In this second book of the Legacy of War Series, I will deal with the consequences of war, specifically what I term “PEM injuries,” the psychological, emotional, and moral injuries suffered by those who fight. The intent of all combat action is to neutralize the enemies' ability to wage war. The primary means of accomplishing this end in warfighting is by creating enemy casualties, i.e., by rendering the enemy incapable of continuing the hostilities. As was illustrated during the endless artillery bombardment experienced by soldiers fighting in the trenches of the Western Front during World War I, this includes not only killing and physically injuring enemy combatants, but psychologically and emotionally incapacitating them as well (then termed shell shock).
I will argue that language, how we characterize the human cost of war, the nature of the injuries sustained by the warriors, is critical both to our understanding of the institution of war and to veteran healing. I doubt, for example, that we would describe a broken tibia sustained during the bombardment as an illness, or as normal response to being hit by shrapnel. Rather, we recognize it as a combat injury, a war wound. Similarly, it is just as inaccurate and disingenuous to characterize a broken mind or damaged spirit, however it may be designated at the time – Soldier’s Heart, Shell Shock, Battle Fatigue, Combat Exhaustion, or Post Traumatic Stress Disorder (PTSD) – as mental illness or as a normal response to battlefield conditions. Since PEM injuries are the direct consequence of warfighting, they are as much combat injuries as a shrapnel-broken tibia. To say otherwise betrays either an effort to disenfranchise PEM injured veterans or an ignorance of the nature and severity of such injuries and the effects of combat action on the individual.
Though the military has given lip service to the prevalence, severity and debilitating effects of PEM injuries, specifically PTSD, and the importance of screening and treating soldiers and veterans for its occurrence, given the military's culture of physical and mental toughness, these invisible wounds of war are rarely taken seriously, are ignored completely, or stigmatized as mental illness. Further, until rather recently, the mainstream therapeutic community have neither recognized nor adequately addressed the prevalence and severity of moral injury suffered by members of the military and veterans. Tragically, military mental health professionals understand implicitly if not explicitly, that their function is to "cure" the soldier quickly, or, more likely, to mask his symptoms with medication and return him to the fighting.
I will argue that what is required to assist veteran recovery is a comprehensive and holistic treatment program that includes but goes beyond PTSD, that is, beyond traumatic stress, and deals with the detrimental effects of war upon one’s moral character and integrity – moral injury. Foundational to all moral injury are issues of meaning, value, and of personal, ideological and moral conflict precipitated by the veteran's experiences in war. A comprehensive treatment protocol requires, therefore, some understanding of the theoretical nature of war – its moral, social, and political underpinnings – the impact of the profound indoctrination, what I term the “conversion process,” soldiers endure during basic training – the process by which nations create effective warriors – soldiers who will kill. Additionally, healing may be augmented by an understanding of the nature of moral values, an abandonment of the warrior mythology, and a “sorting out” of the existential reality of war, all of which are essential to addressing the seemingly irreconcilable moral conflicts inherent to surviving the battlefield.
If the government is to fulfill its obligation to soldiers and to veterans, if their injuries are to be taken seriously and their needs met, the military and the Veterans Administration must go beyond lip service and pretense and create an environment in which veterans can feel confident and comfortable that their PEM injuries will be taken seriously and treated effectively. To encourage soldiers and veterans to accept and seek treatment for their injuries, I will argue below that a good first step would be to recognize PEM injured veterans as combat-wounded and therefore eligible to be awarded the Purple Heart medal. To do so would eliminate the stigma of mental illness; send the message that PEM injuries are not to be regarded as a source of weakness, embarrassment, or shame, but of courage, honor, and sacrifice.
Ultimately, however, war can never be forgotten nor put behind us. It will be with us for the remainder of our lives. By accepting responsibility and culp-ability for our actions, by performing acts of penance and retribution, “giving back,” however, we may achieve a sense of normalcy, forgive ourselves for our transgressions, and find a place for the experience in our being.
Table of Contents
Foreword
Introduction…………...................................................…………………1
Atrocity Producing Situations….....................................................……11
Invisible Wounds Of War:
The Clinical Model………...…...............................................................23
The Normal Response Model……........................................................31
The Moral Casualties of War…....................................................……..47
War Crazy…...…………….......…...................................................……86
Some Suggestions for Healing:
Introduction……...…………....................................................…………95
Transitioning from War……....................................................…...........96
Futility……………………..….................................................................102
Atonement Through Activism……........................................................103
The Rose………………....................................................……………..113
Transforming the Wounds Of War:
A Mindfulness Retreat with
Claude AnShin Thomas……......................................................……...114
When Soldiers Say No to War…......................................................….132
PEM Injuries and
the Purple Heart……….......................................................……………150
Parades: March of Folly…….......................................................……...167
Epilogue……………….…......................................................................169
