Moral injury as a cause of PTSD

I stayed in a motel over the Thanksgiving weekend, and on Friday morning had a look at USA Today, copies of which were stacked in the lobby they way they are in hotels and motels across the country. USA Today is not a paper I normally read. I found one of the front page articles deeply distressing. Its title: Study suggests feelings of guilt are a top PTSD cause. The article is a heartbreaking work of staggering density.

Here are the first couple paragraphs:

A leading cause of post-traumatic stress disorder is guilt that troops experience because of moral dilemmas faced in combat, according to preliminary findings of a study of active-duty Marines.

The conflicts that servicemembers feel may include "survivor's guilt," from living through an attack in which other servicemembers died, and witnessing or participating in the unintentional killing of women or children, researchers involved in the study say.

Well, yes.

I don't want to be flippant here, because this topic about as far as one can get from Things That Matter. I'd prefer to withhold from my fingers permission to type something sharp and angry, like No sh*t, Sherlock.

(Oops. Those fingers, they've got a mind of their own.)

Full disclosure: I have never served in the military. And yet. It's hard for me to fathom how this study qualifies as news.

I can wrap my mind partway around how the study qualifies as science: at its most pedantic, science (and perhaps especially social science) formalizes things known by pretty much anybody who's paying attention.

Indeed, to anyone who has been paying attention to pretty much any part of the last several millenia of recorded human culture, it's obvious that war has been destroying the bodies, minds, and souls of young men and women for a very long time. Destroying bodies, minds, and souls is pretty much an existential condition of war. Has been since war's invention.

Homer and the Greek tragedians who wrote some centuries after him made that plain a looooooooooong time ago. But you don't have to go back to the classical period for evidence in the human record. There are plenty of lessons to be drawn from more recent history and culture.

Siegfried Sassoon's poetry might be a place to start if you're looking for evidence from the most recent century of war's human and psychic toll. Sassoon wrote vividly of his horrific experience in the trenches of World War I. If you aren't into poetry, you can't go wrong with Pat Barker's fictionalization of the same period, including her fictionalization of historical figures. Barker's Regeneration trilogy starts with an evocation of the poet Sassoon being classified as mentally unsound for refusing to continue to fight an insane, inhumane, and senseless war (Regeneration); the last book in Barker's trilogy won the Man Booker Prize (The Ghost Road).

You'd rather watch a movie? Try The Deer Hunter or Apocalypse Now, which won five and two Oscars respectively, among many other awards. Those two movies describe the insane, inhumane, and senseless war in Vietnam of the 1960s and 70s. For films that go to the heart of how troops are affected by the current war in Iraq, watch The Hurt Locker or In the Valley of Elah.

It is a national shame and tragedy that among the men and women returning from wars in Afghanistan and Iraq who have been treated by the Department of Veterans Affairs, half have been diagnosed with mental health issues, and nearly 200,000 of these suffer from PTSD (these numbers pulled from the same USA Today article linked above). How can we bear having done this to our own young people, let alone bear the crushing horror of what we've demanded our young people do to the men, women, and children of Iraq and Afghanistan?

It is an embarrassment to human capacity for belaboring the obvious that it takes a scientific study for a national newspaper to connect the inhumanity that troops were trained and ordered to inflict in Afghanistan and Iraq, and compelled by the brutal circumstances of their deployment to endure; with the deforming effect on their psyches that overwhelms these veterans when they return home.






Thanks to tiganatoo for the image shared on Flickr of a stencil drawn from Pablo Picasso's painting, Guernica.