Os problemas mentais com que os veteranos de guerra se deparam quando regressam a casa – ou alguns anos depois – têm sido descritos, geralmente, como stress pós-traumático. No entanto, há um novo conceito medico que está a ser usado para descrever o que muitos sentem: lesões morais. Ou seja, a noção de que, em combate, violaram aquilo que a sua consciência diz que a fronteira entre o bem e o mal, com todos os sentimentos de culpa que daí advém. Nesta série de três partes, Moral Injury, o jornalista David Wood, do The Huffington Post aborda esta questão com o testemunho de ex-militares e o diagnóstico de especialistas.
Damned If They Kill, Damned If They Don’tMARCH 18, 2014
How do we begin to accept that Nick Rudolph, a thoughtful, sandy-haired Californian, was sent to war as a 22-year-old Marine and in a desperate gun battle outside Marjah, Afghanistan, found himself killing an Afghan boy? That when Nick came home, strangers thanked him for his service and politicians lauded him as a hero?
Can we imagine ourselves back on that awful day in the summer of 2010, in the hot firefight that went on for nine hours? Men frenzied with exhaustion and reckless exuberance, eyes and throats burning from dust and smoke, in a battle that erupted after Taliban insurgents castrated a young boy in the village, knowing his family would summon nearby Marines for help and the Marines would come, walking right into a deadly ambush.
Here’s Nick, pausing in a lull. He spots somebody darting around the corner of an adobe wall, firing assault rifle shots at him and his Marines. Nick raises his M-4 carbine. He sees the shooter is a child, maybe 13. With only a split second to decide, he squeezes the trigger and ends the boy’s life.
The body hits the ground. Now what?
“We just collected up that weapon and kept moving,” Nick explained. “Going from compound to compound, trying to find [the insurgents]. Eventually they hopped in a car and drove off into the desert.”
There is a long silence after Nick finishes the story. He’s lived with it for more than three years and the telling still catches in his throat. Eventually, he sighs. “He was just a kid. But I’m sorry, I’m trying not to get shot and I don’t want any of my brothers getting hurt, so when you are put in that kind of situation … it’s shitty that you have to, like … shoot him.
“You know it’s wrong. But … you have no choice.”
Almost 2 million men and women who served in Iraq or Afghanistan are flooding homeward, profoundly affected by war. Their experiences have been vivid. Dazzling in the ups, terrifying and depressing in the downs. The burning devotion of the small-unit brotherhood, the adrenaline rush of danger, the nagging fear and loneliness, the pride of service. The thrill of raw power, the brutal ecstasy of life on the edge. “It was,” said Nick, “the worst, best experience of my life.”
But the boy’s death haunts him, mired in the swamp of moral confusion and contradiction so familiar to returning veterans of the wars in Iraq and Afghanistan.
It is what experts are coming to identify as a moral injury: the pain that results from damage to a person’s moral foundation. In contrast to Post-Traumatic Stress Disorder, which springs from fear, moral injury is a violation of what each of us considers right or wrong. The diagnosis of PTSD has been defined and officially endorsed since 1980 by the mental health community, and those suffering from it have earned broad public sympathy and understanding. Moral injury is not officially recognized by the Defense Department. But it is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans: a bruise on the soul, akin to grief or sorrow, with lasting impact on the individuals and on their families.
Moral injury raises uncomfortable questions about what happens in war, the dark experiences that many veterans have always been reluctant to talk about. Are the young Americans who volunteer for military service prepared for the ethical ambiguity that lies ahead? Can they be hardened against moral injury? Should they be?
With widespread public impatience to move beyond the long war years, it’s easy to overlook the pain that endures among service members and their families. Experiences like those of Nick Rudolph and tens of thousands of others are theirs to bear. Many have found peace and acceptance: I did what I had to do, and I did it well and honorably. Others struggle to reconcile the people they have become with those innocent selves who jubilantly enlisted just a few years before. Either way, they manage mostly out of sight and on their own.
Yet a glimpse into their world also raises troubling questions for those of us outside the military – about wartime morality, about the accountability of those who encouraged or tolerated the decisions to go to war. What is the culpability of those who engineered the wars? Of those who approved the funding that enabled the fighting to go on, year after year? What of those who demanded the end of the draft in 1973 and its replacement with a professional fighting force? This “all-volunteer” military excused almost all Americans from service, while its relatively small numbers mean those who do serve must deploy again and again, and again.
As the broad moral injury of these wars is acknowledged, what is our part in the healing?
“Maybe people don’t want to talk about or know about what can happen to some of our sons and even some of our daughters when they go defend the country. It’s not politically correct. It’s not attractive,” said Michael Castellana, a psychotherapist who provides moral injury therapy at the U.S. Naval Medical Center in San Diego. “But it’s the truth.”
‘Bad Things Happen In War’
Until now, the most common wound of war was thought to be PTSD, an involuntary reaction to a remembered life-threatening fear. In combat, the physical response to fear and danger – hyper-alertness, the flush of adrenaline that energizes muscles – is necessary for survival. Back home, it can be triggered suddenly by crowds, noise, an argument – causing anxiety, anger, sleeplessness and depression. PTSD can be quickly diagnosed, and therapy at last is more widely available.
It is not fear but exposure that causes moral injury – an experience or set of experiences that can provoke mild or intense grief, shame and guilt. The symptoms are similar to PTSD: depression and anxiety, difficulty paying attention, an unwillingness to trust anyone except fellow combat veterans. But the morally injured feel sorrow and regret, too. Theirs are impact wounds caused by the collision of the ethical beliefs they carried to war and the ugly realities of conflict.
Most people enter military service “with the fundamental sense that they are good people and that they are doing this for good purposes, on the side of freedom and country and God,” said Dr. Wayne Jonas, a military physician for 24 years and president and CEO of the Samueli Institute, a non-profit health research organization. “But things happen in war that are irreconcilable with the idea of goodness and benevolence, creating real cognitive dissonance – ‘I’m a good person and yet I’ve done bad things.’” Most veterans with moral injury, he said, “self-treat or don’t treat it at all.”
A moral injury, researchers and psychologists are finding, can be as simple and profound as losing a loved comrade. Returning combat medics sometimes bear the guilt of failing to save someone badly wounded; veterans tell of the sense of betrayal when a buddy is hurt because of a poor decision made by those in charge.
The scenarios are endless: surviving a roadside blast that strikes your squad, but losing lives for which you felt responsible. Watching as your dead friends are loaded onto helos in body bags. Being wounded and medevaced yourself, then feeling burdened with guilt for leaving behind those you had sworn to protect. Seeing evil done and being unable, or unwilling, to intervene.
“An individual on a mission may at the end have questions about the morality of what went on, and most guys reconcile that fairly rapidly,” said Thomas S. Jones, a retired combat-decorated Marine major general. He is fiercely fond of young Marines and runs a retreat for the wounded,Semper Fi Odyssey, where he sees many cases of moral injury. He speaks with a parade-ground staccato, occasionally punctuating his thoughts with a concussive “Hell-fire!”
The majority of moral injury cases go much deeper, he said. “They’re more about survivor’s guilt, death of children, death of civilians, that are just part and parcel of combat action. We continue to see guys four, five years on, still struggling.
“This is experience talking! Hell-fire!”
Dr. James Bender, a former Army psychologist who spent a year in combat in Iraq with a cavalry brigade, saw many cases of moral injury among soldiers. Some, he said, “felt they didn’t perform the way they should. Bullets start flying and they duck and hide rather than returning fire – that happens a lot more than anyone cares to admit.” Bender found himself treating anxiety and depression among soldiers “doubting the mission, doubting the fundamental nature of who they are – pretty deep stuff.”
O trabalho completo, está aqui.