That price could be called moral injury.
The term may have come from Jonathan Shay, though he demurs. Whatever its origin, it wasn't until the end of 2009 that it began to resonate in therapeutic communities. That was when Brett Litz, the Associate Director of the National Center for PTSD in Boston, and several colleagues involved in a pilot study for the Marines published "Moral injury and moral repair in war veterans," a paper aimed at other clinicians. Their stated aim was not to create a new diagnostic category, nor to pathologize moral discomfort, but to encourage discussion and research into the lingering effects on soldiers of their moral transgressions in war.
The authors found that emotional distress was caused less by fear of personal harm than by the dissonance between what soldiers had done or seen and what they had previously held to be right. This echoes Grossman, who concludes that the greatest cause of psychological injury to soldiers is the realization that there are people out there who really want to hurt you.
Moral injury seems to be widespread, but the concept is something of an orphan. If it's an injury, then it needs treatment, which puts it in the realm of medicine, but its overtones of sin and redemption also place it in the realm of the spiritual and so, religion. Chaplains, however, are no better trained to deal with it than clinicians, since their essential job is to patch up soldiers, albeit spiritually, to fight another day.
Yet the idea that many soldiers suffer from a kind of heartsickness is gaining traction. The military began to consider moral injury as a war wound and possible forerunner of PTSD when Litz presented his research at the Navy's Combat Operational Stress Control conference in 2010. The American Psychiatric Association is also thinking about adding guilt and shame to its diagnostic criteria for PTSD. A small preliminary survey of chaplains, mental health clinicians, and researchers found unanimous support for including some version of moral injury in the description of the consequences of war, though they weren't all enamored of the term. As if to mark the start of a new era in considering the true costs of war, a new institution, the Soul Repair Center has just been launched at Brite Divinity School in Fort Worth, Texas, with a $650,000 grant from the Lilly Foundation to conduct research and education about moral injury in combat veterans.
Of course, to have a moral injury, you have to have a moral code, and to have a moral code, you have to believe, on some level, that the world is a place where justice will ultimately prevail. Faith in a rightly ordered world must be hard for anyone who has been through war; it's particularly elusive for soldiers mired in a war that makes little sense to them, one they've come, actively or passively, to resent and oppose.
When your job requires you to pull sleeping families from their beds at midnight thousands of miles from your home, or to shoot at oncoming cars without knowing who's driving them, or to refuse medical care to decrepit old men, you begin to question what doing your job means. When the reasons keep shifting for what you're supposed to be doing in a country where most of the population wants you to go home even more than you want to, it's hard to maintain any sense of innocence. When someone going about his daily life is regularly mistaken for someone who means to kill you -- as has repetitively been the case in our occupations of both Iraq and Afghanistan -- everyone becomes the enemy. And when you try -- and fail -- to do the right thing in a chaotic and threatening situation, which nothing could have trained you for, the enemy can move inside you and stay there for a very long time.
In trying to heal from a moral injury, people struggle to restore a sense of themselves as decent human beings, but the stumbling block for many veterans of recent U.S. wars is that their judgment about the immorality of their actions may well be correct. Obviously, suffering which can be avoided should be, but it's not clear what's gained by robbing soldiers of a moral compass, save a salve to civilian conscience. And despite all the gauzy glory we swath soldiers in when we wave them off to battle, nations need their veterans to remember how horrible war is, if only to remind us not to launch them as heedlessly as the U.S. has done over these last years.
When you've done irreparable harm, feeling bad about your acts -- haunted, sorrowful, distraught, diminished, unhinged by them -- is human. Taking responsibility for them, however, is a step toward maturity. Maybe that's the way the Army makes a man of you, after all.
Two final observations from veterans who went to war, then committed themselves to waging peace, apparently a much harder task: Dave Cline began his lifetime of antiwar work as a G.I. in the Vietnam War. A few years into the Iraq War, when he was president of Veterans For Peace, he told me, "Returning soldiers always try to make it not a waste." The second observation comes from Drew Cameron in a preface to a book of poems by a fellow veteran, published by his Combat Paper Press: "To know war, to understand conflict, to respond to it is not an individual act, nor one of courage. It is rather a very fair and necessary thing."
Recognizing moral injury isn't a panacea, but it opens up multiple possibilities. It offers veterans a way to understand themselves, not as mad or bad, but as justifiably sad, and it allows the rest of us a way to avoid reducing their wartime experiences to a sickness or a smiley face. Most important, moral repair is linked to moral restitution. In an effort to waste neither their past nor their future, many veterans work to help heal their fellow veterans or the civilians in the countries they once occupied. Others work for peace so the next generations of soldiers won't have to know the heartache of moral injury.
Nan Levinson, a Boston-based journalist, reports on civil liberties, politics, and culture. Her next book, War Is Not a Game , is about the recent G.I. antiwar movement. She is the author of Outspoken: Free Speech Stories, was the U.S. correspondent for Index on Censorship, and teaches journalism and fiction writing at Tufts University.
Follow TomDispatch on Twitter @TomDispatch, join us on Facebook, and check out the latest TD book, Terminator Planet: The First History of Drone Warfare, 2001-2050.
Copyright 2012 Nan Levinson
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
