Beyond PTSD: Pulitzer winner comes to ASU to discuss 'moral injury'

“Moral injury” is a term known mostly to the veteran and mental health communities, but military correspondent David Wood wants to introduce it to the public lexicon.

That’s why the Pulitzer Prize-winning reporter dedicated his latest book to the topic, and why he’s coming to ASU to explain the ethical dilemmas in modern conflict.

Moral injury, Wood says, is a violation of one’s sense of right and wrong. He says soldiers suffer from it after battlefield conflicts and that it’s far more pervasive than post-traumatic stress disorder.

Recently selected as an ASU Senior Future of War Fellow with the Center on the Future of War, Wood (pictured above) will commence its spring 2017 lecture series Tuesday at the Memorial Union on the ASU Tempe Campus.

“David is one of the country’s finest war and military journalists,” said Daniel Rothenberg, co-director of the Center on the Future of War. “His writing on moral injury among those who have served in the post-9/11 wars has helped focus attention on the complex experiences of our nation’s longest-running conflict, reminding us that distant conflicts have broad and sometimes overwhelming consequences for those who serve, their families and our society.”

Wood's “What Have We Done: The Moral Injury of our Longest Wars" features portraits of combat veterans and leading mental health researchers along with his personal observation of war, the soldiers deployed in Iraq and Afghanistan and some of the challenges they face after leaving the battlefield.

A former conscientious objector, Wood spoke to ASU Now in advance of his Jan. 17 lecture:

Question: Your new book, “What Have We Done: The Moral Injury of our Longest Wars,” introduces to the public the idea of moral injury in soldiers. What is the difference between PTSD — a well-known term — and moral injury?

Answer: PTSD is based on a situation where you are terrified and in fear of losing your life imminently. That came out on research that had been done on people who were in car crashes. When that happens, it sets off your fight-or-flight senses and response. It’s totally involuntary and floods your system with adrenaline, widens your irises so your eyesight improves and strengthens your muscles. Your body tells you, “You’re in danger.” And you’re in crisis response. I know people with PTSD, and it’s a terrible thing to deal with.

Moral injury is completely different. It’s not a physical reaction. Simply put, moral injury is a violation of what your sense of right or wrong is.

We all walk around with a sense of what’s right and wrong. We learn this from our parents and in school. In the military, you learn a very coherent and pretty strict set of moral values to define what’s right. Then you go to war and almost everything that happens violates your sense of what’s right. Moral injury, like any injury, can range from hangnail to quadruple amputation.

I suspect that many people who experience moral injury have a momentary twinge of conscience, and then they move on and it never affects them again. I’ve certainly had those experiences. We probably all have.

But then there are cases where moral injury touches you really deep, and it does affect people’s lives and, in a few cases, it can be debilitating. That’s really the difference.

One of the problems that I’ve come across is that the Veterans Administration, in its treatment of veterans, is that I think they’ve overdiagnosed PTSD and prescribed the wrong types of therapy. I believe very slowly there’s a growing recognition that most people who have some form of war trauma have moral injury and not PTSD.

Q: Why is it important for the public to understand the distinction between the two?

A: The reason I wrote the book is to explain to the vast majority of the American public who doesn’t know anyone in the military and doesn’t know the experiences they’ve had to face and experiences that we have put them into.

It’s important to recognize that most people who go to war come back strengthened by their experience and are proud of what they have done, and certainly an abiding love with the people they served with.

Those things are all true. It’s also true that some people come back disturbed with the things that have happened and are not OK with that.

As a quick example, I’ve written about a young Marine who shot a child in combat, which as you know, isn’t right. But it was a situation where it was a firefight, he saw somebody coming around the corner of a building and it was a 12-year-old kid and he shot him. This was a kid that the Taliban had trained and armed, and by any definition he was a combatant. So this Marine was perfectly justified in taking his life.

Tactically correct, legally justifiable, but he killed a child and that violated his sense of what was right. I know this person pretty well, he’s out of the Marine Corps now. He’s not disabled or on drugs. He’s a perfectly normal and responsible person, but he carries this bruise on his soul knowing that he killed a child.

It’s important for us to know because we’re the people who send them into wars. I feel pretty strongly that before we send people to war, they ought to know what it is that they’re going to face, particularly the morally ambiguous wars that we’ve been in the last 15 years and are still in. So that’s why I really wrote the book.

Q: Wouldn’t some say these young people are actually told in boot camp what they will be facing when heading into combat and they know what they’re up against?

A: People do go into wars thinking they know what they’re facing, but ask ... that Marine I just spoke about, “When you signed up for the Marine Corps, did you think you were going to kill a child?”

Or, “Did you know that you’d be put into a situation where you have to make a split-second decision to shoot or not?”

Probably not.

One of the things that might be fair to consider is should the military do a better job preparing people to think about the morally complex situations they might run into and how to deal with that in advance? I know you can’t imagine every difficult situation you might find yourself in, but you could certainly teach people that they are going to run into morally ambiguous situations and how to think about them. Furthermore, once it’s over, how to process it so that they’re not just stuffing that memory deep down inside.

Moral injury is not talking about people doing something wrong. The Marine who shot the child, you can honestly say he did not do something wrong.

Some of the moral injury comes when you get home. For example, in small combat units, people are joined together by intense, intense devotion to each other and reliance on each other.

When you get home from your service, all of that goes away. The grief and loss and sense of sorrow that follows could be really difficult for people to deal with. I’ve spoken with many soldiers whose legs were blown off in service, and they wake up here at Walter Reed Hospital and the first thing they say when they wake up is, “I’ve gotta get back to my unit!”

That’s a very, very strong impulse and hard to deal with when you can’t.

I’ve thought about this many times. How do you tell your wife that you’re closer to the guys in your unit than I am to you? They can’t talk about it because they feel as though their wife would never really understand because they weren’t there. So there’s all kinds of dynamics that happen after you come home from war that are morally injurious.

Again, it’s just something that we need to be aware of because that’s a burden that we put on the kids that go to war.

Q: Wouldn’t it be a fairer statement to say that politicians place soldiers in war situations, not the public?

A: In the days after 9/11, there were two or three days of debate in Congress about how to respond. Everybody who got up to give a speech basically said, “We’ve got to go over there and kill the people who did this. We’ve got to respond. We’ve got to retaliate.” A lot of “let’s go to war” talk.

One person stood up and said, “We should go to war, but we’re going to create a new generation of veterans. And we have to commit ourselves now to take care of them.” Then when wounded veterans started coming back, the VA was not prepared to take care of them.

People actually do have a voice. This is a democracy, and when there’s talk of going to war or expanding the wars that we’re in, you can have your voice heard through your representative. If enough people do that, then you’re not just one person standing up; it would be a bunch of people standing up.

I think it’s important that we not give up and cede to the politicians the power to send people into combat. We’re ultimately the ones who are responsible. We must understand what the costs are and make that known. It doesn’t mean don’t ever go to war. I’m not saying that at all. I’m saying, “Go to war in the knowledge of what’s going to happen.”

Q: Any other issues you’ll be touching upon in the lecture?

A: There’s a lot of talk about sending robots and drones into combat, this feeling that we’re moving away from the era of sending people into combat.

I’ve been hearing this for 20 to 30 years, and ultimately it always ends up that we send young Americans into bad places to do difficult things.

We are still sending people into combat. And this is still a very live subject, and we need to pay attention to it.

And it’s not just people on the ground. I’ve spoken to Air Force people who tell me they are morally injured by dropping bombs on people. There are also people at Dover Air Force Base [in Delaware] who’ve never left the state and might have been exposed to moral injury because they handle the remains of the people who have been killed in combat and have to come through Dover.

Well, taking care of those remains is an honorable job, and it’s also extremely difficult. Moral injury is not just confined to people who are engaged in combat or are looking into the eyes of the people they are killing. It goes way beyond that. It’s a big deal, and people should know about it.