I don't know why it took so long to come up with the miraculous term, "moral injury," but it did.
Shell-shock, battle-fatigue, PTSD—these terms described something that some combat veterans suffered from, while it always seemed many more—and maybe all of them—were suffereng from something else, that didn't have a name.
And then along trapses a clinical psychiatrist named Jonathan Shay, and coins the term "moral injury," which distinguishes people who are fucked up from fearsome events shocked their nervous system … from those fucked up because war disturbed their moral system. For victims of "moral injury," living in a world of killing upset their sense of right and wrong and they feel nuts being back in the world that formed their original morality.
And then up shambles a Huffington Post military writer who popularizes the term by describing some of its victims, and the treatment approaches that differ from traditional PTSD tactics.
And then on Veteran's Day last week, in tiptoes National Public Radio's elfin giant Terry Gross, to expose the HuffPo writer's ideas on Fresh Air.
And suddenly I'm thinking about Stephen T. Banko, who won the Cicero Speechwriting Award the first year I presided over them, in 2009, with what is still the best speech I've ever published in Vital Speeches, I think.
Here's how Banko described "moral injury" without knowing of the term:
It was but a blink of an eye from a violent Sunday night when I killed a man from ambush to a disoriented Friday night back home, among those I'd left behind when I went off to war. It's over they kept telling me. It's over. Just forget about it.
In real time, they were right, of course. But my reality was somewhere between what I'd left and what I couldn't fully walk away from. My war was indeed over—and over and over and over again in my mind, playing on an endless loop—the same heat, the same hurt, the same horror … always ending with me alive and so many of my friends dead.
It didn't take long for me to realize that surviving combat was almost as bad as not surviving.
So why did it take our government so long to realize it? Why did it take the psychiatric profession so long? Why didn't our fathers tell us the ugly, immutable truth about war: that never does anyone return as the same person who left?
Primitive societies knew it. They had no Dr. Phils … no Sanjay Guptas … no plethora of pop psychologists to gum the problem to death. But they had experience. They knew what war did to the soul and the mind as well as to the body. Reach back into antiquity. Go all the way back to Virgil and his class "The Aeneid." In Book II, Aeneis recognizes:
'In me 't is impious holy things to bear,
Red as I am with slaughter, new from war,
Till in some living stream I cleanse the guilt
Of dire debate, and blood in battle spilt.'
Aeneas knows he has murdered and plundered. He knows he has offended the gods. His survival does not excuse it. His cause cannot justify it. He knows he must atone for his combat conduct and cannot even touch the cherished things of his life until he finds that living stream in which he can cleanse his guilt.
Why didn't anyone tell us that which the ancients knew? Why didn't they tell us about the guilt of dire debate and blood in battle spilt? Why didn't they help us find the living stream of cleansing?
Aeneas knew that he needed to be cleansed. He knew he needed a living stream to make him human again. But he wasn't the only one. American Indians knew it too—the ones we called primitive savages. They were smart enough to know that warriors return from battle damaged in body and spirit. Bodies heal themselves. Spirits need work. So the tribes sent returning warriors off to retreats distant from the tribe. They sent them off to decompress, to purge their guilt, to heal their spirits. In modern society, we assign too few to care for too many and take too long to do it. There remains a built-in bias against those who seek care for damaged spirits, considering them weak or effeminate, so we tend to physical wounds but we don't talk much about spiritual wounds.
Our belief in the righteousness of our causal justification and the refusal to understand the conflict between a collective national conscience and individual mores increase the odds against any quick or complete return to normalcy. As the soldier struggles in the bivouac of his private first class world, society proclaims combat service a virtue. The dichotomy can be devastating. The veteran finds he is unable to be who he was, unable to connect with who he is and over time, becomes unable to be unable any more.
Or, in other words, he has a "moral injury," which (clearly) requires an entirely different treatment approach than PTSD. And its having a different name makes this different treatment possible! In fact, its having a different name is part of the treatment.
How did it take so long for us to make this crucial and obvious distinction?
And goddamnit, what other muddled maladies would some new terminology set us down a brand new path toward solving?