Moral Injury and the Humanities: Interdisciplinary Perspectives [1 ed.] 9781003281122, 9781032249964, 9781032249971

Table of contents :
Cover
Half Title
Series Page
Title Page
Copyright Page
Table of Contents
Acknowledgments
Introduction
Section 1 Some Frameworks for Moral Injury
1 The Moral Challenges of Moral Injury
2 Ulterior Motives and Moral Injury in War
3 Theorizing Moral Injury with Reports of Trauma
4 The Ethics of Moral Injury
5 Moral Injury and the Making of Amends
Section 2 Experiences of Moral Injury
6 Greek Tragedy, Virgil's Aeneid, and the Moral Injury of Combat Veterans and Health-Care Workers
7 Moral Injury in Law Enforcement
8 Photojournalism and Moral Injury: An Inquiry
9 The Moral Limits to Moral Testimony in Soldiering
10 Meaning-Making and Moral Injury: The Role of the Narrative in Understanding Trauma
Section 3 Accounts of Recovery: Applying Humanistic Approaches to Moral Injury
11 Evil in Innocence: Moral Injury and the Encounter with Children
12 On the Necessity of Ritual for Moral Injury Recovery
13 Animist Forms of Atonement and Healing in Edwidge Danticat's the Dew Breaker
14 Rituals and Moral Injury: How Veterans Make Peace
Conclusion
List of Contributors
Index

Citation preview

Moral Injury and the Humanities

This book brings together leading interdisciplinary scholars to broaden and deepen the conversation about moral injury. In the original chapters, the contributors present new research to show how the humanities are crucial for understanding the expressions, meaning, and significance of moral injury. Moral injury is the disorientation we suffer when we are complicit in some moral transgression. Most existing works address moral injury from a clinical or neuroscientific perspective. The chapters in this volume show how the humanities are crucial for understanding the meaning and significance of moral injury as well as suggesting how to grapple with its lived challenges. The chapters address the conceptual, sociological, historical, and ritualistic dimensions of moral injury across three thematic sections. Section 1 explores how tools of the humanities provide new lenses for understanding conceptual and genealogical themes about moral injury. Section 2 highlights the experiences of moral injury in combat soldiers, law enforcement, and noncombatants such as photojournalists. These chapters examine the power and limits to theorizing moral phenomena by appeals to lived experience. Section 3 considers how humanistic inquiry illuminates important dimensions of the aftermath of moral injury beyond the scope of clinical research. These chapters consider how ritual, relationship repair, and atonement might shape the ways people navigate moral injury and consider how such responses shape our understanding of what we owe to one another. Moral Injury and the Humanities: Interdisciplinary Perspectives is an essential resource for researchers and advanced students in philosophy, religious studies, literature, journalism, and the arts who are interested in moral injury. Andrew I. Cohen, Ph.D., is a Professor of Philosophy and the Director of the Jean Beer Blumenfeld Center for Ethics at Georgia State University. He is the author of Philosophy, Ethics, and Public Policy (Routledge, 2015)

and Apologies and Moral Repair: Rights, Duties and Corrective Justice (Routledge, 2020). He has edited or co-edited books on applied ethics and public policy. His current research focuses on the requirements of corrective justice. Cohen currently serves on the Board of Directors for the Association for Practical and Professional Ethics. With Jennifer A. Samp and Kathryn McClymond, Cohen investigated moral injury through a study funded by the National Endowment for the Humanities. Kathryn McClymond, Ph.D., is Provost and Vice President of Academic Affairs, Oglethorpe University. Prior to that, McClymond was a Professor of Religious Studies at Georgia State University where she served as Department Chair and Associate Dean for Faculty Affairs. McClymond is a comparative scholar of religions, with a particular interest in religion, ritual, and violence. McClymond’s most recent book, Ritual Gone Wrong: What We Learn from Ritual Disruption (2016), examines a range of case studies of ritual gone wrong, exploring what we learn about the nature of ritual itself by studying ritual mistakes, sabotage, misappropriation, and failure. Her first book, Beyond Sacred Violence: A Comparative Study of Sacrifice (Georgia Author of the Year Award 2009), argued against prevailing conceptions of sacrifice as a violent, destructive activity.

Routledge Studies in Ethics and Moral Theory

The Transcendent Character of the Good Philosophical and Theological Perspectives Edited by Petruschka Schaafsma Philosophical Perspectives on Moral Certainty  Edited by Cecilie Eriksen, Julia Hermann, Neil O’Hara, and Nigel Pleasants  The Guise of the Good A Philosophical History Francesco Orsi The Making of the Good Person Self-Help, Ethics and Philosophy Nora Hämäläinen Moral Teleology A Theory of Progress Hanno Sauer Agent Relative Ethics Steven J. Jensen Moral Injury and the Humanities Interdisciplinary Perspectives Edited by Andrew I. Cohen and Kathryn McClymond

For more information about this series, please visit: https://www.routledge.com/ Routledge-Studies-in-Ethics-and-Moral-Theory/book-series/SE0423

Moral Injury and the Humanities Interdisciplinary Perspectives

Edited by Andrew I. Cohen and Kathryn McClymond

First published 2024 by Routledge 605 Third Avenue, New York, NY 10158 and by Routledge 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2024 selection and editorial matter, Andrew I. Cohen and Kathryn McClymond; individual chapters, the contributors The right of Andrew I. Cohen and Kathryn McClymond to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Cohen, Andrew I., editor. | McClymond, Kathryn, 1960– editor. Title: Moral injury and the humanities : interdisciplinary perspectives / edited by Andrew I. Cohen, and Kathryn McClymond. Description: New York, NY : Routledge, 2024. | Series: Routledge studies in ethics and moral theory | Includes bibliographical references and index. Identifiers: LCCN 2023016450 (print) | LCCN 2023016451 (ebook) | ISBN 9781032249964 (hardback) | ISBN 9781032249971 (paperback) | ISBN 9781003281122 (ebook) Subjects: LCSH: Moral injuries. | Psychic trauma—Social aspects. | War—Moral and ethical aspects. | Law enforcement—Moral and ethical aspects. Classification: LCC BF175.5.P75 M67 2024 (print) | LCC BF175.5.P75 (ebook) | DDC 155.9/3—dc23/eng/20230522 LC record available at https://lccn.loc.gov/2023016450 LC ebook record available at https://lccn.loc.gov/2023016451 ISBN: 978-1-032-24996-4 (hbk) ISBN: 978-1-032-24997-1 (pbk) ISBN: 978-1-003-28112-2 (ebk) DOI: 10.4324/9781003281122 Typeset in Sabon LT Pro by codeMantra

Contents

Acknowledgmentsix Introduction

1

ANDREW I. COHEN AND KATHRYN McCLYMOND

SECTION 1

Some Frameworks for Moral Injury15   1 The Moral Challenges of Moral Injury 

17

JOHANNES LANG AND ROBIN MAY SCHOTT

  2 Ulterior Motives and Moral Injury in War

35

SABA BAZARGAN-FORWARD

  3 Theorizing Moral Injury with Reports of Trauma

50

ANDREW I. COHEN AND JENNIFER A. SAMP

  4 The Ethics of Moral Injury

68

DAVID RODIN

  5 Moral Injury and the Making of Amends

85

LINDA RADZIK

SECTION 2

Experiences of Moral Injury101   6 Greek Tragedy, Virgil’s Aeneid, and The Moral Injury of Combat Veterans and Healthcare Workers HENRY BAYERLE

103

viii Contents   7 Moral Injury in Law Enforcement

124

JOHN KLEINIG

  8 Photojournalism and Moral Injury: An Inquiry

138

LAUREN WALSH

  9 The Moral Limits to Moral Testimony in Soldiering

162

KEVIN CUTRIGHT

10 Meaning-Making and Moral Injury: The Role of the Narrative in Understanding Trauma

178

JOSHUA MANTZ

SECTION 3

Accounts of Recovery: Applying Humanistic Approaches to Moral Injury195 11 Evil in Innocence: Moral Injury and the Encounter with Children

197

ALAN ROOF

12 On the Necessity of Ritual for Moral Injury Recovery

214

RITA NAKASHIMA BROCK

13 Animist Forms of Atonement and Healing in Edwidge Danticat’s The Dew Breaker

230

JAY RAJIVA

14 Rituals and Moral Injury: How Veterans Make Peace

249

KATHRYN McCLYMOND

Conclusion

266

List of Contributors 271 Index275

Acknowledgments

The Editors thank Ashley Lindsley-Kim for help in copyediting many essays and for preparing the index. The Editors are grateful to Catherine Jacob for stewarding this project in its final stages, to Charles Arokiaraj for meticulous copyediting, and to Andrew Weckenmann and Rosaleah Stammler at Taylor and Francis for their support, guidance, and patience.” Research on portions of this project was supported by a National Endowment for the Humanities Grant, RZ-249909-16, “Reparative Justice and Moral Injury among Post-deployment Soldiers.”

Introduction Andrew I. Cohen and Kathryn McClymond

There is growing awareness of the lasting physical and psychological impacts and many dimensions of trauma. Important research over the last five decades has targeted the physical and mental health problems associated with combat. This work has given language to and validated the experiences of many who have served in the armed forces and their families. Combat and other great traumas can inflict invisible wounds. Clinicians have long documented post-traumatic stress disorders (PTSDs). Practitioners and survivors can attest to variably successful treatments. There are, however, other hidden wounds. Among them are harms linked to moral commitments. In the wake of combat violence, people often grapple with guilt, shame, betrayal, dishonor, resentment, and an incapacitating disorientation about the meaning and power of moral norms. Scholars, clinicians, and clergy increasingly speak of “moral injury” when describing such trauma, a term first coined by psychiatrist Jonathan Shay. Moral injuries can result from committing, witnessing, or failing to stop an injustice. Because moral injuries are types of debilitating ethical disorientations, they can be distinct from post-traumatic disorders. As Jonathan Shay and Nancy Sherman document, the phenomena of moral injury are evident throughout history and in a variety of human experiences (Shay 1994; Sherman 2015). There are reports of moral injury in Greek tragedies and other texts. For example, Euripides describes the bloodguilt of Herakles, who laments the madness that drove him to massacre his family (Euripides and Cannon 1997). The book of Genesis reports Cain’s shame for the sin of murdering his brother (Carroll and Prickett 2008). As Jonathan Shay documents, Achilles in the Iliad responds after a betrayal with what the Greeks called menis, or a sort of indignant rage (Shay 1994). Such narratives show moral injuries including the disorientation one suffers from complicity in injustice. In American history, US armed forces personnel from many tours of duty have reported the types of wounds scholars currently call moral injury. Letters from US Civil War soldiers and descriptions of their post-combat DOI: 10.4324/9781003281122-1

2  Andrew I. Cohen and Kathryn McClymond challenges show a debilitating struggle with guilt and shame for complicity in atrocity (Dean 2000). World War I veterans frequently struggled with what was termed “shell shock.” US Airmen in WWII suffered shame for harming or killing civilians (Grinker and Spiegel 1945). More recently, soldiers’ published narratives (Marlantes 2012; Sites 2013; Capps 2014; Klay 2015; Morris 2015; Mantz 2017) and clinicians’ studies (Litz et al. 2009; Shay 2011; Nash and Litz 2013; Farnsworth et al. 2014; Currier, Holland, and Malott 2015) describe how such injuries disable soldiers as moral beings. Moral injuries shatter a person’s self-image and confidence in foundational moral frameworks. Moral injury is not unique to those who serve in the armed forces. Journalists, health care providers, first responders, and others have reported the phenomena (Benshoof 2017). While important clinical work has targeted the physical and mental health problems associated with combat and other traumatic experiences, such models are incomplete resources for addressing the distinct set of post-combat moral challenges characteristic of moral injury. As Jonathan Shay writes, moral injury typically involves unaccounted moral losses that come from the “betrayal of ‘what’s right’ in a high-stakes situation by someone who holds power” (Shay 2011). Such unwelcome losses might link to increased dispositions to violence, decreased ability to trust loved ones or those in authority, and an incapacitating despair, guilt, or indifference. While scholars have recently added to, adapted, or sometimes challenged Shay’s account of moral injury, in all such accounts, the morally injured and those in their families and communities do not merely need clinical guidance in confronting the challenges they face. The clinical sciences alone do not adequately address meaning and justification as dimensions of human experience. These dimensions are crucial for understanding the normative significance and social manifestations of some post-trauma challenges. In particular, those who experience (or might experience) moral injuries might have reasons to do or not do certain things for prevention, coping, or recovery. Family members, citizens, and the state might also have reasons for action or forbearance in light of such injuries. Those reasons might be crucially shaped by moral understandings. Such reasons might engage apologies, forgiveness, penitential practices, and normative accounts of state responsibilities to its citizens. Understanding whether there are such reasons and what their structure might be are not clinical tasks. Exploring such issues is the province of humanities disciplines attuned to questions of meaning and justification. This is why clinical accounts of combat trauma in general, and the PTSD framework in particular, are alone inadequate for understanding moral injury. Humanists are only beginning to study the meaning and significance of moral injuries. The few available humanistic studies of moral injury focus

Introduction  3 on just war theory, the justification for engaging in combat. These studies offer critiques of the just war tradition (Meagher 2014) or blend searing narratives with suggestions for reconstructing empathy, hope, and trust (Brock and Lettini 2012; Sherman 2015). There is now an opportunity for new theorizing about the individual experience of moral injury and the social cost of trauma, broadening the focus from justifying and recovering from combat to understanding the meaning and significance of the moral injury that occurs in other contexts. The humanities, broadly conceived, are a family of related fields of inquiry. They often include literature, philosophy, art, language, religion, and humanistic social sciences such as anthropology, history, and sociology. The humanities are platforms for critically understanding what makes our lives and our connections meaningful. They help us to understand what it is to be human. They provide tools for interpreting and understanding human experiences. They highlight the significance of lived experience for communities that transcend generations. The humanities also help us to imagine alternative ways of constructing significance. At their best, these fields study and cultivate tolerance, openness, and a sensitivity to vulnerability as parts of understanding our shared interests and our shared humanity. The humanities offer constructive strategies for understanding the many dimensions of our human condition, across varied historical, linguistic, and cultural communities. This volume deepens and broadens the growing conversation about what the humanities contribute to scholarly inquiries into moral injury. We divide the volume into three sections: (1) frameworks, (2) experiences, and (3) recovery. In the first section, “Some Frameworks for Moral Injury,” contributors consider the notion of moral injury itself. While the humanities laid the foundation for discussions of moral trauma such as with Ancient Greek drama and Christian religious texts, in modern times, clinicians have dominated discussion of this area with valuable research that operationalizes moral injury. Their models of moral injury provide important advances in understanding the clinical dimensions of the phenomenon. Their models, however, are incomplete. Humanistic lenses complement and enrich what the clinical sciences tell us. Many humanists writing about moral injury are keen to say what it is not. It is not PTSD. It is not many types of identifiable mental disorders. What is it? Humanists offer a powerful complementary (if not alternative) perspective on how to understand moral injury. Chapters in this section explore how tools of the humanities provide new lenses for understanding conceptual and genealogical themes about moral injury. In “The Moral Challenges of Moral Injury,” Johannes Lang and Robin May Schott explore the theoretical foundations of “moral injury.” They trace the concept to work by mental health care providers working with

4  Andrew I. Cohen and Kathryn McClymond the US military. These mental health scientists lacked the vocabulary and methods to address the moral dimensions of trauma. As the authors note, since the Vietnam War, “Post-traumatic Stress Disorder” has become the master category for thinking about and treating the psychological effects of trauma. Proponents of the notion of “moral injury” challenge this medicalized conception of post-traumatic distress as disorder and revive an earlier understanding of trauma as a moral form of suffering. Lang and Schott understand moral injury in terms of being haunted by one’s past. The morally injured have a sense of being diminished by the horrible things they have seen, done, or suffered. Lang and Schott argue that a leading clinical model of moral injury, which supposes a psychological mechanism of “cognitive dissonance,” is too narrowly conceived as an “inner conflict” between beliefs and action. This model takes no account of crucial social-psychological work. The theory of cognitive dissonance, originally developed in the 1950s, emphasizes that beliefs are highly resistant to change when they enjoy social support and that the most likely result of cognitive dissonance is self-justification, not self-condemnation. If cognitive dissonance persists, this is because one’s beliefs and actions do not have social support. Drawing on humanistic research from Holocaust and genocide studies, Lang and Schott argue that understandings of moral injury must acknowledge the temporal dimension of moral experience, engage with the perspectives of others, acknowledge responsibility for harms done in one’s name, as well as acknowledge one’s own fallibility and the need to revise one’s account of self and nation. For the concept of moral injury to capture a distinctly moral form of suffering, it must be lifted from the framework of “inner conflict” and placed firmly in the context of social norms and harms. Guilt is a moral emotion that plays an important role in some understandings and manifestations of moral injury. In “Ulterior Motives and Moral Injury in War,” Saba Bazargan-Forward considers the place of guilt in contexts of collective action. Bazargan-Forward notes that soldiers returning from war are often assailed by profound feelings of guilt. Such soldiers might feel irrevocably diminished as persons, which is characteristic of a type of moral injury. Soldiers who feel diminishment might feel guilt for what they did or did not do, insofar as they believe they fell short of a critical moral standard to which they hold themselves. Bazargan-Forward highlights how such guilt feelings then seem necessarily “first-personal.” But warriors might feel profound guilt for what they did with their comrades – even if their contributions were minimal. One might think such warriors are making a sort of philosophical mistake. You are, after all, only responsible for your conduct and its consequences. If your contribution is minimal, then so is your guilt. Drawing on the tools of humanistic inquiry, Bazargan-Forward

Introduction  5 develops an account of moral injury that allows us to make sense of cases in which soldiers feel guilty for more than what they did. Bazargan-Forward argues that soldiers who agree to work together enjoy a kind of authority over one another: they can legitimately demand of each other that they “do their part,” whatever that might be. One application of this shared authority is shared accountability. Victims can “look through” what comrades did to those who have practical authority over those comrades. That includes the individual warrior, who, in virtue of agreeing to work with others as part of joint action, then shares accountability for that act. So, when a warrior feels guilty for being part of a morally problematic undertaking, the basis for this guilt is not merely her causal contributions to that undertaking. Such a warrior, in effect, supplied the practical reasons for that undertaking. To the extent that those practical reasons were problematic, the victims of the undertaking can rightly direct their reactive attitudes toward other warriors, including those who did not immediately participate in moral harms. Warriors who feel guilt for what their comrades did, then, are not making a philosophical mistake when they express feelings of guilt in contexts where their contribution to the problematic outcome was minimal. Instead, the moral injury they suffer is a response to morally relevant features of the relationships constituting the shared actions in which they participated. By focusing on guilt, Bazargan-Forward’s inquiry illuminates important features of the concept of moral injury. Scholars and laypersons increasingly draw on the notion of moral injury. One task for theorists is to clarify the boundaries of the idea so it maps some analytically fruitful concept while at the same time providing a useful lens for understanding a phenomenon of moral experience. These two aims, one of theoretical adequacy, and the other concerning extensional adequacy, can clash. In “Theorizing Moral Injury with Reports of Trauma,” Andrew I. Cohen and Jennifer A. Samp caution against a certain way of privileging theoretical adequacy. Moral injury involves a cluster of certain moral emotions. There are challenges when including any emotions in any fruitful concept of moral injury. Among such challenges are cases of what Cohen and Samp describe as variously “misplaced” emotions, especially involving guilt. Sometimes the guilt is ill-suited as a response to what one did. Sometimes there are moral reasons the person feeling the guilt should not feel it. Sometimes the guilt reflects other cognitive errors. The authors discuss examples of debilitating guilt and argue that the guilt characteristic of many cases of moral injury need not be rationally appropriate. This tells us a bit about the notion of moral injury. Their chapter begins with a gloss of certain moral emotions as they figure in the idea of moral injury. Cohen and Samp then consider some of the

6  Andrew I. Cohen and Kathryn McClymond various dimensions by which to assess the emotions. The authors argue that the concept of moral injury must be capacious enough to allow for cases of morally injured vicious persons. The authors detail some of the costs of this conclusion. Cohen and Samp close by identifying and reluctantly embracing the costs of including some such cases. Humans exhibit a distinctive range of psychic reactions to our own moral agency. As David Rodin notes in “The Ethics of Moral Injury,” moral injury occurs when various psychic reactions become overwhelming or debilitating. Like other forms of moral-psychic response, moral injury straddles two dimensions of our self-experience as agents. First, there is the psychological dimension: we experience psychic responses such as pride and guilt as emotions that are pleasant or painful, and that can facilitate or impede our ability to act as integrated psychological actors in a social world. Second, there is the moral dimension of our psychic responses. Pride and shame are reactions that emerge from our success or failure in responding appropriately to moral reasons and realizing moral values and help to regulate and enable our compliance with moral requirements. Rodin’s chapter explores the ethics of psychology. He investigates the moral obligations applicable to the treatment of moral injury and the coherence of the concepts and categories that therapists deploy in undertaking treatment. Rodin’s central argument is that the standards for whether a psychic reaction is appropriate and adaptive will diverge depending on whether we are considering them from the perspective of the patient’s moral or psychological health. The extreme negative moral-psychic reactions that characterize moral injury which, from the perspective of psychological health, present as a disorder, may, from a moral perspective, be an appropriate and morally healthy reaction to the commission of a grave moral wrong. From a moral perspective, “moral injury,” far from a problem to be solved, may be a necessary and appropriate form of internal moral regulation. This has significant implications for how we should understand the moral obligation on therapists in the therapeutic relationship with their patients. In her chapter, “Moral Injury and the Making of Amends,” Linda Radzik highlights the role of moral amends as part of understanding moral injury and how best to respond to it. Radzik reviews some culturally prominent conceptions of atonement and considers how they bear on and deepen understandings of moral injury. Radzik puzzles over leading accounts of making amends, particularly in light of the distinct form of trauma from those suffering the debilitating cluster of symptoms known as moral injury. According to one view, the making of amends is impossible because the past cannot be changed. According to another view, which is both ancient and widespread, atonement is possible but painful. In this model, wrongdoers may expiate guilt only through suffering. These conceptions of

Introduction  7 atonement are unlikely to appeal to clinicians. As Radzik argues, they are also unsatisfactory for moral reasons. Radzik warns against a leading notion of amends among clinicians, which involves the transformation of the wrongdoer and that either begins with or culminates in self-forgiveness. Atonement so conceived appears much more likely to reduce the symptoms of moral injury. However, Radzik argues, these conceptions of moral amends are open to serious moral objections. They are in danger of making atonement too cheap. They also elide the significance of the victim, in that the focus remains on the wrongdoer’s internal life. Radzik defends instead a “reconciliation theory” of atonement. On her account, wrongdoing damages relationships among victims, wrongdoers, and communities. Atonement repairs this damage and can do so even in some cases of serious wrongdoing. Atonement comes in degrees. When pursued well, it offers benefits to victims and communities as well as to wrongdoers themselves. It can be a platform for properly responding to moral injury. Section II of the volume, “Experiences of Moral Injury,” draws on the humanistic tradition of critically theorizing moral experience. Contributors link cultural norms to narratives of normative challenge and resilience. Some reports of moral injury may offer a privileged insight into the meanings of the phenomena. Other accounts, however, would explore how much stock to place in first-person testimony. Oral history is a rich resource for highlighting phenomena that illuminate important shared elements of the human condition. The chapters here explore the power and limits to theorizing moral phenomena by appeals to lived experience. In “Greek Tragedy, Virgil’s Aeneid, and The Moral Injury of Combat Veterans and Health-Care Workers,” Henry Bayerle draws on the classics to explore the meaning and impact of moral injury. Using data he and other researchers gathered from semi-structured interviews, Bayerle shows how the humanities provide resources for both understanding the notion of moral injury as well as what might give rise to instances of the phenomenon. Bayerle explores how recent leading accounts (such as those from Shay [1995], Litz et al. [2009], or Nash [2020]) often converge on a notion of moral injury that includes the disorientation from facing impossible moral dilemmas. Bayerle serves on a research team exploring moral injury among veterans and healthcare workers. They routinely describe the sense of betrayal and moral frustration from cases involving unequal distribution of risk, rapidly changing rules of engagement, and being burdened by others’ trust to save their lives. Whether the deficits are in leadership or in urgent supplies, these frontline personnel report the aftermath of choices with no morally satisfactory solution. Drawing on field research, Bayerle documents how the performance or study of ancient literary tragedy offers

8  Andrew I. Cohen and Kathryn McClymond a platform for understanding moral injury and taking partial steps toward closure. Sophocles’s Philoctetes and Virgil’s Aeneid each draw our attention to defective social and political structures that impose undue psychological tolls on frontline personnel. Reflecting on the lessons of such classics for contemporary challenges can illuminate the meaning, impact, and some ways to begin recovering from moral injury. Moral injury is commonly associated with combat soldiers, but as many contributors to the volume note, the concept is helpful for understanding the challenges others face. In “Moral Injury in Law Enforcement,” John Kleinig notes we can locate the damage that is distinctive to moral injury outside military contexts. He then pursues two related goals. The first is conceptual. Kleinig shows how law enforcement personnel often experience moral injury. This not only helps us to understand the broader range of the phenomena but also helps us to be more precise about what moral injury is. The moral injuries policing involves are not restricted to the officers. Given its public nature, policing can produce moral injury in the persons upon whom the police use force as well as for bystanders in the community. Kleinig’s second task is to explore the implications of such moral injuries when considering an ethics of policing and a political morality that governs the use of force by police personnel. The conceptual and substantive investigation Kleinig pursues enriches our understanding of moral injury and suggests some paths toward addressing some of its manifestations. Kleinig concludes by considering some ethical strategies for minimizing the occurrence of moral injury. Lauren Walsh shows how moral injury is common among other noncombatants. Drawing on notable research findings, Walsh discusses how war correspondents suffer PTSD at rates equivalent to soldiers in active combat (Feinstein, Owen and Blair 2002). In “Photojournalism and Moral Injury: An Inquiry,” Walsh considers the moral and psychological tolls reporters pay when covering combat, suffering, and injustice. Photojournalists may be particularly vulnerable. They must be at the site of what they document. Filling a key gap in journalism scholarship, Walsh explores photojournalists’ risk of moral injury in both combat and non-conflict settings. Many cases of moral injury involve bearing witness to events that violate deeply held moral values. Journalists sometimes do more than bear witness. Sometimes there are events featuring ghastly human costs, but which happened precisely because they are reporting. They might be embedded in military units or at the site of developing atrocities. Sometimes professional codes restrict them from ameliorating the very injustices they document. Providing several gripping case studies, Walsh discusses the distinctive challenges photojournalists face. As Walsh notes, neutrality requirements and journalistic conventions sometimes put reporters at risk

Introduction  9 of the moral injuries people face when complicit in harmful and unjust systems. In her chapter, Walsh documents some of the ways moral injuries manifest among photojournalists. She considers what norms and institutions might better prepare journalists for their job—a job that includes reporting on suffering and injustice with accounts that must compel readers and viewers at home. In “The Moral Limits to Moral Testimony in Soldiering,” Kevin Cutright argues that the moral judgments of others can provide moral knowledge but not moral understanding. To defend the view that moral understanding is essential to good character and morally worthy action, Cutright draws on the work of Alison Hills. On an account inspired by Hills, moral knowledge enables a person to take the right action, but moral understanding equips the person to develop moral knowledge in new situations. Moral understanding also allows persons to evaluate the moral aspects of their circumstances in ways that moral testimony does not. Hills argues that moral understanding is necessary to be a responsible moral agent. Cutright’s chapter appeals to moral injury among soldiers as additional evidence for Hills’s claim. Hills’s notion of moral understanding is an important correction for current military training, which systemically pursues only moral knowledge through testimony (to the extent that it directly addresses the moral aspects of war at all). Aiming for moral understanding among soldiers would help to minimize moral injury. Cutright further draws on the work of philosopher Julia Driver, who offers an important amendment to Hills’s argument by highlighting moments of justified moral deference. In some cases, a responsible moral agent is right to defer to the moral testimony of another due to her own epistemic or temperamental shortcomings. War’s complexities support Driver’s argument, offering examples of collective action that necessitate divisions of moral responsibilities and corresponding moral deference to the stewards of such responsibilities. One consequence of this division is a greater risk of moral injury. Cutright argues that we can mitigate this risk by fostering soldiers’ moral understanding of war. Such a division of moral labor entails making moral deference routine and suggests something like moral expertise. As Cutright shows, however, this conclusion is too hasty. Instead of moral experts, we should think in terms of moral trustees. These dimensions of moral understanding illuminate the experience of and responses to moral injury. Despite a growing interest in the study of moral injury over the last decade, significant challenges still remain in our ability to understand the profound influence of moral wounds on the post-trauma state. In “Meaning-Making and Moral Injury: The Role of the Narrative in Understanding Trauma,” Joshua Mantz offers first-person testimony of moral injury in a way that will be of interest to clinicians, researchers, and theorists. Mantz

10  Andrew I. Cohen and Kathryn McClymond distinguishes moral injury from other forms of trauma. He recounts his trauma from 2007 experiences near Baghdad. He had been shot and killed by an enemy sniper, leading to a near-death experience and was flatlined for 15 minutes. His senior non-commissioned officer, Staff Sergeant Marlon Harper, was killed by the very same bullet that struck Mantz. This traumatic loss prompted a profound moral dilemma – a type of moral injury – for an attending medic who was forced to choose which person to save. Mantz notes his physical injuries were platforms for moral injuries among many other persons. These others were conscripted as fellow stakeholders in the moral challenges Mantz faced. He highlights how their experiences, emotional challenges, and recoveries manifest multiple dimensions of moral injury over time. Mantz then draws on the story of a young Iraqi girl named Hajil who, along with her family, were unintended victims of an American mortar attack catalyzed by exploitive insurgent tactics. Hajil’s injury, and its impacts on her family and community, illuminate moral injury’ scope. Mantz points to such tragic losses as endemic to today’s operating environment. Mantz identifies some mechanisms of resilience for managing moral wounds. As he notes, healing is a journey, never complete at any particular fixed point in time. The same seems to hold true for moral development and the assimilation of moral wounds. Moral injury does not completely “go away.” Our understanding of the complex dynamics of moral wounds may deepen by further reflection on its many lived manifestations. Mantz closes by demonstrating why the role of the moral philosopher can have a particularly decisive impact in guiding people through the assimilation of moral wounds. Section III of the volume, “Accounts of Recovery: Applying Humanistic Approaches to Moral Injury,” takes as a springboard much of the constructive work by clinicians, which has dominated discussions of moral injury over the past 25 years. Chapters in this section consider how humanistic inquiry illuminates important dimensions of the aftermath of moral injury beyond the scope of clinical research. The concepts and tools of the humanities develop understandings of whether and how to recover, who bears which responsibilities for recovery, and what if anything constrains responses to reports of moral injury. Contributors in this closing portion of the volume suggest alternatives and supplements to medicalized models of moral trauma. They consider how ritual, relationship repair, and atonement might shape the ways people navigate moral injury, and consider how such responses shape our understanding of what we owe to one another. In “Evil in Innocence – Moral Injury and the Encounter with Children,” Alan Roof, a chaplain with the Billings Clinic, examines the disconcerting

Introduction  11 and disturbing encounters that service members have had with children on the battlefield. Many recent wars have been unquestionably different from the mere fact that the battle lines and battlegrounds were unconventional and did not hold to the “standard” operating procedures for engagement. Combat’s impacts on children highlight particularly stark catalysts for moral injury. Roof writes about how we can illuminate features of moral injury in the incredible encounters of children with military men and women. Children became both victims and perpetrators of evil. Roof’s chapter looks at the horror of losing one’s innocence and its connection to moral injury. The chapter draws much from an extended meditation on the struggle of a veteran with an encounter involving children during a Good Friday Service. Drawing on his own experiences, Roof discusses the conceptual tools available to treatment teams when identifying the problems a patient faces. The chapter engages recent literature about the increasing use of children in the process of war. Roof highlights the soul-crushing and life-altering moral injury that results when service members encounter evil in the guise of children and the decisions that had to be made involving children in a time of warfare. This narrative offers crucial resources in understanding some of the many lived dimensions of moral injury. In “On the Necessity of Ritual for Moral Injury Recovery,” Rita Nakashima Brock considers the role of ritual in shaping the persons who will serve as warriors. Though ritual constructs the combat context and persons who fight, it is morally fraught. Ritual can be a platform for inuring people to challenges to important moral values. In her chapter, Brock considers how ritual can also be a platform for combatants to make sense of the experiences that left them injured. Ritual can enable transition, help to heal the moral agency that combat might undermine, and can be a vehicle for reconstructing damaged moral relationships. Brock considers the role of ritual in light of evolving definitions of moral injury. Drawing on her own experiences counseling veterans recovering from combat, Brock offers insights about the need and power of ritual in recovering from morally injurious experiences. Using literature as a lens for understanding the meaning and experience of moral injury, Jay Rajiva looks to Edwidge Danticat’s story cycle The Dew Breaker as a platform for reflecting on the morally injurious experiences of Haitian and Haitian-American victims of state violence. State violence by the Haitian secret police, the Tonton Macoutes or dew breakers, triggered moral injuries in the citizenry and among the police themselves. The protagonist in The Dew Breaker flees his life in Haiti and, in doing so, invites a reconceptualization of healing from moral injury through its attentiveness to animist structures of meaning. The protagonist’s experiences, as well as those of his family, illuminate complex cultural and

12  Andrew I. Cohen and Kathryn McClymond spiritual dimensions that preclude healing in the traditional and Western sense of the term. The reimagining of moral trauma in the story suggests a provisional form of healing from moral injury by private reconciliation, in contrast with the public and ritual purification processes common among other frameworks. In “Rituals and Moral Injury: How Veterans Make Peace,” Kathryn McClymond argues that religious rituals and practices developed around the globe and over several centuries offer opportunities for wounded soldiers to publicly acknowledge, make amends for, and mark the traumatic actions that caused their wounds. Soldiers and their caregivers have made peace with what happens on the battlefield through acts of pilgrimage, public testimony or “prophecy,” atonement, and memorial-making. For centuries, religio-cultural traditions have offered these practices as paths forward for those crippled by guilt, shame, and betrayal. By tapping into these cultural traditions, soldiers and their caregivers have an opportunity to “own” their guilt, address it, and move forward. While the term “moral injury” is relatively recent, humans have experienced trauma from warfare for centuries. Clinical treatments have offered some relief, but we have known for decades – if not longer – that certain individuals have engaged in traditional religio-cultural practices to acknowledge, address, and move through feelings of guilt, shame, and dishonor. Similarly, as McClymond discusses, their families and communities have developed ways to acknowledge the moral wrongdoing without permanently isolating the wrongdoer from home and community. Perhaps most importantly, communities are acknowledging their participation in the wrongdoing of war, not only in the actions of soldiers, but also by training soldiers to harm, kill, and destroy. Works Cited Benshoof, Courtney. 2017. “Not on My Watch: Moral Trauma and Moral Injury Among Combat Medics.” Master’s Thesis, Atlanta, GA: Georgia State University. https://scholarworks.gsu.edu/rs_theses/52. Brock, Rita Nakashima, and Gabriella Lettini. 2012. Soul Repair: Recovering from Moral Injury after War. Boston, MA: Beacon Press. Capps, Ron. 2014. Seriously Not All Right: Five Wars in Ten Years. Tucson, AZ: Schaffner Press, Inc. Carroll, Robert, and Stephen Prickett, eds. 2008. The Bible: Authorized King James Version. New York: Oxford Paperbacks. Currier, Joseph M., Jason M. Holland, and Jesse Malott. 2015. “Moral Injury, Meaning Making, and Mental Health in Returning Veterans.” Journal of Clinical Psychology 71 (3): 229. https://doi.org/10.1002/jclp.22134. Dean, Eric T. Jr. 2000. Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. Cambridge, MA: Harvard University Press.

Introduction  13 Euripides, Kenneth McLeish, and Robert Cannon. 1997. Euripides Plays: 5: Andromache, Herakles’ Children Herakles. London: Bloomsbury Methuen Drama. Farnsworth, Jacob K., Kent D. Drescher, Jason A. Nieuwsma, Robyn B. Walser, and Joseph M. Currier. 2014. “The Role of Moral Emotions in Military Trauma: Implications for the Study and Treatment of Moral Injury.” Review of General Psychology 18 (4): 249–62. https://doi.org/10.1037/gpr0000018. Feinstein, Anthony, John Owen, and Nancy Blair. September 2002. “A Hazardous Profession: War, Journalists, and Psychopathology.” American Journal of Psychiatry. 159(9): 1570–75. https://doi.org/10.1176/appi.ajp.159.9.1570. Grinker, Roy R., and John P. Spiegel. 1945. Men under Stress. Philadelphia, PA: Blakiston. Klay, Phil. 2015. Redeployment. Reprint edition. New York: Penguin Books. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, ­Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29: 695–706. https://doi.org/10.1016/j.cpr.2009.07.003. Mantz, Joshua. 2017. The Beauty of a Darker Soul: Overcoming Trauma Through the Power of Human Connection. Austin, TX: Lioncrest Publishing. Marlantes, Karl. 2012. What It Is Like To Go To War. Reprint edition. New York: Grove Press. Meagher, Robert E. 2014. Killing from the Inside Out: Moral Injury and Just War. Eugene, OR: Cascade Books. Morris, David J. 2015. The Evil Hours: A Biography of Post-Traumatic Stress Disorder. New York: Houghton Mifflin Harcourt. Nash, William P., and Brett T. Litz. 2013. “Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members.” Clinical Child and Family Psychology Review 16 (4): 365–75. https://doi.org/10.1007/ s10567-013-0146-y. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Simon & Schuster. ———. 2011. “Casualties.” Daedalus 140 (3): 179–88. https://doi.org/10.1162/ DAED_a_00107. Sherman, Nancy. 2015. Afterwar: Healing the Moral Wounds of Our Soldiers. New York: Oxford University Press. Sites, Kevin. 2013. The Things They Cannot Say: Stories Soldiers Won’t Tell You About What They’ve Seen, Done or Failed to Do in War. Original edition. New York: Harper Perennial.

Section 1

Some Frameworks for Moral Injury

1 The Moral Challenges of Moral Injury Johannes Lang and Robin May Schott

Sergeant Adam Gray was never the same after he came back from Iraq in 2004. You could tell just by looking at him, his mother told the journalist Joshua Phillips three years later. “He was way different, that’s for sure.” A year in Iraq had made Gray reclusive and aggressive, prone to terrible mood swings. “He looked troubled,” his mother remembered, and he would scream in his sleep (Phillips 2012, 7). Gray initially refused to talk about his experiences, but after a long night of drinking, he told his mother that his unit had killed a little Iraqi girl by mistake. They had also abused and tortured detainees in a prison they were guarding. His mother “patiently listened to her son’s justifications for mistreating Iraqi detainees,” Phillips reports, but finally, she had to interrupt him. It all sounded “so incredibly inhumane,” she recalled (8). After a month-long leave, Gray left home to undergo further military training. A few weeks later, he committed suicide. A psychological report written shortly before his death noted that Gray “had experienced poor sleep, decreased appetite, stomachaches, headaches, and hypervigilance” since returning from Iraq. “Gray was upset by thoughts of not being a good NCO [non-commissioned officer],” and he had “said that those problems were due to the way he felt about what happened to him during his deployment” (cited in Phillips 2012, 15). He “could not sleep without alcohol,” and “the last time he did sleep without alcohol, he woke up screaming,” the “sheets soaked with his sweat” (15). The report concluded that Gray “suffered from post-traumatic stress disorder from his experiences in Iraq, and he had a substance abuse problem” (15). Both conditions, the report warned, increased the risk that Gray might commit suicide. “Post-traumatic Stress Disorder (PTSD).” Did this diagnosis really capture what Gray was going through? He certainly displayed a range of symptoms associated with the disorder: hypervigilance, loss of appetite, and trouble sleeping. Yet there also appeared to be a distinctly moral quality to the suffering. Gray seemed haunted by the things he had done. Was DOI: 10.4324/9781003281122-3

18  Johannes Lang and Robin May Schott “PTSD” the right way to think about this kind of moral anguish? When the PTSD diagnosis was introduced in 1980, five years after the end of the Vietnam War, guilt was listed as a symptom (APA 1980). But the morally imbued conception of trauma inherited from the Vietnam War—the idea of post-traumatic suffering as the result of moral failure—was soon displaced by a bio-medical conception of post-traumatic stress as a condition of uncontrollable anxiety. In 1987, the American Psychiatric Association relegated guilt from a symptom to an “associated feature” of PTSD. Fear, not guilt, was said to be at the core of the disorder. It would require another long and painful war to remind mental health experts and the United States military about the moral dimensions of trauma. The Iraq War and the Concept of Moral Injury On May 4, 2007, a press briefing took place at the U.S. Department of Defense. The Pentagon was finally releasing the findings of its annual report on the mental health of American forces in Iraq. The Army had in fact received the report six months earlier but had decided to postpone the release of its findings. Timing was a sensitive issue because in late 2006, when the report had landed on the Army Surgeon General’s desk, the war was about to escalate. The Army had recently decided to lengthen the duration of individual combat deployments from 12 to 15 months to keep as many soldiers in Iraq as possible, and in January 2007, President Bush announced “the surge” of an additional 20,000 soldiers into the country. The Americans were making a last determined effort to regain the initiative in a war that was spiraling out of control. This was no time to discuss soldiers’ mental health. The report revealed how the war was affecting the soldiers. As deployments lengthened and multiplied, the rates of acute stress and mental health problems increased. But even more troubling, perhaps, was the effect the war appeared to be having on soldiers’ moral sensibilities. For the first time, the Mental Health Advisory Team’s annual survey included questions about battlefield ethics. The results showed that only 47% of Army soldiers and 38% of Marines agreed that non-combatants should be treated with dignity and respect (Mental Health Advisory Team 2006, 35). One in ten said they had mistreated non-combatants or damaged property when it was not necessary, and less than half of the soldiers and Marines said they would report a team member for unethical conduct. “These findings may seem alarming,” the acting Surgeon General of the Army, Major General Gale Pollock, told reporters at the briefing, “but it is important to keep them in perspective. These troops have been seeing their friends killed and injured, and anger is a normal reaction” (cited in Wood 2007).

The Moral Challenges of Moral Injury  19 The  brutality of the war, Pollock seemed to suggest, was degrading the soldiers’ ethical standards. Five military doctors who had contributed to the report were on hand at the press briefing to explain their findings. One of them was Colonel William P. Nash, coordinator of the Marine Corps’ Combat and Operational Stress Control Branch. Nash had served as a psychiatrist in Iraq and had found that the military’s approach to combat stress had changed little since World War I. Both the Army and the Marine Corps were still using the century-old principles of “forward psychiatry”: proximity, immediacy, expectancy, and simplicity (“PIES”). According to this doctrine, mentally disturbed soldiers should be treated as quickly and as close to the front as possible. The assumption was that the soldiers were temporarily shaken or exhausted, and treatment consisted mainly of rest, sedatives, and, if appropriate, a few sessions of psychotherapy. The idea was to keep it simple, with the expectation that the soldiers would soon return to duty. Nash and his colleagues were trained to think of every stress reaction—no matter how severe—as normal and temporary. It didn’t matter whether the person was “psychotic, manic, suicidal, or whatever,” Nash recalls; the message to the soldier was always: “Don’t worry about it, it’s gonna go away” (Nash 2017).1 But over the course of his deployment, Nash became increasingly uncomfortable with this message. Clearly, many soldiers were not going to be fine. They were broken, perhaps damaged for life. In 2006, as the psychological consequences of war were becoming increasingly evident, the Army decided to rewrite its stress control doctrine. The previous edition was a “very tiny little document,” Nash remembers, “and it was based entirely on PIES and the World War I model.” It was a joint doctrine, and all branches of the U.S. military used it. Now the Army wished to expand it. They sent the new version over to the Navy and Marine Corps and asked them to sign off on it to keep it a joint doctrine. But as Nash read the document, he was disappointed to see that nothing had really changed. The revised doctrine continued to rely heavily on PIES, and there was no recognition that certain experiences might cause serious, perhaps even permanent, psychological damage. Nash believed that severe stress could injure a soldier’s brain and nervous system just like a bullet or bomb could. He called it “stress injury.” The Army wanted nothing to do with the idea, so Nash convinced the Navy and Marine Corps leadership to develop their own approach. A group of experts were summoned, including a psychologist at the Veterans Affairs hospital in Boston named Brett Litz. The atmosphere at the group’s first conference was “sort of electric,” Litz recalls.2 The stakes were so high. Except for the six days of the Gulf War in 1991, there had been no major American ground war since Vietnam, and Litz had spent most of his career working with aging Vietnam veterans and veterans of UN peacekeeping

20  Johannes Lang and Robin May Schott missions in Somalia and the former Yugoslavia. Like other mental health experts affiliated with the American military in the 1990s and early 2000s, Litz had extensive experience studying the traumatic effects of war, but he had never been called upon to prevent such psychological harm from occurring in the first place. This was what the Marine Corps was now asking them to do (Litz 2017). Litz, Nash, and their colleagues were convinced that the military’s prevailing notions of stress and trauma were too narrowly conceived. The military assumed that the harmful stress of war was caused either by threats to the soldier’s life, by the loss of one’s comrades, or by the “wear and tear” of accumulated tension. But the stress of war was not just about fear, grief, and exhaustion, Nash and Litz argued; there was also a distinctly moral quality to many soldiers’ distress. This kind of moral distress could come from having killed another human being, from having witnessed atrocities, or from having fought an unpopular, mismanaged, and morally questionable war. This sort of suffering went beyond the concept of stress: it was the anguish of betrayal—not only the sense of having been betrayed by one’s leaders, but also the sense of having betrayed oneself, one’s friends, or one’s ideals. The afflicted individual was consumed by anger, guilt, and shame. Litz told us he had first become aware of this moral aspect of soldiers’ suffering when he was studying the psychological consequences of peacekeeping in the 1990s. American peacekeepers, he realized, were suffering from a “broken heart,” having witnessed atrocities they had been unable to prevent. A decade later, Litz, Nash, and their colleagues were rediscovering and rearticulating the moral dimension of soldiers’ distress. They called it “moral injury.” We have conducted interviews with Litz and Nash, and in this chapter, we engage primarily with their influential model of moral injury. Litz and Nash approach the problem from the perspective of military mental health, and their focus is on helping veterans recover. Yet they acknowledge that this kind of suffering is beyond the power of psychology or psychiatry to heal—that “some injuries, like moral injuries and loss, can only be healed in the person’s social world” (Litz 2017, unpublished interview). They use the language of “moral repair” and of “making amends,” and they invite interdisciplinary reflection on how to heal soldiers’ moral wounds. With our backgrounds in social psychology and philosophy, we accept their invitation to provide new perspectives on the moral dimensions of soldiers’ distress. We explore the notion of dissonance to understand how moral injury is moral, and how dissonance reveals important dimensions of moral thinking and moral repair. We argue that the concept of moral injury has been restrained by the military-medical context in which it originated, and that we need to go beyond what is essentially a cognitive-­ psychological model of moral pain.

The Moral Challenges of Moral Injury  21 The Origins of Moral Injury The concept of moral injury first appeared in the field of military mental health in the 1990s, when the psychiatrist Jonathan Shay used it in his work with Vietnam veterans. “I’ve come to strongly believe,” Shay wrote, “that moral injury is an essential part of any combat trauma that leads to lifelong psychological injury” (1994, 20). The new phrase reverberated with an older, more original meaning of “injury” as something “not” (in-) “right” or “lawful” (jure). Shay conceptualized moral injury as the “betrayal of ‘what’s right’ in a high-stakes situation by someone who holds power” (2002, 240). Weak, selfish, or incompetent commanders had placed soldiers in morally compromising situations or ordered them to perform acts that dramatically violated their sense of right and wrong. The betrayal was two-fold: first, soldiers had been betrayed by someone in authority; then they had betrayed their own basic ideals and thereby also themselves. They had witnessed their own moral undoing. “I look back today,” one Vietnam veteran said, and I’m horrified at what I turned into. What I was. What I did. I just look at it like it was somebody else. […] War changes you…. strips you of all your beliefs, your religion, takes your dignity away. […] You know, it’s unbelievable what humans can do to each other. I never in a million years thought I would be capable of doing that. Never, never, never. (cited in Shay 1994, 33) It is this sense of moral unraveling that is at the core of former soldiers’ chronic psychological suffering, Shay believed. Veterans, he claimed, “can usually recover from horror, fear, and grief once they return to civilian life, as long as ‘what’s right’ has not also been violated” (1994, 20). Shay’s notion of moral injury closely resembled the earlier idea of a “post-Vietnam syndrome.” In a 1972 article in the New York Times, the psychiatrist Chaim Shatan had written that many Vietnam veterans felt “deceived, used, and betrayed” by the military and their government. The war, they realized, had been based on lies and deception. Moreover, their military training and the tactics deployed in Vietnam had encouraged indiscriminate aggression and violence against various targets, including civilians, and this had brutalized the soldiers. “You are just the fingers pulling the triggers,” as one veteran put it (quoted in Shatan 1972). After having systematically numbed their “humane responses” to the suffering around them, Shatan observed, “veterans find it difficult and painful to experience compassion for others” (quoted in Shatan 1972). Enraged and ashamed, they felt incapable and unworthy of love, alienated from their own feelings as well as from other people.

22  Johannes Lang and Robin May Schott When “PTSD” was introduced in 1980, it included many of the elements of the post-Vietnam syndrome. Anger, guilt, and estrangement from others (including an inability “to have loving feelings”) were listed as typical symptoms (APA 1980). But some observers worried that the diagnosis was turning the moral and political issues raised by the war into a technical, medical problem for doctors and psychologists to solve. Reading through the medical and psychological literature on Vietnam veterans, remarked the social critic Peter Marin in 1981, one notices again and again the ways in which various phrases and terms are used to empty the vets’ experience of moral content. […] Repugnance toward killing and the refusal to kill are routinely called ‘acute combat reaction,’ and the effects of slaughter and atrocity are called ‘stress,’ as if the clinicians describing the vets are talking about an executive’s overwork or a hysterical housewife’s blood pressure. Nowhere in the literature is one allowed to glimpse what is actually occurring: the real horror of war and its effects on those who fought it. (Marin 1981, online version)3 The clinicians who did mention guilt, Marin noted, described it as “survivor’s guilt”—remorse or shame, “not for what one has done, but for having outlived one’s comrades.” Why, he asked, “has most psychological thinking about Vietnam avoided the issue of judgment?” Perhaps most clinicians “shy away from the question of moral pain,” Marin suggested, “simply because it is likely to open up areas of pain for which there is really nothing like a ‘cure’” (1981). Litz echoed this sentiment in his conversation with us. “The reality [of moral injury] is scary and painful and sad,” he said: that there is no cure, that suffering cannot be eradicated, that on an individual, communal, cultural, and societal level we did this, and this is the aftermath. […] We can’t make this person what he or she was before this happened. It is just not possible. There is no going back. The question is whether there is a way to move forward. Fear and Loathing In 2007, Brett Litz was studying the effects of therapy on veterans receiving treatment for PTSD. Officially, PTSD was categorized as an anxiety disorder, said to be caused by a life-threatening event that initiated the brain’s fear system and triggered an unconditioned fight, flight, or freeze response. But as Litz examined the data, he found that many of the former soldiers

The Moral Challenges of Moral Injury  23 being treated for PTSD were struggling with problems that had little or nothing to do with fear, and more to do with shame and self-loathing. Their most persistent and bothersome memories did not revolve around the threat of death or serious injury, but around situations that involved a perception of moral failure (Litz 2017, unpublished interview). The counterinsurgency warfare in Afghanistan and Iraq had often blurred the distinction between combatants and non-combatants, confronting soldiers with difficult ethical decisions about when to use force. Already by 2003, 20% of U.S. soldiers and Marines reported having killed non-combatants. And the military had few resources, Litz, Nash, and their colleagues later wrote, “to mitigate and heal the lasting impact of perpetrating, failing to prevent, or bearing witness to war zone acts that produce inner conflict because of moral compromise” (Litz et al. 2017, 2). No training, no matter how intense and realistic, prepared soldiers for the “surreal, unparalleled, evil acts that can sometimes occur [in war]” (21). On the contrary, the culture of the U.S. military, with its low tolerance for mistakes and its emphasis on personal responsibility and moral accountability, might heighten the risk of moral injury (Litz et al. 2017). And yet there had been an almost complete lack of attention to the moral dimensions of military trauma, Litz, Nash, and their colleagues argued. There was a “vacuum” in the field (Litz et al. 2009, 696). The problem was not just a matter of professional discomfort in the face of moral questions, nor was it simply a result of veterans’ unwillingness to speak about their morally injurious experiences. The reason why moral aspects had been neglected in the study and treatment of trauma also had to do with the very character of scientific inquiry itself, as it had developed in the mental health field over the past decades (Litz 2017, unpublished interview). The struggle of American psychiatry, since the late 1970s, had been to make the study and treatment of mental illness more scientific. “The irony here,” Litz reflected, was that the more science was brought to bear on the study of trauma, “the more it lost its soul, basically, and the more it lost its clinical phenomenological sense.” Curiosity about individual experience and the possible causes of mental illness was sidelined by methodological concerns with objective measurements and evidence-based treatments. Gradually, the PTSD diagnosis was incorporated into a reductionistic psychiatric apparatus of quantifiable symptoms, standardized treatments, and measurable improvements. “I realized that the science was betraying us,” Litz said. “The whole DSM is a lie.” The DSM, or Diagnostic and Statistical Manual of Mental Disorders, describes the officially recognized categories of mental illness. This is supposed to be a purely descriptive list of disorders and symptoms—as Gary Greenberg notes, the manual “renders the varieties of our psychospiritual suffering without any comment on where it comes from, what it means, or what ought to be done about it” (2010, 15). According to critics like Greenberg, the manual also

24  Johannes Lang and Robin May Schott medicalizes and pathologizes what in many cases might be normal reactions to painful experiences. The concept of moral injury was meant to challenge the mental health field to think differently about trauma, “to be more sophisticated and curious,” as Litz put it, “and not too reductionistic.” The “best part of PTSD,” he told us, is that “it describes the experience of being haunted.” And many things in war can end up haunting you. Having almost died can haunt you. Having killed another human being can haunt you. Witnessing the death of your best friend or being betrayed by someone you trust can haunt you, as can your own failure of courage or character at a decisive moment. Any of these experiences could lead someone to develop symptoms of PTSD. Involuntarily reexperiencing the traumatic event, having difficulties sleeping, feeling intense anxiety, and trying hard to avoid thinking about what happened: these are symptoms of PTSD that also describe aspects of moral injury. Yet moral injury is “more than that,” Litz insists; it both overlaps with PTSD and is distinct from it. We should resist the temptation to reify moral injury as a new syndrome or category of mental illness (Litz 2017, unpublished interview). Rather than thinking of moral injury as a category of post-traumatic distress, Litz suggests, we should think of it as a dimension of human suffering. Inner Conflict Subjective meaning-making is at the core of moral injury, as Litz and his colleagues define it. No experience, they argue, is traumatic or morally injurious per se—it is the subjective interpretation or “appraisal” of the event that makes it so (Litz et al. 2009, 698). This is a traditional cognitive-psychological view of stress and coping, espoused by influential researchers like Richard Lazarus since the 1960s. The cognitivist approach was originally a reaction to behaviorism, just as the cognitive model of “moral injury” is a reaction to today’s neo-behaviorist and bio-medical conceptions of PTSD, where a traumatic stimulus is said to trigger a posttraumatic response. From a cognitivist perspective, cognitive appraisal precedes affective response. Whether an event will be traumatic or morally injurious—or not—depends on how it is construed by the individual. If individuals construe an event as incongruous with their deeply held moral beliefs and assumptions, Litz et al. (2009) argue, then “dissonance” will occur. This dissonance, they claim, is the psychological condition that might lead to moral injury. But what, more precisely, is the relation between dissonance and moral injury? Despite its centrality, the notion of dissonance is undertheorized in the work on moral injury. Most authors, including Litz and Nash, use the term heuristically, as synonymous with inner conflict. This inner conflict, they argue, stems from witnessing or perpetrating acts that violate personal convictions about right and wrong.

The Moral Challenges of Moral Injury  25 In other words, moral injury is said to result from the perception of a profound conflict between one’s beliefs and actions.4 This conception of inner conflict or dissonance resembles the classic notion of “cognitive dissonance,” developed by the social psychologist Leon Festinger in the 1950s. For Festinger (1957), the need to resolve cognitive dissonance when it arises is a basic human need, akin to hunger. We feel an urge to act in accordance with our beliefs, Festinger claimed—so, if dissonance occurs, we must either acknowledge our mistake and change our behavior or alter our beliefs to justify our actions. This is the transformative potential of cognitive dissonance: it motivates people to change either their beliefs or their behavior. But as Festinger observed, it is usually easier to justify your behavior than it is to change it, especially when that behavior consists of acts whose consequences cannot be undone. Cognitive dissonance, in this view, is not a condition that encourages genuine moral reflection or behavioral change as much as it encourages self-justification. In Festinger’s theory, cognitive dissonance is a weak moral force, and therefore, in our view, in and of itself an unlikely source of moral injury. Instead, according to Festinger, the most likely results of cognitive dissonance are self-justification, rationalization, or a change in beliefs to fit the behavior.5 The ease with which people change their beliefs to fit their behavior is also something Hannah Arendt observed in her reflections on the period leading up to World War II and the horrors of Nazi Germany. Describing what she saw as the total collapse of conventional moral standards in ­Hitler’s Germany, Arendt wrote that, all this collapsed overnight, and then it was as though morality suddenly stood revealed in the original meaning of the word, as a set of mores, customs and manners, which could be exchanged for another set with hardly more trouble than it would take to change the table manners of an individual or people. (2003a, 50) Most people simply adapted to the new reality. And while many Germans may have initially experienced a profound dissonance between their traditional Christian values and the violence of the Nazi regime, they found ways to subdue or resolve this inner conflict. And it is precisely in the refusal of dissonance that its moral character becomes clear. For when the openness to experience dissonance disappears, the very conditions for a moral conscience disappear along with it. Arendt understood this. In “Thinking and Moral Considerations,” she wrote that difference and otherness are not only conditions of living amidst a plurality of things and beings in the world, but they are also conditions within the self for thinking and moral judgment (Arendt 2003b). And Arendt agreed with

26  Johannes Lang and Robin May Schott Socrates that the different voices within the self should best be friends—after all, you need to be able to live with yourself. The doubleness of internal enmity, as wrongdoer-and-judge-in-one, helps explain the deep self-loathing that often accompanies moral injury. For when one can no longer feel like a friend to oneself, dissonance and disharmony can become intolerable. The view that conscience is carried out through an inner dialogue does not commit oneself to any specific moral theory. But it does locate moral judgment within oneself (May 1983, 66).6 Moral dissonance, however, is not just an inner conflict. In many cases, the dissonance signals conflict with and resistance to an authority that has the power to prevail over one’s own actions and in this sense reflects a form of moral coercion.7 In Jonathan Shay’s (1994) original definition of moral injury, the sense of having been betrayed by someone in power was a key element. Maybe the soldier had been carelessly and unnecessarily exposed to enemy fire, as when U.S. soldiers in Vietnam were ordered to conquer a heavily defended hilltop, only to abandon it again shortly thereafter. Or perhaps the soldier had been ordered by his or her superior to perform a morally degrading action, as when a U.S. soldier in Afghanistan was sent to provide disrespectful and inappropriate compensation to a grandfather who had lost his son and grandchildren in the “collateral damage” of war. When the old man reacts with disbelief and disgust in response to being handed a thin envelope of cash, the soldier silently concurs with the old man’s condemnation and feels ashamed.8 One of the early meanings of betrayal is to be delivered or exposed to the power of an enemy by treachery (Online Etymology Dictionary, n.d.). In the first example mentioned here, the soldiers’ lives are so recklessly endangered that they are effectively delivered to the power of the enemy. In the second example, the soldier comes to believe that the enemy is also the system he serves and thereby himself. Examining moral injury from the field of moral theory, instead of from psychiatry or cognitive psychology, makes one aware of the inherent limits of morality itself when it is not possible to do the right thing. Stories of moral wounds often convey how terrible things happen, despite one’s best efforts to prevent them. Sometimes doing the morally right thing is impossible because there are conflicting moral requirements (protecting one’s comrades versus protecting civilians, for example). Sometimes all options are unthinkable, and there is no possibility of doing the right thing. These types of moral failure lead us to think of morality as tragic in nature (see also Tessman 2014). Knowing that moral failure may be unavoidable might help relieve some of the self-blame that often accompanies moral wounds. Moral theorists who draw on phenomenological arguments to illuminate and make sense of the experience of moral agents are often attuned to the ideas of moral impossibility and moral failure (see Schott 2003). Bernard Williams introduced the notion of moral remainder to capture the difficult

The Moral Challenges of Moral Injury  27 moral costs even of actions and decisions that are fully morally defensible (Williams 1973). Can an appreciation of moral failure and moral remainders as intrinsic to moral experience help alleviate moral wounds? Therapies addressing guilt and moral injury often highlight exactly these constraints: the context was hazardous and there were no better options that one could see or bear at the time. Psychologists emphasize the importance of focusing on concrete actions at a specific place and time to help prevent persons from developing globalized perceptions of themselves as bad, wrong, weak, and deserving of self-hatred. Placing actions in context helps people accept that they are not forever defined by an event or action, that they can develop and change. But psychologists have also found that sometimes, even when people clearly could have had no responsibility for the events, they nevertheless assume some of the responsibility for what happened. The psychologist Libby Tata Arcel, who worked for years with women who had been raped in the wars in former Yugoslavia, has described this response. The women often said things like: if only I had kept my coat on, if only I had not gone down the hallway to the back, then I would not have been raped (Arcel 1998). While there are obvious grounds for debunking this response (war, the pattern of blaming rape victims for being raped, etc.), Arcel insisted that there was an important message to be heard. When women narrated their rape in terms of their own responsibility, they were able to retain a sense of agency. A woman would be stitching together an account in which she could recognize herself as the person she used to know. Claiming responsibility and blaming oneself for violence or betrayal may be unrealistic. This gesture does not account for context, constraints, and the inevitability of moral failure. Nonetheless, it may help the individual wake up to a world where there is moral meaning. Claiming responsibility is one way of sustaining a belief that there is a moral world. Arendt’s study of the Holocaust and evil more generally led her to ask whether human beings fit into the world (Arendt 1963/1994). Her answer was, yes. If we can understand the world, then we can feel at home in it even in the midst of great tragedies (Neiman 2002, 303). Perhaps another way of understanding the suffering of moral injury is as a struggle to feel at home in the world. In understanding and addressing moral injury, it would be wise to respect this moral impulse. While therapists might help a person let go of self-blame and self-hatred, they should be sensitive to constructing other paths to moral meaning. Another moral feature of moral injury is that it hurts. Having been betrayed, or having betrayed oneself, one’s friends, and one’s ideals, matters. These events and actions have weight, and one suffers from them. That one suffers from one’s own role in wrongdoing is not self-evident. As we have noted above, social psychologists have long emphasized the

28  Johannes Lang and Robin May Schott human tendency to justify our own actions, especially when those actions violate our deeply held moral beliefs. Albert Bandura’s model of “moral disengagement,” for instance, describes a range of mechanisms that perpetrators of violence use to justify or excuse their actions. This model is frequently cited in the social-psychological literature on war, genocide, and atrocity to describe how “ordinary” human beings become perpetrators of mass violence. In the language of social-cognitivists like Bandura, guilt and shame are “self-sanctions” that “keep conduct in line with personal standards” (Bandura 1999, 193–94).9 As individuals become socialized, Bandura says, they tend to “invest their sense of self-worth so strongly in humane convictions and social obligations” that a violation of moral standards usually leads to “self-devaluation”: “They refrain from behaving in ways that violate their moral standards because such conduct will bring self-condemnation” (193–94). But this, of course, is not the end of the story. “Self-regulatory mechanisms do not come into play unless they are activated,” Bandura writes, “and there are many social and psychological maneuvers by which moral self-sanctions can be disengaged” from what he calls “inhumane conduct” (1999, 194). As Festinger (1957) emphasized about cognitive dissonance, the conduct itself can be reconstrued—justified—so that it is no longer viewed as immoral. This is one way of avoiding self-condemnation. Alternatively, perpetrators can minimize their own agency and role in causing the harm, or they can minimize, distort, or ignore the consequences of those actions. Finally, Bandura points out, those who harm others can devalue their victims or blame the victims for what is being done to them (1999, 203). The overall effect of these cognitive strategies is to justify harmful conduct or otherwise displace or diffuse the sense of personal responsibility for the consequences of those actions. Indeed, Bandura’s account of “moral disengagement” reads almost like the mirror image of “moral injury.” Where the “morally disengaged” perpetrators justify their own conduct, the “morally injured” tacitly believe or explicitly acknowledge that they have violated their own deeply held moral convictions. Where the “morally disengaged” minimize their own agency and complicity in the harmdoing, the “morally injured” accept and sometimes exaggerate their personal responsibility. Where the “morally disengaged” distort or ignore the consequences of their actions, the “morally injured” are tormented by the knowledge of the suffering they have caused. And where the “morally disengaged” devalue or blame or even dehumanize their victims, the “morally injured” acknowledge their shared humanity with their victims. We do not try to give an account of why some people morally disengage and others morally suffer. But we point out this contrast to ask the question: Is moral injury good? Is moral injury a sign of concern for the world, care for others, and a willingness to take responsibility for one’s own actions and listen to one’s conscience? One can imagine that these

The Moral Challenges of Moral Injury  29 fundamental moral commitments make the strategy of disengagement abhorrent or inaccessible to some people. But while there is moral value in moral injury, one should also be wary of describing it in positive terms, as if moral injury were redemptive (Arnault 2007, 163). If one gave an account of moral injury as moral growth, and as the silver lining to the horrors of war, one would echo a redemptive longing that is very popular in narratives of cruelty or horror. If only something good comes from it, then the horrors are not so bad. This temptation to put a positive spin on violence risks giving too little attention to the victims of harm—those who were killed, tortured, raped, or otherwise harmed— and their families. One should also be wary of viewing moral injury as good, as this could contribute to a narrative that normalizes cruelty or reinforces a good guy/bad guy dichotomy when talking about the harms of war. With these cautions in mind, we will consider whether attending to moral suffering might help us think about moral repair. Making Amends The mental health experts in the U.S. military who promote the model of moral injury use the language of “moral repair” and of “making amends.” The philosopher Margaret Urban Walker has thought carefully about these issues, and at one point, Nash invited Walker to discuss her work with him and his colleagues in the military. But for whatever reason, the encounter never took place.10 This is a pity because Walker’s reflections on moral repair have a lot to offer to the work on moral injury. Moral injury calls out for moral repair, but what kinds of repair are moral repair? One might be tempted to think of moral repair as requiring repair of relationships between the injured and injurer, as in the model of restorative justice. But this is mistaken. Restorative justice, according to one Victim Care and Advice Service, brings those harmed by conflict or crime and those responsible for the harm together. It gives victims the chance to meet or communicate with their offenders to explain the real impact of the crime and it empowers victims by giving them a voice…. It prioritizes victim participation and holds offenders to account for what they have done as it helps them to take responsibility and make amends. (Victim Care and Advice Service, n.d.)11 But in situations where moral repair is required, it is often impossible, inappropriate, offensive, and indecent to try to set up a dialogue between the wrongdoer and the ones who were wronged. In Walker’s approach, moral repair aims instead at “reinstating moral terms and replenishing our trust and hope in them and in ourselves” (Walker 2001, 115). It is not so much about repairing relations as it is about repairing morality as a part of

30  Johannes Lang and Robin May Schott our social lives. Walker distinguishes moral repair from strictly therapeutic measures (122). Moral repair is not one thing that can be pointed to, not a single theory or method that can heal the world. When one repairs moral relations for one party, one may even damage them for another, and Walker points to the Truth and Reconciliation Commission in South Africa as an example of the limits of moral repair (119). Instead of looking for big solutions, moral repair takes place through different kinds of practices that involve detailed understandings of concrete situations and being attentive to the “countermemories” that challenge official narratives about war, oppression, justice, or truth (124). Repairing trust in morality will often require trying to make things right with those who have been injured: making amends. One way of doing so is to participate in local, national, or international groups or collectivities that emerge to repair communities in formal or informal ways (Walker 2006, 223). Crucial in this process is accepting one’s responsibility and acknowledging that one’s actions or their consequences were wrong or harmful (Walker 2006, 191). To genuinely accept responsibility, one cannot diffuse responsibility among an indeterminate number of persons or portray one’s actions as part of events over which one had little or no power—a typical maneuver in self-justification. Instead, making amends requires not only acknowledging responsibility for one’s own actions and their consequences but also for harms done by others in one’s name, as with collective harms. This requires a willingness to challenge institutional and national narratives of self-justification (van Domselaar 2020, 25), so that one can be more open to listening to “countermemories.” Accepting responsibility entails engaging with the perspective of others and accepting their right to give their accounts of the harm done—thereby relinquishing a good deal of control over accounts of what has happened (Walker 2006, 200). There may be cases where the harms of violence, mistreatment, and death are so severe that the notion of repair seems meaningless (206). But even when moral repair is impossible, failing to seek it is a form of acquiescence that effectively compounds the wrong that has been done (205). Conclusion At first, mental health experts in the military “would roll their eyes” at the idea of moral injury, Litz recalls (2017, unpublished interview). But over time, the concept has gained recognition and has begun to reframe broader discussions on violence and trauma, not only within the military but also within healthcare and emergency services. A new language of suffering is taking shape, centered around the idea of “moral injury.” Commentators note that the fight for social and racial justice in the United States is fueled by “the fierce energy of moral injury” (Brock and Moon 2020). Meanwhile, the BBC reports that physicians and first responders on the front lines of

The Moral Challenges of Moral Injury  31 the COVID-19 pandemic are “at risk of moral injury” (BBC News 2020), and the American Psychiatric Association agrees “that ‘moral injury’ is an emerging consequence of this pandemic” (APA 2020). It is becoming clear that the events of the twenty-first century—wars, pandemics, and social movements—have unsettled our established notions of trauma, urging us to think differently about the human response to violence and suffering as we face the crises of our own times. As the term moral injury travels between military, healthcare, emergency services, and elsewhere, it brings with it questions of moral repair. For Litz, Nash, and their colleagues, moral repair involves accepting the imperfect self and drawing “a firm line around the past and its related associations, so that the mistakes of the past do not define the present and the future” (Litz et al. 2009, 704). But this approach still echoes a view of the problem as one’s own, implicit in the model of moral injury as inner conflict. In this view, moral injury inhabits the dissonance in the multiple voices within oneself that make up moral thinking and conscience. Yet, as the psychological experts on moral injury acknowledge, dissonance also has other dimensions, and in this chapter, we have explored the dissonance that goes beyond a cognitive-psychological model of moral injury. For the moral dissonance involved in moral injury is not only the result of a profound inner conflict between deeply held moral convictions and actual behavior, nor is moral repair only a matter of alleviating self-loathing or repairing social relationships. Morality itself is constituted by conflicting claims that can make moral failure inevitable and moral life tragic. But moral injury also ultimately embodies a need to believe in moral meanings, and it is this moral urge that distinguishes those who experience moral pain from those who morally disengage and become indifferent. Any adequate therapeutic response to moral injury must therefore grapple not only with the subjective experience of the individual but also with the moral and political dimensions of violence and trauma—and ask: How do you live a moral life under such conditions? What matters most to you now? How can you “re-moralize” your world and reinfuse it with moral meaning? (Kleinman 2006, 227). In their efforts to repair the moral fabric of their lives and reassert themselves as moral agents, there is hope that the morally injured will once again feel at home in the world. Notes 1 We interviewed Nash on October 31, 2017, and all quotes attributed to him  in  this chapter come from our unpublished interview, unless otherwise specified. 2 We interviewed Litz on November 6, 2017, and all quotes attributed to him in this chapter come from our unpublished interview, unless otherwise specified. 3 While we find these gendered examples outdated and problematic, we appreciate Marin’s focus on moral pain.

32  Johannes Lang and Robin May Schott 4 In this view, moral beliefs are moral because they are personal convictions about right and wrong. These authors do not discuss whether personal convictions about right and wrong are justifiable. At the conference Humanistic Perspectives on Moral Injury, at Georgia State University, April 12–13, 2019, the co-organizer (and co-editor of this volume) Andrew I. Cohen raised the question whether Nazis and racists can experience moral injury and answered affirmatively. 5 There are many other contexts in which the concept of dissonance is used without suggesting it has moral force. Existentialist philosophers like Jean-Paul Sartre and Simone de Beauvoir, for example, view human existence as conditioned by a fundamental alienation. From this existentialist perspective, there is a dissonance between how one experiences one’s own consciousness and freedom and how one is judged by others (Beauvoir 1948). In discussions regarding conflicts over historical memory, dissonance refers to the contested interpretations of the past (Kisić 2013). 6 The philosopher Larry May combines the older judicial meaning of conscience, where conscience operates after one has acted, with the legislative notion of conscience from the early Christian period, where conscience operates in advance of acting (1983, 62). 7 Moral coercion refers not only to being forced to comply with something that you reject. It also refers to being put in a situation in which one’s own moral commitments are used by others to undermine oneself and one’s goals, often in situations of extraordinary stress (Bazargan 2014). 8 Nancy Sherman (2021) mentions this example in the opening of her recent book, Stoic Wisdom. 9 Law professors have also observed this tendency. David Luban writes that, “Apparently, we are all highly resistant to the thought of our own wrongdoing, and the result is that we will bend our moral beliefs and even our perceptions to fight off the harsh judgement of our own behavior” (2003, 281). 10 Walker could not remember why she had declined Nash’s invitation when we asked her about this in 2019. 11 See https://victimcareandadviceservice.uk/help/repairing-harm-restorative-­ justice, accessed July 4, 2022. According to this website, “government research demonstrates that restorative justice provides an 85% victim satisfaction rate, and a 14% reduction in the frequency of reoffending.”

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The Moral Challenges of Moral Injury  33 ———. 1963/1994. Eichmann in Jerusalem: A Report on the Banality of Evil. New York: Penguin Books. Arnault, Lynne. 2007. “Cruelty, Horror, and the Will to Redemption.” In Feminist Philosophy and the Problem of Evil, edited by Robin May Schott, 160–92. Bloomington: Indiana University Press. https://doi.org/10.2307/j.ctt1zxz0w2.12. Bandura, Albert. 1999. “Moral Disengagement in the Perpetration of Inhumanities.” Personality and Social Psychology Review 3 (3): 193–209. https://doi. org/10.1207/s15327957pspr0303_3. Bazargan, Saba. 2014. “Moral Coercion.” Philosophers’ Imprint 14, no. 11 (May): 1–18. BBC News. 2020. Coronavirus: Why Healthcare Workers Are at Risk of Moral Injury. London: British Broadcasting Corporation, April 6. https://www.bbc. com/news/world-us-canada-52144859 Beauvoir, Simone de. 1948. The Ethics of Ambiguity. Translated by Bernard Frechtman. Secaucus: Citadel Press. Brock, Rita Nakashima and Zachary Moon. 2020. “Activism Is Moral Injury Gone Viral.” Medium, August 6, 2020. https://medium.com/@rita_brockVOA/ when-moral-injury-goes-viral-5f22b983e726. Carbonell, Vanessa. 2015. “Moral Failure: On the Impossible Demands of Morality.” Review of Moral Failure: On the Impossible Demands of Morality, by Lisa Tessman. Notre Dame Philosophical Reviews, May 24, 2015. https://ndpr. nd.edu/reviews/moral-failure-on-the-impossible-demands-of-morality/ Festinger, Leon. 1957. A Theory of Cognitive Dissonance. Stanford: Stanford ­University Press. Greenberg, Gary. 2010. Manufacturing Depression: The Secret History of a Modern Disease. New York: Simon & Schuster. Kisić, Višnja. 2013. Governing Heritage Dissonance: Promises, Realities, and Selected Cultural Policies. Amsterdam: European Cultural Foundation. www. europanostra.org/wp-content/uploads/2017/01/Governing_Heritage_Dissonance.pdf Kleinman, Arthur. 2006. What Really Matters: Living a Moral Life Amidst Uncertainty and Danger. Oxford: Oxford University Press. Litz, Brett T. 2017. Unpublished interview with Johannes Lang, Robin May Schott, and Mille Keis. Boston, MA, November 6. Litz, Brett T., Leslie Lebowitz, Matt J. Gray, and William P. Nash. 2017. Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury. New York: The Guilford Press. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (December): 695–706. https://doi.org/10.1016/j. cpr.2009.07.003 Luban, David. 2003. “Integrity: Its Causes and Cures.” Fordham Law Review 72, no. 2 (November): 279–310. Marin, Peter. 1981. “Living in Moral Pain.” Psychology Today 15, no. 11 (December issue, online version). May, Larry. 1983. “On Conscience.” American Philosophical Quarterly 20, no. 1 (January): 57–67.

34  Johannes Lang and Robin May Schott Mental Health Advisory Team (MHAT-IV). 2006. Operation Iraqi Freedom 05-07. Report chartered by the Office of the Surgeon General Multinational Forces-Iraq and the Office of the Surgeon General United States Army Medical Command, available at https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB20101 03335.xhtml. Nash, William P. 2017. Unpublished interview with Johannes Lang, Robin May Schott, and Mille Keis. Alexandria, Virginia, October 31. Neiman, Susan. 2002. Evil in Modern Thought. Princeton: Princeton University Press. Online Etymology Dictionary. n.d. “Betray.” Accessed July 2, 2022. www.etymonline.com/word/betray. ——— n.d. “Suffer.” Accessed July 3, 2022. https://www.etymonline.com/word/ suffer. Phillips, Joshua. 2012. None of Us Were Like This Before: American Soldiers and Torture. London: Verso Books. Schott, Robin May. 2003. Discovering Feminist Philosophy: Knowledge, Ethics, Politics. Lanham: Rowman and Littlefield. Shatan, Chaim F. 1972. “Post-Vietnam Syndrome.” New York Times, May 6. www.nytimes.com/1972/05/06/archives/postvietnam-syndrome.html Shay, Jonathan. 2002. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner. ———. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner. Sherman, Nancy. 2021. Stoic Wisdom: Ancient Lessons for Modern Resilience. Oxford: Oxford University Press. Tessman, Lisa. 2014. Moral Failure: On the Impossible Demands of Morality. Oxford: Oxford University Press. van Domselaar, Iris. 2022. “Law’s Regret: On Moral Remainders and a VirtueEthical Approach to Legal Decision-Making” (January 18). Jurisprudence. An International Journal of Legal and Political Thought. https://doi.org/10.1080/2 0403313.2021.2014709 Walker, Margaret Urban. 2006. Moral Repair: Reconstructing Moral Relations after Wrongdoing. Cambridge: Cambridge University Press. ———. 2001. “Moral Repair and Its Limits.” In Mapping the Ethical Turn: A Reader in Ethics, Culture, and Literary Theory, edited by Todd F. Davis and Kenneth Womack, 110–29. Charlottesville: University of Virginia Press. Williams, Bernard. 1973. “Ethical Consistency.” In Problems of the Self: Philosophical Papers 1956–1972, edited by Bernard Williams. Cambridge: Cambridge University Press. Wood, Sara. 2007. “Defense Department Releases Findings of Mental Health Assessment.” American Forces Press Service, May 4. www.army.mil/article/3005/ defense_department_releases_mental_health_assessment_findings

2 Ulterior Motives and Moral Injury in War Saba Bazargan-Forward

Introduction Suppose our government leaders sincerely state that they have the military aim of halting the ongoing genocide of an ethnic minority in a foreign country, which will require toppling the autocratic regime in power there. Once the regime is overthrown, the subsequent democratically elected government will ally with ours, thereby providing financiers from our country economic access to lucrative natural resources. They, in turn, will help fund our leaders’ reelection campaigns. Anticipating all this, our leaders consequently intend to halt the ongoing genocide only as a means – albeit a felicitous one – to furthering their own political ambitions. Indeed, absent those self-serving benefits, our government would not authorize intervening in the genocide. Yet our leaders falsely indicate to us that what motivates them is the fact that stopping the genocide is the humanitarian thing to do. This is just one example of an ulterior motive. It is a common refrain among soldiers fighting in anything less than an obviously defensive war, that their government leaders have this sort of ulterior motive, in which the leaders authorize ostensibly humanitarian aims solely or mostly for mercenary rather than moral reasons. I think soldiers often correctly attribute such ulterior motives to their leaders, especially in countries less restrained in their resort to military force. My issue in this chapter is not with whether ulterior motives affect the jus ad bellum status of wars. I suspect that at least sometimes they don’t – and those are the cases I’ll be focusing on here.1 Rather, my concern is with whether, and if so, how the ulterior motives leaders harbor might lend to the moral injury of soldiers who take themselves to be fighting for the right reasons. According to the argument I develop here, civilian and military leaders, by virtue of their practical authority over combatants serving in the military, confer upon those combatants a particular purpose. The ulterior motives that the leaders harbor constitutively determine the DOI: 10.4324/9781003281122-4

36  Saba Bazargan-Forward content of the purpose they confer. So long as a combatant remains under the ­practical authority of her leaders, there is nothing she can do to divest herself of the specific purpose conferred upon her. Though the war and her conduct in it are just by hypothesis, her sense of integrity might demand more: that she helps kill only for scrupulous purposes. It might be impossible to reconcile the demands of integrity with the cynical purpose that her self-serving, career-minded, opportunistic leaders confer upon her. This failure to justify to herself the carnage she helps cause can exacerbate the severity of any psychological trauma she suffers. But first, consider some preliminaries regarding the concept of “ulterior motives”. I begin with motives. For expository convenience, I will understand motives in terms of motivating reasons. Though such a move is controversial, I doubt that anything substantive turns on this assumption, given the aims of this chapter. So, returning to the aforementioned example, the government leaders have selfish motives in that the reasons they take themselves to have in favor of halting the genocide are, by their own lights, wholly instrumental to achieving the reasons they take themselves to have in favor of furthering their political ambitions. What makes a motive “ulterior”? I do not here develop a comprehensive account of ulterior motives. Suffice it to say that an ulterior motive is one particular way of intentionally misrepresenting the reasons for one’s action. So, for example, a motive to achieve some aim ф is ulterior if the agent takes herself to be acting on one set of reasons for ф (typically selfregarding reasons), while insincerely indicating to others that she takes herself to be acting on another set of reasons in favor of ф (typically otherregarding). So, suppose the only political benefits the aforementioned government leaders anticipate is the increase in favorability ratings at home resulting from a successful humanitarian military operation. If this serves as the motivation in favor of authorizing military force, then this would count as an ulterior motive. But what of mixed cases? Suppose the government leaders authorize military force necessary to stop the genocide partly for humanitarian reasons and partly to further their own political ambitions. Here, the government still has an ulterior motive, though it does not serve as the sole basis for halting the genocide. In this case, the leaders recognize that stopping the genocide is a choiceworthy aim in itself, in addition to whatever self-serving political benefits it confers. For purposes of this chapter, we can resolve these cases by running a counterfactual test: would the government leaders still authorize military force to stop the genocide if they knew beforehand that doing so would do nothing to either advance or hinder their political ambitions? I will focus on cases where the answer is “no”. That is, I will focus on cases where ulterior motives in favor of ф are sufficiently important that absent those motives, the agent would not pursue ф. (This test,

Ulterior Motives and Moral Injury in War  37 like most counterfactual tests, is merely heuristic; it’s not hard to imagine cases of overdetermination, or cases of deviant causal chains, in which an agent with an ulterior motive will continue to pursue ф even if that motive is absent. I set these cases aside). Having presented a brief but, I hope, serviceable account of ulterior motives, I turn to any analysis of their relevance to moral injury in war. I start in the next Section, “Conferring Purposes Upon Soldiers,” by elucidating the sense in which the motivations of civilian and military leaders constitutively determine the purpose conferred upon the combatants they order to fight. Next, in the Section titled “Ulterior Motives and Integrity”, I argue that a combatant’s integrity might demand that she help kill only in furtherance of scrupulous purposes. So, when leaders confer upon such combatants the purpose of killing in furtherance of their own political ambitions, the combatants violate their integrity in a fundamental way, which can result in moral injury. In the “Criticisms” Section that follows, I consider objections to this view. I offer summative remarks in “Conclusion.” Conferring Purposes Upon Soldiers A government’s ulterior motives with respect to a war can result in the moral injury of its combatants fighting in that war – even if the war is just and the combatants violate no one’s rights in the course of fighting the war. To understand why, it’s necessary to elucidate the relationship between a government’s leadership and the combatants who fight at their behest. And to do this, we need to investigate how practical agency functions at the most basic level. This is because I allege that aspects of rational agency, normally wrapped up in a single agent, are “distributed” between the leaders and their subordinates, which ultimately explains the sense in which combatants act at the behest of their leaders. Our practical agency can be understood, at the broadest level of generalization, in terms of its deliberative and executory functions. An agent exercises its deliberative agency in the course of determining what to do. And that agent exercises its executory agency in implementing that choice. At that point, the agent shifts from the deliberative mode to the executory mode, by implementing through conduct the practical reasons the agent takes there to be in favor of the selected option. This process just describes what it standardly means to decide what to do and then act accordingly. Normally, the deliberative and executory functions of agency are embedded in a single agent. That is, normally, an agent – call her “A” – ­deliberates by assessing the options available to her, and A undertakes the selected option. In some cases, though, she might “outsource” the

38  Saba Bazargan-Forward executory functions of her practical agency to another agent – call her “B”. This happens when A assigns to B the role of implementing the practical reasons A takes there to be. Assuming B agrees to that role, the practical reasons A takes there to be now have the function of guiding B’s conduct. Concomitantly, B’s conduct now has the function of implementing the practical reasons A takes there to be. A and B have thereby established a division of agential labor in that A qualifies as the “deliberator” and B qualifies as the “executor”. By establishing this division of agential labor, A and B effectively trade their deliberative and executory functions, so that A has the function of evaluating and selecting among options for B, and B has the function of implementing that option for A.2 But how exactly does A come to serve as B’s deliberator, and how does B come to serve as A’s executor? A and B establish a division of agential labor when A comes to have practical authority over B. But what is it for one person to have practical authority over another? In standard cases of decision-making, I decide whether to undertake some salient conduct ф (understood broadly enough to include not just actions but omissions) by evaluating the reasons for and against it. But suppose I believe that you have the authority to issue commands to me pertaining to ф. In such a case, the pros and cons of ф itself no longer determine the reason I take myself to have for or against ф. Instead, I take you to have a practical claim over me with respect to what I should do about ф. H. L. A. Hart points out that regardless of the differences in what authorities require of us, they all present us with the same practical reason to comply: the very fact that they have authority over us (Hart 1990, 101).3 So, if I take you to have authority over me, then I take myself to have a reason to do what you say, because you say it (at least within the domain of conduct in which you have authority). But, in addition, your practical claim against me that I do ф provides me with what I take to be a reason for excluding from my deliberations certain reasons against ф. The zone of exclusion will vary with the nature of the authority in question.4 If ф is morally wrongful, you lack moral authority over me that I comply with your command that I commit it. But you will nonetheless retain practical authority over me that I comply. The first-order reason to comply with your authoritative command, combined with the second-order reason to exclude certain competing considerations, yields what Joseph Raz calls a “protected reason” (Raz 1977; 1990, 35–84).5 The upshot is that if we take you to have practical authority over me when it comes to ф, your commands pertaining to ф will provide me with a protected reason to comply, as far as we’re concerned. Put differently, your command pertaining to ф settles the matter for me. Consider, now, the following version of a well-known philosophical example.

Ulterior Motives and Moral Injury in War  39 Strategic Bomber

A captain in the air force orders a pilot to drop a bomb on a ­munitions factory. Doing so will cripple an enemy’s bomb-making capabilities which will help end the unjust war that the enemy is waging. But the ensuing explosion will also collaterally kill dozens of civilians in a nearby village. Given the moral costs and benefits, bombing the factory is morally permissible. But when the captain issues the order, he harbors the inimical intention of murdering the villagers. The pilot does as she is ordered with the permissible intention of destroying the munitions factory. The pilot will of course have his own motivating reasons – the practical reasons he takes there to be – which his conduct will have the function of implementing. Some might be lofty. He might take there to be reasons to help win the war in which he is fighting. Others might be prosaic. He might want to complete his tour of duty and return home. The pilot recognizes though that the captain has practical authority over him, by virtue of their mutual participation in the military. As a result, the captain’s order to drop the bomb is supposed to settle the matter for the pilot as to what he is practically supposed to do and why he is supposed to do it. The practical reasons the captain takes there for dropping the bomb have the function of guiding the pilot’s conduct; concomitantly, the pilot’s conduct has the function of implementing the practical reasons the captain takes there to be. This is in keeping with the division of agential labor in which the captain serves as deliberator and the pilot serves as executor. An upshot is that in morally evaluating what the pilot has done, we must repair to the captain’s motivating reasons. This is because the pilot’s conduct had the function of enacting the captain’s motivating reasons. Thus, such reasons will be included among those by which we evaluate what the pilot has done. Presumably, the pilot and his victims have, at the most fundamental level, equal moral standing in that they are mutually accountable to one another as moral agents. This suggests any given innocent victim of the bombing is entitled to demand an explanation from the pilot – an explanation revealing the role that her rights and welfare played, if any, in the decision to drop the bombs. This means repairing to the practical reasons the captain took there to be in favor of the bombing, since the captain served as deliberator and the pilot served as executor. This is because the protected reasons that the pilot takes herself to have will refer anaphorically to the reasons that the captain takes there to be. So, describing the pilot’s conduct requires adverting to the captain’s motivating reasons. This determines the purpose of the pilot’s conduct.

40  Saba Bazargan-Forward In contrast to the pilot’s motivating reasons, the pilot’s purpose might be introspectively opaque to him. This is because it’s the captain rather than the pilot that determines the content of the pilot’s purpose. Suppose, then, the captain’s motivating reasons – the practical reasons determining the purpose of the pilot’s conduct – are morally problematic, in that the captain wanted the villagers killed. This means it was therefore the pilot’s purpose to kill the villagers, even if the pilot had no such intention and did not know that the captain possessed that aim. And if the pilot suspects that her superiors do indeed harbor inimical purposes, the concomitant purpose conferred upon her can be a source of moral injury – or so I will argue. I have presented an account explicating the sense in which combatants have purposes attributed to them by their commanding officers. These purposes, though they might remain introspectively opaque to the combatants who harbor them, are nonetheless integral to describing fully what they have done. In the same way that the captain’s motivating reasons constitutively determine the pilot’s purpose in conducting the bombing, the motivating reasons of the civilian and military leaders who authorize the war in the first place constitutively determine the purpose of the combatants ordered to wage that war.6 An upshot is that regardless of what reasons the combatants take there to be in favor of what they do – regardless of what their own personal motivations might be in favor of fighting – the combatants are, in addition, saddled with the purpose that the leadership confers upon them. As we saw, this is in virtue of their status as combatants in a hierarchical command structure in which they serve as executors and the leadership as deliberators. The basis for their status as such is “externalist” – it lies in their social role as combatants.7 Save for ending her military service, there is nothing any given combatant can do to unilaterally amend or otherwise divest herself of the specific purpose her leaders have conferred upon her, no matter how much she might vociferously disagree with and reject that purpose. Recall the case with which we began, in which leaders authorize military action to put a stop to a genocide. Take a particular combatant fighting in that war. Call her “Soldier”. So long as Soldier follows orders, she acts according to the purpose conferred upon her, which by hypothesis is ultimately to promote her leader’s political ambitions by helping provide financiers access to lucrative natural resources. Whatever other purposes the combatant might take herself to have and which are derived from her own private aims – e.g., to help stop the genocide for its own sake – will have to co-exist alongside the purposes conferred upon her and constitutively determined by the private aims of her leaders. She can no more unilaterally amend the purpose conferred upon her by her superiors than can the pilot in Strategic Bomber.

Ulterior Motives and Moral Injury in War  41 In what follows, I explain how the purpose conferred upon Soldier can be incompatible with the demands of her integrity, even if the war and her conduct in it are morally permissible. Ulterior Motives and Integrity Given the account I have presented so far, when Soldier kills others in the war her leaders authorized, she cannot ingenuously and correctly aver that her purposes were all virtuous, even if those killings were justified. In addition to her personal reasons for killing, which might be morally unimpeachable, she has the purpose of killing in order to advance the political ambitions of her leaders. As we have seen, there is nothing she can do or so say to exorcize that purpose conferred upon her, so long as she remains under the practical authority of her leaders. And she remains under their practical authority so long as she serves in the military. An upshot is that when reckoning morally with what she has done in the war, she is forced to confront the unpleasant fact that she possessed a morally unscrupulous purpose. To be clear, the claim here is not merely that there is a basis for Soldier to feel agent-regret. Take for example a case belonging to Jeff McMahan in which, unbeknown to you, a terrorist rigs your cellphone so that it sets off a bomb killing innocents on the other side of town the next time you answer a call (McMahan 2005). Of course, it makes sense to feel agentregret for having been used as a means to a nefarious end. But you can ingenuously and correctly deny that it was your purpose to do so. Because the terrorist has no practical authority over you, the terrorist’s purpose doesn’t become yours. This is in contrast to Soldier whose purpose was indeed conferred upon him by her superior officer. On this view, the cynical and self-serving ulterior motives of leaders half a world away can have decidedly personal consequences for the combatants enacting those motives. Given the purpose conferred upon Soldier, and given the harms she commits over the course of the war, it can be psychologically and morally difficult for Soldier to regard herself as acting with integrity. After all, regardless of how scrupulous her own motives might be, she knows or has good reason to suspect that she is purposed with killing to enrich her self-serving leaders. So, suppose Soldier attempts to explain to herself, or to her victims, why she participated in a presumptively objectionable activity: killing. That is, suppose she holds herself or is otherwise held by others to account for her conduct in the war. In providing an explanation, she might cite her own personal reasons for helping kill others. But this explanation will remain crucially incomplete if she neglects citing the cynical, self-serving purpose conferred upon her by her leadership.

42  Saba Bazargan-Forward Recall that I do not claim that such a purpose makes it impermissible to fight and kill in the war. The enemy combatants perpetrating the genocide might be morally liable to be killed even in furtherance of self-serving aims (though not, I believe, in furtherance of manifestly evil aims). Rather, the point is that the purpose the leaders confer upon Soldier might be antithetical to her self-regard as someone who is willing to inflict grievous harms only to prevent such harms. Reconciling this principled stance with the purpose conferred upon her requires impossible moral and psychological contortions – at least if and when she learns of her superior’s ulterior motives. The result is that Soldier might come to see herself as morally diminished in an important way for participating in that war, even though the war as well as her conduct in it are morally permissible. To better explicate this phenomenon, I will repair to a canonical discussion of integrity. In Bernard Williams’ famous example, a pacifist named “George” is offered a job manufacturing chemical weapons (Smart and Williams 1973, 97–99). Refusing this opportunity will not only leave his family impoverished but will also result in greater harm overall since a more zealous applicant will take the job, and he will be producing chemical weapons in greater quantities. Yet if George takes the job, he would be contributing to an end he personally finds morally abhorrent. In discussing this example, Williams is concerned less about what George should do and more about how he should deliberate about what to do. There is something morally perverse, Williams suggests, about expecting George to treat the violation of his deepest commitments as an entry in the costs-column of a Utilitarian balance sheet. To do so would be “to alienate him in a real sense from his actions and the source of his action in his own convictions” (Smart and Williams 1973, 116–17). This would be an “attack” on his integrity, insofar as integrity prohibits acting in a way contrary to our deepest convictions. This is because our deepest convictions, Williams says, “will characteristically be what gives one’s life some meaning, and gives one some reason for living it” (Williams 1995, 169–70). I suggest, though, that the attack on George’s integrity is more fundamental than Williams realizes. The attacks consist not only in requiring him to contribute to an end he regards morally abhorrent. The attack on George’s integrity also consists in requiring him to accept the purpose of contributing to that end. As Sophie-Grace Chappell puts it, “[a]n agent’s integrity, in Williams’ sense, is his ability to originate actions, to further his own initiatives, purposes or concerns, and thus to be something more than a conduit for the furtherance of others’ initiatives, purposes or concerns…” (Chappell 2018). Though Williams was addressing the “initiatives, purposes, or concerns” deriving from the impersonal point of view

Ulterior Motives and Moral Injury in War  43 that Utilitarianism demands, his point can nonetheless be generalized. For George, “his projects and his decisions have to be seen as the actions and decisions which flow from the projects and attitudes with which he is most closely identified” (Smart and Williams 1973, 116–17, emphasis in original). We can now appreciate the sense in which George is in a position similar to Soldier. By taking on jobs in which they serve as executors and in which their superiors serve as deliberators, they have relegated themselves to the role of “a conduit” in furtherance of “initiatives, purposes, or concerns” antithetical to their own. Their superiors, after all, confer upon them protected reasons to comply with their instructions. So long as they act according to their roles, George and Soldier are supposed to refrain from weighing the pros and cons of fulfilling the tasks assigned to them. They are thereby ceding deliberation regarding a critical issue to unscrupulous opportunists. Their deepest moral convictions demand the opposite: that they grant their tasks precisely the sort of critical moral deliberation that their role as executor prohibits. This is, in and of itself, a violation of their integrity quite apart from whether they end up causally contributing to unjust ends. To be clear, Soldier’s decision to serve in the military, and thereby serve as a “conduit” for another’s “projects and decisions”, does not necessarily undermine her sense of integrity. Civilian and military leaders often enough authorize a resort to war for reasons consistent with their combatants’ views regarding the military’s fundamental purpose. In such cases, the leaders’ practical reasons – which constitutively determine the purpose they confer upon Soldier – are compatible with her integrity’s demands. The problem occurs when Soldier serves as a conduit for corrupt projects and decisions. Soldier’s integrity, then, demands that she serves as a conduit only for scrupulous projects and decisions. If her superior possesses unscrupulous aims, and Soldier suspects as much, acting in accordance with those aims violates her integrity’s demands. But why should Soldier’s integrity be so demanding? Isn’t such a standard quixotic? I do not believe so. It is difficult even in the morally best circumstances for a combatant to react with anything but moral horror at the abject misery and death of war, and at having directly contributed to such carnage. The worse the harms, the higher the standard that must be met to reconcile those harms with integrity’s demands. And when that standard is not met – when Soldier’s sense of integrity is violated – she cannot justify to herself her contribution to that carnage. And this can affect the severity of any resulting psychological trauma she suffers. I do not claim that all combatants suffer thusly. Many might be unphased by the horror of war. And among those who are indeed psychologically

44  Saba Bazargan-Forward traumatized, there will be some for whom diminished self-regard resulting from violating the demands of integrity will have little effect on the severity of that trauma. And there will be still others who are psychologically traumatized, and for whom diminished self-regard would indeed ­exacerbate such trauma, but who find nothing especially problematic about acting on the cynical and self-serving purpose that their leaders conferred upon them. But I suspect that for many if not most soldiers, their ability to morally reconcile what they do in war with the demands of integrity significantly exacerbates the severity of the psychological trauma they suffer. And I suspect that for many if not most soldiers, their integrity demands that they kill solely for legitimate reasons, and not to advance or enrich the political ambitions of their leaders.8 Criticisms Here, I turn to two criticisms. They both suggest that Soldier should not hold herself accountable for the ulterior motives of her leaders. The first does so by alleging that absent control over her leaders’ motivations, Soldier should not hold herself to account for implementing such motivations. The second does so by alleging the motivations have only first-personal and not third-personal moral relevance. Both of these criticisms, I argue, fail. According to the first criticism, Soldier cannot be held to account for the problematic motivations of her leaders at least in part because she has no influence over those motivations. Though it is true that Soldier is enacting the self-serving motivations of her leaders, that should play no role whatsoever in Soldier’s moral evaluation of herself. Rather, such an evaluation should be based solely on her own actions and on her own motivations, all of which by hypothesis are morally beyond reproach. On this view, the leaders’ ulterior motives do not reflect badly on Soldier’s character – rather, only on their own. This criticism is, at first, compelling. After all, it is uncontrovertibly true that Soldier cannot be held accountable for the fact that her leaders have the motivations that they do. But the resulting purpose conferred upon Soldier can still compromise her integrity. To see why, it’s helpful to repair once again to Bernard Williams’s canonical examples in his discussion of integrity – but this time, to Jim rather than George. In this classical example, the protagonist, in order to save nine innocents, must compromise his commitment to pacifism by killing an innocent who would have been killed anyway. The moral here (contrary to many an undergraduate essay) is not that Jim acted wrongly. Indeed, Jim probably did the right thing. Rather, the point is that in doing the right thing, he was forced to violate the demands of his integrity.

Ulterior Motives and Moral Injury in War  45 Though certainly not a pacifist, Soldier is in a somewhat analogous situation. Suppose Soldier knows or suspects that her superiors have ulterior motives. Yet she has a moral commitment to participate in killing for scrupulous reasons only. Helping put a stop to the genocide is one such reason. Advancing the ambitions of her political leaders is not. Yet she cannot do one without simultaneously doing the other. So, in order to do what is right – to help put a stop to the genocide – she must enact the corrupt purpose conferred upon her. That is, she must violate the demands of her integrity. The point here, then, is this. Even though Soldier has no control over her leader’s ulterior motives, and thus over the purpose conferred upon her, she does indeed have control over whether she obeys their commands. Suppose she, like Jim, chooses to do as commanded, on the grounds that it is what morality ultimately requires: it is better to act according to the unscrupulous purpose her leaders conferred upon her than it is to refrain from helping put a stop to the genocide. She must, then, like Jim, set aside as best she can her integrity’s demands in order to do what is morally required of her. And this, again, is a source of moral injury. According to Nancy Sherman, “moral injury” refers to experiences of serious inner conflict arising from what one takes to be grievous moral transgressions that can overwhelm one’s sense of goodness and humanity. The sense of transgression can arise from (real or apparent) transgressive commissions and omissions perpetrated by oneself or others, or from bearing witness to the intense human suffering and detritus that is a part of the grotesquerie of war and its aftermath. In some cases, the moral injury has less to do with specific (real or apparent) transgressive aces than with a generalized sense of falling short of moral and normative standards befitting good persons and good soldiers. (Sherman 2015, 8) On this account, it is clear that acting in a way that violates the demands of one’s own integrity can serve as a source of moral injury. This takes us to the second possible criticism which alleges that motivations are only first-personally and not third-personally morally relevant to conduct (Nagel 1989, 175–79). By hypothesis, Soldier does the right thing by participating in the war. Though her leaders’ motivations are morally problematic, Soldier’s aren’t. If motivations are morally relevant only from an agent-centered standpoint, then the leaders’ unscrupulous motivations should not affect our moral evaluation of Soldier or of what she does. At best, it should affect our moral evaluation of what the leaders bring about via Soldier.

46  Saba Bazargan-Forward But why believe that motivations are only first-personally morally ­relevant? Consider this case: Poisoning

You have the option of preventing a culpable poisoner from surreptitiously poisoning a random innocent, where the poison will cause that innocent 10 hours of extreme pain (which the victim will mistakenly attribute to having eaten spoiled food). Alternatively, you have the option of preventing a non-culpable poisoner from accidentally poisoning a different random innocent, where the poison will cause that innocent 11 hours of extreme pain (which the victim will mistakenly attribute to having eaten spoiled food). Given you can stop only one of the two poisoners, which one should you pick? Presumably, the second; the fact that the first is acting according to bad motivations should play no role in who you stop. Rather, the total amount of harm inflicted has (arguably) lexical priority. This is not to say motivations are morally irrelevant. Rather, it is to say that motivations give moral reason only to their bearers. On this view, though it is incumbent upon the leaders to act solely out of the right sort of motivation, that requirement is wholly first-personal in that no one else has the responsibility to ensure that they adopt those motivations. So even if Soldier, by participating in the war, helps achieve the leaders’ ulterior motives, she is on the hook solely for her own motives – not for those belonging to her leaders. As a result, Soldier has no reason to think that her actions violate her commitment to killing only for scrupulous reasons; this is because she is not accountable for the reasons that the leaders attach to her conduct. But this argument fails, even if it is correct in its surmise that motivations are relevant only from a first-person standpoint. To see why, consider again a terror-bomber whose motive is to target innocent villagers, in contrast to a strategic bomber who collaterally kills the villagers as a side-effect of harboring the motive to destroy a munitions factory. If different conduct were necessary to kill the civilians, the terror-bomber, unlike the strategic bomber, would alter his behavior accordingly. Thomas Nagel points out that in this case, the agent “tracks” the harm through modal space. If the conditions for causing the harm were to change, his actions would change accordingly. This systematic counterfactual interdependence between his agency and the harm connects him to it in a morally egregious way, Nagel suggests (1989, 175–88). This standard counterfactual description of an ordinary intention is supposed to help show why motivations are morally relevant, at least from a first-personal standpoint.

Ulterior Motives and Moral Injury in War  47 Similarly, Soldier does not just happen to enact the leaders’ practical reasons. Instead, it is quite literally her function to do so. Recall that Soldier and her leaders have established a division of agential labor in which the leaders count as the deliberators and Soldier counts as an executor. In accordance with this division of agential labor, the leaders establish the purpose of Soldier’s conduct with respect to her role in the war. Soldier has, then, the function of enacting the practical reasons the leaders take there to be. Though Soldier might disavow the leader’s practical reasons, Soldier’s conduct still counterfactually depends on the leader’s practical reasons in a systematic way: where the leaders’ reasons change, Soldier’s purpose ipso facto changes as well. The counterfactual sensitivity that Soldier’s conduct bears to the leaders’ ends is the same counterfactual sensitivity that an agent’s actions bear toward her own ends. Similar to how, in ordinary cases, an intention disposes you to change your actions (within limits) in ways instrumental to achieving its object, Soldier’s relationship to the leader disposes Soldier to change her actions in ways instrumental to achieving the object of the leaders’ intentions. This is because the reasons the leader takes there to be constitutively determine the purpose of the soldier’s conduct. So, if we think that intentions are first-personally relevant because they counterfactually relate the individual to an end in a systemic way, then we should also think that the leaders’ reasons are morally relevant to Soldier’s actions. This should come as no surprise. Recall that Soldier and her leaders have established a division of agential labor in which the deliberative and executory aspects of agency are distributed among them. There is a sense, then, in which they together constitute a locus of agency. The argument that motivations have only first-personal relevance will, if anything, help strengthen rather than weaken the claim that the leaders’ ulterior motives are relevant to Soldier’s integrity. So even if she is herself free of ulterior motives, and even if she makes the correct decision by fighting in the war, and even if motivations are in general morally relevant only first-personally, Soldier still violates the demands of her integrity by killing in part for the purpose of advancing her leader’s political ambitions. And this, as I have indicated, can serve as a cause of moral injury. Conclusion If what I have argued is correct, the ulterior motives of civilian and military leaders authorizing a just war can lend to the moral injury of the combatants tasked with fighting in that war, even if the combatants are morally permitted to so fight. We often hear soldiers suggest that their leaders are waging war ultimately for political gain. This is not just an offhanded

48  Saba Bazargan-Forward cynical remark from jaded combatants. It is often an accurate observation, the truth of which can be a source of moral injury in war. Notes 1 For arguments against the relevance of the “right intention” criterion for jus ad bellum, see McMahan (2005) and Frowe (2014). 2 For a more complete discussion, see chapters 2 and 3 of Bazargan-Forward (2022). 3 For helpful discussion, see Shapiro (2002), Owens (2008), and Westlund (2011). 4 For helpful discussion, see Shapiro (2002, 406–07) and Owens (2008). 5 See also Hinchman (2003), Sciaraffa (2009, 248), and Ferrero (2010, 8). 6 What about cases where multiple persons comprise the leadership? How do we determine the content of the purpose they collectively confer in such cases? We need a judgment-aggregating decision-procedure to answer this question, which is beyond the purview of this chapter. For more on judgment aggregation in the context of shared decision-making, see List (2005). 7 For a related, externalist analysis of combatancy as a social role, see Benjabi and Statman (2019, 124–126). 8 This seems borne out in the extensive work Nancy Sherman has done on this subject. See in particular Sherman (2015).

Works Cited Bazargan-Forward, Saba. 2022. Authority, Cooperation, and Accountability. New York: Oxford University Press. Benbaji, Yitzhak and Daniel Statman. 2019. War by Agreement. Oxford: Oxford University Press. Chappell, Sophie-Grace and Nicholas Smyth. 2018. “Bernard Williams.” Edited by Edward N. Zalta. https://plato.stanford.edu/archives/fall2018/entries/ williams-bernard/. Ferrero, Luca. 2010. “Decisions, Diachronic Autonomy, and the Division of Deliberative Labor.” Philosophers’ Imprint 20 (2): 1–23. Frowe, Helen. 2014. “Judging Armed Humanitarian Intervention.” In The Ethics of Armed Humanitarian Intervention, edited by Don E. Scheid, 93–110. Cambridge: Cambridge University Press. Hart, H. L. A. 1990. “Commands and Authoritative Legal Reasons.” In Authority, edited by Joseph Raz, 92–114. New York City: New York University Press. Hinchman, Edward S. 2003. “Trust and Diachronic Agency.” Noûs 37 (1): 25–51. List, Christian. 2005. “Group Knowledge and Group Rationality: A Judgment Aggregation Perspective.” Episteme 2 (1): 25–38. https://doi.org/10.3366/ epi.2005.2.1.25. McMahan, Jeff. 2005. “Just Cause for War.” Ethics & International Affairs 19 (3): 1–21. https://doi.org/10.1111/j.1747-7093.2005.tb00551.x McMahan, Jeff. 2005. “Moral Liability to Defensive Killing.” Philosophical Issues 15: 386–405.

Ulterior Motives and Moral Injury in War  49 Nagel, Thomas. 1989. The View From Nowhere. Oxford: Oxford University Press. Owens, David. 2008. “Rationalism about Obligation.” European Journal of Philosophy 16 (3): 403–31. https://doi.org/ 10.1111/j.1468-0378.2008.00327.x. Raz, Joseph. 1977. “Promises and Obligations.” In Law, Morality and Society: Essays in Honour of HLA Hart, edited by P. M. S. Hacker and Joseph Raz, 210–28. Oxford: Oxford University Press. ———. 1990. Practical Reasons and Norms. Princeton: Princeton University Press. Sciaraffa, Stefan. 2009. “On Content-Independent Reasons: It’s Not in the Name.” Law and Philosophy 28: 233–60. https://doi.org/10.1007/s10982-008-9037-7. Shapiro, Scott J. 2002. “Authority.” In The Oxford Handbook of Jurisprudence, edited by Jules Coleman and Scott J. Shapiro, 382–439. Oxford: Oxford University Press. Sherman, Nancy. 2015. Afterwar: Healing the Moral Wounds of Our Soldiers. New York: Oxford University Press. Smart, J. J. C. and Bernard Williams. 1973. Utilitarianism: For and Against. Cambridge: Cambridge University Press. Westlund, Andrea. 2011. “Autonomy, Authority, and Answerability.” Jurisprudence 2 (1): 161–79. https://doi.org/10.5235/204033211796290317

Williams, Bernard. 1995. Making Sense of Humanity. Cambridge: Cambridge University Press.

3 Theorizing Moral Injury with Reports of Trauma Andrew I. Cohen and Jennifer A. Samp

Introduction Since Jonathan Shay (1994) introduced the term in the 1990s, the notion of moral injury has gained more currency with scholars and laypersons. It has served in clinical, ethical, and political contexts. Its meaning and applications have evolved as writers variously interpret and apply the concept. (See, for instance, Wiinikka-Lydon 2019.) Persons unfamiliar or uneasy with the term might not know how to evaluate different understandings and applications. Common accounts of moral injury include a harmful and disorienting trauma that comes from witnessing or participating in an act that violates deeply held moral values (Litz et al. 2009; Shay 1994; Molendijk, Kramer, and Verweij 2018). Moral injury typically involves certain negative selfappraising moral emotions such as guilt and shame. Such moral emotions become part of moral injury when their experience becomes chronic and debilitating. In this chapter, we do not provide an exhaustive catalog of the ways one might use the term. We also do not consider the merits of clinical classifications as they might appear in any edition of the DSM. Instead, we consider how to interpret each part of the term: the moral and the injury. We consider what makes the phenomenon injurious. We distinguish moralized from nonmoralized accounts of moral injury and raise doubts about moralized understandings of the term. We argue the “injury” of moral injury is a distinct sort of harm, and it is one with a certain sort of experience requirement. The “moral” part of “moral injury” best serves as a marker of the types of emotions involved in a harm and not a substantive constraint. Allowing that moral injury might include “invisible wounds” potentially makes the term more capacious than we might hope before theorizing it. In short, our argument is this: it is not necessary that the moral emotions relevant to moral injury be morally

DOI: 10.4324/9781003281122-5

Theorizing Moral Injury with Reports of Trauma  51 supportable. Indeed, we go further and argue that among the ­morally injured might be persons whose emotions are irrational or mistaken. If our argument succeeds, then there can be cases of moral injury among persons whose emotions indicate some moral or evaluative errors. Indeed, there can be cases of moral injury that revolve around moral emotions felt by dubiously moral persons about questionably moral activities. Just as confused and wicked persons can experience moral emotions—including about their confused and wicked commitments—so too might confused and vicious persons be morally injured. The modifier “moral” in moral injury is then not a substantive constraint but a formal marker of the sort of emotions that the relevant phenomena involve. Moreover, among the morally injured can be persons who are importantly mistaken about their pasts. When investigating a term that speaks to a multidimensional phenomena of moral experience, theorists can serve several roles. Among them is to clarify the boundaries of the idea so it maps some analytically fruitful concept, which would further theoretical adequacy. Another is to distill the meaning of the term in light of usage and experience, which would take extensional adequacy as a desideratum. These two aims can clash. (See a related discussion at Rainbolt 2006, sec. 4.6.) In this chapter, we caution against certain ways of privileging theoretical adequacy. We begin by providing an overview of certain moral emotions as they figure in the idea of moral injury. We then assess the fit, warrant, and moral suitability of guilt in cases of apparent moral injury. We consider challenges with cases involving misplaced guilt or shame. By drawing on examples and testing the boundaries of adjacent concepts, we compare the costs of a concept of moral injury that includes cases of misplaced guilt against a concept that excludes them. We argue that the concept of moral injury can be capacious enough to allow for cases of morally injured deluded and/or vicious persons. Moral Emotions and Moral Injury In this section, we identify certain cases of misplaced guilt. We draw on some recent work about how the emotions connect to judgments, beliefs, and dispositions. We consider how guilt and trauma figure in moral injury. Moral injury captures certain extended and unwelcome emotional states. In many cases, it involves (or is constituted by) certain recalcitrant emotions such as shame and guilt. For ease of discussion, we focus on the case of guilt. A mere moment of guilt is not a moral injury. The experience must be protracted. Moreover, and more basically, the injury has an “experience

52  Andrew I. Cohen and Jennifer A. Samp requirement.” One must experience it in some way to have it. (See related discussion at Wiinikka-Lydon 2018, 4–5.) Consider the case of David Cash, Jr. In 1997, then 17-year-old Cash witnessed his friend Jeremy Strohmeyer restraining and molesting a 7-yearold girl, Sherrice Iverson, in the restroom of a Nevada casino. Surveillance camera footage showed Cash entering and leaving the restroom where Iverson’s body was later discovered. Strohmeyer was later convicted of sexual battery and murder. Cash demonstrated no remorse for not intervening. In some interviews, he seemed to show a chilling moral insensitivity about the horror he allowed to happen (“The Bad Samaritan?” 1998; Sumter 2020). Cash was not morally injured. He felt no guilt or shame for his conduct. He ought to have been morally injured. That would have been a marker of some moral reckoning. He would have been a better person had he felt the guilt that would have triggered moral injury. Unlike shame, guilt regularly (if not necessarily) connects to some retrospective moral assessments of one’s acts (D’Arms and Jacobson 2000, 74, 87; Prinz 2009, 527). Guilt is the negative emotional appraisal arising from a belief that one’s actions or inactions were morally wrong and that one is thus blameworthy. (See, for instance, Sherman 2010, 91; Radzik 2011, 67.) Many morally injured persons suffer from dysfunctional guilt even though on some accounts they did nothing for which they should feel guilty. On some accounts, however, the guilt might not be dysfunctional. (See, for instance, David Rodin’s contribution to this volume.) We sometimes assess whether guilt is an appropriate response to what we or others did. When considering cases among former combatants, for instance, Nancy Sherman distinguishes rational from irrational guilt (Sherman 2010, chap. 4). In some instances, guilt is inappropriate but understandable. Regardless of its rational merits, the guilt some combatants feel, she writes, “is often a testament to a sense of moral accountability in the use of lethal force” (Sherman 2010, 91). Even when combatants might not have done anything for which they deserve blame, feeling guilt “is a way of repossessing moral agency and control … in a chaotic world” (Sherman 2010, 104). Guilt, though typically an unwelcome moral emotion, is part of the process for agents to reconstruct some notion of moral order and agency. Sometimes guilt seems appropriate. Sometimes it even seems deserved. In cases of moral injury, the guilt is both debilitating and typically has a genealogy in some moral phenomena. Often it is tragic. In order to assess how that genealogy inflects the concept of moral injury, we next turn to an account of some dimensions by which to evaluate the emotions. Warrant, Fitness, and Moral Appropriateness

In this subsection, we consider some of the dimensions by which to assess human emotions. We explore such points in order to argue that moral

Theorizing Moral Injury with Reports of Trauma  53 injury need not be the monopoly of virtuous persons or otherwise decent persons suffering in tragic choice situations. Sometimes, people can experience emotions in ways that qualify as or constitute moral injuries but are not part of examples that would inspire much if any sympathy or pity. Emotions are multidimensional phenomena involving, among other things, variably conscious, variably lengthy, and variably cognitively mediated dispositions to act, feel, and behave in light of our understandings, interpretations, and experiences (Scarantino and de Sousa 2021). Emotions serve various representational and evaluative roles. (See, for instance, ­Scarantino and de Sousa 2021; D’Arms and Jacobson 2000; Nussbaum 2003.) Fear, for instance, is an emotion that connects to a view that something in the world is fearsome. Of course, we can feel fear in response to things that are not fearsome, but the feeling of fear, on the one hand, itself typically represents that there is something worthy of one’s being afraid. Guilt, on the other hand, is an emotion that represents oneself as being worthy of blame for having done something wrong, particularly according to some interpersonally justifiable moral standards (Wallace 1994; ­Darwall 2006; Haidt 2002; Smith 2007). In contrast with fear, guilt is distinctive by being a moral emotion. It casts its object, oneself, unfavorably in light of moral evaluations (D’Arms and Jacobson 2000, 87).1 Crucially, the moral evaluations must be one’s own. One is not morally injured if one is complicit in betrayal of a value that one does not hold. Many examples of moral injury involve a sort of misplaced guilt, where persons suffer because they were complicit in some act or omission that betrayed some of their important moral values. Their guilt often seems misplaced because their suffering seems undeserved. They could not have done much if anything to avoid the moral loss. The decision in Auschwitz that the title character made in Sophie’s Choice (Styron 1992) left her morally injured. Her guilt for choosing which of her children would die had ruined her life. As in many cases of moral injury, however, there was not much she could have done to avoid the injury. It was a tragedy following a moral horror. We have spoken loosely of emotions being “appropriate,” “inappropriate,” or “misplaced.” As D’Arms and Jacobson (2000) note, when applied to the emotions, the term “appropriate” is importantly ambiguous. It risks conflating various ways of assessing the emotions. Consider three dimensions along which to examine the emotions, (1) fittingness, (2) moral suitability, and (3) warrant. “Fittingness” revolves around whether the object of the emotion has the evaluative property[ies] the emotion presents it as having. Suppose you feel fear at the surprise sound of a shotgun cocking behind you. Following the views of theorists such as Scarantino and deSousa (2018) and D’Arms and Jacobson (2000), the fear is fitting insofar as it is a response to the sounds of an armed intruder meaning to do one harm. An emotion would not be fitting

54  Andrew I. Cohen and Jennifer A. Samp if its object lacks the properties that the emotion represents it as having. Suppose the ­gun-cocking sounds come from a new whole-house stereospeaker-system your partner installed without you knowing. You had thought they were out of town, but they had instead resumed watching a movie in another room. Your fear is not fitting since it does not accurately represent the world. The “moral suitability” of an emotion is a function, at least in part, of whether it is morally appropriate to feel the emotion. D’Arms and Jacobson (2000) discuss in detail how this comes apart from fittingness. It might, for instance, be morally inappropriate to laugh at a joke for which it amusement would be fitting. If the joke is indeed funny, then amusement is a fitting response, even if there are strong moral reasons against amusement. Emotions can also exhibit levels of rationality as “warrant.” D’Arms and Jacobson do not distinguish warrant from fittingness (and at times use them interchangeably), but we take an emotion as warranted when the system that produces it functions as it should in light of various evidential cues.2 Suppose while driving in an unfamiliar town, you see what seems to be a police officer using a radar gun pointed in your direction. Seeing your excess speed, you feel some fear and immediately slow down. It turns out you had only spotted a cardboard cutout of a cop, which the town puts in areas prone to speeders. (See, for instance, Fedschun 2019.) Your anxiety was warranted in that your emotions were functioning as they should in circumstances where you were speeding. However, it was not fitting since the cutout was a ruse. Insofar as emotions express various evaluations, some function much faster than others, and some are more cognitively mediated than others. We pass over such details here. Here we reiterate that a warranted emotion might not be fitting, as in the case of one’s fear of a cardboard cop. Conversely, a fitting emotion might not be warranted. Suppose Sam has an irrational fear of people from Tennessee. One manifestation of it is this: Sam has a recalcitrant fear of a sibling’s friend, Pat, who comes from the state’s capital in Nashville. It turns out Pat (a) is from Tennessee, but (b) was hired to infiltrate Sam’s family, get to know Sam and Sam’s habits, and murder Sam. Emily is Sam’s enemy. Emily hired Pat to kill Sam. Emily always hated Sam for marrying the person Emily loved. Sam does not know any of this. Emily is a secretly seething enemy. Sam thus has a reason to fear Pat, but not because Pat is from Tennessee. Sam should fear Pat because Pat means to kill Sam. Sam’s fear of Pat is fitting but unwarranted. This fear is unwarranted since, by hypothesis, there is nothing about Pat that would inspire any rational person to be fearful of Pat just because Pat is from Tennessee. We may then assess the suitability of emotions along several dimensions, among which are fittingness, moral appropriateness, and warrant. We next apply this rubric to the guilt distinctive of moral injury.

Theorizing Moral Injury with Reports of Trauma  55 [In]appropriate Guilt

We now turn to the case of guilt. We consider how and whether guilt can be warranted, fitting, or morally appropriate. Here we lay further groundwork for doubting that the guilt of moral injury must be rationally or morally supportable. Guilt is typical of reports of moral injury. Many narratives, such as those by Nancy Sherman (Sherman 2010; 2015; 2017), David Wood (Wood 2016), Edward Tick (Tick 2014), and those Brett Litz and colleagues discuss (Litz et al. 2009; Nash and Litz 2013), document the incapacitating guilt afflicting decent persons who faced tragic choice situations. Their guilt is often persistent, unwelcome, and undeserved. As unwelcome and unpleasant, their guilt is a harm because it involves a setback to their interests (­Feinberg 1987). Of course, we do not need clinicians, philosophers, or social scientists to tell us that guilt can be harmful, recalcitrant, disproportionate, and unwarranted. Theorists can nevertheless help us to be clearer on what moral injury is and means. One of the ways they do that is by applying and refining understandings of the term in light of reflecting on actual and hypothetical cases. We can experience guilt despite our judgment that we have done nothing wrong.3 One such example is Bernard Williams’s case of the lorry driver who faultlessly kills a child (Williams 1993; see related discussions at McConnell and Mason 1996; Dahl and Mason 1996). The driver might have exercised appropriate care and concern but the tragic loss implicates his agency. Guilt is an understandable response in such cases, and it might resist argument that he is not to blame. The guilt may be warranted in an important sense: the driver is responding to perceived threats to multiple moral relationships: with the parents of the dead child, with his community, and with himself. Reassurances that he did nothing wrong might not dispatch such guilt. If the driver did nothing wrong and the loss was tragically unavoidable, the guilt is in some important way unfitting. The guilt, on the one hand, evaluates the driver as having violated important values. On the other hand, the guilt might be warranted. The driver’s appraisal, which gives rise to the guilt, is functioning correctly as a way of responding to relationship threats. In our NEH study (Cohen, Samp, and McClymond 2016), one focus group participant, “L,” was wracked by persistent guilt for his role in a Navy accident many years ago. The accident led to the deaths of some Navy personnel. He had failed to check some equipment before an unrelated explosion. This was one of many links in a chain of events culminating in a loss of life when his vessel was in a combat exercise. It is unclear whether it was his responsibility to check the equipment. It is unclear whether other sailors had the same responsibility. It is unclear whether checking the equipment would have made any difference.

56  Andrew I. Cohen and Jennifer A. Samp L seemed to have a type of survivor’s guilt. He seemed to believe that he lived at least partially because one of those who died shoved him through a hatch to safety. To this day, L torments himself with guilt for not having done more to prevent the loss of life. L is morally injured. L feels persistent guilt for having failed to do what he believes he morally ought to have done. He judges himself as blameworthy in light of his moral assessment. L struck us as a good and conscientious man. With his wife, he raised a family whom he cherishes. Such a good man seems not to deserve the persistent harm that comes from recalcitrant and suffocating guilt. L lived when (and perhaps because) others died, and he will never know for sure whether that extra step he might have taken would have made a difference and whether command failed the sailors by not clearly specifying whose duty it was to check that equipment. Guilt often resists such careful analyses of ambiguity. Indeed, guilt is often a response to ambiguity if one believes one could have done more to avoid having one’s agency implicated in such a morally ambiguous situation. We cannot know whether L’s guilt is fitting. Neither can L. It would be fitting if indeed he had done (or failed to do) something against some moral reason(s). Consider a related example of Oskar Schindler. Inspired by a book based on events in Schindler’s life (Keneally 1982), the film Schindler’s List depicts him as a German businessman who builds and manages several factories during WWII (Spielberg 1993). Schindler secretly resists Nazi atrocities by employing Jews in his factories for manufacturing various (inevitably ineffective) products, ostensibly to support the Nazi war effort. But the factories are a front to shelter Jews from certain death in concentration camps. Schindler spends his fortune bribing Nazi officials to protect the hundreds of Jews in his care. As the war ends, the film shows Schindler overcome with guilt for not having done more to rescue more Jews.4 Schindler’s guilt is likely not fitting. It represents himself as blameworthy for having failed to take more efforts to do more good. Schindler went far beyond the call of duty and, at great risk to himself, sheltered especially vulnerable persons from undeserved slaughter. Ordinary persons cast into similar circumstances might doubt whether they did everything that they could. In this way, Schindler might be like “L” from our study: neither is certain that he is free from blame for not having done more. Second-party observers might discount L’s or Schindler’s self-doubt given their decency or heroism. The discounting is not to deny their self-doubt but as a tribute to their respective virtue. That virtue contributes to their self-doubt. We might think their decency is a reason their doubt is ultimately not fitting: the object of each man’s doubt, his self, is ill-suited as a target for blame. One might say: they should not blame themselves. They should not feel guilty.

Theorizing Moral Injury with Reports of Trauma  57 Many of us know that recalcitrant emotions do not yield so easily. Addressing such lasting difficulty is perhaps best left to clinicians and counselors. All of this nevertheless suggests that some fittingness is unnecessary for moral injury. More precisely, the case of L and the case of Schindler each show that justified findings of the fittingness of the experiences of moral emotions are unnecessary for claims about moral injury to be true. Neither L nor Schindler nor others can know if they are blameworthy, yet they can fit the bill of morally injured agents. To paraphrase Nancy Sherman, the emotions are real even if they are irrational (Sherman 2010, 106, 90). Schindler and L suffer the setback even if from some standpoint neither is the sort of person who deserves it or for whom the guilt is fitting. Each was morally injured because each felt recalcitrant shame, their shame was a function of a negative self-appraisal in light of moral values, and the shame was incapacitating. Whether L’s guilt is morally appropriate is more complicated. It might be morally appropriate if there are strong moral reasons for L to feel it, and to feel it in the persistent way that L feels it. We did not know enough about L’s personal, family, and emotional circumstances to have any views about this. If his recalcitrant guilt keeps him from fulfilling other important moral obligations, then perhaps his guilt is morally inappropriate in some way. (Compare a related discussion of grief at D’Arms and Jacobson 2000, 76–78.) Thinking about the common cases of moral injury, though, we might balk at saying it must be somehow morally permissible for persons to feel the guilt they feel in order for them to be experiencing moral injury. They experience the guilt. Whether it is morally appropriate turns on their character and circumstances, which are distinct issues. We have begun to question whether fittingness and moral appropriateness are conditions of moral injury. It seems cases of moral injury need not hang on whether a person’s guilt is a fitting response to something they have done, nor that their experiencing the guilt somehow be morally permissible. To see whether serious moral error is compatible with moral injury, we must consider whether the moral commitments whose betrayal inspires one’s negative self-appraisal must somehow be correct. It is to such cases we now turn. Moral Injury Among the Morally Misguided or Vicious

As we have noted, many common examples of moral injury are of otherwise decent persons put in tragic choice situations. Does moral injury require that the moral disorientation be a function of moral commitments that withstand critical scrutiny? In this subsection, we consider the tradeoffs of moralized versus nonmoralized accounts of moral injury. We raise doubts about the merits of moralized accounts and suggest some reasons in favor of nonmoralized accounts.

58  Andrew I. Cohen and Jennifer A. Samp Consider the case of Huck Finn. Huck was tormented about whether to turn in his friend Jim, who was an escaped slave (Twain 1999). Huck believed morality required that he stop Jim’s escape. Ultimately, however, Huck gave up on morality’s demands and privileged the call of his sympathies (Bennett 1974). He lied to some slave hunters in order to help Jim escape. On Jonathan Bennett’s account, Huck believes he is guilty of a serious moral wrong: he let Jim escape (Bennett 1974, 127). Huck was initially deeply troubled. He saw himself as complicit in a serious wrong. Huck feels this as guilt and, at least initially, seems morally injured.5 Huck’s guilt is a function of a negative self-appraisal. However, his guilt was not fitting because Huck was mistaken. Moral reasons do not require him to turn in Jim because slavery is pernicious. Huck overcomes his unsettled condition by giving up on his moral commitments. Since he abandons such commitments, he loses the basis on which he might have felt shame. As soon as he does, he is no longer morally injured. Fortunately for Huck and certainly for Jim, Huck’s sentiments inclined him to do the right thing anyway. However, Huck is the victim of a perverse body of norms that purport to provide correct moral reasons.6 The case of Huck Finn shows that moral injury might need to be importantly insensitive to the validity of the moral norms to which it anchors in any given instance. Had Huck’s guilt persisted, he would have remained morally injured. He would have had a disorientation that comes from having his agency implicated in an act he regarded as violating significant moral values. The case of Huck Finn points to more troubling sorts of cases of disorientation from violating invalid moral norms. Consider the racist who is traumatized by recent disorienting (to the racist) progress toward racial equality. Let us suppose by hypothesis the racist wrongly regards certain racist norms as among if not exhaustive of correct moral norms. However, the racist feels guilt for complicity in some act that violates deeply held racist moral values. The norms that the racist wrongly regards as the correct moral norms are plausibly moral. The racist’s moral norms offer immensely stringent if not exclusionary reasons, they can be counterpreferential, they are otherregarding, they are central to a comprehensive vision of a good life, they are mutually justifiable among a certain suitably specified set of interlocutors, and so forth. They fit the formal features of moral norms, but, we suppose, not the substantively correct features. The racist’s guilt for participating in or witnessing some act that transgresses deeply held values can have the same shape, intensity, duration, recalcitrance, disorienting structure, content, and effects as that of many cases of moral injury among

Theorizing Moral Injury with Reports of Trauma  59 decent persons. Such cases are vividly and often chillingly described in recent books. The racist’s trauma might be formally indistinguishable from that of Army Major Jeff Hall or Sgt. Rob Sarra, each of whose tragic stories Nancy Sherman describes in detail (Sherman 2010, chap. 4), or the cases Jonathan Shay describes from the classics or from Vietnam (Shay 1994), or any other case of otherwise decent persons traumatized by tragic circumstance. Grouping Sgt. Hall with the traumatized racist seems to threaten the normative power of moral injury—especially as this concept gains increasing currency among laypersons and scholars. Theorists might caution that we tread carefully here. Allowing that the vicious can experience the same sort of debility as the decent might seem to undermine the very decency that roots the trauma of the decent. We must consider whether the racist’s disorienting guilt counts as moral injury. We must consider, in short, whether vice precludes moral injury. There are two basic options. One is to moralize the concept of moral injury. The other option is not to moralize the concept. A nonmoralized concept casts moral injury as the trauma that comes from betraying or violating deeply held values that have the formal structure and function of moral norms. Nonmoralized accounts suspend judgment on the substantive merits of the moral commitments whose betrayal figures in some moral injury. The racist above can be morally injured. Insert your favorite example of persons whose trauma is misguided because of their vicious substantive views: each can be morally injured. We take this nonmoralized concept to be extensionally adequate: it captures how people might use, or would be inclined to use, the concept. They might say, for instance, that the racist is a horrible person, but he can nevertheless feel genuine and debilitating shame for failure to fulfill racist commitments. A moralized concept of moral injury would restrict cases of moral injury to those that engage correct moral values. Such a moralized concept might then seem theoretically adequate. It would distinguish among various types of trauma to isolate certain psychological and spiritual dysfunctions as moral injuries—provided they are responses to or traceable to substantively correct moral values. There is a certain theoretical tidiness to this moralized approach. The moral disorientation persons suffer when betraying their flawed moral views cannot then qualify as moral injury. Proponents of the moralized approach would describe such persons as morally confused or mistaken, but since their disorientation comes from betrayal of unjustified moral commitments, they are not and cannot be morally injured. Perhaps they can suffer debilitating and disorienting guilt, but they do not have moral injury.

60  Andrew I. Cohen and Jennifer A. Samp A fuller analysis of moralized approaches to moral injury would ­ istinguish among commitments to incorrect values (in terms of the depth d or seriousness of the perniciousness of the values) and include some attention to a person’s culpability for having such commitments. Armed with such a fuller analysis, theorists might then consider whether some persons cannot count as morally injured insofar as they are committed to subpar values (either by failing to maximize the realization of available value, or by abiding by commitments that otherwise leave available moral value unrealized). We bracket such details here only to note that, in at least some cases, traumatized vicious persons, or traumatized persons with vicious moral commitments, cannot then suffer moral injury under a moralized concept of moral injury. Though their trauma may look a lot like that of the good guys, it is not moral injury. Indeed, proponents of moralized concepts of moral injury might say that their guilt gives rise to something else. Let us call them sufferers of schmoral injury. Schmoral injury is the disorientation and trauma one suffers from betrayal of deeply held but pernicious values. Discounting the experiences of the “shmorally injured” risks discounting their trauma as trauma. Consider the example of the character Javert in Les Miserables (Hugo 2013). Simplifying characters and story details, Javert is unable to cope with the tension between Jean Valjean’s mercy, on the one hand, and, on the other hand, a commitment to upholding a law that will unjustly send Valjean to prison. Javert then commits suicide. We can suppose Javert judged himself a moral failure for not being able to act in a situation featuring impossible choices. Suppose also he felt incapacitating guilt and shame for his failure to uphold an immoral body of laws. He did not think of such laws as immoral. On a moralized concept of moral injury, he might simply be schmorally injured. Even if the phenomenology he experiences is similar to that of persons troubled for betrayal of morally supportable norms, Javert did not have any moral injury.7 We might query how hard to press the boundaries of what would be distinct concepts of moral and schmoral injury. Consider the associated phenomenology. What does Javert feel? It might seem he feels guilt, shame, or both. If, however, he cannot be morally injured, then perhaps what he feels is neither guilt nor shame. Perhaps it is something else.8 On the moralized account, moral injury is distinctive by engaging the (or at least, a) correct morality. The moralized approach rules out as constituting or generating moral injury those recalcitrant and debilitating reactive attitudes that might be phenomenologically indistinguishable from the guilt and shame of persons who satisfy the substantive constraint. That restricts the theoretical reach of moral injury. Clinicians and laypersons might need to be mindful of this constrained concept when they are trying to understand the invisible wounds people navigate. The debilitating guilt

Theorizing Moral Injury with Reports of Trauma  61 (or, if it cannot be guilt, some emotional upset) someone suffers for failing to live up to (by hypothesis) unjustified moral commitments cannot be part of moral injury. R. Jay Wallace offers a view of the moral emotions that might support such an interpretation. In critically assessing Strawson’s account, Wallace distinguishes moral from nonmoral types of reactive attitudes (Wallace 1994, sec. 2.3). Allowing that self-regarding attitudes can still be moral, Wallace writes that what makes something into a moral reactive attitude is “the kind of expectation that it is essentially bound up with” (Wallace 1994, 35–36). Reactive attitudes that are moral are those that link to moral expectations, which Wallace defines as “expectations that are justifiable in terms of distinctively moral reasons” (Wallace 1994, 36). Drawing on such an account, we might say that moral injury must connect to debilitating experiences of moral emotions. On the view of theorists who might defend moralized concepts of moral injury, the emotions that (for instance) the racist experiences for betraying racist values cannot then be moral emotions. Such theorists might point again to Wallace, who writes, More precisely, we should count reactive attitudes as moral when they are linked to obligations for which the agent is herself able to provide moral justifications; these justifications identify reasons that explain the agent’s own efforts to comply with the obligations in question, and they provide moral terms that the agent is prepared to use to justify such compliance on the part of others, whom the agent holds to the obligations. (Wallace 1994, 36, footnote omitted) Insofar as guilt is a moral emotion, vicious persons whose vicious values are betrayed can experience neither moral injury nor even the guilt characteristic of it. They can at best experience some unsettling nonmoral reactive attitudes that bear only a superficial similarity to genuine guilt. Proponents of the moralized reading of moral injury could say that racists who are complicit in some actions that violate their racist commitments are not then feeling guilt. They do not feel guilt because the agents are unable to offer mutually justifiable accounts of obligations rooted in their racist commitments. We might thereby discount the trauma people seem to experience when it is rooted in pernicious commitments. While such moralized understandings of moral injury can be conceptually coherent, we worry they make moral theory do more work in understanding the content of a concept than is either necessary or extensionally plausible. Of course, theorists sometimes need to clean up conceptually confused understandings. On our view, however, it does not seem confused to say that Huck Finn felt shame and was morally injured. It also does

62  Andrew I. Cohen and Jennifer A. Samp not seem confused to say that pernicious racists, diehard Nazis, or other sinister persons are quite capable of experiencing certain moral emotions regarding their sinister commitments, and they can suffer trauma when those values are threatened. The concept of moral injury can be capacious enough to include vicious persons’ trauma. We would guess that typical persons—even decent persons firmly committed to decent values—would acknowledge the possibility of shame among vicious persons for challenges to values they should not hold. Such challenges can stem from a tension with other obstructive vicious values. Allowing for the possibility of such shame seems to be how people use the terms. People do not typically ask if someone who feels putative shame is feeling it because of betrayals of values worth caring about. On hearing such persons feel shame for betrayal of pernicious values, we might then say: they feel shame, but they feel shame about the wrong things. Sometimes we might say: they should be ashamed for being ashamed of that. Certainly, there is room to criticize people’s moral values. Perhaps vicious persons’ disorientation is a sign of some moral confusion or mistake. But the confusion or mistake might still be connected to a trauma that can be moral injury. Perhaps the proper second-party response in such cases is not pity or sympathy but something else, such as discussion or investigation into the merits of certain moral commitments. One’s broken arm is an injury regardless of whether one is a good person or whether one deserved that it broke. Similarly, recalcitrant and debilitating guilt is part of a moral injury regardless of whether one has the correct moral values. Proponents of moralized accounts will insist that the moral part of moral injury does much work. We believe we can have adequate understandings of moral injury by leaning on formal, and not substantive, accounts of what is moral. We do not pretend to have offered a decisive argument against moralized understandings of moral injury. We only claim to have shown some of the costs of such understandings. They risk missing ordinary and entirely sensible understandings of concepts about our emotions, the phenomena of loss, and the experiences of human beings. Nonmoralized accounts, which do not restrict moral injury to decent persons, seem extensionally adequate and entirely serviceable for theoretical analyses of the relevant phenomena. We next consider how the potentially clashing aims of theoretical adequacy and extensional adequacy might handle other marginal cases of moral injury. Delusions, Mistakes, and Lies: Moral Injury in Edge Cases

We have seen that the concept of moral injury can be put in service of certain theoretical aims. It can then rule out the suffering of vicious persons

Theorizing Moral Injury with Reports of Trauma  63 as qualifying for moral injury. We raised doubts about such an approach. We favored a more capacious account that includes cases of trauma even if the sufferers of trauma are vicious persons. How might the concept fare with edge cases involving disputable fittingness and questionable warrant? We suggest the concept’s boundaries might be blurry and not decisively resolve such cases. Previously we considered Sophie from Sophie’s Choice as morally injured. Her guilt for the choice she made in Auschwitz took over and ultimately destroyed her life. Imagine a case of someone we call Sara. Sara suffers from the delusion that she is Sophie. Sara firmly believes that she had been arrested by the Nazis, that her father was an anti-Semitic legal theorist in Kraków, and that she had made that fateful decision to send her daughter Eva to death in Auschwitz when a Nazi officer demanded that she choose. Sara feels incapacitating and debilitating guilt for what she believes she has done. Sara is deluded. Is Sara morally injured? Her guilt is not fitting. It does not fit because she is not Sophie. She did not face or make the choice Sophie faced. Since she did not live Sophie’s life, we might wonder whether Sara feels guilt at all. Romance novelist Susan Meachen seemed to have committed suicide. (See the detailed account at Barry 2023.) In 2020, her Facebook page announced that she had died. Friends and colleagues mourned her passing. In January of 2023, Meachen reappeared, announcing that she was back and ready to return to work. Fans, colleagues, and friends were confused, horrified, and angry. The fuller story featuring this false report of Meachen’s death involves a sad mix of mental illnesses, the challenging online community connected to romance novels, and the demands of life as a writer. Here, though, consider the emotional experiences of her friends. For several years, they thought her dead. They grieved her passing. Meachen’s friends’ grief was warranted: on the one hand, it was an appropriate response to the evidence they had. On the other hand, it was not fitting. Meachen was not dead. Suppose we lean hard on fittingness as a condition for the experience of certain emotions. One might then say Meachen’s friends did not grieve because she was not dead. It seems more plausible to us to say instead that they grieved Meachan’s death but Meachen was not dead. We might say something similar about Sara, who is delusional about being Sophie from Sophie’s Choice. Sara might feel guilt and be morally injured, but Sara is profoundly mistaken. Her phenomenology of guilt might be identical to those who are not deluded, but it is not fitting. We might say that Sara feels incapacitating guilt but only because she wrongly believes she is Sophie. We suspect most people would agree and say the more important problem for Sara is her delusion. Similarly, Meachen’s friends grieved but there are more important problems

64  Andrew I. Cohen and Jennifer A. Samp regarding the challenging online world for romance novelists, Meachen’s family’s deception, and Meachen’s mental illness. Such marginal cases show the limits of our concepts. One might theorize moral injury in a way to restrict the concept to cases where the recalcitrant emotions are in some sense fitting. We believe that would unduly restrict the scope and meaning of the concept. We acknowledge, though, that critics might say such are not genuine cases of moral injury. No doubt, such unusual cases are not useful for publicizing the power of the concept for illuminating phenomena of human experience. However, we believe there are tools available to do the work that a fittingness constraint might otherwise do. We can qualify ascriptions of the relevant moral emotions. Just as Meachen’s friends grieved but were misled, so too Sara is morally injured but deluded. People can have the emotional experiences but be mistaken in their understandings or beliefs. That is part of the complicated world of being flawed and fallible human beings. Conclusion We have considered how moral injury involves a certain sort of trauma. That trauma involves the protracted experience of unwelcome moral emotions after damage to a prized moral value. Sometimes one’s moral emotions do not fit their object. We can be factually or morally mistaken in our assessments and understandings of the world. Our trauma can be just as real and indistinguishable from those of cases with better optics when promoting moral injury as a useful interpretive lens. That vicious people with vicious morals can be morally injured shows a problem with vicious morals, but it does not disqualify trauma from being morally injurious. Perhaps, too, deluded or mistaken people can have the experiences that mark them as morally injured. As the concept gets more currency, this may mean that not all morally injured persons deserve the same personal or institutionalized responses. The same is true of other injuries. Notes 1 Fear and shame are examples of what Strawson (1962) calls “reactive attitudes.” We also regard them as “moral emotions” because they engage moral appraisals. Strawson resists treating such self-regarding attitudes as moral emotions (Strawson 1962). We agree with Wallace, who prefers treating at least some such self-regarding reactive attitudes as moral emotions (Wallace 1994, sec. 2.3). 2 We are indebted to Andrea Scarantino for correspondence and conversation on this point. 3 For suggestions and conversation on these and related issues, we thank Andrea Scarantino.

Theorizing Moral Injury with Reports of Trauma  65 4 To be clear, our remarks here are about the fictional portrayal of Schindler in the movie. 5 In case Huck’s guilt seems too brief or insufficiently debilitating to count as moral injury, we can easily refine the example to be about a similar Huck who experienced exactly such lengthy debility. 6 It should go without saying that Huck’s victimization pales in comparison to that of Jim and the millions of others who suffered as slaves. Many slaves might also be morally injured by having felt negative self-appraisals for being punished for doing things that they in fact ought to have been free to do. One theme we do not pursue here is the possibility (indeed, likelihood) that many slaves were victims in another way: they had insufficient agency to recognize and experience their own moral injuries. 7 The case of Javert is certainly more nuanced than we present it here. It might be Javert’s underlying decency that grounds his trauma; otherwise Valjean’s mercy would not have been so disorienting to Javert. Readers can substitute another example of a thoroughly vicious person who is traumatized by threats to thoroughly vicious values. 8 Shmuilt? Shmame?

Works Cited Barry, Ellen. 2023. “A Fake Death in Romancelandia.” The New York Times, January 16, 2023, sec. Health. https://www.nytimes.com/2023/01/16/health/ fake-death-romance-novelist-meachen.html. Bennett, Jonathan. 1974. “The Conscience of Huckleberry Finn.” Philosophy 49: 123–34. Cohen, Andrew I. (P.I.), Jennifer A. (co-P.I.) Samp, and Kathryn (I) McClymond. 2016. “Reparative Justice and Moral Injury among Post-Deployment Soldiers NEH Collaborative Research Grant RZ-249909-16.” National Endowment for the Humanities. Dahl, Norman O. and H. E. Mason. 1996. “Morality, Moral Dilemmas, and Moral Requirements.” In Moral Dilemmas and Moral Theory, edited by H.E. Mason, 86–101. New York: Oxford University Press. D’Arms, Justin and Daniel Jacobson. 2000. “The Moralistic Fallacy: On the ‘Appropriateness’ of Emotions.” Philosophy and Phenomenological Research, 2000. Darwall, Stephen. 2006. The Second-Person Standpoint: Morality, Respect, and Accountability. Cambridge, MA: Harvard University Press. Fedschun, Travis. 2019. “Texas Police Use Cardboard Cutouts in Attempt to Crack down on Speeding Drivers | Fox News.” Foxnews.Com. January 10, 2019. https://www.foxnews.com/us/texas-police-roll-out-cardboard-cutouts-inattempt-to-crack-down-on-speeding-drivers. Feinberg, Joel. 1987. Harm to Others. Oxford: Oxford University Press. Haidt, Jonathan. 2002. “The Moral Emotions.” In Handbook of Affective Sciences, edited by Richard J. Davidson, Klaus R. Scherer, H. Hill Goldsmith, and Jonathan Haidt, 852–70. New York: Oxford University Press. Hugo, Victor. 2013. Les Miserables. Translated by Lee Fahnestock and Norman MacAfee. New York: Signet.

66  Andrew I. Cohen and Jennifer A. Samp Keneally, Thomas. 1982. Schindler’s Ark. Schindler’s Ark. London: Hodder and Stoughton. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, ­Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29: 695–706. https://doi.org/10.1016/j.cpr.2009.07.003. McConnell, Terrance C., and H. E. Mason. 1996. “Moral Residue and Dilemmas.” In Moral Dilemmas and Moral Theory, edited by H.E. Mason, 36–47. New York: Oxford University Press. Molendijk, Tine, Eric-Hans Kramer, and Désirée Verweij. 2018. “Moral Aspects of ‘Moral Injury’: Analyzing Conceptualizations on the Role of Morality in Military Trauma.” Journal of Military Ethics 17 (1): 36–53. Nash, William P., and Brett T. Litz. 2013. “Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members.” Clinical Child and Family Psychology Review 16 (4): 365–75. https://doi.org/10.1007/ s10567-013-0146-y. Nussbaum, Martha. 2003. Upheavals of Thought: The Intelligence of Emotions. Cambridge: Cambridge University Press. Prinz, Jesse. 2009. “The Moral Emotions.” In The Oxford Handbook of Philosophy of Emotion, edited by Peter Goldie. New York: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199235018.003.0024. Radzik, Linda. 2011. Making Amends: Atonement in Morality, Law, and Politics. New York: Oxford University Press. Rainbolt, George W. 2006. The Concept of Rights. Dordrecht: Springer. Scarantino, Andrea, and Ronald de Sousa. 2021. “Emotion.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta. Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/sum2021/entries/ emotion/. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Simon & Schuster. Sherman, Nancy. 2010. The Untold War: Inside the Hearts, Minds, and Souls of Our Soldiers. New York: W. W. Norton & Company. ———. 2015. Afterwar: Healing the Moral Wounds of Our Soldiers. New York: Oxford University Press. ———. 2017. “Moral Recovery After War: The Role of Hope.” In The Ethics of War: Essays, edited by Saba Bazargan and Samuel C. Rickless, 243–64. New York: Oxford University Press. Smith, Angela M. 2007. “On Being Responsible and Holding Responsible.” Journal of Ethics 11 (4): 465–84. Spielberg, Steven. 1993. Schindler’s List. Universal City, CA: Universal. Strawson, Peter F. 1962. “Freedom and Resentment.” Proceedings of the British Academy 48: 1–25. Styron, William. 1992. Sophie’s Choice. Reissue edition. New York: Vintage. Sumter, Angelica N. 2020. “Sherrice Iverson: The Murder of a 7-Year-Old Girl by Jeremy Strohmeyer.” The Criminal Journal. March 9, 2020. https://www.thecriminaljournal.com/murder-of-sherrice-iverson-by-jeremy-strohmeyer-7-yearold-girl-was-found-dead-inside-a-restroom-stall-at-a-casino/. “The Bad Samaritan?” 1998. 60 Minutes. CBS.

Theorizing Moral Injury with Reports of Trauma  67 Tick, Edward. 2014. Warrior’s Return: Restoring the Soul After War. Boulder, CO: Sounds True. Twain, Mark. 1999. Adventures of Huckleberry Finn: An Authoritative Text, Contexts and Sources, Criticism. 3rd ed. Norton Critical Edition. New York: Norton. Wallace, R. Jay. 1994. Responsibility and the Moral Sentiments. Cambridge, MA: Harvard University Press. Wiinikka-Lydon, Joseph. 2018. “Dirty Hands and Moral Injury.” Philosophy: The Journal of the Royal Institute of Philosophy 93 (3): 355–74. ———. 2019. “Mapping Moral Injury: Comparing Discourses of Moral Harm.” Journal of Medicine & Philosophy 44 (2): 175–91. Williams, Bernard. 1993. “Moral Luck.” In Moral Luck, edited by Daniel Statman, 35–55. Albany: State University of New York Press. Wood, David. 2016. What Have We Done: The Moral Injury of Our Longest Wars. New York: Little, Brown and Company.

4 The Ethics of Moral Injury David Rodin

Moral Injury and the Moral-Psychic Responses Humans exhibit a distinctive range of positive and negative psychic reactions to their own agency. Acts that are commendable typically generate in the agent psychic reactions of pride, satisfaction, calm, peacefulness, or joy. Acts that are objectionable tend to generate in the agent the opposite: psychic reactions of shame, guilt, regret, anxiety, agitation, pain, or suffering. Both forms of psychic reaction are characterized by their distinctive connection to our own agency. Other forms of psychic reactions arise from our being the subjects of experience. For example, grief is the characteristic psychic reaction to experience of loss; fear is the characteristic reaction to experience of peril. Similarly, other forms of psychic reactions arise from our experience of agency in others. For example, commendable action on the part of others elicits the reaction of admiration, while experiencing objectionable action elicits disproval, disgust, or horror. But pride, shame, and guilt are all distinctively self-regarding and are logically connected to our experience of our own agency. It does not make sense to speak of feeling pride, shame, or guilt except in connection to some form of our own acting and doing.1 Positive and negative responses to our own agency can range over the many different ways that acts can be commendable or objectionable. The positive and negative psychic reactions are therefore always responses to agency that can be more or less successful with respect to some underlying conception of excellence or value. For example, positive psychic reactions routinely emerge from agency that is commendable from the perspective of achieving victory in sport or in war, achieving aesthetic success in art, achieving epistemic success in science and learning, achieving flourishing relationships of love and friendship, and so on. Negative psychic reactions often arise from agency that is unsuccessful in respect to these underlying conceptions of excellence.

DOI: 10.4324/9781003281122-6

The Ethics of Moral Injury  69 Of particular importance and power are the psychic reactions a­ ssociated with the achievement of moral excellence and the experience of moral failure. Moral satisfaction, moral shame, moral guilt, and moral regret are all achingly familiar psychic reactions to the moral success or failure of our own agency. These psychic reactions may range from the mild and transitory to the powerful and enduring. Negative reactions to moral agency, in particular, can present in very severe forms. An extreme reaction of guilt and shame may constitute such a significant psychic trauma that it entirely debilitates the subject, effectively destroying their agency.2 It is such debilitating psychic responses that constitute the domain of moral injury. Moral injury is often characterized as “the strong cognitive and emotional response that can occur following events that violate a person’s moral or ethical code” (Williamson et al., 2021). The phenomenon was first described by Jonathan Shay in his book Achilles in Vietnam who linked it to the experience of betrayal or malpractice by leaders who command or mandate immoral actions by subordinates (1994). J.D. Jinkerson (2016, 126) identifies four core symptoms: guilt, shame, spiritual/existential conflict, and a loss of trust in oneself, others, or higher beings. These core symptoms are in turn associated with a range of secondary symptoms, including depression, anxiety, anger, self-harm, and social problems such as substance abuse. Work on symptoms has also led to a number of sophisticated diagnostic schemas for the clinical syndrome of moral injury, and the concept of moral injury has been extended from the military domain where it was first theorized into many other areas of life, including youth and teachers exposed to violence (Chaplo et al., 2019), refugees (Hoffman et al., 2019), health care providers (Førde & Aasland, 2008), and public safety personnel (Papazoglou et al., 2020). Ethical and Psychological Approaches to the Phenomenon of Moral Injury Moral-psychic responses – of which moral injury is one example – are interesting because they straddle the psychological and moral dimensions of our own self-experience as agents. First, there is the psychological dimension of the moral-psychic responses. We experience psychic responses such as pride, guilt, and shame, as emotions that are pleasant or painful, and such emotions can facilitate or impede our ability to act as successful and integrated psychological actors in a social world. In this sense, the psychic reactions are features of our psychological functioning and our existence as psychological agents. Second, there is the moral dimension of our moral-psychic responses. The positive and negative responses (moral pride and shame) are reactions that emerge from our success or failure in responding appropriately

70  David Rodin to moral reasons and realizing moral values. In this sense, the psychic ­reactions are features of our existence as moral agents responding successfully, or unsuccessfully, to moral reasons. These two facets of the moral-psychic responses are explored with differing methodologies and differing objectives within the disciplines of psychology and philosophical ethics. Psychology encompasses both a descriptive or experimental field, which seeks to understand regularities within, and causes of human behaviour, as well as a therapeutic field, from which the literature on moral injury primarily springs. The therapeutic objectives of psychology include both the treatment of psychic illness or disorder and the realization of the psychic flourishing of the individual subject. The objectives of philosophical ethics are very different. Moral philosophy seeks firstly to identify and describe the moral reasons and values that characterize our moral experience. Secondly, moral philosophy seeks to create the conditions for individuals and social groups to better act in accordance with those moral reasons and to realize those values. Both philosophy and psychology therefore have important therapeutic ambitions, but in very different ways. Psychological health is primarily self-regarding, in that its objective is the flourishing of the therapeutic subject. By contrast, when agents exhibit what I call moral health, they are (among other things) reliably and properly responsive to moral reasons. Specifying what this means would require some care and would depend crucially on our particular substantive moral theory. Whatever precise shape the account might take, moral health would have a strong other-regarding dimension. Whereas some of the moral reasons and values that the moral philosopher studies are self-regarding, many moral obligations and values intrinsically involve forms of moral concern owed by the moral subject towards others. Given that we have reason to seek both psychological health and morally right action, both psychology and moral philosophy have a valuable and important perspective to bring to bear on topics like morally injury. There are, in addition, two significant meta-activities: the psychology of ethics and the ethics of psychology. The psychology of ethics we may characterize as the investigation of the psychological effects of philosophical moral inquiry. For example, what impact will the activity of moral philosophizing have on our psychological health? Is it likely to bring happiness or psychological well-being? Are there distinctive psychic afflictions that are linked to the process of philosophising? The ethics of psychology has two principal goals. First, it investigates the moral obligations, permissions, and constraints governing the practice of psychology. Second, it investigates the moral-conceptual clarity and coherence of the concepts and categories that psychology deploys. This chapter

The Ethics of Moral Injury  71 is an exercise in the ethics of psychology. In what follows I first hope to show that there is a potentially problematic discrepancy between the moral and psychological interpretations of moral injury. Second, I will reflect on what this implies for the ethics of treating moral injury as a psychological syndrome. Third, I will briefly discuss the social ethics of the discourse on moral injury. The Divergence Between Psychological Health and Moral Health In order to understand the notion of moral injury, it will be helpful to start with the broader concepts of injury and health. To talk of an event or a state of affairs as constituting an injury, one must implicitly reference an underlying conception of health, and a spectrum from health to disease or disorder on which the injury falls. When I introduced the idea of psychic moral responses above, I described them rather ambiguously as psychic states that “typically” or “tend to” arise in an agent as a response to certain forms of commendable or objectionable action. But these responses are not simply statistically correlated with underlying forms of agency. They can be more or less appropriate, adaptive, and fitting to that underlying agency. It is surely by reference to the appropriateness of the psychic responses that we must articulate our underlying conception of psychic health or disorder: a healthy agent is one that has appropriate moral-psychic responses. A diseased or disordered agent, by extension, is one that exhibits inappropriate or unfitting moralpsychic responses. How then should we understand the standards of appropriateness, adaptivity, and fittingness by reference to which we must articulate our conceptions of healthy or disordered responses? It seems clear that there can be at least two different standards for the appropriateness of psychic responses: the psychological and the moral. One standard will speak to the appropriateness of the responses in the context of our effective functioning as psychological agents. The other will speak to the appropriateness of the responses in the context of our effective (that is morally certified) functioning as moral agents. While there are overlaps and connections between them, it is clear that there is no necessary convergence between these two different standards – and on the contrary, it is possible that they may diverge significantly. A psychic response may be appropriate and functional to our psychological agency, but it may be inappropriate or dysfunctional to our moral agency, and vice versa. To see this more clearly, let us sketch, in a crude and indicative way, the central elements of health and flourishing within the two dimensions of our agency – the psychological and the moral.

72  David Rodin To be a healthy and flourishing psychological agent entails at a minimum: 1 regularly enjoying basic psychological goods such as pleasure, happiness, fulfilment, security, creativity, meaning, and so forth; 2 enjoying key social relations, including friendship, love, familial relations employment; and 3 possessing the capacities of agency required to achieve (1) and (2). A moral-psychic response will constitute an injury when it significantly disrupts or impedes these and other relevant dimensions of psychological wellbeing. This is certainly true of soldiers diagnosed with moral injuries who may experience intrusive memories, emotional numbing, self-injury, demoralization, and self-handicapping as symptomatic expressions of their negative moral-psychic responses. From the perspective of psychological health, there are strong reasons to view moral injury as a form of disorder or syndrome. However, things look very different from the perspective of moral agency. To be a healthy moral agent entails at a minimum: 1 acting in the proper consideration of the moral reasons to which the agent is subject; 2 realizing some measure of moral value in the world and expressing some element of virtue; and 3 possessing the capacities of agency required to achieve (4) and (5). Are the moral-psychic responses that characterize moral injury inconsistent with healthy moral agency? Different theories of ethics will provide different perspectives on the role and appropriateness of the psychic responses to our moral health and wellbeing. Virtue theorists may view the moralpsychic responses as internal to the expression of virtues. For example, part of what it means to be courageous is to feel pride at resolutely facing danger; part of what it means to be just is to feel shame and guilt at acting in a way that treat others unfairly. On this view, morally appropriate psychic reactions are those that are fitting to the underlying virtue or vice of the agent. A key aspect of fittingness is that the responses are proportionate – neither excessive nor insufficient in relation to the virtuousness or viciousness of the agent’s action and character. An extreme moral-psychic response such as experienced by those diagnosed with moral injury may be morally unhealthy if it is excessively severe, for example, if it arises in response to an action which is only trivially wrongful. However, even an extremely severe psychic response may be morally fitting, and therefore presumptively healthy, if it is proportionate to the viciousness of action that precipitated it.

The Ethics of Moral Injury  73 Consequentialists can provide a different perspective on the a­ppropriateness of the moral-psychic responses. Consequentialists will focus on the role of these responses in regulating actions that are potentially harmful to others. Feelings of guilt and shame are unpleasant and cause us distress. On the consequentialist account, these experiences are morally bad in themselves, but they may be morally valuable, all things considered, because they can act as a powerful incentive against performing such actions in the future. On this view, the moral-psychic responses are the internal analogue of social punitive sanctions, such as public condemnation or incarceration. Similarly, the feelings of pride and satisfaction experienced as a response to acts that benefit others are both morally good in themselves (since they are experienced as pleasurable) and in addition provide internal incentives for beneficial behaviour in the future. On a consequentialist view, just as much as on a virtue view, debilitating forms of moral-psychic response may be morally healthy and even necessary. If an agent has been complicit in bringing about grave moral harms, then in extremis destroying that individual’s capacity for action and agency may be the most morally desirable outcome, because it may be an effective way of preventing that agent from perpetrating further harm in the future. A third perspective on the moral appropriateness of the psychic responses is provided by deontological ethics. Deontological theories of ethics are concerned with identifying the duties that moral agents owe to other persons, for example the duties not to harm or kill others without sufficient moral justification. As with consequentialism, a deontologist will accord instrumental value to self-directed psychic reactions like guilt and shame that may facilitate moral agents in complying with these duties. But deontology brings an additional theoretical lens to the moral assessment of psychic responses, through the related conceptions of rights and liability which form a part of deontological ethics. It is well understood that persons who perform wrongful actions can forfeit rights and thus become liable to be harmed in order to prevent or compensate the effects of the wrongdoing. Familiar examples include an aggressor who may be liable to be killed in self-defense, a tortfeasor who may be liable to forfeit property in order to compensate an injured party, and a convicted criminal who may liable to be incarcerated. In each of these cases, in order to protect or make whole the unjustly injured party, the person who is morally responsible for unjustly threatening or harming another loses or forfeits their own right against being harmed. We characteristically believe that human beings possess the right to mental and physical health. This right implies two sets of duties on the part of others – first the duty not to undertake actions that will negatively impact the mental or physical health of others without justification; and second the duty of health care providers and institutions to provide medical care

74  David Rodin and therapy to those in need. This right implies that we have a duty not to intentionally trigger distressing or painful mental emotions in others, and that health professionals and institutions have a duty to an individual to reduce or eliminate those emotions if they become debilitating. While it is not a prominent strand of classical deontological literature, it is natural to suppose that just as an individual can be liable to harmful treatment by others in cases of necessary self-defense, compensation of a tortfeasor, or punishment of a convicted criminal, so an individual can be liable to internal psychic responses such as guilt and shame if those emotions contribute to preventing such actions in the future. Thus, we may hypothesize that when an agent is responsible for violating the rights of others, it is not simply that they characteristically experience the negative internal responses of shame and guilt – they are morally liable to experience those negative responses, at least in so far as these emotions prevent the agent from performing wrongful action in the future. If someone who has committed a grave moral violation is liable to negative psychic responses such as guilt and shame, this has implications for the duties and rights of others. First, it implies that others do not have the duty to avoid words or actions that would trigger or facilitate such negative emotions. Second, it suggests that medical professionals may not have the duty to ameliorate or treat these negative psychic emotions even if it is possible to do so through medical intervention – they would not violate or infringe the health rights of sufferers by withholding treatment. Clearly, such a conclusion will be highly controversial and will require careful further examination and analysis – but it is certainly suggested by the logic of a deontology of moral emotions. It is possible to formulate an even stronger version of this argument by drawing from notions of desert rather than liability. When we say that someone who does wrong is liable to be harmed, we assert that they do not any longer possess a right against being harmed in this way and that we are morally at liberty to harm them provided that doing so is necessary to prevent or remediate their wrongdoing. When we say that a wrongdoer deserves to be harmed, we assert something stronger – that inflicting this harm is good in and of itself, and that others have a prima facie duty to facilitate and not to prevent the infliction of the harm – irrespective of whether the harm will have any other morally valuable effects. Many theorists have held that the harm inflicted on wrongdoers through punishment is deserved in this sense. I do not endorse this view, but suppose one believed that those who have committed serious moral violations are not simply liable to experience negative psychic responses but, in a stronger sense, deserve to experience those responses. A consequence of this view would be that that medical professionals are not simply at liberty to abstain from undertaking therapeutic interventions that would remove the

The Ethics of Moral Injury  75 emotions characteristic of moral injury, but that they would further have a prima face obligation not to undertake such interventions. This is because such a course of intervention would impede psychic responses which, ex hypothesis, it is morally important for the subject to experience. In summary, on each of these ethical views – virtue, consequentialist, and deontological – the extreme negative moral-psychic reactions that characterize moral injury may in certain circumstances be healthy. Whether they are so will not depend solely on the extent to which these psychic responses impair the psychological wellbeing of the subject. It will instead depend on whether the reactions are morally speaking fitting, proportionate, and appropriate. We will explore these conditions in greater detail below. But clearly it is possible that psychic responses which, from the perspective of psychological health present as a disorder, from a moral perspective may potentially be an appropriate and therefore morally healthy reaction to the commission of grave moral wrong. Far from a problem to be solved, moral injury may in certain circumstances be a necessary and appropriate form of internal moral regulation. Assessing the Divergence between Moral and Psychological Approaches to Moral Injury How extensive is the potential gap between moral and psychological health? To what extent does this gap create a problem for the conception of moral injury? Let us begin with the first question. The potential for divergence occurs because the standard definitions of moral injury do not clearly distinguish morally relevant differences in the way that an agent can be connected to an incident of harm or wrongdoing. For example, we have seen how Jonathan Shay, who first described moral injury, linked it to the experience by a subordinate of wrongdoing on the part of superiors. Shay’s definition has three elements: “moral injury is present when (1) there has been a betrayal of what’s right (2) by someone who holds legitimate authority (3) in a high-stakes situation” (Shay 2011, 183). More recent definitions of moral injury have expanded the definition to include the experience of wrongdoing by others who are not superiors and crucially also to include the experience by the agent of their own wrongdoing. For example, Jinkerson defines moral injury as a trauma that follows “perceived violations of deep moral beliefs by oneself or trusted individuals” (2016, 126). In an influential paper, Litz et al. offer a definition of “potentially morally injurious experiences” as consisting of “perpetrating, failing to prevent, bearing witness to or learning about acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009, 700). What is striking about these definitions is that none of them clearly distinguishes agential experiences of wrongdoing (perpetrating, failing to

76  David Rodin prevent) from non-agential experiences (bearing witness, learning about). Jinkerson’s definition does not even require an actual violation of a moral norm, but only a “perceived violation” of a deep “moral belief”. But as we noted above, the moral-psychic responses of guilt and shame are conceptually connected to both wrongdoing and to our own agency. From an ethical perspective, a person who feels guilt or shame for an action for which they are not responsible, or an act that is morally justified, is then making a conceptual mistake. This is important because it allows us to spell out more precisely the conditions under which moral and psychological health will diverge in cases of moral injury. There are four different classes of case we must consider. 1. No responsible agency or diminished responsibility. Emotions of guilt and shame for an action are only coherent from a moral perspective when the person experiencing them bears sufficient moral responsibility for that act. Moral responsibility can arise from positive agency, such as in cases of doing, performing, or perpetrating. Moral agency can also arise from negative agency, such as in cases of allowing or failing to prevent. Negative agency can generate moral responsibility in two ways. The first way is evident in cases where an intentional omission means to create some effect. An example would be if I fail to throw you a rope, intending for you to drown. The second way negative agency can create moral responsibility is clear in cases when a person fails to undertake a reasonable duty to assist. Peter Singer (1972) offers one such famous example in which a man fails to wade into a fountain to save a drowning child. Whether there exists a reasonable duty to assist depends on the harms that one can be expected to bear in the course of providing assistance. There is a duty to rescue the child in Singer’s fountain case because the damage to one’s shoes is a reasonable cost to bear to save a life. But morality does not require one to put one’s own life at risk in order to save a stranger. (It is rather a supererogatory action.) A person who feels shame and guilt for an action but has no agential responsibility for it – for example simply because they merely witnessed or learned about the act – is clearly deficient and unhealthy from a moral as much as from a psychological perspective. There is no divergence. There are more complex cases in which a person bears some responsibility for a wrongful act, but the responsibility is in some way diminished. This is the characteristic feature of the range of exonerating circumstances we call excuses. An important example from combat involves a soldier who kills an innocent person under the false but reasonable belief that they are a liable enemy combatant. In such a case, we say that the killing is justified by the circumstances as the soldier believes them to be (belief relative) and as the evidence suggests them to be (evidence relative), but it is not justified by the circumstances as they actually are (fact relative). The standards for due care in the exercise of lethal force are exceedingly high,

The Ethics of Moral Injury  77 so mistakes will often diminish, but not fully eradicate, responsibility for a wrongful killing. Another form of excusing condition arises in the context that Jonathan Shay is interested in, namely when a superior in a chain of command requires a subordinate to act in a wrongful way. Chain of command may often place a soldier in circumstances of reasonable mistake because soldiers frequently have only a partial view of the battle space and must trust targeting information provided by others, which may not always be accurate. But military chain of command also involves coercion, which can diminish agency and thus create excusing conditions. International law provides that no soldier is obligated to obey a manifestly unlawful command. But in practice, militaries have many ways of compelling soldiers to follow even unlawful commands. This may range from subtle social and institutional pressures through to the threat of imprisonment or even summary execution. Whether being subjected to such coercion creates an excuse sufficient to remove or diminish responsibility for wrongful killing depends on the costs that one can be reasonably expected to bear to refuse. Because the duty not to harm is stronger than the duty to assist, one can be expected to bear greater costs in order to not participate in a wrongful killing than one can be expected to bear in order to save a life. This suggests that even strong forms of coercion such as being threatened with execution can provide only a partial excuse for wrongful killing. Excuses diminish, but in many circumstances do not eliminate, the responsibility for wrongful harming. A person who does wrong with some element of excuse will merit experiencing some level of negative psychic response. Sometimes this negative psychic response will take the form of what Bernard Williams (1976, 124–25) called “agent regret” but it is unlikely that they will merit the extreme forms of shame and guilt characteristic of moral injury. Therefore, in cases of diminished agency or moral excuse, there will normally be no significant divergence between the moral and psychological assessments of moral injury. 2. Justified agency. Psychic reactions of moral guilt and shame are conceptually linked to agency and they are also linked to wrongdoing. A person may be morally responsible for an act that causes grave harm, and which would normally constitute a profound moral wrong, and yet the act may be entirely morally appropriate in the circumstances. Such actions are morally justified, and it is morally incoherent to experience emotions of guilt and shame in response to them. Justifications come in two varieties: liability (and its closely related cousin, desert) and lesser evil. Liability and desert justifications arise from the interaction of our rights and duties. As we have already seen, when a person is liable to be harmed, that person has forfeited or lost their right against being harmed in a particular way and for particular

78  David Rodin purposes. Familiar examples include the way that a person who is engaged in ­wrongdoing can become liable to be harmed in self-defence, to pay compensation, or to be punished. When a person is liable to be harmed, then there is no moral obligation for others to abstain from harming them in this way. Desert functions in a different way. If someone deserves to be harmed (as for example many people believe that wrongdoers deserve to be punished), then others are not only permitted to harm them in this way but also they may have a positive obligation to harm them. Most accounts of the morality of war are premised on the idea of liability to defensive harm. They identify a class of legitimate targets – normally, enemy combatants who are morally liable to be killed in self and other defense to prevent them from violating the rights of others. Killing a liable enemy soldier in war may appear to transgress important moral norms against taking life, but in fact – provided they really are liable – these acts should be seen as morally permissible or even creditable. Many clinical cases of moral injury have involved treating soldiers who have experienced guilt and shame after killing legitimate enemy combatants. Here again, there is no divergence between the moral and psychological view of healthy psychic reactions. A person who experiences symptoms of moral injury after killing a liable enemy soldier experiences emotions that are defective from both a psychological and moral perspective. In this sense, the divergence between the moral and psychological accounts of moral injuries that arise from killing enemy combatants is narrower than it might appear. But in other respects, the divergence is far broader than may be apparent. Traditional accounts of the morality of war follow international law in holding that any enemy combatant who is not hors de combat (removed from combat through surrender or injury) is liable to be killed. This holds irrespective of whether the enemy combatant is fighting in a just or an unjust war. But newer “revisionist theories” of the ethics of war give a very different account of what it means to be liable to be killed in war (Lazar, 2016). For these theorists, one becomes liable to be killed in war (with a few marginal exceptions) by participating in aggressive or otherwise unjust war, but one does not become liable to be killed simply by resisting aggression in a war of self-defence. This implies that soldiers fighting in an unjust war who kill enemy combatants are committing a grave moral wrong. They are killing people who are not liable to be killed (again with some rare exceptions). Most service personnel who return from serving in an unjust war having only harmed enemy combatants do not experience shame and guilt at their action. But from a revisionist Just War perspective they ought to. The fact that they do not reflects a disordering of their moral personhood as surely as the case of someone who spuriously experiences shame and guilt in the face of morally permissible or justified action, or one for which they are not morally responsible. From

The Ethics of Moral Injury  79 a moral perspective that incorporates r­ evisionist insights, the p ­ roblem of moral injury is not simply the persistence of negative responses that are inappropriate but also the absence of negative responses in situations where they are in fact warranted. 3. Disproportionate moral injuries. We have seen that there is no divergence between the moral and psychological assessments of moral injury when the acts that precipitate it are either justified, or for which they do not bear sufficient (or any) moral responsibility. But as we have already seen, the same is true of a person who experiences negative psychic reactions that are clearly excessive or disproportionate to either the seriousness of the wrongful action, or to their degree of responsibility for it. Proportionality can be understood and cashed out in subtly different ways in each of the central ethical traditions. For virtue theorists, proportionality means that the emotions of guilt and shame are fitting and appropriate to the viciousness of one’s own agency. For consequentialists, proportionality means that the harms of experiencing painful negative emotions are sufficiently outweighed by the benefits of preventing future harm to others. For deontologists, proportionality is a key test for whether one is liable to or deserving of painful moral emotions. On a liability model, proportionality requires balancing the pain of the emotions against the defensive, compensatory, or preventive good effects they may achieve. On a desert model, proportionality involves balancing the pain of the emotions against the gravity of the wrongdoing that triggers them. In each of these cases, disproportionate psychic responses are both psychologically unhealthy and morally defective. There is once again no gap between moral and psychological assessments. 4. Proportionate responses to responsible wrongdoing. We are now in a position to define more precisely the contexts in which psychological and moral assessments of moral injury will diverge. They will diverge only in cases where a person has extreme psychic moral responses that are debilitating to their psychological agency but are nevertheless proportionate (in one of the senses articulated above) in the context of their own moral responsibility for moral wrongdoing. Such emotional responses to one’s own culpable agency are viewed in the psychological literature as a disorder (as we have seen that they are explicitly included in standard definitions of moral injury), but from a moral perspective they are healthy and appropriate. Having clarified the contexts in which moral and psychological accounts of moral injury may diverge, let us now investigate the extent to which this divergence constitutes a problem for the concept of moral injury. One potential view is that it need not be problematic at all. The psychological and moral conceptions of health are logically distinct and address two different features of our agency. There is certainly no logical contradiction in

80  David Rodin saying that the same psychic response can be healthy with respect to one of feature of our nature as agents (our moral agency) and unhealthy with respect to another (our psychological agency). But the divergence undeniably causes discomfort. It would appear that the problems are not strictly logical but rather concern the ethics of treating moral injury. When faced with a patient exhibiting signs of distressing moral injury in the fourth class of cases above, the same therapeutic action has the potential to improve the patient’s psychological health while at the same time diminishing or impairing their moral health. What (morally) should a psychologist or psychiatrist do in such circumstances? Should they treat a patient to diminish the symptoms of moral injury, even though the emotions are a morally proportionate and justified response to their own grave wrongdoing? Or should they rather abstain from treatment? This is the central problem of the ethics of psychology for moral injury. It may be thought that these questions also have an easy answer. Psychologists and psychiatrists are morally obligated to prioritise the mental health of their patients over other considerations – including the patient’s broader mental health. Just as lawyers and financial advisors are bound by professional codes that require them to service the best legal and financial interests of their clients irrespective of whether this will best service their moral health or wellbeing, so mental health professionals are required to service their client’s mental health. Professional codes of this kind are often justified as “bounded” moral systems that permit members of the profession to act in ways that differ from ordinary moral obligations because of the greater social importance of the profession’s effective functioning. But we have seen that negative moral emotions such as guilt and shame themselves play a crucial role in creating valuable social outcomes for example by disincentivizing future wrongful action. There are strong prima facie reasons to believe that even extreme moral-psychic reactions such as moral injury can sometimes conduce to important and socially valuable outcomes. Moreover, we may assume that moral health is more closely tied to a patient’s psychological health and welfare than it is to (for example) a client’s legal interests or financial wellbeing. Even acknowledging that a mental health professional has strong and peremptory duties of care to his patient, why should they privilege the psychological over the moral aspects of the patient’s moral-psychological welfare? A better answer is unfortunately obscured by the unhelpful way in which the moral injury literature lumps together without proper distinction psychological responses that are appropriate in the context of our moral agency and those that are not. A better approach is to inquire not simply whether professionals should treat cases of moral injury, but how they should treat.

The Ethics of Moral Injury  81 There are significant differences in approaches to treating moral injury. Early research suggested a considerable overlap in the symptoms of moral injury and of post-traumatic stress disorder (PTSD), and early treatment strategies were based on those for PTSD (Litz et al., 2007, 607). These treatments included pharmacological interventions to reduce anxiety and depression, exposure therapy to reduce negative emotional reactions stemming from painful memories, and cognitive behavioural therapy and cognitive processing therapy to increase awareness of and recontextualize negative emotional reactions, as well as to reconstrue the context of their own actions. We might call these interventions “psychological pathway therapies.” They seek to diminish or remove the distressing psychological symptoms and underlying causes of moral injury through psychological mechanisms without necessarily addressing or resolving the underlying moral reasons for shame and guilt. In contrast, an alternative group of approaches may be called “moral pathway therapies.” These therapies seek to ameliorate the psychological burdens of moral injury through acts of moral remediation and redemption. Often conducted under the supervision of a priest or other ethical authority, such therapies typically involve acknowledging the wrongful event that precipitated the moral injury, accepting responsibility for it, undertaking symbolic or substantive acts of apology, compensation, and restitution, seeking forgiveness, and committing to act differently in the future (Litz et al., 2009, 702-04). The distinction between psychological pathway and moral pathway therapies is helpful because it enables us to see that different forms of therapeutic strategy may be appropriate to different forms of moral injury. If one were to treat moral injuries that fall into the fourth category discussed above (those in which the patient is responsible for exceptionally grave moral violations) with psychological pathway therapies, one would open up a problematic gap between the patient’s psychological and moral health. The patient may experience improvement in his psychological presentation, but the underlying moral responsibility for wrongdoing has not been remediated. However, moral pathway therapies offer the opportunity to do just that. They are a form of practical ethics as therapy that seeks to reduce not simply the emotional results moral taint but the moral taint itself. However, psychological pathway therapies are appropriate to treat moral injuries of the forms 1–3 above (no responsible agency, justified agency, or disproportionate emotional responses). This is because the emotions of guilt and shame are not morally justified in these cases, and there is no comparable act of moral remediation required. Moral pathway therapies, however, are not appropriate to moral injuries of the forms 1–3. Indeed, it would be logically nonsensical to attempt moral pathway therapy in these contexts. To offer apology, to accept responsibility, to

82  David Rodin offer compensation and restitution, and to ask forgiveness, all conceptually entail that the agent is morally responsible for an act of wrongdoing – a condition that is precisely absent in these cases. These distinctions – between classes of moral injury that arise from responsible wrongdoing and those that do not, and between proportionate and disproportionate psychic responses – seem essential to conceptual clarity and to effective therapeutic intervention. Yet they are not currently reflected in standard definitions. This seems an important and urgent issue to address in the literature of moral injury. The Politics of Moral Injury I would finally like to consider the social and political role of the practice and discourse of moral injury therapy. The individual therapists and scholars who work on moral injury are clearly driven by a deep sense of compassion, humanity, and empathy. They see vulnerable, fearful, anguished souls who have experienced unimaginable horrors, and their instinct is to offer succour. This is not only human, but it is admirable also. But it is impossible not to also consider the broader social and rhetorical function that the conception of moral injury plays. Moral injury was first theorized, and is still most prominently deployed, in the context of war, and the conception positions the wrongdoing in war in a very particular way. It positions the soldier, who may be the agent of horrendous wrongs, at least in the public discourse as victim rather than perpetrator.3 Except for self-harm, which is an aberrant case, an injury is a misfortune that befalls you rather than something of your own doing. Because of this, the conception of moral injury has the effect of effacing agency. Agency, recall, was our starting point for understanding the psychic moral responses. Worse still, it has the effect of effacing the actual victims of wrongful action in war, those killed or injured in illegal military acts or in unjust wars. Where are their voices and where are their memories in the moral injury discourse? Politically and institutionally, moral injury has complex effects. A diagnosis of moral injury can unlock financial and medical resources for veterans, who are often vulnerable and disempowered. But the conception of moral injury also serves a broader institutional purpose. To be injured in war is not only a misfortune, but it is also heroic. A narrative of heroism has always been essential to the recruitment process that sustains modern militaries. The concept of a moral injury helps to neutralize the damage that wrongdoing in war may otherwise do to this narrative. Moral injury – understood as injury – is, paradoxically, the shame of which we can be proud.

The Ethics of Moral Injury  83 The intertwining of the moral and psychological in cases of moral injury is doubtless more complex than I have here suggested. Nonetheless, it can be instructive to tease them apart. Moral health and psychological health are not the same. Psychological healing can sometimes be a moral disorder, and moral health can entail grave psychological burdens. It is important that we be fully cognizant of this in our understanding of moral injury, the way we approach treatment and the way the discourse functions in the political environment. Notes 1 We frequently, though somewhat tenuously, extend this to the acting and doing of a broader group which might not be strictly speaking a collective agent, for example when I feel pride in achievements of a sport team I support, or shame in actions of compatriot. 2 The different psychological presentations of guilt and shame are interestingly discussed in Litz et al. (2009, 699) and Roth et al. (2022, 595). 3 I am grateful to Andrew I. Cohen for pointing out that the soldiers who suffer moral injury are often very clear that they are perpetrators and in many cases, they resist having their actions dismissed or their agency minimized by others.

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84  David Rodin Singer, Peter. 1972. Famine, Affluence, and Morality. Philosophy and Public Affairs 1, 229–43. Steinmetz, S.E., M.J. Gray, and J.D. Clapp. 2019. “Development and Evaluation of the Perpetration-Induced Distress Scale for Measuring Shame and Guilt in Civilian Populations.” Journal of Traumatic Stress 32, 437–47. Williams, Bernard A.O. 1976. “Moral Luck.” Proceedings of the Aristotelian Society, Supplementary Volumes, 115–35. Williamson, V., D. Murphy, A. Phelps, D. Forbes, and N. Greenberg. 2021. “Moral Injury: The Effect on Mental Health and Implications for Treatment.” The Lancet Psychiatry, March 17, 2021. https://doi.org/10.1016/S2215-0366(21)00113-9.

5 Moral Injury and the Making of Amends Linda Radzik

Moral injury involves the experience of significant emotional distress and dysfunction in the aftermath of a transgression that “severely and abruptly contradicts an individual’s personal or shared expectation about the rules or the code of conduct” (Litz et al. 2009, 700). Drescher et al. define moral injury as involving “[d]isruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner” (2011, 9). The sorts of events that trigger moral injury include: “Perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (Litz et al. 2009, 700). The clinical literature on moral injury sometimes mentions the making of amends as part of a possible treatment plan (Litz et al. 2009; Purcell et al. 2018). However, it is typically unclear how clinicians are conceiving of the making of amends or “atonement.” Many culturally prominent conceptions of atonement are deeply problematic, especially when applied to people suffering from the debilitating cluster of symptoms known as moral injury (see Drescher et al. 2011). According to one view, the making of amends is impossible because the past cannot be changed. Another view, which is both ancient and widespread, holds that guilt can only be expiated by the wrongdoer’s suffering. These conceptions of atonement are unlikely to appeal to clinicians. They are also unsatisfactory for moral reasons. Other conceptions of making amends are more popular among clinicians. These typically involve an inner transformation of the wrongdoer and emphasize self-forgiveness. Atonement so conceived may be helpful in reducing the symptoms of moral injury. However, these conceptions of atonement are in danger of making atonement too cheap and eliding the significance of victims and affected communities. In this chapter, I review some popular conceptions of atonement. I raise a number of objections to these from the point of view of moral theory. I argue that the “reconciliation theory,” which I have developed elsewhere, can avoid these objections (Radzik 2009). This theory conceives of DOI: 10.4324/9781003281122-7

86  Linda Radzik wrongdoing as damaging relationships among victims, wrongdoers, and communities and of atonement as repairing this damage. Atonement for serious wrongdoing isn’t easy, but it isn’t impossible either. Importantly, atonement comes in degrees. This conception of the making of amends appears to offer benefits to victims and communities as well as to wrongdoers themselves. Relevance to Moral Injury Before turning to different moral theories of atonement, we must consider to what extent they are relevant to the phenomenon of moral injury, especially as it appears among veterans of warfare. The ethics of atonement addresses the moral obligations of wrongdoers to respond to their own misdeeds. What can someone who is guilty of a moral transgression do in order to right the wrong? How can a wrongdoer achieve a state wherein the wrong is appropriately left in the past, such that feelings of guilt and shame are no longer fitting? As I use the terms here, “wrong” and “wrongdoer” imply culpability, that is, not just responsibility but also blameworthiness. However, the morally injured includes people who are not culpable. Some soldiers who are morally injured suffer from guilt and shame, even though guilt and shame are not fitting from a moral point of view. Examples include people who merely witnessed atrocities or who experience moral injury as a result of having been betrayed by their leaders (Shay 1994). In other cases, soldiers have committed morally weighty acts, such as killing or injuring other people, but those actions were morally justified or excused.1 To describe the action as justified is to say that the action was the morally right thing to do given the situation. To say that the action was excused means that, although the action was not morally correct, given the circumstances, the actor bears no blame (or less blame) for having so acted. For example, the person may have acted in ignorance of crucial facts where her ignorance was caused by someone else’s mistake, or she may have acted under extreme duress. In other cases, soldiers experience moral injury after failing to have done something heroic, that is, for not having done something that was not morally required. Heroic actions are those that exceed what morality can demand of a person. In still other cases, soldiers appear to suffer over not having been able to do the impossible, for example, to protect their buddies from unforeseeable dangers (­Sherman 2015). None of the morally injured subjects just described is culpable for the traumatizing events and so none of them are morally obliged to atone. So, the ethics of making amends, which is our topic in this chapter, is directly relevant only to those among the morally injured whose injuries are at least partially tied to their own, culpable misdeeds.2 However, I hope that

Moral Injury and the Making of Amends  87 thinking about the making of amends can also be indirectly useful for these other cases as well. Fear of being culpable might contribute to the suffering of the non-culpable. Consider an analogy. Fear of having cancer might prevent a person from going to the doctor and so unnecessarily increase his suffering. Insofar as we can make cancer less terrifying by, for example, assuring this person that a cancer diagnosis is not a death sentence, we might succeed in getting him to visit his doctor. Similarly, a less terrifying vision of the obligation of atonement might help non-culpable, morally injured people to address their condition. After all, morally traumatizing events include those where it is very hard to say whether one acted with justification or not. Prominent Conceptions of Atonement This section of the chapter briefly introduces several different conceptions of atonement that have been culturally prominent in the West. Most of them are connected in one way or another to Western religious traditions, although I do not explore those connections here. Instead, these views of atonement are presented simply as different moral ideas. Each is compelling to one extent or another, yet each one faces objections or limitations. Changing the Past

According to one line of thought, nothing can right a wrong because wrongful actions lie in the past and the past cannot be changed. Wrongdoing, as Josiah Royce puts it, dooms the actor to “the hell of the irrevocable”: If I ever say, ‘I have undone that deed,’ I shall be both a fool and a liar. … That, so far as the real facts are concerned, cannot be done. For I am, and to the end of endless time shall remain, the doer of that wilfully [sic] traitorous deed. Whatever other value I may get, that value I retain forever. My guilt is as enduring as time. (1968, 161) If the past cannot be changed, then perhaps it is best forgotten. Or, if such a repression of memory would cause additional problems, the wrongdoer might “draw a firm line around the past and its related associations so that the mistakes of the past do not define the present and the future” (Litz et al. 2009, 704).3 Yet forgetting and line-drawing imply that the past wrong, the suffering of one’s victims, and one’s responsibility do not matter. They are forms of self-deception or abandonment of one’s moral commitments. So, concludes Royce, the wrongdoer is doomed to suffer “unless I call treason my good, and moral suicide my life” (1968, 162).

88  Linda Radzik The view that atonement requires changing the past seems to offer nothing but despair to wrongdoers. Reading more deeply, we find that those who espouse this view often believe that, although wrongdoers cannot right those wrongs through their own efforts, wrongdoers can be redeemed through divine intervention (Wyschogrod 1986). Whatever value that position might have from a theological point of view, it undervalues human relations in the aftermath of wrongdoing. The sin against God may be redeemed, but the wrong against one’s human victims remains unaddressed. No reason is provided for apologizing or paying reparations, since nothing one does can change the past. Yet, the claim that it is impossible for wrongdoers to make amends through their own efforts contradicts our everyday experiences of moral life. People satisfactorily respond to wrongdoing all the time. They break promises to family members, take advantage of friends, or recklessly cause harm to neighbors’ property. But then they apologize. They offer gifts. They pay for damages. They show that they are worthy of renewed trust. And it is enough. In other words, our experience of everyday life suggests that the making of amends does not require the impossible act of changing the past. Suffering

Another prominent strand of thought holds that wrongdoing requires the suffering of the wrongdoer. This view is often called “retributivism” in philosophy and “satisfaction theory” in theology (Moore 1987; Gorringe 1996). The etymology of the word “retribution” is tied to “repayment.” Wrongdoing creates a debt and suffering is the coin that repays that debt. Atonement, then, requires that the wrongdoer suffer in proportion to the misdeed. This suffering might be imposed by others in the form of punishment or as a self-inflicted penance. Guilt and shame, on this view, are valuable because they are painful, and apologies have significance because they express that pain. On some versions of retributivist accounts of atonement, good works performed by the wrongdoer can also be used to pay the debt (Anselm 1998). However, when one looks more closely, the value of the good work is rooted in the fact that it requires some kind of sacrifice or effort from the wrongdoer – that is, a kind of suffering. Here, too, we have a terrifying vision of atonement. Yet, the idea that wrongdoers deserve suffering is deeply embedded in Western thought. In moral philosophy, it is often treated as a core intuition, a kind of moral bedrock on which other moral ideas are developed. Upon reflection, though, the view is bizarre. The suffering of another human being is treated as intrinsically desirable, that is, as valuable for its own sake even if no further good follows from it. Isn’t such a view bloodthirsty and repugnant?

Moral Injury and the Making of Amends  89 Often, retributivist views seem to partake in a kind of magical thinking. Only blood washes blood. Only the suffering of the wrongdoer can undo the suffering of the victims. But, how, exactly, does that happen? How is it that the suffering of the wrongdoer “undoes” past suffering rather than simply adding more suffering to the world? Self-forgiveness

Other culturally prominent ideas of atonement are much less terrifying. Indeed, they might be thought of as reactions to the notions of atonement described above that seem to counsel despair and pain. Some thinkers conceive of atonement after wrongdoing as a process of self-forgiveness. The wrongdoer must restore compassion for himself, see himself as distinct from his misdeeds, and learn to let go of feelings of guilt and shame. Since it is impossible to change the past, and since adding future suffering to past suffering accomplishes nothing, an unconditional self-forgiveness provides the best way to move on. A major objection to this view, however, is that it is morally lax. Again, it risks suggesting that the past does not matter. This risks condoning the wrong or dishonoring the intrinsic significance of the victim’s past suffering. It also ignores the significant potential that the past wrong continues to create current hardships for victims, their survivors, or the community. Unconditional self-forgiveness, by focusing on ending the wrongdoer’s suffering, suggests that he is the only one who matters. Less extreme defenses of self-forgiveness are available, however. Some represent self-forgiveness as merely the beginning of a longer process of atonement (Holmgren 2012). The idea here is that the wrongdoer must exercise self-compassion in order to regain the strength to do the other, difficult things that atonement requires. Alternatively, one might see selfforgiveness as the culmination of a process of atonement (Radzik 2009, chap. 5). On this view, self-forgiveness is conditional upon satisfying one’s obligation to atone. In the next several sections, we see some suggestions about what this obligation to atone might include. Repentance

According to many moral thinkers, atonement is centrally a matter of repentance (Gorringe 1996; Cook 2001). Repentance is frequently understood as a turning back to the right and the good. The repentant wrongdoer feels remorse over her wrongful actions, reforms her character, and recommits herself better behavior in the future. Repentance involves suffering. Honestly acknowledging one’s failings will be painful insofar as one remains alive to moral value. Reforming oneself is hard work. But the

90  Linda Radzik value of atonement, according to this view, is not in the suffering itself; it is in the return of the wrongdoer to the right path. Here too, one might object that placing this focus on the improvement of the wrongdoer continues to overlook the people who have been wronged. The defender of repentance typically insists that a truly repentant person will do things such as apologizing and making reparations where possible. Insofar as a wrongdoer fails to make such responses, those failures are a sign of incomplete repentance. Yet while this is a step in the right direction, it still elides the central significance of victims. Wrongs are wrongs because of what they do to victims.4 Victims deserve to take a central place in a theory of what it takes to right a wrong. Apology

A more victim-centered conception of atonement is apology (Lazare 2004). To wrong another person is to behave toward him as if he does not deserve decent treatment. For this reason, all wrongful actions against another person are forms of insult. Apology is a means of withdrawing the insult. In apologizing to the victim, the wrongdoer declares that the victim did, indeed, deserve better. The wrongdoer accepts responsibility for the misdeed, condemns his past action, expresses remorse, and promises better behavior. A good apology often includes an explanation of how the misdeed came about, which can help the victim to make sense of the past. Ideally, the wrongdoer also listens to what the victim has to say in response. Apologies often explicitly ask the victim for forgiveness, which puts the victim in the position of making a decision that matters to the wrongdoer. In these ways, apologies express renewed respect for the victim. This account of the value and appropriateness of apologies in the aftermath of wrongdoing is compelling. More controversial is the claim that apologies suffice for atonement. Apologies will seem like empty words where repentance is incomplete or other demands for justice go unsatisfied. For example, these other demands of justice might include submission to a formal punishment where the wrong was also a crime. Another concern about apology is that, especially when performed poorly, it risks increasing the burden on victims. The victims may feel pressured to relieve the wrongdoer’s suffering by offering a forgiveness they are not ready to give. Compensation

For some, the phrase “making amends” most readily suggests the payment of compensation. Compensation involves returning or replacing something of value that was lost, damaged, or destroyed. Stolen property

Moral Injury and the Making of Amends  91 may be returned. Wrongdoers might repair damaged property with their own hands. Money can repay the cost of medical care or lost wages. The duty to compensate wrongfully created harm is a familiar and important demand of justice. The problem with this conception of atonement is that it is rather limited. Some losses are simply not compensable. A lost life cannot be recalled or replaced. Money can compensate for hospital bills but not for physical suffering or mental anguish. Reparations and Good Works

To address incompensable harms, the wrongdoer might pay symbolic reparations. Money offered for a lost life does not literally replace the value of that life. Seen in that light, the offer of money would be insulting to the dignity of the victim and the integrity of their loved ones. But, the wrongdoer and the survivors may share an alternative interpretation of the payment. The payment might serve as an outward symbol of the wrongdoer’s remorse and respect for the value of the person who has died. It may make repentance more credible and express caring for the well-being of the survivors. Reparations can have symbolic value even in cases where they benefit parties other than direct victims or their survivors. For example, a drunk driver who has killed another person can be said to make reparations when he makes contributions to a fund for the benefit of the victims of drunk driving more generally. His own victim will not benefit, but in helping those who resemble his victim, he communicates respect and remorse. In educating others about the dangers of drinking and driving, the wrongdoer may strengthen his own commitment to not repeating the wrong. One way of understanding the value of reparations, especially in the form of good works that benefit people other than direct victims or survivors, brings us back to the idea that righting the wrong requires changing the past. A different way of interpreting what it means to “change the past” emphasizes the possibility of changing the meaning of the past by changing the trajectory of the larger narrative of which it is a part (Scheler 1960). Were the drunk driver in our example to do nothing to respond to the killing, or to do nothing but suffer over it, the death remains simply a tragedy. But when the killing inspires him to help others and prevent future deaths, the original loss takes on a new meaning. It becomes part of a narrative that bends toward the good, perhaps even making the world “better than it would have been had all else remained the same, but had that deed … not been done at all” (Royce 1968, 180–81). This reinterpretation of what it means to change the past is appealing in many ways. But it leaves open a significant question: Whose narration of the past counts? The wrongdoer’s? The victim’s family? The community’s?

92  Linda Radzik Reconciliation Theory of Atonement The theory of atonement that I defend starts from the idea that atonement is a kind of moral repair. It is a matter of repairing what has been damaged and neutralizing any continuing threats posed by the past wrong. For reasons that will become clearer below, the relevant forms of repair will often require reconciling the relationships that have been damaged or threatened by wrongdoing. Before building an account of atonement as a kind of repair or reconciliation, we need to think more carefully about what has been damaged. Of course, the answer to this question will depend on the details of the wrongful action (e.g., lying, promise-breaking, or murder). But, we can sketch the contours of what a careful assessment of a particular wrong would need to consider. Typical cases of wrongdoing that involve victims include a mix of insults, threats, and harms. Wronging another person is almost invariably a form of insult. The wrongful act sends the message, whether intentionally or not, that the victim did not deserve better treatment. The act suggests that the value of the victim was so low that it did not require one to restrict one’s behavior (Murphy and Hampton 1988). In some cases, wronging one person conveys insults to other people as well, such as her community or people who resemble her in a relevant way (e.g., her co-religionists or other women). To describe wrongs as issuing threats again picks up on the messages that are conveyed by the wrongful action (Hieronymi 2001). If the victim’s value did not preclude this act, it will not preclude other abuses in the future. The wrong gives the victim, and perhaps also her community or people who resemble her, a reason to fear future mistreatment from this wrongdoer. Depending on the case, the wrong may also give them reason to fear mistreatment from the wrongdoer’s community or people who resemble him in relevant ways (e.g., other soldiers or other Americans). Wronging a victim may involve inflicting some form of harm, such as physical or material forms of harm. Wrongdoing also typically creates what I refer to as “relational harms.” In talking about “relationships,” I mean to draw attention to the beliefs, attitudes, emotions, and expectations people hold regarding others and the patterns of interaction shaped by these psychological states (cf. Govier 2002). Different kinds of relationships (e.g., fellow soldiers, therapist/patient, and boss/subordinate) are appropriately governed by different norms. Some relationships may include special obligations (e.g., duties of confidentiality) or higher degrees of goodwill (e.g., self-sacrifice). Some morally permissible roles are shaped by circumstances in which things have already strayed far from a moral ideal (e.g., combatants or prison guard/prisoner).5 But all morally permissible relationships require some fundamental forms of respect and some degree of goodwill.

Moral Injury and the Making of Amends  93 In a healthy relationship, each party can reasonably trust that the other will abide by the norms appropriate to that relationship. Each party feels the proper kind of respect and goodwill toward the other and is confident that the other returns that respect and goodwill. Healthy relationships enable people to function and interact in appropriate ways. Wrongdoing damages or threatens relationships (Radzik 2016). When relationships are damaged, relationships actually deteriorate. One or more of the parties negatively adjust their beliefs, emotions, attitudes, expectations, or interactions regarding the other. For example, they might feel anger and suspicion toward the other and so refuse to cooperate or become aggressive. When relationships are threatened, these relational harms are not actualized, but the parties have reason to make negative adjustments to their relationship with the other. For example, when one spouse betrays the other, but the betrayal has not yet come to light, we can describe their relationship as threatened by the transgression. Most obviously, wrongdoing damages or threatens the relationship between the victim and the wrongdoer. The wrong gives the victim reason to resent, distrust, or refuse to interact with the wrongdoer in the future. The risk of future harms and wrongs between these two parties increases as trust in mutual respect and goodwill is undermined. But the wrong can also damage other relationships. The victim’s relationship to her community may be harmed. For example, she may be shamed in their view, making her more vulnerable to mistreatment at their hands. She may have lost trust in them for not having been able to prevent the wrong. The wrongdoer’s relationship to the community (his own or the victim’s) may have been damaged. They may feel angry, indignant, or fearful toward him. On the one hand, they may no longer be willing to interact with him. On the other hand, they may have been influenced by him to engage in similar wrongs, making the community as a whole less safe and less trustworthy. Wrongs can also harm the victim’s relationship to herself. The victim may feel a loss of self-respect or confidence in her own judgment or ability to protect herself. Furthermore, the transgression can also damage the wrongdoer’s relationship to himself. This sort of relational damage is highly relevant to the phenomenon of moral injury. The wrongdoer may feel guilt and shame. He may doubt his own moral competence, that is, his own ability to distinguish right from wrong. The transgression may give him reason to question his own trustworthiness in moral matters. Even if he is able to identify the right action, perhaps he cannot be trusted to actually perform it. He may view himself as simply a bad person. This may feed further social alienation, wrongdoing, and self-destructive behaviors. Part of the value of attending to these insults, threats, and relational harms is that it draws our attention to the ways in which past wrongdoing

94  Linda Radzik does not stay in the past. The wrong may continue to cause suffering, ­mistrust, and dysfunction into the future. The impact may radiate through a variety of relationships. Atoning for a particular wrong requires reconciling the relationships that have been damaged or threatened by wrongdoing. The specific shape the making of amends should take depends on the specific forms of damage or risk that were created by the particular transgression. Generally speaking, atonement for a wrong committed against another person or persons will involve three interrelated tasks: respectful communication, the compensation of harms, and the moral improvement of the wrongdoer. First, respectful communication with victims and/or communities is required. The insults and threats that were communicated by the wrongful action must be withdrawn. Doing this well requires the wrongdoer to properly identify the nature of the wrong and his degree of responsibility for it. The evidence of untrustworthiness that the wrongful act provided must be balanced with renewed evidence of a recommitment to moral behavior. Apologies are the chief means by which this sort of respectful communication can take place. Symbolic reparations or participation in religious or secular rituals may also contribute to this task. Messages of renewed respect and goodwill must be sent in forms that the victims and relevant communities will understand and value. Second, atonement requires compensating those harms that are compensable. Not only is the compensation of such harms a straightforward requirement of justice, leaving compensable harms uncompensated would exacerbate relational harms. In other words, continuing material loss provides continuing evidence of the wrongdoer’s disrespect and ill will. A failure to pay compensation can undermine the value of apologies. Where literal compensation is impossible, paying symbolic reparations and performing good works, especially for people who resemble the victims or affected communities, can provide both the wrongdoer and other people with evidence of his renewed trustworthiness. When relationships can be reconciled, other forms of loss become more bearable. Third, the wrongdoer must reform himself. This requires an honest reckoning with past failures. Perhaps it is appropriate to explain the transgression in a “specific (i.e., highly context [war] dependent), not stable (i.e., time-locked), and external (e.g., a result of exigencies and extraordinary demands) way” (Litz et al. 2009, 701). But such explanations may not be accurate. The transgression might instead have been rooted in problematic attitudes and character traits, in which case those must be amended. Reform requires committing, or re-committing, oneself to moral behavior in the future. The experience of remorse is part of this process. Making apologies and paying compensation, in addition to being owed in themselves, can help wrongdoer better understand the nature and effects of the

Moral Injury and the Making of Amends  95 wrong. Reparations and good works that benefit non-victims can reinforce the wrongdoer’s efforts to develop respect and goodwill for others. The development of self-compassion toward his own frailties and limitations can help the wrongdoer find the strength and hope to improve himself and take on the other tasks of atonement (Walker 2006). Regaining one’s sense of oneself as morally trustworthy does not require perfection. In fact, those who are better acquainted with their own and others’ frailties, and the limitations of moral ideals, may have a better claim to trustworthiness. When atonement is performed well, the wrong is left in the past in the sense that its harmful effects on the present and future are stopped or blunted. The parties can let go of the roles of “victim” or “wrongdoer.” The parties see one another, and reasonably trust that the other sees them, with respect and goodwill. Their relationships to themselves are healed. Importantly, reconciling or repairing one’s moral relationship with another person (or oneself) does not amount to restoring one’s relationship to whatever it was before the wrong occurred. After all, that relationship might itself have been problematic, in which case atonement requires the establishment of a new, decent relationship. In some cases, the previous level of intimacy (e.g., close friends) may not be recoverable, but a new relationship, which is a healthy version of its type, takes its place (e.g., coworkers or neighbors). The main argument in favor of the reconciliation account of atonement is quite simply that it addresses more of what is wrong with wrongdoing. Many of the insights from the accounts of atonement surveyed above are incorporated here. Repentance, apology, compensation, reparations, and good works each play a part in atonement. The account of atonement recognizes that the past cannot literally be changed but provides a rough map for incorporating the past into a narrative of reconciliation. A wrongdoer who atones has good reason to forgive himself. At the same time, the reconciliation theory avoids the objections we raised those other accounts. The reconciliation theory of atonement is neither bloodthirsty nor morally lax. It grants a central place to victims. Victims’ needs are addressed to the extent possible, as are the legitimate interests of the community. But, at the same time, the reconciliation account is concerned with the wellbeing of the wrongdoer. The wrongdoer regains a positive sense of himself as a morally trustworthy person and a member in good standing in his relationships. Objections In this section, I consider some likely objections to the reconciliation theory of atonement, especially as part of a response to moral injury. Several of these objections emphasize that war is simply different. The reconciliation

96  Linda Radzik account might deal well with more common cases of wrongdoing, such as theft or marital infidelity. But, one might object, the wrongs committed in conditions of war are so different from everyday wrongdoing that we must think about atonement differently. Certainly, war presents situations, requires decisions, and imposes pressures that differ significantly from everyday life. In warfare, many actions that would normally be wrongful are justified or excused. But, recall, atonement is a response to culpable wrongdoing. What counts as culpable is certainly affected by the context of war. But we would need an additional argument for why or how the obligation to atone is also different. One reason for thinking that the reconciliation theory of atonement will be unable to deal adequately with wrongs committed during war is that there is often no relationship to reconcile. At least for many of the transgressions that trigger moral injuries, the wrongdoers had no relationship with the victims. They were strangers to one another or even enemies. One response we might offer to this objection is that wrongdoing itself creates a relationship between the wrongdoer and the victim (Govier 2002, 47–48). They may not have harbored beliefs, attitudes, expectations, or emotions toward one another before, but they do now, and so there is reason to improve or transform those relationships. A second response, which I favor, is that all human beings stand in relationships with all others in the sense that they owe one another basic respect and a modicum of goodwill. The resentment we feel when a stranger mistreats us is evidence that we harbored expectations that they behave better. The relationship becomes visible at the moment it is breached. The relationship between combatants on opposite sides of a conflict is a difficult and tragic relationship, but it certainly is a relationship. The articulation of the norms that properly govern that relationship is a long-standing philosophical and political project. A different reason for thinking that the reconciliation theory of atonement is ill-suited to deal with wrongdoing in war is that, in these cases, it is often simply impossible to make amends to victims or communities (Litz et al. 2009, 704). Victims may be dead or impossible to locate. The affected community may be inaccessible, perhaps lying on the other side of the globe. The amount of compensation that is owed may be far more than could ever be repaid by the wrongdoer. It is true that the reconciliation theory presents atonement as a very demanding task in cases of serious wrongdoing. However, atonement involves three different tasks, each of which admits of degrees. Where full compensation for harm is impossible, there are still the possibilities for respectful communication and the reformation of the wrongdoer. Where communication directly with victims or their communities is not possible, communicating with people who resemble those victims or communities still has value, even if only for the wrongdoer’s efforts to fully acknowledge

Moral Injury and the Making of Amends  97 and understand her faults, to reform her character, or to regain confidence in her own trustworthiness. Atonement requires repairing what can be repaired, to the degree that this is possible. For what remains, all one can do is honestly acknowledge responsibility and mourn one’s inability to repair it. This reckoning acknowledges the limits of what atonement is possible, but at the same time, it is itself evidence of renewed moral competence and trustworthiness and so is part of atonement. A further objection to the reconciliation theory of atonement is that it seems to require precisely the sort of moral acumen the loss of which defines moral injury. People who have experienced morally traumatizing events in war suffer from a kind of disorientation (Drescher et al. 2011). Perhaps their ideas of right and wrong were inadequate to the complex situation they found themselves in. They may have faced a dilemma in which none of their options was acceptable. The people they depended on to help them identify and carry out acceptable courses of action let them down. Such experiences may fuel not only a loss of trust in oneself but also a loss of trust in one’s community or the very viability of a moral order. This objection emphasizes what is so challenging about moral injury. But rather than undermining the reconciliation theory of atonement, the objection seems to share that theory’s understanding of what atonement requires, namely, the recovery of morally governed relationships between the wrongdoer and others as well as the wrongdoer’s own sense of herself as a morally trustworthy person. Recovering these goods will require a process, perhaps a long process. But the theory does offer some guidance on how to get started, including identifying the transgression, recognizing its negative consequences, naming the parties who were affected, communicating with those parties (where this includes listening to them), examining one’s character and values, and taking steps to repair those harms that one can identify. Rebuilding an understanding of what we owe to one another in our relationships is likely to require significant help from others. This idea supports some of the recommendations that one finds in the clinical literature on veterans and moral injury, including that the wrongdoer connect with others who have faced similar challenges in wartime and those who can serve as compassionate moral authorities in her own community (Litz et al. 2009; Klinghorn 2012). These aspects of, and aids to, reconciliation are valuable, but they do not replace the value of also reconciling with victims and their communities. One might well worry that reconciliation theory of atonement leaves the wrongdoer vulnerable to the responses of other people. Reconciliation requires a mutual response from all parties to the relationship. Some victims, survivors, or affected community members may be unwilling to

98  Linda Radzik reconcile. In some cases, this unwillingness may be unfair or unvirtuous. But, especially in cases of serious wrongdoing, a wide range of responses will be reasonable and morally permissible. Some victims are surprisingly forgiving. Others are not. Whether the wrongdoer’s efforts to reconcile will be successful seems to depend on an unsettling degree of luck. Some may see this as a problematic feature of the reconciliation theory of atonement. But it follows from a commitment to showing proper respect to victims and communities (Radzik 2009, chap 5). Much of what is wrong with wrongdoing is the damage it does to one’s relationships with other people. That damage cannot be fully repaired without their free cooperation. The wrongdoer should make what efforts she can to offer these other parties good reasons to reconcile with her. But whether they do so is up to them, and properly so. This does, indeed, leave the wrongdoer and the success of her attempts to atone vulnerable to their reactions to her. There is comfort to be found, though, in the thought that atonement comes in degrees. The better an effort the wrongdoer makes in offering atonement, the more reason she has to reaccept herself as a morally trustworthy person. Conclusion The reconciliation account of atonement is, indeed, demanding. It rejects the claim that, since the past cannot be changed, wrongs cannot be repaired. It also insists on placing victims’ claims and interests at the center of obligations to atone. Relieving the suffering of the wrongdoer matters, but it is not the only thing that matters. And wrongdoers cannot be healed in a moral sense unless they retain (or regain) an understanding of what they owe other people. As a moral philosopher rather than a clinician, I am poorly placed to judge whether or how the reconciliation account of atonement could contribute to a treatment plan for moral injury. I fear that, for people guilty of serious wrongdoing, an honest reckoning with their actions and the consequences of those actions may be unbearable. Yet, patients’ susceptibility to this sort of suffering is itself a sign that they are alive to the demands of morality (Litz et al. 2009, 701). My hope is that the treatment of moral injury can preserve, rather than sacrifice, that moral sensitivity. Notes 1 In moral philosophical literatures, omitting to act is generally treated as an action that might be culpable, justified, or excused. 2 I put aside the difficult question of whether there are obligations to atone when one bears no individual culpability but is part of a wrongdoing group. See Boudreau (2011) and Radzik (2009, chap. 7).

Moral Injury and the Making of Amends  99 3 Although Litz and colleagues use this unfortunate and historically fraught turn of phrase, a closer reading of their 2009 article suggests that they favor what I will refer to below as a repentance model of atonement, in which atoning amounts to the wrongdoer turning toward the good. I describe the “drawing a line” phrase as historically fraught because it is associated with, for example, the efforts of some in postwar Germany to avoiding dealing with the legacy of the Nazi atrocities. 4 There are victimless wrongs, but I suspect such wrongs are less likely to result in moral injuries. 5 I refer to these as “morally permissible” roles in order to mark a distinction from other relationships that are fundamentally incompatible with respect and goodwill (e.g., conman/patsy or torturer/tortured).

Works Cited Anselm of Canterbury. 1998. “Why God Became Man.” In Anselm of Canterbury: The Major Works, edited by Brian Davies and G. R. Evans, 260–356. New York: Oxford. Boudreau, Tyler. 2011. “The Morally Injured.” The Massachusetts Review 52 (3/4): 746–54. Cook, Michael. 2001. Commanding Right and Forbidding Wrong in Islamic Thought. New York: Cambridge. https://doi.org/10.1017/CBO9780511497452. Drescher, Kent D., David W. Foy, Caroline Kelly, Anna Leshner, Kerrie Schutz, and Brett Litz. 2011. “An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans.” Traumatology 17, no. 1 (March): 8–13. https://doi.org/10.1177/1534765610395615. Gorringe, Timothy. 1996. God’s Just Vengeance: Crime, Violence, and the Rhetoric of Salvation. New York: Cambridge. https://doi.org/10.1017/CBO9780 511627934. Govier, Trudy. 2002. Forgiveness and Revenge. New York: Routledge. https://doi. org/10.4324/9780203870136. Hieronymi, Pamela. 2001. “Articulating an Uncompromising Forgiveness.” Philosophy and Phenomenological Research 62, no. 3 (May): 529–55. https://doi. org/10.1111/j.1933-1592.2001.tb00073.x. Holmgren, Margaret R. 2012. Forgiveness and Retribution: Responding to Wrongdoing. New York: Cambridge. https://doi.org/10.1017/CBO9781139086165. Klinghorn, Warren. 2012. “Combat Trauma and Moral Fragmentation: A Theological Account of Moral Injury.” Journal of the Society of Christian Ethics 32 (2): 57–74. https://doi.org/10.1353/sce.2012.0041. Lazare, Aaron. 2004. On Apology. New York: Oxford. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (December): 695–706. https://doi.org/10.1016/j. cpr.2009.07.003. Moore, Michael S. 1987. “The Moral Worth of Retribution.” In Responsibility, Character, and the Moral Emotions: New Essays in Moral Psychology, edited

100  Linda Radzik by Ferdinand David Schoeman, 179–219. New York: Cambridge.  https://doi. org/10.1017/cbo9780511625411.008. Murphy, Jeffrie G. and Jean Hampton. 1988. Forgiveness and Mercy. New York: Cambridge. https://doi.org/10.1017/CBO9780511625121. Purcell, Natalie, Kristine Burkman, Jessica Keyser, Phillip Fucella, and Shira Maguen. 2018. “Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans.” Journal of Aggression, Maltreatment & Trauma 27, no. 6 (July): 645–73. https://doi.org/10.1080/109267 71.2018.1463582. Radzik, Linda. 2009. Making Amends: Atonement in Morality, Law and Politics. New York: Oxford. https://doi.org/10.1093/acprof:oso/9780195373660.001.0001. ———. 2016. “Relationships and Respect for Persons.” Reasonable Responses: The Thought of Trudy Govier, Windsor Studies in Argumentation, Vol. 4, edited by Catherine E. Hundleby, 105–27. Windsor, ON: Centre for Research in Reasoning, Argumentation and Rhetoric. https://doi.org/10.22329/wsia.04.2017.4. Royce, Josiah. 1968. The Problem of Christianity. Chicago: University of Chicago Press. Scheler, Max. 1960. “Repentance and Rebirth.” In On the Eternal in Man, translated by Bernard Noble, 35–65. New York: Harper and Brothers. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Atheneum. Sherman, Nancy. 2015. Afterwar: Healing the Moral Wounds of Our Soldiers. New York: Oxford. Walker, Margaret Urban. 2006. Moral Repair: Reconstructing Moral Relations after Wrongdoing. New York: Cambridge. https://doi.org/10.1017/ CBO9780511618024. Wyschogrod, Michael. 1986. “Sin and Atonement in Judaism.” In The Human Condition in the Jewish and Christian Traditions, edited by Frederick E. Greenspahn, 103–28. Hoboken, NJ: Ktav.

Section 2

Experiences of Moral Injury

6 Greek Tragedy, Virgil’s Aeneid, and The Moral Injury of Combat Veterans and Healthcare Workers Henry Bayerle Moral Injury and Ancient Greek Literature In the first major work on moral injury, Jonathan Shay used Ancient Greek literature to describe the trauma experienced by combat veterans (1994). His groundbreaking book, Achilles in Vietnam, used Homer’s Iliad to explain what can happen to a soldier who experiences leadership malpractice. In Book 1 of Homer’s epic, Agamemnon, the most powerful of the Greek chieftains, violated the norms of Homeric society by confiscating the war prize of Achilles. In response to this outrage, Achilles experienced righteous anger (mēnis), which predisposed him to fall into a berserk state when he learned of the death of his beloved friend, Patroclus. In this berserk state, Achilles violated the norms of Homeric warfare by slaughtering enemy fighters without mercy and abusing the body of Hector after killing him in battle. In Shay’s definition, moral injury is present when there has been a “betrayal of ‘what’s right’ by someone who holds legitimate authority in a high-stakes situation” (2003, 240). This describes the experiences of many combat veterans, from Shay’s patients who served in Vietnam to US veterans of the conflicts in Iraq and Afghanistan. Leadership Malpractice in Military Combat and in Health Care In recent years, the concept of moral injury has been applied to the experiences of healthcare workers (HCWs) as well. Wendy Dean and Simon Talbot narrowed Shay’s definition to make it even more specific for the context of HCWs: “Moral injury describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control” (Dean, Talbot and Dean 2019). This phrasing also owes much to Andrew Jameton’s definition of moral distress in the context of nursing: “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (1984, 6). DOI: 10.4324/9781003281122-9

104  Henry Bayerle It may seem odd to compare health care to military service since they are very different professions. The goal of the former is to save lives, and those who work in the latter field are prepared to take lives to carry out their duties. Nevertheless, they have much in common. Workers in each profession take an oath before beginning service. Many workers are inspired to enter these professions by strong moral beliefs, whether their sense of duty focuses on a perceived need to defend their country against the threat of people who do wrong or to help people who are suffering, or both. These factors predispose many people in both fields to dwell on the moral ramifications of their acts. They also make it difficult to compartmentalize and isolate their jobs from the other parts of their lives (Sherman 2010). During the COVID-19 pandemic, these two professions shared even more experiences as governments “declared war” on the virus. Many of the morally injurious events of Vietnam veterans described by Shay are strikingly similar to the experiences of HCWs. For example, Shay described the unequal distribution of risk when specific individuals or groups were sent on dangerous missions more often than others, resulting in disproportionately high casualty rates. He also wrote of insufficient supplies of food, water, ammunition, and medical supplies. The resulting shortages were often attributed to the indifference or incompetence of superiors, such as when soldiers were issued M16 rifles that they believed their commanders knew to be defective (Shay 1994). David Wood has written about the negative impact of excessively rapid redeployment (2016, 32). Soldiers who are sent back to combat with insufficient time to recover from their most recent deployment may be more susceptible to moral injury, especially if they feel that this is the result of bad leadership. During the COVID-19 pandemic, risk has been distributed unevenly, and some would say unjustly, among members of our population and even among HCWs. In the view of some HCWs, many of the extraordinary challenges they have faced are the result of a failed response by national leadership. Following the advice of medical professionals would have made it easier to limit the negative effects of the pandemic. Better implementation of masking protocols could have saved thousands of lives. Decisions to allow market forces to shape health care left hospitals unprepared for patient surges and led to shortages of personal protective equipment and other critical resources (Dean, Talbot and Caplan 2020; Hegarty et al. 2022, 15). Some blame the rapid re-occurrence of surges in COVID cases on politicians and other leaders who discouraged citizens from taking a vaccine proven to limit infection. Likewise, when patients and their families, following the baseless advice of some politicians, request medications that are not recommended for COVID treatment, clinicians may feel resentment (LeClaire et al. 2022). Like rapidly redeployed soldiers, traumatized HCWs were required to return to work with insufficient time to

Moral Injury of Combat Veterans and Health-Care Workers  105 recover from their previous experiences. Frustration and righteous anger are predictable responses to the moral injury caused by these leadership failures. In the words of Venktesh Ramnath, “Our societal and individual morality, grounded in what should happen, had drowned in the quicksand of what actually did happen” (2021, 1325). Moral Injury Beyond Leadership Malpractice Fifteen years after the publication of Achilles in Vietnam, Brett Litz expanded the definition of moral injury to include “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs” (Litz et al. 2009,  695). More recent research has demonstrated that moral injury need not be the result of leadership malpractice, or any actions perpetrated by others (Nieuwsma et al. 2022). It is also not always the case that moral injury results from knowing the right thing to do but being prevented from doing it. Several years before moral injury was commonly discussed in the context of HCWs, some scholars were raising questions about Jameton’s definition of moral distress among nurses. In 2013, Carina Fourie argued that moral distress could occur without the presence of institutional constraints. Fourie wished to expand the definition of moral distress to include both institutional constraints and moral conflicts. She defined moral conflicts as “any situation where normative factors (such as moral principles, values or even certain forms of moral duties) clash and require incompatible actions” (Fourie 2013, 94). Applying this argument to Dean and Talbot’s definition would mean that HCWs can also experience moral injury when they have the autonomy, latitude, or authority to do the right thing, but are forced to choose between two incompatible kinds of “right thing.” Whether the HCW chooses the first option or the second, moral injury can occur. It can also occur if the HCW does not make a choice. The remainder of this chapter will focus primarily on moral injury experienced by those who face impossible choices between incommensurable values. Ancient Greek epic provides a model to help us understand moral injury from leadership malpractice. Similarly, Ancient Greek tragedy should help us understand moral injury through the lens of the moral dilemmas that might trigger instances of it. Greek Tragedy as Model of Moral Injury I propose that Greek tragedies can help us understand an important category of moral injury in which a person experiences a moral dilemma in which commitments to incommensurable values cause significant emotional distress. Many of these ancient dramas relate stories in which

106  Henry Bayerle a tragic hero faces this kind of dilemma, a difficult choice between two paths, each of which involves the betrayal of deeply held moral values. In some of these stories, the choice is impossible since neither path can be considered preferable. In others, it is possible to construct a rational argument that one of the two courses is ethically preferable, but that does not save the hero from feeling that choosing the preferable course is a betrayal of an essential part of his ethical character. In either case, the hero suffers emotional pain and a profound sense of guilt. Greek tragedy has inspired discussions on ethical questions for millennia. Recently, Bryan Doerries has directed public readings of passages from the works of the Aeschylus, Sophocles, and Euripides to help audiences of veterans and HCWs talk through their own experiences of trauma (2015). Though he did not devote much attention to moral dilemmas in Achilles in Vietnam, Jonathan Shay credited Martha Nussbaum’s famous work on the ethical content of Greek tragedy, The Fragility of Goodness (1986), as an inspiration for his concept of moral injury’s negative impact on character. It is a fitting extension of Shay’s work to use Nussbaum’s ideas on tragic conflict to describe moral injury. Nussbaum rejects the Platonic and Kantian position that two duties can never truly conflict (1986, 31). She argues that circumstances do occasionally present two valid and opposing ethical claims that may not both be fulfilled. Greek tragedy reflects the lived experience of these situations: I must constantly choose among competing and apparently incommensurable goods and … circumstances may force me to a position in which I cannot help being false to something or doing some wrong. (5) Nussbaum analyzes ethical conflicts in multiple Greek tragedies. In Aeschylus’s Agamemnon, the title character is ordered by Zeus to go to Troy to avenge the crime of stealing Helen. Artemis will not allow the winds to blow to bring the fleet to Troy unless Agamemnon sacrifices his daughter, Iphigenia. Following either course will leave Agamemnon guilty. If he refuses to sacrifice his daughter, he will be a deserter who has violated the command of Zeus; sacrificing his daughter is a crime as well. Agamemnon’s choice to sacrifice his daughter is the better course in terms of the number of people impacted since the successful launching of the ships will save all of the Greeks – yet it leaves Agamemnon with the terrible guilt of having violated his own ethical commitment. Likewise, in Aeschylus’ Libation Bearers, Orestes is ordered by Apollo to kill his own mother, Clytemnestra, who had killed Agamemnon, her husband and Orestes’ father. Orestes is pulled in two directions by the need to avenge his father and the natural aversion to killing one’s mother.

Moral Injury of Combat Veterans and Health-Care Workers  107 Tragic heroes must often choose between two equally valid ethical claims. However, as Nussbaum explains using examples from Aristotle’s Nicomachean Ethics, emotional pain may also be present when it is possible to argue that one of the two claims is stronger: Sometimes he may be clear about which is the better choice, and yet feel pain over the frustration of other significant concerns. For it is extremely important to insist from the start that the problem here is not just one of difficult decision – that such conflicts can be present, as well, when the decision itself is perfectly obvious. (Nussbaum 1986, 27) The cumulative effect of facing ethical dilemmas repeatedly in high-stakes situations over an extended period can have emotional consequences which I will call, for the purposes of the chapter, tragic moral injury . Tragic Conflict as a Source of Moral Injury in Sophocles’ Philoctetes I have argued elsewhere that Sophocles’ Philoctetes presents the same kind of tragic conflict (Bayerle et al. 2022). This tragedy tells the story of Philoctetes, a Greek warrior who was bitten on the foot by a snake while the Greek fleet stopped at a desert island on the way to Troy. The painful festering wound could not be healed so Odysseus convinced the Greeks to abandon Philoctetes on the island of Lemnos. After almost ten years of fighting at Troy, the Greeks learn that they will not be able to win the war without the magical bow of Heracles, which is in the possession of Philoctetes. Odysseus volunteers to return to Lemnos to retrieve the bow, but he knows that Philoctetes resents him so he recruits Neoptolemus, the son of Achilles, to trick Philoctetes into handing over the bow. Following the instructions of Odysseus, Neoptolemus gains the trust of Philoctetes by lying to him. Neoptolemus claims falsely that he too has been wronged by Odysseus and hates him just as Philoctetes does. Neoptolemus then promises care for Philoctetes’ wound and a trip home. As he prepares for what he believes is a voyage home, Philoctetes gives the bow of Heracles to Neoptolemus. Feeling guilty about his manipulative acts, Neoptolemus confesses the truth to Philoctetes. During this confession, Odysseus appears and tells Neoptolemus not to compromise the mission. Nevertheless, overcome by shame, Neoptolemus returns the bow to Philoctetes. Neoptolemus tries without success to convince Philoctetes to come to Troy with his bow. At the end of the tragedy, the deified Heracles appears, promising a cure to Philoctetes and telling him to go to Troy to fight. Philoctetes consents.

108  Henry Bayerle Many readers of Sophocles’ tragedy have condemned Odysseus for his callous abandonment and later attempted manipulation of Philoctetes (Knox 1964; Woodruff 2012). From the perspective of HCWs, Odysseus could appear to be a source of trauma since he denies care to a suffering person. Following this logic, to the degree that any character experiences moral injury in this tragedy, Odysseus would represent the leadership malpractice that leads to moral injury. He is the leader who mistreated Philoctetes and who ordered Neoptolemus to commit an act that violated his ethical commitments to care for the suffering and to tell the truth. It is also possible to see this tragedy as a story of opposing values in a tragic conflict (Reinhardt 1947). Odysseus is committed to the best possible outcome for all the Greeks, which in this context is victory in the Trojan War. Without the bow of Heracles, which Philoctetes possesses, the Greek army cannot succeed in its divinely commanded military mission. Odysseus represents the utilitarian view that any act can be justified as long as it brings about “the greatest possible good of all citizens” (Nussbaum 1976, 30). Odysseus knows that Philoctetes’s hatred and resentment will make him unwilling to be persuaded to act for the common good, so he resorts to trickery. At the beginning of the drama, Philoctetes has never seen Neoptolemus so Odysseus recruits the young warrior for the mission. Odysseus is not motivated by a desire to enhance his own reputation; he is willing to accept blame for his acts if they help the Greeks in the long run. He tells Neoptolemus to feel free to blame him: “Say what you will, as bad as bad can be, the worst things imaginable; it will do me no harm. But if you fail in this task, you will inflict terrible pain on your fellow Greeks” (Meineck 2014, 6). The original abandonment of Philoctetes ten years earlier can be justified with a utilitarian argument. The terrible stench emitted by his wound and his blasphemous screams of pain prevented the Greeks from performing religious rites essential for their military success (Meineck 2014, 3). Thus, the suffering of Philoctetes was preferable on this utilitarian account to the failure of the Greek military mission. Unlike Odysseus, Neoptolemus does not see the utilitarian solution as the clearly superior path. He is moved by the need to ensure the success of the Greek army, but he is also deeply moved by Philoctetes, who has suffered both from his physical wound and from being cut off from all human contact for ten years. In addition, Neoptolemus believes that telling a lie is a betrayal of a central value that defines his character. On the command of Odysseus, he commits an act that violates his own principles. While Philoctetes is defined by physical pain, made evident by his cries of agony throughout the drama, Neoptolemus experiences psychological pain. By lying and betraying the trust of Philoctetes, Neoptolemus has betrayed the moral values that define him. To Neoptolemus, this betrayal is far more offensive than the smell of Philoctetes’ wound: “What is disgusting is when

Moral Injury of Combat Veterans and Health-Care Workers  109 a man abandons his own true nature and acts shamefully” (Meineck 2014, 44). Neoptolemus too cries in pain and claims that he has felt the emotional trauma of his moral transgression since the beginning of his mission (Meineck 2014, 38). Later, he explains, “It will look as if I have no shame, and I am tormented by this” (Meineck 2014, 44). Like Aeschylus’s Agamemnon, Neoptolemus understands that he must make a choice between two valid ethical claims. Circumstances prevent him from fulfilling both. He may help the Greek army or he may help Philoctetes. Ignoring either claim will bring guilt. At first, like Agamemnon, Neoptolemus accepts the utilitarian argument that the suffering of one person is a lesser evil than the suffering of the entire army. The emotional pain he experiences after he makes this choice leads him to recant and change course, but this reversal does not necessarily end his pain and sense of guilt. The impossibility of Neoptolemus’s choice is highlighted by a structural detail of Sophocles’ tragedy. Of all the surviving plays of Sophocles, the Philoctetes is the only one in which he resorts to a deus ex machina, the device whereby an actor dressed as a god is lowered by a crane to the stage to resolve a plot that has devolved into an impasse with no hope of solution. After Neoptolemus voluntarily returns the bow to Philoctetes, Philoctetes still refuses to return to Troy to help the Greeks. Just as Neoptolemus has given up hope of fulfilling his mission and saving the Greek army, the deified Heracles appears on stage and tells Philoctetes that he must go with Neoptolemus to Troy, where he will receive glory and a cure to his painful affliction. Aristotle and others have considered the use of a deus ex machina a sign of lazy writing, but it is possible in this instance that Sophocles used the device to signal to his audience that there is no easy way to reconcile the conflict between utilitarianism and other conflicting personal values. Tragic Moral Injury in Military Service and Health Care Like the tragic heroes of the Athenian stage, soldiers and HCWs often face moral conflicts. Their work conditions have made these impossible choices even more common and more stressful in recent years. To create a more nimble fighting force, the US military has pushed the decision-making process down the chain of command so that junior officers are now making decisions that were only made by senior command in the past. In addition, rules of engagement changed so often in the conflicts in Iraq and Afghanistan that it was difficult for many US soldiers to know at any given time what official parameters constrained their decisions. Likewise, during the COVID pandemic, many HCWs needed to make quick decisions with insufficient information under rapidly changing conditions (Liberati et al. 2021, 6; Robert et al. 2020, 202; Rushton et al. 2022). Members of both

110  Henry Bayerle professions are constantly aware of the potential legal repercussions of a wrong decision, whether in the form of a court-martial or a malpractice lawsuit. For some, the moral costs they would suffer if they allowed the fear of lawsuits to guide all of their decisions would be worse than any legal repercussions they might face. For US soldiers serving in Iraq, guarding checkpoints was a frequent source of moral conflict. What were they to do if a car approaching the checkpoint at high speed did not slow down when commanded to do so? The official rules of engagement required them to hold their fire until they had evidence of hostile intent. Experience taught them that loyalty to these rules and the values behind them could result in their own deaths and the deaths of their fellow soldiers. Firing on the approaching vehicle out of loyalty to the value of protecting their friends, however, could result in the deaths of innocent civilians and a court-martial. These tragic choices can be morally injurious. Questions about the appropriate treatment of captured people who were believed to be enemy combatants frequently created moral conflicts for US soldiers in Iraq and Afghanistan. David Wood (2016) wrote about the internal debates of soldiers who had captured the same people multiple times. They were often convinced that they had seen these people set and/or monitor remotely controlled IEDs that had killed their fellow soldiers, yet the rules of engagement dictated that there was insufficient evidence to detain them: Should you kill him? Or detain him for questioning that may result in his release? For the rest of your life, to whose version of morality do you answer: Your own? Your dead buddy’s? The version understood by the battalion commander? The one presented to a court-martial jury? The morality of the God who let your buddy die? The moral beliefs of your buddy’s widow? (186) Nancy Sherman has described the challenges faced by marines who fought in civilian areas in Iraq as a double bind: Some marines may feel they are in a double bind: They are taught to cover their buddies, yet fighting in civilian areas requires restraint of firearms. Sacrificing each other becomes all the harder when troops don’t trust the locals they are asked to protect. (2010, 76) Repeated exposure to these kinds of dilemmas takes an emotional toll that can lead to moral injury.

Moral Injury of Combat Veterans and Health-Care Workers  111 The moral conflicts facing HCWs have become more frequent in the c­urrent pandemic. Before the development of vaccines, HCWs did not know if insufficient and overused personal protective equipment would protect them against COVID infection so that they often feared contact with their own family members when they came home from hospitals. They had to balance the value of caring for patients with contagious diseases against keeping family members safe from infection (Watson et al. 2022). Other HCWs felt a conflict between the need to isolate COVIDpositive mental health patients to prevent infection and the need to provide them with human contact to keep their psychological state from deteriorating (Liberati et al. 2021). Mental health HCWs in England also reported strong feelings of guilt and self-doubt about making decisions to discharge patients because of the shortage of beds in their facilities. In one case, an HCW believed that one discharged patient who later committed suicide might have been saved if they had remained in the hospital (Liberati et al. 2021). HCWs routinely faced moral conflicts when needing to implement crisis standards of care to allocate scarce resources during the pandemic. Their conflicts resemble most closely the tragic conflict of Philoctetes: the choice of utilitarian or deontological ethics. When patients outnumber the number of available hospital beds, treatment may be given to patients with the highest chance of survival to maximize total benefits to society (Jaziri and Alnahdi 2020). Quality-adjusted life years and social utility are calculated to maximize the benefit to society as a whole. Applying these utilitarian guidelines requires HCWs to discount values based on procedural justice, distributive justice, and ideas of personhood (Robert et al. 2020). For many HCWs, being forced to choose between utilitarian guidelines and the caregiving-based values that define their understanding of their professional identity has resulted in moral injury (Binkley and Kemp 2020; Fins 2020). Moral Injury and Identity Another important detail in Sophocles’ Philoctetes helps explain the emotional experience of moral injury. Recall Philoctetes’s remark, “What is disgusting is when a man abandons his own true nature and acts shamefully” (Meineck 2014, 44). Philoctetes was expressing his emotional response to telling a lie. Achilles, the father of Neoptolemus, was known for despising liars. In Homer’s Iliad, Achilles says, “I hate that man like the very Gates of Death who says one thing but hides another in his heart” (Fagles 1990, 262). To Neoptolemus, truth-telling is the characteristic of all noble people and of his family above all. It defines his character. After telling lies to

112  Henry Bayerle manipulate Philoctetes, Neoptolemus feels that he has abandoned his true nature. The perception of a changed identity plays a central role in the moral injury of some combat veterans. David Wood describes the experiences of soldiers who fired back at enemies in Iraq and Afghanistan, only to discover that the enemies they had killed were armed children. Legally, these were considered “good kills” since the US soldiers were defending themselves in battle. For some of these soldiers, these circumstances did not mitigate the guilt they felt. The knowledge that they had killed children impacted their ideas about who they were. Wood relates a story about Sendio Martz, a marine who befriended a young boy in Afghanistan who later set off an IED blast that killed several marines and severely wounded many others. Martz blamed himself for allowing the boy access to areas patrolled by the marines. After returning home to America, he felt the moral injury resulting from this event turned him into a person who was unable to be around children: “I just don’t trust the innocence of children” (Wood 2016, 64). For HCWs, the shame and guilt of moral injury can lead to an existential crisis that causes them to question who they are (Williamson et al. 2021). In 1993, a physician named Keith Wrenn faced a moral conflict while treating a man who had been brought to an ER against his will (Wrenn 1993). His feet were severely infected, but he only wanted to go home. Concerned about sepsis, the physician sedated the man and kept him in the hospital. The next day, he checked on the man, who was still sedated, and passed him on to the care of another team member. A week later, he learned that the man had broken out of his restraints, broke his femur, and died of acute respiratory distress syndrome. The physician responded by saying, “I killed him,” since he had refused to honor the request of the patient by allowing him to return home. His colleagues tried to comfort him by saying that he had made the most rational choice under the circumstances and could not have done anything to save the man. Nevertheless, this experience changed the way the physician thought about himself. Nancy Sherman has written about the long history of thinkers who emphasize the need to compartmentalize by distinguishing one’s occupation from one’s identity (Sherman 2010, 21). She quotes Montaigne, who, distinguishing between Montaigne the Mayor and Montaigne the person, wrote, “We must not turn masks and semblances into essential realities.” For many soldiers and HCWs who believe that they were motivated to embark on their careers by the moral values that define who they are, this is not always possible. Some may be more resilient at first because they succeed in compartmentalizing their professional and personal lives for some time, but eventually incur moral injury due to the cumulative effects of facing these dilemmas day after day.

Moral Injury of Combat Veterans and Health-Care Workers  113 Virgil’s Aeneid as Model of Tragic Moral Injury The ethical dilemmas faced by the protagonists of Greek tragedy correspond to some of the morally injurious events experienced by HCWs and combat soldiers. Similar situations arise in Roman epic as well. Virgil’s Aeneid, the most influential epic poem of ancient Rome, tells the story of Aeneas, a Trojan warrior who survived the destruction of Troy at the end of the Trojan War. Aeneas leads a group of Trojan refugees from Asia Minor to Italy on a divinely ordained mission to found the city that was to become Rome, the capital of the greatest empire in the world. This triumphalist message presumably pleased Augustus, the first Roman emperor, and many later rulers who read the Aeneid as a template for empire-building. Nevertheless, Virgil’s epic describes in great detail the emotional challenges faced by soldiers in war. Despite the long-term success of Rome, Virgil’s epic is marked by trauma. The earliest event narrated in the poem is the destruction of Troy, Aeneas’s homeland, by Greek soldiers. Having witnessed the burning of his city and the killing or enslavement of almost every Trojan he knew, Aeneas carries a sense of loss through every book of the epic. Some critics have argued that the Aeneid is the story of a man who succeeds in moving past the loss of the Trojan War by re-inventing himself as a proto-Roman hero. I agree that the need to recover from this trauma is one of Virgil’s central themes, but I am not convinced that Aeneas ever truly succeeds in this sense. The Aeneid was modeled in large part on Homeric epic. Virgil based entire scenes on passages from the Iliad and the Odyssey, reproducing many of the episodes that inspired Shay’s first definition of moral injury. In some ways, Aeneas would seem to be even more susceptible to moral injury than Achilles or Odysseus. One important distinction between Virgil’s poem and his Greek models is the heroic identity of the main protagonists. Odysseus was defined by his heroic epithet, polutropos, which means “much turned,” i.e., cunning, multi-faceted, and much traveled. Achilles is podarkes, “swift-footed.” Aeneas too has an epithet: pius, which means “dutiful.” The noun form of this word, pietas, describes a central value of Roman culture, an over-arching duty to family, state, and the gods. Like some HCWs and soldiers who define their sense of self by the oaths they have taken, Aeneas judges all of his own actions through the lens of this sense of duty. His commitment to duty comes into conflict with multiple other moral claims in Virgil’s poems. He frequently suppresses his emotions for the sake of his mission, as we see in Book 1 when he encourages his men after a terrifying storm at sea: though sick with heavy cares, he counterfeits hope in his face; his pain is held within, hidden.

(Mandelbaum 1971, 8)

114  Henry Bayerle As we shall see, however, Aeneas’ attempts to compartmentalize his ­professional life and personal life end in failure. Tragic Moral Injury and the Death of Dido Fighting and losing in the Trojan War, which occurs before the beginning of the Aeneid, each pose risks of moral injury. Aeneas also faced multiple moral conflicts after leaving Troy that exemplify the experience of tragic moral injury. Virgil’s Aeneid was influenced on many levels by tragedy, so it should not be surprising to find tragic moral dilemmas in the plot. Already in the late fourth and early fifth centuries AD, Servius and Macrobius wrote that Virgil borrowed from Greek tragedies. Scholars from the early twentieth century to recent times have analyzed the structure of the Aeneid using Hegel’s formulation of tragedy as the conflict between two goods that each make an exclusive claim (Hardie 1997, Panoussi 2008). Book 4, which narrates the great love affair of Dido and Aeneas, has received more attention than any other part of the Aeneid by scholars looking for the hallmarks of Athenian tragedy. The structure, diction, and multiple plot elements of this book invite comparison between the characters of Dido and Medea, the hero of multiple Greek tragedies. While Dido is regularly understood, for good reason, as the tragic hero of Book 4, these episodes also portray tragic choices in which Aeneas is pulled in two directions by commitments to incommensurable values. His love pulls him to stay in Carthage with Dido while his sense of duty pulls him to leave Carthage and go to Italy to complete his mission to found the Roman Empire. Jupiter, the king of the gods, makes it very clear in a message conveyed to Aeneas by Mercury that the choice should be clear for Aeneas: his duty to his son and his unborn descendants leaves no room for romantic love. Thus, to the gods, there is no moral dilemma here. Nevertheless, the emotional turmoil experienced by Aeneas suggests that he does not see this decision as easy. In a famous simile, Virgil compares Aeneas to an oak tree battered by storm blasts: As when, among the Alps, north winds will strain against each other to root out with blasts—now on this side, now that—a stout oak tree whose wood is full of years; the roar is shattering, the trunk is shaken, and high branches scatter on the ground; but it still grips the rocks; as steeply as it thrusts its crown into the upper air, so deep the roots it reaches down to Tartarus: no less than this, the hero; he is battered

Moral Injury of Combat Veterans and Health-Care Workers  115 on this side and on that by assiduous words; he feels care in his mighty chest, and yet his mind cannot be moved; the tears fall, useless.

(Mandelbaum 1971, 94)

There has been debate since antiquity about whose useless tears are falling – those of Dido, of her sister Anna, or of Aeneas. While the most authoritative voice of the text, that of Jupiter, would suggest that only Dido ought to cry in this scene, many other passages in the epic support the reading of Aeneas as emotionally battered. In Book 6, when Aeneas sees the shade of Dido in the underworld, he weeps as he pleads: Did I bring only death to you? Queen, I swear by the stars, the gods above, and any trust that may be in this underearth, I was unwilling when I had to leave your shores. But those same orders of the gods that now urge on my journey through the shadows, through abandoned, thorny lands and deepest night, drove me by their decrees. (Mandelbaum 1971, 145–46) As he attempts to cope with the guilt of causing Dido’s death, Aeneas explains that performing his duty to follow the commands of the gods forced him to make a decision that led to emotional pain for him and for Dido. He chose duty over romantic love, but not willingly. Earlier, when Aeneas tells Dido of his plans to leave in Book 4, she responds in a highly emotional speech that his departure will ruin her. The narrator then tells us that Aeneas suppressed his desire to comfort her: But though he longs to soften, soothe her sorrow and turn aside her troubles with sweet words, though groaning long and shaken in his mind because of his great love, nevertheless pious Aeneas carries out the gods’ instructions. Now he turns back to his fleet. (Mandelbaum 1971, 92) Many critics have noted that this is the first time Virgil uses the epithet pius to describe Aeneas in Book 4, presumably to signal that Aeneas was not actively pursuing his duty before this point. He still wants to comfort

116  Henry Bayerle the woman he loves, but his painful choice of duty prevents him from doing so. Commenting on this passage, R. G. Austin wrote the word pius describes “adherence to a personal ideal of devotion, which may nevertheless bring pain and sorrow” (1955, 122). Austin calls the scene with Dido “the greatest crisis of Aeneas’ life” and concludes that Aeneas “has been true to himself and done his duty at a dreadful cost.” (Ibid.) The Curse of Dido By the end of the epic, it becomes clear that Dido symbolizes more than just one sacrifice. In a speech before committing suicide, Dido curses Aeneas and all of his Roman descendants. She famously calls for an avenger who will torment the Romans. Virgil’s audience would have immediately understood this as a reference to Hannibal, the brilliant Carthaginian general who inflicted painful defeats on the Romans during the Second Punic War (218–201 BCE), killing tens of thousands of Roman soldiers and coming close to destroying Rome itself. While this neat etiology of the hostility between Rome and Carthage fits the historical plan of Virgil’s work, there is more to Dido’s curse than this. Her final words hint at the lasting pain that Aeneas, whom she refers to as “the savage Dardan,” will carry after the death of Dido: Thus, thus, I gladly go below to shadows. May the savage Dardan drink with his own eyes this fire from the deep and take with him the omen of my death.

(Mandelbaum 1971, 101)

Dido haunts Aeneas throughout the story. Long after the Trojans have left Carthage, Virgil includes reminders of Dido throughout his text. These echoes occur most often when a beautiful young person dies tragically. Just before Nisus and Euryalus leave for the mission that will end in their deaths in Book 9, Ascanius (Aeneas’s son) offers them a precious goblet that had been a gift from Dido.1 At the funeral of Pallas, a young inexperienced warrior killed by Turnus, the main antagonist of the poem, Aeneas wraps his body in two tunics made by Dido: And then Aeneas brought twin tunics, stiff with gold and purple, which Sidonian Dido, glad in that task, had once made for him with her own hands, weaving thin gold into the web. Sadly he wraps

Moral Injury of Combat Veterans and Health-Care Workers  117 one of these tunics around the youth, his last honor; with it Aeneas veils the hair soon to be burned.

(Mandelbaum 1971, 272)

Clearly Dido represents more than the romantic love that Aeneas foregoes in the name of duty. She represents also the tragic deaths of young beautiful people. Since Aeneas died, in Virgil’s chronology, over eight centuries before the Second Punic War, he would never see the scourge of Hannibal. He did, however, carry with him the painful memory of Dido’s death, which never left him. There is nothing in the logic of the plot that required Virgil to mention Dido’s name in these scenes. Virgil deliberately made the connection between these two characters to highlight the emotional response of Aeneas to their deaths. By the end of the poem, Dido has come to symbolize all of the sacrifices made by Aeneas in the name of duty, all of the deaths that might have been prevented. Like many who have died in tragic events that contribute to moral injury, Dido and Pallas have become ghosts who continually haunt Aeneas. Final Dilemma – To Spare Turnus or to Kill Him? The final scene of the Aeneid has been a source of debate since antiquity. After multiple battles, Aeneas finally meets and defeats his enemy, Turnus, in one-on-one combat. Admitting that he has been defeated, Turnus begs Aeneas to spare him. At first Aeneas hesitates. In a famous scene in Book 6, the shade of his father had told him that the clemency was a central Roman value: Roman, these will be your arts: to teach the ways of peace to those you conquer, to spare defeated peoples, tame the proud. (Mandelbaum 1971, 158) Aeneas considers following this Roman precept until he sees that Turnus is wearing the belt of Pallas, a trophy he took after killing the young warrior in combat. Aeneas had promised Evander, the father of Pallas, that he would protect his son in the fight. Feeling guilt over failing to keep this promise, Aeneas becomes enraged and kills Turnus: And when his eyes drank in this plunder, this memorial of brutal grief, Aeneas, aflame with rage—his wrath was terrible—

118  Henry Bayerle cried: “How can you who wear the spoils of my dear comrade now escape me? It is Pallas who strikes, who sacrifices you, who takes this payment from your shameless blood.” Relentless, he sinks his sword into the chest of Turnus. (Mandelbaum 1971, 331) Aeneas’s emotions are clearly focused on his relationship with Pallas at this point.2 Some prominent scholars of the twentieth century have argued that this rage led to a failure on the part of Aeneas since obeying the directives of one’s father was a central aspect of the Roman concept of pietas (Putnam 1965, Thomas 2001). These modern arguments continue a tradition that dates back to Lactantius, the Christian apologist who wrote in the early fourth century AD in Divine Institutes 5.10.9 that Aeneas did not deserve to be called pius since he ignored the precepts of his father by slaying in anger those who did not resist and begged for mercy (Bowen and Garnsey 2003, 301). Thus, one kind of duty (pietas) demanded that Aeneas spare Turnus. Another kind of duty, however, demanded that Aeneas kill Turnus. At the funeral of Pallas, Evander demanded that Aeneas kill Turnus to avenge the death of his son, stating that the death of Turnus was now something owed to Evander and Pallas. Go, and be sure to give your king this message: that if I drag along my hated life though Pallas now is dead, it is because of your right hand—which, as you see, still owes Turnus to father and to son. This is the only thing that still is left undone by your own worth and fortune. (Mandelbaum 1971, 275–76) Writing later in the fourth century AD, Servius acknowledged that pietas required Aeneas to spare Turnus, but Servius also called the killing of Turnus a mark of pietas because in doing so Aeneas avenged the death of Pallas out of consideration for Evander. Servius (on 12.940) claimed that Aeneas fulfilled his debt to both of these conflicting duties since he actively considered sparing Turnus before killing him. Most modern scholars who have written on these two duties have concluded that Servius willfully ignored the ethical complexity of this scene, possibly in response to the criticism of Lactantius, since Aeneas is unable to fulfill his commitment to one of these values without betraying the other. As Richard Tarrant wrote, Aeneas is pulled in two directions by these two conflicting kinds of pietas

Moral Injury of Combat Veterans and Health-Care Workers  119 in the final scene: “whatever he does will violate a claim made upon him by pietas” (Tarrant 2012, 23). Richard Thomas described the consequences of Aeneas’ choice: As for Dido, so here for Turnus, the pietas on which Aeneas settles is the one that eclipses other pieties and brings with it doom. That doom is required by public, Augustan pietas, but that is small comfort to those whose own claims on pietas are rejected. (Thomas 2001, 112) It is also conceivable that those other claims on pietas rejected in the final scene would continue to haunt Aeneas just as the rejected claims of Dido did.3 Turnus has much in common with Dido. Both are young and noble; both have been pushed to extreme behavior by the manipulation of gods; both die as a result of Aeneas’ commitment to his duty. The success of Aeneas’ mission does not mean that Aeneas experienced these interactions without emotional pain. There is no triumph at the end of the Aeneid, only a protagonist who is aflame with rage (furiis accensus in Virgil’s Latin) after years of war and sacrifice. In 1964, before most of Jonathan Shay’s patients had experienced combat in Vietnam, Wendell Claussen famously described the Aeneid as “a long Pyrrhic victory of the human spirit” (Clausen 1964, 146). Killing Turnus may have been the best course of action to take, but this does not mean that Aeneas was free of guilt and anger after facing multiple tragic dilemmas in his career. As a foundation story of Rome, the Aeneid is a political poem; it has elicited political responses from readers from Virgil’s time to ours.4 Servius claimed that Virgil wrote his epic to praise Augustus through his ancestors (mainly Aeneas). Many of those who believe that Aeneas should not have killed Turnus also believe that the Aeneid subtly undercuts the praise of Augustus’ regime by portraying Aeneas as a savage killer. Others follow the tradition of Servius, saying that all of the sacrifices made by Aeneas were justifiable and necessary to found Rome. Neither reading of the Aeneid is inconsistent with the recognition that Virgil described an emotionally damaged hero. Nicholas Horsfall argued in great detail that Aeneas did the right thing at the end of the poem, but concluded that “there is no general resolution of issues and tensions…such as to leave us (or Aeneas) emotionally at ease or content.” (1995, 216) Conclusion Martha Nussbaum’s reading of Greek tragedy as an exploration of how humans respond to ethical dilemmas can expand our understanding of

120  Henry Bayerle moral injury. As she wrote, a full life with deeply meaningful connections to other people and institutions will inevitably force us to choose between incommensurable values. Certain professions (military service and health care) at certain times (conflicts in Iraq and Afghanistan and the COVID-19 pandemic) expose people to a greater number of ethical dilemmas in highstakes situations. Among those who practice these professions, some experience moral injury more than others. This may be related to the degree to which they define their own moral identities by commitment to professional oaths or a duty to specific principles, and also to their ability to compartmentalize.5 Neoptolemus and Aeneas exhibit a great deal of the former and little of the latter. My goal is not to prove that Neoptolemus or Aeneas suffered from any specific condition listed in the Diagnostic and Statistical Manual of Mental Disorder of the American Psychiatric Association, but rather to demonstrate that their stories, told by poets who understood the costs of war, can serve as models to guide discussions on the experiences of people who suffer from moral injury as a result of repeated exposure to moral dilemmas involving decisions that require sacrifice regardless of the choice taken. Jonathan Shay (1994) wrote that the communalization of trauma through storytelling is the best source of healing for moral injury. ­Witnessing ­performances of Greek tragedy, such as those led by Bryan Doerries (2015), and reading the stories of conflicted warriors in Greek and Roman epics in discussion groups provide excellent opportunities to share experiences with others who know what it is like to face these dilemmas. This may be the greatest contribution that the humanities can make to our understanding of moral injury. Notes 1 Virgil’s epitaph to Nisus and Euryalus has been re-used over the centuries to commemorate those who have died. In 2014, Virgil’s words were inscribed at the entrance to the National September 11 Memorial Museum. Classicists have debated about the significance of this. 2 Vassiliki Panoussi (2020) has written extensively about the return of Pallas during this scene as Aeneas re-experiences the trauma of his death. 3 Scholars such as Horsfall (1995) and Tarrant (2012) have convincingly argued that Virgil’s Roman audience would have considered the killing of Turnus necessary. Nevertheless, as Nussbaum (1986) explained, moral conflicts can cause emotional pain even when the best decision is obvious. Moreover, this chapter is about the responses of readers to the Aeneid, from late antiquity to our times, for whom the challenges faced by Aeneas reflected ethical conflicts in their own lives. As K. W. Gransden wrote (1984, 217, quoted in Thomas 2001, 13–14): The modern reader may invest Aeneas with a greater range of insight and choice than he could have possessed for his creator, and may also create an implied author with access to value systems which lie in fact the limits of

Moral Injury of Combat Veterans and Health-Care Workers  121 the poem and of the pagan world. Yet the reader, importing these, is not, save in the narrowest and most scholastic sense, ‘misinterpreting’ the Aeneid. Indeed, he may be uncovering a more significant text, one that may be related to a greater range of insights into history and humanity. 4 This aspect of Virgil’s epic may make it an even more suitable than Homer’s Iliad as a lens through which to examine the experiences of US veterans since Virgil reflects, for better or for worse, a clear political program espoused by the leaders of one of the most powerful military forces in the world. 5 Bernard Williams’ concept of moral luck, which Nussbaum discusses (1986), surely can play a role as well in determining if a person will experience morally injury or not.

Works Cited Austin, Roland G. 1955. P. Vergili Maronis Aeneidos Liber Quartus. Oxford: Clarendon Press. Bayerle, Henry, John Ike, Robert Logan, and Ruth Parker. 2022. “Sophocles’ Philoctetes and Moral Injury in the COVID-19 Pandemic.” Journal of Health Communication 27 (2): 134–39. https://doi.org/10.1080/10810730.2022.2054032. Binkley, Charles E., and David S. Kemp. 2020. “Ethical Rationing of Personal Protective Equipment to Minimize Moral Residue During the COVID-19 Pandemic.” Journal of the American College of Surgeons 230 (6): 1111–13. https:// doi.org/10.1016/j.jamcollsurg.2020.03.031. Bowen, Anthony, and Peter Garnsey (trans.) 2003. The Divine Institutes of Lactantius. Liverpool: Liverpool University Press. Clausen, Wendell. 1964. “An Interpretation of the Aeneid.” Harvard Studies in Classical Philology 68: 139–47. Dean, Wendy, Simon Talbot, and Austin Dean. 2019. “Reframing Clinician Distress: Moral Injury Not Burnout.” Federal Practitioner 36 (9): 400–02. Dean, Wendy, Simon G. Talbot, and Arthur Caplan. 2020. “Clarifying the Language of Clinician Distress.” Journal of the American Medical Association 323 (10): 923–24. https://doi.org/10.1001/jama.2019.21576. Doerries, Bryan. 2015. The Theater of War: What Ancient Greek Tragedies Can Teach Us Today. New York: Alfred A. Knopf. Fagles, Robert (trans.) 1990. The Iliad of Homer. New York: Viking. Fins, Joseph. (2020). “Pandemics, Protocols, and the Plague of Athens: Insights from Thucydides.” The Hastings Center Report 50 (3): 50–53. https://doi. org/10.1002/hast.1132 Fourie, Carina. 2013. “Moral Distress and Moral Conflict in Clinical Ethics.” Bioethics 29 (2): 91–97. https://doi.org/10.1111/bioe.12064. Gransden, Karl Watts. 1984. Virgil’s Iliad: An Essay on Epic Narrative. Cambridge: Cambridge University Press. Hardie, Philip. 1997. “Virgil and Tragedy.” In The Cambridge Companion to Virgil, edited by Charles Martindale, 312–26. Cambridge: Cambridge University Press. Hegarty, Siobhan, Danni Lamb, Sharon A.M. Stevelink, Rupa Bhundia, Rosalind Raine, Mary Jane Doherty, Hannah R. Scott, Anne Marie, Victoria Williamson,

122  Henry Bayerle Sarah Dorrington, Matthew Hotopf, Reza Razavi, Neil Greenberg, and Simon Wessely. 2022. “’It Hurts Your Heart’: Frontline Healthcare Worker Experiences of Moral Injury During the COVID-19 Pandemic.” Preprint. medRxiv. https:// doi.org/10.1101/2022.06.17.22276433. Horsfall, Nicholas (ed.). 1995. A Companion to the Study of Virgil. Leiden: Brill. Jameton, Andrew. 1984. Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall. Jaziri, R., and S. Alnahdi. 2020. “Choosing Which COVID-19 Patient to Save? The Ethical Triage and Rationing Dilemma.” Ethics, Medicine and Public Health 15 (October): 100570. https://doi.org/10.1016/j.jemep.2020.100570. Knox, Bernard. 1964. The Heroic Temper: Studies in Sophoclean Tragedy. ­Berkeley: University of California Press. LeClaire, Michele, Sara Poplau, Mark Linzer, Roger Brown, and Christine Sinsky. 2022. “Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians.” Critical Care Explorations 4 (2): e0629. https:// doi.org/10.1097/CCE.0000000000000629. Liberati, Elisa, Natalie Richards, Janet Willars, David Scott, Nicola Boydell, ­Jennie Parker, Vanessa Pinfold, Graham Martin, Mary Dixon-Woods, and Peter B. Jones. 2021. “A Qualitative Study of Experiences of NHS Mental Healthcare Workers During the COVID-19 Pandemic.” BMC Psychiatry 21 (1): 250. https://doi.org/10.1186/s12888-021-03261-8. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, ­Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29 (8) (December): 695–706. https://doi.org/10.1016/j. cpr.2009.07.003. Mandelbaum, Allen (trans.) 1971. The Aeneid of Virgil. New York: Bantam Dell. Meineck, Peter (trans.) 2014. Sophocles: Philoctetes. Indianapolis: Hackett Publishing Company, Inc. Nieuwsma, Jason A., Emily C. O’Brien, Haolin Xu, Melissa A. Smigelsky, VISN 6 MIRECC Workgroup, HERO Research Program, and Keith G. Meador. 2022. “Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers.” Journal of General Internal Medicine 37: 2033–40. https://doi.org/10.1007/s11606-022-07487-4. Nussbaum, Martha. 1976. “Consequences and Character in Sophocles’ Philoctetes.” Philosophy and Literature 1 (1): 25–53. https://doi.org/10.1353/ phl.1976.0004. ———. 1986. The Fragility of Goodness. New York: Cambridge University Press. Panoussi, Vassiliki. 2008. Greek Tragedy in Vergil’s Aeneid: Ritual, Empire, and Intertext. Cambridge: Cambridge University Press. ———. 2020. “Combat trauma in Vergil’s Aeneid.” In Emotional Trauma in Greece and Rome: Representations and Reactions, edited by Andromache Karanika and Vassiliki Panoussi, 30–46. New York: Routledge. Putnam, Michael. 1965. The Poetry of the Aeneid. Cambridge: Harvard University Press. Quint, David. 1993. Epic and Empire: Politics and Generic Form from Virgil to Milton. Princeton: Princeton University Press.

Moral Injury of Combat Veterans and Health-Care Workers  123 Ramnath, Venktesh. 2021. “Moral Injury.” Annals of Internal Medicine 174 (9): 1325–26. https://doi.org/10.7326/M21-0997. Reinhardt, Karl. 1947. Sophokles. Frankfurt: V. Klostermann. Robert, René, Nancy Kentish-Barnes, Alexandre Boyer, Alexandra Laurent, Elie Azoulay, and Jean Reignier. 2020. “Ethical Dilemmas Due to the Covid-19 Pandemic.” Annals of Intensive Care 10 (1): 84. https://doi.org/10.1186/ s13613-020-00702-7. Rushton, Cynda H., Tessy A. Thomas, Inga M. Antonsdottir, Katie E. Nelson, Danielle Boyce, Anna Vioral, Deborah Swavely, Cathaleen D. Ley, and Ginger C. Hanson. 2022. “Moral Injury and Moral Resilience in Health Care Workers During COVID-19 Pandemic.” Journal of Palliative Medicine 25 (5): 712–19. https://doi.org/10.1089/jpm.2021.0076. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner. ———. 2003. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner. Sherman, Nancy. 2010. The Untold War: Inside the Hearts, Minds, and Souls of Our Soldiers. New York: W. W. Norton & Company. Tarrant, Richard (ed.) 2012. Virgil: Aeneid, Book XII. Cambridge: Cambridge University Press. Thomas, Richard. 2001. Virgil and the Augustan Reception. Cambridge: Cambridge University Press. Watson, Patricia, Sonya Norman, Shira Maguen, and Jessican Hamblen. 2022. “Moral Injury in Health Care Workers.” PTSD: National Center for PTSD, U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/ cooccurring/moral_injury_hcw.asp. Williamson, Victoria, Dominic Murphy, Andrea Phelps, David Forbes, and Neil Greenberg. 2021. “Moral Injury: The Effect on Mental Health and Implications for Treatment.” The Lancet Psychiatry 8 (6): 453–55. https://doi.org/10.1016/ S2215-0366(21)00113-9. Wood, David. 2016. What Have We Done: The Moral Injury of Our Longest Wars. New York: Little, Brown. Woodruff, Paul. 2012. “The Philoctetes of Sophocles.” In A Companion to Sophocles, edited by Kirk Ormand, 126–40. Chichester: Wiley Blackwell. Wrenn, Keith. 1993. “Lethal Cascade.” Annals of Internal Medicine 118 (7): ­562–63. https://doi.org/10.7326/0003-4819-118-7-199304010-00012.

7 Moral Injury in Law Enforcement John Kleinig

The term “moral injury” has its primary home in military contexts, in which the demands and experiences of military combat expose participants to the kind of damage to which “moral injury” refers. Occasionally, the concept is discussed in the context of law enforcement. In this chapter I engage in two tasks. One is to be more precise about the paradigm for moral injury: what kind of injury constitutes a moral injury? The other is to broaden the scope of moral injury in police work to cover not only what occurs to police officers, but also what, given the public nature of police work, can be inflicted upon both the direct objects of police activity and, as well, to onlooking bystanders. I hope that what I say here will provide a richer account of moral injury than is usually to be found in the literature and that additionally it may prove suggestive of ways in which incidents of moral injury might be addressed. I conclude with some ethical strategies for minimizing its occurrence. Moral Injury In the social scientific and psychiatric literature, moral injury is characterized as caused or suffered, or both. It is usually portrayed as something suffered by agents engaged in situations that are regarded as “critical” (such as those encountered by military personnel and, less often, by law enforcement and emergency medical personnel). Jonathan Shay, who may have coined the term, argues that “moral injury is present when there has been (a) a betrayal of ‘what’s right’; (b) … by a person in legitimate authority … ; (c) in a high stakes situation” (2014, 182).1 Others (including those Shay sees as the main competitors to his view) expand the view that moral injury is caused by “a person in legitimate authority” to include any who perpetrate or might be seen as complicit in the “betrayal” (Shay 2014, 182–83). Thus, Brett Litz (and associates), another major contributor, states that “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in DOI: 10.4324/9781003281122-10

Moral Injury in Law Enforcement  125 the long term, emotionally, psychologically, behaviorally, spiritually, and socially” (2009, 695). From a review of the literature (Griffin et al. 2019), it becomes clear that there is no universally shared understanding of what constitutes a “moral” injury: although moral injury may characterize a distinct set of harms, the concept probably overlaps with other kinds of injury that humans perpetrate and suffer. My focus in this chapter will be on moral injury in law enforcement; however, I hope that what I have to say will shed light on the notion of moral injury as it may occur in other contexts. Injury may be thought of in more than one way. On some accounts, injury is treated as a type of violation (injuria), or harm, often as something deserving criminalization or compensation. On other accounts, it is thought of more broadly as damage to (often human) interests, usually, though not exclusively, a material interest. In my treatment of moral injury, it is in the broader latter sense that I wish to understand it. I see issues of accountability for the causing of such injury as a subset of concerns. Moral injury clearly has a psychological dimension, and because of this it may be associated with psychological trauma. Thus, post-traumatic stress disorder (PTSD) might overlap with, without being identical to, moral injury. I wish to suggest that – paradigmatically – moral injury refers to damage that is caused to a person’s ability (and perhaps even capacity) to process and/or respond to the moral issues that are implicit in (primarily) human interactions.2 This is what constitutes moral injury. The impairment that constitutes the injury may manifest itself, however, in a variety of ways, from misdirected moral emotions to withdrawal from ordinary human interactions to strong tendencies to engage with others in ways that would be deemed inappropriate or harmful. A morally injured person may, on account of the trauma endured, suffer over-reactive or inappropriate feelings of guilt or come to fear interactions with others – often evident in people with PTSD – or may find that empathy for others has been diminished to the point of inclining them to engage with impunity in harmful behavior, to the point that (as is often the case with child soldiers) they feel diminished compunction about inflicting harm on others. Moral injury, like other forms of injury, might be temporary or long term: in the former, one’s abilities are affected and, in the latter, one’s capacities as well. Other common evidences of moral injury might include depression, a sense of hopelessness, moral numbness, cynicism, PTSD, a recurring sense of guilt or shame, feelings of betrayal, suicidal tendencies, and/or self-sabotaging social behavior. Whether, as a result of moral injury, it is one effect or another that surfaces will depend on a variety of factors, including the personality of the injured person and the availability of various supports (familial, communal, therapeutic, and so forth).

126  John Kleinig Although most of the literature on moral injury focuses on what is e­ xperienced by or what happens to active agents in critical situations (for example, soldiers in wartime or police officers on duty), the morally injured may include bystanders or others who may deem themselves in some ways complicit in the triggering events. Thus, a bystander who believes that she should have intervened in the events she was witness to or someone who in some way identifies with the perpetrators of those events might suffer from moral injury. An example of the latter might be the foot soldier who sees the effects of his country’s napalming of innocent civilians and suffers intense and haunting guilt and shame at what has been done. Central to understanding what constitutes moral injury is the recognition that individual social judgments and relations are normatively infused. Normativity per se does not prevent people from making misguided or perverse judgments or from seeking to disengage in certain ways from others. Moral injury comes about when what might be understood as expected or reasonable engagements with others have been so deformed by one’s acts or the acts of others that one cannot think and behave in ways that are apposite to the situation at hand. Thus, a father who abuses his child may cause moral injury (to both himself and the child) as may a soldier who mistakenly (or deliberately) shoots an innocent civilian; an innocent defendant who is convicted by a corrupt court may be morally injured as may a police officer whose judgment results in a fellow officer being killed. Responsibility for moral injury may vary with the case, though in each case there will have been an impairment of the injured person’s ability (and perhaps also capacity) to respond to situations in morally appropriate ways. The character and extent of moral injury can find easy illustration in law enforcement contexts. Law Enforcement Although we still lack full information about the participants in and witnesses to Eric Chauvin’s killing of George Floyd, it is not hard to get some sense of the range of persons who were or might have been subject to moral injury on account of what they did or witnessed. Ten persons, ranging in age between 9 and 61, testified at Chauvin’s trial (nearly one year after Floyd’s killing). Although some of those involved in the incident were more resilient than others, it is probably fair to say that they were all morally injured in some way on account of what they did or witnessed (Eligon 2021). Testimony from Christopher Martin, the cashier at Cup Foods who initially accepted Floyd’s allegedly phony $20 bill but later reported it – an act that he allows might have precipitated subsequent events – suggests that he was deeply traumatized by what he did, to the point of continuing

Moral Injury in Law Enforcement  127 self-blame and leaving a job that he loved (Laughland and Ajasa 2021). Whether Martin should have simply refused the allegedly counterfeit $20 bill or reported it is a matter that might be disputed, but it is certain that the consequences for Floyd when apprehended by law enforcement helped to transform what he did into something that was profoundly disturbing. How long that will diminish Martin’s life and relations with others is still unclear. A number of bystanders were present during the time in which Floyd was arrested and held down by the police. 1 There was Darnella Frazier, who videoed the killing and was clearly traumatized by her inability to do more to help Floyd – even though what she did do was critical3 to Chauvin’s conviction. She said at the trial: “It’s been nights I stayed up apologizing and apologizing to George Floyd for not doing more and not physically interacting and not saving his life” (Bogel-Burroughs and Arango 2021).4 2 Present also was Donald Williams II, who was trained in martial arts and on his way to Cup Foods when he saw what was going on. He was acutely aware of the effects of Chauvin’s knee on Floyd’s neck and called out to warn the officers. He was ignored – indeed, brushed off – but later called 911 to say he’d just witnessed a murder. Regarding what he saw, Williams said: “I’m dealing with stuff, with trauma…. We all are. Everyone who watched that. We’re all dealing with it. It’s trauma.” In response to the question of whether he was fearful for his safety, Williams was blunt. “‘Am I fearful for my safety? Of course, I’m fearful for my safety,’ he said. ‘I’m a Black man in America’” (Hunt 2021). 3 Another who was present was Charles McMillian, who was driving by, before Floyd was pinned to the ground. McMillian pulled over and advised Floyd not to resist. Floyd tried to assure him that he wasn’t resisting. McMillian stayed nearby and was deeply moved by the events that he saw: Later, McMillian would tell a journalist how seeing a man die continued to affect him: “Waking up, the first thing I hear is Mr. Floyd saying, ‘Mom, they are killing me in the street’” (Villegas 2021). Had George Floyd not died – as is the case with many who become the objects of police use of force – we might nonetheless have viewed what was done as morally injurious to him as well. When you consider the offence for which Floyd was apprehended, and look at the steps taken to apprehend him, there is a fair likelihood that any moral injury already experienced by Floyd as a result of his previous encounters with law enforcement would have been aggravated by this particular one – not a respect for the valuable social peacekeeping work that we employ police to perform on

128  John Kleinig our behalf but added alienation and difficulty in viewing police activity for the public good that it is intended to secure. One kind of moral injury caused, or exacerbated, by the Floyd killing was a general loss of trust in police. Given societies that humans such as ourselves construct, I do not believe that we can do without a policing function and, as populations have increased and become more complex, I do not believe we can do without a professionalized police force. But for police to work effectively, there must be a general public trust in them, one that is based on a perception of their legitimacy. Otherwise they will not be able to provide the social benefits that we as a society expect from them both in their role as law enforcers and more generally in their role as social peacekeepers.5 Effective and ethical policing relies significantly on informational and other supports from the populations that police serve. The situation is aggravated in the United States and other racially divided countries. Even if we grant that a disproportionate amount of crime is committed by minority members of society, and even if we allow that a disproportionate amount of crime is committed on other minority members, we cannot detach such phenomena from their historical antecedents and continuing impact on such communities, intensified by a policing system that has traditionally enforced the norms and expectations of a dominant white majority. The erosion of public trust in police is deeply racialized. Perhaps, the most important form of moral injury that results from misuses of power and authority by institutional officeholders is a chronic loss of trust in others. Most of our daily interactions with others depend on some measure of trust that others will not take advantage of us. When that trust is diminished or lost, we are at risk of moral injury: our world tends toward a Hobbesian one in which vital benefits of sociality and community are absent, denying us critical means of human flourishing.6 And thus we become victims of moral injury. The situation is exacerbated when moral injury is perpetrated from within institutional structures on which we have to rely. In Lockean social contract theory, police and their associates constitute an essential means for shoring up public trust (Locke 1690, chap. 9). Unsurprisingly, because police are drawn from the general population, there will inevitably be a tendency for those who become police to manifest some of the failings as well as the virtues of that population. Through selection and training, we seek – albeit sometimes unsuccessfully – to shift the balance to the virtues. In a historically divided society such as we have in the United States, especially racially, the failures have been magnified and distorted and, as we saw in the immediate aftermath of the Floyd killing, these failures triggered a massive expression of distrust in the fairness and, in some quarters, even in the legitimacy of the police. Because “policing by consent” is critical to a democratic society (cf. Wikipedia 2022; Jackson et al. 2012), widespread lack of trust in the legitimacy

Moral Injury in Law Enforcement  129 of police is moral injury on a massive scale, beyond that of injury to those who were bystanders to the events of May 25, 2020. In part, large-scale public moral injury is occasioned because police, unlike the military, carry out their work within communal borders rather than at or beyond them, and they should be morally constrained by that internality. We do not know with any specificity the moral injuries sustained by each of the four officers who were most directly involved in George Floyd’s death. But from past reports, they are likely to be diverse, maybe singly experienced but often in clusters of morally deleterious effects. Some writers on policing have taken pains to specify a range of morally injurious sequelae that are closely associated with some kinds of police work. One, which I have discussed at length elsewhere, is the mistrustful habit of mind that we label “cynicism” (Kleinig 1996, 77–80).7 Not only may this be experienced by police themselves, but it is also to be found in others as a result of their having witnessed what police have sometimes done.8 Police work often confronts its practitioners with the underbelly of society – at many levels and in many institutions. Given the nature of their work and the investigative resources available to them, they see the hypocrisy of “respectable” people – the gap between what is publicly said and what is done and what people “get away with.” Their perception of a generally moral and law-abiding society, of which they are important guardians, is undermined. Their trust in others is weakened, they develop a general suspiciousness of others and, over time, lock in their cynicism by adopting what is often referred to as “the blue wall of silence.”9 This self-preservationist strategy amounts to a judgment that police are exempt from accountability (Kleinig 2001). Cynicism “relieves” police of their communal loyalty obligations and manifests itself in the refusal to hold their fellow officers accountable. It corrupts other human as well as police relations – relations that depend on a moral undergirding and become, as a result of cynicism, merely pragmatic or – as we now often say – transactional determinants of behavior. This is evidence of deep moral injury. In a brief but thoughtful discussion of moral injury in law enforcement, Konstantinos Papazoglou and co-authors offer the following schematic account of its various manifestations (Papazoglou 2019). Possible Cues of Moral Injury

1 Social and behavioral problems • Social withdrawal and alienation • Aggression • Misconduct • Sociopathy (behaviorally expressed as an inability to get along with others or abide by societal rules)

130  John Kleinig 2 Trust issues • Lack of trust in self or others 3 Spiritual and existential issues • Loss of religious faith • Loss of trust in morality • Loss of meaning • Fatalism (behaviorally expressed as powerlessness or an attitude of resignation) • Negative changes in ethical attitudes and behavior 4 Psychological symptoms • Depression • Anxiety • Anger • Impulse to seek revenge 5 Self-deprecating emotions and cognitions • Shame • Guilt • Self-loathing (behaviorally expressed as self-blame, self-attack, and self-destructive behaviors) • Feeling of being damaged 6 Unwanted reexperience of morally injurious events • Nightmares • Flashbacks • Intrusive recollections.10 Although this schema (or something like it) might provide evidence of moral injury in a number of occupations, it is fairly clear how it may be linked to work in law enforcement. People go into law enforcement as individuals, but their training encourages them to be part of a team for which norms regarding conforming to an authoritative order are especially important.11 J. Alexander Kueng, a rookie officer involved in Floyd’s apprehension, was aware that something was wrong about Chauvin’s knee-to-neck treatment of Floyd. Kueng could feel no pulse, and his partner, Thomas Lane, even suggested rolling Floyd onto his side. Still, both deferred to Chauvin’s supervisory judgment and failed to take further action to assist Floyd. Because the legal case against them is ongoing, we don’t know much about the moral impact of their behavior on their own sense of moral well-being. It is, however, almost certain that each will carry the scars of not having done what he thought he should have into his future. If they do not feel those scars, it may be because a process of moral rationalization has already taken root, enabling them to convince themselves that whatever failures there might have been, the failures were not their own, but Chauvin’s, or a failure in the training provided to them, or something else. In the

Moral Injury in Law Enforcement  131 case of adults, the adoption of responsibility-denying rationalizations for behavior that has been injurious to others is in itself likely to be evidence of moral injury. Of course, moral injury need not be solely the effect of poor or negligent decision-making. Innocent and unforeseeable mistakes that leave others injured or dead – especially fellow officers – are likely to have abiding deleterious effects on the moral well-being of the acting officers (Komarovskaya et al. 2011). “If only” reflections may haunt one for years. There is some evidence that police engage in domestic violence more than the general population (Cheema 2016; Fridersdorf 2014) are more likely to engage in suicide than the general population (The Marshall Project n.d.; Perine 2021) and often use illegal drugs to deal with the pressures of the job (AAC 2022). This may be due to the fact that police culture is such that police feel themselves required to “come on strong” when efforts at de-escalation and negotiation would be preferable. Inevitably, aggressiveness leads to a numbing of moral as well as tactical sensibilities. Although police frequently suffer from psychological stress, they are often deterred from seeking therapeutic help, because they view knowledge of such help as compromising their reputation in others’ eyes as well as their own (Burns and Buchanan 2020). This is not only counterproductive but also exacerbates the harms they suffer. Personal detachment and cynicism become their “go-to” Band-Aids. One needs to recognize that moral injury experienced by law enforcement is not merely a matter of personal suffering. The moral injuries suffered by law enforcement can manifest themselves in impaired decisions (when patrolling/on the beat). They can also show themselves in withdrawal, aggression, and poor recovery after subpar policing decisions.12 Likely signs of culturally sustained moral injury will be cynicism replacing a healthy skepticism, suspiciousness replacing a careful attentiveness, and spontaneous aggression replacing de-escalation. Strategies for Minimizing Moral Injury in Law Enforcement Once we grasp the causal factors that incline to moral injury, we may gain some understanding of ways in which moral injury might be minimized, which is not to say that it might be altogether eliminated. One reason moral injury may continue to be part of police experience is that a significant amount of police work is “on the edge”: it often takes place in response to situations in which the constraints of civil society have broken down, either as a result of crime or other forms of social disorder. Responses to human crises in such circumstances call upon resources that are hard to develop and require considerable discretion if they are to be equitably and effectively addressed. No doubt some of what police are

132  John Kleinig expected to deal with would be morally less injurious were their work to be supplemented by various forms of social work (such as that provided by crisis managers). However, given the current 24/7 expectations that we have of police, they, along with firefighters and emergency medical teams, will often be first responders to critical incidents and expected to deal with such incidents in the absence of others who have more specialized training to deal with them. Here are some possibilities: 1 Although calls to “abolish” or “defund” the police are socially unrealistic, such calls often highlight the smorgasbord reality of police work – the expectation that wherever there is a perceived social crisis, the police are to be called: domestic violence, traffic accidents, clusters of homeless people, mentally disturbed persons in public places, robberies, private disputes, distressed animals, missing children, gang warfare, street urination, and so forth. The social peacekeeping work of police currently knows few bounds, and many social peacekeeping activities – especially in large urban centers – are better handled by trained specialists, even if police are appropriately present to provide some form of social control or backup. There is, therefore, an argument – one with which few police would disagree – for transferring to specially trained others some of the work that police are currently expected to do. Or (given that some of these critical social situations may require a police presence) of teaming up law enforcement personnel with, say, social workers or counselors or addiction specialists, so that police are not expected to wade into waters for which their skill training has not prepared them. It is likely that, in some critical situations, if certain social services were to be performed by those other than law enforcement personnel, there would be fewer persons morally injured, for there would be fewer who create situations in which acting in morally injurious ways would occur.13 2 As is probably true in most cases of moral dislocation, therapeutic measures to help the injured should include engagement with people whose compassionate understanding and relational support restores to the injured a sense of normalcy in their social and personal experience. This is not the place to review therapeutic and other measures that might be employed to deal with moral injury.14 Nevertheless, it stands to reason that moral dislocation is likely to be most effectively repaired in contexts that help to normalize moral bearings, and that these will also be contexts that offer relational support – such as that we aim for in familial and friendship contexts. 3 In an occupation such as policing, which tends to encourage machismo behavior and attitudes, one often finds a resistance to therapeutic interventions on the ground that they betray psychological weakness and

Moral Injury in Law Enforcement  133 might be used to delay or even prevent career advancement. For this reason, some police departments have separated mental health supports and facilities from other organizational sites so that officers in need of treatment can do so privately.15 What is really needed here is a change in police culture. We need an understanding of police work that does not unreasonably expect police to place themselves in harm’s way, and a frank appreciation of the fact that stresses of various kinds are more than likely to be part and parcel of police work and that, therefore, police, as citizens in uniform, can expect to confront serious challenges to their moral well-being. Moral injury is not to be seen as a sign of weakness, to be hidden from view, but as a normal, if unfortunate, occupational hazard that police can be expected to encounter. Police departments should be openly concerned to address this aspect of police work in both their training and, of course, after the occurrence of critical incidents. 4 In connection with the above point, we should add that police training needs to include some segment on self-care, lest police unnecessarily place themselves at risk of harm, not only physical but also moral (Copple and Copple 2018). There is, however, a problematic flip side to this. Police have learned that a potent defense to charges that they have used unnecessary force in the course of their work is that they have “feared for their lives.” Learning to balance risk to themselves against risk to others is a key training problem, one that is often dealt with in an unsatisfactory way by using scenarios that develop in them a sense that each and every day they “put their lives on the line,” thus encouraging an overreaction to situations that would and should be handled more judiciously. The situation is not helped by the fact that police inhabit an organization whose culture tends to be more punitive or retributive rather than educative or rehabilitative.16

Conclusion Any occupation that deals with critical incidents involving other human beings has the potential to produce not only stress but also responses that cross moral boundaries, affecting not only the responders and those they respond to, but also others who may be witnesses to or otherwise causally associated with the unfolding events. Unlike the military, who have traditionally dealt with “the enemy on the borders,” police do their work within their own communities, and their moral obligations are more complicated as well as subject to more constraints. But, as was clearly exemplified by the case of George Floyd, those constraints may easily create opportunities for dispersed moral injury.17 The widespread multi-ethnic

134  John Kleinig protests that followed in the wake of Floyd’s killing, and the unusually revealing trials of Derek Chauvin opened up, in a way often previously obscured, the prevalence of moral injury in policing contexts.18 Notes 1 Shay overstates it. It should not be presumed that events causative of moral injury cause it in every case. Critical events of the kind that cause moral injury will also require other conditions to be satisfied. 2 These need not all be human interactions. The scope of the injury may be limited to the circumstances in which it was suffered (e.g., bad experiences with a police officer). 3 John Elder wrote the original anodyne police report for press release on May 25, 2020 (Linder n.d.; cf. McCarthy 2021). 4 As Bogel-Burroughs and Arango (2021) report, Ms. Frazier has largely stayed out of the spotlight since Mr. Floyd’s death, but she said his death has haunted her and that she has anxiety. ‘When I look at George Floyd, I look at my dad, I look at my brothers, I look at my cousins, my uncles, because they’re all Black,’ Ms. Frazier said. ‘I have a Black father. I have a Black brother. I have Black friends.’ She added: ‘I look at how that could have been one of them.’ It is not simply the fact that she would not have been able to do anything to ‘save’ Floyd, but also the subsequent trolling by those who thought she should have intervened more actively that aggravated Frazier’s moral trauma. (Bogel-Burroughs and Arango 2021) 5 For my defense of that view, see Kleinig (2019, chap. 2). 6 I have addressed related concerns in Kleinig (2000). 7 As I argue there, Central to cynicism is the lack of trust that is shown towards the objects of cynicism. And where that distrust is directed to both the police organization and the wider society, there is a corruption of the very conditions of a form of policing that takes seriously the idea of service to, and partnership with, the community (78). For a lengthier discussion, see Vice (2011). 8 I suspect that cynicism often undergirds calls for defunding or abolishing the police. See Kleinig (2016). 9 Essentially, a judgment that police are exempt from accountability. See Kleinig (2001). 10 The authors cite as their sources: Drescher et al. (2011); Nash and Litz (2013); and Litz et al. (2009). 11 In theory, at least, this may not true in British policing, where the authority of the constable is said to be original rather than delegated: see PFEW (2018). 12 This is strongly reinforced by the culture of the “blue wall,” which seeks to insulate police behavior from outside scrutiny, whether by the public or the police administration, as the street wisdom goes: “The Commissioner is the Mayor’s puppet. The Mayor doesn’t care for us. The media puts us down and the public hates us. All we have is each other. Stick together” (from a police academy toilet wall).

Moral Injury in Law Enforcement  135 13 In the wake of Black Lives Matter demonstrations, the New York Police Department (NYPD) initiated a pilot program in which not the police but Emergency Medical Services mental health response teams are deployed to situations that previously had police responses. It appears to have had good results (Shivaram 2021). Nevertheless, most calls are still taken by police, the reasoning being that many of those in need of help are dangerous to themselves or others (Smith 2021). 14 An overview can be found in Griffin et al. (2019). 15 For example, see the NYPD’s formation of the Police Organization Providing Peer Assistance (Dowling et al. 2005). Even this is not sufficient in some cases. Officers become so cynical about their organization that they prefer to engage in private therapeutic efforts. 16 How that culture expresses itself in practice often reflects the competing concerns of police management and police unions. But this large issue is a topic for another discussion. See Fisk (2017); and Levin (2020). 17 The distinction is more theoretical than practical as both contexts provide contexts in which dispersed moral injury is caused. We are, however, more familiar with the morally deleterious effects of military service than of police work. 18 I thank Andrew I. Cohen and Tziporah Kasachkoff for helpful comments on an earlier draft.

Works Cited AAC (American Addiction Centers). 2022. “Substance Abuse Among Police.” AAC. Last update: March 22, 2022. https://americanaddictioncenters.org/ rehab-guide/police. Bogel-Burroughs, Nicholas and Tim Arango. 2021. “Darnella Frazier, the Teenager Who Filmed George Floyd’s Arrest, Testifies at the Trial.” New York Times, March 30, 2021. https://www.nytimes.com/2021/03/30/us/darnella-frazier-video-georgefloyd.html. Burns, Carolyn, and Marla Buchanan. 2020. “Factors that Influence the Decision to Seek Help in a Police Population.” International Journal of Research in Environmental and Public Health 17, no. 18: 6891–916. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7559930/pdf/ijerph-17-06891.pdf. Cheema, Rafaqat. 2016. “Black and Blue Bloods: Protecting Police Officer Families from Domestic Violence.” Family Court Review 54, no. 3: 487–500. https:// scholarlycommons.law.hofstra.edu/cgi/viewcontent.cgi?article=1009&context= hofstra_law_student_works. Copple, Colleen K., and James E. Copple. 2018. Risk Management in Law Enforcement: Discussions on Identifying and Mitigating Risk for Officers, Departments, and the Public. Washington, DC: Office of Community Oriented Policing Services. https://cops.usdoj.gov/ric/Publications/cops-w0865-pub.pdf. Dowling, Frank G., Bill Genet, and Gene Moynihan, “A Confidential Peer-Based Assistance Program for Police Officers.” Psychiatric Services 56, no. 7: 870–71. https://doi.org/10.1176/appi.ps.56.7.870. Drescher, Kent D., David W. Foy, Caroline Kelly, Anna Leshner, Kerrie Schutz, and Brett Litz. 2011. “An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans.” Traumatology 17, no. 1 (March): 8–13. https://doi.org/10.1177/1534765610395615.

136  John Kleinig Eligon, John. 2021. “‘I Was Failing’: Bystanders Carry Guilt from Watching George Floyd Die.” New York Times, updated April 21, 2021. https://www.nytimes. com/2021/04/03/us/george-floyd-derek-chauvin-trial.html. Fisk, Catherine L., and L. Song Richardson. 2017. “Police Unions.” George ­Washington Law Review 85, no. 3 (May): 712–99. Friedersdorf, Conor. 2014. “Police Have a Much Bigger Domestic Abuse Problem than the NFL Does.” The Atlantic, September 19, 2014. http://www. theatlantic.com/national/archive/2014/09/police-officers-who-hit-theirwives-or-girlfriends/380329/. Griffin, Brandon J., Natalie Purcell, Kristine Burkman, Brett T. Litz, Craig J. Bryan, Martha Schmitz, Claudia Villierme, Jessica Walsh, and Shira Maguen. 2019. “Moral Injury: An Integrative Review.” Journal of Traumatic Stress 32, no. 3: 350–62. https://doi.org/10.1002/jts.22362. Hunt, Loretta. 2021. “How MMA Fighter Donald Williams Helped Achieve Justice for George Floyd.” The Guardian (US Edition), April 26, 2021. https://www.theguardian.com/sport/2021/apr/26/donald-williams-witness-george-floyd-mma. Jackson, Jonathan, Mike Hough, Ben Bradford, Katrin Hohl, and Jouni Kuha. 2012. “Policing by Consent: Understanding the Dynamics of Police Power and Legitimacy.” In Legitimacy and Compliance in Criminal Justice. Edited by Adam Crawford, and Anthea Hucklesby, 29–49. London: Routledge. Kleinig, John. 1996. The Ethics of Policing. Cambridge: Cambridge University Press. ———. 2000. “The Burdens of Situational Crime Prevention: An Ethical Commentary.” In Ethical and Social Perspectives on Situational Crime Prevention. Edited by Andrew von Hirsch, David Garland, and Alison Wakefield, 37–58. Oxford: Hart Publishing. ———. 2001. “The Blue Wall of Silence: An Ethical Analysis.” International Journal of Applied Philosophy 15, no. 1: 1–23. https://doi.org/10.5840/ijap20011515. ———. 2016. “Reform, Don’t Abolish, the NYPD.” GPS (Gotham Philosophical Society), August 15, 2016. http://gothamphilosophicalsociety.org/?p=65998. ———. 2019. Ends and Means in Policing. New York: Routledge. Komarovskaya, Irina, Shira Maguen, Shannon E. McCaslin, Thomas J. Metzler, Anita Madan, Adam D. Brown, Isaac R. Galatzer-Levy, Clare Henn-Haase, and Charles R. Marmar. 2011. “The Impact of Killing and Injuring Others on Mental Health Symptoms Among Police Officers.” Journal of Psychiatric Research 45, no. 10: 1332–36. https://doi.org/10.1016/j.jpsychires.2011.05.004. Laughland, Oliver, and Amudalat Ajasa. 2021. “‘I Allowed Myself to Feel Guilty for a Very Long Time’: The Teenage Cashier Who Took George Floyd’s $20 Bill.” The Guardian (US Edition), May 23, 2021. https://www.theguardian.com/ us-news/2021/may/23/christopher-martin-george-floyd-minneapolis-cup-foods. Levin, Benjamin. 2020. “What’s Wrong with Police Unions?” Columbia Law Review 120: 1333–401. https://doi.org/10.2139/ssrn.3469958. Linder, Douglas O. n.d. “Original MPD Statement on Floyd: ‘A Medical Incident.’” Famous Trials (blog). https://www.famous-trials.com/george-floyd/2720-­originalmpd-statement-on-floyd-a-medical-incident” https://www.famous-trials.com/ george-floyd/2720-original-mpd-statement-on-floyd-a-medical-incident. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War

Moral Injury in Law Enforcement  137 Veterans: A Preliminary Model and Intervention Strategy.”  Clinical Psychology Review 29, no. 8 (December): 695–706. http://doi.org/10.1016/j.cpr.2009. 07.003. Locke, John Locke. 1690. Second Treatise, of Civil Government. The Marshall Project. n.d. “Police Suicide.” https://www.themarshallproject.org/ records/1778-police-suicide. McCarthy, Bill. 2021. “What the First Police Statement About George Floyd Got Wrong.” Politifact (Poynter Institute), April 22, 2021. https://www.politifact. com/article/2021/apr/22/what-first-police-statement-about-george-floyd-got/. Nash, William P., and Brett T. Litz. 2013. “Moral Injury: A Mechanism for WarRelated Psychological Trauma in Military Family Members.” Clinical Child and Family Psychology Review 16, no. 4 (December): 365–75. https://doi. org/10.1007/s10567-013-0146-y. Papazoglou, Konstantinos, George Bonanno, Daniel Blumberg, and Tracie Keesee. 2019. “Moral Injury in Police Work.” FBI Law Enforcement Bulletin, September 10, 2019. https://leb.fbi.gov/articles/featured-articles/ moral-injury-in-police-work. Perine, Tara. 2021. “The Law Enforcement Suicide Data Collection: The FBI’s New Data Collection on Officer Suicide and Attempted Suicide.” Police Chief Online 5/26: https://www.policechiefmagazine.org/the-le-suicide-data-collection /?ref=ae5ca299c8680237feeed39ae41b1016. PFEW (The Police Federation of England and Wales). 2018. The Office of Constable: The Bedrock of Modern British Policing. Surrey: PFEW. https://www.polfed. org/media/14239/the-office-of-constable-with-links-2018.pdf. Shay, Jonathan. 2014. “Moral Injury.” Psychoanalytic Psychology 32, no. 2 (April): 182–91. https://doi.org/10.1037/a0036090. Shivaram, Deepa. “Mental Health Response Teams Yield Better Outcomes Than Police in NYC, Data Shows.” NPR, July 23, 2021. https://www.npr. org/2021/07/23/1019704823/police-mental-health-crisis-calls-new-york-city. Smith, Greg G. “Cops Still Handling Most 911 Mental Health Calls Despite Efforts to Keep Them Away.” The City, July 22, 2021. https://www. thecity.nyc/2021/7/22/22587983/nypd-cops-still-responding-to-most-911mental-health-calls. Vice, Samantha. 2011. “Cynicism and Morality.” Ethical Theory and Moral Practice 14, no. 2 (April): 169–84. https://doi.org/10.1007/s10677-010-9250-y. Villegas, Paulina. 2021. “Witness Who Confronted Chauvin Sobs While Watching Floyd Video: ‘I feel helpless.’” Washington Post, March 31, 2021. https://www. washingtonpost.com/nation/2021/03/31/charles-mcmillian-chauvin-trial/. Wikipedia. 2022. “Peelian Principles.” Last modified March 22, 2022. https:// en.wikipedia.org/wiki/Peelian_principles.

8 Photojournalism and Moral Injury An Inquiry Lauren Walsh

“I killed.” The protagonist of the fictional film Before the Rain (Manchevski 1994) is a war photographer. Set in the 1990s during the violent break-up of the former Yugoslavia, the narrative follows Aleksander, a native of Macedonia, who leads a cosmopolitan life as a celebrated photographer. Before the Rain is a quiet art film, and doesn’t explicitly focus on the psychological, but this is the strength of the film, forcing viewers to wrestle with the subtleties of what is rarely spoken about. Part-way through, we learn that Aleksander unexpectedly left his work in the Balkans, although he has just recently won a Pulitzer Prize for his photography. Without further details, the viewer understands that something occurred and it was too much; it crossed a line that should not have been crossed. All we know is that Aleksander claims he is responsible for killing someone. Ultimately, we learn from Aleksander that he complained to a guard that he “wasn’t getting anything exciting.” In response, the guard “pulled a prisoner out of the line and shot him on the spot. ‘Did you get that?’ he asked.” Aleksander did. An off-hand comment leads to death. On screen, we see photographs of the execution. Pushed perhaps by a profession that rewards dynamic, graphic imagery, and by the media industry’s desire for visual sensation, at times to combat audience fatigue—in this case, likely the international public’s waning interest in the ongoing conflicts of the Balkans—Aleksander commits what he views as a horrible moral violation. “My camera killed a man.” This anecdote evidences a situation of what is now recognized as moral injury. Can You See What Isn’t Photographed? To back up a moment, the term moral injury is quite new for my field, which is photojournalism, or even journalism broadly. I approach this DOI: 10.4324/9781003281122-11

Photojournalism and Moral Injury: An Inquiry  139 topic with an expertise in conflict photography and the photographic ­coverage of crisis. Both are realms that can put photographers in physical danger and, importantly, can put them at emotional risk. More often, however, we think about what happens in front of the camera lens—because that is what we can see. For instance, Walter Patrick Wade uses the photographic medium to conceptualize the trauma experienced by military combatants, exploring how the distribution of “thousand-yard stare” imagery—which, he notes, recurs through wars—impacts a civilian understanding of soldiers’ wartime psychological suffering (Wade 2019).1 As Wade puts it, “The stare is suggestive of dissociative responses to trauma insofar as it separates the bearer of the stare from his or her surroundings” (2019, 121). And, argues Wade, that stare has become the visual symbol of mental injury. It is a visible appearance of invisible emotional distress. Or in the words of Ariella Azoulay, “The traces of the injury are imprinted on the surface of the photographic image” (2008, 143). (See Figure 8.1)

Figure 8.1 A shell-shocked US Marine, Hue, Vietnam, February 1968. © Don McCullin/Contact Press Images.

140  Lauren Walsh It has been more than 40 years since the American Psychiatric A ­ ssociation first included post-traumatic stress disorder (PTSD) in its Diagnostic and Statistical Manual of Mental Disorders. This occurred in the wake of the Vietnam War and allowed for a new level of study and diagnosis of V ­ ietnam War veterans. Jonathan Shay’s Achilles in Vietnam: Combat Trauma and the Undoing of Character (1994) focuses exactly on these veterans, deeply exploring the traumas that soldiers serving in Vietnam brought back home to the United States. Shay’s book is also considered one of the first investigations of what we now term moral injury. Achilles in Vietnam takes us into the post-war lives of soldiers who suffer mental trauma and exhibit, at times, consequent maladaptive behaviors. We all know that military personnel face mortally dire situations in combat zones. It likewise involves no stretch of the imagination to grasp that photojournalists who work in hostile environments, like conflict zones, may face grave physical dangers: bullets, shrapnel, mortars, and more. But it is less common to consider the emotional tolls of that kind of work, let alone consider such tolls in spaces that don’t typically conform to what we think of as overtly dangerous or hostile. Yet if we stop to think about it, of course we can understand that witnessing and documenting suffering, grief, injustice, or death can weigh heavily on the documentarian. What Is Moral Injury? PTSD and other psychological traumas have, at this point, been well studied in soldiers and veterans; but as far as research on journalism and PTSD, the timeframe is far shorter. A seminal study in 2002 explored the psychopathology of war journalists and ultimately concluded that close to onethird of conflict correspondents experience PTSD (Feinstein, Owen, and Blair 2002), a rate that exceeds such diagnosis in non-war journalists yet is comparable in veterans. But moral injury and PTSD are not one and the same. PTSD is a clinically diagnosable disorder that tends to occur in individuals who have experienced or witnessed a traumatic event and is characterized by symptoms such as flashbacks, nightmares, intrusive memories, hypervigilance, and/or anger, among other post-exposure reactions. Moral injury, by contrast, is not a diagnosable mental illness, even as the two conditions frequently cooccur and share characteristics in consequences and behavioral responses. In the end, moral injury is more akin to an existential crisis that involves deep emotional pain. More specifically, moral injury derives from “a profound sense of betrayal of ‘what’s right,’ either by a ‘legitimate authority’ or by oneself” (Meagher and Pryer 2018, 2). Moral injury also “denotes the harm that may arise when people witness things that transgress their expectations of a

Photojournalism and Moral Injury: An Inquiry  141 just and morally ordered society” (Jukes, Fowler-Watt, and Rees 2021, 2). Put simply, it is the emotional state of being that may occur after one perpetrates, or participates in, an act that crosses one’s moral boundaries in a profound and lasting capacity. Like PTSD, moral injury has been linked to depression, hopelessness, anger, and suicidal thoughts (Gaudet et al. 2016; Bryan et al. 2014). This chapter aims to investigate the vastly underexplored realm of moral injury specifically within the field of photojournalism.2 To my knowledge, there is no critical literature on this exact topic,3 and yet as Tess Browne, Michael Evangeli, and Neil Greenberg have said, journalists comprise “a unique cohort, distinct from other high-risk groups in that they often experience or witness traumatic events…Not having a direct helping role when attending to traumatic incidents may present journalists with complex ethical dilemmas” (2012, 207). This is especially of concern for photojournalists who document war, crisis, and other forms of suffering and injustice, because they can never report from afar. The photographer must be close enough to witness and record what is happening, and yet the job imposes no specific duty to intervene, assist, or even mitigate with respect to whatever is occurring in front of the lens. Too often in the clinical research, however, the photographer is treated as a broader subset of journalist, without the recognition that this line of work carries with it unique aspects and singular experiences. In the past few years, the conversations within the photojournalism community have begun around this topic, and it is my hope that this chapter continues that effort, with a deeper evaluation of moral injury and photojournalism, adding new perspectives to an under-investigated yet highly important concern. As Bruce Shapiro, executive director of the Dart Center for Journalism and Trauma at Columbia University, has said: The work of photojournalism involves a constant navigation of values and ethics that are quite consequential. We know that photojournalism involves being up close and personal with traumatic events, violating experiences, and high stakes situations, and we know that the photojournalism ecosystem can impose demands that can sit at odds with people’s values. That is a recipe for a lot of moral conflict, moral distress, and moral injury. (interview with author, June 2022) My goal here is not to finalize how we think about moral injury within photojournalism, but in fact the opposite—to open the discussion. I will borrow from a few extant studies, largely on moral injury and journalism broadly, in order to frame my own overview. By way of setting up the clinical approaches, I offer this set of statements, which were

142  Lauren Walsh posed to reporters and photographers who covered the Mediterranean migrant crisis. This survey, by Anthony Feinstein, Bennis Pavisian, and Hannah Storm, explores the emotional consequences on journalists who “have been exposed to the suffering of huge numbers of refugees against the backdrop of how their own countries, colleagues and fellow citizens have responded to a humanitarian crisis in their backyards” (2018, 1). For this study, journalists responded to the following prompts: I saw things that were morally wrong; I am troubled by having witnessed others’ immoral acts; I acted in ways that violated my own moral code or values; I am troubled by having acted in ways that violated my own morals and values; I violated my own morals by failing to do something that I felt I should have done; I am troubled because I violated my morals by failing to do something that I felt I should have done. (Feinstein, Pavisian, and Storm 2018, 2) Ultimately, the researchers concluded that some journalists did suffer moral injury, and the incidence was higher in journalists who are parents, who worked alone, who lacked prior experience in hostile environments, who had an increased workload, and who reported a lack of professional support, for instance from media organizations. The authors emphasize, “A significant association was found between guilt and moral injury” (Feinstein, Pavisian, and Storm 2018, 4). Other clinical literature echoes this note, with guilt and shame often cited as hallmark features of moral injury. The Feinstein, Pavisian, and Storm (2018) study offers a useful frame for understanding aspects of moral injury within the sphere of journalism and highlights important factors for consideration of when and why certain journalists may experience moral injury. It is nevertheless crucial to note that the understanding of this term remains fuzzy, with no uniformly accepted consensus definition, and there is, at times, a blur with phrases like “moral distress” and “moral pain.” For some, those terms are interchangeable; for others, there are distinctions, with moral injury being the most enduringly severe, a long-lasting psychological pain (Maguen and Norman 2022). Despite such differences in the clinical field, I seek to contribute to the broader study by offering short but descriptive case studies that allow for individuals’ experiences and first-person perspectives in the deliberation of moral injury. In giving emphasis to the experiences of photojournalists, I hope to highlight demands they face and raise questions around their risk of moral injury. Ultimately, I offer ideas for steps to better understand and mitigate the pain and disruption of severe emotional injury—both within the photojournalism community and, in the end, in a broader journalistic ecosystem.

Photojournalism and Moral Injury: An Inquiry  143 Cases Case 1: Iraq

This case highlights what may be thought of as a traditional example of moral injury, that is, conforming to definitions like those offered above and enhanced by this one: “the injury done to a person’s conscience or moral compass when that person perpetrates, witnesses or fails to prevent acts that transgress their own moral and ethical values or codes of conduct” (Feinstein, Pavisian, and Storm 2018, 1). Photojournalist Ashley Gilbertson was working in Iraq in 2004 when an episode occurred that would forever change his life. In his own words: I heard that an insurgent lay dead in a minaret from which he had been firing. No one had yet produced evidence that the insurgents were warring from mosques, which the Geneva Conventions put off-limits. I had to photograph him. The company captain assigned a squad, including Lance Corporals William Miller and Christian Dominguez, to escort me, and soon I was climbing the stairs to the minaret behind them. Moments before we reached the top, Miller was shot point-black by an enemy fighter. I ran out as fast as I could, covered in Miller’s blood, forever changed. (Gilbertson 2014, 83) Gilbertson penned these thoughts as the opening to his essay that appears in his powerful photo book Bedrooms of the Fallen (2014). It contains a series of wide-angle, black-and-white photographs of the bedrooms of soldiers who died in service, fighting in Iraq or Afghanistan4 (See Figure 8.2). In losing their sons and daughters, many families turned the bedrooms into memorial spaces, keeping the rooms intact, an effort to freeze time—to a moment when their sons and daughters were still alive. In addition to narrating that short opening about the soldier who dies, Gilbertson also recounts a sense of overwhelming failure. This note occurs more than once in his essay. Speaking of the public’s fatigue with war imagery, he writes: “They’ve seen it before. The same thing over and over” (Gilbertson 2014, 86). His work as a photojournalist feels futile; the images don’t have impact. Gilbertson says explicitly, “I was failing in my role as a conflict photographer” (Gilbertson 2014, 85). He describes that sense of failure as, in part, a motivation to do his book. This was a novel way to cover war, a different route to visualize the story of soldiers’ deaths and the immense grief that is left behind in those who have lost a loved one. In this sense, one could say he harnessed a feeling of futility toward a productive outcome.

Figure 8.2  The bedroom of Army Cpl. Brandon M. Craig. © Ashley Gilbertson/VII.

144  Lauren Walsh

Photojournalism and Moral Injury: An Inquiry  145 But that sense of failure can also be quite dislocating. One can imagine that Gilbertson may have questioned: Why am I doing this work, documenting in Iraq? What is the point? Such a mindset can lead to the guilt or shame so associated with moral injury—for instance, a sense that one is a “vulture” for photographing another’s worst moments and not even raising awareness or bringing about change. Writing about moral injury and soldiers, Amy Taub offers, “soldiers often impose a heightened sense of responsibility on themselves, feeling guilt and shame for failing to save a fellow service member, even if doing so would have required them to disobey orders or leave their post.” She continues, “In many situations, then, the moral demands that a soldier places on him or herself are unrealistic or impossible to meet” (Taub 2015). In the same way, I see photojournalists often placing unreasonable expectations on themselves: The conflict photographer endeavors to communicate knowledge, to let others know of the conditions of suffering or violence that exist, often as a first step toward transforming things for the better. But whether or not the possibility for transformation is realized rests, many would argue, with the viewership—with the citizens who donate to causes or vote in their elected officials, with the policymakers in power, or the corporations, organizations, and governments whose decisions affect the circumstances captured in a photo. Yet as the documentarians on the frontlines—both literal frontlines as well as the “frontlines of history”— many feel a strong obligation to those they’re photographing, whether combatants or civilians. And when terrible situations aren’t transformed, despite getting the images out, the emotional toll can be heavy. (Walsh 2019, 13) I hear this echoed in Gilbertson’s self-critique of his “failure” as a conflict photographer. And so Bedrooms of the Fallen becomes a space to work through that sense of failure and guilt. “Photographing these spaces carried a responsibility,” says Gilbertson. “I quickly came to understand that after death, all that’s left are memories. To trust somebody, an outsider, with any of those memories requires an enormous leap of faith” (Gilbertson 2014, 91). Gilbertson works to gain trust, and this seemingly operates on many levels—the trust of strangers who let him photograph in their homes and, significantly, the permission and trust of parents who had lost a child, like William (Billy) Miller, the singular death that plagued Gilbertson for his direct connection to it. If the book itself can be seen as a constructive way to move forward through an extremely emotionally challenging situation, Gilbertson says

146  Lauren Walsh little on that. His essay does discuss the PTSD suffered by some soldiers: it “is not an obvious physical wound” (Gilbertson 2014, 103). But aside from the wrenching opening—the quickly communicated death of Miller—Gilbertson keeps his emotional self out of the narrative, despite the seeming enormity of that event. Philip Gourevitch, who wrote the introduction to Bedrooms of the Fallen, offers a little bit more: “Gilbertson was haunted by the feeling that Lance Corporal Billy Miller, in doing what he understood as his duty, had died for him” (Gilbertson 2014, x). The word that resonates most with my focus is “haunted,” propelling me to ask: Just how did this haunting play out? What did Gilbertson feel inside? Did he feel responsible that someone had “died for him”? The answer is yes. “I killed someone. It’s my fault.” A devastated Gilbertson spoke these words to his then-girlfriend. The reporter he was working with in Iraq, Dexter Filkins, adds, “A 22-year-old kid was killed because Ashley needed a photograph” (McCauley 2012). In 2012, The Atlantic featured a piece on Gilbertson’s experience and framed it through the lens of PTSD. And while it seems logical that Gilbertson could receive a clinical diagnosis, the concept of moral injury was entirely overlooked. And yet that appears, quite readily, to be what Gilbertson describes: an episode so traumatic, in which he played a role and for which he assigns himself responsibility, and which broke with his own moral code. “Someone paid for my life with theirs,” he says. Filkins adds, he was “tormented” by this (McCauley 2012). Case 2: Black Lives Matter

In contrast to the previous case, which involves a perceived direct role in another’s death, this next example considers the possibility of moral injury in a photojournalist who feels unable to best do her job and best help those she is covering, precisely because the conventions of journalism limit her. Patience Zalanga is a photojournalist based in Minneapolis, Minnesota, and has worked extensively covering racial injustice and the Black Lives Matter movement in the United States. She has spoken about the tension she feels, complicit with a journalistic landscape that doesn’t in fact well serve the populations reported on. With regard to racial inequality in the United States, Zalanga says, “It’s really frustrating to see what is happening today and how the news doesn’t contextualize it fully. I struggle with that” (interview with author, June 2022). A 2021 study has shown that moral injury was evident in journalists who felt that their reportage inadvertently enabled harm (Jukes,

Photojournalism and Moral Injury: An Inquiry  147 Fowler-Watt, and Rees 2021, 7).5 This offers a lens through which to ­consider Zalanga’s experiences. I’ll begin not with the photo, but its caption. The conventional photojournalistic caption, giving solely the “who, what, where and when” of what is pictured, is a problem for Zalanga; as she says, it renders “an oversimplified story” and ultimately “that is dangerous” (Walsh 2019, 43). Yet as a photojournalist, she is expected to abide by such rules even if she believes they can be injurious. In short, the caption—which doesn’t carry a “why”—fails to properly explain the circumstances. By way of example, Zalanga offers this image (Figure 8.3), of which she has said, “Often, the fixation around looting is relegated to the stealing of property, but is never understood as a reflection of what people desperately need” (Zalanga’s Instagram post, May 12, 2022).6 To call this the visual evidence of looting is not inaccurate per se, but elides so much, including social, political, economic, and racial dynamics.

Figure 8.3 Theft in the baby formula aisle in a Walmart, Brooklyn Center, Minnesota, April 2021.  © Patience Zalanga.

148  Lauren Walsh But it is not just the caption that is problematic for Zalanga. The larger operating principles of the industry, she says, create harm: The fast pace of the 24-hour news cycle hampers our ability to report well. Because this industry is so dependent on metrics like ‘What are people paying attention to?’, ‘What is going to get the most views?’, ‘What will increase the number of subscribers?’ But we need to ask: What is the long-term impact of that kind of work? (interview with author, June 2022). In other words, who is served and who is hurt by the coverage? And for Zalanga, there is also the self-questioning about what role she plays in a potentially harmful practice. In combination with these concerns is the fact that Zalanga, despite being a Black woman affected by many of the issues she covers, feels pressure to keep her personal views silent. This has created an enormous tension for her, ultimately experienced as a lack of professional support for her identity. In order to succeed in the industry, I was told I would have to change the way I engage on social media, with the opinions that I put forth. So I tried that, just captioning my photos traditionally. But it feels outrageous to be in an industry that requires you to remain neutral about things that you’ve observed and photographed and documented and can draw conclusions from. This is not useful to the public. (interview with author, June 2022) Zalanga’s words resonate with other clinical findings, including a greater likelihood of moral injury in journalists covering stories “close to home” and those who “step outside” their professional role in order to intervene (Feinstein, Pavisian, and Storm 2018). In Zalanga’s case, the major Black Lives Matter headline of 2020 was literally in her hometown (George Floyd was murdered in Minneapolis) and the “stepping outside” involves her breaking with the journalistic convention of neutrality. Some have explored work-related guilt, as correlated with PTSD, in journalists with exposure to traumatic circumstances; for instance, Browne, Evangeli, and Greenberg describe situations such as “morally believing the right thing to do is to provide aid, versus the knowledge that one should remain objective.” They add, “Ethical dilemmas may result in behavior perceived as violating moral standards” (2021, 207). But such studies tend to focus on specific traumas (coverage involving child abuse, mass casualty, motor vehicle incident, etc.), whereas Zalanga’s case asks us to consider

Photojournalism and Moral Injury: An Inquiry  149 the emotional injury of an ongoing feeling that one is ­participating in a system that causes harm. Feinstein, Pavisian, and Storm offer another way to approach this situation. They report that the “belief that organisational support is lacking” can also result in moral injury (2018, 4). Translating this into Zalanga’s experience, there isn’t merely a lack of support for her personal identity, especially her personal views, but, again, the idea of an overall lacking system due to how journalism is practiced. In particular, Zalanga describes guilt and frustration around knowing her local community well and not seeing their realities reflected in the coverage, because editors frequently craft the news for a national or international audience.7 “When I am photographing, I would really like for my work to impact the people who are closest in proximity to me,” but often, she says, that hope is not realized. It is in this sense that her crisis of identity—personal versus professional—and her questioning of the overall journalistic system collide: I can actively pinpoint where journalism is failing and it’s painful to see it. Good journalism requires you to actually be in a relationship with people, to understand the complexities of their situation, but that necessitates a much deeper investment that the journalism industry discourages. I feel I am not considered to be a good journalist because I engage with the community, so then someone else is assigned to report, but that individual doesn’t understand the layers and their reporting is actually causing harm. But that reporting is perceived to be ethically done— because it’s neutral. But is neutrality always the most ethical way? (interview with author, June 2022) Ultimately, for Zalanga, this was, in her words, “a serious compromise” of her belief system: “I am a Black woman who is expected to be quiet, and I have been that person, but I just don’t think I can afford to be that person anymore” (interview with author, June 2022). The frustration and violation were too great: “We are humans before we are journalists, and I need to be true to that, so I released myself of any expectation of working in the industry” (interview with author, June 2022). Zalanga’s recent decision to protect her values by leaving aside career expectations may have been informed by the timing. An increase in workload is a factor identified in at least one study as influencing the likelihood of moral injury (Feinstein, Pavisian, and Storm 2018). The murder of George Floyd in 2020 coincided with the Covid-19 pandemic, producing an unprecedented set of circumstances for journalists and leading to situations of increased work on stories that were both

150  Lauren Walsh ­ angerous and t­ raumatic (Walsh 2022). As photo editor Danese Kenon d has said, we don’t have routine ways of decompressing—especially now when you can’t even hang out with friends or take a trip to the beach, because of Covid. We went through a lot that year and I think anyone who worked as a journalist in 2020 is going to need to spend some time really processing how dramatic and traumatic this was. (Walsh 2022, 109) Zalanga herself said in 2021, “What happened with me in 2020 was that there was not enough time to process the events in the wake of Floyd’s murder because it was all breaking news” (Walsh 2022, 45). Faced with all this, and especially with violations of her values, Zalanga found a way to reestablish moral control. Freeing herself from former expectations, she prioritizes her own way of sharing stories, which may not conform to the rules of a traditional media ecosystem. As Shapiro says, “One way to get better is by restoring a sense of moral purpose.” He continues, “Sometimes this means becoming agents of change in the workplace. Sometimes it means leaving the conventional way one has been operating. Sometimes it means doing a different kind of storytelling” (interview with author, June 2022). In Zalanga’s case, there was no one defining violating experience, but a longer-standing feeling of participating in a process that did not adhere to her own moral beliefs. Hers may be a case of moral distress if it isn’t a situation of moral injury. But with both Zalanga and Gilbertson, one needs to ask: Could either or both have been better prepared or better supported along the way? Case 3: Ukraine

My third case involves a highly experienced war photographer. Clinical literature suggests that those with prior conflict experience are more readily prepared for—and therefore more likely protected from—situations that could result in moral injury in a less seasoned individual (Feinstein, Pavisian, and Storm 2018). In that regard, I would expect Lynsey Addario, an American photojournalist with over two decades of experience photographing conflict and crisis, to be well positioned as resilient in the face of episodes that could otherwise lead toward existential emotional distress. On top of that, she works for major media outlets that are likely better positioned to offer support and resources as needed. But the specific episode I explore adds a new element, one that Addario grappled with publicly, as it was reported in the news, and which other

Photojournalism and Moral Injury: An Inquiry  151 photojournalists have dealt with or will wind up dealing with on their own, even if in a more private capacity. In short, this situation rests on the fact that social media, as a prevalent and ever-updating digital distribution space, has fundamentally shifted how photojournalistic images are received—and in turn, that has altered the landscape for how images may wound. On March 6, 2022, a family attempting to flee the war in Ukraine was killed in Irpin, outside the capital city of Kyiv. A mother, her two children, and a family friend lost their lives as a Russian mortar struck. In the chaos of the moment, Addario, who was close enough to feel the spray of gravel crash into her, didn’t even initially know if she was injured: “Am I bleeding?” she asked (Chamlee 2022). She wasn’t. She moved forward: I was shaken up. And when we were told that we could run across the street by our security adviser, I ran and I saw this family splayed out. And I saw these little moon boots and puffy coat, and I just thought of my own children, of course. And I thought, “It’s disrespectful to take a photo, but I have to take a photo. This is a war crime”. (Dwyer 2022) Addario’s sense of purpose, and the justified recognition that the documentation of war crimes serves a vital function in holding perpetrators to accountability, likely steadied her through the traumatic experience of witnessing the deaths of civilians, children among them. The fact that she is a mother, as her words acknowledge, makes it that much more personal for her. But her mission as a photojournalist seems to carry her through that harrowing event. As she later observed, this is a “historically important image” (Dwyer 2022). So important in fact that the New York Times, for whom she was working, published the photo of the dead family on its front page. Where this experience walks us toward the realm of moral injury is when we think about how the one surviving member of that family, the father, learned of the deaths of his wife and two young children. He saw Addario’s photo on Twitter before he had received any sort of official news about this episode. As the New York Times describes, Ms. Perebyinis, 43, and her two children, Mykyta, 18, and Alisa, 9, along with a church volunteer who was helping them, Anatoly Berezhnyi, 26, were killed on Sunday as they dashed across the concrete remnants of a damaged bridge in their town of Irpin, trying to evacuate to

152  Lauren Walsh Kyiv. Their luggage — a blue roller suitcase, a gray suitcase and some backpacks — was scattered near their bodies. (Kramer 2022) The image of this scene went viral. Serhiy Perebyinis, encountering the photograph on social media, said, “I recognized the luggage and that is how I knew” (Kramer 2022)—a devastating way to learn of the deaths of loved ones. In an interview with CNN’s Erin Burnett, he added, “I recognized my children. I recognized their things and their clothes” (Burnett 2022). While Addario is not responsible for the information landscape and the ways in which photographic movement can outpace the journalist’s intentions and context, I nevertheless wonder how she feels about this. “These images will live in perpetuity,” she has said. “That image will be there for the rest of his [Serhiy’s] life in his head. And I can never take that back” (Chamlee 2022). In short, this compounds an already emotionally fraught situation. The media landscape led to a traumatically unexpected form of revelation for the surviving father and is illustrative of the fact that the current information environment, allowing for vast if unintended distribution patterns, can result in a host of inadvertent consequences—some of which wound members of the public and, by consequence, can raise the possibilities for moral injury in representatives of the press. Beyond Photojournalism The above cases offer insight into aspects specific to photojournalism: needing to get visual proof, the convention of photojournalistic captions, the news image that goes viral, and more. But those examples also address issues of journalism broadly, pulling attention toward certain systemic practices that can result in a journalist’s moral pain. While my own specialty is photojournalism, I nevertheless work with other sectors of media, and I see the phenomenon of what appears to be moral injury occurring at large. I offer the following brief examples to highlight this concern beyond photojournalism. The Reporter

“In my job, I am so often asking people some version of ‘Please tell me about the worst day of your life.’” The reporter went on to say, “That’s hard enough. But then sometimes the subjects of these interviews reach out to me after the piece has

Photojournalism and Moral Injury: An Inquiry  153 published. ‘Help me.’ ‘Get me out of here.’ ‘I’m not okay.’ ‘Can you please send money?’” “But what can I do? And that feels awful. I feel so terrible when I get those messages”. (conversation as part of a workshop discussion, April 2022)8 The bigger picture is that there was little, if anything, the reporter could— or should—do. But her experience of stress and guilt was very real nonetheless. As Stephen Jukes, Karen Fowler-Watt, and Gavin Rees, in their study of journalism and trauma, have said, “The crucial challenge for many was how much does a journalist engage; how much does he or she detach? … Helping others can also help oneself: but there is only so much that can be done” (2021, 10). The Local Producer

My second example within the broader landscape of media workers involves a local producer.9 Asser Khattab, now a print journalist who has worked with organizations like the Washington Post and the Financial Times, began his days in journalism in his early 20s as the civil war raged in his home country of Syria. Assisting foreign TV crews, as a translator and a guide, Khattab found himself in situations that later bothered him; for instance, at times they followed cars that were bringing the injured, victims of the regime’s attacks, to the hospital in the wake of an explosion. Khattab recounts, “There was a woman whose 9-year-old daughter was dying and I was pushed to ask the mother questions: ‘How does this make you feel? What do you have to say?’” He continues, “I was too young to understand the meaning of what we were doing. I was partaking in this. I was not challenging the TV crew.” Moreover, he offers, “I was working with famous journalists. This was a kind of education, and I thought that what they were doing was right” (interview with author, June 2022). Khattab’s emotional response was, one might say, delayed. It wasn’t until he left Syria that he had a personal reckoning, deciding never again to work with TV, especially in conflict zones: “I was remembering those scenes and the way I was pushed. It was not very ethical on our parts” (interview with author, June 2022). While this could have resulted in greater emotional damage, Khattab has been able to rationalize the experience: he was young, he was disempowered by the foreign journalists, and though he wishes he had not intruded on the mother whose child was dying, he understands that the

154  Lauren Walsh greater harm was the loss of her daughter and not his questions. But what his situation reveals are structural inequalities in the journalistic landscape that can lead toward situations where a different local producer or other media worker could experience a far more injurious emotional reaction. Ultimately, this education, as Khattab has called it, highlights some of the harms of prioritizing the visually graphic—including the graphically emotional—over an empathetic reaction: You come upon situations that are gold for television, but maybe we should give up that gold sometimes. I think many of those French or British TV journalists subconsciously feel they’re never going to see this family again, those people don’t speak English, they live in this remote part of the world that will not even see the TV report, so the journalists don’t really worry about them as much. But when many journalists do this again and again, then local people’s distrust and disrespect for journalists grows. (interview with author, June 2022) Potential Avenues to Mitigate Moral Injury The above examples—in photojournalism and beyond—can and should be powerful motivators, encouraging us to rethink how journalism works and the emotional consequences that can occur. There is no way to remove conflict from the world or prevent all trauma; but moral injury and related emotional conditions are real occupational mental health concerns—crises of purposes and identity—and as a profession, journalism should take steps to mitigate the harmful effects and recognize the prevalence of this situation. Potential steps include the following: Identify What Exactly Moral Injury Is and Whether It Is Transient or Longer Lasting

The “fuzziness” of this term is both expected and frustrating. As a psychic pain or even an existential construct, the lack of precision makes sense. But as Shapiro has also observed, If all we do is use moral injury as a substitute for ethical conflict or guilt or shame, we’re not doing ourselves a lot of good. We need a more precise understanding, because that will aid us in both prevention—or minimization and mitigation—and in finding resolution and healing to situations of moral injury. (interview with author, June 2022)

Photojournalism and Moral Injury: An Inquiry  155 Offer Education to Ensure That Newsrooms Understand This Construct

In order for photojournalists, photo editors, and other media workers to understand moral injury, it needs to become a routine part of journalism education. There are a growing number of curricula that address emotional challenges,10 but not enough, and certainly not enough with attention to this specific concept. In addition to university-based learning, trainings by organizations should include attention to self-care, occupational hazards that place mental health at risk, and strategies for resilience.11 Moreover, guiding journalists to have a clear sense of purpose and mission, which can be supported by editors and colleagues, has been shown to be a significant factor of resilience (Novak and Davidson 2013). Such clarity of professional identity and responsibility can help to avoid the selfreproach that sometimes stems from unreasonable expectations of oneself or one’s work. Establish a Duty of Care and Culture of Support

Aleksander, in the fictional Before the Rain, and Zalanga, in actuality, both retake some control over their situation by leaving the confines of the traditional job. While this is one way to claim agency, it also would seem to reflect a lack of support from the industry. In Shapiro’s words, Organizations have a duty of care that is no different from providing the right keyboard to prevent repetitive stress injury. In this sense, it means constantly interrogating our approaches to photojournalism, making sure they are consistent with our values. Newsroom managers must be attuned to the profound ethics concerns of people in the field. (interview with author, June 2022) Crucial questions include: Are newsroom leaders trusted by their colleagues, particularly those working under them? Are problems addressed openly? The values violations of the work of photojournalism should not be echoed in the workplace. Mark Pearson, Cait McMahon, Analise O’Donovan, and Dustin O’Shannessy add, “The lack of organisational and social support for media workers who have witnessed traumatic events or material adds to a feeling of isolation that has been pinpointed as a predictor of negative post-trauma outcomes” (Pearson et al. 2021, 1654).12 Moreover, the potential for psychological distress increases when journalists feel vulnerable about sharing their feelings or worry that they will be seen as “weak” and passed over for future assignments. In short, a culture of support, at peer and management levels, is vital for multiple reasons.

156  Lauren Walsh This demands that we not overlook freelancers, who exist, often, outside the traditional newsroom, working assignment to assignment. They are at a special risk for lack of organizational support, experiences of isolation, and feeling under-resourced. All of those factors leave them vulnerable to moral injury and other emotional distress. Advocate for a Deeper Interrogation of Power Dynamics Implicit Within the Journalism Landscape

Khattab’s example reflects the most obvious situation of a power imbalance, where the local producer occupied the lowest rung of the power ladder despite being most familiar with the circumstances on the ground. His case, though not a situation resulting in moral injury for Khattab, echoes a classic structure of moral injury per Jonathan Shay’s conceptualization, where someone of lower status is forced to breach their moral compass by someone of higher status. Local producers frequently assist foreign photojournalists and other media workers in conflict zones and other hostile environments. In other words, they are already operating in a space of harrowing events. To experience power imbalance dynamics is to magnify the potential harms the local journalist might suffer. Furthermore, Khattab usefully points out that the power imbalances are not solely of a professional hierarchy in nature; they are also reflective of identity, class, and privilege. In his case, it is the Western journalists who use their privilege and power to report in ways he sees as damaging. That question of identity and privilege must also be interrogated outside of traditional conflict zones. To this end, I echo Shira Maguen and Sonya Norman’s request to better study how identity factors, for instance race or ethnicity, may inform reaction to a potentially morally injurious event (Maguen and Norman 2022, 3). In Zalanga’s case, it seems apparent that her identity as a Black woman and her close affiliation with communities she covers played a role in feeling that she had let others down and violated her own belief system. For Zalanga, none of this is divorced from power dynamics. Speaking of a lack of self-reflection in contemporary journalism, she has said that despite a recent push to diversify newsrooms, everyone in the field needs to honestly “consider their roles and biases and privileges” (Walsh 2022, 45). Consideration for How We Award Photojournalistic Work

“The worse off journalists are, the more rewarded they tend to be,” said Gilbertson’s partner at the time, referring to the Robert Capa Medal, a major photo world prize he had won for his work in Iraq; “Ashley felt

Photojournalism and Moral Injury: An Inquiry  157 like he traded [Billy] Miller for his award” (McCauley 2012). This idea of career success due to others’ suffering can loom large. It’s echoed in Before the Rain, with Aleksander winning a major honor, the Pulitzer. Zalanga says that such photography and journalism contests make her uncomfortable: “That’s not why I make pictures. I want viewers to wrestle with what the image shows you. I don’t want the photo reduced to an award or to its aesthetic qualities or its composition” (interview with author, June 2022). But if contests could ensure public engagement or deeper learning around the depicted issues, that could help in easing a photojournalist’s feeling of guilt at benefiting, in career recognitions and awards, from another’s suffering. It would also extend the role of photojournalism. If the photographer’s job is to create documentation to make others aware, this carries that vital responsibility into yet another sphere, beyond the traditional space of the news image’s publication. At the same time, contests should take care in what imagery they are rewarding. Are they perpetuating a cycle that applauds certain kinds of photos? Certain scenes—whether violent or colonialist or demeaning (to the depicted individuals) or otherwise? A frank interrogation of which images matter most and why would also be beneficial. Conclusion In the end, whether it is moral injury or another form of emotional distress, these situations cannot be overlooked. “The older I get, the more I feel the pain from the emotional fractures inside me” (conversation with the author, June 2022). These are the words of a Lebanese photojournalist. He covered conflict in Lebanon in the 1980s, but ultimately left behind war photography. He describes the coping strategies when he, as a young man, covered conflict: drinking, laughing with friends, feeling untouchable, and believing in the work. He still believes in the role of photojournalism in informing the public, but articulated a heavy weariness, a feeling of past traumas looming larger than ever before. As the listener, I felt he was inadvertently telling me the past was catching up with him. He is not the only one to feel this. Up to 13% of non-war journalists experience psychological distress of a severity that suggests probable PTSD (Backhold and Idås 2015, 142). Studies remain to be done to give us a comparable understanding of the rates of moral injury. It is imperative that journalists generally, and the industry of photojournalism especially, understand that the situations that can produce the experience of moral injury exist broadly. It is incumbent upon media organizations to support their workers; and the understanding that this

158  Lauren Walsh kind of work—whether in a war zone or not—can produce psychological stress, should be a topic treated in journalism schools and other forms of journalistic education. This needs to be a conversation the media industry has, again and again, in a preparatory if not preventative capacity.  The more support that photojournalists and other media workers receive, the better positioned they are to face these taxing demands and to produce the vital work that keeps the world informed. The pioneering French physician René Leriche has said, “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures” (quoted in Marsh 2016, xv). Photojournalists have those cemeteries, too. It is time to address them.13

Notes 1 Wade’s essay also explores the “thousand-yard stare” in painting and references its repeated appearance in movies, television, video games, and beyond. 2 The literature on journalism and PTSD includes: Feinstein and Nicolson (2005); Buchanan and Keats (2011); Pyevich, Newman and Daleiden (2003); Feinstein, Owen and Blair (2002); Feinstein, Audet and Waknine (2014). On journalism and ethical dilemmas as well as work-related guilt, see Backholm and Idås (2015) and Browne, Evangeli and Greenberg (2012). On moral injury and journalism, see Feinstein, Pavisian and Storm (2018); Drevo (2016); and Rees (2019). 3 Studies have taken photographers into account, but typically not as a profession unto itself; photographers are generally lumped with reporters and other media workers under a broader heading of journalism. A 2003 study on photojournalists did highlight their risks of PTSD (Newman, Simpson and Handshuch 2003), and a 2019 study, investigating symptoms of PTSD in war reporters and war photographers, looked at these as two unique groups (Feinstein, Osmann and Pavisian 2019); neither study, however, addressed moral injury. 4 In one case, Gilbertson also includes a soldier who became addicted to pills after needing treatment for physical pain. His death, which occurred after his tour in Iraq, was ruled an accidental overdose, but friends and family, Gilbertson says, “believed he killed himself” (2014, 105). 5 In the case of this study, which focused on Covid-19 coverage, this played out in situations where journalists provided voice to individuals who were then exposed to harassment online. 6 Instagram post last accessed on June 28, 2022. 7 The collapsing of local journalism has been well documented in the United States. See, for instance, Hendrickson (2019); Sullivan (2021); and Abernathy (2018). 8 The author heard this spoken at a hostile environment and emergency first aid training session for journalists in April 2022, but withholds other identifying details to protect the speaker’s identity. 9 The author prefers the term “local producer” to “fixer,” which tends to connotatively devalue the significant role that such individuals play in journalism.

Photojournalism and Moral Injury: An Inquiry  159 10 For instance, The James W. Foley Journalist Safety Curricula, https://­ jamesfoleyfoundation.org/journalist-safety. 11 The Dart Center for Journalism and Trauma is an excellent resource, https:// dartcenter.org/. 12 See also Beam and Spratt (2009); Hatanaka et al. (2010); Newman, Simpson and Handshuch (2003); Weidmann, Fehm and Fydrich (2008). 13 I would like to thank everyone in this chapter who gave time to do an interview with me and the photographers who allowed use of images, including Jeffrey Smith at Contact Press Images. I am also grateful to the editors of this book, and to friends and colleagues who helped with ideas, support, and draft review, including Colin Dickey, Anthony Feinstein, Alex Ginsberg, and Santiago Lyon.

Works Cited Abernathy, Penelope Muse. 2018. Expanding the News Desert. The Center for Innovation and Sustainability in Local Media. https://www.cislm.org/wp-content/uploads/2018/10/The-Expanding-News-Desert-10_14-Web.pdf. Azoulay, Ariella. 2008. The Civil Contract of Photography. New York: Zone. Print. Backholm, Klas and Trond Idås. 2015. “Ethical Dilemmas, Work-Related Guilt, and Posttraumatic Stress Reactions of News Journalists Covering the Terror Attack in Norway in 2011.” Journal of Traumatic Stress. April 2015, 28: ­142–48. https://doi.org/10.1002/jts.22001. Beam, Randal and Meg Spratt. 2009. “Managing Vulnerability: Job Satisfaction, Morale and Journalists’ Reactions to Violence and Trauma.” Journalism Practice. https://doi.org/10.1080/17512780902798653. Browne, Tess, Michael Evangeli, and Neil Greenberg. 2012. “Trauma-related Guilt and Posttraumatic Stress Among Journalists.” Journal of Traumatic Stress. 2: 207–10. https://doi.org/10.1002/jts.21678. Bryan, Annabelle O., Craig J. Bryan, Chad E. Morrow, Neysa Etienne, and Bobbie Ray-Sannerud. 2014. “Moral Injury, Suicidal Ideation, and Suicide Attempts in a Military Sample.” Traumatology. 20(3): 154–60. https://doi.org/10.1037/ h0099852. Buchanan, Marla and Patrice Keats. 2011. “Coping with Traumatic Stress in Journalism: A Critical Ethnographic Study.” International Journal of Psychology. 46: 127–35. https://doi.org/10.1080/00207594.2010.532799. Burnett, Erin. March 16, 2022. Interview with Serhiy Perebyinis. CNN. https:// vimeo.com/689079672/f9dc4197c3. Chamlee, Virginia. March 15, 2022. “Photographer Opens Up After Capturing Wrenching Viral Photo of Fleeing Family Killed in Ukraine.” People Magazine. https://people.com/politics/photographer-capturing-viral-scenesof-chaos-death-in-ukraine-opens-up/. Drevo, Susan. 2016. “The War on Journalists: Pathways to Posttraumatic Stress and Occupational Dysfunction Among Journalists.” Unpublished doctoral dissertation, University of Tulsa, Oklahoma. Dwyer, Dialynn. March 8, 2022. “NYT Photojournalist Lynsey Addario on the Moments Before and After a Mortar Strike Killed a Mother and Her Two Children in

160  Lauren Walsh Ukraine.” Boston.com. https://www.boston.com/news/world-news/2022/03/08/ lynsey-addario-photo-mother-two-children-killed-ukraine/. Feinstein, Anthony and Dawn Nicolson. 2005. “Embedded Journalists in the Iraq War: Are They at Greater Psychological Risk?” Journal of Traumatic Stress. 18: 129–32. https://doi.org/10.1002/jts.20020. Feinstein, Anthony, Jonas Osmann, and Bennis Pavisian. June 13, 2019. “Symptoms of Posttraumatic Stress Disorder in Journalists Covering War and Conflict: A Study Comparing Photographers with Print Reporters.” Traumatology. http:// doi.org/10.1037/trm0000207. Feinstein, Anthony, John Owen, and Nancy Blair. September 2002. “A Hazardous Profession: War, Journalists, and Psychopathology.” American Journal of Psychiatry. 159(9): 1570–75. https://doi.org/10.1176/appi.ajp.159.9.1570. Feinstein, Anthony, Blair Audet, and Elizabeth Waknine. 2014. “Witnessing Images of Extreme Violence: A Psychological Study of Journalists in the Newsroom.” JRSM Open. 5: 1–7. https://doi.org/10.1177/2054270414533323. Feinstein, Anthony, Bennis Pavisian, and Hannah Storm. 2018. “Journalists Covering the Refugee and Migration Crisis Are Affected by Moral Injury not PTSD.” JRSM Open. 9(3): 1–7. https://doi.org/10.1177/2054270418759010. Gaudet, Camille M., Karen M. Sowers, William R. Nugent and Jerry A. Boriskin. 2016. “A Review of PTSD and Shame in Military Veterans.” Journal of Human Behavior in the Social Environment. 26(1): 56–68. Gilbertson, Ashley. 2014. Bedrooms of the Fallen. Chicago: University of Chicago Press. Hatanaka, Miho, Yutaka Matsui, Kiyoshi Ando, et al. 2010. “Traumatic Stress in Japanese Broadcast Journalists.” Journal of Traumatic Stress. 23(1): 173–77. Hendrickson, Clara. November 12, 2019. “Local Journalism in Crisis: Why America Must Revive its Local Newsrooms.” Brookings. https://www.brookings.edu/research/local-journalism-in-crisis-why-america-must-revive-its-localnewsrooms/. Jukes, Stephen, Karen Fowler-Watt, and Gavin Rees. 2021 (Ahead of print). “Reporting the Covid-19 Pandemic: Trauma on Our Own Doorstep.” Digital Journalism. 1–18. https://doi-org.proxy.library.nyu.edu/10.1080/21670811.202 1.1965489. Kramer, Andrew E. March 9, 2022. “They Died by a Bridge in Ukraine. This Is Their Story.” The New York Times. https://www.nytimes.com/2022/03/09/ world/europe/ukraine-family-perebyinis-kyiv.html. Maguen, Shira and Sonya B. Norman. 2022. “Moral Injury.” PTSD Research Quarterly. 33(1): 1–9. https://www.ptsd.va.gov/publications/rq_docs/V33N1.pdf Manchevski, Milcho (Dir.). 1994. Before the Rain. Perf. Katrin Cartlidge, Rade Šerbedžija, Grégoire Colin. Aim Productions, Noe Productions, and Vardar Film. Marsh, Henry. 2016. Do No Harm. New York: Picador. McCauley, Adam. 2012. “Overexposed: A Photographer’s War with PTSD.” The Atlantic. https://www.theatlantic.com/health/archive/2012/12/overexposed-aphotographers-war-with-ptsd/266468/. Meagher, Robert Emmet and Douglas A. Pryer. 2018. “Introduction.” In War and Moral Injury: A Reader, edited by Robert Emmet Meagher and Douglas A. Pryer. Oregon: Wipf and Stock Publishers.

Photojournalism and Moral Injury: An Inquiry  161 Newman, Elana, Roger Simpson, and David Handschuh. 2003. “Trauma E ­ xposure and Post-traumatic Stress Disorder among Photojournalists.” Visual Communication Quarterly. 10(1): 4–13. Novak, Rosemary J. and Sarah Davidson. 2013. “Journalists Reporting on Hazardous Events: Constructing Protective Factors within the Professional Role.” Traumatology. 19(4): 313–22. Pearson, Mark, Cait McMahon, Analise O’Donovan, and Dustin O’Shannessy. 2019. “Building Journalists’ Resilience through Mindfulness Strategies.” Journalism. 22(7): 1647–64. https://doi.org/10.1177/1464884919833253. Pyevich, Caroline, Elana Newman, and Eric Daleiden. 2003. “The Relationship Among Cognitive Schemas, Job Related Traumatic Exposure and Posttraumatic Stress Disorder in Journalists.” Journal of Traumatic Stress. 16: 325–28. https:// doi.org/10.1023/A:1024405716529. Rees, Gavin. 2019. “Occupational Distress in UK Factual Television: A Report Supported by Wellcome.” Dart Centre Europe. https://dartcenter.org/sites/ default/files/full_report__occupational_distress_in_uk_factual_television.pdf. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner. Sullivan, Margaret. November 30, 2021. “What Happens to Democracy When Local Journalism Dries Up?” Washington Post. https://www.washingtonpost. com/magazine/2021/11/30/margaret-sullivan-the-local-news-crisis/. Taub, Amanda. 2015. “Moral Injury — The Quiet Epidemic of Soldiers Haunted by What They Did During Wartime.” Vox. May 25, 2015. https://www.vox. com/2015/5/7/8553043/soldiers-moral-injury. Wade, Walter Patrick. 2019. “Witness to the Thousand-Yard Stare: Civilian Imagination of Service Members’ Mental Injuries in Wartime,” Rhetoric Society Quarterly. 49(2): 118–41, https://doi.org/10.1080/02773945.2019.1575461. Walsh, Lauren. 2019. Conversations on Conflict Photography. New York: Routledge. Walsh, Lauren. 2022. Through the Lens: The Pandemic and Black Lives Matter. New York: Routledge. Weidmann, Anke, Lydia Fehm, and Thomas Fydrich. 2008. “Covering the Tsunami Disaster: Subsequent Posttraumatic and Depressive Symptoms and Associated Social Factors.” Stress & Health. 24(2): 129–35.

9 The Moral Limits to Moral Testimony in Soldiering1 Kevin Cutright2

Introduction Alison Hills (2012) points out that moral testimony—the moral judgments received by a person from others—can provide moral knowledge but not moral understanding. As Hills distinguishes them, moral knowledge is knowing what the right action is, while moral understanding is grasping why. Hills (2012, 188–214) maintains that moral understanding is essential to good character and morally worthy action. It also allows the agent to evaluate the moral aspects of her circumstances in a way that moral testimony does not. Hills offers an important defense of moral understanding as necessary to being a responsible moral agent. I offer the occurrence among soldiers of the psychological trauma known as “moral injury” as additional evidence for this claim. I also take Hills’s notion of moral understanding as an important correction for current military training, which systemically pursues moral knowledge only through testimony (to the extent that it directly addresses the moral aspects of war at all). Aiming for moral understanding among soldiers would help to minimize moral injury. However, Julia Driver’s (2015) defense of justified moral deference is an important amendment to Hills’s argument. In some cases, a responsible moral agent is right to defer to the moral testimony of another, and the agent can justify this decision by pointing to her own epistemic or temperamental shortcomings. War’s moral complexities support Driver’s argument, offering one example of collective action that necessitates a division of moral responsibilities and a corresponding moral deference to the recipients of such responsibilities. The morality of war is traditionally, and reasonably, divided between principles governing the resort to war (the purview of political leaders) and principles governing its conduct (the purview of military personnel). Such a division entails making moral deference routine and suggests something like moral expertise, but this term is misleading. Instead of moral experts, we should think in terms of DOI: 10.4324/9781003281122-12

The Moral Limits to Moral Testimony in Soldiering  163 moral trustees. This distinction reflects the important differences between epistemic deference and moral deference. It also helps to make sense of the coexistence of moral understanding and moral deference in our conception of a responsible moral agent. Merely Moral Testimony Invites Moral Injury In this section, I first provide a description of moral injury and how it differs from post-traumatic stress disorder (PTSD). I then claim that military training aims at providing soldiers with moral knowledge almost exclusively through testimony, with almost no attempts at fostering their moral understanding. I employ some of Hills’s insights to explain how moral injury is more likely when soldiers lack moral understanding. Equipped with moral knowledge solely from testimony, soldiers are more susceptible to moral injury because they cannot adequately reflect on the moral aspects of their actions. This susceptibility remains even if the moral testimony was true, meaning it accurately reflected the morally right actions for the given circumstances. Moral Injury

PTSD stems from intense fear associated with a catastrophic event, resulting in symptoms of persistent emotional distress, emotional numbing, depression, nightmares, nervousness, and an inability to conduct normal daily life. Moral injury often shares these symptoms but also involves a lack of self-worth, self-directed reactive attitudes such as anger and resentment, and may result in self-harm.3 Instead of fear, moral injury stems from guilt felt as the result of some action taken, not taken, or something merely witnessed. While it is possible to incur this psychological injury in a wide array of life experiences, it has gained the most attention through its occurrence among military veterans. One journalist summarizes moral injury as a perceived moral failing focused on “what service members do to others, or in some cases fail to do for each other—not what gets done to them” (Dokoupil 2012). Morally injured veterans speak of the futility of their efforts to accomplish the mission, the grief of killing another human being (especially noncombatants), the shame of abandoning wounded civilians, or the betrayal by a superior who issues a flawed order. Fear is the one thing not mentioned, which distinguishes it from PTSD (Litz et al. 2009). The same trauma may generate both PTSD and moral injury, but their different natures necessitate different diagnostic steps and treatment. Moral injury is not a fancy term for the awakening conscience of a war criminal. Researchers highlight veterans who abided by the established rules of engagement, who exhibited genuinely moral motivations, or who

164  Kevin Cutright performed well under pressure but still suffer from debilitating guilt.4 These observations have perhaps been the most sobering aspect of moral injury for the US military. Even if units complete preparatory training and soldiers fulfill ethical and legal expectations during deployment, the soldiers remain susceptible to this psychological trauma. (I suspect service members with high moral acuity tend to be more susceptible.) My argument is that, despite their training, soldiers are not equipped with the moral understanding necessary for reflection on their actions and, furthermore, that this moral understanding would help reduce instances of moral injury. My first claim is an empirical one regarding the content and outcomes of military training. I will devote only a little attention to this claim, partly because it is so plausible and partly because the second claim regarding moral injury remains important even if my concern about military training is unduly pessimistic or inaccurate. Minimal Moral Preparation of Soldiers

As Peter Kilner (2017) argues, “there is a gap between what [American] soldiers experience and what they are intellectually prepared to experience.” US soldiers are morally unprepared for war. In his interviews of over 350 soldiers and research spanning the last two decades, he has found that few of them could answer two questions regarding the morality of war: (1) How can war be morally justified? (2) How can killing in war be morally justified? Presumably, these questions are basic to a moral understanding of war. Yet, in all the training that soldiers complete, both in classroom settings and field exercises, Kilner’s research reveals that the moral dimension of war is addressed only minimally or indirectly and almost never includes discussions of these two questions. Moral expectations are communicated in overarching military doctrinal manuals; written and verbal guidance from commanders in their orders, briefings, and regulations; pre-deployment briefings conducted by military lawyers regarding rules of engagement and other legal expectations for behavior; and sometimes in training scenarios and subsequent discussions, if the supervisor includes the topic. These moral expectations, however, are generally left as expectations, with no explanation of their underlying principles for the soldiers to consider and incorporate into their “systematic grasp of morality” (Hills 2012, 194). There are some exceptions to this general criticism: the US service academies (one source of military officers) all mandate a core course in ethics, which includes several lessons devoted to the ethics of war. Other academy courses also address the moral evaluation of battlefield conduct. The Reserve Officer Training Corps (ROTC) programs at college campuses, the source of most military officers, requires a few hours of instruction in

The Moral Limits to Moral Testimony in Soldiering  165 military ethics that also move beyond the topic of rules to follow (barely).5 The same is true of the third source of officers, Officer Candidate School. It is also important to recognize the education on ethics that occurs later in military careers at each service’s professional development schools for commissioned and noncommissioned officers. These leaders are an authoritative group within the larger military population, so the investment in moral understanding is a meaningful one, but the investment is haphazard and insufficient. The point is even plainer with the enlisted majority of service members, who receive the least instruction in the moral dimension of war.6 Even with these exceptions, there remains the pedagogical risk that instructors present moral concepts merely as moral expectations. If the instruction they provide stops there, instructors miss the opportunity to develop soldiers’ understanding of the principles underlying their moral duties. Choices affecting the class’s style, curriculum, and accommodation of open-ended discussion can all steer the course toward rote training instead of education; or, in other words, toward Hills’s moral testimony (communicating merely the instructor’s own judgments and a corresponding expectation that students master them) instead of moral understanding (fostering the soldier’s own ability to judge what is moral).7 Literature regarding educational theory in general, and soldier development in particular, often contains this distinction between training and education. “You train people for performance. You educate people for understanding” (Burrus 2015). One army officer aptly describes training as oriented on the doing of specific tasks, while education aids a student in more holistic thinking (Foster 2009). This distinction between training and education is useful in discussing the military profession’s approach to moral knowledge vs. moral understanding. Soldiers gain moral knowledge through the moral testimony of the chain of command and the indirect testimony present in training manuals and doctrine. This testimony may very well equip soldiers to take morally appropriate action in certain circumstances. It does not, however, aid the soldier in understanding why the action may be morally appropriate or enable her to adapt moral principles to novel circumstances. A moral education for soldiers focuses on how to think about a situation and evaluate the morally relevant aspects, moving beyond moral knowledge to moral understanding. Moral Understanding Minimizes Moral Injury

As Kilner (2017) warns, “Moral injury occurs when soldiers are unable to reconcile their wartime experiences with their existing (i.e., peacetime) moral frameworks.” One way to consider a soldier’s deficiency in moral

166  Kevin Cutright understanding is in terms of good character. As Hills (2012, 201) describes, being virtuous involves, at the very least, a cognitive and non-cognitive component: good judgment and good motivations. If a person has good motivations but lacks good judgment, she might still reliably perform good actions. Hills (2012, 203–04) illustrates this possibility by describing an incompetent judge who invariably relies on her fellow judge’s opinion for verdicts. The incompetent judge is devoted to justice but is unable to discern what justice entails in the cases over which she presides. If we grant soldiers a similar presumption of good motivations,8 they might still lack good judgment and act solely on the moral testimony of others, particularly members of their chain of command. This moral testimony can supplant good judgment in guiding action, but it cannot supplant the role of good judgment in reflection. It is in this reflection that a soldier experiences a “collision of the ethical beliefs they carried to war and the ugly realities of conflict” (Wood 2014a). Military training and culture instill a general habit of accepting the testimony of superiors, and this habit easily comes to include moral testimony. When that testimony is erroneous, soldiers are well set to suffer moral injury once they begin reflecting on their actions. As Jonathan Shay notes, “The bright line between murder and legitimate killing is something that our most junior enlisted person cares deeply about. When they kill somebody who didn’t need to be killed, they are really wounded themselves” (Wood 2014b). A proper moral understanding in the soldier can prevent morally wrong actions by informing her own deliberation before taking the lethal action, as well as steeling her resolve to resist the erroneous moral testimony she received. Moral understanding also benefits the soldier even in the aftermath of a morally wrong action, since it helps to delineate exactly how the action was wrong and who bears responsibility. While the guilt that underscores moral injury may be revealed by this moral understanding, she is more capable of working through a process of acknowledgment, atonement, self-forgiveness, and related steps following wrongdoing. She is not stuck concluding with some veterans that war simply demands that soldiers “push past immoral behavior” until “it becomes easier” (Wood 2016, chap. 1). Even if moral testimony conveys the correct moral knowledge, the soldier receiving the testimony and acting on it may still suffer moral injury. In reflecting on his actions, the soldier may not be able to properly assess how his actions were moral. The moral testimony that helped in the moment of decision proves no help in the process of reflection. By definition, the moral knowledge received through testimony is the bare fact of knowing that a given action is right in a given set of circumstances. From this testimonial knowledge, one cannot offer a justification for one’s action. The most that one can say is, “So-and-so told me this was right; I trusted him and acted

The Moral Limits to Moral Testimony in Soldiering  167 on his testimony.” In reflection, the soldier needs to be able to justify his actions, not merely review the input that led to them. Hills highlights this need to justify as one important reason to seek moral understanding instead of merely moral knowledge. As she says, “… the practice of exchanging reasons and the motivation to find a justification that could not be reasonably rejected by others is clearly morally very important” (2012, 199). For soldiers, the risk of moral injury is heightened because the availability of others to serve as an audience for this process of justifying one’s actions is more limited. Especially for American veterans, the moral injuries are most often related to events that occurred while deployed to a remote location. Consequently, the soldier’s family and friends are not familiar with the context in which his actions occurred. They struggle to act as an audience of fellow moral agents that can provide meaningful feedback. Furthermore, these same civilians in a soldier’s social network tend to be unaware of the moral principles specific to military actions. Like the average soldier, they lack a moral understanding of war and are unable to participate in the soldier’s process of justification; they are not equipped to offer or consider relevant reasons. This lack may also increase the likelihood of the civilian audience condemning his actions outright and ostracizing him as an expression of this condemnation. As one psychological study notes, “…compared to those suffering from PTSD, those who suffer from moral injury may be more reluctant to utilize social supports, and it is possible that they may be actually shunned in light of the moral violation” (Litz et al. 2009, 699). Ironically, the soldier may face similar challenges even when finding an audience among his military peers, due to the profession’s promotion of moral knowledge through testimony instead of moral understanding. In addition to this need to justify one’s actions to others, instances of moral injury also reveal one’s need to justify one’s actions to oneself. Others are not the only relevant audience for attempts at justification. Given the limits above to finding others, the soldier struggling with moral injury is even more in need of moral understanding that would enable him to make sense of his own actions.9 Regardless of the result in assessing past actions, a soldier is better equipped to minimize moral injury with moral understanding. If she assesses past actions as morally acceptable, she can grieve the necessity of the actions and yet grasp why they were necessary. Moral understanding equips her to provide the justification of actions described above that is inherent to moral agency. It is a justification she needs to offer herself as much as others. Alternatively, even if a soldier’s moral understanding results in an assessment that the past actions were morally wrong, she is better equipped to deal with it.

168  Kevin Cutright Some Key Clarifications

In arguing for moral understanding instead of merely moral knowledge through testimony, I am not trying to say that a well-developed moral understanding will paint a soldier’s past actions with a glowing, rosy hue. I acknowledged a version of this concern just now in terms of a soldier assessing her past actions as morally bad. I also want to address a related concern of the soldier assessing her actions as “overly good.” War is never ideal, nor are the soldiers’ forceful acts that it entails. As human agents, soldiers naturally want to consider their actions as praiseworthy. In addition, some portray war in such a manner as to lose the sense of regret that a reasonable person associates with it. Soldiers possessing a well-developed moral understanding of war will harbor a remorse for it, just as a virtuous surgeon does not relish surgery without a corresponding regret that it is necessary. A well-developed moral understanding simply helps to reduce a soldier’s cognitive dissonance during reflection, reconciling one’s moral intuitions with war’s demands (reducing Kilner’s gap from above), instead of abandoning one or the other. Abandoning one’s intuitions (including an intuitive regret for war) invites war crimes; abandoning war’s demands invites the failure of achieving its ostensibly legitimate ends. Cultivating moral understanding helps to refine both one’s moral intuitions and one’s judgment on what the war effort actually requires; it does not entail judging those demands as morally ideal. As another clarification, I want to underscore that moral understanding can be spurred by moral advice; in this sense, receiving moral opinions from others is not problematic. It is only moral testimony that is received uncritically as knowledge that risks moral injury. Part of the concern above with current military training is that it does not include enough moral advice in training discussions, military schooling, or performance evaluations. Another problem is that in circumstances that warrant moral advice, the moral authority may, instead, communicate his moral testimony as a decree. Military culture promotes strong personalities with a forceful demeanor, and these traits play an important role in proper military conduct. However, these traits can also undermine opportunities for fostering the moral understanding of others. Military leaders should look for occasions to allow subordinates to consider their words as advice instead of decrees for them to blindly accept. Of course, not every situation provides the luxury of time for this development through moral advice, but the opportunities are far more common than many hard-charging leaders recognize. Unfortunately, moral advice will not always result in greater moral understanding. There are appropriate times for a soldier to defer to the moral testimony of another, accepting the testimony as more authoritative than

The Moral Limits to Moral Testimony in Soldiering  169 advice. In these moments, accepting the testimony is not blindly uncritical, but wise. As Driver (2015, 34) points out in a response to Hills, humans are subject to both epistemic and temperamental limitations, and the “responsible moral agent will want to do the right thing more than she will want to exhibit…moral understanding.” These limitations may vary with circumstances, with an individual’s dynamic mental and emotional states, and with the availability of trustworthy moral authorities. However, some of these limitations will endure over time. It is to a soldier’s moral credit if she recognizes her own inability to think quickly or tendency toward recklessness and attempts to overcome these traits through the moral testimony of another. In considering the testimony, if the soldier still fails to grasp the moral understanding that she knows underlies it, she should defer and act according to it. In this way, “responsible moral deference is required of the virtuous person in some circumstances” (Driver 2015). So moral knowledge through testimony (not merely advice) is best kept as a rare procedure in the military profession; the goal in military training and education should be moral understanding. These moments of deference should be minimized for at least two reasons. There is, to my mind, a greater risk of moral wrongdoing if the deferring moral agent habitually and robotically refrains from judgment. The lack of practice ensures the agent is ill-equipped to make moral judgments when the testimony from another is no longer available. Second, the deferring moral agent is at greater risk of moral injury. As described above, the testimonial knowledge received from another provides no support for the agent’s reflection and justification regarding the action. If unable to properly assess the action, the individual may spiral into self-doubt and perceived guilt, especially since military actions can be so morally complex and tragic. There remains yet a further clarification to better account for the moral deference that is customary in the military profession regarding the overall justice of a war. It is a complex clarification involving collective action; thus, I devote the next section to it. This clarification helps to establish the compatibility of moral understanding and moral deference in a responsible moral agent. Justified Moral Deference: Jus Ad Bellum vs. Jus In Bello Judgments For this chapter, I accept the overarching framework of just war theory, which divides war’s morality into two traditional categories: the morality of initiating war (jus ad bellum) and the morality of actions within the war (jus in bello).10 These distinctions reflect the separate moral evaluation of war’s ends and means. In considering ends, philosophers of war generally defend the following six principles: just cause, right intention, public

170  Kevin Cutright ­ eclaration by proper authority, last resort, probability of success, and d proportionality (Orend 2013, 31–104).11 The application of these principles is ultimately the responsibility of the relevant leaders of a political community, though every member of a community employs them in some manner to the extent that they act as responsible moral agents evaluating the judgments of their leaders. Similarly, responsible moral agents within a community employ principles of jus in bello to evaluate the actions of its military personnel charged with the primary responsibility of enacting the judgments of the political leaders. These jus in bello principles restrict who the military may attack and what means the military may use. The principles generally espoused are: discrimination between combatants and noncombatants with a corresponding immunity to attack for noncombatants; minimizing unintended harm in legitimate attacks; proportionality (using sufficient, but not excessive, force; distinct from the jus ad bellum version above), proper treatment of captured combatants, and a prohibition on gratuitous harm (whether through a type of weapon or a type of tactic) (Orend 2013, 105–37).12 The moral judgments under the category of jus ad bellum are probably the hardest test for insisting on moral understanding for soldiers and not merely moral knowledge through testimony. In fact, jus ad bellum judgments are one example of collective actions that require a qualification to this standard of promoting moral understanding. As moral agents, soldiers require this understanding; yet as limited moral agents, they responsibly defer to the judgment of political leaders regarding the application of jus ad bellum principles to initiate a war. This deference is not automatically morally permissible (even if, empirically, it is almost ubiquitous). It is provisional in nature, dependent upon the competence of leaders in making these jus ad bellum judgments, their trustworthiness and transparency in making these judgments, and the general plausibility of their judgments in specific instances.13 Furthermore, soldiers still need an understanding of jus ad bellum principles both to fulfill their military duties and to minimize moral injury. I will explore this qualified preference for moral understanding by beginning with a brief consideration of a contentious topic in military ethics, that of selective conscientious objection.14 Current policies of conscientious objection in Western democracies grant soldiers only the option of refusing participation in all wars due to conviction of conscience or religious principle. Some argue that the policy should be changed to allow soldiers to refuse participation in a specific war, instead of insisting on their rejection of all wars.15 Selective conscientious objection respects the promotion of moral understanding among soldiers instead of requiring their uncritical receipt of moral testimony regarding a specific war that political leaders judge as warranted.

The Moral Limits to Moral Testimony in Soldiering  171 At first, both Hills’s argument in favor of moral understanding and my application of it for the prevention of moral injury seem to support a further argument favoring selective conscientious objection. However, in light of the epistemic and temperamental limitations of all moral agents, as Driver highlights, there may be an important middle ground that accommodates an individual soldier’s status as a moral agent and democratic citizen, yet also accommodates the limits of the soldier’s ability to judge rightly. The debate on selective conscientious objection is not settled merely by the superiority of moral understanding to moral knowledge. Instead, it requires consideration of when there can be responsible moral deference regarding war, despite the general preference for moral understanding. As introduced above, Driver argues that there are moments of legitimate deference to the moral testimony of others, due to the differing epistemic access to information or to the incomplete nature of any one person’s particular moral understanding. Driver’s argument for moments of appropriate moral deference seems to entail that there are some actions that have moral worth even if done merely on the basis of moral testimony. The moral worth is grounded in the moral understanding of the action’s initiator. For example, if the US president had ordered the deployment of military forces to stop the Rwandan genocide in 1994, yet the soldiers acted on this order out of pure deference to the president’s moral testimony without an appreciation themselves for the moral reasons to intervene, it still seems like the action of intervention, and the subordinate actions necessitated to realize this overarching action, would have moral worth. This worth would be grounded in the moral understanding of the leaders, even if not that of the soldiers. Of course, such collective action is complicated. There are multiple moral judgments involved in deciding what subordinate actions are truly necessitated by the action of intervening. Even if the soldiers’ deference is considered appropriate in this case, they would still need to employ some kind of moral understanding in determining the subordinate actions. For these judgments, the soldiers still require a grasp, to some degree, of the moral principles that the president originally applied to justify the intervention, since what makes the soldiers’ actions subordinate to intervention is, by definition, those actions that contribute to the fulfillment of intervention. Yet, if this is the case, then it is unclear how the soldiers were acting on moral knowledge solely through the president’s testimony. If there is such a thing as a “division of moral labor,” then it would seem to be only a provisional division in the application of moral principles for specific judgments, not a strict division involving uncritical deference to those with the primary responsibility for the judgments. This provisional division is compelled by the urgency of the circumstances, differences in epistemic access to information, potential differences in epistemic abilities,

172  Kevin Cutright and potential differences of temperament among all of those involved. In this way, moral deference is unlike the epistemic deference that I grant to my car mechanic. Even if I come to suspect his testimony as unreliable, I will normally not educate myself on the proper operation and repair of my vehicle to form my own judgment; I will seek the testimony of another mechanic. While I might similarly seek a second opinion regarding moral testimony on some matter, it is always with an eye toward the judgment falling back to me, because the action corresponding to the judgment falls to me. Driver maintains responsible moral deference as a virtue. To be responsible, such deference must be based on an assessment of one’s own limitations and the other’s ability to render an appropriate moral judgment. Moral deference is always approached from the starting point of my own judgment and action, shifting from this default only in light of relevant limitations. It is a “coping virtue,” as Driver labels it, involving a concession to these specific limitations affecting my judgment (2015, 36). Epistemic deference, on the other hand, does not involve this same default that prioritizes my own judgment on the relevant matter in question. From my first identification of an epistemic need that exceeds my current knowledge and my reasonable abilities and opportunities to acquire new knowledge, I may immediately seek an expert and accept the testimony that I receive, with no obligation to try to meet the need myself before seeking the expert. I will employ some criteria in evaluating the reliability of the expert, but the criteria will focus on the expert’s credentials and trustworthiness; I will not necessarily add into these criteria my own understanding of the field in which the expert’s aptitude lies. In this regard, the concession I make in appealing to the expert’s testimony is different than the concession made in the coping virtue of justified moral deference. The epistemic concession carries no weight of unfulfilled personal responsibility, but the moral concession inherently involves acknowledging some deficiency that, if it could be corrected, would enable me to make the judgment that I, ideally, should. In a moral matter, I have a prima facie obligation to form a judgment that is only alleviated when epistemic or temperamental limitations are present and a moral judgment is urgently required. So, the division of moral labor that exists within the morality of war— that of the jus ad bellum and jus in bello categories—deserves a different term than “expert” for those who wield primary responsibility for forming moral judgments according to the relevant principles. Instead of moral experts in either of these categories, we should recognize the different kind of deference involved with a term like moral “trustees.” These trustees form moral judgments on matters that still fall under authoritative scrutiny of other members of the community. Furthermore, it is immoral to grant these trustees too much discretion and a correspondingly irresponsible level of deference. In other words, the obedience expected of soldiers

The Moral Limits to Moral Testimony in Soldiering  173 appropriately involves “critical intention, deliberation, and decision,” not unreflective acceptance (Shanks Kaurin 2020, 31). If political leaders are the trustees of jus ad bellum, then military personnel are the trustees of jus in bello. There is a reciprocal moral deference due to reciprocal limitations. The soldiers who execute the leaders’ judgments of jus ad bellum have greater epistemic access than those leaders regarding the facts informing subordinate jus in bello judgments, as well as an urgency for decisions in those judgments. In addition, the soldiers have honed their epistemic abilities and temperament through military training and experience, which presumably equips them to better fulfill jus in bello principles. These factors justify the provisional delegation of jus in bello judgments to the military. All the while, trustees of each moral category remain subject to the scrutiny of the other trustees, as well as community members at large. This framework allows for the coexistence of moral understanding and moral deference in responsible moral agents regarding the morality of war. To illustrate this concurrence, consider the defense often offered by soldiers who have committed war crimes: “I was just following orders” (Osiel 1998). This defense has failed to absolve soldiers of guilt in almost every instance, even if it commonly motivates a mitigation of the punishment. The most notable failures are the Nuremberg Trials of Nazi war criminals after World War II and the court martial of William Calley following the My Lai massacre in Vietnam (Osiel 1998, 948, 957). These trial proceedings involved charges of immoral acts falling under jus in bello. Soldiers are the trustees of this category, deserving the least excuse for failing to apply these principles to the actions under their control. In contrast, soldiers are peremptorily absolved of responsibility in violations of the jus ad bellum category. The deference of soldiers to the moral judgments of political leaders who initiated wrongful wars is unequivocally respected by international law (Orend 2013, 175). Given Driver’s notion of responsible moral deference, soldiers may enjoy too much legal protection, at least those senior in rank and influence. This idea is most easily motivated by considering military leaders who participate in the discussions preceding war. The Nazi general Erwin Rommel, for example, is simultaneously praised for his enforcement of jus in bello principles in the European theater of World War II and decried for contributing so significantly to Hitler’s violation of jus ad bellum principles that rule out such a war of aggression (Walzer 1977, 38–40). Rommel’s position is where the mix of moral understanding and moral deference is the most suspect because the division of moral labor is the least defensible. The cases get easier the more one travels down the military chain of command to personnel without the requisite combination of epistemic ability, temperament, experience, and information, or in the opposite direction to unambiguous

174  Kevin Cutright members of political leadership plainly responsible for jus ad bellum ­judgments with no one to properly defer to. These concessions to moments of legitimate moral deference do not remove the enduring need to foster a thorough moral understanding among soldiers. Soldiers need a grasp of jus ad bellum principles to fulfill their fundamental duties as a democratic citizen, to fulfill their military duties in conducting the war’s operations, and to provide themselves and others a moral justification for their actions. Lacking such understanding, soldiers will struggle to “contextualize or justify personal actions or the actions of others” and accommodate “these potentially morally challenging experiences into pre-existing moral schemas” (Litz et al. 2009, 705). These inadequate moral schemas contribute to two specific judgments that underlie moral injury: the soldier’s opinion regarding the moral status of his act, and his opinion regarding his responsibility for the act. Getting either judgment wrong can prompt moral injury; moral understanding improves these judgments and thus helps to prevent moral injury (ibid.). Admittedly, greater moral understanding can make a soldier more susceptible to moral injury in at least one way. The soldier may evaluate the moral aspects of an international issue more accurately (or even just more acutely) than the senior political leaders, to the point that the leaders’ decision for war is taken as a betrayal. One possible example, depending on the moral status of the 2003 invasion of Iraq, is the struggle of Navy officer Steven Dundas, who deployed to Iraq with full confidence in the justice and humanitarianism of the mission but “returned home broken.” He explains, Seeing the devastation of Iraqi cities and towns, some of it caused by us, some by the insurgents and the civil war that we brought about, hit me to the core. I felt lied to by our senior leadership. And I felt those lies cost too many thousands of American lives and far too much destruction.16 (Wood 2014b) This route to moral injury is a risk inherent to war (and to collective action, in general). This risk can be mitigated by the political leaders employing the same level of moral understanding that I am recommending for soldiers. Even with the presence of this risk (mitigated or not), though, improving soldiers’ moral understanding remains vital for the reasons noted above. Conclusion Hills’s distinction between moral knowledge and moral understanding helps in a critique of US military training, which too often settles for moral

The Moral Limits to Moral Testimony in Soldiering  175 knowledge through testimony instead of fostering moral understanding. One consequence of this shortcoming is an increased risk of moral injury among military personnel, since they are less able to reflect on actions taken or not taken and offer an underlying moral justification. Moral understanding improves their moral reasoning in reflection, equipping them to justify their actions to others and, just as importantly, to themselves. Despite the superiority of moral understanding, it is still compatible with responsible deference to the testimony of others on moral matters, which is an important amendment that Driver makes to Hills’s argument. This deference reflects an honest assessment of one’s epistemic and temperamental limitations that may necessitate acting on the moral testimony of a trusted and reliable authority. Such action is morally worthy, even if less so than possessing the moral understanding to form the moral judgment for oneself. As the morality of war demonstrates, this suboptimal concession is a common and persistent part of real life, especially given the nature of collective action that spurs a division of moral labor where some community members have primary responsibility for certain moral judgments. However, these judgments remain subject to the assessment of the remaining members of the community, making those in charge of certain moral categories (such as jus ad bellum and jus in bello) more accurately described as moral trustees than moral experts. The deference offered to these moral trustees is different than the epistemic deference granted to experts in non-moral areas. Notes 1 Copyright 2022 from The Empathetic Soldier by Kevin Cutright. Portion of material reproduced by permission of Taylor and Francis Group, LLC, a division of Informa plc. 2 The views expressed in this chapter are those of the author only and do not reflect the official views of any agency of the US government. 3 The term “moral injury” is largely attributed to Jonathan Shay (1994) in his work Achilles in Vietnam: Combat Trauma and the Undoing of Character. Journalist Tony Dokoupil (2012), however, attributes it to Mac Bica, a Vietnam veteran and philosophy professor. Regardless, as Shay’s title implies, only the term is new – the phenomenon is as old as war. 4 See, for instance, Wood (2016), Wilson (2014), Litz et al. (2009), and Shay (1994). 5 To its credit, the ROTC program at Texas A&M University mandates a semester-long ethics course. My thanks to Jon Thompson for pointing out this exception. 6 I draw these facts from my own experience; they are also corroborated by Burkhardt (2017). 7 I would be remiss if I did not recognize the efforts of the US Army’s Center for the Army Profession and Ethic, which led a campaign for greater clarity and attention regarding the professional ethic that ought to ground military

176  Kevin Cutright service and the development of soldiers’ moral understanding. In 2019, CAPE was combined with the Center for Army Leadership to form the Center for the Army Profession and Leadership (https://capl.army.mil/). 8 Lacking good motivations, and having bad ones, are important possibilities that I do not take up here. 9 I am not trying to imply that soldiers must wrestle with the dissonance between their actions and their moral beliefs alone. I only mean to point out that the difficulty of finding an appropriate audience heightens the benefit of refining the soldier’s moral understanding. 10 For many, the seminal text remains Michael Walzer’s (1977) Just and Unjust Wars: A Moral Argument with Historical Illustrations. More recently, contemporary thinkers have added a third category for the morality of actions in the aftermath of the war (jus post bellum), considering principles that ought to apply to post-conflict actions such as peace treaties, war crimes trials, and amnesty policies, among other things. For a recent defense of just war theory in view of realist and pacifist criticisms, as well as an extensive introduction to jus post bellum, see Brian Orend (2013). 11 For the sake of brevity, I will only list these principles and not explain them. My argument regarding moral understanding and moral deference do not rest on any particular interpretation. 12 Again, I offer no explanation of these principles or the debates they generate. It is enough for my present purpose that there is such a category of moral principles falling primarily on the soldiers for their fulfillment. 13 I take the first two of these conditions for justified deference from Driver (2012, 35). 14 For a general historical overview, see Charles Moskos and John Chambers (1993). 15 See, for example, Paul Robinson (2009). 16 It is important to note that Dundas’ concern does not seem irrational in principle; in fact, there is something commendable in his refusal to simply insist on the justice of the war no matter the devastation he witnessed. This aspect further reinforces the limited nature of moral deference proposed above.

Works Cited Burkhardt, Todd. 2017. Just War and Human Rights: Fighting with Right Intention. Albany: State University of New York Press. https://doi.org/10.1353/ book.50036. Burrus, David. 2015. “Teach a Man to Fish: Training vs. Education.” The Huffington Post, 10 June. https://www.huffpost.com/entry/teach-a-man-to-fishtraining-vs-education_b_7553264. Dokoupil, Tony. 2012. “A New Theory of PTSD and Veterans: Moral Injury.” Newsweek, 3 December. https://www.newsweek.com/new-theory-ptsd-and-veteransmoral-injury-63539. Driver, Julia. 2015. “Virtue and Moral Deference.” Ethics and Politics XVII, no. 2: 27–40. Foster, Chad. 2009. “The Case for Outcomes-Based Training and Education.” Armor. https://www.benning.army.mil/armor/eARMOR/content/issues/2009/ NOV_DEC/ArmorNovemberDecember2009web.pdf.

The Moral Limits to Moral Testimony in Soldiering  177 Hills, Alison. 2012. The Beloved Self: Morality and the Challenge from ­Egoism. New York: Oxford University Press. https://doi.org/10.1093/acprof: oso/9780199213306.001.0001. Kilner, Peter. 2017. “Military Leaders’ Role in Mitigating Moral Injury.” Thoughts of a Soldier-Ethicist (blog). 11 November 2016, Updated 6 January 2017. http:// soldier-ethicist.blogspot.com/2016/11/the-military-leaders-role-in-mitigating. html. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (December): 695–706. https://doi.org/10.1016/j. cpr.2009.07.003. Moskos, Charles, and John Chambers, eds. 1993. The New Conscientious Objection: From Sacred to Secular Resistance. Oxford: Oxford University Press. Orend, Brian. 2013. The Morality of War. 2nd edition. Toronto: Broadview Press. Osiel, Mark. 1998. “Obeying Orders: Atrocity, Military Discipline, and the Law of War.” California Law Review 86, no. 5 (October): 939–1128. https://doi. org/10.2307/3481100. Robinson, Paul. 2009. “Integrity and Selective Conscientious Objection.” Journal of Military Ethics 8, no. 1: 34–47. https://doi.org/10.1080/15027570902782035. Shanks Kaurin, Pauline. 2020. On Obedience: Contrasting Philosophies for the Military, Citizenry, and Community. Annapolis, MD: Naval Institute Press. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner. Walzer, Michael. 1977. Just and Unjust Wars: A Moral Argument with Historical Illustrations. New York: Basic Books. Wilson, Mark. 2014. “Moral Grief and Reflective Virtue.” Virtue and the Moral Life: Theological and Philosophical Perspectives. Eds. William Werpehowski and Kathryn Getek Soltis. Lanham, MD: Lexington Books, 57–73. Wood, David. 2014a. “Moral Injury: The Grunts.” HuffPost, 18 March. https:// www.huffpost.com/entry/moral-injury-the-grunts-t_n_4985610. ———. 2014b. “Moral Injury: The Recruits.” HuffPost, 19 March. https://www. huffpost.com/entry/moral-injury-the-recruits_n_4992991. ———. 2016. What Have We Done: The Moral Injury of our Longest Wars. New York: Hachette Book Group.

10 Meaning-Making and Moral Injury The Role of the Narrative in Understanding Trauma Joshua Mantz When I’m thinking about trauma, I like to think about Plato’s Cave (Plato 514a–520a). This allegory from ancient Greece asks us to imagine that there’s a group of prisoners trapped inside of a cave. The prisoners have been trapped in this cave since early childhood, and they’re chained to the wall so that they can’t escape. Their only known reality is the world inside of the cave and they know of no other forms of existence. One day, one of the prisoners manages to break free. He discovers the cave’s entrance and crosses through the threshold of its borders. For the first time, he steps into the boundless light of nature. His eyes begin to focus on the horizon as an entirely new form of reality is revealed. He finds himself overwhelmed with the realization of a higher truth. After gaining his bearings, he rushes back into the cave to free the other prisoners. However, much to his surprise, the other prisoners are unable to comprehend what he’s trying to tell them, and they choose to remain in the cave. There are two relationships I’d like to make between Plato’s Cave and trauma, which will show up as central themes throughout this paper. The first relates to the intensity of an experience, and the second relates to the challenge of articulating that experience. Trauma is a form of high-intensity experience that introduces the perceiver to a new form of reality, just like the escaped prisoner. In trauma, this new reality may not be a pleasant one, but it is still an experience that reveals a more comprehensive truth about our world. That trauma exists is a reality that some people may never come to know. The second point relates to the challenges of understanding this new reality, first for ourselves, and then in articulating it to others. I’ll demonstrate throughout this chapter how the meaning-making process, along with philosophical inquiry and a commitment to the pursuit of one’s inner truth, creates the conditions for healing and perpetual growth through trauma.

DOI: 10.4324/9781003281122-13

Meaning-Making and Moral Injury  179 Intensity, Complexity, and Chronicity Trauma can be understood by thinking about it as a function of intensity, complexity, and chronicity. By intensity, I’m referring to the emotional power, or magnitude, of a given experience. By complexity, I’m referring to the total number of emotions, thoughts, and sensations that are involved during a given experience. By chronicity, I’m referring to the total number of times that an individual has experienced similar clusters of events throughout their lives. When inquiring about trauma, we can ask how intense an emotion is, how many emotions there are, and how many times they’ve occurred across time. Consider the following four scenarios to think through some differences between chronic and complex trauma. Imagine a sole person driving down back-country road. The driver gets tired and swerves off the road. The car falls off a small embankment and flips over, rolling two or three times before it comes to a stop. No physical injuries are present, but the driver is emotionally shaken. This is because he just experienced fear at its highest intensity – terror – which is closely associated with life-threat. Notably, the experience of even a single emotion, like terror, is enough to produce long-lasting effects from trauma. Now, let’s imagine that the driver was travelling along the same road, only this time he’s carrying a passenger. Perhaps this person is a child, a close friend, or a spouse. The driver comes around a corner and suddenly encounters a large cow crossing the road. He swerves to miss the animal and, in doing so, loses control of the car. The car falls down the embankment, flips over, and hits a tree. The passenger is killed, and the driver survives. Here, we can expect that the driver still experiences terror, just as he did in the first example, only this time, the death of the passenger introduces the dimension of traumatic loss into the equation. We therefore have multiple high-intensity emotions firing during the second scenario (e.g., terror and grief) whereas, in the first scenario, we only have one (e.g., terror). In this way, the second situation is more complex than the first, because more elements require integration and processing. Imagine now that there’s a third scenario and, just like the second, there’s a driver and a passenger. Only this time, the couple is hit by an intoxicated driver. The spouse is killed, and the driver survives. Unlike the prior two examples, this situation introduces the dimension of moral trauma into the equation, in addition to traumatic loss and life-threat. The driver not only has to contend with grief, loss, and terror, but also with any forms of anger that may arise in response to the actions of the other driver. As powerful as these events may be, in and of themselves, we can imagine a fourth scenario that represents being exposed to multiple car accidents, or experiencing many traumatic events, over time. In thinking about

180  Joshua Mantz this, we don’t need to limit ourselves to just vehicle accidents. All forms of trauma have the potential to shape, shift, and uniquely influence the human being who’s experiencing them across time. The lingering effects of a traumatic event that occurred several years ago may unduly influence the present moment, especially when experiences remain unprocessed and unintegrated. The concept of chronicity accounts for the cumulative effect of experiencing repeated, high-intensity events over time. We can therefore refer to the 1st scenario as “trauma,” to the 2nd and 3rd scenarios as forms of “complex trauma,” and to the 4th scenario as a form of “chronic and complex trauma.” A high-intensity experience has “the quality of being felt strongly or having a very strong effect” (Cambridge Dictionary, 2022). The emotions, thoughts, and feelings that are generated through trauma are perceived along a spectrum of intensity. Emotion researcher Robert Plutchik suggests that a more intense arousal of emotion produces different forms of behaviour and experience (Plutchik 1991, 13–15). This means that we perceive things differently and respond differently during experiences of higher intensity. For example, terror is a different experience than fear. Rage is a different experience than anger. Ecstasy is a different experience than happiness. This is because terror, rage, and ecstasy are experienced at higher intensities than are their counterparts of fear, anger, and happiness, respectively. The fear dimension of emotion, for example, moves along a gradient of increasing intensity, ranging from apprehension to terror. Consider a person who’s slowly walking up to a cliff’s edge. Standing afar from the cliff, the person probably feels safe and is not yet emotionally engaged. As the person begins to walk towards the edge, they start to experience apprehension, which is a lesser intense form of fear. If the person then slips, and nearly falls over, they may experience fear itself, which is a more intense form of apprehension. Finally, if the person falls over the cliff, and finds themselves tumbling down its face, they’ll probably experience a form of terror, the highest intensity emotion within the fear dimension. When we’re talking about psychological trauma, we’re talking about falling over the cliff. Whether I’m tumbling down a cliff or bleeding out on a battlefield, I’m being forced into a new, novel, and highly intense form of experience. For most of us, tumbling down a cliff is a novel experience; so too is being shot. By novelty, I’m referring to any form of experience that is strikingly new or previously unknown to an individual. Novelty has little to do with making judgements of “good” or “bad,” only with the newness of the experience. The cliff tumbler, Plato’s escaped prisoner, and the car driver are all witnesses of shockingly new and more comprehensive forms of reality. In this way, trauma is a high-intensity but negatively perceived

Meaning-Making and Moral Injury  181 experience. For many of us, trauma is a novel episode in our lives. Those who ­experience it often need new language to process it effectively. Trauma is an experience of intense novelty. This is why articulation proves difficult. In the earlier years of my recovery process, “How do you feel?” was the most difficult question I could’ve been asked. It felt impossible to answer with any sort of integrity, not because I didn’t want to, but because I didn’t yet have the words. Discovering those words would entail a decade-long creative journey, which still continues today. “Pure emotions,” as Plutchik points out, are simply “hypothetical constructs” (Plutchik 1991, 41–42). They are tools of theorists and not the phenomena we know from our emotional lives. The emotions we routinely experience are instead “mixed”: they are “combinations of the primary emotions” (Plutchik 1991, 41–42). This is part of why there’s no easy way to describe how we feel – especially for novel and intense experiences. We must become the artists of our own experience. Complexity, as a variable of trauma, describes the totality of environmental factors that influence a given situation (including, but not limited to, emotions). During a traumatic event, it’s possible to experience a wide array of emotions, thoughts, and sensations. Sometimes, these feelings can vary widely and even be conflicting. For example, we may experience feelings of love and hate during the same event. Describing such feelings accurately therefore requires some combination of love and hate. Achieving a synthesis between these two in an account of these feelings is a creative act that leads to the production of meaning and a more granular understanding of the self. Trauma is a form of emotional alchemy. Finding the words to express it is to turn it into gold. Finally, chronicity refers to the number of high-intensity clusters of events to which one has been exposed across time. The effects of trauma build up over time, and the energy from unprocessed events tends to compound. However, life isn’t just about trauma. The intensity-complexity relationship works both ways. We can have intense experiences that are profoundly positive just as we can have intense experiences that are profoundly negative. And, regardless of whether an event is perceived as positive or negative, the complexity and intensity of the experience still creates difficulties with articulation. It can prove as difficult to describe a positive experience that is immensely powerful, such as a spiritual revelation, as it is a negatively perceived trauma. The restoration of balance within the self requires accounting for the arc of both of these extremes. Experiences can be visualized by constructing a life timeline, which can be done graphically or in other creative forms, where an individual identifies key experiences across their lives and assigns each with a subjective rating, indicating their intensity and effect. Graphically, for example, the “x” axis could represent a person’s age and the “y”

182  Joshua Mantz axis could represent a person’s rating of the experience, between a range of, say, −10 to +10, with zero representing an individual’s baseline state, or datum, of emotional non-arousal. A rating of +10 indicates an overall positive experience of great intensity – a peak experience. A rating of −10 indicates an overall negative experience of great intensity – a trauma. Points can be plotted on the graph which represents each experience. Once the points are connected, a timeline emerges consisting of various peaks and troughs, and a visual depiction of the person’s emotional life begins to appear. We’re then in a better position to evaluate our emotional condition as it changes across time. There are a number of reasons why I find the construction of a timeline valuable in understanding trauma. First, timelines help us remember positive aspects of our lives that were previously repressed by the negative forces of trauma. This can lead to a more balanced and fair assessment of the self. The timeline is a method for gathering evidence from our past experiences and arranging that evidence into a more coherent narrative structure. Evidence is available to us not only from the memories of our minds but also from tangible and digital sources as well. Physical sources might include going through the old “war chest” stashed under the bed or, digitally, in consolidating the thousands of photographs stashed on our hard drives. When I went through this process myself, I realized that my mind was as cluttered as my hard drive. How could I possibly process my experience with any sort of accuracy if I was in a state of disorganization and confusion? Consolidating my hard drive and other memory sources was therefore akin to consolidating my inner-self. The timeline process can lead to a renewed sense of coherence with past and present and, in doing so, can create space for a perpetually unfolding future. Second, a timeline can give us an appreciation for how much we’ve been through along the way. In this regard, my emphasis on chronicity comes primarily from a place of validation. Humility is, to my mind, among the most essential virtues for navigating trauma. The ability to visualize one’s timeline showcases the sheer volume of events that one has experienced throughout life. Sometimes, we may come to realize that we’ve been through considerably more than we previously realized. The sheer number of ups and downs, peaks and troughs, and successes and failures may be staggering when graphically visualized. The number of times we’ve experienced death and loss, relationship break-ups, divorce, disease, and other forms of trauma stand in stark contrast to the peak experiences of our lives, times when we were performing optimally and feeling great. Life tends to move so quickly that we neglect opportunities for reflection, recapitulation, and contemplation. Visualizing one’s timeline can help create the conditions for self-directed empathy. We are, after all, human. And

Meaning-Making and Moral Injury  183 while we’re undoubtedly flawed and capable of failure, we’re also highly resilient and capable of perpetual growth. Third, a timeline can help us ask more insightful questions about ourselves. Specifically, when I’m looking at a timeline, I’m not only looking at the peaks or troughs, but what took place between them. I’m as interested in understanding a disruptive experience as I am in understanding the factors that allow an individual to recover from it. A rock-bottom, “negative 10” experience in one year followed by a “positive 7” experience the following year demonstrates, clearly and logically, that something has changed between these two points. Our task is to figure out what these factors are. What are the variables that have allowed us to get back on our feet and continue the journey? Over time, patterns of resilience begin to emerge that can be elevated, lifted up, and reinforced to cultivate personal growth and embrace a more optimistic and meaningful future. In summary, a timeline is a tool for narrative development. Narrative leads to meaning, and meaning-making leads to the restoration of integrity. There’s a saying that complexity is better than confusion, and simplicity is better than complexity. I find value in applying the same concept to understanding trauma, because trauma initially presents itself in the form of sheer and utter confusion. Thoughts, feelings, and emotions converge inside of a “traumatic vortex” and unfold into a radically new experience. Many different shades of emotion can exist right alongside conflicting thoughts and actions. By now, we should have an appreciation for the challenge that intensity poses to our expressive capacity. The aim in resolving trauma, then, is to move from a state of confusion, into a state of “controlled complexity” and finally into a state of simplicity. We can accomplish this movement largely through the process of storytelling. Trauma in 15 Seconds – Life-Threat, Traumatic Loss, and Moral Injury In my view, narrative development requires breaking down an experience into its respective components in order to better understand each element in isolation. Then, those elements can be recombined to form a new meaning. Like emotion, trauma can be temporarily reduced to categories in order to better understand its components. While these categories don’t need to be viewed as absolutes, they can serve as useful handrails for gaining more information about our experiences. In combat, for example, there are three broad types of psychological trauma that tend to dominate the landscape: life-threat, traumatic loss, and moral injury (Litz et al. 2018, 287). Life-threat involves an actual or perceived threat to one’s own life, or witnessing a threat to someone else’s life and is generally associated with fear. Traumatic loss involves the sudden

184  Joshua Mantz or unexpected loss of someone or something we care about deeply and is generally associated with grief. Moral injury involves exposure to events that disrupt deeply held beliefs or expectations about ourselves, other people, or the world around us and is generally associated with emotions like shame, guilt, anger, and betrayal. I’ll add that a significant relationship exists between traumatic loss and moral injury. We can see it in cases of what is called survivor’s guilt, which refers to the challenge of having survived when someone else did not. In what follows, I’ll demonstrate how all of these forms of trauma can emerge within the same traumatic landscape and occur during the same event, either simultaneously or within rapid succession of one another. Consider Baghdad on April 21st, 2007. That day, as a young lieutenant, I was leading my scout platoon on a dismounted patrol when we were engaged by a sniper. The bullet first severed the aorta of our senior noncommissioned officer, Staff Sergeant Marlon Harper – killing him – before striking my upper right thigh and severing my femoral artery. My body recoiled backwards from the shock of the bullet, and I noticed Harper’s body fall to the ground. Instinctively, I ran to Harper’s aid and dragged him across the battlefield to a safer location. I began to render medical assistance to him and removed his tactical vest, exposing a large chest wound. For a brief instant, in recognizing the severity of his injury, I froze in place. I vividly remember thinking “he’s done.” Within seconds, our medic arrived and took over treatment. I collapsed to the ground from blood loss and exhaustion. The sequence of events I just described, which represents only the first part of a much larger experience that day, occurred in approximately 15 seconds of real time. This is probably the same amount of time it took most people to read this paragraph! In this very short duration, life-threat, traumatic loss, and moral injury are all vividly present. To demonstrate this, I’ll break the experience down into three distinct clusters, which I’ve named The Shot, The Drag, and The Fall. I’ll then evaluate each of these components of the experience across the dimensions of trauma. The Shot represents the first instance of the experience that occurred in less than a second of real time. Phenomenologically, the first instance was marked by the dull sound of a sniper’s bullet, a cloud of dust slowly moving through the air, and an alchemical mixture of terror, disbelief, shock, and dread. It was a realization that something very bad was actually beginning to happen, that I was inescapably caught within its vortex, and that I was effectively “tumbling down the cliff.” Physiologically, my body had already taken over. I was a conscious observer going along for the ride and I had no rational or cognitive control whatsoever. The autonomic response is activated during fear-based situations, triggering the fight-flight-freeze response. When this happens,

Meaning-Making and Moral Injury  185 the limbic system seizes control from the rational mind and takes over the situation. All bodily functions deemed unnecessary to the immediate resolution of the experience at hand are discarded. In this sense, we become vulnerable to our own bodies during the autonomic response. My body initially assumed a flight configuration, as evidenced by my arms initially flying backwards. This situation represents the life-threat dimension of trauma because there was both an actual threat to my life, and the witnessing of a threat to, Harper, whose life was in danger. This brings us to the second experiential cluster, The Drag, which was phenomenologically marked by the recognition of Harper’s face, a comrade in trouble. Here, I experienced tunnel vision with a distorted sense of time and witnessed Harper’s body slowly fall to the ground. Physiologically, my body assumed a fight configuration as I dragged Harper to safety. I was still under the influence of the autonomic response and had no rational control. I felt no pain, exerted no effort, and was little more than an observer riding a wave. The body seemed to know exactly what to do. In the context of our discussion on trauma, The Drag represents the precise moment in time where the seeds of traumatic loss were planted. I emphasized earlier that traumatic loss is the sudden or unexpected loss of someone or something we care about deeply. Here, I’m using a rather potent example to describe it, wherein someone was actually killed, but I want to emphasize that the concept of traumatic loss extends far beyond the loss of people. For example, feelings of loss can be generated through the loss of a career, the loss of a relationship, or the loss of innocence or trust. In fact, I’d go as far as saying that, in trauma, loss isn’t just sometimes present, but that it is always present. When we’re dealing with trauma, we’re dealing with some form of loss. Finally, we move to The Fall, the third experiential cluster, which was phenomenologically marked by the recognition of Harper’s chest wound and accompanied by emotions of confusion, shock, and hesitation. The feeling was nihilistic, one of hopelessness. Physiologically, my body assumed a freeze posture. Fortunately, while I hesitated, our 19-year-old medic didn’t. He arrived within seconds and got to work. I sensed the safety of his presence as he took over treatment, and it was at that point that my body gave way, and I began the transition into death. This marks the end of the first part of the experience that day. In the context of our discussion on trauma, The Fall represents at least three potentially morally injurious situations. First, in my hesitation to act. In theory, I could’ve applied pressure to the wound immediately. While this action might not have influenced the outcome, it may have helped. Second, in the feeling of nihilism itself. Soldiers “never quit.” This is a value embedded within the Soldier’s Creed itself. Even though my hesitation was

186  Joshua Mantz very brief, I had to contend with the guilt that I briefly gave up on Harper when I thought, “he’s done.” And, for the third, we must examine the situation from the position of the medic, who had to make a conscious choice between who was going to live or die. Both Harper and I had severed arteries, and both of us had less than two minutes to live. The medic couldn’t save both of us. From the standpoint of training and medical triage, the medic did everything textbook perfect that day, but it’s still the medic who must contend with the moral weight of such a decision. This is called an irresolvable moral dilemma, a situation in which there is no positive outcome, regardless of the choice taken (Kubany and Watson 2006, 63). In these situations, the movement of time forces decisions to occur or to not occur “in enough time.” We can see from this example that all three primary forms of trauma can show up in a very short time span and even occur as part of the same event. We can also see that all three forms of the autonomic response are present within the very same experience. To summarize, The Shot is associated with life-threat and flight, The Drag is associated with traumatic loss and fight, and The Fall is associated with moral injury and freeze. Moreover, all of this occurred in just 15 seconds of real time. Even then, this represents one experience, on one day, of just one deployment. How much more could occur over a lifetime? Trauma is dense with data, waiting to be cleaned and processed. It’s possible to “mine for meaning” within this data set, provided that we’re willing to sift through it. When multiple intense variables converge into a single point, the complexity and intensity of that experience increases, rendering articulation difficult. It took me 15 years to process 15 seconds of real time. I don’t think it has to take 15 years, which is one of the reasons why we’re writing this book, but it can take 15 years, or more, and that’s ok. Truth has no time limit. Articulation is difficult, but it’s a journey worth taking. The Hero’s Journey Events from 2020 to 2021 ripped open the moral landscape of our world. We don’t have to look far to identify moral injury. A global pandemic, racial tensions, natural disasters, and political instability all carry with them moral implications. A virus is as much of a life-threat as a bullet, and all of us were vulnerable to this “invisible enemy.” As of early 2023, there have been nearly 700 million cases worldwide, and nearly 7 million people have lost their lives (New York Times, 2023), which implies that many more had to contend with traumatic loss, grief, and survivor’s guilt. And like my medic’s irresolvable more dilemma, how many medical

Meaning-Making and Moral Injury  187 professionals were forced to play God? Who gets the ventilator when two people urgently need it and only one is available? Moreover, the sheer volume of deaths that our medical teams had to process would weigh heavily on anyone’s soul. Then, of course, was the death of George Floyd and the social justice movements that followed. All of these events contributed to sharp political divisions that fractured the fabric of our nation, if not ourselves. They demonstrate that the moral dimension of trauma is ever-present. Events like these may feel difficult if not impossible to resolve. In many ways, however, healing from moral injury is a process of reconstituting the self. Joseph Campbell was a prominent mythologist in the twentieth century who evaluated various mythologies across history and identified common themes that many of them shared. In doing so, he formulated the concept of “the hero’s journey.” The hero’s journey consists of three broad phases: the separation, the initiation, and the return (Campbell [1949] 2008, 23). After accepting the call to action, the hero undergoes an intense period of training and development, which prepares them for the challenges to come. After this separation is complete, the hero departs the society and embarks on a great journey. During this initiation, the hero encounters significant challenges where they usually learn something profound about themselves and the world. In the final phase, the hero comes home and shares the wisdom that they’ve gained with the tribe. From a modern perspective, we can think of the initiation as a soldier going through basic training, preparing for battle. The separation is akin to the combat deployment itself. And the return represents the reintegration of the soldier into society. We can also think of the hero’s journey in the context of trauma, where the separation is the traumatic event itself, and the return represents our opportunity to synthesize the meaning of the experience and share it with others. As a culture, we tend to be very good at accepting calls to action and stepping up to the plate. We also tend to be very good at training, deploying, and overcoming difficult situations. But some of us might struggle with the return, and culturally we seem to have lost focus on the ancient discipline of philosophical contemplation, myth, and meaning-making. In my view, sometimes the greatest challenge isn’t surviving the trauma itself, but in finding the words to articulate it. The most important hero’s journey we’ll ever take is an inward one, leading to meaning. Meaning-making is a process by which the thread of life, having been severed by trauma, is repaired and reconstituted. Trauma cuts the storyline. It creates a broken plot; it leaves an unfinished chapter. It disrupts the integrity of the self and alters the arc of life. As human beings, we have an “unceasing trend towards unity” and a “directional tendency towards wholeness” (Maslow 1954, 30; Rogers 1980, 120). Trauma disrupts the

188  Joshua Mantz energetic flow of self-actualization. This separation of the self deprives individuals of wholeness and “imposes a painful fragmentariness” upon their lives (Jung 1989, 193). The challenges that trauma poses to articulation create the conditions for isolation. Isolation is eliminated through connection. Connection is established by achieving resonance between the self and another. Achieving resonance requires creative expression. Creative expression requires knowledge of the self. Knowledge of the self is generated through meaningmaking. Meaning is created through narrative, story, and myth. Narrative unites our inner world with an outer reality and, in doing so, recaptures the integrity of the self and reestablishes a connection with the environment. As MacIntyre writes, “The unity of a human life is the unity of a narrative quest” (MacIntyre 2007, 219). For all its difficulties, trauma provides us with tremendous opportunities to attain deeper self-knowledge and to, in turn, communicate a deeper form of truth to the world. The Story of Hajil Morally injurious experiences tend to disrupt the ways we feel about ourselves, other people, and the world around us. Moral trauma can involve both internally and externally directed emotions. Internal emotions consist of things like shame and guilt, such as a feeling that I should’ve done something differently to prevent a negative outcome from occurring. External emotions consist of things like anger and resentment, such as a feeling that someone else should’ve done something differently to prevent a negative outcome from occurring. The three primary determinants of moral trauma include responsibility, justification, and wrongdoing. Each of the three determinants carries with them numerous philosophical interpretations that can’t possibly be covered in a short text. In the context of moral injury, wrongdoing suggests that I knew something was wrong, but I did it anyway. Philosophically, this implies that we need to be concerned with the nature of right and wrong, which is among the most fundamental of all philosophical inquiries. Justification (think “justice”) asks whether my actions were appropriate and balanced within the context of the event. Responsibility implies that I, in some way, feel that I contributed to or failed to prevent a negative outcome from occurring. For those people whose sense of responsibility runs deep, any perceived transgression of this value can lead to a disintegration of self-worth. Much like how we saw the three forms of trauma appear during the same event, so too can the determinants moral injury arise as part of the same experience. Consider the story of Hajil, who was a 13-year-old Iraqi girl when I met her in Baghdad. She and her family were displaced by sectarian conflict. They moved north and eventually settled on an old

Meaning-Making and Moral Injury  189 garbage dump in my sector, a place that was believed to be unpopulated. One night, an insurgent group intentionally set up mortars behind their home and launched them at the American base. They did this because they anticipated that the Americans would fire back and inadvertently kill or wound innocent people, which would compromise trust and undermine their efforts. Tragically, this is precisely what happened. When the Americans returned fire, Hajil’s family was destroyed. Several people were killed, including her mother, and several others were severely wounded. Hajil herself had a deep shrapnel wound in her leg, and when I discovered the scene the next morning, she was tending to her younger brother who was wounded in the thigh – somehow with a smile on her face. No one, neither she nor anyone else in the family, expressed even an ounce of resentment towards us. They seemed to understand what happened and why. They led with forgiveness and love, and they were a family of unshakable spiritual strength. I learned a lot about life from them that day, and we can learn a lot about moral injury from this experience. Can we see how the determinants of responsibility, justification, and wrongdoing might show up here? The moral landscape of modern conflict can be notoriously complex.1 The Story of Harper – Narrative, Values, and the Art of Articulation This brings us back to April 21st, 2007, the day Harper and I were shot. At the time, we were embracing a relationship-centric strategy that focused heavily on building trust with the local people. For whatever the reason, our scout platoon had an affinity for this type of mission. They embraced it and took on significant personal risks in order to build trust. In this type of environment, simply driving down the road to meet with a local leader could prove fatal, as our biggest threats were generally roadside bombs. Similarly, standing in the street to engage in a conversation with that local leader could prove equally fatal, as snipers were also a major threat. Still, these risks had to be taken in order to earn the trust of the local people. In other words, in an environment like this, bravery doesn’t only show up in the form of decisive battlefield victories. It shows up, also, in the soldier who displays humility, patience, and restraint. That day, we were conducting a humanitarian patrol in the northern part of our sector, delivering supplies to the local people. Everything went well until we were diverted to another part of our sector to investigate the aftermath of a recent attack. Upon our arrival, we noticed a suspicious vehicle circling our position and we stopped the driver for questioning. When I approached the vehicle, I got the impression that the person in the

190  Joshua Mantz car was most likely not an insurgent. However, in the driver’s back seat was a large video camera that added to our suspicion. With the presence of the video camera, the circling of our position, and the recent attack that occurred, there was enough probable cause to detain the driver and bring him to a safer location for further questioning. Occasionally we had to detain people for various reasons, but it wasn’t something we were quick to do. We made every conceivable effort to give people the benefit of the doubt when we could. This day was no different. Harper and I gave the driver the benefit of the doubt. It’s while we were standing in place – questioning the driver – that the first shot rang out. I’ve already covered the first 15 seconds of this experience in detail. What followed was a series of heroic actions taken by soldiers, medics, nurses, and surgeons that saved my life. I went on to flatline for 15 minutes before being revived and regained consciousness a few days later to learn that Harper had died. The 15 years since Harper’s death have consisted of many ups and down and many evolutions of trauma. However, I wasn’t able to get any sense of true resolution on the meaning of his death until quite recently. There was a void within myself surrounding this experience that I was never able to resolve or articulate – an elusive void of meaning. There was a weight to the experience that I was unable to release. Eventually, instead of trying to release it, I made a conscious choice to embrace it and follow the lure to its meaning. Sometimes, the weight of our experiences brings us where we need to go. I spent several years in solitude examining every detail of my experience, embracing the contemplative life, and mining for a meaning that I sensed was there. The energy inspiring me to do this was a creative energy, a spiritual force. It was inescapable, and even maddening. I analysed every instance; from the moment I was shot through my death, searching for the words to describe it. However, while this process yielded tremendous insights into death and trauma, it fell short of providing any sort of resolution to the meaning to Harper’s death. The feeling of loss was still there, unresolved, and I began slipping into nihilism. After all, what does meaning-making really mean anyway? Is it actually possible to make meaning out of someone’s tragic death? Or are we just paying lip service to the process, trying to make ourselves feel better along the way? Does the whole pursuit just lead to a dead end, or is there something actually worth going after? For a time, I seriously doubted that there was, and I nearly abandoned my work in moral trauma as a result. I didn’t want to risk leading people into a moral abyss without offering them a way through it, and I believed that I had to first find this pathway for myself. It was around this same time that the events of 2020 we mentioned earlier began to unfold. Perhaps like it was for many of us, the backdrop of

Meaning-Making and Moral Injury  191 these events gave me an opportunity to reflect on some of my experiences in new ways. The most important of these reflections were associated with the meaning of Harper’s death. First, I realized that I may have spent too much time focusing on the way Harper died instead of reflecting more on how he lived. At the end of the day, Harper gave his life protecting the dignity of someone he didn’t even know. He took tremendous risks to maintain the trust of the people he encountered. And on this day, it cost him his life. Through Harper, I realized that, if dignity was a value that we were willing to die for back then, perhaps it is a value worth living by now. In the aftermath of moral trauma, one’s value system and sense of self can be shattered. Asking a person what they value, or who they want to be, may be a more difficult question than asking them how they feel. Sometimes, we can rediscover these values during the meaning-making process. This is an example of how narrative development can lead to meaning, how meaning can lead to values, and how values can lead to the reconstitution of the self. Second, I came to recognize how Harper’s death represents the paradoxical and sometimes irresolvable nature of moral tension under high-intensity conditions of conflict. On one hand, I recognize the many benefits of a relationship-centric approach and the values it might be said to inspire. On the other hand, and with the same breath, I recognize that Harper lost his life for it. The line between trust and vulnerability is very thin. At what point do things go too far in either direction? I don’t think that this question is ultimately resolvable in terms of providing a black-and-white answer to a right or wrong situation, but it does represent the grey area within which moral injury lives. Third, I realized that the meaning-making process doesn’t have to be absolute. It’s not an all-or-nothing process. Earlier, I asked what meaningmaking actually means. Reflecting on Harper’s experience taught me that there may come a time when it feels appropriate to abandon certain aspects of an experience and leave some things behind. It also shows that there may be other elements of an experience that are worth preserving. My sense is that values that are shaped under conditions of strife may become more resilient over time. In my situation, the value of dignity was the “pearl” of wisdom waiting for me at the end of my journey with Harper. Once I realized it, I could begin the process of integrating it into my life. I extracted the pearl and let go of the rest. My aim here isn’t to offer any value judgements on morality but rather to emphasize how the meaning-making process itself can deepen one’s own values. For me, what this story translates to in terms of meaning in my dayto-day life is a simple reminder to try to treat people with dignity. It’s an opportunity to recapitulate my actions against a standard that was set by Harper that day. Dignity is a value that’s become more tightly integrated

192  Joshua Mantz into my life. This is because my personal story, largely as a result of the meaning-making process, now gives me an opportunity to measure that value against someone who gave his life defending it. The story intensified my relationship to the value. Closing Thoughts It took the better part of 15 years, and a considerable amount of effort, to retrieve the meaning of this experience. The journey was difficult, and well worth it, as it led to the realization of a higher truth and a deeper knowledge into myself. To get there, I deliberately embraced the contemplative life and went into a prolonged period of solitude and introspection that lasted more than two years. Some people thought I was going mad, others thought I was in denial, suggesting that my “internal investigation” was really just a mask, covering up an inability to accept the reality of the past. Yet a deeper truth is still called. I trusted in that intuition and I trusted in myself. I had to become my own philosopher and discover my truth. While my focus in this chapter has been on meaning-making and moral injury, I don’t want to discount the many other ways people may find useful in moving through trauma. The reality is that each person is on a unique path and may benefit from different approaches at different times. The meaning-making process may not be appropriate for everyone and it may not be appropriate for every experience. Each individual person will have to determine whether or not it’s appropriate to look at components of their past experiences and to what extent. My reason for emphasizing the meaning-making process here is because this is where my journey naturally led. It’s a valid pathway to healing. Creativity is the pathway through trauma. Where words don’t exist, we must create them. Where obstacles arise, we must find ways around them. We must become the artists of our own experience and render its meaning. And we must leverage any or all of the modes of creative expression to do so, be it narrative, poetry, art, expressive movements, or music. Creativity is a process through which meaning is revealed. Creativity isn’t necessarily a fun or enjoyable process. It can be excruciatingly difficult. In this way, the trauma survivor is no different than the “mad artist” trying to find their words. In The Phaedrus, Plato discusses the madness of divine inspiration and suggests that surrendering ourselves to the creative or spiritual energy of the divine leads to a greater good, a higher truth. Staying with the tension of an experience long enough can produce a work of art. As Plato writes, “the greatest blessings come by way of madness, indeed madness that is heaven-sent” (Plato 244b). In this regard, and in emphasizing the role that philosophy plays in healing trauma, we must use caution not to confuse rumination with

Meaning-Making and Moral Injury  193 contemplation and isolation with solitude. In contrast to an age that desires fast solutions and quick fixes, the meaning-making process requires time. Isolation means that I’m shutting myself off from the world; solitude means that I’m engaging in a contemplative process. Rumination is unproductive thinking. Contemplation is methodical, intentional, and searches for a higher truth. We don’t blame philosophers and scientists for thinking. Nor should we automatically assume that a trauma survivor is isolating, or that they are in denial. Sometimes, we need time to sort it out. Throughout this chapter, I’ve discussed the challenges associated with creative expression and I’ve leveraged my narrative to differentiate between the three commonly accepted forms of trauma. I’ve also shown that it’s possible to take an experience from a state of confusion and render it a meaning that’s both simple and powerful. In my situation, The Story of Harper is now, in many respects, reducible to one word – dignity – a value that I make a conscious choice to live by now. It’s become a North Star for me, something I can always fall back on and live by. With this revelation in meaning, the experience felt complete, and so did I. I’m confident that readers can discover their own meaning, within their own experiences. Healing is a journey, never a fixed point in time. Growth is a process, not a destination. And always remember – the story is still being written. Note 1 To learn more about this experience and others, please refer to Mantz (2018).

Works Cited Cambridge Dictionary. 2022. “Intensity.” https://dictionary.cambridge.org/dictionary/english/intensity, accessed June 21, 2022. Campbell, Joseph. (1949) 2008. The Hero with a Thousand Faces. Novato, CA: New World Press. Jung, Carl. 1989. Memories, Dreams, Reflections. New York: Random House, Inc. Kubany, Edward and Susan Watson. 2006. “Guilt: Elaboration of a Multidimensional Model.” The Psychological Record 53: 51–90. Litz, Bret, Ateka A. Contractor, Charla Rhodes, Katherine A. Dondanville, Alexander H. Jordan, Patricia A. Resick, Edna B. Foa, Stacey Young-McCaughan, Jim Mintz, Jeffrey S. Yarvis, and Alan L. Peterson. 2018. “Distinct Trauma Types for Military Service Members Seeking Treatment for Posttraumatic Stress Disorder.” Journal of Traumatic Stress 31: 286–95. https://doi.org/10.1002/jts.22276. MacIntyre, Alasdair. 2007. After Virtue. 3rd ed. Notre Dame: University of Notre Dame Press. Mantz, Joshua. 2018. The Beauty of a Darker Soul: Overcoming Trauma through the Power of Human Connection. Austin, TX: Lioncrest Publishing. Maslow, Abraham. 1954. Toward a Psychology of Being. Floyd, VA: Sublime Books.

194  Joshua Mantz New York Times. 2023. “Reported Cases, Deaths, and Vaccinations by Country.” At https://www.nytimes.com/interactive/2021/world/covid-cases.html?pageType =LegacyCollection&collectionName=Maps+and+Trackers&label=Maps+and+ Trackers&module=hub_Band®ion=inline&template=storyline_band_recirc, accessed January 28, 2023. Plato. 1989. The Collected Dialogues of Plato. Edited by Edith Hamilton and Huntington Cairns. Princeton: Princeton University Press. Plutchik, Robert. 1991. The Emotions. Lanham, MD: University Press of America, Inc. Rogers, Carl. 1980. A Way of Being. New York: Houghton Mifflin Company.

Section 3

Accounts of Recovery Applying Humanistic Approaches to Moral Injury

11 Evil in Innocence Moral Injury and the Encounter with Children Alan Roof

For to him that is joined to all the living, there is hope… –Ecclesiastes 9:4 (King James Version)

Introduction Lord of the Flies by William Golding was published as a novel in 1954 and serves as an enduring entry into the inherent nature of evil as it reveals the profound truths of humanity through the lives of children. Golding served in the British Navy in World War II and became familiar with human depravity in war. His novel is about a group of kids living alone on an island outside the purview of adults after a plane wreck. The aspiring leader, Ralph, tried his best to implement the structures of civilization and moral order. He failed at that mission. Ralph despite his strong commitment to moral and civic order would end up with blood of a child on his hands. Though Golding intended to call attention to a bias toward evil in civilized society, his use of children to demonstrate human destructiveness in murder and killing done by kids to other kids awoke many to the potential of evil in innocent children. Surprising to most Americans, Save the Children states that between 2005 and 2018, 65,081 children were verified to have been “recruited and used by armed forces and groups, but actual numbers are likely much higher” (Save the Children 2022). This use of children as instruments of war seems strangely shocking to a population that has seen and lived through the tragedies of Columbine High, Virginia Tech, Sandy Hook, and a myriad of other horrible confrontations of the capacity of adolescents to act with anger, vengeance, and weapons. Professor David Rosen has studied children’s role in war and discusses how the seemingly new precedents of recent wars and conflicts are merely an escalation of children’s use. He argues that our perceived innocence of children is not a temple of truth we can maintain. Children and civilians have been used in war for hundreds of years as weapons, fighters, cooks, and scouts (Rosen 2005, 8). DOI: 10.4324/9781003281122-15

198  Alan Roof Many discouraged persons finding their efforts failing, their perspective on life changing, or the bearing on their compass having lost its ability to find true north, could turn for some reassurance in the midst of their disorientation to the first chapter of the Ecclesiastes. Their disheartened soul will find solace, “that all is vanity and vexation of spirit. That which is crooked cannot be made straight: and that which is wanting cannot be numbered” (Ecc. 1:14–15 [King James Version]). The more discouraged soul might turn to the writings of Friedrich Nietzsche, finding solace and comfort in his reassuring words that life is a mess, and no God is waiting to save us, for he is dead (Nietzsche 1995). This current project explores where the confrontation with child soldiers took a Marine named Ryan, a treatment team, and a chaplain. How innocence is lost, evil disorients, ancient symbols can bring hope, and how sharing the journey in the land of the living can help love and compassion triumph over the demonic and diabolical. Those returning home from war and those caring for the wounded should be prepared and willing to have their lives, perspectives, and understanding transformed so that our mutual journey into moral injury is a truly human experience, not an intellectual exercise. Those who care for those with moral injury must be willing to sit with, process, acknowledge, and grieve a worldview altered when service members encounter the evil in innocence. In looking at the moral injury, moral despair, and moral ambiguity of our most recent combat operations and their effects, great wisdom and understanding can come from joining existentialist thinkers. Along with their perspective is an accounting for the spiritual and religious influence on the development of morality, as seen by James Fowler. Ryan and our encounter with devastating effects of moral injury initially came to light through events sparked during a Good Friday service. Beginning the Journey In our service to others, we may be granted the privilege and honor of caring for those returning home from war. I am one who voluntarily offered my hand and my life to care for the souls and spirits. My openness to do so led me unexpectedly down a road I never saw coming. One of my many affirmative nods in life led me to become a hospital chaplain. Even before my move to become a chaplain, my life in healthcare has made me well versed in the blood, the raw human emotion, and the pain humans experience. I have seen and experienced much about the joy and pain that is a part of life. My willingness unexpectedly led me to be active in helping veterans and active-duty personnel in a program developed at a rehabilitation hospital where I was a chaplain working with patients recovering from brain and

Evil in Innocence: Moral Injury and the Encounter with Children  199 spinal cord injuries. The program, an early effort by civilian organizations to take on the work of helping vets returning from Iraq and Afghanistan, was an outgrowth of our excellent knowledge and skill at helping people who have suffered from brain injury – from moderate to significant. The interdisciplinary team includes counselors, neuropsychologists, physicians, nurses, case managers, and physical, occupational, and speech therapists. As each of us volunteered to contribute to this program, many of us would not know how much we would be changed, touched, and challenged. Our encounter and involvement with those wounded by war would teach us, stretch us, humble us, and create new cracks in our self-perceived armor of experience. We would each find places in our hearts and minds that had somehow retained some level of innocence about the ways of life. Perhaps for the team and myself, the real awakening about the realities of battle in Afghanistan and Iraq was the heart-wrenching and innocencealtering reality of children in a time of war. Acknowledging the encounter service members have with children was one of the places our participation in the program led us that we had not expected. Dealing with the side effects of brain injury was something we were good at doing. Entering the world of war wounds opened all of us to an entirely new world of issues. The psychological, physical, spiritual, emotional, and physical injuries that came to us provided an entirely new world to try to comprehend and understand as we struggled to find ways of healing and help. Since our civilian program was an early entry into this effort, not much was known by most of us at the time regarding moral injury. Many moral injury issues were easily attributed through ignorance and blindness to an expanding list of accepted and properly coded conditions and diagnoses. Together we will share the story of a young, medically discharged Marine named Ryan. Ryan’s family knows him by another name. For confidentiality and anonymity, his name and details have been changed. This story and its components come from a variety of my memories though not verbatim recollections. The spirit and substance are true, as authentic as they can be by one sharing in a mutual story of trauma and healing. His story will be an entry point on our road to understanding children’s impact in wartime on those who serve. We’ll look at how the twentieth and twentyfirst centuries as a time when traditional rules of engagement were altered intentionally by leveraging the innocence of civilians and children against the technologically advanced armies who were left to deal with the mess such actions caused. Our encounter with Ryan was an opening salvo into our way of looking at a depth of soul wounds in a much different manner. Our eventual epiphanies with Ryan were only the beginning of a multi-year effort to comprehend and come to a deeper understanding of war’s impact on an individual. Not all the insights presented here were fully formed realizations when

200  Alan Roof we cared for Ryan. Many connections were made, darkness uncovered, and ah-ha moments were discovered not exclusively through our encounter with Ryan, but for me and many on our team, the many things Ryan taught us gave us the seed of understanding. Our encounter with Ryan resulted in a seismic shift for me in grasping the effects and depths that a soul wounded by moral injury could undergo. This narrative presentation will document my comprehension of moral injury through Ryan’s story and add insights and understanding that my encounter with him would have on my ongoing and passionate interest in moral injury. Individuals who face the effects of battle experiences are often left alone and disconnected from the world as they try to make sense of their time in combat. Shame, fear, and unexpressed emotions about the worst experiences of their lives are often locked away in the deepest recesses of their body, mind, and soul. Often, these experiences are left to rot and infect a person’s perception of themselves, others, and the world in which they live. The resulting wound to the soul becomes a seed for the evil of disconnection, isolation, and pain. These combat encounters profoundly affect the ability to engage with the world and, more importantly, with relationships and community. Meeting Ryan During high school, Ryan lived in a small Midwestern town where ­Friday Night Football games faced higher attendance than all the churches could muster up on Sunday. A wide receiver, Ryan’s athletic prowess had brought him cheers, awards, and more than a couple of concussions. These preexisting injuries added to the cumulative effect of those he would experience in Iraq. Like many other service members, Ryan wrestled with numerous cognitive impairments making simple tasks and decision-making difficult and overwhelming. Ryan was “discovered” by a Marine reserve officer who spent days and weeks hunting down wounded warriors huddling in dark basements and lonely homes and apartments in the Midwest. The officer had sent several retired and medically discharged Marines to our program. Once a gregarious and welcoming young man, Ryan now lived life in an isolated basement. Ryan told me a story I had heard many times from Marines, soldiers, and airmen who had gone from being engaged with life to finding their only comfort in being alone – drapes on their life and the tightly shut basement windows. Arriving at our program with an over-sized backpack stuffed with t-shirts, sweatpants, video games, and jeans, Ryan was anxious and doubtful. His efforts to find healing and wholeness through other programs had

Evil in Innocence: Moral Injury and the Encounter with Children  201 not worked well for him. He left several programs only a few weeks into treatment, unable to believe that anyone “got him” or could comprehend what it is he battles daily. He gave our program a shot to make the “Captain happy.” Two years post-discharge, Ryan had spent most days isolated in the basement of his sister’s house and relived the battle in his mind by playing endless hours of video war games. Like so many, Ryan had found comfort in playing and replaying games of war, perhaps in a continuous effort to make sense, perhaps in an attempt to deaden any feelings or thoughts that might become an infinite loop of ideas in his brain. The struggle to find healing and relief from complicated psychological trauma, pre-existing mental health issues, post-traumatic stress disorder (PTSD), and insomnia, is extra exasperating when combined with mild to moderate injuries to the brain. The cumulative effect of concussive injuries from explosive blasts and head trauma impairs an individual’s ability to cope and manage emotions, thoughts, pain, and other small functional decision-making processes. The wars in Iraq and Afghanistan have shown a hundredfold increase in conclusive and moderate brain injuries (Yuhas 2016). Ryan’s first few days in the program went well. He felt good about things when I first met with him. During our initial conversations, he relayed his story, including his active involvement with a Baptist church through high school. Since returning from Iraq, Ryan had not returned to his faith community. He indicated that one of his goals was to get reconnected to his faith and his church. He struggled with all the changes in his life and his outlook since being down range and admitted he felt very different from what he used to be. Over the next several weeks, Ryan made significant progress. He was engaged in therapy and finding connections with others in the program. He was making regular outings to the grocery store, doing recreational activities, and feeling improvement in his executive functioning. The medications prescribed by the physician and group and individual psychological therapy helped him find some sense of peace, better sleep than he had in ages, and confidence. Good Friday Ryan met with me one day. He had been thinking about trying to get connected with church again. He had seen a sign outside a nearby church promoting a Community Good Friday service that was coming up in a couple of weeks. We discussed how to make it happen safely and successfully. We made plans to visit the church on a day when no one was there to scope things out and make him familiar with the space. His counselor and recreation therapist incorporated his goal into their work with him. They

202  Alan Roof were running through scenarios and thinking through the details of the upcoming visit. Ryan and the team decided on Thursday that the mid-day Good Friday service was a go. At 11:30 on Good Friday, Ryan, Tricia (the recreation therapist), and I joined the crowd heading into the large, white, brick church. We took our scoped-out seats in the upper back balcony close to the exit. Ryan smiled with confidence as the three of us took our place. Joining such a large crowd in such a public event was a monumental achievement for this Marine. This Good Friday service was an ecumenical community event featuring participants from a broad range of churches. The crowds quieted down, and the service began. Initially, everything was going well for Ryan. Eventually, though, Ryan’s legs started to bounce up and down. He began to look more uncomfortable. His eyes darted around and sweat started to form on his forehead. Ryan’s situation did not look good. Tricia and I looked at each other with concern. Tricia asked Ryan if he wanted to go, but he chose to stay. As the program continued, Ryan’s rapid leg movements increased in intensity. He wrung his hands, eventually shoving them under his bouncing jean-clad thighs. Finally, it all became too much for Ryan. He rose from his seat without looking at us and headed for the door. Tricia and I joined him in his swift exit. Intuitively, Tricia and I knew that talking and exploring things right now would not be helpful. So, we followed in behind Ryan, who led the way down the back hall of the balcony, retreating down the stairs and heading toward the nearest exit. Walking toward the car, we were all silent. Soon we were in the car and headed back to the program. Ryan said abruptly. “Drop me off at my place. I need space.” We pulled into the residential parking lot of the apartments where the clients we worked with lived while with us. We briefed the resident assistant on the situation, asking her to make extra checks on Ryan throughout the weekend. Returning to our therapy facility, Tricia and I were a little overwhelmed. Both of us had been present when clients had struggled in a public setting, especially with PTSD. However, Tricia and I both agreed that this was different. Ryan was fully present in the moment, engaged with the environment, and showed no signs of disassociation. On Monday morning, Ryan rejoined the group, embarrassed and shameful. He began by expressing his sorrow for disappointing us and said that he was “pissed” at himself for all the grief and disappointment he had caused so many. The statement was strong. It seemed an overreaction to an outing that didn’t go so well. While we all tried to assure Ryan that these things happen, he was adamant that this was all his fault, that he would never find peace and couldn’t be welcomed into any church or community again.

Evil in Innocence: Moral Injury and the Encounter with Children  203 While Ryan continued to try to participate in therapy, the entire team noticed a drastic change. He had become even more withdrawn than when he had joined our program. Ryan stayed to himself in his free time. Though he had required attendance at counseling, medical, physical therapy, and psychological groups, he was not required to meet with me. Ryan’s engagement in these sessions bottomed out and he had no desire to meet with me. Throughout the week, team members worked hard at trying to figure out what had gone on at the service that had affected him so dramatically. The physician was doubtful that medication changes would do anything to improve his situation. His current regime had worked well up until that day. The counselor and Tricia, the recreation therapist, were sure that he needed more exposure therapy to work through his social anxiety. Our discussions explored linkages to PTSD, but his reaction was different. First Steps to Opening Up Two weeks later, Ryan approached me and asked to set a meeting time, which we arranged for the next day. During our meeting, I wondered how he was doing, and his answer revealed an ongoing struggle with his selfworth. Knowing his background, I began our time with prayer and then we began a long wait in a heavy silence. I was anxious to get to the heart of what was happening with Ryan. He was burdened with wanting to start but not knowing how. Eventually, Ryan grabbed the brim of his cap, pulled it down tight on his forehead, crossed his arms, and leaned back in the chair. We continued to sit in a thick silence. My gut was tight, picking up on the discomfort filling the room. Deciding to break the tension, I asked a question. “What happened at the service?” Ryan looked at me and then bowed his head. There was more silence. Ryan looked at me again. I could see tears in his eyes. “It was the kids, the kids on the balcony.” Finally, we had the first revelation to come from Ryan in weeks. After sitting in silence for some time, Ryan recounted the whole story. While preparing for deployment, he and his platoon had received training and background about conditions in Iraq. As a Marine in training, Ryan was warned about using children in the conflict. At the time, it hadn’t sunk in. It didn’t make sense to him. He said perhaps he was naive to how bad it was until about a month after his arrival. Ryan was out on patrol with another well-oriented team of Marines when they faced a kid about eleven years old in the middle of the road. He was standing there as their Humvee moved slowly down the road. They stopped, and the kid refused to move. The Sergeant ordered the driver to back the Humvee away and gave the order to take out the kid. Without hesitation, the experienced gunner let loose with fire, killing the kid.

204  Alan Roof That was Ryan’s first awakening to the reality of what they had talked about in training. He said he found himself “morally incensed” at the callousness of the Sergeant and the machine-gunner. After carefully approaching the boy, they determined he wasn’t a real threat. They had killed an innocent kid that found himself in the wrong place. Ryan said he felt moral revulsion that the kid had died at the hands of Marines who are supposed to be protecting and helping kids like that. The Sergeant and others tried to help him understand about necessary precautions. Ryan said it still didn’t make sense to him, and he was all wrapped up for weeks over the incident. The air, once filled with an unbearable silence, was now filled with the heaviness of the reality of war. Ryan continued and spoke about how weeks later he and his team were on an urban operation going door to door, breaking into homes, and trying to find combatants. He was overwhelmed by the terror he saw in the eyes of the women and children who were in their homes and suddenly had their lives upended by a crew of Marines with guns. He was still haunted by the looks in their eyes. On the same mission, while in the streets, Ryan and his patrol received fire from a window above them. Deciding that the building was a hiding place for a cell, he and his team headed in to assess the threat. The anxiety was high as they entered the building. Everyone was on edge. Having worked themselves to the top floor, the source of the shots, they broke through a door. In the room were five kids ages 10–13. One kid turned with a gun in hand, and Ryan and his team responded with gunfire, killing all five. Only one of the kids had a gun. Ryan was quiet for some time. “That’s just wrong,” he said, half angry and half remorseful. “I got caught up in all of it and killed unarmed kids. I shot them. Dead.” He expressed regret that he had done what he had to, but it still didn’t feel right. “Jesus says we should welcome the little ones, not shoot them.” In this intense encounter with children, Ryan’s eyes and soul became aware of the moral ambiguity, the visceral reality of the information he had. Knowing that he may encounter armed and unarmed child soldiers was intensely different from actively participating in a situation involving them. In a fraction of an instant, the moral innocence of Ryan’s worldview was decimated by his actions. His experience catapulted him from a place of moral high ground to a shattered world, leaving his self-worth and moral fiber torn and bruised. From when he arrived in Iraq, Ryan had gone through many transitions in his moral outlook, losing innocence through experience and the lived realities of battle. Ryan apologized to me. He felt deep shame for what he had had to do. He was overwhelmed with grief and regret. Sharing this dramatic moment with me was the first time he had revealed this to anyone. After the event,

Evil in Innocence: Moral Injury and the Encounter with Children  205 no one talked about what had gone on that day. It was just another day for some of the guys; for others, it took on a life of its own. Ryan was particularly bothered that the kids were the same age as his brothers. Ryan expressed how difficult it had been to connect or even be around his family, particularly his brothers. “I can’t look at them without seeing them and thinking about what an awful person I am,” Ryan said. During Ryan’s story, I had a profound realization regarding other service members facing the same difficulty, especially disconnection from their children or younger siblings. For me, it became clear, perhaps for the first time, that while other members of the team and I had contributed this disconnection to memories or flashbacks, the reaction was related much more deeply to the moral implications of encountering, killing, and witnessing the death of kids. For Ryan and others, seeing kids and being around them highlighted the guilt and shame they felt for what they had done. They believed their actions were evil and immoral. Separating and isolating themselves from others – especially children – was a way of quieting the moral struggle in their presence. The Good Friday service had been a catalyst for Ryan to open up to someone. At the same time, on the same account, it offered me an opportunity to truly understand the moral wounds and harm that resulted from doing what, by all standard operating procedures, was the right thing to do. From that day onward, Ryan expressed how he felt so much shame about the incident. Seeing kids on the church’s balcony standing up and moving about turned out not to be about reliving the events in Iraq as much as it was about the incredible shame and guilt and self-loathing that reared its head during the Good Friday service. Arguments about it being part of the war, of doing what had to be done, found no opening in the hurting soul of this Marine. He had been forced to go against everything he believed was his job as a Marine, as a warrior, and as a Christian. This event and subsequent encounters with armed and unarmed children during deployment had created a deep wound to Ryan’s moral understanding of his world, role, and values. The Reality of Children Soldiers In his comprehensive look at the situation, P.W. Singer examines the utilization of children in war, As the most basic laws of war have been increasingly violated, there is a new, perhaps even more disturbing element. Not only have children become new targets of violence and atrocities in war, but many now have also become the perpetrators (Singer 2006, 6).

206  Alan Roof In 2008, Human Rights Watch (HRW) reported that since 2001, 21 ­ongoing and recent global conflicts report the use of child soldiers (Human Rights Watch 2012). HRW also points out that while exact figures aren’t available, hundreds of thousands of kids under 18 and as young as eight years old serve in government forces or armed rebel groups. The HRW notes that as of 2012, the Taliban in Afghanistan use children as fighters, including suicide bombings. In addition, in Iraq, “Al-Qaeda recruits children to spy, scout, transport military supplies, plant explosive devises, and actively participate in attacks against security forces and civilians, including suicide attacks” (Human Rights Watch 2012). The chance that service members like Ryan will or have encountered children during deployment is high. Anyone taking care of these men and women must familiarize themselves thoroughly with these facts and be prepared in their mental framework to accept and work with these brutal realities. The use of children in war is a reality that haunts the moral fiber of those facing them in battle. There are many reasons leading to this reality. Singer and others have documented these factors (Singer 2006, Human Rights Watch 2012, Save the Children 2022). I do not detail their findings here except to note this: those who send child soldiers to fight intentionally muddy the playing field for combat troops expecting to conduct war by conventional means. This shift in methods and standards brings more potential harm to non-soldier children and sets service members up for an ongoing struggle to differentiate targets. Using children as soldiers and decoys is a well-documented method of instilling psychological trauma and resistance in the minds of conventional troops (Grossman [1995] 2009, 269). The many aspects and conditions related to children’s involvement in war and combat are complex and difficult to comprehend by most Western readers. Reorientation and Paths to Healing It seemed fitting to me as a chaplain that such a profound realization would come in the wake of a Good Friday service. Throughout most of Western history, the events that unfolded on a cross on a Friday afternoon have reverberated throughout culture, history, and our understanding. Perhaps more than anything, the redemption offered through the cross has taken the dominant lead in the story coming from that day. Jesus’s crucifixion is a pivotal example of the encounter of evil in innocence. Jesus died accused of a crime he did not commit at the hands of a crowd seeking a scapegoat handed over by a leader who wanted to wash his hands of any controversy, which holds one key to understanding the struggles of moral injury. Jesus’s

Evil in Innocence: Moral Injury and the Encounter with Children  207 disciples had given up their lives to follow him but witnessing their leader and teacher being unjustly crucified was much more than many of his closet followers could handle, and they fled, isolating themselves from the event. Experiencing all the resulting reactions and actions that came to Ryan, the team, and myself on that Friday afternoon holds hope that we can come to understand our nature and our response to a loss of innocence. Having spent a good portion of my life in healthcare, I am incredibly comfortable working with the loss of innocence. Grief at the loss of how things should have been or should be causes disorientation. In the case of Ryan and other service members, experiences often bring great grief at the loss of innocence. Once a person has a profoundly unexpected encounter as a witness or participant, innocence is lost, and a new way of operating in and perceiving the world must occur. Human encounters with the evil in us or the world can bring about frightful disorientation and profoundly impacts the soul. The freshest supply of troops comprises mainly people in early adulthood. J. Irene Harris and her colleagues point out that the young adult pool of service members is facing life-altering experiences and moral challenges at a “critical time” in their moral development (Harris et al. 2015). The spiritual development framework of James Fowler points out that at this stage of life and spiritual growth, people will naturally be at a time when doubts and questions about their faith and spiritual understanding are developing and rearranging (1981, 174–83). Setting the stage in that understanding can bring clarity to the impact morally challenging decisions and actions can have on a person’s spiritual and moral development. Initially, the wars in Iraq and Afghanistan were set up in the minds of those who would serve as an existential battle of good vs. evil. The perceptional groundwork for the war was in narrow black-and-white terms. This worldview resonated strongly with many of the first to join the patriotic battle. Accepting and working with service members’ spiritual and religious environment and mindset is vital since belief in a Higher Power is present in a majority of Americans and veterans. Additionally, as of 2021, 69% of Americans identify as Christian; 7% more are Jews, Muslims, Buddhists, or identify with another religion (Jones 2021). For Ryan and many service members, an orientation to life, meaning, and moral action is influenced by a mindset shaped by religious and spiritual perspectives and therefore should be accounted for by members of the treatment team. Typical worldviews include some parameters of good and evil. Drawing on these ideas can be particularly helpful when working with morally injured persons with religious worldviews. In his work, Power and Innocence, Rollo May offers two concepts useful in discussing and engaging a mindset/perspective that incorporates the idea of evil. While not directly

208  Alan Roof “evil,” he discusses the “diabolical” in contrast to “symbolic” (1972, 67). In working with Ryan and others, this was helpful to me. Given Ryan’s encounter with the cross symbol, it has significant meaning to him and his view of the world. May points out that the etymology of the word “symbol” has its roots in two Greek words: “with” and “to throw.” He states, “It means literally to ‘to draw together’” (67). May continues by discussing the antonym of symbolic: “diabolic,” which is “to tear apart” (67). May writes, “The ‘devilish’ functions are thus separating, alienating, breaking relationships, in contrast to bringing together, connecting, uniting” (67). It, therefore, is easy to comprehend that evil, in its diabolical nature, works to separate, isolate, destroy relationships, and create a sense of loneliness and alienation. Combining this perspective and understanding of evil and symbols can aid in reforming a worldview that is harmonious with a person’s moral outlook while creating space to move and counter its effects through positive (good) action. The evil which causes separation and alienation can be opposed positively by joining with others, building and repairing relationships, and synthesizing a new understanding or symbol that results in a person drawing themselves into rather than away from others. Working with moral injury by engaging a person’s spiritual perspective and understanding is essential in helping people to find healing. Efforts by healthcare and mental health professionals to find a diagnostic slot, category, or code often seem counter-intuitive for something based on normal human processes of spiritual despair, struggle, and disorientation. These are historic and well-known human dilemmas documented for eons in spiritual writings, ancient texts, and sacred scripture. Anyone opening the book of Psalms can find any of these spiritual and many more spiritual struggles and moral questioning. Keith Meador and Jason Nieuwsma highlight a perspective on moral care by addressing the idea that moral injury can be viewed as from a useful perspective offered by Carol Gilligan that it is a “shattering of trust that compromises our ability to love” (Meador and Nieuwsma 2018, 95). This understanding of moral injury provides a lens connoting the relational intricacies and implications of moral injury and serving as a harbinger of the destructive potential of moral injury “for basic human flourishing” (95). In the context of clinical care, Meador and Nieuwsma note, they “use the language of ‘belonging’ and ‘communities’ very intentionally to avoid an excessive medicalization of moral injury…” (95). Understanding the disconnecting, diabolical nature that encounters with children can have on service members offers clear direction in providing opportunities for healing through the symbolic and through constructing an orientation toward community and belonging.

Evil in Innocence: Moral Injury and the Encounter with Children  209 At the root of Western civilization is the story of Adam and Eve and their intentional, though encouraged effort, to separate themselves from God. In the same way, evil is demonic because it generally results when we move away from our center, disassociate from others, and move into our isolated world. If God is love and loving our neighbor is part of the way we actively express that love in action, then acts we take that move us away from others in the same regard result in us moving toward the demonic. We move toward isolation, disconnection, and loneliness. A New Approach In Good Friday’s context, we witness ultimate forms of good. We see an innocent savior who dies for the redemption of others to heal the broken relationship between humans and God. We see Jesus, who, rather than reject the world in his sorrow and disappointment, focuses on building relationships even as he faces death. He invites the thief by his side to join him in paradise, and he offers consolation to his followers and mother at the foot of the cross by submitting them to each other in the form of an ongoing relationship. He tries to build relationships rather than letting the bad and forsaken feeling of abandonment draw him away. With this personal realization of the severe effects of moral injury and specific events and the involvement of children in war, my approach to talking with Ryan and others resulted in a significant shift in my working with service members. All the rational questions and suggestions relating to perspective required a new approach. We are seeing the devastating isolation and disconnection that resulted from the use of children in war necessitates new ways to confront this evil. Indeed, the evil inherent in using children whose vulnerability and malleability have made the utilization of this pool of resources possible requires methods that help counter the psycho-spiritual effects on service members. In my experience, among the most helpful initial steps is to give space to discussions about involvement with children. With remarkable consistency, anyone who has had to confront the reality of children in war, anyone who has had to utilize their training to take out, kill, or destroy children, harbors an unspeakable shame and regret. It is prevalent for these stories and experiences to be hidden deeply. The result is that the service member goes through months of therapy, not getting to the heart of the actual moral issue with which they are struggling. After working with Ryan and others, I found it very helpful early on to ask about their involvement or encounter with children. In those initial sessions, the service member is rarely willing to open that can of worms. But initiating the first discussion, perhaps even as part of the initial mental

210  Alan Roof health or spiritual assessment, sets a stage and communicates a willingness and understanding. Such an opening speaks to your awareness of these situations to the person in your care. This welcoming demonstrates a desire to make those things a part of the conversation. The questioning conveys understanding when done in a gentle, casual, accepting way. While initially, there is hesitancy to talk, the service member is more likely to allow details related to encounters with children to emerge as your professional relationship with them grows and as you gain their trust. For trust and comfort to take place, those hoping to help must understand, explore, and learn about the use of children in war. As loved ones, counselors, clergy, chaplains, psychologists, and family members, we must be willing to encounter those realities and integrate them into our understanding. Becoming familiar and comfortable with the darkness in humanity is vital to engaging with those struggling to make sense of their experiences. Our ability to offer compassionate support necessitates our exposure to facts and emotions related to those that service members can face. First encounters with service members’ stories who described their encounters with children were difficult to hear. Awareness of information is different from hearing about others who had devastating experiences with children in combat. Had I and other treatment team members not been intentional about sitting with this information and exploring our reactions and feelings, our discomfort would have shown through with Ryan and most likely would have made honest and courageous sharing fail. Veterans who carry the burden of having to kill civilians, and particularly, children, are hypersensitive to detecting discomfort in others when sharing their experiences. Those we are trying to help can easily misread our discomfort as judgment or disbelief (Litz et al. 2009, 702). As my team members discovered through our encounter with Ryan and others, being quick to attribute struggles to a physiological diagnosis or medical condition can act to hinder the revelation of moral injuries. As a result, many whom complete years of therapy have not had the opportunity to confront and deal with the serious moral harm their various struggles have had on their assessment of their moral fiber. Losing their ability to look upon the world with an honest understanding and an inability to place their actions in a workable moral frame exacerbates the event’s consequences. It is vital to our efforts to help with healing to understand and be aware of the place that morals or religious understandings have in the lives of those we serve. Including those aspects are vital to offering compassionate care. People are more than their experiences, their statistics, or their diagnosis. As helpers and ones who care, we must be willing to acknowledge and work with the multiple components (social, psychological, physical,

Evil in Innocence: Moral Injury and the Encounter with Children  211 spiritual, and emotional) that make up the person who comes to us for help. Breaking out of our professional silos and learning from each other were significant reasons we could help so many of our clients to find healing and hope. My insights related to Ryan and others aided the team in providing care as much as their knowledge and observations helped me better meet the needs of Ryan and others. Concerning encounters with children, an ability to reframe the moral dilemma is vitally important. In so many situations that I have been privileged to share, it is often useful to move the focus of the moral struggle away from the person and toward the social context is often very useful. In the case of having to kill children, it is paramount to shift the moral responsibility from the killer to the adults and the circumstances that created this dilemma and the trauma that followed. When Ryan understood and saw that he was in a difficult situation because of decisions, events, and people on the other side who utilized the children as weapons and soldiers in the first place, he began to see a way forward. The shift in worldview, widening it to account for all the factors and discovering the natural source of questionable morality, can result in an instant epiphany. In a moment, years of burdensome self-judgment are lifted and released. The moral anger is shifted from the service member. It can often be refocused on moral outrage directed toward opposing forces, social structures, and worldviews that permit or force children to serve as weapons and soldiers. The connection and sharing of experiences, plus broadening a worldview by stepping out of an individually focused moral perspective, brings relief from holding oneself entirely morally accountable. The new worldview and understanding of a mixed social situation allow clients like Ryan to begin to move forward. The redistributed moral challenge eases the burden if a single person does not entirely bear the responsibility. The moral shift of responsibility is perceived not as an individual transgression but as a global challenge; the personal moral offense becomes an ethical challenge faced by multiple players. Service members can truly see themselves in the broader human challenge of the problem of evil. Many who are morally injured have had evil encounters that result in the diabolical separation and isolation from others. They can begin to find healing with one willing listener. The initial sharing of the events and the broadening of perspective can help persons burdened by moral injury back into constructive relationships. Over time, wounded individuals can learn they need not carry their moral burdens alone having had a positive moment of open sharing with another. They can work with caring others and come to process their experiences more efficiently. In the context of Good Friday, the morally disoriented and disappointed disciples and witnesses to the crucifixion were able to process the event

212  Alan Roof later because Jesus had shown his willingness to encourage connectedness from the cross. For Ryan and others, being able to find a connection in the wake of a world turned upside down is an essential counter to the sinister evil of disconnection and separation. Jesus, while suffering and dying, was still forming relationships with the thief and handing his followers over to his mother, giving them hope that their work could continue. It took some time for Jesus’s followers to make sense of all that had happened, but eventually, they found redemption and purpose. For Ryan and others, their efforts to reconnect also took time, patience, and a willingness to reorient themselves to life, redemption, and flourishing. Ryan and others struggle with a loss of innocence and deep moral injury. Others help them to redemption with gentle invitations to reconnect. They find reinforcement and a willingness to share the burdens they carry with a world that struggles to find new orientation. Over time, a compassionate and understanding invitation to share their moral load allows all of us to take on the struggle of finding direction in a world in which separation, isolation, and disconnection continually are at work, challenging all of us to engage in caring and compassionate action. In time and with lots of help from his team, Ryan began to reconnect and find healing. Though he will always bear the scars of war, he can now use them as reminders of the evil that results when the diabolical is allowed to work its evil, but also of the redemptive powers of connecting with caring others. Ryan found a great deal of redemption in the wake of his descent into despair at the Good Friday service. He had been thrown into deep darkness, but a compassionate and caring team of people helped him channel his openness to others toward a path forward. Ryan will deal with his encounters, his disabilities, and his struggles for a long time to come, but he can now do it in communities with family, friends, and others who care. Other clients that sought help from our team also began to find ways to move ahead. With work, love, compassion, engagement, and relationships, Ryan and others have found the wisdom of Ecclesiastes true. “For to him that is joined to all the living, there is hope” (Ecc. 9:4). Works Cited Fowler, James W. 1981. Stages of Faith. New York: HarperCollins. Grossman, Lieutenant Colonel Dave. (1995) 2009. On Killing. New York: Back Bay Books/Little, Brown and Company. Harris, J. Irene, Crystal L. Park, Joseph M. Currier, Timothy J. Usset, and Cory D. Voecks. 2015. “Moral Injury and Psycho-Spiritual Development.” Spirituality in Clinical Practice 2, no. 4 (December): 256–66. Holy Bible. 1997. Authorized King James Version. Oxford: University Press. Human Rights Watch. 2012. Child Soldiers Worldwide. March 12, 2012. Accessed May 15, 2022. www.hrw.org/news/2012/03/12/child-soldiers-worldwide.

Evil in Innocence: Moral Injury and the Encounter with Children  213 Jones, Jeffrey M. 2021. “How Religious Are Americans?” Gallup.com, December 23, 2021. https://news.gallup.com/poll/358364/religious-americans.aspx. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Sila, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterrans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (December): 695–706. May, Rollo. 1972. Power and Innocence. New York: W. W. Norton and Company. Meador, Keith G. and Jason A. Nieuwsma. 2018. “Moral Injury: Contextualized Care.” Journal of Medical Humanities 39, no. 1: 93–99. Newport, Frank. 2012. In U.S., 77% Identify as Christian. December 24. Accessed April 20, 2022. https://news.gallup.com/poll/159548/identify-christian.aspx. Nietzsche, Friedrich. 1995.Thus Spoke Zarathustra: A Book for All or None. Translated by Walter Kauffman. New York: Modern Library. Rosen, David M. 2005. Armies of the Young. Piscataway, NC: Rutgers University Press. Save the Children. 2022. Child Soldiers: The Tragic End of Childhood for Boys and Girls in Conflict. Accessed May 06, 2022. https://www.savethechildren.org/ us/charity-stories/child-soldiers. Singer, P.W. 2006. Children at War. Berkeley and Los Angeles: University of California Press. Yuhas, Daisy. 2016. Veterans of Iraq, Afghanistan Show Brain Changes Related to Explosion Exposure. January 16. Accessed May 20, 2022. www.scientificamerican.com/article/veterans-of-iraq-afghanistan-show-brain-changes-related-toexplosion-exposure/.

12 On the Necessity of Ritual for Moral Injury Recovery Rita Nakashima Brock

Introduction The military uses ritual more effectively than virtually any other institution in society. Its intensely prescribed and canalized initiation, commonly referred to as boot camp, occurs in a tightly sealed liminal world via a carefully designed process that transforms recruits at the threshold of adulthood into effective fighting units. The process overrides personal sincerity and orients people’s identity and behavior toward a shared meaning system that values honor, courage, self-sacrifice, loyalty, service, competence, and obedience to authority, values reinforced by stories of battles and heroes to be revered and emulated. Ritualized drilling enables every physical activity of boot camp, including using lethal weapons, to be performed without being slowed by thinking. Boot camp creates units that are so deeply bonded, recruits become willing to kill or die for each other, even if they have little affection for some of the members of their unit.1 This orientation into “warrior”2 culture and instruction in the Geneva Convention Rules of Engagement enables most service members to “assimilate most of what they do and see in war because of training and preparation” (Litz et al 2016, 11). They are supported by the cohesion of their units, respect for leadership, the support of families, and civilian recognition of what is asked of them (Litz et al 2016, 13). Bereft of military systems, many veterans find themselves in culture shock and discombobulated after their time in service. Military personnel experience nothing as ritually deep and transformative as boot camp when they depart the military. Marine Corps veteran Ron Self describes his own suicide attempt and notes that this lack Is the equivalent of bringing a 60-ton Abrams tank back from war, painting it yellow, slapping some stickers on it, and calling it a school bus…Can you imagine this big yellow Abrams tank cruising down the street, leaving a wake of torn-up asphalt and crushed cars behind it? It’s not trying to do that; it’s not trying to be destructive. But it’s a tank; it’s DOI: 10.4324/9781003281122-16

On the Necessity of Ritual for Moral Injury Recovery  215 a weapon of war. When the veteran comes back from war, it’s the same thing. For that tank to be a school bus, clearly some changes have to be made. (Self 2016) Veterans must leave a military world thick with ritual and return to a civilian world impoverished of it. They can experience the individualistic, consumption-driven civilian world as dull and trivial after the intensity of combat and regard personal success as an uninspiring ambition after life in a system that values self-sacrifice and service to a larger purpose and mission. Even when trauma and moral injury haunt their military experience, veterans can miss life in the military, which places them in a confusing suspension between worlds. Expecting them to cope alone with the transition out means many dwell for months or years in emotional isolation and suffering. That suffering is often moral injury (Moon 2019). Moral Injury Moral injury is a term used to capture inner anguish so deep, it disrupts people’s identity and meaning systems. It was coined in 1994 by Jonathan Shay to describe the devastating power of betrayal to undo the character of good warriors. Shay, who worked with Vietnam-era veterans at the Boston VA, defined moral injury as the outrage, humiliation, and shame of having been betrayed by someone in authority who violates core moral foundations in a high-stakes situation. In an effort to help his clinical colleagues understand experiences that veterans might be unwilling to disclose, he wrote an internal paper that used Homer’s Iliad to describe the furious meltdown of the great warrior Achilles when his king betrayed him. Through the voices of Vietnam veterans in his subsequent book, he showed how such betrayal inflicted on men of good character can lead to substance misuse, self-harm, despair, unresolved grief, social isolation, homelessness, cynicism, toxic anger, blaming, a desire for revenge, deep mistrust of others, violent behavior, suicide, and chronic post-traumatic stress disorder (PTSD) (Shay 1994).3 Shay focused on betrayal, but perpetrating harm can also lead to moral injury. In 2009, a VA clinical team led by Brett Litz defined moral injury as the “lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (2009, 695). It is important to note that both Shay and the Litz team do not regard moral injury as pathology. While usually regarded as disordered thinking, feelings of guilt, shame, and fury are often “judgments and beliefs about the transgressions [that] may be appropriate and accurate, as well

216  Rita Nakashima Brock as ­psychologically toxic and excruciating” (Litz et al 2016, 13). A morally devastating experience, such as killing, cannot be minimized, forgotten, or reframed as distorted thinking, and many veterans resent the pathologizing of their moral judgments. Instead, such experiences remain permanent features of their past that they struggle to accept (Webb 2021, 552–69). The Shay and Litz definitions are sometimes referred to as receptive and agential moral injury to distinguish between being subjected to harm and inflicting it (Graham 2016). They also reflect historical differences between the wars in Vietnam, with a military that was 25% conscripted and included men who enlisted in an attempt to avoid combat duties, and the all-volunteer military that fought the Global War on Terror (GWOT). In 1980, after years of facing a hostile public and having their suffering dismissed, Vietnam veterans were able to receive treatment for “posttraumatic stress disorder” (PTSD), which medicalized their suffering as a legitimate, fear-based disorder. The diagnosis has benefited many trauma survivors because it challenges victim-blaming and offers relief from a fear center in overdrive, but it also has had serious unintended consequences. Turning mental trauma into a disease sterilized the combat trauma discourse, removing complicated morality debates. This constructed a PTSD disease that could be understood as inevitable, amoral, and analogous to physical injury. This officially pardoned war veterans of guilt, while affording legitimacy and resources for suffering people within an intense culture of audit. (Webb 2021, 564) GWOT veterans can be reluctant to embrace the idea of being a victim of leadership, according to anthropologist Christopher Webb, who is a veteran of the war in Iraq. They tend to feel personally responsible for morally injurious experiences, even when they were forced to carry out orders that they knew were wrong. They have served in the military during a time when neoliberal policies have defined their lives, which means they face a more precarious future of greater economic inequality and increasing effects of climate change while bearing “a more galvanized commitment to the notion of individual responsibility per se. …The goal of a livable life seems to be found not through healing but through finding how to live anyway” (Webb 2021, 564).4 The formalization of the PTSD diagnosis buried the moral suffering of Vietnam veterans. Shay’s work placed that suffering front and center. Subsequent research has shown that high rates of PTSD in veterans involve perpetration and betrayal (Jordan et al 2017).5 But treatments for PTSD do not address moral suffering, and therapists are not trained in handling

On the Necessity of Ritual for Moral Injury Recovery  217 religious questions. The Litz team, in their protocol for processing moral injury called “adaptive disclosure,” included a session in which patients imagine a conversation about moral injury with a “benevolent moral authority” (2016, 124–33). In a 2018 controlled study of veterans with a PTSD diagnosis, those who went through additional group therapy saw less favorable outcomes for their PTSD treatments than those who had group sessions discussing moral injury and forgiveness with an actual chaplain (Harris et al 2018, 420–28). Both the imagined conversation and the time with a chaplain carry echoes of a ritual. Ritual for Moral Injury Moral injury, unlike a physical injury, is a crisis in the intangible realities of identity and meaning. The crisis involves complex interactions among the behavioral, spiritual, mental, emotional, physical, and social aspects of a person’s life. Recovery from moral injury begins with participants becoming consciously aware of painful moral feelings and the experiences that caused them. But once this process begins, a person needs others they trust to support them in constructing a viable identity and meaning system adequate to integrating their morally injurious experiences. In March 2017, I organized the designing of an evidence-based, 50-hour process for addressing moral injury called Resilience Strength Training (RST). A team of eight experts in psychiatry, military sexual trauma, moral psychology, peer specialist work, pastoral care, ritual studies, and Zen Buddhism created the program. They were led by Jonathan Shay and his Boston VA colleague, James Monroe, who is an Army veteran. Shay also acted as a senior advisor during the two-year pilot phase of the program. RST uses trained peer facilitators as ritual guides to help participants negotiate transformations that use, but do not depend on, personal sincerity to effect change. In its length and strategies, RST is akin to a traditional, multidimensional, and communal process, such as the Diné (Navajo) Enemyway Sing that uses chant, story, art, symbolic objects, and dance and lasts several days (Nez 2011, ch. 17).6 In November 2017, the first RST group of nine military veterans met at the Mary & Joseph Retreat Center in the sere hills of the Palos Verdes Peninsula. Veterans of the U.S. Army, Navy, and Marine Corps, the ­ women lived near the port of Los Angeles on a decommissioned Navy base in refurbished townhouses provided for unhoused veterans with children. They ranged in age from 30 to 50; one was white, one was Indigenous American, and five were African American. A male Latinx Marine Corps veteran and a female African American Army veteran, both peer specialists, guided the group through the weeklong program after receiving 40 hours of training in facilitating the program.7

218  Rita Nakashima Brock Opening activities involved participants taking a research survey and making name tags.8 They were also asked to choose a ribbon to tie on their lanyard, green for “I can be touched,” yellow for “ask first,” and red for “I do not want to be touched.” Then, after brief self-introductions, the facilitators asked the group to set consensus guidelines about confidentiality, respect, and participation. This act of negotiating how they would proceed, called a metacommunication in ritual and games, is akin to saying “play ball.” It signals the start of a liminal process or activity with its own rules and values outside of the stresses and chaos of mundane experience. As an initial ritual activity, the RST participants received instruction in mindful breathing, which we called “belly” breathing to emphasize the deep inhale and slow exhale that lower stress in the body. Breathing set the parameters of the start and finish of each sharing activity. In addition, the facilitators used it strategically during the most intense sharing to calm roiling emotions. Participants learned how to listen to each other in silence, without judgment, and with an open heart and quiet mind. Such listening enabled participants to validate deep moral pain with empathy and compassion and without minimizing it, explaining it away, interrogating it, or attempting to fix each other—embracing instead the struggles and feelings of near-strangers as their own. The group was then invited to give themselves a squad name using the total number of years they had served in the military. They arrived at the number 67, but then, one member of the group, G., who had not spoken, blurted, “I don’t belong here. I’m not really a veteran. I only lasted 21 days in boot camp.” Surprised by her distressed outburst, they wanted to know what happened. G. told them she went to the recruiting office to enlist, and the two recruiters told her that she was too overweight to qualify. Disappointed, she prepared to leave, but the men offered to create a weight-loss training program for her, which she eagerly accepted. Her program involved running and calisthenics, as well as being raped by the men. When she told her mother what was happening, her mother encouraged her to stick with it because “You’ll have a better life if you can join the military.” She persisted and became pregnant. When she told the recruiters, they found a female recruiter who took her to a clinic for an abortion, after which they enlisted her. “I only lasted 21 days in boot camp before I melted down.” The outraged group said it was not her fault. What happened to her was wrong. They insisted she belonged with them—she had wanted to serve her country, swore the oath, and made it to boot camp. They were emphatic that she counted as a veteran. They decided their name should be Squad 67-21 to include her 21 days. With that threshold activity and her confession, the moral injury floodgates opened. By the end of the first day, others had also shared their own military sexual trauma (MST) stories.9

On the Necessity of Ritual for Moral Injury Recovery  219 Every afternoon before dinner, the group spent an hour learning spiritual practices, such as yoga, walking meditation, or simple physical, tension-relieving exercises. The retreat center had a large outdoor labyrinth like the one in Chartres Cathedral, and the facilitators were inspired to use it on the second day of RST. They encouraged the group to notice the beauty of the garden and towering eucalyptus trees around them, and they admitted the participants two minutes apart at the pace of walking meditation. The participants collected at the center and waited in silence. When the facilitators arrived, one participant observed, “When I was walking around all the turns, everywhere I looked, I could see one of you. It made me realize I’m not alone, and there are people who support me and have my back.” G., who had put a red ribbon on her nametag, tore it off and said, “I don’t want this anymore. I need a green ribbon.” Another participant untied her green ribbon, ripped it in half and gave her the other half. Then, the entire group participated in a long group hug. By the next day, all their ribbons were green. Labyrinths have an ancient history of ritual uses. In the last few decades, they have proliferated in public parks and on religious community properties. They have multiple designs and interpretations as to their purpose, such as mazes for entertainment, as an allegorical journey of life, or as a spiritual pilgrimage toward the inner self and a return to the world. After this first group found it so powerful, we integrated a labyrinth walk into the program whenever one was available. It was not the only ritual activity this first group added to the program. On the last night of their week together, the group requested they be allowed to have a fire where they could burn things that they were ready to release—we used the Tibetan Buddhist Tantric principle of “sitting in the fire” to describe the painful process of facing into moral emotions directly so that participants could burn clean. This metaphor may have inspired the request for a fire to make their emotional journey tangible. The group invited the program administrator and me to join them, despite our not being part of the group. They were proud of their progress during the week and wanted us to be there. We gathered in a circle in a concrete portico area with the lights of Los Angeles glittering below. After a facilitator lit the fire, each member of the group read from a piece of paper before putting it into the coals. As we watched each page being consumed, we stood in silence, breathing until the next person was ready. One participant read a letter she had written that week to her rapist, forgiving him. Another, E., prefaced her reading with, “I’ve had so much pain in my life that I did not feel like myself if I was not in pain.” Then, she read, My pain began as a child. I was sexually abused by multiple members of my family. My mother did not love me. I joined the military to get

220  Rita Nakashima Brock away, and I was raped in the military. When I left, I became addicted to drugs, went to prison, and lost custody of my son. E. had so much difficulty during the first three days of the program that she became ill during some of the sessions. The first time it happened, she told the program administrator she wanted to go home. The administrator suggested she first go to her room and lie down and if she felt better, she could return to the group. She followed this suggestion several times, but continued to feel homesick for her six-year-old son. Mid-week, the administrator suggested she skip the evening program and spend the time with her son. If she wanted to, she could return in the morning, but if she didn’t, we would understand. She came back and finished the week. When Squad 67-21 returned home, they changed their self-isolating neighborhood into a more connected and engaged community. Three of them trained to become RST facilitators. One of the women, inspired by the art-making activities in RST, decided to create a program for the children in the community and offered it monthly for a time. Two participants eventually bought homes and one entered a doctoral program in organizational management. At an RST reunion event in November 2019, E.’s adult son pulled me aside and said, I know this program is for veterans, but it is also for the families. My mother was so different when she came home from that week. She stopped being mean to me and my little brother, and she listened to us. You saved our family, and I just wanted to thank you. In New York, our second pilot group, Squad Stony Point O-N-E, was eight men as racially diverse as the women’s group. It included two Vietnam-era veterans in their seventies who had recently been unhoused. It was co-facilitated by an African American Army veteran in his fifties, T., who had shot himself in the heart, and an African American Army veteran, K., in her late thirties, who, during a role-play activity, became beloved by the participants for taking the part of their mothers. When T. shared his attempt to die with his group, his openness elicited stories from several participants about their own attempts. At the squad’s concluding certificate ceremony, T. issued an open invitation to anyone in the group to join him in pledging not to die by their own hands. Five stood with him in making the pledge while the rest of the group and program staff stood and cheered. Veterans in that group reconnected with estranged children or families, found jobs, undertook service projects, became peer specialists, and, in one case, married after years of being unhoused and in suspended grief at the loss of his beloved wife. He attended an RST reunion with his fiancée’s name tattooed on his arm. RST used multiple strategies—writing, making masks, dancing, and role-playing—to help participants remember, examine, share, process,

On the Necessity of Ritual for Moral Injury Recovery  221 and reflect upon their experiences to the point that inner anguish was mitigated. As their experiences were processed and shared, their personal stories became valuable to others in the group and their empathetic engagement with others’ stories enabled them to transcend their own sincerity. The empathy of others also enabled them to feel empathy for themselves. At the end of every sharing session, we gave them time to record words and phrases of insight and gratitude on popsicle sticks and give them to each other. Near the end of their time together, participants were asked to engage with possible meaning systems and new moral identities that were adequate to integrating their morally injurious experiences. To make that process tangible, we had them build a collective moral house out of their popsicle sticks that had to include all the sticks. In three of the RST groups, a veteran who was present on the first day did not complete the process. Their Squads placed them at the doorway of their houses so as not to leave them behind. J., a white Air Force veteran in his late sixties, did not want to be in RST. He had followed his only friend, a veteran half his age, to the Passionist retreat center in Jamaica, NY, where the group met. He was a small man who was shrunken into himself so he seemed even smaller than his 5’4” height. J. had been living in the woods for 13 years after 23 years in prison and had moved into affordable housing for veterans. His curly gray hair and long white beard were oily and dirty, his skin was sallow, and he refused to shed his filthy parka and knit hat as he sat in the group shaking and saying, “I don’t want to be here,” repeatedly. At lunch the first day, I spotted him alone outside smoking furiously. I approached carefully and asked, “J. how are you doing.” Shaking his head while trembling and not looking at me, he said, “It’s too hard. I can’t do it. I want to leave.” I replied, “Yes, it is really hard. If you can get through the first few days that are hard, I promise you you’ll get to the good part.” “Too hard; can’t do it,” was his reply. I asked, “J., could you do me a favor? If you decide to leave, would you just let me know?” “OK,” and then he walked away. The second morning of the week, J. arrived at breakfast without his coat and hat, clad in clean clothes, hair and beard clean and fluffy, skin ruddy. He sat with members of the group, laughing and talking as he ate. He continued to come out of his shell all week, and by the time the group had to build their popsicle house, he took charge because he’d been an engineer and knew how to construct a house that would not fall down. At the certificate ceremony, J. said, “I’ve been under psychiatric care for 27 years, and, somehow, you all managed to do in five days what those years could not do. You gave me myself back. Thank you so much.” When he returned home, he bought steaks for his entire floor, which his friend grilled. He started playing a guitar—he’d once been in a rock band, and

222  Rita Nakashima Brock he connected with a nephew he’d not seen in decades. He continued to struggle sometimes with fear and executive cognitive functions, but he was pleased to have his story told. How Ritual Works All cultures use ritual to negotiate difficult or chaotic forces, such as death, illness, birth, adolescence, and major life transitions. Rituals provide fenced, formulaic processes that attend to integrating such forces into ordinary life. Ritual succeeds by engaging imagination, attention, emotion, and creativity. It uses material objects, as well as story, music, the body, and art symbolically to depict its intended aims. Ritual per se is, of course, not an unalloyed good. It can be harmful, especially when personal sincerity is required within narrowly confined, intense, and entrapping ritual structures. Post-enlightenment societies influenced by the Protestant resistance to ritual as Catholic “superstition” can be averse to ritual, which makes military training an outlier in its premodern, formal character.10 Relatively indifferent to sincerity, boot camp is able to override personal beliefs with its authoritarian structures and intense training in habitual behaviors. The pressures of sincerity are controlled by military order and discipline and unit cohesion, which remain effective until people end their time in service, whereas religious systems that too fiercely suppress sincerity can spawn reformist or sectarian movements to restore a balance with ritual processes. Ritual is, nonetheless, indispensable in its ability to convey a subjunctive, “as if” mood that displaces the frustrations and chaos of ordinary life with the powers of imagination and play and thus suspends personal sincerity as a means of transforming it. Ritual and sincerity offer alternative modes of framing social thought, action, and interaction. … the “balance” between them and differentiation of realms that each addresses in society have critical consequences for the ways individuals experience the world and, significantly, the social order. (Seligman et al 2008, 104) This force of ritual is especially useful in handling the struggle with multiple role conflicts and moral contradictions. It engages inner ambivalence about difference without putting the weight on individuals to manage the struggle solely via their own personal sincerity. In its effectiveness, Ritual is not best understood as congruent with something else—a magical imitation of desired ends, a translation of emotions, a symbolic

On the Necessity of Ritual for Moral Injury Recovery  223 acting out of ideas, a dramatization of a text, or the like. Ritual gains force where incongruence is perceived and thought about. (Smith 1982, 65) Pre-modern and indigenous societies are thick with rituals that enable people to play with multiple roles and identifications, allowing both the coexistence of differences and possible resolutions of ambiguity and conflict, as well as tolerance for forms of cunning and deceit to negotiate them. In doing so, they provide efficient means for handling devastating experiences and difficult social relations. For example, the ancient three-day rituals of Greek tragedy performances processed “the traumatic, forbidden, and, most painfully, that web woven of divine actions (often malicious or capricious), and human self-deception,” using the chorus that responds to all these forces. In the willing suspension of disbelief, such ritual theater gave liminal space for the “transient crossings and blurring of boundaries between licit and illicit, the speakable and the unspeakable, the real and the imaginary,” so that much could be negotiated without anyone being permanently chained to one role. “The formal frame of a ritual—acting, dancing, music, evocations of the divine origins of the ritual—all contribute to the communication and containment of what is, in life, ‘radioactive material’” (Seligman et al 2008, 61–62).11 In contemporary Western societies, the use of ritual has re-emerged in liturgical renewal movements, immigrant communities, and new hybrids, especially influenced by the appropriation of indigenous and non-Western religious practices among the “spiritual but not religious.” However, ritual generally functions in the context of “an emphasis on inner states like sincerity or belief,” often with “an overtly subjectivist and individualist emphasis on meaning and interaction” (Seligman, 4). When people participate in rituals without believing in them, they are often regarded as hollow and hypocritical acts or as trivial conventions. This modernist view regards ritual as an expression of personal sincerity reflecting beliefs in invisible essences that transcend ritual, are the reason for it, and are the reality to which the ritual points. In their cross-cultural examination of ritual, the authors of Ritual and its Consequences suggest this bias toward faith or belief also ignores discussions of the importance and meaning of rituals in non-Western and ancient sources, generally dismissing their rituals as maintaining fixed traditions or as quaint superstition. Instead, the authors note, effective rituals can override personal sincerity and deliver a new meaning system while also allowing for sincerity. Humans are social animals, and our emotions are highly contagious. We are deeply influenced by unconscious behaviors that are automatic and not

224  Rita Nakashima Brock under the control of rational volition or conscious belief. Moral behavior is learned and reinforced through ritual repetition in relationships, which results in habits that are quite stable and fixed in our character, sans ­conscious choice. While various areas of our brain handle functions from higher level intellectual thinking to brain stem functions, such as breathing and heartbeat, “the learning process is highly dynamic and engages in parallel, not simply in series, sets of neural circuits” across many areas of the brain as “a result of experience-dependent plasticity … that can influence not only overt behaviors but also cognitive activity,” such as moral judgment (Graybiel 2008, 359–387). The establishing of new habits requires ritual practice to implant new meaning systems to the point they are embedded and behavior becomes habit. Without ritual to access meaning and make abstract, immaterial, and intangibles real, they tend to fade and to feel less real as time passes (­Luhrman 2020). This need for regular ritual is because even very religious people relate to clear, sensory, and observable phenomena in ways different from how they relate to spiritual, conceptual, and emotional experiences. Maintaining invisible realities like memory, a self, and relationships takes great effort because meaning systems and belief in spiritual realities involve non-sensory, theoretical ideas about the construction of a self, love, and the moral values that sustain relationships. People who devoutly believe in an omnipresent, omnipotent deity still seek ways to experience the presence of that deity in rituals that enact and reinforce what they believe. The focus and effort involved may be why people are more likely to make sacrifices for what they believe rather than for observable facts. Ritual works by creating a liminal space and time that makes the invisible real and embodied, liminality that is separate from mundane existence. People wait before a room, building, or circumscribed outdoor area that has been prepared for the ritual and is the site where significant activities will take place (Webb 2021). They may physically cross a threshold or circumscribe a hospital bedside temporarily for prayer. A college friend who was a Marine lieutenant in Vietnam once shared a story about an ambush his unit fought their way through. He remembers little of the actual battle, beyond shouting rapid-fire orders in the midst of the chaos. What he remembers and what brought him to tears in the telling was a ritual. Out of the corner of his eye, he saw one of his men take a gut shot that was clearly fatal. He registered the wound in a split second, shouted, “Corpsman,” and returned to commanding the fight. When he turned again in the direction of the wounded Marine, he saw his corpsman holding the man in his arms and singing to him. That liminal moment of care and humanity in the midst of war is one of my friend’s most vivid memories. As ritual, it suspended the war for just an instant and made compassion unexpectedly real.

On the Necessity of Ritual for Moral Injury Recovery  225 Ritual spaces can hold people’s humanity and heartbreak in the direst of circumstances using imagination, an expectation of change, and the agency of participants in managing chaos and tragic realities (Seligman et al 2008, 17–42).12 The duration of rituals vary widely from a minute to years, but they take place within a telos, a destination that is not measured by chronos, ticking time. In that sense, ritual is a kind of liminal journey or pilgrimage. Its narrative arc has a beginning, middle, and end, and it has the power to move people from isolated suffering to relationships that can support healing from pain, regaining positive self-regard, and finding a life purpose through its subjunctive mood for engaging difficult stories and emotions. RST is one example of such a process. Conclusion Mental health professionals can be helpful, but moral injury is a break in relationships to self and world, which involves, for many, a spiritual dimension. However, religious traditions that require belief in a harsh and punitive understanding of higher powers or a view of humans as helplessly sinful or evil are likely to exacerbate moral injury, rather than heal it (Drescher et al, 2011). Chaplains or religious communities trained to understand moral injury can be helpful as people rebuild a capacity for reconnecting to self and meaning, especially via rituals. Global War On Terror (GWOT) veteran Webb has studied the use of the Lakota Sweat Lodge Ceremony by non-Native veterans, a ceremony that emphasizes healing “the sickness that comes from fighting people.” He used it himself when his VA treatments for PTSD left him feeling miserable. Despite the progress I made in clinical PTSD therapy, there were other things I could not escape. Confusion about what had happened and why—and trying to account for my role in it all—became tortuous, consuming me like a parasite from the inside out. The evil, unjustifiable violence of the war I had fought was something I could not avoid. I wrestled with this not only in my nightmares but every day at work as I committed myself to the scholarly study of war, colonialism, and trauma.13 (Webb 2020) As Seligman writes, ritual helps teach us to recognize the fragmented and discontinuous nature of the world, the endless work entailed in building and refining our multiple and often conflicting relationships within that world and the ultimately tragic fate of that work. And it helps teach us the powers of ethical action based upon such a tragic vision. (Seligman et al 2008, 181–82)

226  Rita Nakashima Brock The most robust power of ritual lies with its formal properties of being porous to ambiguity and not dependent on individual sincerity, while also respecting it. Ritual is a multidimensional process for supporting recovery from moral injury in a collective context where all can benefit, whatever they bring to the ritual. Some participants with a mental health diagnosis were sent to RST by their therapists. It offered participants a powerful safety net for processing profoundly disturbing and life-threatening memories of moral injury, using multiple modalities for bonding and sharing pain. Participants imaginatively engaged in a process that helped them find footing to face the future with anticipation. RST was validated as an evidence-based program, which matters to funders and to all of us who put so much work into creating and implementing it. However, the data tell us about averages, whereas the stories describe what is surprisingly possible beyond the numbers. At the end of every evening of RST sessions, the program administrator debriefed the facilitators so they were supported, could process difficult moments, and report on noteworthy things that happened within the group that day. As project director, I was present at these sessions and heard many more stories of transformations than I have permission to tell. All the stories still strike me as miraculous. Notes 1 In Sebastian Junger’s documentary, Korengal, the sole Black soldier in his unit discusses racism matter-of-factly and then asserts, despite such attitudes, he and his comrades were willing to die for each other. He admits, “I’d go back there in a heartbeat” (Wikipedia 2022). 2 I use warrior in scare quotes because it is both an ancient mythic military identity with continuing valance and a mask that hides the modern military and its science of war, which uses individuals to implement mass lethality far beyond the imaginings of ancient warrior cultures or modern Rules of Engagement. 3 I first met Shay in March 2010, and in a conversation around 2017, he told me the story of the unpublished paper. 4 “Two factors that distinguish the GWOT era are the open-ended and uncertain nature of the war and the fact that it has been waged by an all-volunteer force (AVF) (Hautzinger and Scandlyn 2014, 22–24). The resulting situation is comprised of an ambiguous battlefield of unclear enemies/motives … and a force that is comprised almost entirely of people who, for diverse reasons, went into combat by their own volition. This distinction makes the experience of GWOT veterans unique and makes it difficult to describe their situation through the theories that have developed through other wars” (Webb 2021, 563). 5 “Our findings suggest that for a substantial proportion of service members and veterans, PTSD symptoms may be due to morally injurious experiences of perpetration or betrayal rather than danger-based events” (Jordan et al 2017).

On the Necessity of Ritual for Moral Injury Recovery  227 6 Chester Nez (2011) describes how his life was saved by a four-day Enemyway Sing that finally purged the Japanese ghosts that had haunted him night and day for six months. 7 The RST pilot program was funded by a grant from Bristol-Myers Squibb. The facilitators were supported by an on-site program administrator and an on-call clinician, who provided one-on-one counseling if needed and consultation in case the facilitators faced challenges better handled by a mental health ­professional. As the project director, I shared meals with participants and attended the facilitator debriefings every evening. 8 Participants took an hourlong survey before and immediately after going through RST and six months later. For details about the research, see Timothy Barth et al (2020). 9 Everything that took place in the group was confidential. The stories in this chapter are included with permission from the individuals or groups involved. While not the topic of this chapter, sexual assault is a serious factor in moral injury that disproportionately happens to non-cis-male gendered people. Accurate numbers are difficult to determine, as assaults are generally under reported and those on men are seriously underreported. A 2021 study determined that “One in 16 women and one in 143 men are estimated to experience sexual assault within DoD. At the service academies, one in six women and one in 29 men experience sexual assault” (Acosta 2021, 4). 10 A significant lacuna in Seligman et al (2008) is its absence of analysis of military ritual. 11 Brian Doerries’s work (2015) attempts to capture some of this power with its performances of Sophocles’ plays on military bases and for veterans’ groups, though the ritual aspects of its presentations are relatively thin. 12 Webb (2021, 556) adds, “The reality of the military veteran, as an actively performing subject, is  the  integral detail here, as crossing these thresholds is only possible by an active agent; they cannot be carried across them as a passive imperial object.” 13 “What originally began as a way for the VA to provide help for Native American Vietnam War veterans who were not recovering from PTSD through clinical therapy has now become a healing path for a diverse set of veterans, including me—sometimes with remarkable outcomes” (Webb 2010).

Works Cited Acosta, Joie D., Matthew Chinman, and Amy L. Shearer. 2021. “Countering Sexual Assault and Sexual Harassment in the U.S. Military: Lessons from RAND Research.” Santa Monica, CA: RAND Corporation. https://www.rand.org/pubs/ research_reports/RRA1318-1.html. Almost Sunrise. 2016. Directed by Michael Collins. New York: ITVS and POV. Barth, Timothy M., Charles G. Lord, Vishal J. Thakkar, and Rita N. Brock. 2020. “Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans.” Journal of Veterans Studies 6, no. 2: 101–13. http://doi. org/10.21061/jvs.v6i2.199. Blumenthal, David R. “Soul Repair: A Jewish View, Parts 1–3.” Canopy Forum: On the Interactions of Law & Religion. Accessed April 20, 2020. https://canopyforum.org/2020/04/20/soul-repair-a-jewish-view-part-1/.

228  Rita Nakashima Brock Doerries, Bryan. 2015. The Theater of War: What Ancient Greek Tragedies Can Teach Us Today. New York: Alfred A. Knopf. Drescher, Kent D., David W. Foy, Caroline Kelly, Anna Leschner, Kerrie Schutz, and Brett Litz. 2011. “An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans.” Traumatology 17, no. 1: 8–13. Graham, Larry. 2016. Moral Injury: Restoring Wounded Souls. Nashville: ­Abingdon Press. Graybiel, Ann M. 2008. “Habits, Rituals, and the Evaluative Brain.” Neuroscience 31: 359–87. Harris, Irene J., Timothy Usset, Cory Voecks, Paul Thuras, Joseph Currier, and Christopher Erbes. 2018. “Spiritually Integrated Care for PTSD: A Randomized Controlled Trial of “Building Spiritual Strength”.” Psychiatry Research 267: 420–28. https://doi.org/10.1016/j.psychres.2018.06.045 Hautzinge, Sarah and Jean Scandlyn. 2014. Beyond Post-Traumatic Stress: Homefront Struggles with the Wars on Terror. London and New York: Routledge. Jordan, Alexander H., Ethan Eisen, Elisa Bolton, William P. Nash, and Brett T. Litz. 2017. “Distinguishing War-Related PTSD Resulting from Perpetrationand Betrayal-Based Morally Injurious Events.” Psychological Trauma Theory Research Practice and Policy 9, no. 6: 627–34. https://doi.org/10.1037/ tra0000249. Litz, Brett T., Leslie Lebowitz, Matt J. Gray, and William P. Nash. 2016. Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury. New York and London: Guilford Press. Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. 2009. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8: 695–706. https://doi.org/10.1016/j.cpr.2009.07.003. Luhrman, Tanya M. 2020. How God Becomes Real: Kindling the Presence of Invisible Others. Princeton and Oxford: Princeton University Press. Nez, Chester. 2011. Code Talker: The First and Only Memoir by One of the Original Navajo Code Talkers of WWII. New York: The Berkley Publishing Group. Scott, James C. 2019. Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven, CT and London: Yale University Press. Self, Ron. 2016. “How to End Veteran Suicide.” Filmed November 2016 at TEDxSanQuentin, San Quentin, CA. Video, 12:47. https://www.youtube.com/ watch?v=IfG7WV-bN6Y Seligman, Adam B., Robert P. Weller, Michael Puett, and Bennett Simon. 2008. Ritual and Its Consequences: An Essay on the Limits of Sincerity. New York: Oxford University Press. Shay, Jonathan. 1994. Achilles in Vietnam: Combat Trauma and the Unmaking of Character. New York: Athenaeum Press. Smith, Jonathan Z. 1982. Imagining Religion: From Babylon to Jonestown. ­Chicago and London: University of Chicago Press.

On the Necessity of Ritual for Moral Injury Recovery  229 Webb, Christopher. 2020. “How Sweat Lodge Ceremonies Heal War’s Wounds.” Sapiens. Accessed September 3, 2022. https://www.sapiens.org/culture/ptsd-sweatlodge/. Webb, Christopher M. 2021. “The Wounds That Never Heal: Transgression, Liminality, and Ethical Ruin in Battlefield Thresholds.” ETHNOS 86, no. 3: 552–69. https://doi.org/10.1080/00141844.2019.1665568.Wikipedia. 2022. “Korengal.” Accessed September 3, 2022. https://en.wikipedia.org/wiki/Korengal.

13 Animist Forms of Atonement and Healing in Edwidge Danticat’s The Dew Breaker Jay Rajiva

What are the ethical limits of moral injury when the concept is detached from an examination of the Western structures of meaning that shape it? Drawing on the work of feminist scholars such as Miranda Fricker, ­Matthew Congdon analyzes the basis for any form of transformative justice making claims to legibility, which he calls “the condition of conceptual adequacy” (2016, 817). This condition requires a publicly intelligible category of wrongdoing into which a specific moral grievance can fall. For Congdon, it becomes difficult for a victim of sexual harassment, for example, to seek moral and legal redress if they live “in a time and place still lacking the moral and legal category ‘sexual harassment’” (2016, 817). The use of “still” as an adverb, though, speaks volumes about the cultural and geographical presumptions that underpin Congdon’s otherwise-insightful discussion of moral grievance. A sense of Western teleology emerges: those times and places lacking “conceptual adequacy” to address moral injury are clearly “developing” nations that have not yet caught up to the West in ethical, legal, and cultural sophistication. Moral injury, in Congdon’s example, becomes almost impossible to apply to non-Western and nonwhite contexts without serious reflection, particularly when we approach the concept of healing and the problem of ritual atonement for wrongdoing. How might subjects participate in recognizable rituals that atone for acts of wrongdoing if the condition of conceptual adequacy, to use Congdon’s term, is absent from the cultural and social register? What if that condition is not only absent but constitutively absent, taking place in a diasporic context in which marking and memorialization are fraught sites of physical and social return? This complicated absence is the site of both trauma and a provisional form of healing in Edwidge Danticat’s The Dew Breaker, a story cycle organized around the afterlife of a former member of the paramilitary group later named the Milice de Voluntaires de la Sécurité Nationale (Volunteers for National Security). This group, colloquially known as the Tonton Macoutes, was

DOI: 10.4324/9781003281122-17

Animist Forms of Atonement and Healing  231 responsible for countless acts of abduction, murder, and torture in Haiti for almost 30 years. Danticat’s story cycle represents the lived experience of Haitian and ­Haitian-American victims of state violence. For decades, the macoutes, sometimes referred to as choukèt lawozes (dew breakers), terrorized ordinary Haitians during successive authoritarian regimes from the late 1950s to the mid-1980s (led by François “Papa Doc” Duvalier and his son, JeanClaude “Baby Doc” Duvalier). Though directly involved in abductions, torture, and murder, the Macoute in Danticat’s story cycle, known as Mr. Bienaimé, flees Haiti and builds a new life for himself in the U.S. with his wife and daughter. In this chapter, I argue that The Dew Breaker reconceptualizes healing from moral injury through its attentiveness to animist structures of meaning. Broadly defined, animism is the belief in the spiritual properties of nonhuman matter. This belief shapes the inner lives and cultural practices of millions of people across the world in non-Western religious and cultural contexts. For the man, who committed countless crimes against ordinary Haitians in his former life as a dew breaker, as well as his wife, whose stepbrother was one of her husband’s victims, moral injury includes complex cultural and spiritual dimensions that preclude healing in the traditional and Western sense of the term. Instead, The Dew Breaker mobilizes the animist concepts of marasa (two people being one without being identical to each other) and the luck charm (a concept found in Haitian Obeah and American Conjure) to establish a structural and narrative basis for healing throughout the collection. By paying attention to partial but non-identical patterns of animist resemblance across and within each story, The Dew Breaker reimagines how Haitian victims of Tonton Macoute violence—whose stories form the bulk of the collection—negotiate and work through their personal traumas. This reimagining, I suggest, offers a provisional form of healing from moral injury to both the man and his wife, but in a private and specifically Haitian-American context without ritual atonement and public disclosure. Historical Trauma, Victim-Perpetrator Ambiguity Since the encounters between indigenous Taíno and Spanish colonists in the late fifteenth century, trauma has been constitutive of, not incidental to, Haiti’s collective national history. Aiton Ibarrola-Armendáriz notes the cruelty of the Spanish colonialists that culminated in the destruction of the fort La Natividad, in which the indigenous Taíno inhabitants revolted “against [Columbus’s] men due to their cruel mistreatment of the Taíno workers and the kidnapping of their women” (Ibarrola-Armendáriz 2010, 26). As the Spanish installed the plantation slave system, they also decimated

232  Jay Rajiva the island’s indigenous population within a few decades, prompting the importing of African slaves. Spanish colonial interest subsequently shifted from the Caribbean to gold mining in the American mainland in the seventeenth century, allowing the French West India Company to establish colonial rule in 1659 over the western part of the island (Hispaniola), renaming it Sante Domingue. Two-colony warfare persisted until the treaty of 1697, which allowed the French to take one-third of the island from the Spanish. Through this extended colonial period, Caribbean trauma was inextricable from European violence across an interconnected spectrum of economic, social, and political forms. The colonial period established trauma’s permanent presence; decolonization amplified and refined its intensity. Though Haiti won political freedom in the late nineteenth century, independence triggered a host of crippling economic sanctions from European powers, the most notable being the astronomical debt Haiti was forced to pay back to France to justify the loss of its colonial holdings. From sola independence, then, came multis instability, which led to the revolt of the island’s eastern half in 1844 and the establishment of the Dominican Republic. As the U.S. entered the colonial landscape, it began to establish permanent military bases in the Caribbean, leading to a period of overt occupation in the early twentieth century, and two Central Intelligence Agency (CIA) sponsored coups against democratically elected governments in the post-Duvalier era (Collins 2011, 8–9). The recent “natural” disasters—the 2010 earthquake and the damage wrought by Hurricane Irma in 2017—have been magnified, then, by the country’s impoverished status, which we can at least partially attribute to the scope and persistence of exploitation by colonial and neocolonial powers. The atrocities of the Duvalier regime, moreover, were committed by Haitians against the general population, troubling clear ethnocultural distinctions between victims and perpetrators. In other words, violence did not take place between groups claiming different ethnic identities or class positions. Haitian trauma is certainly marked by singular events of collective violence. However, it also shares the aspect of insidious or everyday trauma, a kind of messiness and ambiguity that disrupts the symmetry of moral injury as a concept. It falls to Danticat, Haiti’s foremost contemporary storyteller, to articulate the complexity of Haitian experience, a responsibility that the author has pursued in different literary and non-literary forms including novels, individual short stories, story cycles, memoir, children’s books, and young adult fiction. Fittingly, Danticat’s story cycle rests on a term borrowed from Haitian myth: The Dew Breaker, choukèt lawoze, a bogeyman making off with children in the middle of the night, the purveyor and embodiment of unforeseen terror. The story cycle does not waste time conveying the visceral

Animist Forms of Atonement and Healing  233 sense of apprehension that the name evokes through the haunting image of a torturer, a member of the Duvalier regime’s secret police, stealthily making his way across the still-bedewed grass at earliest light, to attack, kill, or abduct. The collection’s first story, “The Book of the Dead,” finds its Haitian-American narrator, Ka Bienaimé, confronting a dew breaker in the flesh: her own father, Mr. Bienaimé, a former macoute who fled Haiti and has spent the past few decades living anonymously with his wife and child in the U.S. This revelation surfaces as Ka is about to sell a sculpture modeled on her father to a Haitian television star. Ka’s father goes missing, reappearing over a day later in order to take the sculpture and fling it into a nearby lake, after which he confesses his past to Ka. Struggling to reconcile the gentle, quiet man, she has always known with the figure of the dew breaker, Ka returns to Egyptian mythology, which had always held a special attraction for her father. In the end, she concludes, she and her mother had become her father’s “kas, his good angels, his masks against his own face” (Danticat 2005, 34). More than terror is at work in this image, which is a natural one, an encounter between the torturer’s booted heel, water, and grass, the dew itself barely perceptible as the object of attack. The dew breaker, secret policeman and murderer, comes into representational significance through a profoundly ambiguous image, one that conveys both fear and beauty, transience and an awful kind of finality. As the title to Danticat’s collection, it functions as a mask of sorts, roughly analogous to the Egyptian masks of the collection’s first story, a shape that compels the reader to investigate further, to dispel the ambiguity it generates. As an image, the dew breaker could very well be anything, bearing no association with torture and trauma. Yet it is precisely this ambiguity that bears the shape of representation, a sort of chrysalis connoting trauma’s partial trace, neither patterned nor chaotic, but built according to a different organizing principle. The mask of the dew breaker, when torn off, reveals not a face but rather an assemblage of attributes, a set of characteristics marked by their refusal to settle into the unity of a single identity. This ambiguity pushes us to interrogate the de facto application of moral injury to contexts involving soldiers, since the dew breaker, of course, is part of a paramilitary group. Here, we run up against some of the limitations of moral injury: how it tends to foreground soldier trauma at the expense of civilian trauma, restricts culpability to a naive, apolitical, and ahistorical conception of morality and bad acts, assumes mostly white, western military subjects, and relies on a Western approach to healing premised largely on the Freudian talking cure. For example, a recent article relies on the Aristotelian notion of the excellence of character to provide a framework for studying moral injury outside of the clinical domain (Atuel et al. 2021). This decontextualized use of Aristotle, absent any discussion

234  Jay Rajiva of its relevance to non-Western instances of collective trauma, assumes that one can simply use ancient Greek philosophy as a ready-made template to understand the broad phenomenon of moral injury. To be clear, I am not suggesting that using Aristotle to help soldiers work through moral injury is inherently problematic. The issue, rather, is how this type of philosophical framework is simply not transportable into specific instances of collective trauma in Haiti and in other parts of the postcolonial world. Even the touchstone of ritual atonement, in which the soldier receives some form of healing from moral injury through a public-facing act of contrition, depends on a shared set of ritualized practices, whether religious or not, carried out in a setting that allows a recognizable type of memorialization, none of which is guaranteed or certain in the migrant experience detailed in The Dew Breaker. Mr. Bienaimé, like many ex-macoutes, lives incognito in a different country (the U.S.), in which disclosure of his past could bring about instant ruin for both his family and himself. Moreover, redress from moral injury demands a conceptual stability that is difficult to articulate in stable terms. The harmony of the family depends on avoiding the fact that Ka’s father is also the person who abducted, tortured, and later killed Ann’s stepbrother, albeit by accident, in the course of a botched interrogation. The very circumstances of Ka’s family, then, militate against disclosure, talking cures, and ritualized forms of expiation for crimes of the past. If moral injury is to serve as a basis for understanding trauma, it must widen to accommodate frames of meaning that do not tacitly rely on a universalized notion of Western philosophy and culture. Moral Injury and Marasa Consciousness Danticat’s collection offers mystery in the first story and disclosure in the last. But in between, the connection to the theme of Haitian trauma is suggested, not stated. The second story in the collection, “Seven,” is a brief vignette, told in the third-person limited narration about a couple separated for seven years by immigration. The husband works two jobs in the U.S., obtains his green card after seven years, and then sends for his wife. They are sexually intimate, though each has been occasionally unfaithful to the other during the seven-year interval. The collective trauma that emerges is oblique and opaque, at a distance from lived experience: references to real-life Haitian-Americans beaten or killed by New York police that they hear over the radio. One of the husband’s ex-lovers becomes the focus of the next story, “Water Child,” a nurse grappling with having aborted a child while living a solitary existence in Brooklyn but sending money to her ailing parents back in Haiti. Ka’s family swings back into focus in “The Book of Miracles,” a snapshot of a past Christmas when Anne, in the midst of attending midnight mass with her family, is shaken

Animist Forms of Atonement and Healing  235 by the possibility that another churchgoer may be Emmanuel Constant, a Haitian war criminal living incognito in the U.S. “Night Talkers” picks up the story of Dany, one of two men who shares a room with the male protagonist of “Seven,” visiting his dying aunt in Haiti, trying to process the trauma of having lost his parents to Duvalier-era terror while getting to know Claude, a HaitianAmerican who killed his father in drug-induced paranoia. In the next story, a young Haitian-American reporter interviews a bridal seamstress on the brink of retirement, in a story named for her profession, a woman haunted by the memory of torture at the hands of a dew breaker and convinced that her former tormentor is stalking her. “Monkey Tails” takes the reader back to Duvalier-era Haiti, through the memory of a man recalling the shock of discovering that he was the unacknowledged son of Monsieur Christophe, who controlled the water in their community, on the eve of the birth of his own child. “The Funeral Singer” follows three women—Mariselle, Rézia, and the narrator, Freda—as they each attempt to recover from the trauma of loss and collective violence while studying for their General Educational Development (GED) exams. The final story, named for the collection itself, looks back at Mr. Bienaimé’s turbulent past, an examination of both his crimes and his ambivalent relationship with being a dew breaker. We open with a revelation about the identity of Ka’s father, and we close in the same temporal moment that concludes “The Book of the Dead,” with Ka having just discovered her father’s identity, asking for more information, then hanging up the phone, leaving Anne, her mother, struggling to process this “dread,” the “pendulum between regret and forgiveness, this fright that [her] most important relationships” are “always on the verge of being severed or lost” (Danticat 2005, 242). The formal ambiguity of The Dew Breaker—most notably, how it can be potentially read as a novel, a collection of short stories, or a story cycle—has received a considerable amount of critical attention since the story cycle’s publication. Nadge T. Clitandre characterizes this ambiguity as an “echo trope,” which constitutes “a strategy of working through and transgressing the psychic anxiety of fragmentation and separation that produces alienation” (2018, 105). For Sarah G. Waisvicz, the indeterminacy of The Dew Breaker is “in line with the particular Caribbean cultural tradition of opaqueness … an oppositional and inscrutable impulse … a going back and forth” without fixed or explicit states (2018, 96). More specifically, Birgit Spengler considers how the text’s use of “visual cues and objects” establishes unsettling connections between “the impact of the past on the perpetrator” and the perpetrator’s “inner life after relinquishing violence,” pointing to a fundamental instability in trauma’s representation (2014, 198).

236  Jay Rajiva Maria Rice Bellamy has persuasively read The Dew Breaker through the animist lens of marasa (sometimes spelled marassa), a “theory of textual relationships based on the Haitian divine twins” (Pressley-Sanon 2013, 118) that originates in the pan-African worship of twinning and doubling (MacGaffey quoted. in Pressley-Sanon 2013, 120). Bellamy argues that marasa “creates a framework for understanding Ka’s parents’ relation to their traumatic pasts and enables her to imagine a character like Ka’s father who has committed violent acts but is also a loving husband and father” (2012, 180). Correspondingly, Danticat herself has explicitly invoked marasa as an ethical touchstone for reading The Dew Breaker: Marassa is actually part of the African tradition where there were twin deities…. Marassa in common language means twins…. The idea is that two people are one, but not quite…. Doubling is a similar idea … that someone is doubly a person but really one person—as opposed to the twins who are really two people…. Doubling acknowledges that people make separations within themselves [and] … the separation allows people to do very cruel things. (2011, 385) As a binding concept, marasa allows the story cycle to offer a representation of trauma that resists the event-based model of western trauma theory. In a Western diagnostic mode, marasa might be erroneously seen as a gateway to dissociation; here, and by contrast, Danticat puts twinning to work within a cultural context that is recognizable to Haitians and those of Haitian descent. One does not need to resolve doubled selves into a unified whole, just as one does not need to expiate the “bad” self through a particular type of Western atonement ritual. I want to extend Bellamy’s reading by adding two additional and vital elements to the marasa concept. The first element is the dosu/dosa (masculine or feminine versions), “the attendant third element/space/moment of resolution or completeness through creativity” that constitutes “the marasa twa, the movement into the third element to completion” (Pressley-Sanon 2013, 119). The dosu/dosa is riddled with tension, frequently “left open to speculation, an invitation to the reader to contribute his/ her own creative power” (124). In marasa consciousness, the double gives way to a third space made possible through creativity, a rich metaphor for describing the complexity of Afro-Caribbean diasporic experience, which is marked by “displacement and rupture” (123). The animist structure of The Dew Breaker, I suggest, compels readers to question received notions of unity and completeness, particularly as they pertain to the possibility of healing from moral injury. After the events of “The Book of the Dead,” Mr. Bienaimé disappears from direct perception

Animist Forms of Atonement and Healing  237 in the ensuing two stories, resurfacing again in “The Book of Miracles,” which is told from the point of view of Anne, his wife, in a time anterior to the happenings in “The Book of the Dead,” before Ka discovers that her father was once a Tonton Macoute. In the latter story, Anne’s reflections on “the simple miracle” of her husband’s transformation from Tonton Macoute to loving husband and father (Danticat 2005, 72–73) are intertwined with her fear, while attending Christmas Eve Mass, that her daughter would judge her father harshly if she were to find out his violent past. The story centers on a brief moment when Ka thinks a man in the church is actually Emmanuel Constant, the notorious ex-leader of another, later paramilitary group who fled Haiti to live in exile in New York, until convicted of property fraud in 2008 (Semple 2008). Though the man eventually turns out not to be Constant himself, the specter of resemblance haunts Anne, who remembers seeing a flyer accusing Constant of “crimes against the Haitian people” (Danticat 2005, 78) and having to fight a strong desire to pull it down, not out of sympathy for Constant but out of a fear that even though her husband’s prison ‘work’ and Constant’s offenses were separated by thirty-two years, she might arrive at the store one day to find her husband’s likeness on the lamppost rather than Constant’s. (2005, 80) In the specter of Constant, the reader is directed to an analog of Mr. Bienaimé, but partial and contradictory, buried behind layers of mediation. We do not confront Constant himself, but rather someone who bears some likeness to the war criminal, whose picture features on the flyer that Anne sees every day when she goes to the store. At the time of the story, the secret of Mr. Bienaimé’s past remains concealed from Ka, though of course not from readers, who are privy to Anne’s thoughts and who have already read “The Book of the Dead.” Through temporal and narrative rupture, Danticat’s collection creates an expectation of closure, only to thwart it, since the deep encounter with Mr. Bienaimé’s crimes is withheld. Just as Anne imagines how she might react if the man at mass turns out to be Emmanuel Constant, so does Danticat ask readers to inhabit this space of “failed” reading, in order to illustrate healing as a complex and ongoing process bereft of any public-facing rituals of atonement. We see then, how the terms of Haitian-American trauma might correspond to “the stage in which some inchoate sense of injury or harm is registered yet remains socially inarticulable” (Congdon 2016, 816). In shifting from the moral injury of the perpetrator, Mr. Bienaimé, to stories that deal with the experience of Haitian-American immigrants, The Dew Breaker keeps the resolution of moral injury open, gesturing at once

238  Jay Rajiva to rupture and to the possibility of healing without its facile enactment: that is, without categories of atonement that would be out of place for the characters and presented simply to soothe readers. Mr. Bienaimé is thus both emblematic and ordinary, a man whose past shadows him in ways that he is unable to escape or control. The dew breaker’s victims are many, and we only encounter some of them in Danticat’s collection. Moreover, Mr. Bienaimé is only one dew breaker, one of potentially thousands of former Tonton Macoutes living in or outside Haiti. Structurally, the collection introduces him through the eyes of his daughter Ka, whose understanding of Mr. Bienaimé’s past is no different from that of any reader: the first-person narration of the opening story ensures that the full scope of his past transgressions is hidden, coded, and long past, since the story takes place in the collection’s present (the early 2000s). Mr. Bienaimé is caught between his past crimes and his present life in the U.S. as a loving father and husband, a tension that Ka must now negotiate on her own. Father and daughter might thus be seen to occupy marasa consciousness, doubles of each other without being identical, indicative of “the Caribbean reality of large diasporas and international interventions, which is especially true of Haiti, that produce here/there, us/them, and home/abroad dichotomies” (Pressley-Sanon 2013, 119). Luck Charm, Mojo Bag The second animist element I want to consider is a practice common to both American conjure traditions in the U.S. South and Haitian Obeah (to which conjure owes much of its lineage): transforming a series of everyday objects into animist things, imbuing the ordinary with ritualistic significance. The most striking image of this transformation is the luck charm, which, as Katherine Biers notes in her analysis of Zora Neale Hurston’s synthesis of theater and American conjure practices, “consists of a collection of objects that conflate the human with the nonhuman, such as teeth, dirt, or bones” (2015, 73). In the hands of an Obeah priest or a conjurer, the objects constituting the luck charm, frequently stored in a “mojo” bag (sometimes called a “hand”), grant mysterious powers, part of animist traditions that are “often understood as creative appropriations of Catholic ritual” (69). This appropriation, Biers suggests, “understands meaning-making less as a conceptual activity carried out by human subjects on material and historical objects than as a product of assemblages of human and nonhuman agents” (70). In challenging distinctions between human and nonhuman, between sentient and nonsentient matter, the luck charm interrogates “the sovereignty and agency of the authorial self and the divide between the human and the nonhuman that undergirds it” (71).

Animist Forms of Atonement and Healing  239 Through this challenge, we can see how animist practice not only r­ ecuperates a sense of the world persistently obscured or derided by European colonists, but also how it illuminates responses to forms of collective trauma that require different conceptual tools to understand. Discussing Obi, a Jamaican variant of Obeah, Elizabeth Maddock Dillon notes that animist practice “places into relation a set of subjects and objects that are seen as unrelated, at least in the reckoning of European observers” (2013, 175): Obi reassembles the social in order to render visible and meaningful an alternative set of relations—an ontology—that has been previously regarded as inauthentic, untruthful, barbaric, or meaningless. Obi asks us to make sense of unfamiliar—unrealistic, even— relations between and among objects and subjects: between, say, rusty nails, grave dirt, a slave woman, a missing gown, and shoe leather. Unfamiliar, unrealistic relations between, say, masters, slaves, and sugar cane or between a master, a slave, a shirt, potatoes, rocks, and the devil. Unfamiliar, unrealistic relations between medicine, religion, and revolution. (175–76) The definition Dillon offers is not detached from history or politics. The words “master” and “slave,” which evoke the history of enslavement in the Caribbean, rub up against the economic reality of that enslavement (“rocks” and “potatoes”), making visible the discursive violence that accompanied the material violence of colonialism. What would it mean to consider healing from moral injury within the terms of animist ritual, specifically, the luck bag and its provisionality, its undermining of human agency, and its willingness to trace connections between “rusty nails, grave dirt, a slave woman, a missing gown, and shoe leather”? If Obi, like Haitian Obeah and American Conjure, “reassembles the social,” it also demonstrates how the social, as traditionally constituted in white, western contexts, sometimes fails to provide the adequate conditions for subjects to heal from moral injury. Let us consider this “unrealistic” ontology in relation to the narrative structure of The Dew Breaker. The story is a thing, an artifact, a residue of pages within the story cycle, and a discrete stratum that we contact through a given sense (usually sight). Before extracting literary meaning, before we even understand what it is that we’re reading, we confront a story title, a blank page between stories, and an indication that one object follows another. The mojo bag, as it were, contains the elements, objects within the bag, and things in the hands of the conjurer. Arrange them in a given sequence, hold each one up in turn, invoke different meanings, and enact the transformation of the luck charm.

240  Jay Rajiva The story rises into perception, or in the conjurer’s flash, a trick of the eye, penetrating to that half-fathomed layer of cognition that resides somewhere between processing and response, the intuition that shapes eventual awareness of the literary techniques we encounter—metaphor, symbol, imagery, and so on. To move from Duvalier-era trauma to the dislocated pain of diaspora, intermingled with Haitian-American experience of police violence—this is neither the self-conscious pose of postmodernism nor the product of an equally self-conscious realist preoccupation with creating verisimilitude via detail in increments. It invites a change in bodily posture, a command to lean into levels of engagement with Haitian trauma that have to be absorbed over time, through each story in the collection. Michael Taussig’s meditation on the cognitive dimension of shamanism, another animist practice, is instructive: Shamans make mighty conjurors, we are told. They can throw voices, talk to spirits, travel the skies, and walk the depths of the ocean. They can extract strange objects from their bodies or from the bodies of the sick, and just as easily make those objects disappear. In the twinkling of an eye. They can cure and they can kill through seeing, and such seeing … is a bodily substance—like the down of newborn birds in Tierra del Fuego—that fills the body of the shaman. Seeing is a substance and such seeing changes fate. Seeing is the feathers of newborn birds. (2012, 7–8) Once we adopt the idea that animist seeing is substance, an act that confirms the relational and spiritual position of the one who sees, we can see how the shape of The Dew Breaker—its loose connections, partial resemblances, and persistent ambiguities—militates toward a type of healing from moral injury that lacks the certainty and public face of ritual. The very title of the story, “Seven,” for example, invites further work, the references to Dorismond and others appearing through other media (the radio) to the story’s characters. Silence falls at story’s end, the silence of diaspora, of a couple alienated by the work of knowing each other after seven years of separation. Seven, first merely an interval, blooms into a cryptic command to count out the silences, to be aware of what trauma does not reveal in the act. Self-chosen silence modulates into enforced silence, by way of the single-person interiority of the third story, “Water Child,” the story of a nurse dealing with the emotional aftermath of an abortion while tending to a patient who has lost the ability to speak after an operation. Down to the character, back up again to the story-object, to the work of interpretation, of working over the image of the pebble refusing to dissolve in water. And it is in this slow-dissolve, this patient spilling out of objects on the “table,” that the stories in The Dew Breaker dramatize trauma’s inner life:

Animist Forms of Atonement and Healing  241 the agony of the past, decision-making in the present, the persistence of memory, the objects at hand, objects cradled and scrutinized from different angles, until trauma’s complexity seeps out from things, which have now been given the necessary time to disclose their significance, to work toward some form of healing. For the stories in The Dew Breaker, alternative modes of understanding trauma require displacing two urges: the urge to disclose and the urge to keep silence. These urges typically operate along corresponding literary axes of acting out and working through trauma: one gains a measure of healing by speaking, on the one hand, or one remains trapped by silence and omission, on the other. Danticat’s collection is not interested in that type of binary. Instead, the story cycle’s literary mode makes productive use of silence, opacity, doubling, and splitting—each is folded into disclosure, irreducible to the simple act of speaking out. Anne’s split position is not dissociation; Ka and her father turn the potentially harmful aspect of marasa into a type of healing, characterized by acknowledging the newfound complexity of their relationship; silence and speech are used in equal measure to cope and survive; and opacity is the given state of being. A Productive Failure of Reading These connections to animism are slender, tensive, but present, bodied forth from a text that contains no explicit mandate to trace out Haitian animist thought for its readers. No “satisfactory” or uniform symbolic tapestry emerges. One might say that this elusiveness fits animism, which is itself syncretic. Through the persistence of these connections, we can discern a distinct esthetic mode for considering the complexity of moral injury in the Duvalier era. Danticat, as storyteller, gives these stories prosaically, without recourse either to strict mimetic realism, psychological allegory, or postmodern self-referentiality. Patient engagement with the object of trauma, which sometimes ends in defeat, other times in a fleeting but intense satisfaction: this is the labor of Danticat’s The Dew Breaker, both its subject and its esthetic mode. This type of failure, in a real sense, constitutes the work of reading The Dew Breaker, but a failure that challenges traditional ideas about “failing” to read properly. We’re taught to fail, as good readers, in a certain way: confronting the absence of direct representation, the viscera of postmodern excess. Failures of apprehension (in the cognitive sense) and failures of understanding. What passes through our perception here, in Danticat’s unnerving story cycle, is something else entirely. Swing the mojo bag, spill its contents, find one item, arrange it on the table, move on to the next item, and so on. But the provisionality of the luck charm, the synthesis, remains tenaciously in view.

242  Jay Rajiva The work of conjuring comes to the reader right away, in the form of Ka’s art—the sculpture of her father, created in the false image she has of him—as prisoner, not warden, before she learns about his past. We’re not privy to the time of creation but rather to the work of reengaging with the object after her father’s revelation. Even his surname, Mr. Bienaimé, is sadly inapt: to be well-liked or loved, per the literal translation from the French, is not to be a member of a murderous paramilitary unit. The sculpture, hurled into the nearby lake by her father, takes on water, expands with water’s weight, and changes form. Father and daughter have a conversation: they too are transformed. He tells his story, she listens, reacts, questions, becomes angry, and then thoughtful. She returns then, at story’s end, to the tales he once told her about ancient Egypt, the origin of her name, the “good angel” Ka. Here, we can see how the story “juxtaposes the dead body as an art object that functions as a memorial and a stand-in for the life lost with the attempt to annihilate both victims and memory by eradicating their lives materially and symbolically” (Spengler 2014, 199). These stories are animated, in themselves, as things for the reader, not as passive objects to which we can ascribe any meaning, but by dint of placement, context, and aura. Wilson Chen’s discussion of the curious shape of the story cycle provides insight: These multiple stories—conveyed from a variety of narrative points of view and linked together into a composite whole by way of intersecting, parallel, and entangled plot lines—are suggestive of the proliferation of perspectives and voices in a community’s discursive response to historical violence, displacement, and dislocation. Even though the text is clearly framed by the first and last stories, which focus on the figure of the dew breaker (an emblem of the violence in whose shadow these Haitian diasporic communities form), this framing device does not fully contain the narratives within. This is a book we could easily imagine the author expanding by continuing to insert or collect stories that provide additional perspectives, layers, testimonies—thus simulating the dialogic, polyphonic qualities of a community’s response to trauma and displacement. (2014, 222) Chen’s nuanced account of structure, particularly the attention that he pays to “intersecting, parallel, and entangled” lines of narrative, provides a frame for the need to expand the conceptual capacity of moral injury. Besides the dew breaker himself, many characters in the story cycle qualify as sufferers of moral injury: committing, witnessing, or failing to stop acts of violence within the broader structure of the Duvalier regime. In “Night Talkers,” Dany is haunted by the murder of his parents, a murder

Animist Forms of Atonement and Healing  243 he was powerless to stop as a child; Michel, the narrator of “Monkey Tails,” realizes in retrospect that his tacit relationship to his biological father, Monsieur Christophe, implicated his family in the perpetuation of everyday violence in his hometown community; and “The Funeral Singer” concludes with Frieda announcing her intention to return to Haiti to join the resistance to the Duvalier regime, the soldiers of which were directly responsible for her father’s death. Moral ambiguity matches the structural ambiguity of the story cycle, which gathers a tapestry of stories both voiced and unvoiced and provides a frame that is deliberately incomplete, flawed, and provisional, without any recognizable form of ritualized healing. Dany’s pain, for example, remains trapped and unvoiced in traditional terms. It is only by connecting with others after the death of his aunt, in a traditional Haitian context, that he can find some form of closure. While visiting his aunt in her mountain village, he is introduced to Claude, a Haitian-American boy who killed his father in a drug-induced haze in the U.S., and who is now trying to atone for his past in Haiti. As Claude opens up, his assessment of his past transgressions demonstrates that he has achieved some form of healing only through the community’s acceptance of him, despite his lack of a prior connection: These people don’t even know me, man. They’ve never seen my face before, not even in pictures. They still took me in, after everything I did, because my moms told them I was their blood. I look at them and I see nothing of me, man, blank, nada, but they look at me and they say he has so-and-so’s nose and his grandmother’s forehead, or some shit like that … It’s like a puzzle, a weird-ass kind of puzzle, man … I’m the puzzle and these people are putting me back together again, telling me things about myself and my family that I never knew or gave a fuck about. (Danticat 2005, 102) “Blood” is both metaphor and material reality, signing kinship in uncertain terms: Claude is told by his mother that despite having murdered his own father, he has a blood connection to the community in Beau Jour (“beautiful day”), the name itself an interesting contrast with the punishing heat that gives Dany heat stroke as he travels to the village. Why this community has chosen to embrace Claude remains a mystery to him; he even notes that he would have dismissed the villagers as nothing but “backward-ass peasants” when he was still living in Brooklyn (2005, 102). Yet the inhabitants of Beau Jour discern affiliation in aspects of Claude’s face using methods that defy rational understanding. Crucially, the story detaches confessional structures from the expectation of full disclosure: at this point, Dany does not know that Claude murdered his father, only that

244  Jay Rajiva Claude has served time in prison and been repatriated to Haiti from the U.S. Claude’s questions reflect his ability to articulate lines of affiliation that transcend his individual position, or the position of his nuclear family. The community relation, which may provide “the condition of conceptual adequacy” (Congdon 2016, 817) necessary for transformative healing, is only partially traced in Claude’s words. Dany’s blind aunt Estina is “enthralled” by Claude’s speech despite not understanding much or any of it, since Claude is speaking to Dany in English, not Haitian Kreyol. As Claude talks, Dany notices sunlight reflecting on his aunt’s eyes but “never penetrating her pupils,” leading him to “think of his aunt’s eyes as a strange kind of prism” that absorbs light rather than reflecting it (Danticat 2005, 102–03). In this way, “Night Talkers” illustrates Merleau-Ponty’s argument, summarized by MaryCatherine McDonald in her re-assessment of moral injury, that “what is perceived, what comprises the horizon, is shaped not just by objective truths in the external world, but also by meanings conveyed by and in pre-theoretical experience” (2017, 7). In other words, McDonald suggests that the “contingencies, illusions, and contradictions” of perception “shape the horizon of the being-in-the-world as one that is never fixed, never fully positively defined” (7). Perception’s contingency animates the spine of the entire collection, reaching its conclusion in the final story, “The Dew Breaker,” which takes readers back in time to when Mr. Bienaimé still works as a Tonton Macoute in Haiti. Though the story begins with the dew breaker as the focalizer, the person from whose point of view the story is told, Anne’s perspective grows within the narrative, until the conclusion, which shifts back into the immediate present, reprising the phone conversation between Ka and Anne in “The Book of the Dead.” Here, though, the story is told from Anne’s point of view, as she reflects on the relationship between the three of them and recalls her dead stepbrother, a dissident preacher murdered by the Tonton Macoutes during the first Duvalier era. Anne’s story, juxtaposed with that of Mr. Bienaimé, gives us a metaphoric and narratological luck charm: apparently disparate narratives turned into animist things with their own spiritual life, revealing the fissures, contradictions, and trauma that have plagued her in the decades since she fled Haiti with her husband. Points of resemblance suffuse this last story: between Anne and Mr. Bienaimé, between her two brothers (one drowned as a child, one murdered by Tonton Macoutes), and between the stories in the collection themselves. By deferring the dew breaker’s story to the end of the collection, Danticat creates a space that anticipates dosu or dosa, the third element in marasa consciousness. Yet the indeterminacy of that end complicates the family’s position, rather than bringing closure. Readers learn that Mr. Bienaimé is the person who murdered Anne’s stepbrother, and that Anne herself seems to have some partial, ambiguous knowledge of this fact. Tasked

Animist Forms of Atonement and Healing  245 with the silencing of the preacher, a vocal opponent of the Duvalier regime, ­Bienaimé scouts the location, abducts the preacher, and tortures him but learns too late from his superior that he is to release the preacher; he has made too showy and public an arrest, and outright murder would inflame the general population. The release never comes, as the preacher, fearing that the dew breaker means to injure him further, attacks and scars him in the cell. In response, Bienaimé is forced to kill the preacher. This unexpected reversal, in which the torturer is himself wounded by his prisoner, demonstrates the contingency of his role, since Bienaimé’s prisoner only dies as a result of his botched interrogation. Moral injury is matched by the disorder of the death, as well as the wound Bienaimé receives from Anne’s stepbrother. Though no healing is possible at this stage, the stepbrother’s death triggers Bienaimé’s flight from the holding area and triggers his accidental encounter with Anne. A premonition about her brother has sent her out of the house on the very night when he meets his end. Through his eyes and despite his many crimes, we gain a sense of his moral injury: Who was she, anyway? Was she a mother, a wife, a sister who was keeping a vigil for someone? Was she the one who called out “Jean” each time a new prisoner was brought in, the one in whose direction the officers and militiamen often shot? (Danticat 2005, 231) Bienaimé’s questions bring up a well of counterfactual voices, standing in for other victims of Tonton Macoute violence. Of particular note is the fact that he is the one asking them: seeking a frame for understanding his own actions, which he has long subordinated to the business of torture as a job. The “evil tales” (2005, 187) that he typically invents to justify his crimes as a macoute are not sufficient. Anne, in a sense, personifies and almost possesses the questions themselves, animating them into a tangible relation to him. This moment, furthermore, is contingent, evidence of the mojo bag’s contents spilled onto the table, putting a torturer and the sister of his victim on equal footing and dissolving the authority that Bienaimé has become accustomed to wielding as a macoute. Significantly, focalization shifts to Anne as she compares his face to a reversed image of the sun rising (Danticat 2005, 233), before going out in her nightgown to find what she needs to treat the wound on his face. This shift directs readers to consider the dew breaker not as malefactor, not even as an object of scrutiny, but as a flawed being, the elements of which can support analogy to the natural world (the sun); it both anticipates the healing that Bienaimé will receive and acts as a precondition for that healing. But atonement here lacks any

246  Jay Rajiva public face or recognizable ritual. The two of them are alone in Anne’s home; he is on the run from the macoutes. Anne, in fact, wonders if the vendor from whom she finally obtains the herbs necessary to treat Bienaimé thinks she is crazy (234). Provisional healing resides in the point of view of a “madwoman who all of a sudden [is] sobbing” (234). Within the narrative frame of “madness,” implausibility, and coincidence, Bienaimé is eventually able to find a way to forgive himself for the atrocities he carried out as part of the Duvalier regime: “What did they do to you?” she asked. This was the most forgiving question he’d ever been asked. It suddenly opened a door, produced a small path, which he could follow. “I’m free,” he said. “I finally escaped.” (237) The terrain on which forms of moral injury can find recognition, the “condition of conceptual adequacy” (Congdon 2016, 817), finally appears in this laconic exchange between Anne and Bienaimé, yet the story leaves readers with a persistent sense that any healing is tenuous and uncertain. As the pair make their escape to the U.S., they develop a “strained kind of attachment,” a form of love rife with qualifications and provisions (Danticat 2005, 240–41). The matter of the preacher’s death, too, is consigned to the realm of “coded utterances,” each of them fearing to disclose the truth to the other. We are given every indication, as the story returns us to the collection’s present time, that Ka’s discovery of her father’s past will lead to further disclosure, cause more pain, and require more difficult forms of atonement. Yet that future is left for readers to imagine, a gesture to the creative element of dosu/dosa, a synthesis without resolution. If The Dew Breaker employs animist structures of meaning to offer “an ethical and tactical engagement” with power (Biers 2015, 80) that engagement is neither easily achieved nor conclusive and final. The luck charm cannot reveal all or bring unearned closure. What is the responsibility for wrongdoing if locked into the single body of a single transgressor, absent social and cultural context? In this chapter, I have framed this question as a lacuna in theories of moral injury, which, sutured as it is to the Western medical establishment’s emphasis on diagnosis, talk therapy, and medication, has trouble doing two things: first, distributing moral responsibility in a way that does not trivialize the suffering of the transgressor’s victims and second, providing a complex and openended account of healing within non-Western cultural frames of meaning. Animism, as a response to moral injury, is work, creative labor, and, I have argued, both the labor and the mode of healing in a Haitian-American context. In the image of the luck charm and the mojo bag, components

Animist Forms of Atonement and Healing  247 of the Obeah assemblage, we can apprehend the significance of things ­disconnected, sutured together by spiritual connections, and bound by the practitioner’s belief and orientation toward the moment’s experience. The conjurer manipulates nonhuman objects, or things sundered from living bodies—teeth and bones, soil that perhaps contained and intermingled with a body. The inert thing gains power, shapes life, and becomes itself life within the stated context. An animist reading of moral injury allows Haitian cultural practice to acquire its own legitimacy against the long shadow of denigration it faced during the colonial period, when parodies of “voodoo” circulated in Western fiction and the word itself became shorthand for barbarism and savagery. To decenter, the human reframes cultural practices, such as voudou, along lines of affiliation and connection to the material world, rather than asserting human dominance over matter, which risks replaying the hegemony of colonial relations. “Does the conjurer transform the bone,” Biers wonders, “or does the bone transform the conjurer?” (2015, 69). One could equally apply Biers’s question to readers of The Dew Breaker. In this way, animism widens the conceptual parameters of moral injury, allowing different kinds of victims of collective violence to be heard. Works Cited Atuel, Hazel R., Nicholas Barr, Edgar Jones, Neil Greenberg, Victoria W ­ illiamson, Matthew R. Schumacher, Eric Vermetten, Rakesh Jetly, and Carl A. Castro. 2021. “Understanding Moral Injury from a Character Domain Perspective.” Journal of Theoretical and Philosophical Psychology 41 (3): 155–73. https://doi. org/10.1037/teo0000161. Bellamy, Maria Rice. 2012. “More Than Hunter or Prey: Duality and Traumatic Memory in Edwidge Danticat’s The Dew Breaker.” MELUS: Multi-Ethnic Literature of the US 37 (1): 177–97. https://doi.org/10.1353/mel.2012.0005. Biers, Katherine. 2015. “Practices of Enchantment: The Theater of Zora Neale Hurston.” The Drama Review 59 (4): 67–82. https://doi.org/10.1162/dram_a_ 00497. Chen, Wilson C. 2014. “Narrating Diaspora in Edwidge Danticat’s Short-Story Cycle The Dew Breaker.” Lit: Literature Interpretation Theory 25 (3): 220–41. https://doi.org/10.1080/10436928.2014.932242. Clitandre, Nadge T. 2018. “The Dew Breaker as Ècho-Monde.” In The Haitian Diasporic Imaginary, edited by Edwidge Danticat, 103–37. University of Virginia Press. https://doi.org/10.2307/j.ctv6zdbd5.9. Collins, Jo. 2011. “The Ethics and Aesthetics of Representing Trauma: The Textual Politics of Edwidge Danticat’s The Dew Breaker.” Journal of Postcolonial Writing 47 (1): 5–17. https://doi.org/10.1080/17449855.2011.533947. Congdon, Matthew. 2016. “Wronged Beyond Words: On the Publicity and Repression of Moral Injury.” Philosophy & Social Criticism 42 (8): 815–34. https://doi. org/10.1177/0191453715580158.

248  Jay Rajiva Danticat, Edwidge. 2005. The Dew Breaker. New York: Vintage. ———. 2011. Create Dangerously. New York: Vintage. Dillon, Elizabeth Maddock. 2013. “Obi, Assemblage, Enchantment.” J19: The Journal of Nineteenth-Century Americanists 1 (1): 172–78. https://doi. org/10.1353/jnc.2013.0020. Ibarrola-Armendáriz, Aitor. 2010. “The Language of Wounds and Scars in Edwidge Danticat’s The Dew Breaker: A Case in Trauma Symptoms and the Recovery Process.” Journal of English Studies 8: 24–56. https://doi.org/10.18172/jes.147. McDonald, MaryCatherine. 2017. “Haunted by a Different Ghost: Rethinking Moral Injury.” Essays in Philosophy 18 (2): 1–16. https://doi. org/10.7710/1526-0569.1581. Pressley-Sanon, Toni. 2013. “One Plus One Equals Three: Marasa Consciousness, the Lwa, and Three Stories.” Research in African Literatures 44 (3): 118–37. https://doi.org/10.2979/reseafrilite.44.3.118. Semple, Kirk. 2008. Ex-Military Chief in Haiti is Sentenced to Up to 37 Years for Fraud. The New York Times. 28 October 2008. https://www.nytimes. com/2008/10/29/nyregion/29toto.html. Spengler, Birgit. 2014. “Art as Engagement: Violence, Trauma, and the Role of the Reader in Edwidge Danticat’s The Dew Breaker.” Contemporary Women’s Writing 8 (2): 189–205. https://doi.org/10.1093/cww/vpt020. Taussig, Michael. 2012. “The Stories Things Tell and Why They Tell Them.” e-flux 36. https://www.e-flux.com/journal/36/61256/the-stories-things-tell-and-whythey-tell-them/. Waisvisz, Sarah G. 2018. “Remembering Perpetrators: The Kunstlerroman and Second-Generation Witnessing in Edwidge Danticat’s The Dew Breaker.” In The Routledge Companion to Literature and Trauma, edited by Sophia A. ­McClennen, and Alexandra Schultheis Moore, 94–101. New York: Routledge.

14 Rituals and Moral Injury How Veterans Make Peace Kathryn McClymond

Former Specialist Michael Blake (Iraq 2003–2004) describes a c­ onversation he had with an Iraqi man who once lived in a region where Blake had been stationed. When Blake met this man in the U.S. years after his service, he remembers, I just couldn’t help it, just all of a sudden I hugged the guy. And I said that I was sorry, that I was so sorry, and I ended up crying right there, to this perfect stranger. And he told me it was okay. You know, he told me that it was okay. And that, that was, that was redemption. That was redemption. And it was beautiful. As Blake tells this story, he becomes emotional, remembering the conversation. He closes the story saying, “And that’s why we come here and do this” (YouTube 2007). Who is the we Blake refers to, and what do we “do?” In the interview Specialist Blake records, it becomes clear that he is one of thousands of U.S. veterans of the Iraq and Afghanistan wars who tell their stories to find release from guilt, guilt prompted by actions they performed, failed to perform, or witnessed as U.S. soldiers. The question is, how do they live with this guilt? How do they find the redemption Specialist Blake found? For a number of years, I have studied how veterans deal with guilt associated with moral injury once they come home from active duty. I have talked directly with dozens of veterans and their caregivers, reviewed hundreds of online interviews, and read and listened to scores of oral histories archived across the country. Two key points have emerged from all of that listening. First, the guilt that many veterans experience should be distinguished from post-traumatic stress disorder (PTSD). As discussed by multiple authors at length throughout this volume, guilt – an expression of “moral injury” or “moral trauma” – is distinct from and needs to be addressed differently than PTSD.1 While it may have been controversial to distinguish between PTSD and moral injury decades ago, it is DOI: 10.4324/9781003281122-18

250  Kathryn McClymond commonly recognized that while they are related, they are distinct experiences. ­Second  – and perhaps less commonly recognized – veterans have been proactive in developing their own ways of responding to and coping with their moral trauma. While caregiving groups and individuals have crafted rituals deliberately and consciously to help veterans, many veterans were developing their own practices independently or organically with others over many years. Without realizing it, the practices they developed to respond to their moral injuries, while highly personalized, largely mirror classic practices for acknowledging guilt and shame that religio-cultural communities have taught for thousands of years. Underlying individual or small community strategies for moral healing, we find frameworks that are centuries-old, spanning continents and cultures. Specifically, veterans frequently find solace and healing in four classic religio-cultural practices: pilgrimage; offering testimony (public confession and “prophecy”); making restitution or atonement; and memorial-making (physical, institutional, etc.). Recognizing that contemporary veterans are tapping into age-old traditions offers several benefits. First, by understanding how and what veterans have done to address their own feelings of guilt, we can identify strategies that professional caregivers and family members can offer intentionally to support soldiers and veterans based directly on what has benefited veterans in the past, strategies that do not require clinical expertise or medical care.2 Second, once we recognize that many contemporary practices resonate with or draw on religio-cultural practices that go back centuries, we can explore a wide range of practices to determine what else might be helpful. Finally, today’s veterans can know that they are not alone. Not only do many contemporary brothers- and sisters-in-arms relate to individual soldiers’ struggles with guilt and shame; today’s veterans stand shoulder to shoulder with warriors across the ages. What Is Moral Injury? It’s the moral injury over time that really kills people … Soldiers lose their identity. They don’t understand who they are anymore… Most people don’t appreciate the awful weight of that moral injury. (Mantz quoted in Sherman, 2015) As many other authors in this volume have noted, the phrase “moral injury” was coined by clinical psychiatrist Dr. Jonathan Shay to refer to the ethical/religious/personal/moral guilt that thousands of veterans have described experiencing after deployment, either when they return home or while still deployed (Shay 1994). Shay coined the term to distinguish this experience from PTSD. Since Shay coined the term, other scholars have offered alternative definitions, often broader in scope than

Rituals and Moral Injury: How Veterans Make Peace  251 the original. (Shay himself has broadened his definition.) A wealth of literature exists on moral injury (much of which is provided in this volume), so a brief overview will suffice.3 For example, the Army Public Health Center has drawn on Shira Maguen and Brett T. Litz’s work in defining moral injury as a construct that describes extreme and unprecedented life experience including the harmful aftermath of exposure to such events. Events are considered morally injurious if they “transgress deeply held moral beliefs and expectations.” Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth. (https://phc.amedd.mil) Notice that the act of transgression requires the assumption of something that can be transgressed, a foundational “ought” related to the human experience that, through some human’s action, has been ignored or flouted. Moral injury is not traditionally used to characterize the human experience of natural disasters, even in the most tragic circumstances. Rather, humans experience moral injury when other human beings (or themselves) act in ways contradictory to expected standards of right and wrong. The National Center for PTSD, clearly building on Shay’s original definition, explains, “moral injury can occur in response to acting or witnessing behaviors that go against an individual’s values and moral beliefs,” noting that moral injury arises when individuals “perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (U.S. Dept. of Veterans Affairs). Note that there can be several degrees of separation from the person who has acted badly and the individual(s) who experience moral injury as a result. I argue more broadly that moral trauma results not only from participating in or witnessing acts that transgress moral beliefs, but sometimes also from simply living in the context of war, when one’s sense of the nature of day-to-day reality, the stability of a moral compass, and confidence in being a good, moral person are fundamentally shaken. For example, Peter French describes Navy chaplains who were ashamed of what happened at Abu Graib, even though they had nothing to do with actions there: “something very bad had occurred and that rather than being an aberration, it may be a symptom of what sort of war they were in” (2011, my emphasis). Colonel Ted Westhusing, a professor at West Point, was so deeply unsettled by other military members’ behavior to the point that he committed suicide in June 2005. His suicide note suggests that he could

252  Kathryn McClymond not live with what he perceived as a shift in the military community he belonged to. He wrote, I am sullied – no more … I cannot live this way … Death before being dishonored any more. Trust is essential – I don’t know who to trust anymore. Why serve when you cannot accomplish the mission when you no longer believe in the cause, when your every effort and breath to succeed meets with lies, lack of support, and selfishness? No more. (Quoted in French 2011, 24) Moral injury arises not only from direct wrongdoing but also from seeing oneself as part of a broader community that failed morally. One’s view of the nature of the moral universe and one’s place in it are fundamentally upset. Moral injury is closely linked with, but distinct from PTSD. PTSD is generally understood to be grounded in fear or anger, and it is treated in various ways, including talk therapy and exposure therapy. The assumption is that PTSD is a psychologically unhealthy state to be in, best addressed as a mental health problem that needs to be cured. Moral injury, by contrast, is different. Moral injury is, like PTSD, debilitating, and it often exhibits similar symptoms: sleeplessness, substance abuse, difficulty sustaining healthy family and work relationships, cognitive “loops,” flashbacks, obsessivecompulsive behaviors, and sometimes suicidal tendencies. The difference is that moral injury is rooted in guilt, shame, and dishonor attached to specific or general behaviors that the veteran feels morally responsible for.4 Veterans suffering from moral injury often feel guilt or shame about their own behavior. Alternatively, they may feel betrayed by others. In both cases, they often feel alienated from the military community and spiritual world they used to belong to, sometimes to the point of alienation from oneself, leading to shame and despair. Peter A. French argues that such shame often leads to a desire “to conceal oneself, to try to mask oneself” (2011, 148). Bill Russell Edmonds wrote in his journal, “I become a man I no longer recognize. I’ve lost myself” (2015, 29). Hope arises in the recognition that feeling shame implies a sense of honor to begin with. John Kekes argues, “Shame is a sign that we have made a serious commitment, and it is also an impetus for honoring it, since violating the commitment painfully lowers our opinion of ourselves” (1990, 282). In other words, to experience shame reflects a sense of honor – the absence of that would be shamelessness. In this light, moral injury is a positive – albeit painful – indicator that one is still aware of the possibility of honorable living. Understanding Kekes’s point here helps us to see that the shame some veterans feel is sometimes justified. It may, in fact, be ethically appropriate

Rituals and Moral Injury: How Veterans Make Peace  253 to feel guilt, shame, betrayal, or dishonor for certain behavior. Nicolai Hartmann argues, It is not as if one wanted guilt as such – one would be glad not to have it. But once we are laden with it, we cannot allow it to be taken away, without denying our selfhood. A guilty man has a right to carry his guilt. He must refuse deliverance from without. To retain his guilt is valuable for him despite its oppressive load … To surrender it is moral meanness betokening incapacity to be free. He who pardons a guilty person, compromises him spiritually. (2002, 145) To dismiss an individual’s sense of guilt diminishes him as a moral being. To conflate moral injury with PTSD, as solely a medical condition to be treated, is to imply that moral outrage, shame, and guilt at unethical behavior is somehow psychologically wrong. Scholars and clinical practitioners who advocate for a distinction between PTSD and moral injury believe that moral trauma deserves to be addressed differently than psychological trauma, because the root causes differ. A few caveats. Not every soldier experiences moral injury, just as not every soldier experiences PTSD. In addition, some soldiers experience both, and they need treatment that addresses both the psychological problems and the moral trauma. Also, a soldier who experiences moral injury does not necessarily feel general guilt about being a soldier or about military efforts. In fact, many veterans who experience moral injury feel deep loyalty to the military and especially to their comrades. Just as a physical wound does not diminish loyalty to one’s country, one’s branch of service, or one’s unit, neither does moral injury. The key difference is that soldiers and civilians alike tend not to see a physical wound as a sign of weakness. Psychological or spiritual wounds, however, are often viewed differently, either explicitly or implicitly. As a result, many soldiers hesitate to report psychological or spiritual wounds for fear of ridicule or reprisal. Research suggests that at least 20% of Iraq and Afghanistan war veterans experience PTSD and/or depression – that’s easily more than 500,000 veterans (Rand 2008). In addition, research indicates that 50% of veterans with PTSD do not seek treatment, which not only hurts them but also their families, their communities, and the military itself. Moving forward, we will do our soldiers – and our military – a great service if we can raise awareness and acceptance of psychological and ethical/moral/spiritual traumas, precisely so that we can heal soldiers psychically as we heal them physically. So how do we address moral injury? In examining moral injury, I am interested to learn what veterans have come up with on their own to address their moral pain. It’s clear that veterans have pursued non-clinical practices

254  Kathryn McClymond as individuals or in community and found some comfort. I­nterestingly, I found that when veterans generate strategies on their own to address their shame and guilt, their behavior tends to fall into one of four traditional ritual practices: pilgrimage; testimony (public confession and “prophecy”); making restitution or atonement; and memorial-making. Veterans may engage in more than one of these practices, and the activities often inform or invigorate one another. Let’s take these in turn. Pilgrimage “Pilgrimage” typically involves an intentional journey toward a location with special significance with the understanding that undertaking such a physical journey will result in some benefit. Some pilgrims seek spiritual growth, while others look for healing, spiritual and/or physical. Classic examples include pilgrimages to the Sanctuary of Our Lady of Lourdes in Lourdes, France, where pilgrims travel from all around the world hoping to be healed from physical afflictions. Similarly, it is common for veterans to make pilgrimages to countries, even specific locations where they served, and these travels often include a healing dimension. For example, Dr. Edward Tick, an internationally renowned psychotherapist and researcher focused on veterans’ issues, has led numerous “educational, healing and reconciliation journeys” to Vietnam (Soldier’s Heart 2018). A description of the 2017 trip, titled “17th Annual Healing and Reconciliation Journey to Viet Nam,” is described this way: Our journey will focus on healing old war wounds, achieving forgiveness and reconciliation between American and Vietnamese vets and civilians, immersing in the wonderful people, culture, country and spirituality of the real Viet Nam, helping rebuild Viet Nam as we heal Americans, and practicing the healing of deep trauma. A special feature of this year’s trip will be a[n] international Veterans Day healing ceremony that will include veterans from different countries and different factions of the war.  All our journeys to Viet Nam are unforgettable experiences of healing, forgiveness, restoration, peace making and joy. …Each journey is uniquely designed for the healing and educational needs of our participants. (2018) Similarly, the Korean War Veterans Association, Inc. (KWVA) has offered “Revisit Korea Tours.” While inaugurated by the Korean Veterans Association in Korea, in 1985 the U.S. KWVA became involved in organizing these tours as well. Tom Clawson, a former KWVA Chairman, writes that

Rituals and Moral Injury: How Veterans Make Peace  255 the primary goal of this trip was to thank U.S. veterans for their service in the Korean War. However, some veterans also seek and experience healing. Donna Miles writes, “‘This is all part of a healing process, being here and getting to see this beautiful country,’ said [former combat medic Fred] Brady.” James Wiedhahn, the son of a veteran, noted, “‘This is an opportunity for the veterans to see that what they went through made a difference,’ he said. ‘It’s closing that chapter of the conflict they live with every night when they close their eyes’” (quoted in Miles 2010). Some veterans make pilgrimages on their own. Writer Tim O’Brien chronicles his own combat experiences in short stories and novels. His best-known writing is The Things They Carried (1990), a collection of short stories that draw on O’Brien’s personal experiences. In the story “Field Trip,” O’Brien describes a veteran returning to the site of a battle during which a comrade died. The story, while fictional, depicts the real experiences of veterans returning to sites of conflict and loss in an attempt to find some closure. O’Brien’s protagonist reflects on his friend Kiowa’s death, thinking, Twenty years. A lot like yesterday, a lot like never. In a way, maybe, I’d gone under with Kiowa, and now after two decades I’d finally worked my way out. …I felt something go shut in my heart while something else swung open (2013, 324). Over the course of the story, the protagonist finds a modicum of peace and connection in revisiting the site of Kiowa’s death, the closest thing to closure he is likely to hope for. Similarly, the British Normandy Memorial commemorates more than 20,000 men and women who died during the Battle of Normandy. This memorial is located in Ver-sur-Mer, Calvados, and it honors all who served “under British command who died on D-Day and during the Battle of Normandy” (https://www.britishnormandymemorial.org). Since the memorial was inaugurated in June 2019, dignitaries from around the world have traveled to the site. Additionally, the Visitor Book records visits from the battle’s veterans and their families. Like the Vietnam Veterans Memorial, the British Normandy Memorial includes engraved names of fallen servicemen and women, and visitors take rubbings and leave tokens of their remembrance at the site. Of course, many veterans are unable to travel internationally to former conflict locations, and some locations are not accessible for pilgrimages. In those situations, veterans visit alternative pilgrimage sites. For example, the Vietnam Veterans Memorial (commonly referred to as “The Wall”) was dedicated on November 13, 1982. It serves as a national U.S. site for

256  Kathryn McClymond veterans and others to visit as a way of remembering and honoring soldiers who died in Vietnam. In 2021 alone, more than 5.5 million visitors traveled to the memorial (National Park Service). The Wall has had such a great impact that in 1996 a replica of the memorial was created, “designed to travel to communities throughout the United States,” in effect bringing the Vietnam Veterans Memorial to those unable to travel. This mobile memorial is known as “The Wall That Heals.” The site describing this effort states, “Since its dedication, The Wall That Heals has been displayed at nearly 700 communities throughout the nation, spreading the Memorial’s healing legacy to millions” (https://www.vvmf.org). The practice has come full circle: rather than veterans making pilgrimages to the site of pain and loss, a substitutionary site comes to them, an indication of the power that experiencing pilgrimage can have. Tokens It is not unusual for pilgrimages to involve tokens, small items with personal significance that veterans take from or bring to the pilgrimage site. Over the decades, a ritual has developed at the Vietnam Veterans Memorial: visitors place a piece of paper over the etched name of a loved one and create a “rubbing” of the name in pencil to take with them. These rubbings sometimes become tokens that remind the pilgrims of loved ones. Visitors often leave small items (flowers, flags, notes, stuffed animals) at the Memorial. Wikipedia reports a legend that this may have begun when a Vietnam veteran placed his brother’s posthumously awarded Purple Heart into the concrete foundation of the Memorial as it was being built (Wikipedia 2022). Recently, a friend confided to me that someone had carried some of the ashes of a family member who had served in Korea to be scattered at the Korean War Memorial in Washington, D.C. The deceased veteran had wrestled with memories of their service in Korea, alternating between pride in service to their country and guilt over actions they had performed there. By bringing a portion of their ashes to the memorial, the family hoped that the deceased would find peace in feeling connected this way with fellow Korean veterans after death. This act was also the family’s own acknowledgment that the deceased’s experience in Korea had been deeply meaningful. O’Brien includes a “token” in his short story “Field Trip.” In this story, the returning veteran brings moccasins that had belonged to his fallen comrade during the war. The story’s protagonist moves into muddy water, carrying the moccasins. Roughly here, I decided, was where Mitchell Sanders had found Kiowa’s rucksack. I eased myself down, squatting at first, then sitting.

Rituals and Moral Injury: How Veterans Make Peace  257 There was again that sense of recognition. The water rose to mid-chest, a deep greenish-brown, almost hot. Small water bugs skipped along the surface. Right here, I thought. Leaning forward, I reached in with the moccasins and wedged them into the soft bottom, letting them slide away. Tiny bubbles broke along the surface. I tried to think of something decent to say, something meaningful and right, but nothing came to me. I looked down into the field. “Well,” I finally managed. “There it is.” (324) Leaving veterans’ personal effects (or physical remains) at important sites can link veterans to formative experiences and fellow soldiers. As a result, these physical objects can be important elements of meaningful pilgrimages, effecting a tangible connection between the veteran and the site. Public Testimony or “Prophecy” In addition to making pilgrimages, many veterans speak publicly about actions they participated in or witnessed as a way of taking responsibility for perceived wrongdoing. Senator John Kerry is well-known for having spoken out about the Vietnam War when he returned from his tour of duty. In his April 23, 1971, speech to the Senate Committee of Foreign Relations, he describes what veterans of that war saw and did: We watched the United States falsification of body counts, in fact the glorification of body counts. We listened while month after month we were told the back of the enemy was about to break. We fought using weapons against ‘oriental human beings.’ We fought using weapons against those people which I do not believe this country would dream of using were we fighting in the European theater. We watched pride allow the most unimportant battles to be blown into extravaganzas, because we couldn’t lose, and we couldn’t retreat, and because it didn’t matter how many American bodies were lost to prove that point, and so there were Hamburger Hills and Khe Sanhs and Hill 81s and Fire Base 6s, and so many others. (https://www.americanyawp.com) Note that Kerry uses the “we” pronoun. He does not distance himself from the critique; rather he includes himself as a guilty party. He also uses “we” to emphasize that no single individual operated alone. This is classic prophetic rhetoric: the prophet speaks truth plainly and publicly, not mincing words. At the same time, he stands accused himself, acknowledging that he

258  Kathryn McClymond is a member of the community that must take stock of its actions, change course, and repent. Decades later, U.S. war veterans gathered publicly to decry military efforts in Iraq and Afghanistan, and they linked themselves to Vietnam veterans by using the phrase “Winter Soldier.” In 1971, hundreds of Vietnam veterans spoke to the media about atrocities they had witnessed or committed as Vietnam soldiers. This sparked a congressional investigation, which came to be known as “the Winter Soldier hearings” (Lombardi 2021).5 In 2008, 45–55 Iraq veterans gathered publicly to draw attention to military activity in Iraq and Afghanistan, with several veterans linking their activity to “Winter Soldier.” One veteran participating in the 2008 event expressed a perspective that most participants shared: “I do believe that the profession of soldiering is fundamentally an honorable one,” said Perry O’Brien, 25, an Afghanistan veteran and key leader of Winter Soldier. “But the disconnect between the [soldiers’] code and what soldiers are asked to do in the war is the source of a tremendous amount of guilt that many of us carry around. Kids grow up wanting to be GI Joe and save lives. But military policy is dictating that people do terrible things, things that violate their conscience, and then have the psychological burden of carrying that around, because the military says you can’t talk about it. Soldiers live with it and die with it.” (Ackerman 2008) Speaking publicly can bring veterans into conflict with official leaders (including military leaders), the public, and fellow soldiers. Many veterans, though, find that public testimony provides a release for the guilt they feel, a form of action that sheds light on the moral failings they believe they participated in. As veteran-turned-journalist Chris Lombardi puts it, during the 1971 event, “soldiers become veteran-activists.” Like prophets of old, they spoke truth to power. These public truth-telling events empowered vets to take further actions. The act of testifying publicly, speaking truth even when unwelcome, offers a path forward for veterans to name, denounce, and call for the end of actions they understand as immoral. In doing so, some address their personal experiences of moral injury caused by participating in immoral activity. Public “testimony” may also appear in written form. Lt. Col. Bill Russell Edmonds explains his thinking about his book God is Not Here: I hope my telling will inspire them [fellow veterans] to find their own healing voice. But just as importantly, I hope that by reliving my experience,

Rituals and Moral Injury: How Veterans Make Peace  259 one of the lesser yet countless examples of sacrifice, ­Americans will ­realize that their demands come at irreplaceable expense. (2015, 23) Edmonds highlights that publicly testifying about one’s experience of war – whether orally or in writing – exacts another price from the veteran, requiring them to relive the experience, to reopen the wound. Make Restitution or Atonement In 1070, the bishops of Normandy issued a decree known as The Ermenfrid Penitential. This decree, developed in response to the Battle of Hastings (October 1066), directed soldiers who had killed in battle to atone for their actions. Anyone who knows that he killed a man in the great battle must do penance for one year for each man that he killed…. Anyone who does not know the number of those he wounded or killed must, at the discretion of his bishop, do penance for one day in each week for the remainder of his life; or, if he can, let him redeem his sin by perpetual alms, either by building or endowing a church. (https://podcasts.apple.com/us/pdcast) At first blush, this may sound like a condemnation for killing (or, cynically, a post-conflict strategy for establishing a church building fund). However, the decree never states that men should not kill other men in battle. Rather, the decree acknowledges that killing occurs while not glossing over its spiritual impact. The bishops offer penance as atonement for the sin that follows from killing. In fact, the decree offers hope by laying out a pathway for combat veterans to do something active to expunge the sin (and attendant guilt) brought on by killing in battle. In offering this path, the Penitential reflects biblical passages that describe cities of refuge for those who have killed (e.g., Numbers 35, Joshua 21). Penance allows a person to acknowledge and address sin or wrongdoing in a constructive way. It offers a kind of counter-action to the action of killing or wounding another human being. The first step in making amends is acknowledging that something wrong was done. This is personal, individual internal work. Acknowledgment of wrongdoing may subsequently lead to regret, which is still experienced individually and internally. Repentance goes a step further: it involves not only regretting that something wrong was done previously but also taking a deliberate step away from that path of action. To repent is to

260  Kathryn McClymond repudiate, to turn away from a previous course of action. To make amends involves one additional step, and it often involves others. To make amends or restitution, an individual not only turns away from a previous way of acting but also acts to correct or offset past wrongdoing. Internal regret and repentance become expressed externally through action that involves public admission of guilt. Making amends involves owning responsibility for past wrongdoing with the individual or community that one wronged, either directly or indirectly. One thousand years after the Ermenfrid Penitential, veterans still seek out opportunities to atone for wounds they have inflicted, for lives they have taken, and for communities they have harmed. There are countless examples, but one will illustrate the point. In 2014, veterans George Barczay and Judd Kinne opened two kindergartens in central Vietnam (Tuoi Tre News 2014). The kindergartens were responses to guilt they carried that went back more than 40 years to the 1968 Battle of Khe Sanh. Barczay was stationed in Khe Sanh Combat Base. Years later he would tell his wife, “It was a peaceful, rustic land until we brought weaponry and devastation to it. I can’t have my peace of mind until I do something to heal the war wounds.” For 20 years after the war, Barczay and Kinne raised money for a “Khe Sanh wound-healing fund” without knowing specifically what they wanted to do with those funds. A news documentary prompted them to think of building schools, fulfilling their desire to “do something for Khe Sanh.” I want to underscore again that atonement for the act of killing does not imply that killing in battle is wrong – only that it leaves a kind of spiritual stain upon the soldier who killed. To atone for death or destruction does not require that the soldier completely repudiate the action or, more broadly, denounce participating in the military. It simply requires that the soldier acknowledge that the work of war leaves moral traces that must be addressed. It would be easy to overlook much simpler acts of making amends. Bill Russell Edmonds describes meeting a German who survived the Allied bombing of Dresden in 1945. Edmonds describes apologizing to this man: ‘It doesn’t matter how wrong the Nazis were, we were also wrong for Dresden. I know it was a long time ago, but I want to say I’m really sorry.’ … I know now that he has been waiting a long time to share this pain with someone willing to truly listen, who wanted to understand. I squeeze his hand and on this porch, surrounded by Germans and a sunrise over grapevines on a Sunday morning, we cry together. (140) A pain acknowledged, an apology offered and accepted, and a moment of restitution.

Rituals and Moral Injury: How Veterans Make Peace  261 Memorials Scholar Edward T. Linenthal, best known for his study of construction of the 9/11 memorial in New York City, states, “I think there’s a therapeutic dimension to memorials, a sort of healing dimension, in which memorials become an immediate language of engagement after an event, rather than just a distant expression of commemoration” (Linenthal 2012). We tend to think of memorials as structures built primarily to remember and honor specific people or events. Beyond that, however, as Linenthal suggests, memorials provide opportunities for healing. Karl Marlantes observes that the Vietnam Memorial works because “You can physically do something there, touch a name, leave a flower. You’ve got to engage the bodies of these young fighters before you can engage their spirits…” (2011, 206). There is a physicality to engaging memorials, and soldiering involves a soldier’s body as well as their mind and spirit. As Marlantes suggests, connecting with the body opens the door to connecting with the soul or spirit. Memorials themselves, however, exist in forms other than physical structures. Numerous foundations have been established to memorialize fallen soldiers. These foundations invite physical activity, but they themselves may have no significant physical presence. For example, the Travis Manion Foundation, focused on empowering “veterans and families of fallen heroes to develop character in future generations,” was established to memorialize 1st Lt. Travis Manion (The Travis Manion Foundation). The foundation notes that Manion “was killed in Iraq while saving his wounded teammates. Today Travis’ legacy lives on in the words he spoke before leaving for his final deployment, ‘If Not Me, Then Who…’” (The Travis Manion Foundation). Contributors to the foundation honor Travis Manion through their own physical acts, volunteering time to teach and mentor others. In addition, veterans engage in informal, temporary physical memorials. One news article describing a Memorial Day event in 2015 records, “It’s Memorial Day at Veterans of Foreign Affairs Post 2205, and several veterans who served in Afghanistan, Iraq and Vietnam have gathered to remember their brothers and sisters who gave their lives in service to this country” (McPhate 2015). A photo included in this news article captures an informal memorial. Two glasses sit on the bar, each resting on a napkin. On each napkin the name and rank of a soldier are hand printed. One napkin adds the phrase, “Gone but not forgotten.” The caption to this photo reads: “Veterans Troy Goodman and James Mason poured these remembrance shots in honor of their fallen comrades on Memorial Day at the Veterans of Foreign Affairs Post 2205 in Denton.” While the “memorial” created by these standing shots is temporary, it functions in the same

262  Kathryn McClymond way as a permanent building, allowing veterans to remember, honor, and grieve for their friends. Concluding Thoughts We have seen that soldiers experience a kind of moral trauma distinct from PTSD, characterized by guilt and shame rather than anger or fear. Combat veterans experiencing guilt and shame often address these feelings with ritual practices recognizable to scholars of human experience as forms of pilgrimage, atonement, prophecy/testifying, and memorial-making. Why does this matter? My argument is that veterans – on their own – recognize the value of ritual practices, activities that have been part of human culture for millennia. Karl Marlantes, in reflecting on his combat experience, writes: Upon reading Homer’s Iliad, I was struck with how much time the ancient warriors spent in ritual. If they weren’t offering something to a god or goddess, they were burning some dead comrade along with his armor. In the Táin Bó Cúailnge, the Irish equivalent of the Iliad, virtually every encounter is preceded by some ritual marking of stones utilizing the ogham, placing of stakes in streams, placing of heads on stakes. During combat tours time must be carved out in which to reflect. I wish that after every action the skipper could have drawn us all together, just us. In ten or fifteen minutes of solemn time we could have asked forgiveness and said good-bye to lost friends. (2011, 77) Marlantes goes on to imagine ceremonies that could occur on the battlefield that acknowledge the death of human beings and the grief and guilt that accompanies killing. Throughout this chapter, we have seen that veterans who have left the battlefield find meaning in creating rituals themselves to diminish or relieve their moral injuries. Developing and participating in these ritual practices offer opportunities for veterans to be agents in their own healing, proactively addressing feelings of guilt, shame, and betrayal, without being beholden to others. If this is the case, those of us with expertise in cultural traditions linked to warriors have something to offer to these veterans. If we can identify specific practices that have been helpful to veterans in the past, as part of a larger body of ritual activity found across cultures, we as scholars of ritual can broaden the pool of practices available to veterans and their caregivers as models for additional ritual homecoming activity. Note that recognizing the value of these widespread human practices does not involve promoting any specific religious point of view. Pilgrimage,

Rituals and Moral Injury: How Veterans Make Peace  263 public testimony, atonement, and memorial-making appear in virtually every cultural tradition. Wherever there has been war, there have been warrior veterans, many of whom have tried religious practices to address the spiritual, existential challenges that war brings. Marlantes writes of his combat experience, “I was struggling with a situation approaching the sacred in its terror and contact with the infinite. … I needed a spiritual guide” (2011, 7). Bill Nash has written that moral injury “is a relatively new term for a very ancient idea: that people can be damaged in the cores of their personhood by life experiences that violently contradict deeply held, and deeply necessary, beliefs about themselves and the world” (Quoted in Edmonds 2015, 4). Marlantes refers to a “third atrocity” of war, the “fallen standard,” wherein one experiences moral trauma (2011, 89). Veterans who are struggling with the aftermath of combat experiences that shake their existential viewpoint have often turned to spiritual traditions – sometimes unknowingly – to address their unique morally challenging moments. For millennia, religio-cultural traditions have offered respite and healing to individuals suffering from moral anguish. Countless versions of these practices occur around the globe, across widely differing cultures, to address a timeless human experience: the gap between what is and what ought to have been. As embodied beings, humans have, in part, expressed and addressed their moral pain through physical actions. The humanist study of religion helps us see that seemingly new approaches to healing moral injury are actually rooted in ancient practices and widely available to all veterans. A humanist approach to religion brings something healing to the table when addressing moral injury, not from a normative, theological perspective, but from a historical, cross-cultural perspective. We deepen the well from which combat veterans and their caregivers can draw as they look for resources that effectively address moral injury. Notes 1 Here I invoke the terminology coined by Jonathan Shay (2003). 2 Note that I am not suggesting that veterans should not receive medical care; the practices described in this chapter often complement clinical care. 3 “Moral injury is a construct used to help identify those veterans who are at risk of existential and reintegration difficulties and to explain why some veterans suffer with potentially life-threatening psychic distress post-deployment. However, the moral injury field is relatively young and requires greater theoretical development to properly serve veterans” (Frankfurt and Frazier 2016, 313–30). 4 Note that veterans may feel morally responsible for acts and situations for which they are clearly not legally culpable. Nancy Sherman offers thoughtful conversation about this in Afterwar: Healing the Moral Wounds of Our Soldiers (Sherman 2015).

264  Kathryn McClymond 5 The phrase “Winter Soldier” has a long legacy. Current readers may recognize it in connection with the Marvel Comics character Captain America, but the phrase has roots in the writing of Thomas Paine: These are the times that try men’s souls. The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country; but he that stands by it now, deserves the love and thanks of man and woman. Building on Paine’s words, subsequent writers have used the term “winter soldier” to refer to the soldier who continues to serve during dark, difficult times.

Works Cited Ackerman, Spencer. “Iraq Veterans to Testify at Their Own ‘Winter Soldier,’” The Washington Independent, January 22, 2008. Army Public Health Center. “Spiritual Health.” https://phc.amedd.army.mil/topics/healthyliving/bh/Pages/SpiritualHealth.asp. Deigh, John. “On the Right to Be Punished: Some Doubts,” Ethics 94 (January 1984), University of Chicago: 191–211. Edmonds, Bill Russell. God Is Not Here: A Soldier’s Struggle with Torture, Trauma, and the Moral Injuries of War. New York: Pegasus Books, 2015. Ermenfrid of Sion. The Ermenfrid Penitential. 1070 Frankfurt, Sheila and Patricia Frazier. “A Review of Research on Moral Injury in Combat Veterans,” Military Psychology 28:5 (2016), 318–30.  https://doi. org/10.1037/mil0000132. French, Peter A. War and Moral Dissonance. New York: Cambridge University Press, 2011. Hartmann, Nicolai. Ethics Vol. 6. London: Psychology Press, 2002. Kekes, John. Facing Evil. Princeton, NJ: Princeton University Press, 1990. Kerry, John. Statement on behalf of Vietnam Veterans Against the War, presented before the Senate Committee of Foreign Relations, April 23, 1971. https://www.americanyawp.com/reader/28-the-unraveling/statement-by-johnkerry-of-vietnam-veterans-against-the-war-1971/. Linenthal, Edward. “Edward T. Linenthal.” Voices on Anti-semitism Podcast. November 1, 2012. https://www.ushmm.org/confront-antisemitism/antisemitismpodcast/edward-t-linenthal. Lombardi, Chris. 2021. “50 Years Ago, Winter Soldier Exposed the Vietnam War as One Long War Crime,” Waging Nonviolence. https://wagingnonviolence. org/2021/02/fifty-years-ago-winter-soldier-exposed-vietnam-war-crime/. Marlantes, Karl. What It Is Like To Go To War. New York: Atlantic Monthly Press, 2011. McPhate, Christian. “Veterans Remember Fallen Comrades.” Denton Record-Chronicle, May 2015. http://www.dentonrc.com/news/news/2015/05/25/veteransremember-fallen-comrades#ssStory2310018. Miles, Donna. “War Vets Return to Transformed South Korea.” DoD News, September 17, 2010. http://archive.defense.gov/news/newsarticle.aspx?id=60897.

Rituals and Moral Injury: How Veterans Make Peace  265 National Park Service. https://www.nationalparks.org/connect/blog/24-thingsknow-when-visiting-vietnam-veterans-memorial. O’Brien, Tim. “Field Trip,” in Standing Down: From Warrior to Civilian. Edited by Donald H. Whitfield. Chicago, IL: The Great Books Foundation, 2013. Rand Corporation. “One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression.” April 17, 2008. https://rand.org/news/press/2008/04/17. html. Shay, Jonathan. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner, 2003. ———Achilles in Vietnam. New York: Antheneum Books, 1994. Sherman, Nancy. Afterwar: Healing the Moral Wounds of Our Soldiers. New York: Oxford University Press, 2015. Soldier’s Heart. “18th Annual Healing and Reconciliation Journey to Vietnam.” Soldier’s Heart. https://www.soldiersheart.net/2017-journey-to-viet-nam. Soldier’s Heart. “Meet Dr. Tick and Purchase His Books.” https://www.soldiersheart.net/about-dr-tick. The Travis Manion Foundation. http://www.travismanion.org. U.S. Department of Veterans Affairs, PTSD: National Center for PTSD. “What Is Moral Injury?” https://www.ptsd.va.gov/professional/treat/cooccurring/moral_ injury.asp. “US vets build schools in Vietnam to heal war wounds.” Tuoi Tre News, May 30, 2014. https://tuoitrenews.vn/features/19977/us-vets-build-schools-in-vietnamto-heal-wounds. Wikipedia. “Vietnam Veterans Memorial.” https://en.wikipedia.org/wiki/Vietnam_ Veterans_Memorial.

Conclusion Andrew I. Cohen and Kathryn McClymond

The Powers and Lacunae of Science Researchers sometimes find that current frameworks in their field fall short in some way. They spot a phenomenon that does not fit into current categories, seeing a need for new tools to make better sense of our world. They offer conceptual innovation, which advances knowledge by asking new questions and framing the phenomenon in a new way. Such studies complement the groundbreaking work of clinicians and scientists. Consider the example of our climate. Scientists identified trends in weather and linked them to longer term climate changes. They formulated a theory to explain the historical changes and predict related ones. Scientific approaches have increased consciousness of climate change and inspired careful consideration about the causes and consequences of a changing climate. In these and related ways, scientific tools and categories are vital for understanding and predicting climate phenomena. However, scientific interpretative frameworks only take us so far. They are ill-suited to determining the meaning and significance of climate change. Their tools do not illuminate the lived experience of persons displaced, or threatened to be displaced, by rising seas, longer and hotter summers, and more vigorous storms. They do not tell us who owes what if anything to whom in light of the causes and impacts of climate change. They do not tell us how to assess the values linked to potential offsets (such as fewer deaths from cold and changes in lengths/locations of growing seasons). Science does not tell us who should bear the benefits and burdens of such changes. Only the tools and concepts of the humanities can illuminate the significance of climate change for the meaning of our relationships to our many communities, our states, persons beyond our borders, and our sense of and possibilities for a responsible and fulfilling life. The humanities critically investigate human lives and human institutions. They furnish tools to interpret our experiences, particularly as parts of networks of meaning that unite communities and transcend generations. DOI: 10.4324/9781003281122-19

Conclusion  267 The humanities include literature, religion, art, language, philosophy, and history. Among their tools are critical and speculative inquiry into history, tradition, institutions, and cultural norms in their various guises. The humanities empower us to interpret and construct meaning. They help us make sense of different and sometimes incompatible structures of meaning. We do not intend such tributes to the humanities to discount the crucial work that scientists and clinicians do. Certainly in the case of moral injury, clinicians have done, and continue to do, profoundly important work in documenting the causes and manifestations of moral injury. Our point is that the sciences only take us so far. As the contributors to this volume have shown, the humanities offer crucial tools for illuminating the impact, meaning, and significance of moral injury. The humanities tell us what it means to have the experience of moral injury and its significance for families, communities, and social institutions. The humanities will not provide quantitative analyses of reports about the causes, symptoms, and potential cures of disease, but, as some contributors to this volume note, the humanities help us understand whether something such as moral injury is a disease or disorder at all. Humanistic inquiry can help to frame the experience of trauma as a function of tragic choices and systemic failures rather than disease. The humanities offer vital interpretive platforms. They can identify what should guide responses to moral injury. Some responses are incompatible with what ethics requires or forbids. Some responses do violence to key cultural or religious norms. Some responses are fitting in light of the tradeoffs people face when recovering from trauma. Various humanities fields help us interpret the reports of persons and families marked by moral injury. The humanities also help us critically assess whether our concept of moral injury is clear and whether it is appropriate to apply to certain cases. They help us consider what reasons various forms of moral injury supply, to whom such reasons apply, and how weighty such reasons might be. The humanities are crucial for illuminating the structure and impact of moral injury and what if anything anyone should do about it. The humanities can also tell us why moral considerations matter for framing the trauma that people might be vulnerable to experience. Clinicians can identify guilt and consider alternative tools for overcoming dysfunctional debility. The humanities, however, help us understand what is distinctive about the guilt and shame that are characteristic of moral injury. In oral histories, narratives, investigations of ritual, explorations of the boundaries of concepts, and inquiries into the permissions, rights, and obligations that define relationships prone to upset through trauma, the humanities can help us how to critically interpret moral injury for those who experience it and those who hope to respond to it. The humanities help us know not just what moral injury is but why it matters.

268  Andrew I. Cohen and Kathryn McClymond The essays contained in this volume provide a multi-faceted ­humanistic perspective on moral injury, privileging the human experience of, and meaning-making that accompanies, moral trauma. The extensive research done from a clinical perspective builds on the premise that moral injury is a symptom or expression of something physiologically wrong that needs to be fixed. Humanistic approaches, by contrast, lean into the interpretation that moral injury is a bellwether – it is an indication that one’s moral foundations have been shaken. Humanistic approaches are critical in this context in that they honor and interpret the human experience of being wronged (or doing wrong), feeling betrayed, and seeking stability after having one’s moral world rocked. They provide platforms for understanding the phenomenon and, in some cases, for grappling with it. Beyond the Battlefield While this volume has focused largely on moral injury among combat veterans, it’s clear that individuals in other professions also experience moral trauma. Peter A. French describes a British chaplain who believed that he experienced as much “stress and agony of those in Fallujah and Baghdad” as a result of serving soldiers in an English hospital (French 2010, 38). Chaplains and other caregivers experience “collateral” or second wave trauma in tending to the spiritual, physical, and psychic wounds of soldiers. But it is also clear that trauma and moral injury are not restricted to soldiers or those in direct connection with them. Increasingly, researchers and clinicians are recognizing moral injury in other professional communities, especially within medicine, education, and public service professions. As with combat personnel, other professionals who deal daily with violence, systemic injustice, social inequity, and the sustained erosion of hope and opportunity experience moral upheaval. Like combat veterans, they feel betrayed by individuals or a broader professional system or they experience guilt when they fail to live up to their own ideals. They can conclude that their efforts are futile or flawed, and they grieve for those who were failed by the system that was meant to save them. As John Kleinig notes in his chapter “Moral Injury in Law Enforcement,” police (not to mention bystanders) can experience moral injury in “high stakes” situations. Several years ago, one of the editors of this volume (McClymond) facilitated a workshop presenting ritual practices as a resource for nurses and other medical personnel in dealing with trauma that resulted from extended caregiving. During that workshop, healthcare professionals found themselves resonating with descriptions of combat soldiers’ experiences of moral injury. They found affirmation in having the guilt and shame they had experienced in isolation identified, acknowledged, and addressed as a

Conclusion  269 legitimate human response to extended involvement in other people’s pain, especially when they could not offer cures or comfort. As this volume was in development, we experienced a global pandemic; a national reckoning in the U.S. with our racial divide, disparities, and injustices; and deepening political unrest. In these moments, the editors and many authors in this volume have noticed professionals outside of the military reporting experience of moral injury. Local, regional, and national communities will have to address moral trauma. In those moments, humanistic approaches that affirm individuals’ feelings of guilt, shame, and betrayal will be crucial to moving those individuals, their caregivers, and their communities forward. Works Cited Ellis, Jonathan. 2023. “Damar Hamlin Speaks in a Video for the First Time Since His Collapse.” The New York Times, January 29, 2023, sec. Sports. https:// www.nytimes.com/2023/01/28/sports/football/damar-hamlin-video.html. French, Peter A. 2010. War and Moral Dissonance. Cambridge: Cambridge University Press. Hodges, Lauren, Ashley Brown, and Ari Shapiro. 2023. “The Impact Gun Violence Is Having on Society’s Mental Health.” NPR, January 25, 2023, sec. Mental Health. https://www.npr.org/2023/01/25/1151474339/the-impact-gunviolence-is-having-on-societys-mental-health.

Contributors

Henry Bayerle, Ph.D., is an Associate Professor of Classics at Oxford College of Emory University. His research focuses on the reception of ancient Greek and Roman literature, especially in medieval Italy and France. His most recent research and publications use ancient poetry to understand the moral injury experienced by combat veterans and healthcare professionals. He is currently directing a project funded by the “Dialogues on the Experience of War” program of the National Endowment for the Humanities in which groups of veterans meet to read Virgil’s Aeneid and discuss their experiences of military service. Saba Bazargan-Forward, Ph.D., is an Associate Professor at the University of California San Diego’s Department of Philosophy. He works primarily in normative ethics, with a focus on complicity, the morality of defensive violence, and the morality of war. He has also published on a variety of other issues including coercion, rectificatory liability, the grounds for associative duties, and the morality of mediating agency. He has authored a book on responsibility in shared action and has co-edited a volume on collective responsibility. Rev. Rita Nakashima Brock, Ph.D., is the Senior Vice President for Moral Injury Programs at Volunteers of America. Brock has also served as the Director of the Soul Repair Center at Brite Divinity School. She is the first Asian American woman ever to earn a doctorate in Theology (Claremont Graduate University, 1988) and to serve on the Board of Directors of the American Academy of Religion. She was a Professor for 18 years before becoming the director of a think tank for distinguished scholars at Harvard University–the Radcliffe Institute for Advanced Study. An internationally distinguished lecturer and award-winning author, her 2008 book with Rebecca Ann Parker, Saving Paradise: How Christianity Traded Love of This World for Crucifixion and Empire, was a finalist for the American Academy of Religion Award in constructive, reflective theological studies and a best book of the year in

272 Contributors Publisher’s Weekly. Her most recent book is Soul Repair: Recovering from Moral Injury After War, co-authored with Gabriella Lettini. Lieutenant Colonel Kevin Cutright is an Associate Professor in the Department of English and Philosophy at the US Military Academy. He received his Ph.D. in Philosophy from Saint Louis University. His operational experiences have driven his interest in the ethics of military planning and conduct, empathy, and moral injury. John Kleinig, Ph.D., is an Emeritus Professor of Philosophy in the Department of Criminal Justice, John Jay College of Criminal Justice, and in the Ph.D. Program in Philosophy, Graduate Center, City University of New York. After a year at John Jay on a Fulbright Fellowship (1984– 1985), he moved to New York from Macquarie University (Sydney, Australia). His broadest interests are in social and moral philosophy, though, since coming to John Jay, he focused particularly on police ethics and criminal justice ethics. At the Graduate Center, he taught courses in social and political philosophy. From 1987 to 2011, he was the Director of the Institute for Criminal Justice Ethics and the editor of Criminal Justice Ethics. He is the author/editor of 23 books. He retired in 2013 and continues to write. Johannes Lang, Ph.D., is a senior researcher at the Danish Institute for International Studies. Lang was trained as a psychologist, and his current research focuses on the collaboration between psychological science and the US military after 9/11. Before this, Lang worked in the field of Holocaust and Genocide studies. His most recent book (co-edited with Thomas Brudholm) is Emotions and Mass Atrocity: Philosophical and Theoretical Explorations (2018). With Robin May Schott, Lang co-directed a research project on “The New Psychology of War,” which explored the emergence of the concepts of “resilience” and “moral injury” in the US military. Joshua Mantz is a West Point graduate and a retired Army Major. He is a recipient of the Purple Heart and Bronze Star with Valor. He holds a master’s degree in Philosophy, Consciousness, and Cosmology from the California Institute of Integral Studies and is currently pursuing a Ph.D. in the same. He is among the nation’s leading inspirational speakers on adversity, trauma, and resilience. He lives in Las Vegas, NV. Linda Radzik, Ph.D., is a Professor of Philosophy at Texas A&M University. She is the author of Making Amends: Atonement in Morality, Law and Politics (2009) as well as a number of articles on the moral issues that arise in the aftermath of wrongdoing. Her 2018 Descartes Lectures were published by Cambridge University Press as The Ethics of Social Punishment: The Enforcement of Morality in Everyday Life (2020).

Contributors  273 Jay Rajiva, Ph.D., is an Associate Professor of English and the Director of Literary Studies at Georgia State University. Rajiva works at the disciplinary intersection between postcolonial and global Anglophone literature, trauma theory, and phenomenology. Rajiva is a comparative scholar with a strong regional focus on South Asian and panAfrican fiction. Rajiva’s second book, Toward an Animist Reading of Postcolonial Trauma Literature (Routledge 2020), uses the conceptual framework of animism, the belief in the spiritual qualities of nonhuman matter, to analyze representations of trauma in postcolonial fiction from Nigeria and India. He is also the author of Postcolonial Parabola: Literature, Tactility, and the Ethics of Representing Trauma (2017), which analyzes literature of partition and civil war on the Indian subcontinent alongside apartheid and post-apartheid South African fiction. His scholarship has appeared in journals such as Studies in the Novel, Twentieth-Century Literature, ARIEL, Journal of Postcolonial Writing, and Angelaki: Journal of the Theoretical Humanities. He was the recipient of the Dean’s Early Career Award in 2019. David Rodin, Ph.D., spent 20 years at the University of Oxford where he was the founder and co-director of the Oxford Institute for Ethics, Law and Armed Conflict and Principle Investigator of the Changing Character of War Program. He is a Senior Fellow at the Carnegie Council for Ethics in International Affairs and Executive Chair of Principia, an international consultancy that helps large organizations navigate complex ethical challenges. Alan Roof, M. Div., is currently serving as a chaplain in Montana. Prior to that, he served as a chaplain for 13 years in a physical rehabilitation hospital where he provided spiritual support to patients with a brain injury as well as their families. Roof has a BA in Art from Chadron State College, Nebraska, and an MDiv with a certificate in Faith and Health from the Candler School of Theology at Emory University. He has presented his work on recovery to lay and professional audiences throughout the United States. He also served on the advisory board of the Interfaith Disability Network in Atlanta. Jennifer A. Samp, Ph.D., is a communications consultant from Georgia and an MA candidate in clinical psychology at Pepperdine University. She has 25+ years of experience in research and teaching on human interaction, goal-based performance, and conflict management. She has published 58 peer-reviewed articles, 12 book chapters, and presented 100+ conference papers covering topics of human behavior, social interaction, interpersonal conflict, goals, power, commitment, satisfaction, and self-awareness. Samp is the Editor of Communicating interpersonal conflict in close relationships: Contexts, challenges, and opportunities

274 Contributors with Routledge. She is currently working on a book about interpersonal conflict. Robin May Schott, Ph.D., is a senior researcher at the Danish Institute for International Studies. A philosopher, she works with interdisciplinary research on conflict, violence, war, and gender. Recent publications include Resilience; Militaries and Militarization, co-edited with Joanna Bourke (2022); “Resilience as a Failed Concept: The Militarization of Intimate Lives” (2022); “War and Terrorism” (2021); “The ‘Burqa Bans’ and Superficial Politics” (2021); “Arendt, Natality and the Refugee Crisis” (2020). With Johannes Lang, Schott co-directed the research project on “The New Psychology of War,” which explored the emergence of the concepts of “resilience” and “moral injury” in the US military. Lauren Walsh, Ph.D., is a professor, writer, filmmaker, curator, and archivist. She teaches at New York University, where she is the Director of the Gallatin Photojournalism Lab. She is also the Director of Lost Rolls America, a national archive of photography and memory. Walsh focuses on photojournalism, with a specialty in conflict photography and peace journalism. Her newest book is Through the Lens: The Pandemic and Black Lives Matter (2022) on the visual coverage of 2020s two major global headlines. Her other books include Shadow of Memory (coauthor, 2021), on recently discovered photos of the Bosnian War, and Conversations on Conflict Photography (2019), addressing coverage of war and humanitarian crises. She is the co-editor of The Future of Text and Image (2012), collected essays on verbal-visual dynamics, and Millennium Villages Project (2016), a photo book examining UN goals to alleviate extreme poverty in sub-Saharan Africa. She is also the editor of Macondo (2017), a photo book documenting the long-term conflict in Colombia and published shortly after the peace treaty was announced. Walsh has published in the Los Angeles Review of Books, Photography and Culture, the Romanic Review, the New Republic, the Journal of American History, Nomadikon, and elsewhere, and has appeared as a commentator in leading news and media outlets.

Index

Note: Page numbers followed by “n” denote endnotes American Psychiatric Association 18, 31 animism: definition of 23; luck charm 231, 238, 239, 241, 244, 246–247; marasa (see Marasa); mojo bag 238, 239, 241, 245, 246–247; moral injury 239, 246–247 Arendt, Hannah 25, 27 atonement 6, 7, 85, 96–97; as apology 90; as changing the past 87–88; as compensation 90–91; how to 94–95, 97; moral injury 86, 87, 259; reconciliation theory 85–86, 92, 94–95, 98; as reparations and good works 91; as repentance 89–90; ritual 234, 245–246 (see also rituals, making restitution or atonement); as self-forgiveness 89; as suffering 88–89; see also making amends; moral amends Bandura, Albert 27 Bica, Mac 175n3 Black Lives Matter 135n13, 146–150 children: in war 205–206, 209–210 conscience 25, 26 consequentialism 73, 79 COVID–19 pandemic 31, 104, 109, 120

deontology 73, 79 Diagnostic and Statistical Manual of Mental Disorders 23, 120, 140 dissonance: cognitive 4, 24–25, 168; moral 26, 31 DSM see Diagnostic and Statistical Manual of Mental Disorders ethics of psychology 70–71 Floyd, George 126–128, 130, 133–134, 148, 150 Global War on Terror 216, 225, 226n4 guilt 4–5; as a moral emotion 51–52, 53, 61 GWOT see Global War on Terror Hills, Alison 9, 162 humanities: importance of i, 2–3, 266–268 integrity 42–44, 47; role in trauma 36, 43–44 The Iraq and Afghanistan Wars 10, 17, 18, 109–110, 120, 143–146, 201, 199, 249, 258 jus ad bellum 35, 170, 172–173, 174 jus in bello 169, 170, 172–173 just post bellum 176n10 just war theory 2–3, 169

276 Index Litz, Brett 19–20, 22–23, 24, 55, 75, 83n2, 105, 124, 215 making amends 29–30, 85, 259–260; repentance 259–260; see also atonement marasa 236, 231, 238, 241; dosu/dosa 236, 244, 246 marassa see marasa meaning-making 24, 187, 188, 190– 191, 238; moral trauma 268 memorial-making see rituals, memorials mental health treatment: forward psychiatry 19; moral pathway 81–82; psychological pathway 81–82 mental health: military 20, 23, 30 moral amends 6; reconciliation theory 7; see also making amends moral deference 162–163, 169, 170, 171, 173, 175; contra epistemic deference 172 moral disengagement 28 moral emotions 5, 61; deontological perspective 74; fittingness 53–54, 63–64; moral injury 5, 50–51, 57, 61–62, 64, 125; moral suitability 54; warrant 54, 63 moral expert 9, 162–163, 175 moral failure 18, 23, 26–27, 31, 60, 69 moral injury: betrayal 2, 20, 21, 26, 27, 74, 103, 124, 140–141, 215, 252; bystanders 126–127; cognitive-psychological model of 20, 24, 26, 31; conceptions of 208; conceptual adequacy 230, 234, 239, 242, 244, 246; conception of 45, 75, 85, 103, 105, 124, 125, 143, 165, 184, 215, 250–252; contra PTSD 140–141, 163–164, 167, 249– 250, 252, 253, 262; cultural dimensions 231, 238, 236, 247; as distinct trauma 50, 64; effect of ulterior motives on 5–36, 37, 41–42, 47; experiences of 1–2, 5, 17, 18, 20, 21, 22, 24, 44, 56, 60, 64, 97, 126–127, 134, 143, 146, 152, 153–154,

163, 167, 203–204, 205, 210, 245, 251–252, 258; fittingness 57; Greek tragedy 105–107; in Haitian context 231, 232, 234, 246–247; healing 233, 234, 237–238, 239, 240, 241, 243, 246, 250, 263; healthcare workers 2, 7, 31, 69, 103, 108, 109, 111, 112, 268–269; ideas for minimization and mitigation 131–133, 154–157; identity 111–112, 120, 215; inciting incidents 17, 20, 21, 26, 55–56, 60, 85, 86, 103–105, 107–108, 110, 111, 112, 113, 114, 126, 131, 138, 141, 142, 143, 148, 151, 153, 203–204, 242–243, 251, 258; institutional purpose 82; law enforcement 8, 124–125, 128–129, 131, 268; limits of 231, 233–234, 246; military veteran(s) 7, 2, 11, 12, 21, 22, 23, 86, 97, 163; mischaracterized 3, 18, 19, 20, 22, 23, 24, 26, 60, 81, 146, 154, 208, 210, 216; moral appropriateness 57; moral health account 72, 75, 78, 79–80, 83; as moral regulation 6; as a moral-psychic response 69, 72; moralized account of 57, 59, 60–61; non-moralized account of 57, 59, 62; in nonWestern context 230, 233–234, 236, 246–247; origins of 21, 175n3; outside of combat veterans 268; photojournalism 141, 142, 145, 146, 155, 157– 158; possible cues of 129–130; psychological health account 72, 75, 78, 79–80, 83; recovery 209–210, 211, 212, 217, 226; role of justification 77–79; role of leadership 35–36, 37, 40, 41–44, 47–48, 48n6, 77, 86, 103–105, 108, 128, 130, 148–149, 155–156, 157–158, 166, 168, 216; role of narrative 242; role of responsibility 76–77; spiritual dimensions 207, 208, 217, 225, 231, 240,

Index  277 260, 263; spiritual healing 207–209, 217; symptoms 6–7, 20, 24, 69, 131, 167, 252; treatment 80–81, 98, 120, 132, 217–219; understanding 245; value of 27–28, 252–253; war correspondents 8 moral knowledge 162; in soldier training 164–165; through testimony 163, 165, 166, 167, 168, 169 moral meaning 27, 31 moral preparation of soldiers 164–165 moral remainder 26–27 moral repair 20, 29 moral testimony 9, 162, 165; importance 168–169, 171; role in moral injury 166–167, 168, 169, 174–175 moral trustee 9, 162–163, 172–173, 175 moral understanding 9, 162, 165, 170, 173; role in moral injury 162, 164, 165–169, 174 moral-psychic response 69; appropriateness 71, 72–73; dimension 6, 69–70, 72; proportionality 72, 79; psychological dimension 6, 69, 72; see also moral emotions narrative development 183 Nash, Colonel William P. 19–20, 23, 24 negative psychic reactions 68 Nussbaum, Martha 106–107, 119–120, 121 Obi 239 The Pentagon 18 positive psychic reactions 68 post-traumatic stress disorder 1, 3, 8, 17, 22–23, 24, 81, 125, 140, 146, 148, 157, 163, 201, 216– 217, 225, 226n5, 249, 252, 253 practical agency 37 practical authority 38 PTSD see post-traumatic stress disorder

Raz, Joseph 38 reactive attitudes 64n1; see also moral emotions resilience strength training 217–222, 225, 226, 227n7, 227n8 responsibility 30 rituals 11, 12; as healing 254, 255, 261; labyrinth walking 219; making restitution or atonement 250, 259–260; memorials 250, 261–262; military 214; moral injury 215, 217, 250, 262; offering testimony 250, 257–259; pilgrimage 250, 254–256; prophecy 257; public testimony (see rituals, offering testimony); tokens 256–257; value of 222–225, 225–226, 250, 262–263; see also rituals, offering testimony shame: role in moral injury 252–253 Shay, Jonathan 1, 21, 26, 50, 59, 69, 75, 77, 103, 120, 124, 134n1, 140, 156, 166, 215, 217, 250 Sherman, Nancy 1, 45, 52, 55, 57, 59, 110, 112 Sophocles’ Philoctetes: moral injury 107–109 substance abuse 17 suicide 17, 60, 111, 116, 214, 251–252; bombings 206; in law enforcement 131 trauma: chronicity 179, 181; combat 21, 139–140, 183–184, 184– 185; complexity 179, 180, 181; conceptions of 18, 20, 23, 24, 178, 179; experience of 240–241; in Greek tragedies 106, 108, 109, 113; in Haitian context 236, 240; historical 231–232, 237; intensity 179, 180–181; military sexual 218, 219–220, 227n9; moral injury 31, 24, 23, 21, 50, 58–59, 60, 61–62, 64, 75, 97, 126–127, 134, 146, 148–149, 162, 163, 186–187 (see also

278 Index moral injury, experiences of); in non-Western context 239; photojournalism 141; as a psychic response 69; role of narratives 183, 187–188; understanding 182–183, 241; see also moral injury, inciting incidents U.S. Department of Defense 18 ulterior motive: definition 36 utilitarianism 108–109

victim-perpetrator ambiguity 232–233 The Vietnam War 4, 18, 140, 216; post-Vietnam syndrome 21, 22; veteran(s) 104, 140, 216 Virgil’s Aeneid: curse of Dido 116– 117; of Dido 114–116; moral injury 113–119 virtue ethics 73, 79 Walker, Margaret Urban 29–30 the war in Ukraine 150–152 Williams, Bernard 26, 42, 44, 55, 121