When combat stress comes home

There are roughly 2.5 million men and women in United States Armed Forces and National Guard. Each of them must take an oath to support and defend the Constitution of the United States.

U.S. Navy photo by Mass Communication Specialist 3rd Class Kleynia R. McKnight via Wikimedia Commons

In a courtroom or a legislative chamber, “defense” of the Constitution takes the form of argument and analysis; but for the men and women of the armed forces, “defense” requires a confrontation with mortal danger and, as we are increasingly discovering, the real possibility of debilitating psychological injury brought on by what they do as much as by what is done to them.

Even in our sophisticated age, mental health professionals struggle with what to call the condition that results from perpetrating, witnessing, or failing to stop actions that violate a person’s deeply held beliefs about acceptable behavior. This type of stress often develops in connection with the killing of civilians during wartime (either intentionally or by mistake) mass killings beyond any bounds of necessity, killing (or torturing) of prisoners without justification, and failure to prevent the death of comrades.

To some military leaders, the preferred term is “inner conflict” because it focuses on the subject as a psychological matter but avoids any implication of immoral conduct. Mental health professionals tend to use the term “moral injury” because it is evocative and reflects the gravity of the conduct and the deep wounding of the individual based on a moral violation. Yet whichever definition applies, all Americans need to understand and appreciate the gravity of the problem, especially since it is the result of conduct undertaken in defense of our constitutional freedoms.

Recently two significant studies conducted jointly by the San Francisco VA Medical Center and the Department of Psychiatry at the University of California, San Francisco, have produced support for the theory that killing has a significant impact not only in producing psychiatric disorders like PTSD and depression, but in causing suicidal thinking and the desire for self-harm. There is special significance to the increasing awareness of this concept. In the words of the researchers, “prevailing models of posttraumatic stress have focused primarily on the experience and aftermath of severe deprivation, victimization, and personal life-threat, all of which can be experienced by soldiers in a war zone.” But that is only what you might call the “passive” experience of combat — what soldiers, in a sense “receive” from their situation.  The studies show that it is just as important to understand the injury brought about by the “active” or “willful” combat experience – what soldiers do or do not do in the course of battle that may well leave them with this sense of “inner conflict” or “moral injury.”

All Americans need to understand and appreciate the gravity of the problem, especially since it is the result of conduct undertaken in defense of our constitutional freedoms.

The results of these studies should have serious implications for political and military leaders who attempt to justify the killing that soldiers are called on to do in combat situations. Whereas the risks of combat are well known and are intertwined with timeworn concepts of “courage,” “sacrifice,” and “patriotism,” the picture of soldiers emerging from battle suffering from PTSD, depression and suicidal thinking because of what they did or failed to do produces no such images. In fact, historically, such expression has been dismissed out of hand as cowardice.

The first study, published in 2009, examined veterans’ experience in situations involving killing as well as the relationship between killing and various mental health and functioning problems after returning to civilian life. The second study, published this year, carried the research to a different level. It looked at veterans of Operation Iraqi Freedom (OIF) by adding the component of suicidal thinking and the desire for self-harm to the relationship of killing in combat and mental health symptoms. While already noting that suicide rates among veterans of OIF and OEF (Operation Enduring Freedom) have escalated during these wars, the researchers found that suicide risk is even greater for veterans with mental health disorders including PTSD, depression, and alcohol abuse. In 2008, suicides among active-duty soldiers climbed to the highest point in 28 years, surpassing the rates among civilians with similar demographics.

Finally, it is important that our criminal justice system consider the implications of these studies with respect to understanding violent criminal behavior by veterans after they return home from combat. The simple answer is that we do not yet know what role combat stress plays as an inducement to criminal violence.  Still, this much has to be considered: while the researchers envision their findings as being important in developing better methods of evaluation and treatment of newly returned service members, they should also become required reading for political and military decision-makers who commit young men and women to battle.

Barry R. Schaller, a retired Justice of the Connecticut Supreme Court and a Clinical Visiting Lecturer at the Yale Law School, is the author of the forthcoming Veterans on Trial, to be published in the spring of 2012.

Comments

comments

Comments

  1. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  2. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  3. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  4. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  5. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  6. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

  7. says

    In any war, there are victims and there are survivors, and there are those that will take advantage of them. PTSD is real and it is a problem, it is from the way that we have had to incorporate intolerable things into our daily lives and had no other choice at times other than to do so, but it is also a big problem when we are forced or coerced to do so against our own will and better judgement. The actors that think they know it all and have not been there, actually know very little, one can’t read about it and understand it, they have to have a shared experience to understand any of it at all, it is so different for each and every person. We will not all have the same exact experiences or situations to deal with. PTSD is from the memories of those things that have touched our souls and those that we can not just forget, they have affected our decissions forever forward for the good and the bad of it, and life stressors that keep adding on to the stress from the initial experiences, but we should not have to talk about it or be drugged because of it. Most of the drug use or alcohol use we have done is to try to forget that which is intolerable to remember, which is the only true way that we can put it in the past is by being allowed to remember on our terms and in our own ways and at our own times, when we are ready to deal with it. There are things that will trigger us all the time, or make us remember what is in our subconscious minds, but that should be our right when or if we are ready and with whom we choose and want to share it with or not, and our right to explain or not explain it however we want to. Those that call themselves professionals often act more unprofessional than many that have PTSD, because they are actually the ones with the lack of insight other wise they wouldn’t treat survivors the way they do and they wouldn’t be mistreating them either. I actually feel like I understand the meaning of young inexperienced punk now, but it can also be those which are much older too, and they have no right to abuse the victims of whatever type of trauma/drama that they have sufferred, they have no right to take advantage of others memories or pain in such ways as they do, nor to push them over the edge for their very own benefit, just to say that they have fixed them. We have a right to our own life and memories all the good and the bad ones too, we have a right to believe in our own spirits and if any our own forms of spirituality, who has a right to take that away from us? NO one. We can tell you how to give us the hope and assistance we really need most of the time, but only if you don’t try to do it your way, some times we have to do it our own and you have to go along with us and listen and do only what we ask and allow us the right to our own boundaries and dignity, if you want things to get better. Thanks

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