Among veterans of the Global War on Terror, the conscience is alive and kicking. The problem is that it kicks very hard. In The Atlantic, Maggie Puniewska describes a growing awareness of moral injury – the term used by professionals used to denote “a psychic bruise” left after the patient, or someone close to the patient “violated a moral code.”
For service members in war zones, these transgressions might include harming civilians, failing to rescue a comrade, or placing trust in a leader who went on to betray it, for example, by becoming “more concerned with collecting decorative pins than the safety of his troops.” The overall result is “a loss of trust — in oneself, in others, in the military, and sometimes in the nation as a whole.” .
Many symptoms of moral injury, including guilt and shame, as well as suicidal thoughts and behavior, are identical to the symptoms of Post-Traumatic Stress Disorder. But service members are even more reluctant to reveal a moral injury than a trauma. Fear of whatever stigma attaches, in military circles, to self-disclosure and seeking help, is compounded, in the case of moral injury, by the sense of personal disgrace that constitutes the problem itself.
Journalist David Wood, who has covered the armed forces for three years, told National Public Radio: “The biggest thing that [the veterans] told me was that they’re carrying around this horrible idea that they are bad people because they’ve done something bad and they can’t ever tell anybody about it — or they don’t dare tell anybody about it — and may not even be able to admit it to themselves.”
In part, moral injury seems to owe its long life to the shame spiral, a behavioral pattern so named by psychologist Gersten Kaufman. People fall into shame spirals when doing something wrong – or failing to do something right – fills them with a shame so overwhelming that it effectively paralyzes them. This paralysis deepens their sense of shame, which reinforces their paralysis, and so on.
What breaks the spiral, Wood says, is finding an audience that offers a “validating kind of listening.” This sounds much simpler and more anodyne than it really is. In Wood’s experience, veterans don’t want, much less expect, to hear “Well, you couldn’t help it,” or, “You’re really a good person at heart.”
It’s probably a process better observed than imagined. In his short stories, now complied in a book titled Redeployment, Iraq War veteran and National Book Award winner Phil Klay describes many scenes where veterans suffering moral injury find good listeners. In “Psychological Operations,” Waguih, the hero, goes out of his way to unburden himself to a potential hanging judge – a recent convert to Islam and fellow Dartmouth freshman named Zara, who had earlier turned him in for violating a campus hate speech code. At the end of his story, Zara asks, “Am I supposed to forgive you?”“How?” asks Waguih. “For what?” Zara stands up, looking angry. But then she gets it. “It’s okay,” she says. “I’m glad you can talk about it.” That simple statement, we are meant to understand, is the beginning of the psychological “operation” that will – it is hoped – eventually heal Waguih’s psychic bruise.
But that would, at best, be a very bare beginning. Boston University psychology professor Brett Litz denies there’s any “quick fix” for moral injury. Psychiatrists have observed that medication has no lasting effect on it – it seems, fittingly enough, to be a purely spiritual malady. The “talking cure” for PTSD, in which the patient is made, repeatedly, to relive the traumatic event in the hope of reducing the fear caused by the event, actually has a negative effect on moral injury. As David Wood notes in the Huffington Post, it “drives the pain in deeper.”
Civilians can experience moral injury, too. The suggestion that forgiveness from others is irrelevant to its treatment should ring a bell for any Catholic who’s stepped out of a confessional knowing his soul is clean but still feeling no better than when he went in. God’s mercy doesn’t heal moral injury; instead, moral injury prevents us from experiencing, or accepting, God’s mercy.
Whenever I hear Catholics complain about cheap Grace, demanding stiffer penances and reveling in the rare tongue-lashing that comes through the screen, I wonder whether they’re suffering from some form of moral injury – one they believe only stern justice can remove. If so, I suspect that belief is misguided. For all the value justice and mercy have in their own rights, moral injury seems to require its own form of care. A very wise priest I once knew may have had this in mind when he numbered “the gentle art of referral” among a good confessor’s jobs.
Some moral injury patients derive benefit from creative visualization and role-play. In the course of an eight-week program held at the San Diego Naval Medical Center, participants were encouraged to imagine dialogues in which they disclosed the source of their moral injury to a compassionate authority figure, and later, to write letters to themselves in that figure’s voice. A woman I knew who’d had an abortion began to find peace on a retreat where she was asked to imagine her unborn child playing in a field with Jesus.
Yeah, I know. And yes, she was a fundie. But it seemed to work for her, so who are we to judge?