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Moral Injury
May 17, 2013 7:43 PM   Subscribe

A New Theory of PTSD and Veterans: Moral Injury
But as clergy and good clinicians have listened to more stories like these, they have heard a new narrative, one that signals changes to the brain along with what in less spiritually challenged times might be called a shadow on the soul. It is the tale of disintegrating vets, but also of seemingly squared-away former soldiers and spit-shined generals shuttling between two worlds: ours, where thou shalt not kill is chiseled into everyday life, and another, where thou better kill, be killed, or suffer the shame of not trying. There is no more hellish commute.
posted by the man of twists and turns (19 comments total) 32 users marked this as a favorite

 
The article is wrong in that there's no rise in PTSD. Its just getting diagnosed more now. I did my masters work on the First World War. You read the accounts of veterans in the 1920s, they say the same thing veterans do now. Humans are traumatized by combat. You don't just recover.
posted by Ironmouth at 9:37 PM on May 17, 2013 [22 favorites]


The first article mentions Lance Cpl. Walter Rollo Smith, who killed his girlfriend and the mother of his kids in the bathtub... here's an interesting (and lengthy and sad) post about his case.
posted by Auden at 10:04 PM on May 17, 2013 [1 favorite]


War eventually destroys the morals of most people involved. If you are a combatant, the killing will do it.
If you are a civilian, the things you do to survive will do it.
Just being around a high probability of dying yourself, or seeing people you love die, knowing to expect it is a moral risk.
posted by Katjusa Roquette at 11:00 PM on May 17, 2013 [3 favorites]


I went to Bosnia as a peacekeeper in the 90s, being just 20 myself. I remember being aware enough to consider the question of how it would affect me if I would have to kill or wound someone. I considered the risk acceptable, but not anymore. Today I'm just happy I came back in one piece, and am able to lead a peaceful existence. So many aren't.
posted by Harald74 at 2:32 AM on May 18, 2013 [2 favorites]


I wonder if having a volunteer military might place some extra burden on the combat soldier, knowing that everyone on your side is there by their own volition.
posted by bendybendy at 5:16 AM on May 18, 2013


I think it's quite possible that it's both more diagnosed and also really on the rise, considering how the life-saving technologies we have today mean far more soldiers are returning after severe injuries than in the past.
posted by bizzyb at 6:38 AM on May 18, 2013 [2 favorites]


more soldiers are returning after severe injuries than in the past.

And they then get to see what "support the troops" really means when they come back broken.
posted by rough ashlar at 6:54 AM on May 18, 2013 [6 favorites]


You read the accounts of veterans in the 1920s, they say the same thing veterans do now. Humans are traumatized by combat.

Curious to know if anyone has looked into the American Civil War or the Napoleonic wars. Anyone?
posted by IndigoJones at 6:56 AM on May 18, 2013


Veterans of WWII receive an huge amount of social support and approval. Veterans of Viet Nam came home to revulsion, blame, accusations. How does a veteran of Iraq feel about killing in the name of lies? My son is a veteran of Afghanistan, and he knows that war is largely futile, though at least it had some actual justification, to the extent that any war can be justified. Many soldiers see the profits made by the contracting companies, and feel a huge conflict. Huge amounts of activity that used to be done by soldiers is now done by Halliburton, KBR and others. War's always been profitable, but the profit is now so apparent that even soldiers are grossed out by it.

A sense that you are fighting war for a mission goes a long way towards resolving the moral conflict. The military personnel with PTSD are carrying a burden that we should be sharing, for letting our government deceive us into war in the first place.
posted by theora55 at 7:48 AM on May 18, 2013 [3 favorites]


That story of Walter Smith is heart-breaking, as well as being an indictment of our lack of mental health care.
posted by theora55 at 7:54 AM on May 18, 2013


We ask young people to sacrifice in order to protect society and they have agrees to do so for centuries. Yet somehow we have forgotten the other side of the bargain, that we only ask them do so for important, justifiable reasons and that we'll take care of them afterwards. That social contact won't survive unless both sides do their part and, as near as I can tell, only one side is doing so.
posted by LastOfHisKind at 8:07 AM on May 18, 2013 [1 favorite]


The first article mentions Lance Cpl. Walter Rollo Smith, who killed his girlfriend and the mother of his kids in the bathtub... here's an interesting (and lengthy and sad) post about his case.

Jesus.
At a certain point, the Iraqi fighters commandeered civilians’ cars, taking them hostage and ordering them to drive straight at the Marine positions. The marines were forced to shoot at everything headed their way.

“We were opening fire on civilians,” Mr. Smith said. “We were taking out women and children because it was them or us.”

Sergeant Major Lopez, his superior officer, said that his marines were “put in that position” and “trained to protect themselves first.”

“Our marines tried to limit civilian casualties,” he said. “Not a person there didn’t feel bad. But it had to be done.”

That day traumatized the reservists. [Christopher] Quiñones recalled a father carrying toward them the limp body of a young child. His voice cracking, he described a 5-year-old boy screaming as his car “turned into Swiss cheese.”

“I called cease-fire and I wanted to run and grab him, but there were machine gun rounds flying all around,” Mr. Quiñones said. “I watched this kid’s head get blown away, his brains splattering while his screams still echoed. Those images haunt me — haunt many of us — to this day.”
posted by crayz at 11:17 AM on May 18, 2013


That social contact won't survive unless both sides do their part and, as near as I can tell, only one side is doing so.

We had been told, on leaving our native soil, that we were going to defend the sacred rights conferred on us by so many of our citizens settled overseas, so many years of our presence, so many benefits brought by us to populations in need of our assistance and our civilization.

We were able to verify that all this was true, and because it was true, we did not hesitate to shed our quota of blood, to sacrifice our youth and our hopes. We regretted nothing, but whereas we over here are inspired by this frame of mind, I am told that in Rome factions and conspiracies are rife, that treachery flourishes, and that many people in their uncertainty and confusion lend a ready ear to the dire temptations of relinquishment and even to vilify our actions.

I cannot believe that all this is true, and yet recent wars have shown how pernicious such a state of mind could be and to where it could lead.

Make haste to reassure us, I beg you, and tell us that our fellow citizens understand us, support us, and protect us as we ourselves are protecting the glory of the Empire.

If it should be otherwise, if we should have to leave our bleached bones on these desert sands in vain, then beware the fury of the Legions.


Marcus Flavius, Roman Centurion

This kind of thing has been going on a long time. And this kind of thing going on is one reason that Empires (or republics who have imperial ambitions) don't last nearly as long.
posted by bartonlong at 1:51 PM on May 18, 2013


This kind of thing has been going on a long time.

Possibly so, but that quote dates from 1960. (Lot of people were gulled by it, so no serious blame attaches. But it does raise again my original question, how much data if any do we have of this before the 20th century?)
posted by IndigoJones at 5:30 PM on May 18, 2013 [2 favorites]


Indigo, hit the google for "Napoleonic wars nostalgia" or "Napoleonic wars wind contusions"; and "American civil war soldier's heart" or "American civil war Da Costa's syndrome". There's a lot there ranging from posts on io9 to serious academic work (pdf).

I'd guess though, from a historiographical point of view, it's probably wise to go in with your eyes open to the fact that the past is a foreign country and all. Conceptualisation of physical, mental and spiritual norms can radically differ over as short a period as the end of the Vietnam War (Stress Response Syndrome) through to DSM-III (1980, PTSD). You could even extend that to right now, where some of the commentary in the articles linked to in this post seems to suggest "moral injury" as not just an additional potential factor in PTSD diagnoses and treatment, but as a replacement diagnosis.

Anyway, not having a go at anyone, I just think it might not necessarily be possible to equate pre-20th C. sources concerning war related conditions (whether it's info about diagnoses of, treatments for, or any kind of numerical figures available for them) with modern data on PTSD. It's reasonable enough to say that some people have always ended up severely and persistently troubled by war, but rolling that into comparisons with modern data related to PTSD may well be difficult, problematic and/or downright impossible.
posted by Ahab at 3:40 AM on May 19, 2013 [1 favorite]




Thanks, Ahab!
posted by IndigoJones at 2:31 PM on May 19, 2013 [1 favorite]


History of Combat Trauma Bibliography (from Small Wars Journal)
posted by Tuesday After Lunch at 3:34 PM on May 20, 2013


How A War Hero Became A Serial Bank Robber - "Army medic Nicholas Walker returned home from Iraq after 250 combat missions, traumatized and broken. His friends and family couldn’t help him. Therapy couldn’t help him. Heroin couldn’t help him. Pulling bank heists helped him."
During the 11 months in 2005 and 2006 that Walker spent in Iraq, he participated in roughly 250 combat missions, a high number even for trained infantry soldiers, to say nothing of a medic. Walker became so accustomed to combat, in fact, and so good at it, that the infantry soldiers from two separate platoons specifically requested his presence on their most perilous missions virtually every day for over a year. And Walker, who told me he joined the military in the first place because he wanted in the most fundamental way “to help people,” obliged them — over and over again.

“Before you go to war, you want stories, you know — that’s the really tragic thing,” he told me, “because this is that story, and there are no good guys, and no bad guys. And looking back, you think to yourself: What did you think was going to happen? Death or glory? And then you feel bad because this is exactly what you wanted. It’s real easy to get into, and it’s real hard to get out of.”
The descriptions of combat, the aftermath of an IED, are pretty graphic.
posted by the man of twists and turns at 8:40 AM on May 31, 2013 [2 favorites]


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