Moral Injury essay

This juggernaut of war has crushed millions of humankind. Its savagery and decadence is consummate. Such butchery has patently marked all the wars of this century and before. This centralization of mankind on its own is unparalleled. Scenes of human massacre that few persons would believe will be imprinted perpetually in the minds of the combatants. Many of those who experience the immoral, offensive and degrading trauma of war can be physically and psychologically scared indefinitely.

Their sense of what is right and wrong is in constant conflict. The tragedy of war and incomprehensible death will change whoever you thought you were and whatever you think you will become when you encounter its indescribable cruelty. The ferocity of combat is the final test for mankind. No other activity produces such an amplification of emotions. No other activity is so final in its consequences. We often have an enigmatic relationship with combat and war; sometimes it is venerated and other times abhorrent.

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Perhaps this quote put some context to war. ‘The sheer terrors of knowing that the next one is going to have your name on it, when that goes on and on and on… O get a strange feeling in which you seem to become detached… But who cares. And you learn to sort of live with it… You will either survive … Or you will not. So there’s really nothing you can do. And you just take it. ” Sidney Phillips, THE WAR For centuries we have seen victims of war; soldiers who have had numerous physical injuries that last throughout their life.

With the advent of military arsenals capable of world destruction on a horrendous scale we can see the devastation on the human psyche. However, during the 20th century, little was acknowledged about the emotional toll of war. It wasn’t until a psychologically study was outlined that we began to understand what was happening to them. I want to start with some history of the psychological effects war has brought to the 19th and 20th century. During the American Civil War, after ‘insanity, ‘nostalgia’ was the second major diagnostic category used during the Civil War to term what we think of today as a stress disorder.

In the seventeenth century any disorder associated with depression or changes in personality was termed melancholy or nostalgia. Daniel Greenfield, said in the Journal of Psychiatry & Law symptoms analogous to PETS were called ‘Soldier’s Heart’ ND ‘Ad Costa Syndrome’ during the mid to late 1 9th century. During the Civil War era doctor Ad Costa studied this problem in the 19th century. Doctor Jacob Mended ad Costa studied Civil War veterans in the United States; he found that many of them suffered from anxiety and shortness of breath. He called this syndrome “Soldier’s Heart, Irritable Heart and “Exhausted Heart. But it also came to be called “Ad Costa Syndrome” after doctor Jacob Mended ad Costa There is little question that the Civil War psychologically damaged its soldiers. Many soldiers fighting in this war seemed to have more severe homonyms if they attacked or were attacked with a knife or bayonet (Bourne, 201 1). The closer the actual distance between soldiers, the worse the symptoms would become. To defeat the enemy, one had to stare into their eyes and then take their life with bayonet or firearm. Hand to hand combat was without doubt one of the leading causes in the birth of psychological distress.

This antiquated method of fighting is enormously personal and had an extraordinary deleterious consequence on a soldier’s psyche. What established the term nostalgia for the typical soldier during the combat? Francis Clarke acknowledged that the fracturing of family ties as the most upsetting trials that a soldier could experience. Considered as a mental disease there can be little doubt that the primary phenomenon of this state is mental and psychological; it belongs to the class ‘melancholia’. Melancholia was a mental condition consisting of a manic-depressive condition characterized by hallucinations and delusions.

It is an acute mental depression with an unassailable yearning for home that soon produces a state of ‘chef (a profound and patent state Of constitutional disorder; overall ill health. With the arrival of World War I, (the Great War during 1914-1918) ‘Shell Shock’2 was considered a psychiatric disorder resulting from injury to the psychological part of the soldier during warfare. Smith and Pear however preferred the term, ‘war strain’ to ‘shell shock’ as they felt ‘the trigger for war strain was reflected in an intense emotional arousal and the subsequent suppression of sympathy for others, as well as fear’ (Smith & Pear, 1918).

It was felt that the shells formed a concussion that interrupted the physiology of the brain. While the totality of factors exceptionally added o the total misery, it was primarily the artillery shelling which really broke men’s psyche or perhaps more aptly ‘their inner self. ” Wounded soldiers had a shocked unblinking robot like stare that was a common symptom of “shell- shock. ” It was essentially a helpless reaction to the intensity of conflict. The term ‘shell shock’ came into use to reflect a presumed connection between psychological symptoms and the explosions from artillery shells.

It was considered a crushing stress disorder occurring in soldiers, particularly those engaged in close one on one combat, characterized by extreme autonomic automation. Adam Household commented that, “Simply put, after even the most obedient soldier had enough shells rain down on him, without any means of fighting back, he often lost all self-control. “3 Cases of “shell shock” were also construed as a lack of ‘moral fiber. ‘ (It is of interest that it was also considered a lack of ‘moral fiber’ which we will take up later. It entered into widespread public imagination after 1 915 and was known as the signature injury of the war. While it was acknowledged that the trauma of war could cause men to ‘break’, a lasting incident was also suggestive Of a hidden ‘lack Of hearted. Consequently, some men suffering from shell shock were put on trial for military crimes such as: going ALLOW, desertion and cowardice. One diagnosis that gained little currency was Fraud’s “war neurosis. ” Freud felt it brought about an inner conflict between a soldier’s ‘War ego” and his “peace ego. Another diagnosis which accrued little traction was called neurasthenia: “The mental troubles are many and marked; on the emotional side. .. On the intellectual side, lessened power of attention, defective memory and will power…. ” When World War II came in 1939-1945 the name was changed to Battle Fatigue’ also called ‘Combat Fatigue’. It was also referred to as “Combat Stress Reaction” (CAR), some psychiatric professionals also used “Gross Stress Reaction” (GARS)4 to refer to shell shock it is a psychological disorder that progressed in some soldiers who had suffered and agonized over major traumatic experiences in war.

However, this diagnosis (GROSS) served as a proxy, due to the want by psychiatrists of having a more meaningful definition. CAR is a severe response that embraces a range of behaviors ensuing from the stress and trauma of combat that decrease the oldie’s fighting effectiveness. Combat stress was seen as “psychological disintegration suffered during the stresses of battle” (Watson, 1 978, peg. 233). S. E Ambrose noted, “The experiences Of men in combat produce emotions stronger than civilians can know, emotions of terror, panic, anger, sorrow… ND each of these feelings drained energy and mental stability” (Ambrose, 1992, peg. 203). The most common symptoms are fatigue, sluggish reaction times, vacillation, withdrawal from one’s surroundings and helplessness to prioritize. The person is classically traumatized with symptoms including depression, excessive irritability and recurrent nightmares. It became apparent it was not just the “weak” in character who were falling apart. Near the end of Vt/roll War II terms like “combat neurosis” began to shift or give way to the term “combat exhaustion” which was very similar to ‘Combat Fatigue. Author Paul Fusel said the term “combat exhaustion” as well as the term “battle fatigue” suggest “a little rest would be enough to restore to useful duty a soldier who would be more honestly designated as insane. ” Fusel quoted Bruce Cotton: “A singular fact about modern war is hat it takes charge… Doing what has to be done to win, men perform acts that alter the very soil in which society roots are nourished. ” The average age in WI was 26; however it was the 18-year-olds who were put up front. Poet James Dickey said, “Among the horribly wounded the most common cry was ‘mother! During the Vietnam War was when PETS came out of the psychological closet. The symbol of the traumatized soldier was commonly depicted during the Vietnam War. American citizens’ condemnation of the war was a significant environmental factor accounting for the veteran’s PETS. Vietnam was a total reversal of the zeitgeist as was evident during World War II. Before this time veterans coming back from WWW and WI were looked upon as heroes; Vietnam War veterans returning home were seen as murders and were shunned and rejected by much of the community. This only traumatized the returning soldiers more and exacerbated the PETS.

Post- traumatic stress disorder (PETS) is a mental health condition that’s prompted by a terrifying or severely distressing event that could be either experiencing or witnessing it. PETS is marked by a re-experiencing of the trauma: “in Hough, feeling… Which is in turn evidenced by emotional and psychological numbing. ” Symptoms may include flashbacks, dreams and severe anxiety as well as overpowering thoughts about the event. Post-traumatic stress really came to the forefront in the mid-ass to the ass due to the adjustment problems of numerous Vietnam vets.

One Vietnam veteran said, ‘You can’t take a 1 9-year-old brain and subject it to the constant threat of death or injury… And expect it not to be affected. ” Robert J. Liftoff a psychiatrist based at Yale University, said countless Vietnam vets combined characteristics of the … Traumatic Stress Syndrome (TTS) with an overwhelming preoccupation with questions of meaning… ” Psychiatrist Victor Franken wrote in his book, Man’s Search for Meaning that “an abnormal response to an abnormal situation is normal behavior. ” An interpretation would be: if things don’t make you crazy, then you aren’t very sane to begin with.

The Diagnostic and Statistical Manual: Mental Disorders (ADSM-I) published in 1 952 Was the first official manual of mental disorders. The use of the term “reaction” throughout the ADSM-I mirrored the influence of a psychobiology assessment that mental disorders epitomized responses of the personality or character to psychological factors. In the post-Vietnam period (mid ass), it became obvious that many soldiers were in anguish, suffering from severe psychological consequences as a result of their traumatic experience, yet psychiatrists had no diagnosis to refer to in the ADSM-II.

In 1 972, Chain Shasta, a psychiatrist, wrote a piece in the New York Times regarding the termed, “Post-Vietnam syndrome”. Soon afterward, the Committee on Reactive Disorders was commissioned to search for whatever research on tress and explore the possibility of adding the diagnosis to the ADSM-III (Scott, 1990). The committee amassed evidence from hundreds of cases for what was termed, “catastrophic stress disorder. ” In the end, the PAP acknowledged the committee’s conclusions and properly reformed the term to “postgraduates stress disorder”‘ (Scott, 1990).

Satin’s article in the New York Times reaped tremendous support for codifying post-Vietnam syndrome in the ADSM II (Scott, 1990). However, it wasn’t until the 1 sass that the term post traumatic stress. Fortunately, as our understanding of PETS has changed or evolved since its conception, so too has the treatment. Much has changed since America involved itself in the Vietnam War. In 2001 America went to war in Iraq/Afghanistan met with a new tactic of war; terrorism. Technological enhancements occurred and the nature of war transformed so immeasurably that all things associated with war, including PETS, had to evolve.

Yet even with new technological advances, PETS lingers on being an extensive and widespread condition of warfare. Combat in the mountains with an unidentified or unknown enemy has had a tremendous impact on soldier’s psychological welfare. Terrorism has been the most mutating tactic seen in modern conflict. Civilians are not theoretically to be targeted but due the fact that this is an unconventional war the enemy has to use every method of attack they can employ. This transformation in tactics, by both sides, inevitable meant a change in how soldiers would experience combat and this change meant that PETS would likewise change.

Not being able to define who the adversary was by just looking at his flag now it is almost impossible to tell if the people by the side of the road are civilians or part of a military. As a result it led some down the road of intense anguish. The exhaustive work by Kuhn shows that astoundingly it took a drastic or radical upsurge in suicides among veterans for PETS to amass the attention it required. It seemed as if the product of Vietnam had washed-out. Lessons learned were lessons lost. Soldiers are trained to kill with little regard of the enemy; to react instantly or lose your life.

They are conditioned consider the enemy as inhuman, but when they come close in confrontation to the enemy that hypothesis is at times challenged. For example: You are outside on your way and suddenly you hear a shot. You immediately fall to the ground for feet. You then locate the shooter. The shot rang from a distance but you felt the wind as the bullet shushed by your head. You take aim. Slowly you prepare to shoot. As the figure comes into your scope you slowly start to pull the trigger. Your heart is beating for fear. The sweat is pouring off you. Your thoughts are racing. Then suddenly you pull the trigger fully back.

Through your scope you see the shooter fall from a two story building. Feeling somewhat relieved you approach the fallen and suddenly notice it was a little girl about the same age as you daughter Candace. With blood pouring from ere head you just fall down and sit on the ground near her as tears roll down you cheek and fall to the ground. You reach out to touch her almost as if to say you’ll be alright; I’m here. You immediately come back to your senses and realize you have just killed a little girl that did not know. Was she forced to do what she did? Was she a victim of someone else’s anger that forced her to confront you?

You pull out your wallet and slowly take the picture of your daughter out. They could have been play mates. They could have been playing with dolls or having a tea party. How do we reconcile this morally? Where do you go to rationalize her death away? It was her life or yours. This is where ‘moral injury’ comes into play. This is where you have a collision of right and wrong. Moral injury is a philosophy that describes what many feel: a sense that their central understanding of right and wrong has collided and been desecrated and damaged, misery, detachment or guilt often follows. It is besieged with moral and ethical ambiguities of war.

It suggests an injury to a person’s moral conscience ensuing from an act Of moral offense which constructs profound emotional disgrace and shame. 5 It is a disruption of the ailing of right and wrong that allows a wound to aggravate the soul. Moral injury is a typical human reaction to an aberrant incident. 6 Department of Veterans Affairs psychiatrist DRP. Jonathan Shay says, “Post-traumatic stress disorder is the primary injury, the “uncomplicated injury. ” Moral injury is the infection; it’s the hemorrhaging. ” Guilt, self-condemnation, contempt of self and shame are at the epicenter of moral injury.

Brett Lilt, is currently a Professor in the Department of Psychiatry at Boston University School of Medicine and the Psychology Department at Boston university defines moral injury as “perpetrating failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectation” It has also been depicted as act of severe transgression that leads to somber inner conflict because the incident is at odds with core ethical and moral beliefs is called moral injury. Brett T Lilt et al. , “Moral Injury and Moral Repair in War Veterans: a Preliminary Model and Intervention Strategy. Although veterans make up only 7 percent of the U. S. Population, they account for a startling 20 percent of all suicides. Though treatment of post- aromatic stress disorder has unquestionably assuaged suffering and allowed many veterans returning from combat to transition to civilian life, for veterans under thirty the suicide rate has been escalating. It is no doubt that this moral injury has also contributed with its ingrained sense of transgression: feelings, grief, meaninglessness and remorse from having dishonored central fundamental moral values and beliefs they held.

The cultural perception on moral injury has been fostered in Jonathan Shay work. He defines moral injury as stemming from the “betrayal of ‘what’s right’ by someone who holds rower. “8 The treatment of recovery should entail “purification” through the “communication of trauma. “Moral injury can only be forgiven when “the trauma survivor… [is] permitted and empowered to voice his or her experience…. “9 For this to come about there needs to be sincerity on the part of civilians to not just hear but to listen carefully what is not being said. The veterans’ experiences need to be accepted without prejudging.

Fully coming “home” means integration into a culture or society where one is received, valued, appreciated and respected, has a sense of place, purpose, ND collective support. 10 It takes many years for even the most sane among us to arrive at what we have seen and wanted to forget. When a society sends people off to war, it must accept responsibility for returning them home to A Navy corpsman (medic) who served a tour each in Iraq and peace. Afghanistan said, “Guilt is the root of it, asking yourself, why are you such a bad person… L have a hard time dealing with the fact that I’m not me anymore. DRP. Shay says when an individual’s ‘moral horizon shrinks’ so does their ideals, principles, values and beliefs. ‘It’s despair that rips people apart who] feel they’ve become irredeemable. ‘ It’s a colossal emotional and rational pain you live with. You don’t feel that they can get past it because you feel deserve it. It is morality at its best confronted with anxious mindset of self-preservation. Something very devious has happened to you and corrupted your sense of self; you feel your life is without worth, the universe is a vast depraved place.

Moral injuries can also be caused by strikes to their moral stability, ravaging their sense of right and wrong and often leaving them with an ongoing traumatic torment. This is the moral concession made, avian or forced to deliberately cast aside values, break something inside yourself and transforming one into somebody hardly recognizable let alone acceptable. A Marine squad of Charlie Company was pinned down in a gully, taking intense fire from an adobe compound. Unable to move forward or to retreat, the squad leader Good an attack and Lance Cap.

Joseph Cochins, a 22- year-old on his second combat tour, lifted a rocket launcher to his shoulder, took aim and fired. The blast blew apart much of the adobe building. As the dust settled, the Marines could hear shouting and wailing. Their interpreter aid, ‘ ‘They want to bring out the wounded. ” As the torn and bleeding bodies were dragged out, it became clear that the Taliban had herded women and children into the building as human shields. Another soldier told of a firefight in Iraq. Insurgents had suddenly rushed toward him using women and children as shields. He had about three-quarters of a second to decide, and of course he killed. ” ‘When he arrived home, his wife handed him his new baby daughter. She put the baby in his arms and he immediately gave the baby back to her with an almost disgusted look – he almost dropped her,” he said. The thing was his new daughter was so beautiful and perfect and pure that he didn’t want his filth to contaminate her. This is the essence and depth of ‘moral injury. ‘ To speak to moral injury requires participating in moral questions regarding war with families, communities and society.

When such dialogues transpire, they mine a profound level of moral questioning in which language moves from being narrative and descriptive to being immensely transformation. A dialogue about moral injury targets morality, justice, and human dignity at the epicenter of public attention and disclosures a collective amnesia about war and its victims. To listen to the veterans that struggle with moral injury loosens the conversation from the individual issues of veterans after the war to significant questions about the morality of war.