\Æ1;\e`Xcf]Fe\Æj<og\i`\eZ\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 126

8;\j`i\kfY\KXb\eJ\i`fljcp%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 127

K=L#@J8=1Gfc`k`ZXcGiXZk`Z\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ()/

K_\D`jj`fe1:feÐ`ZkjXe[:fdgifd`j\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% ()/

K_\8ɘ\idXk_1J\\è^k_\9`^^\iG`Zkli\fi:cfjè^fe\Æj<p\j6%%%%%%%%%%%%%%%%%%%%%% 131 GXiXcc\cjY\kn\\e;lkZ_YXkXe[K=L1G\iZ\`m\[Gfc`k`ZXc9\kiXpXc#J\\bèÎ\gXiXk`fe 132 Unresolved Issues%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 132

Gfc`k`ZXc9\kiXpXcXe[I\gXiXk`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 134

ÅGKJ;ÆXe[ÅDfiXc@ealipÆXj;flYc\$<[^\[Jnfi[j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 136 :feZclj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 137

ŚĂƉƚĞƌϴ͘^ŽĐŝĞƚĂůDŝƐƌĞĐŽŐŶŝƟŽŶĂŶĚ;^ĞůĨͲͿƐƚƌĂŶŐĞŵĞŶƚ͗

DŽƌĂůŝƐƚƌĞƐƐŝŶZĞůĂƟŽŶƚŽWƵďůŝĐWĞƌĐĞƉƟŽŶƐ ... 141 Introduction%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 141

;lkZ_EXk`feXc8ɝ`kl[\jkfnXi[k_\D`c`kXip%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 142 GlYc`ZG\iZ\gk`fejXe[DfiXccp;`jki\jj`e^<og\i`\eZ\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 143

;lkZ_YXk#LEGIF=FI1K_\=Xccf]Ji\Yi\e`ZX%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 144

;lkZ_YXk#LEGIF=FI1M\k\iXejÆ<og\i`\eZ\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 146

=iljkiXk`feXe[8e^\i%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 146 Silence%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (+/

Disorientation and Alienation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 149

KiX^\[pm\ijljÅN_f[le`kÆ%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 151

K=L#@J8=1K_\9Xɝc\f]:_fiX%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 153

K=L#@J8=1M\k\iXejÆ<og\i`\eZ\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 155

=iljkiXk`feXe[8e^\i%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 155 Silence%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 157 Disorientation and Alienation%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (,/

Efk&NXek`e^kf?\Xi8YflkM`fc\eZ\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 159 GXiXcc\cjY\kn\\e;lkZ_YXkXe[K=L1JfZ`\kXcD`ji\Zf^e`k`feXe[J\c]$ <jkiXe^\d\ek 161 :feZclj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 163

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Contents

WĂƌƚ///͘ŽŶĐůƵƐŝŽŶƐ͗dŚĞŽƌĞƟĐĂůĂŶĚWƌĂĐƟĐĂů/ŵƉůŝĐĂƟŽŶƐ ... 167

ŚĂƉƚĞƌϵ͘ŽŶĐůƵƐŝŽŶƐ͗dŚĞŽƌĞƟĐĂů/ŵƉůŝĐĂƟŽŶƐ ... 169 DXèI\j\XiZ_=è[è^j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 169 I\Ïeè^k_\:feZ\gkf]DfiXc@ealip%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 172 DfiXc@ealipXjXDXe`]\jkXk`fef]CXk\ekK\ej`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 176 DfiXc@ealipXe[GKJ;%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 177 K_\Jkl[pèXN`[\i:fek\ok%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (./

C`d`kXk`fejXe[=lkli\;`i\Zk`fej%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 179

ŚĂƉƚĞƌϭϬ͘WƌĂĐƟĐĂů/ŵƉůŝĐĂƟŽŶƐ ... 183 The Individual and Interpersonal Level%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/*

>l`ckXe[9cXd\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/*

Addressing Ethical Struggles%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/+

K_\MXcl\f]XDfiXcMfZXYlcXip%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/,

<eZfliX^`e^Yfk_@ekifjg\Zk`feXe[Å<okifjg\Zk`feÆ%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/-

K_\C\m\cf]k_\D`c`kXipFi^Xe`qXk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/.

<eZfliX^\XAljk`]p`e^J\ej\f]Gligfj\6%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/.

Gifdfk\X:Xe$;fD`e[j\k6%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (//

8Zbefnc\[^\DfiXc:fdgc\o`kpXe[GXiX[fo\j%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% (/0

K_\C\m\cf]Gfc`k`ZXcGiXZk`Z\%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 191

K_\<k_`Zjf]I\jgfej`Y`c`kpXe[k_\<k_`Zjf]:fem`Zk`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 191

ÅAljkNXiÆ:i`k\i`XXjX>l`[`e^=iXd\nfib%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 192

9\pfe[X:_\Zbc`jk8ggc`ZXk`fef]<o`jk`e^:i`k\i`X%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 194 The Societal Level%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 196

Jlggfik`e^M\k\iXejXj?\if\jXe[M`Zk`dj6%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 196

Gli`ÏZXk`feXe[I\`ek\^iXk`feI`klXcj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 197 :feZclj`fe%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 200 ZĞĨĞƌĞŶĐĞƐ ... ϮϬϯ

ƉƉĞŶĚŝĐĞƐ ... Ϯϯϭ 8gg\e[ò8%@ek\im`\nKfg`ZC`jk%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 231 8gg\e[ò9%;XkX:f[èÎ\jlckj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 235

^ƵŵŵĂƌǇ... Ϯϯϵ EĞĚĞƌůĂŶĚƐĞƐĂŵĞŶǀĂƫŶŐ... Ϯϰϯ

ĐŬŶŽǁůĞĚŐŵĞŶƚƐ ... Ϯϰϵ

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ŝƐƐĞŵŝŶĂƟŽŶŽĨZĞƐĞĂƌĐŚ&ŝŶĚŝŶŐƐ ... Ϯϱϯ Academic Publications (English) %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 253 Academic Publications (Dutch)%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 253 GlYc`ZXk`fejXe[8gg\XiXeZ\j`eGif]\jj`feXcXe[GfglcXiD\[`X%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 253 J\c\Zk`fef]KXcbj%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 254

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Glossary of Military Terms and Ranks

Missions

The former Yugoslavia

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1992-1995

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gXikf]LEGIF=FI#(00+$(00,%=fliifkXk`fej;lkZ_YXk(kf+ n\i\[\gcfp\[

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]Xccf]Ji\Yi\e`ZX Afghanistan

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2003-2014

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Military Terms

OP Observation Post

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Enlisted ranks

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13

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Maps of Mission Areas

Figure 1: Map of Bosnia and Herzegovina¹ Figure 2: Map of Srebrenica ‘Safe Area’ (area: ~150 km²)

Figure 3: Map of Afghani-

stan² Figure 4: Map of Province of Uruzgan (area: 12.640 km²)

14

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Part One

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1

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Chapter 1. Introduction

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25

Chapter 1 Introduction Part I GYɛ]b[h\YGhU[Y

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2

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27

Chapter 2 Toward a Broader Theoretical Approach to Moral DistressPart I GYɛ]b[h\YGhU[Y

Chapter 2. Toward a Broader Theoretical Approach to Moral Distress

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1 As will be explained in chapter 3, all names are pseudonyms to help ensure the veterans’ anonymity.

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The Origin and Rise of PTSD

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Chapter 2 Toward a Broader Theoretical Approach to Moral DistressPart I GYɛ]b[h\YGhU[Y

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2 The amygdala and hippocampus areas of the brain seem to play a critical role in fear-related change (Difede et al. 2014).

Activation of the hypothalamic-pituitary-adrenal axis leads to arousal and sleeplessness (Daskalakis et al. 2016, Fragkaki et al. 2016). Findings suggest a possible biological susceptibility to developing symptoms considered typical for ‘PTSD’.

For instance, a small hippocampus volume and an inability to produce enough cortisol may increase the probability of developing typical ‘PTSD’ symptoms (Yehuda and LeDoux 2007, Daskalakis et al. 2016).