A breakout group talk given at the Delaware Mental Health Summit
The Dover Downs Hotel and Casino, Dover
On September 11, 2018
By Rev. Thomas C. Davis
Senior Advisor at Coastal Group 34
Republic of Vietnam, 1970
Moral Injury and PTSD Are Different, and Often Co-Present
My wife and I have family in London. We cross the pond for a visit there once a year. The Science Museum is a favorite free spot to spend half a day. On our last visit there was a special exhibit about the wounds of war. A banner at its entrance showed soldiers in World War I uniforms carrying a wounded companion on a stretcher. Since I’d been following Google alerts about veteran suicide for several years, I wanted to see whether this exhibit contained anything on the psychological wounds of war.
I was not disappointed. Near the end of the viewers’ walkway were a number of postings about “shell shock,” which therapists now call “post traumatic stress disorder.” Only at the very end of the exhibit, though, did I find any mention of moral injury. For the present, let me posit a working definition of that term. Moral injury is a deep wound to one’s conscience, deriving from the remembrance of something one did or failed to do in the line of duty, which violated one or more of one’s most deeply held values, like the sanctity of human life.
There is no clear evidence that soldiers in the first world war suffered that kind of psychological wound. Why not? Well, I can only speculate. Remember what the British author, H.G. Wells wrote? “This is the war to end all wars.” How could any soldier possibly entertain the thought that he was in any way morally culpable for participating in a global struggle of such consequence? No, it seems to me that patriotism trumped any intimations of personal wrongdoing. If a soldier did feel moral regret, it was for lacking fortitude and abandoning a righteous cause. The exhibit explained that most British citizens attributed shell shock to a lack of courage. Battle fatigue, and the witnessing of horrors, they believed, had simply eroded the will to persevere. World War I poets are renown for their anti-war passions, but I don’t find evidence of moral injury in any of their writings. A few became conscientious objectors while still shooting to survive, but each one’s complaint with a pen was not that of a self-incriminating soul, but rather, the enlightened and righteously indignant indignant one of a warrior-prophet.
What Moral Injury Looks Like
At the very end of that exhibit in London there were some postings and a video about moral injury but these were an historical addendum, because they pertained not to World War I, but to recent wars in Iraq and Afghanistan in which British soldiers have fought. Moral injury among British troops in those war zones resembles what American troops have experienced. Here are a few examples: 1) A soldier and his buddies, pinned down in a firefight, are being attacked by a boy with an automatic rifle. It hurts to kill a boy, but this one had to be shot to protect the squad. It was the right thing to do, but it still hurts. 2) At a checkpoint two soldiers see a car approaching their security barrier. They motion it to stop, but it keeps coming. Suspicious that it’s carrying explosives, the two rake the windshield with automatic fire. The car crashes. Inside they find a mother and father and their three children, all dead. It had to be done. In one sense it was the right thing to do. But the memory still haunts one of them. It returns in nightmares. Now, looking back, it seems to him that he did something terribly wrong. And yet, it had to be done, right? He’s confused, and feels very ashamed, not only because of what happened, but because warriors shouldn’t feel ashamed, should they? Certainly not for doing something in the line of duty! 3) An attack drone pilot gets intelligence which targets a lone insurgent, and gives GPS coordinates for him. The pilot, tens of thousands of miles away, spots the target, and gets confirmation that he is cleared to kill. But there is a young boy with the target, maybe his son? The weather is good and the pilot’s viewing screen is remarkably clear. He launches the rocket and guides it all the way down. He sees it explode upon impact. The boy is still alive. The target has disappeared. After a strike a pilot is supposed to keep observing to make sure of the result. He sees the boy scurrying about, retrieving body parts of the man killed, and dragging them back to the place of impact, arranging them in the shape he remembers. I didn’t make that story up. It was published from an interview published in the New York Times about moral injury in drone warfare.
Most of the examples of events that trigger veterans’ moral injury involve the loss of life, either by aggressive acts such as these, or by failure to save a life. In April of 1975, when North Vietnamese troops seized Saigon, I experienced the latter kind of moral injury, fearing that my counterpart officer in the South Vietnamese navy, Dai Uy Nguyen Tuan, might have been killed or captured, and perhaps his family too.
After returning home in 1971 I had seemed O.K. I had no flashbacks, no nightmares, and only a touch of hyper-vigilance. I was back in school, and doing just fine, I thought. But the war had dragged on, as today’s wars are. Despite the fact that I had been out of harm’s way for several years, a man whom I had come to regard as a brother, as only comrades in arms will understand, was very much in harm’s way, and I was wracked with guilt for having abandoned him. Logically that didn’t make sense. It wasn’t I personally who had abandoned Tuan. My country had. But it was I personally who knew him, so I took the whole responsibility upon myself. Deep emotional attachments don’t always follow the contours of logic. I started to have nightmares, not about battle, but about leaving Tuan behind. I thought I would go crazy with remorse. Reluctant to see a shrink because of the stigma associated with mental illness, I went to see a fellow pastor instead. Presbyterians don’t usually do personal confessions, but I thought that might unburden my conscience. I told David that I couldn’t remember any specific things I felt guilty for. I just felt the deepest sadness and regret for having participated in the whole stinking mess. He spoke a prayer, I don’t remember the words, but he looked me in the eyes and said, “God has forgiven you already, Tom. Go in peace.” An affirmation of pardon by another human being. What a simple remedy for an aching soul! It worked, at least temporarily. My nightmares stopped. I started to right my boat which had been listing badly. I called Camp Pendleton, a military base that was taking in large numbers of Vietnamese refugees. After three weeks of searching intake records they found Tuan. Him and his wife and kids, his mother and two brothers. They had all escaped out of Saigon on a reinforced concrete junk whose engine gave out. They drifted for two days without food or water in the South China Sea, and then were picked up by an American frigate and brought to the U.S. I learned all that later, but in this initial contact I wanted Tuan to know that I hadn’t abandoned him. I offered to sponsor him and bring him to Pittsburgh. “Where Pittsburgh?” he asked. I tried to explain, but he couldn’t picture the map. He was really interested in just one matter. “Snow there?” he asked. “Yes, sometimes,” I cheerily replied. “Thank you, Dai Uy,” he said, “I already get Lutheran sponsor in California.”
LIving With Scars and Shaping a Different Future
Would that all stories about moral injury could end so happily. The fact is that damage from the moral injuries sustained in war don’t go away. Combat veterans will admit that. What one did or failed to do while hunting and being hunted is done and cannot be undone. We cannot change the past. Some of us, to numb the pain, turn to booze or drugs, and then, of course, we just increase our troubles. After I got that good news about Tuan, and even reunited with him and his family briefly in San Jose, I thought the Vietnam blues were behind me. There was nothing but smooth sailing ahead, surely! But I was wrong. I had just scratched the surface of the stinking mess I had confessed about. I had completely buried an incident of deeper moral injury, which surfaced as I was writing a memoir after revisiting the Mekong Delta in 2012. As I look back on my life of 73 years I see that 1970, the year I spent in that now mythic place, changed my life completely and irrevocably. I’m still digesting the outcome, still peeling the onion, still living to atone. We can’t erase the past. We must just learn to live with our scars, and do our best to shape a much different future.
I get good instruction in that from ex-felons. For the last couple years I’ve been sitting weekly in a peer group of citizens returning from Delaware prisons, called New Beginnings-Next Step. I’ve noticed several similarities between the challenges they deal with, and those of returning veterans. Challenges like reconnecting with loved ones after long absences, and trying to find a rightful role in families that have had to get along without them. Challenges like dealing with episodes of anger that seem to come out of nowhere and are completely inappropriate responses to ordinary stressors. Challenges like missing the camaraderie of a former life, and not knowing how to make friends among people who haven’t been there. Challenges like missing excitement. They find this new life pale by comparison. It is so mundane and meaningless, that is, until they find ways to appreciate its advantages over the crazy existence they left behind. Yes, lots of similarities. The returning citizens have taught me chiefly this about moral injury: Don’t dwell on the past. This is bound to send you back to prison. You can’t erase what you did or failed to do, so don’t try. Focus on the way forward. Maybe you’ll never succeed in forging the future you envision for yourself, but you can at least shape it in that direction. Finally, to move forward you must forgive yourself. That will probably prove more difficult than forgiving others. Both must be undertaken, but forgiving yourself is the harder part because you’ll have to let go of some dreams.
Now I want to take this talk about moral injury to a deeper level. I started out with this working definition: Moral injury is a deep wound to one’s conscience, deriving from the remembrance of something one did or failed to do in the line of duty, which violated one or more of one’s most deeply held values, like the sanctity of human life. I’ve been following articles about moral injury on the web for a couple years, and most of the examples of events that trigger moral injury will pose no problem for military recruiters. For instance, one inadvertently shoots a civilian. Or, one fails to save the life of a buddy. Just war theory can deal with such moral wounds by convincing the sufferer that he mustn’t blame himself. The foundational assumption of just war theory is that making war can be kept in morally acceptable bounds. Making war is ugly of course, but sometimes it’s necessary to prevent even more grievous and unjust harms. It was that kind of armchair cogitation that persuaded me to enlist. The problem, I discovered after several months of hunting and being hunted, is that guerrilla war, especially in small units far removed from higher authority, bears little resemblance to armchair cogitation.
There’s Pain in Killing Even Enemies
One day when I went upriver in the skimmer to get supplies from the Army depot I saw a squad of South Korean marines in jungle camies. Each wore a necklace of human ears, trophies of war resembling dried apricots. What makes a soldier do that? Beastly conduct you may say. He’s simply turned into a beast. He has left the human race! Well, that doesn’t answer my query. Name calling simply labels an offense that unnerves us, for the purpose I think, of stopping the inquiry because it’s getting too close for comfort. I want to go deeper. What causes such conduct? Is it fueled simply by adolescent machismo, the will to be the toughest of the tough and to parade that fame? Is it to intimidate the enemy? Maybe a bit of both. But let me suggest that such behavior is a self-protection against moral injury. Let me explain with a paragraph from my memoir:
Imagine that you have killed an enemy soldier. You rifle through his pockets, and find there, bundled in a handkerchief, some rice, a photograph of a young girl, perhaps his sweetheart or his sister, and a carefully folded letter. This begins to remind you of the letter you have folded and carry always in your own pocket. Then you quickly slice off both his ears, to arrest the pull of strange compassion, which will make you –or so you fear–unable to make war efficiently anymore, and unable to make war efficiently anymore, you will surely die. Is it just anger and revenge that makes you cut off ears, or fear of feeling the pain of killing another like yourself? Is wearing ear necklaces, or holding up the severed hand of an enemy corpse and smiling for the camera a twisted means of self-protection?
In his memoir, What It’’s like to Go to War, former Marine, Karl Marlantes, tells how he decided to discipline the men in his platoon who were desecrating corpses, by ordering them to bury the enemy dead. Two of his men, he writes, were crying before the job was finished. Those were the ones, I suggest, who were beginning to experience moral injury. There are many more steps of recovery after that, and they require considerable courage if one is to become a healthy human being. But crying in remorse for what one has done and who one has become, a beastly sort of person, is a first step.
Military training has pretty consistently sought to protect fighters from the moral wound that one may feel not just from inadvertently killing a civilian, but even from killing an enemy. Merlantes was in a raging firefight on a steep hill. In a kind of celebratory rage he and several others charged up the slope and plopped down where they could find the slightest cover. He happened to plop down right below an enemy soldier, and the two of them chanced to rise up at the same instant, looking at each other, not much more than an arm length away. His adversary was a mere boy, and Marlantes had the immediate and stunning feeling that he mustn’t kill him. But the boy raised his rifle to kill Marlantes, and Marlantes, a seasoned veteran, squeezed off his clip faster. The death of that boy haunted Marlantes. Soldiers are not supposed to feel morally culpable for killing an enemy. That may undermine their morale and keep them from being efficient killers; and that’s their job after all, isn’t it?
Not only military trainers, but indeed the whole culture of a military-industrial complex tries to desensitize soldiers to killing. It’s a tough sell, persuading us to resist a natural inborn inclination not to kill members of our own species. Video games condition young people to the thrill of killing enemies, who are portrayed as demonic or sub-human. Drill instructors promote the dehumanization of enemies by labeling them as slopes or gooks or rag-heads or whatever, and by calling any soldier who refuses to fall in line a coward, or worse, a pussy; but gender changes in our military may put a stop to that.
The Myth of Redemptive Violence
The whole selling of war, and it is indeed a lucrative industry for some, rests upon a transcultural myth, the myth of redemptive violence. That’s the notion that evil can be eradicated by wiping out evil doers. Just killing them all. That’s a false idea which video war games instill. It’s also the idea underlying the end-of-time passages in Hebrew and Christian scriptures, which proclaim that God will punish evil doers by cataclysmic violence in the last days. Our present violent culture pays homage to this myth. It isn’t true. Evil isn’t alien. It lies within. That beastly conduct of cutting off ears–anyone is capable of that if worn too thin by the pressures of hunting and being hunted. That’s the scary and sad truth that soldiers with deep inner wounds bear in their hearts, but are afraid to share, because they feel no one “back in the world” would understand. Some feel so out of it in a complacent culture that they come to distrust their own moral instinct, and attribute their moral injury to craziness. I’ve lost my mind, thinks the veteran who has awakened to the craziness of his bellicose culture. No one sees what I see. I must be nuts.
Moral Injury and Veteran Suicide
I hope I’ve helped you realize that moral injury, which some researchers believe is the major engine of veteran suicide, runs much deeper than our military has been willing to concede. Soldiers do indeed feel morally culpable when they inadvertently kill civilians, or when they fail to save the life of a fellow comrade in arms. But soldiers also sometimes experience that strange compassion for enemies, even in the heat of battle, to which I referred earlier. And if our military refuses to acknowledge that making war in itself can cause moral injury, at least to some soldiers, they will not be getting to the root of moral injury, and veteran suicide will likely continue at its present high rate.
Resiliency After Moral Injury
Well, I think I’ve spent enough time on talking about the causes of moral injury. I don’t want to leave you discouraged. Let’s spend some time thinking about what we can do to help veterans with moral injury be more resilient. My therapist colleagues in the new organization, Trauma Matters Delaware, are modest in their claims about treating persons with trauma. They speak not of healing clients, but rather, of helping them be more resilient. In addition to being more modest this term, resiliency, connotes that the client has internal resources which can be brought to bear.
We might start with that well-intentioned greeting, “Thank you for your service.” Lots of people have said that to me. I appreciate their kind intentions, but some veterans would rather not be thanked for what they did. They may regret some things they did in the line of duty. It would be more helpful to say, “Welcome home. What was it like over there?” This opens a door to conversation. The veteran might not want to go through that door with you just yet, but it shows that you’re someone he or she could talk to frankly when the right time comes. Veterans really do want to share their stories, and not just the funny ones. However, they fear being judged and ostracized, especially by their loved ones. That’s why a most important recommendation for folks who care for veterans is this: Listen without judging!
Listen Without Judging
I’ve learned this by sitting with guys coming out of prison and struggling to begin a new life. If I want them to know that I care, I’ve got to listen to them without judging. When caring folk do this it creates a place of safety, where it’s O.K. to be utterly honest, where you won’t be thrown out if you say something offensive. Such a place of safety, a sanctuary if you will, a truly holy place, becomes an incubator for astounding personal growth and community solidarity. New Beginnings-Next Step guys say, “This is my family now.” And what most mean is that it’s the kind of family I never had, but now have found. What a precious gift!
The third recommendation relates to not judging. If a veteran shares a story about an incident that has caused him or her deep shame, just listen, don’t judge whether it’s reasonable to feel that way. For God’s sake don’t try to argue a veteran out of a moral apprehension! I said at the start of my talk that emotions often don’t follow the contours of logic, so don’t try to heal a veteran with moral injury by showing where the holes in his or her reasoning lie. You could be right, actually. But you’ll not likely touch where the hurt lies. And besides you yourself may be blind to a veteran’s moral awakening. Yes, moral injury does hurt like hell, but by trying to persuade a veteran that there was no reasonable moral offense in the first place you may be frustrating the work of sacred spirit which is calling the sufferer to enlightenment. Just shut up and listen, without judging.
We Must Share Moral Responsibility for Making War
My last recommendation is not so easy to execute, because it involves our whole society. It’s long overdue that we share moral responsibility for the wars that our service people are fighting in our name. There was a graffiti on a connex box somewhere in Afghanistan that read, “America is not at war. The Marines are at war. America is at the mall.”
The last time that Americans were at war was in Vietnam, when the draft was still on. Americans did get invested in that war, big time, and they rejected it finally. I suspect that policy wonks opted for an all volunteer military not because we need fewer troops, but because they didn’t want Americans so passionately invested in foreign policy anymore. So now, we have superior fighters, but they’re bearing the burdens alone for what they do overseas. We thank them for fighting for us, but we share almost no responsibility for their moral injury. Is it any wonder that twenty veterans a day take their own lives?
Let’s Create an Interfaith Coming-Home Ritual for Warriors
Well, I doubt that we’ll bring the draft back. That’s a political non-starter. But, a wise coming home ritual could help, I think. Like the Lakota Sioux warriors used to practice. Their villages were always located near a stream. When they returned from battle they were not allowed to go at once into their village. It wasn’t safe for the villagers to have them enter straightaway. They had to stay on the other side of the stream for a spell, remove their war paint, and go through a sweat lodge ceremony to purge from their spirits a warrior’s angry energy. When these steps were completed, each warrior took a knapsack and filled it with fairly heavy rocks. He put the knapsack on his back, mounted his horse, and crossed the stream. On the other side the villagers took those knapsacks from the backs of their warriors, and distributed those heavy rocks, each family carrying one into their own teepee. The moral burdens which their warriors had brought home now belonged to the whole tribe. We need a ritual like that, an interfaith ritual, because our planet is more and more embroiled in inter-religious warfare.
The Mission of Warriors Returned is to Make Peace
I’m sure there must be some veterans here from recent wars. Yes? And maybe you are presently in college, or thinking about enrolling. Well, let me conclude my talk by sharing a letter written by a veteran at Rocky Mountain College in Billings, Montana. His name is Paul Gessler, and he’s a member of Veterans for Peace there. He wrote a letter to his fellow veterans on campus, under the title, “PTSD and Moral Injury Are the Hidden Wounds of Veterans”. He wrote:
Your duty to our nation’s military is over.
Your duty to your nation is entering a new chapter. Seize this opportunity to learn, grow and cultivate the human being you are to its fullest potential.
You are entering a civilian world that is a multi-ethnic cultural environment. This civilian world has been wounded in its soul like many veterans who have preceded you home. This civilian society is fractured, and it is divided ideologically because of these recent wars. Our families are divided. Even veterans are divided.
You have the right to question how our nation got to this divided point.
You have a responsibility to let go of what you’ve been conditioned to think and begin to think and question things like a free-thinking American. You have a responsibility to be a positive role model for other students.
Has the military advised you to see a chaplain? I encourage you to seek out your mentors and friends in this culturally rich environment available to you.
Utilize the Veterans Administration Medical Centers. The VA has, like you, been stigmatized and asked to do the impossible at times. It is there for you. Use it.
Be a healer of wounds in yourself and others. Be a unifier where there is division. Rise above prejudice and be for pluralism, tolerance and an advocate for social justice.
………………………………………………
Amen, I say. And again I say amen!
— TCDavis
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Warriors experience post traumatic stress because the primitive part of their brains, (the back and bottom), have been on high alert for an extended period, so they are programmed to respond automatically and instantaneously and aggressively to threats. While they are in a theater of war this ramped-up condition of their nervous systems protects them. Therefore, this condition is not experienced as dysfunctional then. But when warriors return home and try to cope with daily life in a very different set of circumstances the behaviors that protected them are experienced both by themselves and others as highly dysfunctional, e.g. hypervigilance, automatic and oddly aggressive responses to even minor threats, odd reactions to noises, unconscious behaviors such as crossing a street to walk on the inside of a curve, or always choosing a seat in a restaurant that faces the entrance. I have discovered that it isn’t easy to de-program the primitive, non-reflective part of the brain with reflective methods. To bring down a ramped-up nervous system, talk therapy isn’t very useful. The body must be involved. Breathing meditation is one treatment that is working well on the unconscious part of the brain. Other treatments are working too. We’re in an exciting time of trauma treatment research.