Moral Injury

Moral Injury

“The Truth which was the object of his quest was not outside himself but within. Hence, the more he took to violence, the more he receded from Truth. For in fighting the imagined enemy without he neglected the enemy within.”

–Gandhi, “Ahimsa or Love”

“No evil can befall a good human being.”

–Socrates, Apology

“Socrates: Doing what’s unjust is actually the greatest of evils.

Polus: Really? Is that the greatest? Isn’t suffering what’s unjust greater?

Socrates: No, not in the least.

Polus: So you’d want to suffer what’s unjust rather than to do it?

Socrates: I certainly wouldn’t want either, but if it had to be one or the

other, I would choose suffering over doing what’s unjust.”

–Plato, Gorgias

Moral injury results from having to make difficult moral choices under extreme conditions, witnessing immoral acts, or behaving in ways that profoundly challenge conscience, identity, and the values that support them. Veterans Affairs clinicians define moral injury as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” It can arise from participating in or witnessing cruel or inhumane acts which clearly violate one’s own moral code.

William Nash, combat psychiatrist in the battle of Fallujah in 2004 and lead author of the current US Navy and Marine doctrine on stress control believes that moral injury may be the leading cause of post traumatic stress disorder (PTSD), depression, substance abuse, and even the military’s current suicide epidemic. What is important regarding moral injury is that, unlike most accounts of post traumatic stress disorder, the focus is on what military service members do to others – or in some cases fail to do for each other – not on what gets done to them. Being shell-shocked does not provoke moral injury; participating in an attack on noncombatants does. “War itself, no matter how just or good, will leave many of the men who fight it like they’ve dirtied their souls, and perhaps for a simple reason: there is something about killing that bites the conscience and just doesn’t let go.”

While moral injury is as old as war, the psychological burden of killing in war has become more and more heavy to bear as war increasingly spills beyond combatants to ordinary citizens. At the beginning of the 20th century victims of war were likely to be soldiers; by the end of that century victims were more likely to be civilians. This became especially prevalent during US wars in Korea and Vietnam where guerilla warfare made distinguishing soldiers from civilians impossible. One irony here is that a primary cultural shift in the nature of war – i.e., hiding and wearing camouflage rather than brightly colored uniforms and drill-team maneuvers of soldiers – led to success for colonists overthrowing British rule in North America in the eighteenth century, but nearly two hundred years later American military personnel in camouflage uniforms were out-fought by guerilla soldiers hiding openly among ordinary villagers: women, children, and the elderly. Not only uniforms, but even the battle-line fronts, so familiar in World Wars I and II, had given way to insurgency conflict and the inevitable dislocation, injury to, and killing of increasingly large numbers of innocent citizens. Subsequent wars have continued to blur the distinction between soldiers and noncombatants to the point that, today, half of all veterans of the war in Afghanistan report to the VA looking for help with their mental health and one in five soldiers has PTSD or major depression. Describing their participation in war, one in three soldiers who served in Iraq or Afghanistan reported killing the enemy, one in five reported killing a civilian by mistake, two in three handled or uncovered corpses, and two-thirds saw wounded or sick women and children they couldn’t help. Almost eighty per cent had a friend wounded or killed. Such traumatic experiences often cause moral injury. And wars of this sort have made the just war tradition increasingly obsolete. Perhaps war could be just if volunteers engaged enemies on remote battlefields in unpopulated rural areas, but those days are gone. War is no longer a game played by aristocratic gentlemen maneuvering their pawns/combatants on isolated battlefields; it may have been like that hundreds of years ago but not today. War, now more than ever before, lives up to it’s German etymological root: werra, confusion. The best-trained soldiers cannot tell the enemy from innocent civilians, so the just war principle of discrimination – sparing noncombatants – is impossible to enforce.

Although the US military has been called “the world’s best killing machine,” the word, “killing,” rarely gets used by the military. Twenty years ago I spoke to an ethics class at the US Naval Academy in Annapolis, Maryland. The “middies,” I met, to use their own slang term for Annapolis students (formally “midshipmen” but increasingly including midshipwomen) rejected my suggestion that they were being trained to be effective contributors to the world’s most efficient killing machine. Rather, they insisted they were being trained for careers in middle management, initially for the Navy and, after completing their service obligation, for American and multi-national corporations. “Killing” does not appear in US military training manuals or in surveys of returning soldiers, and “the effects of killing aren’t something the military screens for when service people come home.” Among Vietnam vets, killing in combat doubled the risk of suicidal thoughts; in veterans of Iraq, killing predicts PTSD, alcohol abuse, marital problems, and anger-management issues. A quarter of killers develop drinking problems and a third show signs of depression. Nonetheless moral injury is not an official diagnosis of the American Psychiatric Association. In his 2011 memoir, What It is Like to Go to War, Vietnam veteran Karl Marlantes argued “for an end to our chirpy, parade approach to veterans,” which he compared to clapping for a surgeon who has just amputated a leg. “This ain’t a football game; we’re talking about killing people….”

What has moral injury to do with ahimsa? “Not to hurt any living thing is no doubt part of ahimsa. But it is its least expression. The principle of ahimsa is hurt by every evil thought, by undue haste, by lying, by hatred, by wishing ill to anybody.” Ghandi makes clear that being violent harms the perpetrator as much, perhaps more, than it harms the victim. Socrates makes the same point in his Apology as he explains why he would rather be put to death wrongly than commit a wrong himself: “the difficulty is not so much to escape death; the real difficulty is to escape from doing wrong.” (39b) “Make yourselves as good as you can. This is my last message to you who voted for my condemnation.” (39e)
In Gorgias Socrates develops this point further in discussion:

Polus: Surely it is the man unjustly put to death who is pitiable and wretched.

Socrates: Less so than his slayer, Polus, and less than he who is put to death justly.

Polus: How is that Socrates?

Socrates: In view of the fact that to do wrong is the greatest of evils.

Polus: Is that the greatest? Is it not greater to suffer wrong?

Socrates: Most certainly not.

Polus: Then you would wish rather to suffer than to do wrong?

Socrates: I would not wish either, but if I had either to do or to suffer wrong, I would choose rather to suffer than to do it. (469bc)

Later in the dialogue, after Polus has given up and Callicles takes over the discussion, Socrates drives the same argument to the same conclusion: “the greatest possible evil” is to be “depraved of soul and ruined….” (511a)

What was clear to Socrates 2,500 years ago, that doing evil is worse than being a victim of evil, is equally clear to Gandhi a hundred years ago. This is why both understand the inevitability of suffering in pursuit of goodness. And this is why both realize the wrong of returning evil for evil. A significant aspect of both Socrates’ and Gandhi’s rejection of violence is their challenge to the oldest common law, the lex taliones, the law of retaliation.

Plato’s Crito is an early dialogue reconstructing Socrates’ conversation after his trial and conviction for corrupting the youth of Athens and teaching false religion, but before his execution. It includes Socrates’ claim that we should never do evil, even in response to evil, no matter what we may have suffered. While Plato scholars often dismiss this point as merely rhetorical, Socrates’ rejection of retaliation undermines nearly all the justifications for violence and war offered throughout history. Gregory Vlastos, perhaps the most highly regarded Plato scholar of the twentieth century, regards this as an original moral insight: “if someone has done a nasty thing to me, this does not give me the slightest moral justification for doing the same thing, or any nasty thing, to him. So far as we know, the first Greek to grasp in full generality this simple and absolutely fundamental moral truth is Socrates.”
It is well established that Gandhi’s education was wide and deep, drawn from across the world’s major religions, literary traditions, and philosophical perspectives, certainly including Plato. While Gandhi’s expressions of nonviolence are varied, written and spoken over decades in a variety of settings and presented less as theory and more as advice for action, it is nonetheless clear that Gandhi’s position consistently rejects not only retaliation against but also perpetration of evil. Socrates and Gandhi both knew what contemporary moral psychologists are beginning to realize, namely, that we injure ourselves morally by acting violently, and that moral injury is not only real but it is also serious. Our souls (Greek: psuche, the etymological root for psyche, self), we ourselves, are at risk of ruin by moral injury. To safeguard our own well-being we must do what we can to avoid moral injury just as we try to avoid physical injury. In fact, if we are to believe Socrates and Gandhi, we need to be more careful about moral than physical injury. Our bodies are important, but our very selves are us.

While courses in ethics debate the fine points of deontological and consequentialist nineteenth century moral positions (i.e., Kant and Mill) – for the most part dismissing Socrates’ nonviolence as rhetorical and ignoring Gandhi altogether – the world needs to learn and apply the principles of nonviolence discovered and refined in practice by our true moral leaders. We find these lessons in Plato’s Crito , Gorgias, and Republic, in Jesus’ Sermon on the Mount, Desiderius Erasmus’ Renaissance anti-warism in The Praise of Folly, Immanuel Kant’s Perpetual Peace, Adin Ballou’s pragmatic pacifism, Leo Tolstoy’s The Kingdom of God is Within You, William James’ “The Moral Equivalent of War,” W. E. B. DuBois’ The Souls of Black Folk, Jane Addams’ speeches and papers, John Dewey’s Human Nature and Conduct, Mohandas Gandhi’s satyagraha and ahimsa, Martin Luther King, Jr.’s “Letter From Birmingham Jail” and Where Do We Go From Here: Chaos or Community? (as well as most sermons, talks and papers from Montgomery, Alabama in 1955 to Memphis, Tennessee, in 1968), in Nelson Mandela’s Long Walk to Freedom as well as in his world tour and presidential campaign following his release from 27 years as a political prisoner under apartheid, Sara Ruddick’s Maternal Thinking, bell hooks’ Feminism from Margin to Center, Marilyn Frye’s The Politics of Reality, and more. The shame is not only that dominant academic culture has yet to take nonviolence seriously, largely dismissing nonviolence as hopelessly naïve and/or ghettoizing it into peace studies programs rather than infusing nonviolence into the central focus of all disciplines. The further shame is that Gandhi and many others knew the significance of moral injury a hundred years ahead of what is just now dawning on contemporary military personnel, physicians, psychologists, and the general public, with political conservatives foot-dragging on any and all change. Generations of our best thinkers, going back to Socrates, knew about and warned us of moral injury. Why, then, does it come as a surprise to us? And why do we hesitate to take it seriously? Why does the issue get politicized with the “sides” pushed to extremes? And why are military psychiatrists, those with (arguably) the most experience of moral injury, so reluctant to recognize participation in violence as a cause of the rise in psychological problems from modern war? Gandhi knows how to answer questions like these: “in fighting the imagined enemy without we neglect the enemy within.” And Socrates reminds us that the integrity of our very selves is at stake.

Duane L. Cady
Hamline University