Opinion: Supporting Our Veterans: Moral Therapy in Civilian Life
Matthew Beard is a Research Associate with the Institute for Ethics and Society at The University of Notre Dame Australia.
This opinion piece was originally published on ABC Religion & Ethics.
23 April 2014
One of the more curious trends in Australia's involvement in wars in the Middle East over the past decade has been the double-think among the citizenry about war and soldiers. War is at best a necessary evil, and at worst a manifestation of Western Imperialism, political self-interest, or some conglomeration of vices that threaten the common good of humanity. Throughout all of this, though, the soldier - the literal agent of war - has remained largely untarnished.
The men and women who fight and die in the wars our nation fights are sanctified as heroes, courageous patriots or tragic victims, but never morally culpable for their involvement in wars that are publicly unpopular and generally condemned as immoral.
"Hate the war, love the troops" thinking may, however, be complicit in one of the greatest challenges facing the Australian military community in the last forty years: the increasing mental health concerns of veterans in a post-war climate.
In recent years, veterans of the wars in Iraq and Afghanistan have been diagnosed with a wide array of psychological and medical illnesses. From borderline personality, depression, social anxiety, to the now (in)famous diagnosis of Posttraumatic Stress Disorder (PTSD). The growing prevalence of PTSD was evidenced when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) expanded and revised its criteria for PTSD. To this, we ought to add the undocumented number of veterans suffering from guilt, shame, and other moral traumas which some commentators have begun to describe as "moral injury."
Moral injury is a phenomenon which is particularly relevant to the current pro-soldier, anti-war groupthink that many Western nations are involved in. Unlike PTSD, which begins with experience or threatened experience of a violation of the safety of myself or someone I love, moral injury begins with what military psychiatrist Jonathan Shay describes as "betrayal of what's right." Moral injury involves judgements about the nature of the world; however, rather than seeing the world as unsafe, victims of moral injury determine that the world, and all the people in it - themselves included - are untrustworthy and fundamentally bad. By moral injury, these theorists refer to what Shay describes as "the soul wound inflicted by doing something that violates one's own ethics, ideals, or attachments." Moral injuries begin with a person's direct experience of a betrayal of "what's right" by a legitimate authority. The betrayal "severely and abruptly contradicts an individual's personal or shared expectation about the rules" - a contradiction of which the individual is aware, and thus causes the individual inner conflict.
What is particularly interesting about moral injury is that its causative agent is not entirely external: moral injuries are not things that happen to an individual, but the consequences of events in which the person feels involved. This feeling of complicity in some kind of moral transgression "severely and abruptly contradicts an individual's personal or shared expectation about the rules," which can compound over time until the individual - in this case, the veteran - sees him or herself as utterly incompatible with an ordinary, happy life.
The victim of moral injury sees himself as judge: judge of his world, of his actions, and of his character. This form of judgement usually (but not always) surrounds feeling morally responsible for a betrayal of "what's right." On other occasions, where it is genuinely a case where one has simply witnessed, without any involvement, such a betrayal (for instance, one objects to an order to kill a noncombatant, but it is carried out by somebody else), one may be morally injured in coming to see the world as untrustworthy.
While all forms of moral injury can be devastating to a person's wellbeing, this latter form involves a loss in trust of other people which can hopefully be overcome through the victim directly experiencing instances where other people act kindly, reliably, and honestly in their interactions with him. More serious, to my mind, are those injuries that "deteriorate ... character [and by which] ideals, ambitions, and attachments begin to change and shrink." These seem to occur primarily in cases where self-judgement is passed on actions for which the veteran holds him or herself personally responsible for a serious moral transgression. It should also be noted that the judgements that soldiers make in these cases are false in one of two ways: either by taking one immoral event (admittedly, a very serious one) as defining permanently the moral character of oneself and the world, as if forgiveness or redemption is impossible; or by assuming moral responsibility for an event for which the veteran is not, in reality, responsible.
The reason that moral injury is especially relevant to the disjunction between war and soldiers is because it is naive to believe that soldiers are perfectly inoculated from the judgements of the citizens they serve regarding the wars they fight. The modern condition is one that American theologian John Courtney Murray described as a "false antinomy between war and morality":
"The basic fallacy is to suppose that 'war' and 'peace' are two discontinuous and incommensurable worlds of existence and universes of discourse, each with its own autonomous set of rules, 'peace' being the world of 'morality' and 'war' being the world of 'evil', in such wise that there is no evil as long as there is peace and no morality as soon as there is war."
The sense in which many modern discussions about war and soldiers take place echoes this sentiment: at its best, war is a "necessary evil" and soldiers do a noble thing in doing what is necessary despite its risk and moral hazard. However, a necessary evil is still an evil, and it is naive to presume that veterans will find it easy to reconcile their identities as soldiers who are complicit in evil with the fundamental human project to live a flourishing life.
To put it simply, the way in which recent public discussions of war have taken place makes it extremely difficult for soldiers to avoid thinking that their very involvement in war is a moral transgression. Moral injury is a malady in which the victim sees him or herself as co-conspirator in some grave moral violation. Furthermore, the complicity in that violation makes the victim incompatible with the world as they previously knew it. The transgressor, now defined by his or her (perceived) indiscretion is tainted and unable to reconcile that taint with the purity of the non-war environment.
If that description seems familiar, it may be because it describes precisely the false antimony that Murray referred to - only, in this case, it takes place in the mind of the veteran instead of in public discussion, and it doesn't take too much imagination to see how the double-think about soldiers and war might perpetuate those beliefs. Of course, this is not to say that all citizens ought to, for the sake of veterans, be overwhelmingly supportive of war (indeed, many veterans oppose war as a consequence of their experiences), but it is to say that perhaps citizens ought to evaluate the justice of particular wars on their own merits instead of rejecting the concept en masse. The attempt to reject war but support soldiers was an attempt to avoid throwing out the baby with the bathwater, but if - as I suspect - it has actually been complicit in the moral trauma that many veterans face, it might be that the baby is long gone, and all we have left is the bathwater.
Can we correct moral injuries once they have occurred? Early evidence is positive. Therapy involves revisiting and re-experiencing the emotions associated with the trauma. Thus, a crucial element of the "cure" for victims of PTSD and moral injury will be a listening audience. The central therapeutic method involves what Jonathan Shay calls "personal narrative reconstruction," whereby the veteran can reconcile past actions with the present self in an integrated manner. It is not sufficient for the soldier to be told that he has done nothing wrong; his guilt is subjective and partly subconscious. What is required is a "fully realised narrative that brings together the shattered knowledge of what happened, the emotions that were aroused by the meanings of the events, and the bodily sensations that the physical events created." When this is allowed to occur, "the survivor pieces back together the fragmentation of consciousness that trauma has caused."
Ultimately, this narrative process is aimed at self-forgiveness. For veterans to overcome the guilt and shame of their felt complicity in moral transgressions, they need to feel as though the transgressions no longer define them. Self-forgiveness, however, is difficult because, as moral philosopher Nancy Sherman writes, "the patient revisits ... relives and, most important, reintegrates the traumatic experience into her life." The traumatic feelings are difficult to face at the best of times, let alone in environments where veterans feel judged and persecuted by the anti-war sentiments which, ironically, are aimed to protect them.
A key element in the redemptive framework for those suffering from self-judgemental moral injury is, however, the provision of an environment in which interpersonal (and subsequently self-) forgiveness is possible. This is why veterans are often asked to tell their stories in groups, why so many write songs and poetry about their experiences, and why Nancy Sherman insists - alongside most cognitive behavioural psychologists - on a "supportive therapeutic relationship." Therapy of this nature cannot be undertaken alone.
Crucially, this process requires an audience capable of listening in the correct manner. Listeners require the perfect combination of distance, belief and compassion. "Listeners must be strong enough to hear the story without injury," writes Jonathan Shay, to listen without judging the speaker, and for the audience "to experience some of the terror, grief, and rage that the victim did." In short, listeners must possess certain "therapeutic virtues" in order for narrative rehabilitation to be successful. In speaking, the veteran's isolation shatters: his experiences are felt, validated and shared. Finally, the perceived guilt or shame is shared, false cognitions are dismantled and the warrior can reconcile his past, present, and future. This, perhaps, is a reason for providing the families of soldiers with training in basic therapeutic virtues. The audience, however, must also hold the respect of the warrior: they must be someone who the soldier thinks has sufficient insight, relevance and gravitas to justify the soldier spilling his soul. Otherwise, the audience will lack the moral authority necessary to issue legitimate forgiveness. Shay emphasises the need of the listener to respect the veteran, but I would suggest that the opposite is also true. Veterans are unlikely to engage in conversation with someone they think has no way of understanding or helping them, no matter how well-intentioned and compassionate the listener is.
Herein lies the lesson for civilians. If we are genuinely concerned with the plight of veterans, part of the solution will be in earning their respect as a suitably qualified, capable and authoritative audience to hear their stories and forgive them for them. However, this forgiveness need not be unconditional: soldiers may deserve, and indeed psychologically require, some punishment for the things they have done in order to be able to live with themselves. Being a genuinely capable listener requires more than a "support the troops" bumper sticker.
Hannah Guilfoyle: Tel (02) 8204 4141; firstname.lastname@example.org