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Introduction
Moral Injury Then and Now
That we live today in an age of endless war is a mantra intoned so often as to keep an easily distracted nation ever-mindful that it needs to be vigilant, even preemptive, and above all aggressively armed. War has become our natural posture, our national default position, and we are more or less comfortable with it and its consequences. After all, our lives go on as we feel they should without grave risk or injury, provided we belong to the 99 percent who never see the face of war up front. That honor, as we like to think of it, belongs to our men and women in arms, our heroes, whom we thank for their service and for whom we tie yellow ribbons and all too often lower our flags halfway.
It is a more careless than truly grateful nation, however, that watches and applauds its sons and daughters as they go off to war and return, and yet fails to notice or care for long that they come back different and often desperate. The fact that the majority of their wounds are invisible is no excuse. What we cannot see we can still come to know through listening.
Fortunately, not all combat veterans return from war with wounds to their bodies or to their souls. But many do, too many. Those who come back without limbs or eyes, those who will never work or even walk again, often or maybe even most of the time receive the care they deserve; but those who come back without a scarāsilent, hollowed out, shadowed, and overlooked until they take their agony out on themselves or othersārarely find recognition, much less healing. Yet what would healing mean for them? For the most part, we as a nation havenāt a clue, and there are reasons for that. One of the central tasks of this book will be to examine the reasons why the moral torment of so many veterans mostly falls on deaf ears.
It may be that the question simply makes no sense to those who have thought little and experienced even less of war. How, for example, can those who have served their country, risked death and injury, observed the rules of war, and followed ordersāin what the president of the United States, Barack Obama, in his 2009 Nobel Peace Prize acceptance speech labeled a morally justified use of violenceābe in need of spiritual healing or ārepentanceā? Repentance for what? The clergy, and their congregations with them, regardless of faith or denomination, rarely perceive the possibility of sin in national service. Most of them long ago accepted one or other version of the traditional just war theory, regularly revised and recalibrated across the centuries to certify the moral legitimacy of lethal violence, provided certain conditions are met. Meeting those conditions is, most everyone assumes, the responsibility of the White House and the Pentagon, not that of individual citizens who need to take their government at its word. In general, pastors on the home front, like chaplains in the combat zone, support the troops, as they should, as well as everything the troops are commanded to do, which they arguably should not. The truth is that a great many combat veterans, having followed all the rules, are haunted more by what they have done than by what they have endured in war. Those who work with veterans to help heal their inner, invisible wounds know that the deepest and most intractable PTSD (post-traumatic stress disorder) has its roots in what veterans perceive as the evil they have done and been a part of. They all too often see themselves as criminals, not because they have committed war crimes but because they have become convinced by their own experience of the essential criminality of war. Needless to say this is a conviction that neither the military nor the government is prepared to hear and take seriously.
To whom, then, if not to the clergy, can the morally injured, spiritually desolate veteran turn? The ranks of secular caregivers attending to those suffering from invisible wounds are filled by therapists and counselors with one or other cluster of qualifying letters after their namesāpsychiatrists, clinical psychologists, and social workers and psychiatric mental health nurses. Armed with the latest edition of the DSM, The Diagnostic and Statistical Manual of Mental Disorders, and informed by the vast clinical literature addressing battle trauma, what they see in and hear from their patients more often than not looks like and sounds like classic, standard, well-documented PTSD (post-traumatic stress disorder) or TBI (traumatic brain injury), and they proceed accordingly in weighing their treatment options. Some of these caregivers, however, especially those who have listened longer and more openly to their patients, have begun to question whether they truly grasp the source and extent or even the nature of their patientsā suffering. When combat veterans speak to them of the impenetrable darkness in which they now live out their days, much less their nights, or try to convey the shame and guilt that consumes them, psychiatrists may well and often do question whether the most appropriate solution is to whip out their Rx pads. When veterans, even those not previously or particularly religious, report that their souls are dead or that they have lost their humanity and want it back, many MDs and PhDs on the frontlines of veteran care rightly wonder why they are the ones to be hearing this. But if not they, then who? With no ready answer to this question at hand, they do their best, often generously overstepping their professional training and/or personal beliefs and disbeliefs to acknowledge the obvious suffering of others and to just be there to listen.
The inner damage and pain that even the most qualified and concerned caregivers hesitate to address is what many today diagnose as āmoral injury.ā Moral injury is not a new concept, much less a new reality, as will become painfully clear in the course of this book. All that is relatively recent is the term āmoral injury,ā freshly minted in the minds of psychiatrists, therapists, and counselors. Today we find it in wide circulation among veterans and their professional caregivers, as well as in psychiatric journals, government reports, church pulpits, and the national media. More to our present purpose, it facilitates an inquiry and discussion such as this one, providing a common point of entry into a place that is both dark and painful, a place where many veterans find themselves suffering in confusion and despair, a place where nearly everyone else is reluctant to go. āMoral injuryā has most commonly come to mean the transgression, the violation, of what is right, what one has long held to be sacredāa core belief or moral codeāand thus wounding or, in the extreme, mortally wounding the psyche, soul, or oneās humanity. As with so many concepts for which definitions fall short, moral injury is most clearly seen and understood in stories.
The story to which we first turn to illustrate and understand moral injury is but one of countless tragic stories of war and return, past and present. It is also a possibly familiar story made public in a number of media accounts and notably featured in a recent (2011) documentary titled Wartorn 1861ā2010. It is the heartbreaking story of Noah Pierce who, with his motherās reluctant consent, enlisted in the U.S. Army at the age of seventeen and less than two years later found himself in the vanguard of the March 2003 Iraq invasion. Four years later he sat alone in his pickup truck in Gilbert, Minnesota, put a gun to his head, and ended the life that had for him become unendurable. Scribbled on the back of an NRA pistol-safety certificate were these words to his mother:
In the words of a close family friend, Noah was ātoo sensitiveā and ātoo caringā to go to war and ever come back whole. Those words proved prophetic. He came back different, darkened, broken, haunted. In his letters home, Noah had described many of the ābad thingsā that he had witnessed and done in Iraq, as fear turned to anger and anger turned to hatred. He took some lives by accident, like the child he crushed under his Bradley Fighting Vehicle, but others he took deliberately, like the unarmed man he shot in the forehead at point-blank range or the last person he killed, a doctor, at a checkpoint. āHe couldnāt forgive himself for some of the things he did,ā explains his mother:
Noah Pierce was not a war criminal, only a warrior who served his country as well as he knew how. After two deployments in Iraq he was given an honorable discharge from the army and returned home to a grateful nation. In the eyes of those who knew little or nothing of what he knew, he was a hero, an accolade he wanted no part of. āSo tell me,ā he wrote to his mother while still in Iraq, āhow we are heroes.ā Until he shot himself, Noah Pierce bore no physical wound, no sign of injury. His kind of wound, his mother explains, ākills you from the inside out.ā His kind of wound is what we mean by moral injury, and although this book will not pretend to probe the psychological layers of moral injury, much less prescribe therapies for its healing, it will reveal its roots. And to do that we must trace the Western history of moral injury in war back to its recorded beginnings in ancient Greece and follow its path through the Christian centuries to modern Europe and contemporary America.
The tragedy of Noah Pierce finds an early precursor in a war drama written and enacted twenty-five centuries ago about a war that was already at the time ancient history. I have in mind a seldom read and still more seldom staged play entitled Philoctetes that the classical Greek playwright Sophocles wrote in his old age, at eighty-seven to be exact, after a long life not only in the theater of Dionysus but also in the theater of war. He had so far survived several wars on Greek soil and served in at least two of them, twice elected to the rank of strategos or āgeneral.ā This is to say that in depicting war and its wounds Sophocles knew well what he was talking about. More specifically, he could not have been a stranger to moral injury; for he knew firsthand the intimate face-to-face savagery of ancient warfare, especially the protracted Greek-on-Greek civil warfare of the Peloponnesian War, notorious for its indiscriminate brutality and civilian carnage.
As Sophocles composed and staged Philoctetes, the Peloponnesian War was in its twenty-second year. Although he set the action of the play in the hoary past of the Trojan War, Sophocles wrote to the current war that Athenians knew all too well. It was conventional and convenient for tragic playwrights to don the masks of myth and legend when confronting their contemporaries with inconvenient truths. The past was, or seemed, safe, even entertaining, until like a mirror it reflected its audience. Stories worth telling are like that. They take us up and away into another reality before bringing us back to ourselves, eyes wide open. They promise escape, and give us truth instead. āThe truth,ā wrote the Greek philosopher Heracl...