The Moral Injury

International New York Times | 17 February 2015

David Brooks 

 

David J. Morris returned from Iraq with a case of post-traumatic stress disorder. The former Marine turned war correspondent was plagued by nightmares. His imagination careened out of control; he envisioned fireballs erupting while on trips to the mall. His emotions could go numb, but his awareness was hypervigilant. Images and smells from the war were tattooed eternally fresh on his brain, and he circled back to them remorselessly.

“Trauma destroys the fabric of time,” Morris writes in his book, “The Evil Hours.” “In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again. ... In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas.”

Morris’s book is so good because it relies on literature, history and psychology to communicate the reality of PTSD, both to those who live with it and those who never have. But this book is also important because it’s part of a broader re-evaluation of trauma.

Most discussion about PTSD thus far has been about fear and the conquering of fear. But, over the past few years, more people have come to understand PTSD is also about exile — moral exile.

We don’t think about it much, but in civilian life we live enmeshed in a fabric of moral practices and evaluations. We try to practice kindness and to cause no pain.

People who have been to war have left this universe behind. That’s because war — no matter how justified or unjustified, noble or ignoble — is always a crime. It involves accidental killings, capricious death for one but not another, tainted situations where every choice is murderously wrong.

Many veterans feel guilty because they lived while others died. Some feel ashamed because they didn’t bring all their men home and wonder what they could have done differently to save them. When they get home they wonder if there’s something wrong with them because they find war repugnant but also thrilling. They hate it and miss it.

Many of their self-judgments go to extremes. A comrade died because he stepped on an improvised explosive device and his commander feels unrelenting guilt because he didn’t go down a different street. Insurgents used women and children as shields, and soldiers and Marines feel a totalistic black stain on themselves because of an innocent child’s face, killed in the firefight. The self-condemnation can be crippling.

The victims of PTSD often feel morally tainted by their experiences, unable to recover confidence in their own goodness, trapped in a sort of spiritual solitary confinement, looking back at the rest of the world from beyond the barrier of what happened. They find themselves unable to communicate their condition to those who remained at home, resenting civilians for their blind innocence.

People generally don’t suffer high rates of PTSD after natural disasters. Instead, people suffer from PTSD after moral atrocities. Soldiers who’ve endured the depraved world of combat experience their own symptoms. Trauma is an expulsive cataclysm of the soul.We now have a growing number of books and institutions grappling with this reality, including Phil Klay’s story collection “Redeployment,” which won the National Book Award; Nancy Sherman’s forthcoming “Afterwar: Healing the Moral Wounds of Our Soldiers”; and therapy programs like the one on moral injury found at the San Diego Naval Medical Center. These writers and therapists suggest that there has to be a moral reckoning, a discernment process that doesn’t whitewash what happened but does lead to merciful judgments about how much guilt should be borne; settled and measured conclusions about how responsibility for terrible things should be apportioned.

Sherman, who is a philosopher at Georgetown University, emphasizes that most of the work will have to be done at the micro level — through individual conversations between veterans and civilians that go beyond the cheap grace of “thank you for your service.” The conversations have to deal with the individual facts of each case. The goal is to get veterans to adopt the stance of a friendly observer, to make clear how limited choices are when one is caught in a random, tragic situation, to arrive at catharsis and self-forgiveness about what was actually blameworthy and what wasn’t.

The civilian enters into the world the veteran actually inhabited during those awful crowded hours and expands his own moral awareness. The veteran feels trusted, respected and understood — re-integrated into the fabric of his or her homeland.

We live in a culture that emphasizes therapy, but trauma often has to be overcome morally, through rigorous philosophical autobiography, nuanced judgment, case by case.