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Interfaith Veterans' Workgroup

helping vets come home

post traumatic stress

Come Ye Disconsolate

May 8, 2019 by Rx0puqi Leave a Comment

A Meditation on Moral Injury and Forgiveness

Preached at the Presbyterian Church of the Covenant

On May 5th, 2019

By the Rev. Thomas C. Davis

Irish poet Thomas Moore and American hymnist, Thomas Hastings, gave Christians a beautiful hymn that isn’t in our Presbyterian hymnal. In the 70s my wife and I belonged to a racially diverse congregation in Pittsburgh called the Community of Reconciliation. It was there, sung by African Americans, that I first heard this pre-Civil War hymn, “Come Ye Disconsolate.” The first verse goes like this:

Come to the mercy-seat, fervently kneel;

Here bring your wounded hearts,

here tell your anguish,

Earth has no sorrow that heaven cannot heal.

We don’t use the word, “disconsolate,” much these days. It means inconsolable, hopelessly unhappy. Someone who has endured that sorry state of heart and mind for too long may feel that suicide is the only way out. But the hymn says no! For earth has no sorrow that heaven cannot heal.

Al Mills is an Iraq War veteran. He and his brother, Nnamdi, are the current Twin Poets Laureate of Delaware. Over coffee a couple years ago I learned that Al was struggling with anger and hyper vigilance, symptoms of post traumatic stress. And what bothered him even more was a deep sense of shame, on account of something he had participated in during his tour in Iraq. He belonged to an artillery unit. Soldiers in artillery units rarely see the damage they inflict. But things changed quickly for Al when his unit had to convoy through an urban area. Suddenly he experienced what it’s like to be an infantryman, to kill close up. Duty and fear carried him through a terrible episode, but afterwards, after he had had time to think, what he had done made him terribly ashamed, so ashamed that he was beginning to feel inconsolable, disconsolate.

I would not be sharing these personal details about Al’s experience, were it not for the fact that he has already done so himself in public, by means of a very moving poem which he read for the first time at the St. Stephens Lutheran Church. He worked up to writing that poem after sharing memories with fellow combat veterans in the Interfaith Veterans Workgroup. I was present on both occasions.

Al’s poem was a soul dump. With his pen he let go of so much pent up anger, so much horror, so much moral indignation, and yes, so much shame! Reading the poem among civilians took a lot of courage, because veterans don’t know whether civilians can understand what they’ve been through. A veteran with moral injury has already heaped so much shame on himself or herself, it’s difficult to risk having even more piled on by folks who don’t understand. Al took that risk, and now he was exhausted. I invited him to walk around the block with me

Neither of us said much for a while. Then, finally, to console him I said, “You know, Al, with this moral injury stuff you’re in good company. The Apostle Paul had moral injury, big time.”

I think the Spirit put that idea into my head. I hadn’t worked out the details yet. The elements of an argument were floating around in my unconscious. I just rushed to the conclusion that night to assure Al that he wasn’t a bad person for having done a bad thing.

Now that I have had time to ponder the truth of my intuition that Paul had moral injury too , here’s why I think so.

Moral injury was a term coined by Jonathan Shay, a therapist who was treating Vietnam veterans with post traumatic stress. He observed that some of their symptoms derived from a hyped up nervous system that couldn’t be quieted. But other symptoms related to a deeper level of the self. You could say they are spiritual afflictions. Shay observed that moral injury is a very deep wound to the conscience. As researchers caught on to this term, moral injury, they understandably linked it to an event, a trigger, something that a veteran had done or failed to do in the line of duty which led to grievous harm, often the loss of life.

More than two years of research about moral injury have convinced me, however, that we won’t understand moral injury adequately if we focus just on an event that triggered moral pain. There are high suicide rates among doctors, among police officers, among correctional officers, and small farmers. Researchers are beginning to use the term, moral injury, to refer to the psychological pain among people in these professions too. In many instances their moral injury did not derive from a particular trigger, but rather, from severe moral frustration. Many people choose such professions out of a deep desire to serve, to be helpful to others. Then, they find that they cannot help as they had wanted because the working environment makes this impossible. When they fail, sometimes they don’t blame a system, they blame themselves. A soldier doesn’t blame the craziness of war for his bullet which was meant to kill an enemy but stuck a civilian instead. He blames himself. A doctor doesn’t blame a health system that puts more emphasis on saving money than saving lives. She takes the blame herself. She thinks, “I just didn’t work hard enough.” A farmer doesn’t blame big agriculture and increasing urbanization for losing the family farm. He blames himself.

The most common denominator among sufferers of moral injury doesn’t seem to be a similar trigger, but rather, a quality of personality, namely, a very high dedication to service. People with very high ideals about serving others may be more prone to moral injury than others who are less altruistically inclined.

This brings me back to the story of Saul. He had very high ideals of service. He was a Pharisee, a protector of the sanctity of religious law. Pharisees get a bad rap in the New Testament. They generally were people with very high standards of behavior. I see Saul that way. He was a crusader for the right way of doing things, and he saw followers of Jesus as dangerous underminers of that long tradition. So, when the story in Acts 9 opens he is carrying letters from high priests in Jerusalem bearing the names of followers of Jesus who have fled persecution in Jerusalem to seek refuge in far away Damascus. He is carrying hit lists. He is out to arrest and imprison the enemies of religious rectitude.

But, I don’t think Saul is of one mind. I think he has doubts. Saul was present during the stoning of Stephen, and scripture says he approved of it. But I think there was a growing part of Saul that didn’t approve. Stephen’s bloody clothing was dropped at Saul’s feet. To dispose of it he had to get blood on his hands, and killing up close can change a person. Besides that, scripture notes that Saul was a student of the highly respected Rabbi Gamaliel. And Gamaliel recommended that angry crowds not pursue annoying Christians, because if they were truly doing God’s work, then nothing could stop them. So we notice that Saul’s own rabbi was not of one mind regarding the followers of the Way.

Neither, I think, was Saul. As he rode on to Damascus to take prisoners I submit there was an inner war going on in him. He was beginning to experience an extreme inner tension brought about by a conscience pulling him in opposite directions.

Saul astride his horse was a prime candidate for what mental health practitioners call “conversion disorder.” According to the Diagnostic and Statistical Manual of Mental Disorders, conversion disorder occurs when a person experiences neurological symptoms that are not attributable to any medical condition. The symptoms are real, not imaginary, and they can affect motor functions and one’s senses.

Conversion disorder tends to be manifest in persons who, like Saul, have endured extreme tension. A symptom of their disorder can sometimes be understood as their body’s way of releasing the tension. For instance, a woman who is afraid of showing strong emotion might develop temporary paralysis of her arm when anger motivates her to strike someone. Typical symptoms of conversion disorder are temporary paralysis, weakness loss of balance, and temporary blindness. The story about Saul falling off his horse, needing help to move about, and becoming blind, suggest to me that his body was relieving part of his inner stress by temporarily relieving him of the capacities necessary to carry out a mission about which he had growing misgivings. He was ready to meet Jesus, but didn’t know it yet.

Saul recovers his sight when blindness is no longer necessary to relieve his inner tension. He can see again when he no longer fears that being able to see will enable him to do something against which his conscience has been crying out no, no, no! Notice that he doesn’t receive this assurance until he is forgiven.

And it is Ananias who is the transmitter of a forgiveness coming from the risen Jesus. He says to Saul, “Jesus, who appeared to you on the road as you were coming here—has sent me so that you may see again and be filled with the Holy Spirit.”

Thus it is that Saul, tormented by conscience, is assured by another human being that the old is over and done with. Saul is forgiven and given a new and right spirit for moving ahead. A man who might have taken his own life from agony of soul is saved by the laying on of hands and a declaration of pardon.

This story is very precious to me, a veteran who was once plagued by moral injury, a veteran who fell into a deep depression almost two decades after combat. That’s how long a conscience can stew. The men and women suffering from moral injury are often the morally most sensitive. They blame themselves for failing to clear a high bar that they have set for themselves. I speak from experience. We need an Ananias, another human being, to assure us that there is indeed a balm in Gilead.

Maybe you are presently wrestling with some moral quandary, as Saul did. Maybe you are a mystic and will see Jesus in your own way on your own road, as I did in Vietnam. Maybe you will see Jesus in some modern Ananias who declares to you what you may have learned in Sunday school, or maybe from the Reverend Mr. Fred Rogers, that you are loved just as you are.

Come, ye disconsolate, where’er ye languish;

Come to the mercy-seat, fervently kneel;

Here bring your wounded hearts,

here tell your anguish,

Earth has no sorrow that heaven cannot heal.

Filed Under: moral injury, post traumatic stress, repercussions of killing, Uncategorized, writing to heal

Grief, Post Traumatic Stress, and Moral Injury

August 4, 2018 by Rx0puqi Leave a Comment

An Interfaith Veterans’ Workgroup member who works in the field of mental health observed that some experts recommend that people who are grieving not resist sadness, but rather, allow themselves to feel it and work through it. She asked whether a similar recommendation has been made for veterans suffering from post traumatic stress and moral injury. Here was my answer:

Regarding your excellent question: Grief is a normal response to a profound loss, felt as deep sadness. Cultures have developed ritualistic responses to the death of a loved one. These help people express their sadness in conventional ways, and the rituals provide a way for people to support each other in their grieving. Typically there are not similar rituals for other kinds of deep losses, such as loss of employment or loss of face. It’s good advice, I think, to counsel people to allow themselves to feel the normal sadness of a profound loss. If one tries to avoid feeling this normal sadness one’s grief may turn into the numbness of a severe depression, and that is a condition more difficult to weather.

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.

Moral injury is a deep wound to one’s conscience due to something one did or failed to do in a line of duty which violated one or more of one’s core values. Many of the instances of moral injury involve loss of life. One holds oneself responsible for someone dying, or being put in life-threatening circumstances, and this grieves one very deeply. Warriors often don’t experience moral injury until they have had time to reflect on what happened in a life-or-death situation. Their warrior training programmed them to react automatically and aggressively, causing them to fire immediately, without thinking, upon a perceived threat. Later, remembering the incident in detail and thinking about its consequences, they may or may not forgive themselves for what they did.

Moral injury may be experienced even when there is no loss of life. (I have changed my view on this. In an earlier post I called killing the root of moral injury, but it isn’t always). In 1975, when Saigon fell to North Vietnamese troops I began to have nightmares, not about battle, but about betraying my South Vietnamese comrades in arms, abandoning them to this fate. I was experiencing moral injury. Some members of ICE experienced moral injury when they were compelled by duty to separate children from their parents. Some doctors are experiencing moral injury because they have very high standards for saving lives, but they feel complicit in a system that is dysfunctional and is not protecting the lives of all patients equally and fairly. Some farmers, I would say, are experiencing moral injury because, try as hard as they may, they are losing at a business that is very much more than a business. It’s a precious way of life that has been in their families for generations. And they hold themselves personally responsible for losing the battle to sustain that way of life. I have cited populations where the rate of suicide is rising. Not just military veterans, but also police and correctional officers and doctors and small farmers are taking their own lives at increasing rates. I am not the only researcher who feels that moral injury is a primary engine of suicide.Post traumatic stress and moral injury are often co-present. I feel that mental health practitioners need to deal with the ramped up nervous system before much can be done about moral injury. Otherwise, it’s like trying to treat a patient with an active addiction. Once there is some evidence that a patient is gaining ground dealing with unconscious behaviors, then it becomes possible to deal with wounds to the conscience. Here’s where talk therapy comes in, and also — an under-represented line of inquiry in my opinion — the effectiveness of spiritual disciplines and religious rituals of forgiveness and personal transformation.

You may find the following books helpful:

On Chronic Stress and Its Long Term Damages to Health:

The Body Keeps the Score, by Bessel Van der Kolb
The Deepest Well, by Nadine Burke-Harris

On Moral Injury in Veterans, and Treating It:

The Things They Cannot Say, by Kevin Sites
Afterwar: Healing the Moral Wounds of Our Soldiers, by Nancy Sherman
Killing from the Inside Out, by Emmet Meagher and Jonathan Shay
Soul Repair, by Rita Nakashima Brock
On Killing, by Lt. Col. Grossman
Help for Moral Injury: Strategies and Interventions, by Cecilia Yocum

— TCDavis

Filed Under: moral injury, post traumatic stress

Understanding Post Traumatic Stress and Moral Injury

October 25, 2017 by Rx0puqi Leave a Comment

About two years ago I founded the Interfaith Veterans’ Workgroup, to see what could be done to keep veterans from killing themselves. They were doing that at more than twenty a day. After two years of research I understand better the role of post traumatic stress and moral injury in veterans’ depression, and I’m coming to see that there are some non-clinical ways of helping warriors come home. Please read on:

Post Traumatic Stress is in the Body

A good book to understand the treatment of trauma is The Body Keeps the Score, by Bessel Van der Kolk.  PTSD affects the bottom and back of the brain.  That’s the primitive part that takes care of automatic functions, like breathing, the heart’s beating, etc.  Living under ongoing threat, as in a war zone, conditions that part of the brain to react aggressively without thinking.  PTS is in the entire body.  Warring creates muscle memory for self-preservation.  When warriors come home, and this can be done these days in a matter of hours, the muscle memory continues.  The whole body is still on combat alert.  One is hyper vigilant.  Sleep is difficult.  And when even a slight provocation occurs, like being cut off in traffic, the body reacts aggressively, automatically.  No thinking is involved.  The primitive brain is still doing its thing.  This condition can endure for many years.

Moral Injury is Felt After You’ve Had Time to Think

War is not heroic, as in the movies.  In war you do things merely to stay alive. You do them automatically, without thinking.  After a firefight you may not be proud of your conduct.  Maybe you killed a civilian who got in the way.  Maybe you failed to save a buddy.  Maybe out of anger you abused a prisoner, killed a prisoner, desecrated a corpse. Maybe in a strange moment you got in touch with the humanity of your enemy and you feel bad about shooting him down in an ambush instead of in the give and take of a fair firefight.  After you’ve had time to think there are so many ways to feel rotten about yourself for doing what you did, or failing to do what you think you should have done.  Such nagging reflections happen in the top and front of the brain, the pre-frontal lobes. PTS and moral injury are often co-present.  Both contribute to depression, but I think moral injury is probably the stronger factor in veteran suicide.

Returning Veterans and Returning Citizens from Prison Face Some Similar Challenges

Here’s a piece I shared with IVW and some friends who are working with men and women returning from prison:
For about two years I have been leading a group devoted to helping combat veterans transition successfully to civilian life (the Interfaith Veterans Workgroup).  Concurrently I have been sitting weekly with New Beginnings-Next Step, which helps former inmates transition from prison to society.  I have noticed that some veterans and many returning citizens from prison face similar emotional and behavioral challenges: managing anger, maintaining close relationships, and dealing with depression without self-medicating with substances that often lead to addiction.
One could say that these similarities stem from habits formed for self-protection in persons who have had to cope for a rather long time in dangerous and violent circumstances.  The CDC study done in Wilmington indicates that most young men who end up in prison for gun crimes experienced trauma as children. They were desensitized to violence not only by what they saw on TV or in video games, but much more so by witnessing maimings and killings where they lived, and sometimes in their own families.  Furthermore, they resorted to guns not only as a means of self-protection, but also as a means to assert themselves, to gain and keep respect; and in the long run respect “in the hood” is needed for survival, or so I’m told.  Thus, a habit of responding quickly and violently to even apparent challenges to the self becomes ingrained in the nervous system. Violent aggression becomes a habit of the body.  One doesn’t think anymore before pulling the trigger.

Lieutenant Davis driving boat in Vietnam
author, driving the “skimmer” in Mekong Delta, 1970

In 1970 I had accompanied South Vietnamese sailors to a village in enemy territory where we distributed medicines to “win hearts and minds.”  On the way back to our base we were ambushed.  We couldn’t see who was shooting at us, but every man in our boat sprayed the dense rushes on the canal bank immediately, without thinking.  Our rapid violent response suppressed enemy fire and got us out of that tight spot.  Our military training had desensitized us to killing and had ingrained in our very bodies an automatic response.  In an ambush there is no time to think.  One shoots to survive, and if one does survive, then one has the time afterwards to sort out what one did.  When there was no target, as in this case, one may wonder whether anyone got hit, and if so, was it a shooter or an innocent bystander?

 I know from personal experience that a habit of violent aggression gets ingrained in persons who have had to cope with living under constant threat.  That habit can be unlearned, but it takes time and dedication. Up to now our military hasn’t recognized a need to de-program warriors. You fly out of a war zone and presto, you’re back in the civilized world.  But your body is still on combat alert. Anger, may I suggest, is a natural self-protective human response. In a war zone it can indeed preserve your life.  But when you try to transition to civilization, what saved your life in war is likely to destroy it back home. Your body, not just your mind but your body too, needs to develop new habits for dealing with perceived challenges to the self.
That’s where mind-body disciplines like the martial arts, yoga, and mindfulness based stress reduction come in, and also the Alternative to Violence Project invented by Quakers.  The military deliberately trains people to not be anguished by killing, and to react immediately and violently to a perceived attack.  Those habits of the mind and body are needed in a theater of war, but they must be unlearned upon return, else former warriors may harm others or themselves.

Filed Under: moral injury, post traumatic stress

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