The Invisible Wounds of War

I would add "too horrible." Though I may not share the Spartan aesthetic of war entirely, their mythology does clearly express the very real phenomenon of the bond or "brotherhood of the warrior." Here I think professionals have a place in sorting this out, a therapist proficient at staying out the way and steering the veteran in a direction of healing, and an ethicist who can help to understand and gain a perspective on morality and moral integrity.

Combat Related Psychological, Emotional, and Moral (PEM) Injuries

The intent of all combat action is to neutralize the enemies' ability to wage war.   The primary means of accomplishing this end in war-fighting is by creating enemy casualties, that is, by rendering the enemy incapable of continuing the hostilities.   This will include, of course, not only killing and physically injuring enemy combatants but psychologically and emotionally incapacitating them as well. Consider for example the endless artillery bombardment experienced by soldiers fighting in the trenches of the Western Front during World War One. As a consequence of these bombardments, not only were many individuals killed and physically wounded, but many more suffered PEM injuries (then termed "Shell Shock").   Language, how we characterize the human cost of war, its effects on the warrior, 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 a "normal response" to being hit by shrapnel. Nor would we deem it a physical illness. 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, AKA Shell Shock, Battle Fatigue, Combat Exhaustion, PTSD, as a "normal response" to battlefield conditions, or as mental illness. Since PEM injuries are the direct consequence of enemy war fighting, they are as much combat injuries, war wounds, as is a shrapnel-broken tibia. To say otherwise betrays either an effort to disenfranchise PEM injured veterans or 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 and the importance of treating and screening for their occurrence, given its culture of physical and mental toughness, these invisible injuries of war are rarely taken seriously, or are ignored completely, or stigmatized as mental illness. Further, 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. An important first step for the military in taking PEM injuries seriously, in eliminating the social stigma attached to seeking treatment, in recognizing such injuries not as a source of weakness, embarrassment or shame but of courage, honor and sacrifice, would be to recognize the Combat Related PEM injured soldiers as combat wounded and therefore eligible to be awarded the Purple Heart Medal. Tragically, until then, many soldiers and veterans will avoid seeking treatment for their injuries, and among those that do, adequate treatment and hence, healing, will not be forthcoming.

Some Further Suggestions for Healing

As trauma certainly remains a critical aspect of the war experience, an encompassing and holistic approach to treating the full spectrum of Combat Related PEM Injuries, may well include traditional (and nontraditional) clinical intervention for traumatic stress.

A s late adolescents/young adults were prepared, programmed for war through a sophisticated indoctrination process -- boot camp, basic training -- so also returning warriors must be "deprogrammed," i.e., prepared to reintegrate into a non martial environment. Consequently, veterans require reeducation to replace warrior values and behaviors with those appropriate to the society into which they are to reintegrate. This process is intended to shore up their moral identities and verify that this period of horror -- their time on the battlefield -- was a moral aberration and their doubts and questions regarding war and the warrior mythology well founded.

Once having realized the moral uniqueness of the battlefield, veterans should be guided to evaluate and assess their personal responsibility for their actions during war realistically and honestly. That is, they must take into account that war's cruelty and brutality distorts character and undermines ethical foundations and moral integrity. Further, they must be prepared to grasp, intellectually and emotionally, the impact such experiences have upon one's perception of correct behavior -- war does present a survival situation in which self-preservation and the preservation of comrades, becomes a primary motivation. In so doing, they may realize that their behavior in combat, though not justifiable, may be understandable, perhaps, even excusable and their culpability mitigated by the fact that those who determined policy, declared the war, issued the orders, and allowed the war to occur unchallenged, must share responsibility for the inevitable horror of war.

After all is said and done, a veteran may determine that guilt and shame is appropriate given his actions on the battlefield. In such situations, (self) forgiveness and/or absolution for his moral transgressions may be necessary, whether through religious ritual (confession, sweat lodge, etc.) or through acts of atonement (community service, or perhaps by speaking to students, civic organizations, etc., about the nature and reality of war). What is crucial to healing is that guilt not remain "static." While the past can never be undone, nor the dead be made to live again, this "giving back" may allow the veteran, if not to assuage his guilt, at least to have some sort of life around it. Hopefully, such acts of atonement will restore the veteran's sense of integrity -- his moral cohesion -- thereby raising his self esteem. Further, reestablishing one's moral identity will restore intelligibility to the veteran's world, his relationship to it and to other human beings, thereby ending his alienation and isolation from the remainder of the moral community.

Some Final Thoughts

However we veterans process the experience, what becomes apparent is that war can never be forgotten, or put behind us. We who have experienced its horror can never be made whole again. The best that can be hoped for, I believe, is to find a place for it in our being. As you can imagine this is a perilous journey, a difficult and complex process that unfortunately goes well beyond the telling of war stories, or having civilians understandingly, sympathetically, and   non judgmentally listen.

There are ways, however, in which civilians can help. If you know a PEM Injured veteran, suggest that she talk with other vets or with those who truly understand the experience in a group therapeutic environment. Second, war is violence against human beings, self and others. To help veterans heal and others from becoming victimized, stop the violence, stop the wars. Third, change the environment in which potential "enemies" are dehumanized and objectified, in which our children are indoctrinated into a culture of violence and hatred, and desensitized to the pain and suffering of potential victims. Fourth, demand that the Constitution, the law of the land, be restored and adhered to and that only Congress can declare war or commit troops into combat. Fifth, demand an end to gunboat diplomacy and that the use of violence and war be a last resort and only in the event of a real, immediate, and serious threat to our national security. Sixth, bring the troops home now and ensure that all the necessary resources are made available to assist them to recover from their injuries. Finally, end the influence of the war profiteers, the robber barons, and the military congressional industrial complex that profit from war and the lives and blood of our children.