Introduction

By Robert Emmet Meagher and Douglas A. Pryer

"I open my eyes, and Saedi is bent over the still-crying prisoner. He whispers in his ear, and cigarette smoke escapes his nose to float up in the air and twirl around the one hanging light bulb. I hear more sobs, which become suckling whimpers.

I feel a deep loss.

I despair.

I need to escape.

I must escape, or I will become lost.

I quickly leave the cell and climb the stairs to the room. Outside, the sun is just beginning to rise."

—Lieutenant Colonel Bill Edmonds

So Lieutenant Colonel Bill Edmonds describes the gestation of his own inner torment in a torture chamber in Iraq and his ascent to the light—an ascent that prefigures his own spiritual rebirth, years later, when he leaves this darkness behind him to find self-forgiveness, strength, and new life. He calls this wounding torment “Moral Injury.” 

What is this Moral Injury that Edmonds and others in this collection describe? Many believe it to be the signature wound of today’s wars, a wound that all too often goes unrecognized and improperly treated. Some in this volume go further and see it as the inevitable wound of all war. The psychiatrist Jonathan Shay, who popularized the term and who is a contributor to this volume, uses it to mean a profound sense of betrayal of “what’s right,” either by a “legitimate authority” or by oneself (selection 39). A majority of leading mental health researchers and clinicians define the sources of Moral Injury more broadly, stating it can result from “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Symptoms widely associated with Moral Injury include guilt, shame, a loss of trust (in yourself, others, or God), feelings of powerlessness or hopelessness, depression, anxiety, anger, re-experiencing of the moral conflict, and self-destructive behaviors (suicidal ideation, substance abuse, high-risk behavior, the sabotaging of close relationships). Not all our authors, however, regard medicalized descriptions of Moral Injury, and the recommended therapies emergent from them, as adequate to explain or address the pain they have suffered or witnessed. If there were consensus regarding the etiology and treatment of Moral Injury, there would be no need for this volume, which offers many diverse views and voices.

Despite this lack of consensus, it is clear that Moral Injury is as old as the human record. We see it in the “mark of Cain” borne by the first fratricide, when he was banished in shame. We hear it in the lament of Sophokles’ boy-warrior Neoptolemos, who learns the hard way, the only way, that “All is disgust when one leaves his own nature and does things that misfit it.” We recognize it too in the elaborate system of penances imposed on Christian warriors in the Middle Ages, recompense for every life taken in battle, no matter how valiant the warrior or how just (even holy) the Church declared his cause to be. We witness it too in the refusal of so many RAF bomber crews to take Communion before their life-taking missions over Germany and occupied Europe, despite the odds against their safe return. We read it today in heartrending notes left behind by honored veterans who have found the burden of life after war too heavy to bear for even one more day. However unable we are to agree on a single understanding of Moral Injury, or any one account of its causes, symptoms, or cure, we somehow know it when we see it.

The late great anthropologist Claude Lévi-Strauss, abandoning the search for the one true version of any myth, argued that the truth of a myth is to be found in the sum of all of its versions. While Moral Injury is anything but a myth, the same principle holds true for all of its widely variant understandings. Together they shed more light and advance the common cause further than any one of them can reasonably aspire to do on its own. Clinicians of every stripe and school, Native American healers, Yoga instructors, practitioners of Asian medicine, theologians, chaplains, pastors, rabbis, imams, parents, friends, fellow veterans, companion dogs, therapy horses—these and many others in no clear order—all may play a critical role in understanding and healing the pain of those who go off to war and return visibly intact and invisibly anguished. Whatever sheds light, whatever helps, is worth knowing and sharing—this at the very least is a sound point of departure.

This volume began several years ago with a conversation and meeting of minds that was initiated and fostered, as so often happens today, on the Internet. It was, on the face of it, an unlikely alliance and friendship that ensued between a career military officer and a life-long peace activist, a combat veteran and a college professor. Their—our—point of contact and convergence was Moral Injury or, more precisely, what each of us independently was wrestling with and writing about it. This book began with our reading of each other’s work, our listening to each other’s voice, and our recognizing in that voice a partner—not a “partner in crime” as the saying goes, but rather a “partner in care” for those wounded in war, wounded so deeply and invisibly that their rending pain is still mostly unrecognized, misunderstood, and unaddressed. 

No matter how relatively neat and discreet might be the entry wound of a Moral Injury, the exit wound is inevitably messy and devastating, wide in its reach and incalculable in its damage. Moral injuries are not easily contained. The would-be firewall between our military and civilian worlds, between the war zone and the home front, is in the end illusory. There can be no effective, much less ethical, quarantine installed between the morally injured and the seemingly unscathed. All apparent signs and vocal disclaimers to the contrary, it is the nation that goes to war when it sends its sons and daughters, fathers and mothers, brothers and sisters to kill and be killed. Those same warriors, at the end of the day, bring their war, our war, home with them to the nation, to their neighborhoods, to their families, to us, home to roost, as it were. 

Consequently, the divide between seasoned warrior and would-be peacemaker, between Pentagon planner and classroom instructor—a divide that one might imagine insurmountable—came to nothing in the face of what we each knew to be a national and human crisis. Listening to others, to one another, can do that—tear down walls, cut holes in fences, dissolve differences, reveal common ground. It has been our hope that in widening that conversation, and opening it out to enlist the rich diversity of voices represented between the covers of this book, that a national conversation and community of concern might be fostered. That conversation, we know, is already going on, and that community already taking shape. It is also our hope that this volume will contribute significantly to both.

From the start, the aim of this book project has been to provide for veterans and active-duty military, as well as their families, clinicians, clergy and caregivers, scholars and students, politicians and the concerned general public, an invaluable resource. As we envisioned it, the common cause of every voice in this volume would be to inform the national conversation on war and its deepest wounds and to advocate for the wounded, not only to reveal trauma but more importantly to point out possible paths of healing, and, finally, to instill hope in all those whose grasp on it is loosening. Hope, after all, begins with knowing that one is being heard, understood, and reached out to.

In building this volume “from the ground up,” we reached out first to veterans and asked for their voices, their stories, their poems, their wisdom. The tales of Moral Injury that they tell are both varied and similar: there are stories of killing, witnessing or committing torture, suffering military sexual assault, being cruelly hazed, participating in nuclear preparedness exercises, feeling the failure to protect comrades, loved ones, or civilians, ministering to the broken, and despairing. These tales, though, also include stories of healing. It is these stories that we thought especially important to include.

Next, we assembled an international “university” of other professions and disciplines: psychiatry, psychology, philosophy, classical studies, law, comparative religion, theology, journalism, and poetry. In doing so, it was our avid hope that this volume might encourage further cross-disciplinary and international study among scholars on this vital, universal topic. It would indeed be a terrible shame were scholarship pertaining to Moral Injury to remain stove-piped within different disciplines and more or less confined to a handful of nations.

When choosing what work to include, we looked for writings that were accessible and authoritative. By “accessible,” we mean work that service members, veterans, and their loved ones would want and be able to read without having to cut their way through thickets of jargon or unnecessarily dense prose. So, we did not include some undeniably valuable clinical or empirical studies, though these are cited liberally throughout the book. We encourage readers to dive into that growing scientific literature themselves. One would do well to read, for example, the foundational article by Brett Litz and his colleagues, “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy,” as well as Shira Maguen and Litz’s “Moral Injury in Veterans of War,” an excellent survey of clinical studies of Moral Injury up to 2012. By “authoritative,” we had in mind work by scholars and authors, many already known and noted, who have brought to their writing a depth of research, learning, and personal experience, together with insight and integrity. Most of the contributions collected here are either original or thoughtful reconsiderations of previously printed work. Some seminal work, such as Peter Marin’s classic post-Vietnam reflections on “Living in Moral Pain” (selection 27), WWII Navajo code talker Chester Nez’s account of his ritual path to healing (selection 23), and Tyler Boudreau’s penetrating Iraq War commentary “The Morally Injured” (selection 13), are here reprinted in their original forms. 

In sum, under one cover, the varied materials in this volume comprise studies, essays, memoirs, and poetry—in our view, representative of the finest out there—whether already written, previously published, or created specifically for this collection. To assist readers in selecting readings from this veritable cornucopia of material, we grouped authors into five sections: Poets, Warriors, Reporters, Chaplains, and Scholars. There is admittedly some artificiality in this distinction. Many of our authors wear more than one of these caps. Erik Masick, for example, is not only a military lawyer; he is also an active-duty Army officer and former infantry soldier. He is thus both a scholar and warrior. However, placing his essay in the Scholar section was an easy choice, for what his essay most fully teaches us is firmly grounded, not in combat experience, but in Erik’s professional expertise as a lawyer (selection 37).

It is important to note that, while we focused on veterans’ views and voices, Moral Injury is not something with which only veterans are afflicted. Civilians on the battlefield may also find cause to lose trust in themselves, in others, or in God, and after this loss of faith, feel helpless to remedy their situation. Our focus on the stories of veterans is due to the literature being so rich here, and because veterans are, we believe, the population that is most at risk for Moral Injury. We also have very personal reasons for this narrow scoping. We ourselves both know and care deeply about many veterans suffering with Moral Injury, and one of us believes he himself has been afflicted with it. 

While the stories in this volume are military ones, non-veterans with Moral Injury themselves, or who care for someone with this condition, should well be able to relate to, and learn from, these stories of injury and healing. We advise and ask, though, that those who consider themselves to be morally injured proceed slowly and cautiously while reading this book. Some stories could re-open poorly healed wounds. If you feel that happening, please put this book down, seek the assistance or companionship that will help you, and resume reading only once you are sure that you are ready to do so. 

All readers, take note: this book presents a strong, vivid, to some painful or challenging argument against war. It does not, however, argue that war is never necessary. Several of this book’s authors, while recognizing the vital role of the military, offer options to leaders for reducing the chance that their troops will be afflicted with Moral Injury in the exercise of their duties. At the same time, all the voices in this book are at one in reminding us what war can and often does do to the psyches of warriors who survive it. One of the most alluring and enduring of modern myths is that well-trained, physically protected warriors can as a rule kill without being killed, without suffering a kind of death themselves. War, the authors in this volume make clear, kills not only those it buries in the ground. It can just as surely kill the souls of warriors who, having marched off to war and Moral Injury, return home, where, standing tall while the music plays and their hometowns cheer, feel inside that they are forever lost.

War, therefore, is far harder to comprehend and to recover from than we wish to believe it is. This is especially true of modern war, when, generally, it is not our own loved ones who fly off to wage it. Most of us today don’t have an immediate family member or friend who is a combat veteran, and, even when we do, our loved ones don’t come home to us at sunset, direct from a battle fought that morning, blood-splattered, slimed with gore, with fresh wounds needing treatment. Rather, they are gone from us for months, perhaps a year or more, and when they return, their physical wounds have been cleaned and treated and, in most cases, have completely healed. By the time we see and hug them, our loved ones may not display any visible injury at all. They may even look “good as new.”

The distancing and sanitizing of modern war make it more bearable for those at home and thus, tragically, far more likely to happen and be accepted. Separated from war by time and oceans, those at home may hear stories and see images that horrify them, but this horror possesses none of the haunting immediacy of actual personal memory. Secondhand thoughts and images of war are more like dreams we can choose to wake up from and forget—or, in today’s world, like channels we can instantly escape with a push of a button on our remote, or as easily as exiting a website or closing an app. This physical and temporal remoteness—true, for example, of every American conflict since the Civil War—has meant that even when something like an entire generation feels the horrors of war, their bitter memories typically morph into the next generation’s nostalgic dreams of victory and heroism.

Here we must acknowledge a great gap in this text as in nearly every other on the subject of America’s wars and veterans: the deaths and wounds, physical and spiritual, inflicted on the “others,” our enemies, especially our “civilian enemies.” When we walk the blood-soaked soil of the Gettysburg battlegrounds, we acknowledge and feel the pain of all who suffered and died there, and understandably so; but when we approach the awesome sacred gravity of the Vietnam Wall, we are less likely to bear in mind and mourn the loss of the estimated two million Vietnamese lives taken in that same war. As it happens, one of the editors was recently reminded of that fact by a Vietnam veteran who was central to the creation of the Vietnam Memorial. It is chastening to remind ourselves too that the war Americans know as the Vietnam War is known in Vietnam as the American War. How can we forget that every war has at least two sides? “Easily” is perhaps the answer that first comes to mind. 

Amidst this awful cycle of war and forgetting, this book stands defiantly hopeful. Its authors equip veterans with ways to better understand the moral injuries with which they may be afflicted, reassure veterans that they are not alone, and help them to realize that, just as physical amputees can learn to live well in the aftermath of their injuries, spiritual amputees can restore their lives and rediscover joy. For readers who are caregivers, the authors offer different frameworks for understanding, dealing with, and treating the morally injured. And for readers who have neither gone to war nor interacted closely with those who did, the authors serve collective notice of war’s enduring cost, lest these readers—via nostalgic dream, irrational fear, the incomplete calculation of self-interest, or fleeting passion—endorse yet another unnecessary war and send others off to fight it.