Warren Kinghorn is a friend of mine from my days at Duke and really an amazing human being. A first-rate psychiatrist, he also holds a Th.D. from Duke, where he also teaches.
Working for the Veterans Administration, Warren, like myself, is very much concerned with the effects of modern war on human beings. I missed it some days ago, but he had an op-ed in USA Today dealing with the PTSD produced not by suffering violence but inflicting it:
[The] assumption that trauma is something that happens only to soldiers obscures the truth: Many veterans suffer most not from what they received or witnessed in war, but from what they did. Psychologist Shira Maguen of the San Francisco VA Medical Center, for example, has documented that among veterans of the Iraq and Afghanistan wars, taking the life of another person is linked both to the severity of PTSD symptoms and to thoughts of suicide. Maguen and other VA researchers have recently used the term “moral injury” to describe suffering in which veterans encounter inner conflict due to combat-related transgression of core ethical and moral beliefs. Veterans can suffer deeply, in other words, not just from things that happened to them but from an inability to live with themselves knowing all that they have done to others.
The second common but misleading assumption about combat trauma, related to the first, is that post-combat suffering is at root a technical problem in need of a technical solution. Modern medicine encourages technical thinking. If I have pneumonia, I take an antibiotic. If I have a blocked coronary artery, I undergo a cardiac procedure. If I have PTSD, I take medication or a course of psychotherapy.
There are advantages to this understanding of traumatic suffering, but there are also problems. To see traumatic suffering, particularly moral injury, as a technical, medical problem can easily rob it of its moral significance. If I treat a veteran’s suffering as a technical problem to be medicated away, I can easily miss the fact that the person before me stands as testimony to the wars in which he or she fought. “Treating” veterans must not obscure the important moral stories that they have to tell. […]
Veterans need a civilian culture that refuses to distance itself from them either through reflexive condemnation or, more commonly, through reflexive valorization. Sometimes, they need communities that can offer the non-medical languages of confession, repentance and forgiveness. And above all, they need to be taken seriously as moral beings who have stood for us in hazy and complicated places and who now bear witness to what that commitment entails.