Not reducing war to a sickness or a smiley face

U.S. Marines patrol during an operation near Zalmabad village in Musa Qala district of Helmand province, Afghanistan, Jan. 23, 2011. AFP/Getty Images

(TomDispatch) "PTSD is going to color everything you write," came the warning from a stepmother of a Marine, a woman who keeps track of such things. That was in 2005, when post-traumatic stress disorder, a.k.a. PTSD, wasn't getting much attention, but soon it was pretty much all anyone wrote about. Story upon story about the damage done to our guys in uniform -- drinking, divorce, depression, destitution -- a laundry list of miseries and victimhood. When it comes to veterans, it seems like the only response we can imagine is to feel sorry for them.

Victim is one of the two roles we allow our soldiers and veterans (the other is, of course, hero), but most don't have PTSD, and this isn't one of those stories.

Civilian to the core, I've escaped any firsthand experience of war, but I've spent the past seven years talking with current GIs and recent veterans, and among the many things they've taught me is that nobody gets out of war unmarked. That's especially true when your war turns out to be a shadowy, relentless occupation of a distant land, which requires you to do things that you regret and that continue to haunt you.

Theoretically, whole countries go to war, not just their soldiers, but not this time. Civilian sympathy for "the troops" may be just one more way for us to avoid a real reckoning with our last decade-plus of war, when the hostilities in Iraq and Afghanistan have shown up on the average American's radar only if somebody screws up or noticeable numbers of Americans get killed. The veterans at the heart of this story -- victims, heroes, it doesn't matter -- struggle to reconcile what they did in those countries with the "service" we keep thanking them for. We can see them as sick, with all the stigma, neediness, and expense that entails, or we can recognize them as human beings, confronting the morality of what they've done in our name and what they've seen and come to know -- even as they try to move on.

Sacred Wounds, Moral Injuries

Former Army staff sergeant Andy Sapp spent a year at Forward Operating Base Speicher near Tikrit, Iraq, and has lived for the past six years with PTSD. Seven if you count the year he refused to admit that he had it because he never left the base or fired his weapon, and who was he to suffer when others had it so much worse? Nearly 50 when he deployed, he was much older than most of his National Guard unit. He had put in 17 years in various branches of the military, had a stable family, strong religious ties, a good education, and a satisfying career as a high-school English teacher. He expected all that to insulate him, so it took a while to realize that the whole time he was in Iraq, he was numb. In the end, he would be diagnosed with PTSD and given an 80% disability rating, which, among other benefits, entitles him to sessions with a Veterans Administration psychologist, whom he credits with saving his life.

Andy recalls a 1985 BBC series called "Soldiers" in which a Marine commander says, "It's not that we can't take a man who's 45 years old and turn him into a good soldier. It's that we can't make him love it." Like many soldiers, Andy had assumed that his role would be to protect his country when it was threatened. Instead, he now considers himself part of "something evil." So at a point when his therapy stalled and his therapist suggested that his spiritual pain was exacerbating his psychological pain, it suddenly clicked. The spiritual part he now calls his sacred wound. Others call it "moral injury."

It's a concept in progress, defined as the result of taking part in or witnessing something of consequence that you find wrong, something which violates your deeply held beliefs about yourself and your role in the world. For a moment, at least, you become what you never wanted to be. While the symptoms and causes may overlap with PTSD, moral injury arises from what you did or failed to do, rather than from what was done to you. It's a sickness of the heart more than the head. Or, possibly, moral injury is what comes first and, if left unattended, can congeal into PTSD.

What we now call PTSD goes way back. In "Odysseus in America," psychiatrist (and MacArthur "genius" grantee) Jonathan Shay has traced similar symptoms to Homer's account of Odysseus's homecoming from the Trojan War. The idea that a soldier may continue to be haunted by his wartime life has had a name since at least the Civil War. It was called "soldier's heart" then, a lovely name for a terrible affliction.

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Nan Levinson, a Boston-based journalist, reports on civil liberties, politics, and culture. Her next book, "War Is Not a Game," is about the recent G.I. antiwar movement. She is the author of "Outspoken: Free Speech Stories," was the U.S. correspondent for Index on Censorship, and teaches journalism and fiction writing at Tufts University. This piece originally appeared on TomDispatch. The opinions expressed in this commentary are solely those of the author.

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