[Rev. Dr. Gabriella Lettini co-authored this piece. We led the team that organized the Truth Commission on Conscience in War and are members of the leadership team for "The Soul Repair Project."]
By year's end, 40,000 U.S. troops will return from Iraq and, according to President Obama, "America's war in Iraq will be over." But the long nightmare of the Iraq War will not be over for either side of the conflict. The U. S. will see a new surge of suffering, and it will not be over for generations.
The fatalities will not end when the troops come home. Though veterans are only 7% of the population, they are 20% of all U.S. suicides, 6000 a year, an average of 18 a day. Veterans under 30 have record-breaking suicide rates, despite mental health screenings for returning troops, better research on and treatment of PTSD, and increased VA suicide prevention programs. Between 2005 and 2007, the rate among veterans under age 30 rose 26%; in Texas, rates rose 40% between 2006 and 2009.
Recently, VA clinicians proposed another cause for suicide, a wound they call "moral injury," which may aggravate or precipitate PTSD. As Harvard psychiatrist Judith Herman notes in Trauma and Recovery, once someone begins to recover enough from PTSD to construct a coherent memory of their trauma, they can reflect on their experience. Then, the moral and religious questions emerge.
Moral injury is a wound in the soul, an inner conflict based on a moral evaluation of having inflicted or witnessed harm. It results from a capacity for both empathy and self-reflection on moral values, which means it happens to healthy human beings. The current wars are especially morally compromising because the lines between innocent civilians and combatants are so blurred. Even women, children, and pets can be dangerous or be used as shields.
Though an action in war may have saved someone's life or felt right at the time, a veteran may come to feel remorse, shame, or guilt for having had to inflict harm that violates his or her core values. Moral injury can result not only from active behavior, such as torturing or killing, but also from passive behavior, such as failing to prevent harm or witnessing a close friend be slain. And it can involve feeling betrayed by persons in authority. Just having to view and handle human remains can sometimes cause it.
In betraying their most deeply held moral beliefs, veterans often cannot forgive themselves and can no longer make sense of the world. They often abandon their faith. Such moral anguish is not PTSD, not a temporary medical or psychiatric disorder to be "treated," but a lifelong spiritual and moral struggle to live honestly, courageously, and compassionately with memories of war. It can take a long time to reconstruct a world of meaning in which it is possible to see how one's life matters to others.
The term moral injury names a deep and old dilemma of war. It may be a new clinical concept, but the moral anguish of warriors defines much literature about war from ancient times, such as the Greek Iliad, Indian Bhagavad-Gita, and the Hebrew prophets in the Bible, to the present, in memoirs of the wars in Afghanistan and Iraq. However, secular clinical approaches to such feelings usually treat them as neuroses that inhibit individual self-actualization and interfere with authentic urges and feelings. Veterans are, therefore, often misunderstood and struggle with moral conscience, loss of meaning, and spiritual despair in isolation.
In Packing Inferno: the Unmaking of a Marine, Tyler E. Boudreau, a former Marine Captain and veteran of Iraq, reflects on the apparent inability of societies to learn about the torture war inflicts on the souls of veterans, despite the many witnesses in works of art and history. He concludes that societies have understood it only as much as they really wanted to learn about it and its deeper meaning. For instance, after World War I, the prescribed process of reintegration silenced and pathologized the moral suffering of veterans, treating "shell shock" as an individual inability to put war behind.
Not everyone was so unable or unwilling to understand, Tyler observes. In Mrs. Dalloway, Virginia Woolf portrayed the suicidal anguish of Septimus Smith as if she were a veteran herself. Tyler notes:
She was just a writer. That tells me, if nothing else, that the information was there. The capacity to know existed. It wasn't beyond human understanding. They weren't too primitive. If Virginia Woolf knew about combat stress, everybody else could have known, too. They did not know because they didn't want to know.
Still, not even Tyler could face telling the truth about war. After he left the Corps, he worked as a Casualty Assistance Calls Officer (CACO), which required him to call the parents of wounded Marines. He could not bring himself to call soldiers' families and report honestly that, among the wounds they suffered, "Your boy is coming home with a broken heart." Never once was he able to say it, and he regrets it still that he did not.
We have to support veterans in telling the truths of war. Though the term moral injury is new among VA clinicians, the concepts underlying it ring true to many spiritual and religious people. We know that the loss of faith and meaning, the sense of isolation, and the self-condemnation characteristic of moral injury cannot be repaired by short-term therapies. While around 90% of the public claim a spiritual affiliation, only around 40% of clinicians claim one. VA psychiatrist Jonathan Shay, who received a MacArthur "genius" award for his work on PTSD, noted in 2002,
Medical-psychological therapies...are not, and should not be, the only therapies available for moral pain. Religious and cultural therapies are not only possible, but may well be superior to what mental health professionals conventionally offer.
Rev. Dr. Kent Drescher, who works with veterans, notes that the more judgmental and punitive a veteran's idea of God and religious authority, the more difficult is the recovery from moral injury. Veterans who grieve the losses of war and seek ways to make amends for the harm they have done need trusted places to have conversations about meaning and ethics with others who understand such issues. They need the company of others who understand the lifelong struggle to be their best selves after they have violated their deepest moral values. Recovery includes the restoration of trust in a power strong enough to carry the weight of all inner anguish and honest prayers, and, for many, it comes through trusting in a benevolent spiritual power who is deeply moved by injustice, violence, and human suffering.
Religious professionals are familiar with the personal transformations that occur in worship and community practices when they are repeated over time. Such activities embed the moral values of the community in the whole person and support their being lived out. More veterans seek counsel from clergy than from clinicians, and the clergy they need are those willing to offer a benevolent and caring presence. In addition to veterans who seek out clergy themselves, those in clinical treatment who ask moral questions and express grief, contrition, and shame are usually referred to chaplains because the formal training of mental health professionals does not include theology, discussions of faith, or philosophical questions about evil.
Veterans who do not identify as either spiritual or religious also need communities where they can explore their moral struggles and address their moral injury. More such spaces need to be created, and more civilians need to be trained in understanding the moral injury of war. Whether support for moral injury in veterans occurs in religious or secular spaces, we civilians must understand that we are not only to serve as witnesses of veterans' struggles, but we must also engage in our own ethical questioning in relation to war.
Moral injury is not only about "them;" it is also about "us." In his powerful testimony at the Truth Commission on Conscience in War, Tyler Boudreau challenged the members of the audience to remember that they will never be able to speak the truth about war until they can speak the truth about themselves. Moral injury is an issue for civilians, not just veterans. Regardless of our personal positions on a war, a society that engaged in warfare must come to terms with its responsibilities for its effects and with its own moral injury.
The hidden wounds of war do not heal when left unattended; instead, they may fester for years in depression, homelessness, addiction, and a half-lived existence finished by suicide, which doesn't end the suffering for those who knew and loved the one who died. Unattended, moral injury will linger for generations. Understanding moral injury is a necessary first step in a much longer societal healing process. We should begin that process today.
Thomas David DuBois: Who speaks for religion?
MILITARY: 'Moral injury' as a wound of war
Moral injury and moral repair in war veterans: a preliminary model ...
Beyond PTSD: Soldiers Have Injured Souls | Truthout
Combat stress as 'moral injury' offends Marines - Stripes Central ...
Genuine Justice: The Meaning of Moral Injury
PTSD Symposium 2011- Moral Injury- Mejia -Veterans for Peace ...
what needs to be cured or healed is the underlying reality of this on going problem.
a nation that has become imperialists in the name of peace but the reality is these on going wars are for corp profits and mega CEO profits and to keep a mega size military in place.
Ike and others have warned us about our industrial military complex and our future as a nation but we paid them no mind.
after all we are americans and we are proud to be a super power and police the world. and get some of that oil from third world nations of course. :-)
""Rev. Dr. Kent Drescher, who works with veterans, notes that the more judgmental and punitive a veteran's idea of God and religious authority, the more difficult is the recovery from moral injury. ""
PTSD itself is pretty historically ill-understood, actually... trying to claim the spiritual damage is *caused* by 'moral failure' or contradictions is missing the root causes, though:
PTSD is what happens when our fight-flight-freeze response is bound up in a way, trauma is a physical response to various situations that often gets bound up in our systems by our very capacity (for good or ill) to try and push through them. When a situation is inescapable or ongoing or otherwise *helpless* it's possible for the mind (and the rest of the nervous system) to never really deal with it, whether by necessity or any other conflict.
Cognitively, this can be experienced in the ways very familiar to PTSD sufferers, whether that comes from war or whatever. Psychology and such tend to come into play *afterwards* ...perpetuating what seems to be psychological or 'moral' in nature for to begin with, ...that often being part of the problem.
I humbly and respectfully submit the personal perspective that the Bible appears to offer the most comprehensive set of explanations for the human experience. The Bible appears to suggest that the human individual’s well-being is ultimately the purview of God and that God is the source of individual well-being.
Consequently, an apparently reasonable theory appears to be that the PTSD sufferer most needs to pour out to an omnipotent, omniscient, omnibenevolent God the poison of the toxic perception. The Bible appears to suggest that it is God’s responsibility to then repair and heal the individual.
Perhaps, the best assistance that the community can offer the PTSD sufferer is the space and resources to repair and heal, allowing God to move the individual, at the individual’s optimal pace and fashion, through the repair, healing, and strengthening phases to full productivity.
I welcome your thoughts.
You don't heal people from a 'holy war' by asking them to internalize that. Spiritual healing is really about being here. And whatever your religion, being 'right with your Gods' isn't about more helplessness in the face of words and thoughts and memories and contradictions...
Actually, most important is for the sufferer to have a 'home' to *come* to: in part that very acceptance and healing you're saying comes from your Bible, but, no, not in this case, not like that. (However holy the books, PTSD isn't something you can 'think' your way out of. Nor necessarily just transfer into some 'religious experience' and expect all to be OK. (You can have a lotta faith and still have raging PTSD, Sometimes they even go together in a sort of Stockholm syndrome if you're using just more of the same 'moral conflict' to begin with. )
Sometimes it'll help just to sort of toss the spiritual salad up in the air: sometimes it'll make it worse. As a shamanic type person, look a little deeper and more basic to the human experience of it. *Then* maybe put it in the religious language that the subject might live in.
The LintLass comment to which this is intended to reply appears to suggest “You're hitting on in your below post how theological contradictions can exacerbate PTSDâ€. I would be grateful for clarification thereof.
The LintLass comment appears to suggest that a HuffPostThinker comment includes the premise that “it's the root cause of all PTSD to not obey the dogmasâ€. I humbly and respectfully offer the clarification that the Bible appears to be reasonably interpreted as suggesting that PTSD and all other adversity appears to be the direct result of rejection of intimate relationship with and leadership by God. In this case, such rejection is not suggested to necessarily be on the part of the PTSD sufferer, but on the part of those who willfully, and perhaps even unwillingly or unknowingly, contributed to the circumstance that caused the PTSD.
(a) the PTSD sufferer’s “repair†is the purview of God,
(b) that God is the ultimate source of any such repair, whether or not acknowledge by the PTSD sufferer or by anyone else, and that
(c) achievement of the PTSD sufferer’s “maximum repair†would be accomplished the maximization of the PTSD sufferer’s intimate relationship with and leadership by God.
I welcome your thoughts.
I humbly and respectfully submit, as a believer in God, the following non-authoritative perspective.
An apparently reasonable theory appears to be that the apparently unfathomable horrors of post-traumatic stress disorder (“PTSDâ€) appear to be describable as the effect of witnessing that which ought not be. Perhaps, in the innermost cognition, the mind both appropriately accepts a perception as real and appropriately rejects said perception on the basis that said perception ought not be real.
An apparent major difference appears to exist between this experience and that of perceiving and fearing the purely imagined that might be demonstrable as not being real. Apparently, in the same arena of innermost cognition, there appears to exist the recognition that dispelling said perception as not real is to deny that which is real. Apparently, an inner battle begins, apparently between incapacity to accept said perception and incapacity to reject it.
An apparently reasonable theory appears to be suggest that the PTSD sufferer needs most to (a) reduce the toxicity of said perception to a level at which said perspective is not debilitating, and to (b) then allow the memory to pass into the past.
You're onto some things, but still seeming to want to try and apply the religion before the 'patient,' so to speak.
The experiences of PTSD sufferers are not *imagined,* ...they're real.... To their bodies and nervous systems. Those bodies and nervous systems and limbic brains are still in part in fight-flight-freeze-fawn mode. The cognitive symptoms like flashbacks and such are the more 'conscious' parts of the mind still feeling those responses and attempting to *orient* to those sensations, basically. The perceptions themselves really aren't the problem.
What triggers them is. (They can become patterns, like when the PTSD symptoms just keep coming, there can be habits and patterns of mind that basically say, 'This loud noise means people screaming,= that's why body acts with fear or anger or helplessness, try to resolve this by experiencing something similar to the original trauma.' ) But saying that the flashbacks or anything else are 'false perceptions at the root of the problem' is actually kind of backwards.
If you stop the mind from having *that* flashback to orient to/explain the stress, it'll just find another, like causing a physical ailment or yet another flashback.
I humbly and respectfully submit that the following clarification might be valuable. HuffPostThinker 10/27/2011 11:00am’s use of the word “imagined†is not intended to suggest that the PTSD sufferer’s experience is imagined, although, the flashbacks, appear to be reasonably describable as such. The intention appears to have been to draw the distinction between (a) the cause of trauma experienced by an anxiety attack sufferer, for example, whose anxiety is not associated with a present threat existing external to the sufferer’s perception and the trauma experienced by a PTSD sufferer whose experience is considered to be related to actual occurrence external to the sufferer’s perception. The apparently intended distinction appears to be that an anxiety attack sufferer appears to be reasonably suggested to generally be capable of verifying that there is no existing circumstance beyond the sufferer’s perceived expectation. For the sufferer of PTSD that is considered to have been caused by a violent, war-related event, even that level of dismissal of the cause of perception is not available.
However, I do not claim authoritative knowledge regarding whether any anxiety attack perceptions are considered to not require an actual triggering initial event set.
The LintLass comment appears to suggest that the PTSD-causing perception also triggered a fight/flight/shock reflex that appears to either (a) not be abating at a normal rate, or (b) be involved in a sympathetic retriggering between the flashback perceptions and the reflex. I would be grateful for correction or clarification regarding this apparently reasonable interpretation.
The LintLass comment appears to suggest that the preceding HuffPostThinker comment suggests that false perceptions are at the root of PTSD sufferering. If that is the LintLass comment’s intent, there appears to be a possible misunderstanding regarding the intent of the HuffPostThinker comment. I would be grateful for clarification regarding the HuffPostThinker comment that sourced the apparent LintLass perception. Perhaps clarification of the quoted HuffPostThinker comment might be suppliable.
I welcome your thoughts.
I still use some of the leisure activities used 40yrs ago, in Vietnam: its who I am.
http://www.davidlynchfoundation.org/military.html
http://www.tm.org/blog/research/matching-grant/
http://www.tm.org/blog/research/mental-health/
clergy are there to be comforting but only TM has been shown to releif and heal traumatic sress