A COMPASSIONATE NUDGE

THE ANCIENT BUDDHIST PSYCHOLOGY AND PRACTICE OF DEPENDENT ORIGINATION AS A MEANS OF HEALING WAR-RELATED MORAL INJURY

King’s College of London Department of Defence Analysis Submitted in Partial Fulfilment of the Requirements for a Degree of Master of Fine Arts Word Count: 14982

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INTRODUCTION: WAR STRIPS YOU OF ALL...BELIEFS

War changes you, changes you. Strips you, strips you of all your beliefs, your religion, takes your dignity away, you become an animal.1 - Anonymous veteran

The notion of “moral injury” is neither new nor novel. Although the term only re-entered conversation over the past decade, the wound is intrinsic to all war, as the following accounts demonstrate:

Doug Anderson served as a U.S. Marine Corp corpsman in Vietnam. On his first day in country he knew that something was terribly wrong. A squad leader beat an old man for no reason other than being Vietnamese. His fellow Marines no longer cared what the war was about or why they were all fighting and dying. Anderson felt that there was no longer a noble cause or strategy, only survival. His first patrol was the beginning of his education. “An immense darkness opened under me” he said.2 “What I saw that day in these men was a kind of soul damage.”3

Chester Nez was a U.S. Marine Navajo Code Talker in the Second World War. After returning home he tried to return to his past self, but his “memories were not peaceful like those of [his] grandparents, father, siblings, and extended family.” 4 Nez later said, “The dead Japanese wouldn’t let me sleep or function normally. The quiet grew increasingly disturbing and unreal…all of the blood I walked through had stained my mind.”5

Stephane Greniér is a retired Canadian Army officer who served in the U.N. mission in Rwanda during the genocide in 1994.6 Over a 100-day period, an estimated 800,000

1 Jonathan Shay, Achilles in Vietnam (New York: Scribner, 2003), 83. Shay is a clinical psychiatrist who compared the experiences of veterans with descriptions of war and homecoming in Homer’s Iliad and Odyssey. 2 Doug Anderson, "Something Like a Soul," Massachusetts Review, February 2011, 32. Anderson has published three books of poems on war and one memoir. 3 Ibid. 4 Chester Nez, Code Talker (New York: Caliber, 2012), 17. After the war, Nez was a painter for twenty-five years at a V.A. hospital. In 2001 he received the Congressional Gold Medal. 5 Ibid. 6 William Nash, Introduction, in God Is Not Here (New York: Pegasus Books, 2015), 7. Nash is a psychiatrist, a retired Navy captain, and the current director of the U.S. Marine Corps’ mental health programs. He has

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Rwandans were slaughtered. Greniér had no choice but to stand aside, unable to stop the murder of innocent men, women and children. He struggled for the words to describe the anguish he felt for the deaths he could not prevent. Years later he could only say: "For those who understand, no explanation is necessary; for those who don’t, no explanation is possible.”7

Then there is Daniel Somers, an American who served in intelligence units in Baghdad and Mosul. Five years after returning home, Somers wrote a letter to his wife and then died from a self-inflicted gunshot wound to the head.8 In his heartbreaking last words, he asked his wife “How can I possibly go around like everyone else? There are some things that a person simply cannot come back from.”9

These accounts represent different generations, wars, nations and, most importantly, wartime experiences. What they all have in common, however, is that each finds different words to describe three enduring truths.10 First, that there are limits to human endurance. Second, that war pushes people to and beyond those limits. Third, that war does this by relentlessly attacking and, sometimes, utterly defeating very necessary and deeply held moral beliefs in warfighters. These truths – which are hard-learned in every war and too easily forgotten – are captured in the term “Moral Injury”, a controversial term which theorists and practitioners increasingly believe is the “enduring if hidden signature wound of…war.”11 And though this wound is more apparent in warfighters12, is it critically important to note that moral injuries can happen to anyone in any environment.13

The veteran Monisha Rios, for example, is a survivor of Military Sexual Trauma and strives to propel the conversation on Moral Injury beyond stereotypical, heterosexual, male combat

spent decades attending to the grief, and sharing in the suffering, of warfighters and their loved ones. His experiences and efforts has informed his pioneering research on Moral Injury. 7 Ibid. 8 Daniel Somer’s suicide note was first published at "I Am Sorry That It Has Come to This," Gawker, June 23, 2013. See also Steve Vogel, "After Veteran Daniel Somers's Suicide," The Washington Post, August 23, 2013. 9 Ibid. 10 Nash, Introduction, 15. These three truths are taken from Dr. Bill Nash’s Introduction to God Is Not Here. 11 David Wood, What Have We Done (New York: Little, Brown and Company, 2016), 10. 12 The U.S, U.K., Canadian, Australian, and New Zealand Armed Forces have been at war since late 2001. Eighteen years of operational deployments have increased the opportunities for researchers to collect empirical data on war’s psychological impacts. Additionally, society has become less equipped - and less willing - to meaningfully prepare for, and then engage with, war’s moral corruption. For these two reasons, moral injuries are more apparent (and perhaps more prevalent) in warfighters. 13 Monisha Rios, "The Glue Is Still Drying," in War and Moral Injury, ed. Robert Meagher and Douglas Pryer (Eugene, OR: Cascade Books, 2018), 83.

3 narratives.14 Another example is Project Trauma Support, a new Canadian initiative that addresses Moral Injury in First Responders (e.g. firefighters, paramedics, and emergency room doctors).15 Though these various accounts show that moral injuries can occur in diverse environments, result from a variety of difficult situations, and happen to many demographics, the notions behind this wound are less clear and little understood which drives several key questions.

How can ‘morality’ be attacked? How do defeated moral beliefs result in injury? How can moral wounds so negatively affect a person’s well-being and why is this wound so resistant to healing? One possible answer is that all moral choices have a ‘weight’. In war, however, this weight can become a burden that literally injures. Timothy Kudo, a former U.S. Marine, hints of this weight when he said “It’s not the sights, sounds, adrenaline, and carnage of war that linger. It’s…the responsibility…for the lives of others and the consequences of…our actions.”16 Thomas Gibbons-Neff, however, is more explicit about how the weight of moral choices may impact a person’s well-being.

Gibbons-Neff, a journalist and a former U.S. Marine, recounts the story of Jeff, a friend who shot an Afghan child who picked up a Kalashnikov.17 Jeff later described “the way the kid fell and how he wasn't sure he'd done the right thing.”18 Five years after Jeff made the decision to kill, he put a shotgun in his mouth but did not pull the trigger. Instead, Jeff just sat on his bed “staring at…his life he could no longer understand.”19 Jeff told Gibbons-Neff "I'm not crazy" and Gibbons-Neff knew he wasn’t:

Ten years ago we would have just called it post-traumatic stress disorder. Sixty years ago, it would have been combat fatigue. And in the shell-raked trenches of the Western Front, it would have been shell shock. But Jeff's dead kid was none of those things. Jeff's weight [emphasis added] was something else.20

14 Ibid. 15 SJ Dentry et al., "Addressing Moral Injury in First Responders," Mental Health in Family Medicine, 13. 16 Nancy Sherman, The Untold War (New York: Norton, 2011), 1. 17 Thomas Gibbons-Neff, "Why Distinguishing a Moral Injury from PTSD Is Important," Stars and Stripes, March 2015. Gibbons-Neff deployed twice to Afghanistan. 18 Ibid. 19 Ibid. 20 Ibid.

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What was the weight that Jeff felt, about which Gibbons-Neff writes? One possible answer is that this weight is the felt experience of the moral emotions of guilt and shame, two of the many emotions that are central to warfighter experiences.21 Research shows, however, that it is shame, rather than guilt, that is the more difficult affective issue.22 Shame is one important reason why warfighters may disengage cognitively or emotionally from a painful memory, in order to deny, avoid, suppress or become numb to it.23 Shame is why warfighters often suffer alone, and in silence. Shame is, therefore, one reason why moral injuries are often so resistant to long-term healing. There is, fortunately, an ancient Buddhist psychology and practice that may provide warfighters with a path to ease suffering and which may encourage long-term healing. This ancient practice and psychology is termed Dependent Origination.

A review of extant scholarship shows that the therapeutic benefits of Dependent Origination to relieve the suffering connected to moral injuries may be unexplored. This thesis attempts to correct this gap. The first half lays the groundwork for an exploration of the concept of Moral Injury. First, the core moral-self is established and shown to be vulnerable to injury. Shattered Assumption Theory is then used to explain how our core moral-selves can be damaged in war. Next, the lineage of moral injuries, and the diverse resilience and cleansing rituals, is examined. Moral Injury is then introduced and the progression of our understanding of this concept is explored. Shame is then established as the most difficult affective issue that increases suffering and impedes long-term recovery. Lastly, Dependent Origination is introduced, and a “compassionate nudge” is proposed and argued, as an alternative approach for experiential learning and cognitive reorganization. It is hoped that a “Compassionate Nudge” provides sufferers, loved ones and caregivers with an alternative path toward long- term healing and improved well-being.24

21 Guilt and shame are explored in “The Moral Emotions” beginning page 20. 22 Ibid. 23 William Nash, "Combat/Operational Stress Adaptations and Injuries," in Combat Stress Injury, ed. William Nash and Charles Figley (Routledge, 2015), 37. 24 A “compassionate nudge” builds a bridge between theory to new therapy, and offers the morally injured, and all who are concerned with their well-being, a different approach to reconstructing a shattered moral identity. It is hoped that this approach encourages us to focus more on treating the symptoms of Moral Injury and less on pathologizing a warfighter’s moral anguish.

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THE SHATTERING OF THE CORE SELF: I CAME HOME WITH MY VALUES... DESTROYED

I came home from Vietnam shorn of all that I had previously believed in, my old values system destroyed forever.25 - Stephan Malecek

In his pioneering work The Descent of Man, Charles Darwin concluded that “of all the differences between man and the lower animals the moral sense or conscience is by far the most important.”26 Michael Tomasello, who has studied the human conscience for over 30 years, stated that “it is our morality that defines us as a species.”27 After decades of research, Steven Pinker claimed that our “morality is…close to our conception of the meaning of life. Moral goodness is what gives each of us the sense that we are worthy human beings.”28

It is, therefore, our deeply ingrained sense of right and wrong that makes us unique; our conscience separates us from every other animal. This distinctiveness conveys our humanity and is the source of our fundamental dignity. This is our identity. Our identity, however, is a set of normative thoughts about ourselves. When we remove the normative we are left with a set of meaningless thoughts about ourselves to which we feel no particular attachment. In more simple words, a person’s identity can be shattered, and the investigations of Gitta Sereny support and make apparent the implications of this claim.

Sereny, an investigative journalist, spent decades trying to understand the nature of evil. Her search revealed that the core moral-self is brittle, that our goodness is vulnerable to injury. She claimed, therefore, that “If morality is extinguished there is no human being left.”29 For

25 Stephan Malecek, "The Moral Inversion of War," in War and Moral Injury: A Reader, ed. Robert Meagher and Douglas Pryer (Cascade Books, 2018), 38. Malecek was a Psychology Specialist in Vietnam. His books include “Crazy Tales of Combat Psychiatry” and “Unwitting Witnesses.” 26 Charles Darwin, The Descent of Man: And Selection in Relation to Sex (New York: A.L. Burt, 1874), 67. 27 Michael Tomasello, A Natural History of Human Morality (Harvard University Press, 2016), 208. Tomasello is an American developmental and comparative psychologist and the co-director of Max Planck Institute for Evolutionary Anthropology. He is considered one of today's most authoritative developmental and comparative psychologists. 28 Steven Pinker, "The Moral Instinct," (The New York Times, 2008), 34. Pinker is the Johnstone Family Professor in the Department of Psychology at Harvard University, and is known for his advocacy of evolutionary psychology and the computational theory of mind. 29 Gitta Sereny, Into That Darkness (Pimlico, 1995), 23. Sereny was an Austrian-British biographer, historian, and investigative journalist who was awarded the Duff Cooper Prize and the James Tait Black Memorial Prize for her book on Albert Speer in 1995, and the Stig Dagerman Prize in 2002. She was appointed a Commander of the Order of the British Empire in 2004 for services to journalism.

6 millennia, warfighters have experienced, first-hand, what Sereny recently uncovered: that war can erase the self.30 Nearly 2,500 years ago, Sophocles, one of three ancient Greek tragedians, composed theatre about this wisdom.31

In the classic tale of “Ajax”, Tecmessa, the wife of Ajax, appealed to her husband’s comrades to intervene in his psychological downward spiral. Tecmessa spoke directly to the consequences of Ajax’s moral anguish when she implored: “…our fierce hero sits…in his tent, glazed over, gazing into oblivion. He has the thousand-yard stare.”32 Tecmessa ultimately failed to save Ajax, for the hero takes his own life. The wife of a U.S. Navy SEAL, Marshele Waddell, recently expressed a hauntingly similar thought as Tecmessa: “Each time my husband returned to me in body, and for that I thank God. But to this day, in his soul a war still rages.”33

What Tecmessa and Waddell are telling us – and what the words and stories of countless other warfighters remind us – is that war not only attacks the core self but these attacks can be immensely harmful, if not fatal.34 Consider the words of Chaplain David Peters:

I'm…terribly ashamed of my enthusiasm for the war, for the way I encouraged young women and men to die over there, for blessing a war with my words and presence…Pride and shame flash on the

30 Some researchers and practitioners believe that war, by its very nature, wounds the core moral-self and that this injury affects (in differing degrees) nearly every warrior. Our understanding, therefore, should be as equally diverse. This discussion, consequently, attempts to juxtapose diverse views and lexicons from philosophers, clinicians, journalists, religious leaders, poets, academics, authors, Native Americans, Zen Masters, politicians, theologians, alternative-medicine practitioners, government agencies, peace activists, and warfighters and their kin. Meagher and Pryer in “War and Moral Injury,” 2, explain the importance of diverse understandings by pointing to the anthropologist Levi-Straus. After decades of searching for one true version of a myth, Levi-Straus concluded that the greater truth could be found in the sum of all the versions of a myth. 31 A story may also be a form of myth. Myths help us understand the history of a phenomenon or of a culture. The scholar, writer, and teacher Joseph Campbell, who wrote “The Power of Myth,” believes that “myths are the themes and symbols of ancient narratives that continue to bring meaning to birth, death, love, and war.” Myths illuminate the commonality of human experience across time, and this can be healing. 32 "In Ancient Dramas, Vital Words For Today's Warriors," NPR, 2008. According to the interviewer, “The Greek playwright Sophocles wrote about warriors suffering from the emotional stresses of battle. Scholars believe his plays were performed to help veterans heal.” In this reinterpretation of “Ajax”, the playwright uses a translation that resonates with a modern military audience. For a more literal translation see Sophocles, Ajax, trans. Ian Johnston (Richer Resources, 2010), 11: "For now our master Ajax…lies suffering from tempestuous disease." 33 Ibid. 34 Somers, I Am Sorry That It Has Come to This. Ibid. Somers also wrote about his crushing guilt and shame. His story is often cited as PTSD. His words, however, also speak to Moral Injury. For suicide rates among veterans, see "Office of Public and Intergovernmental Affairs," September 01, 2016.

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screen of my mind during the day and in the night…The fear at the bottom of all this is that I am not good.35

When Chaplain Peters returned home, he tried not to think about his anguish. He was shattered, and he said that that shattering became “normal and familiar. Ten years later, I began to examine my deployment and my homecoming. I…began asking questions of my former, shattered self.”36 There is, fortunately, research that helps answer his questions.

William Nash summarized this research when he explained that certain beliefs act as the “glue” that holds together the core self, and the violent contradiction of these beliefs by one or more overwhelming life event can negatively impact a person’s emotional, psychological, and spiritual well-being.37 This premise began with research on bereavement conducted by Colin Parkes in the 1960s.38 Decades later, in “Shattered Assumptions,” Ronnie Janoff-Bulman, who built on Parkes’ research, explained that we form undeclared and implicit beliefs about the world, and ourselves, and these beliefs give meaning to our existence and are the source for our well-being.39 Brewin and colleagues then proposed five core beliefs, and how an overwhelming life event can shatter one (or a combination) of these beliefs, and how this shattering may be traumatic. These core beliefs are that “the world is benevolent, the world is meaningful, the world is predictable, the assumption of invulnerability, and the self is worthy".40

Described more simply, Shattered Assumption Theory asserts that “we need to believe that the world is a good place; that we, ourselves, are good; and that our lives make sense somehow, that they are not just random chaos.”41 These core beliefs – the moral reasoning derived through the process of human evolution, and then learned through parenting and society – can be shattered by an overwhelming experience.42

35 David Peters, "Sin Eater," in War and Moral Injury, ed. Robert Meagher and Douglas Pryer (Eugene, OR: Cascade Books, 2018), 249. 36 Ibid. 37 Nash, Introduction,8. 38 C. M. Parkes, "Psycho-social Transitions," Social Science & Medicine., 1971. 39 Ronnie Janoff-Bulman, Shattered Assumptions (Free Press, 1992), 5. 40 Chris Brewin and Emily Holmes, "Psychological Theories of Posttraumatic Stress Disorder," Clinical Psychology Review 23/3 (2003): 340. 41 Nash, Introduction, 8. 42 Jonathan Haidt, The Righteous Mind (New York: Vintage Books, 2013). Haidt’s influential Moral Foundation Theory claims that “all individuals possess ‘intuitive ethics’, stemming from the process of human evolution as responses to adaptive challenges.” These intuitive ethics are “Care/Harm, Fairness/Cheating, Loyalty/Betrayal, Authority/Subversion, and Sanctity/Degradation.”

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Looking back over Chaplain Peters’ experiences and resulting self-condemnation, Shattered Assumptions Theory helps us appreciate the source – and consequences - of his moral anguish more clearly: When a transgression is of sufficient perceived magnitude “it can be evaluated as a threat to the integrity of one’s internal moral schema” leading to a crisis of conscience.”43 More consequently, this self-evaluation can have such a profound impact on one’s conscience that the event is not only damaging, it is so destructive that the world becomes no longer decent and meaningful, and the self becomes unworthy. The philosopher Nancy Sherman described this differently.

A wartime experience, she claimed, “…is able to destroy a soldier’s deeply held personal beliefs about right and wrong. It can disrupt an individual’s confidence about his or her own moral behaviour or others’ capacity to behave in a just and ethical manner.”44 An experience, therefore, can result in the “felt experience of damage to one’s moral compass that irreparably changes self-identity.”45 Truly understanding, however, requires empathizing with the felt experience, which can be challenging if not impossible. It is possible, though, to use the power of the mind’s eye.

Imagine, therefore, how drastically different your life would be if you didn't wake up each and every morning secure in the very necessary beliefs that you hold about yourself and the world.46 Imagine if, instantly, an overwhelming experience proved that you were not a good person, that the world was not a good place, and that your life no longer made sense. It is difficult to imagine this different reality, and for probably everyone, this degree of empathy is impossible without the touchstone of like experience. Therefore, it must be taken on faith: Lose your grip on even one of these very necessary beliefs and living can feel like purgatory.47

Though we are only now re-opening our eyes to how wartime moral experiences impact a person’s psyche, and how these experiences can cause immense suffering, we are able to see the shadows of these truths throughout recorded human history.

43 Eileen Dombo, et al., "The Trauma of Moral Injury," Journal of Religion & Spirituality, 32, no. 3 (2013): 201. 44 "The Untold Cost of Moral Injuries in War," ABC News, April 24, 2013. 45 Dombo et al. The Trauma of Moral Injury, Ibid. 46 Nash, Introduction, 8. 47 Bill Edmonds, God Is Not Here, 4.

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LINEAGE AND EVOLVING UNDERSTANDING OF MORAL INJURY: IT SHOULD BREAK YOUR HEART…TO KILL

It should make you shake and sweat, nightmare you, strand you in a desert of irrevocable desolation, the consequences seared into the vein, no matter what adrenaline feeds the muscle its courage, no matter what god shines down on you, no matter what crackling pain and anger you carry in your fists, my friend, it should break your heart to kill.48 - Brian Turner

Martha Nussbaum, a philosopher at the University of Chicago, claimed that our characters, once formed, are changeable and unstable. Our goodness, consequently, is frail and vulnerable to corruption through hardship and misfortune.49 This insight is consistent with 5,600 years of written human history and ancient observation.50 One of the most vivid descriptions of the lineage of moral injury comes from Robert Meagher and Douglas Pryer:

We see it [moral injury] in the ‘mark of Cain’ borne by the first fratricide, when he was banished in shame. We hear it in the lament of Sophokles’ boy-warrior Neoptolemos, who learns the hard way, the only way, that ‘All is disgust when one leaves his own nature and does things that misfit it.’ We recognize it too in the elaborate system of penances imposed on Christian warriors in the Middle Ages,

48 Brian Turner, "Sadiq," in Here, Bullet (Bloodaxe, 2011). 56. Turner is a U.S. veteran of Operation Iraq Freedom who turned his wartime experiences into prize-winning verse. 49 Martha Nussbaum, The Fragility of Goodness Luck and Ethics in Greek Tragedy and Philosophy (Cambridge: Cambridge Univ. Press, 2011), 382. Nussbaum’s research confronts “the ethical dilemma that very moral individuals are nevertheless vulnerable to external factors that may deeply compromise or even negate their humanity.” 50 James Hillman, A Terrible Love of War (New York: Penguin, 2005), 17. Hillman is a psychologist who examines the essence of war, its psychological origins and inhuman behaviours. He states: “during the course of 5,600 years of recorded history, 14,600 wars have been fought. Two to three wars for every year of recorded human history”. He then asks: “Is war abnormal? I find it normal in that it is with us every day and never seems to go away.”

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recompense for every life taken in battle, no matter how valiant the warrior or how just (even holy) the Church declared his cause to be. We witness it too in the refusal of so many RAF bomber crews to take Communion before their life-taking missions over Germany and occupied Europe, despite the odds against their safe return. We read it today in heartrending notes left behind by honored veterans who have found the burden of life after war too heavy to bear for even one more day.51

The harshness of war, and the fragility of our moral identity, can also be read in the Navajo creation story:

When the Two Brothers returned to the Mountain Around Which Moving Was Done, they became weak, sick, and thinner. Even after the Holy People sang and prayed over them, they still lost weight. The Holy People talked it over and decided that they had killed too much and had gone where earth people should not go. After they moved to Navaho Mountain, the Holy People gave the brothers the ritual Where the Two Came to Their Father and they were cured. Then, after four prayers in four directions, they made the Painting of the Twelve Holy People which gave the brothers a personal blessing. The Two Brothers then became healthy again.52

In this parable, the Holy People understood that the Two Brothers’ heroism had come at a terrible price. Put simply, the Two Brothers had killed too many times and had gone where “earth people should not go”. Similar to the Greek warrior Neoptolemos, the Two Brothers had also left their own nature and had done things that misfit it, and their well-being was the consequence. The solution was “to remove the brothers from society, and take them to a sacred place” so they could let go of their experiences.53 Only then could the brothers go on with their lives.54

51 Robert Meagher and Douglas Pryer, eds., War and Moral Injury (Cascade Books, 2018), 12. This work gathers perspectives on Moral Injury from experts in the fields of theology, psychology, psychiatry, philosophy, law, neuropsychiatry, journalism, poetry classics, and the profession of arms. 52 Michael Oakes and Jonathon Campbell, When the Two Came to Their Father (Princeton University Press, 1988), 52. For additional information see Brock and Lettini, Soul Repair, (Beacon Press, 2013), 51. This work explains how a warrior’s experience threatens physical, emotional, and spiritual health, and that ceremonies counterbalance these experiences. 53 Ibid. 54 David Kopacz and Joseph Rael, Walking the Medicine Wheel: Healing Trauma & PTSD (Pointer Oak, 2016), 126. Kopacz, a psychiatrist who works with veterans, and Rael, a Native American healer, believe that the process of seeing and hearing experiences in story reinforces a warfighter’s sense of identify and this is healing.

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A continent away from the Navaho, the Greeks spoke about war’s inherent corruptibility, of the “miasma” which is the “moral pollution or defilement which arises from participation in war.”55 Like the prayers and ceremony for the Two Brothers, Greek priestesses were purging their returning citizens.56 Similar to the Navaho, the Greeks held that a social ritual was required to cleanse the moral defilement attached to war, a process they called “katharsis”.57

The rituals for cleansing, however, need not be complex. Consider the following conversation taken from the Hidatha investigation.58 A U.S. Marine Sergeant Major (SGM) and the investigator are going over the process of talking to a young Marine who kills a child:59

SGM: [speaking to investigator]. We had [fire] fights [where Marines shot at] homes inside of Fallujah and found females inside the homes, not a lot of children obviously…I mean, throughout the time in five months in Al Qarma, I had Marines shoot children in cars and had to deal with the Marines individually one on one about it because they have a hard time dealing with that. The thing I would always ask them was, you know, [did the person they kill] cross the trigger line [the point where a person poses an existential threat]? Marine (responding]: “Sergeant Major, I thought it was, this, this, this.” [his rationale for shooting]. SGM: “Did you use EOF [escalation of force].” Marine: “Yes. But the deal with it was [the] child was still dead.” SGM: “Did you know the child was in the backseat?” Marine: “No, Sergeant Major.” SGM: “Would you have shot in that direction?” [if you had known about the child] Marine: “No, Sergeant Major.” SGM: “I hate to [say it] but there it is. I don’t see that as your fault at that time.” SGM [now speaking to the investigator]: “[The Marine] is going to have to live with that for the rest of his life and that is a hard thing...” 60

55 William Nash and Brett Litz, ‘Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members,’ Clinical Child and Family Psychology Review 16/4 (2013): 368. 56 Bernard Verkamp, The Moral Treatment of Returning Warriors (University of Scranton Press, 2006),124. Verkamp argues that “soldiers returning from war have always exhibited signs of psychological and emotional distress”, and that we could learn from religiously grounded practices. 57 Ibid. 58 “Haditha” refers to when U.S. Marines killed 24 unarmed Iraqi civilians on November 19, 2005. See Douglas A. Pryer, "How to Avoid Future Hadithas," Cicero Magazine,2017. The author discusses the intersection between this massacre and Moral Injury. 59 "Selected Testimony From the Haditha Investigation," The NY Times, Dec 24,2011. 60 Ibid.

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As the previous section illustrates, there are various rituals (or techniques) for cleansing, for lessening the moral burdens of war; from RAF bomber crew communions, to Navaho ceremonies, to the above discussion between a SGM and a young Marine where a respected authority figure shares in the responsibility of a moral choice and thus lessens a young warfighter’s moral suffering. These rituals can be intricate or simple, but they all are powerful; they offer a degree of absolution, pardon, and forgiveness, and they are opportunities for communities to shoulder responsibility and, thereby, decrease the weight of moral burdens. Consider another painful memory from an anonymous U.S. Special Forces soldier who did not accept – or who was not offered – a cleansing ritual:

A kid ran out in front of us and threw a grenade. This was a kid. Not a man, a kid…he raised his arm to throw another one, and me and my gunner, we cut the kid in two. He was just a kid, but he was trying to get us and we had to take him out. But it still stays with me.61

In the above description, what is notable is that the soldier does not talk about being afraid for his life. Instead, what “stays” with him is something else: “what still stays with him” is the memory of a shattered belief. There are, however, diverse views on the impacts of violated ideals, and these understandings have evolved relatively quickly and substantially over the last two decades. The clearest marker for the reentry of this knowledge is when a former psychiatrist for the V.A., Jonathan Shay, provided perceptive insights in the seminal work “Achilles in Vietnam.”62

Two decades before the above anonymous soldier described his moral pain, Shay made a hypothesis: After working closely with Vietnam veterans, he came to believe that his client’s problems were not exclusively fear based; fear being required for a diagnosis of PTSD.63 Shay

61 William Schumacher, Moral Injury and Suicidal Ideation after Military Service, PhD diss., University of Oregon, 2017, 1. 62 Shay, Achilles in Vietnam, 20. He states: “…I’ve come to strongly believe through my work with Vietnam Veterans…that moral injury is an essential part of any combat trauma that leads to lifelong psychology injury.” Though Shay didn’t coin the term in this work, he did bring it into popular use. According to Lorenzo York, the term moral injury was first used 300 years ago by the Anglican Bishop Butler. See "Moral Injury and Moral Healing: A Practical Theologian’s Perspective," Journal of Health and Human Experience, 1, no. 2(2015). 63 David Wood, "Moral Injury: The Grunts," The Huffington Post, March 18, 2014, 1. Wood is a Pulitzer Prize winning journalist who covers veterans struggling with the moral ambiguities of war. He states: “Moral injury is not officially recognized by the [US] Defense Department. But it is Moral Injury, not PTSD that is increasingly acknowledged as the signature wound of this generation of veterans.” For a discussion on the similarities and differences between Moral Injury and PTSD (and the dangers of conflation) see Andrea Ellner, "Moral Injury: A British Perspective," New America, November 2017, 34. In this essay, Ellner

13 believed that instead of overwhelming fear, it was war’s subversion of character that most impacted his patient’s psychological well-being. Shay made it his life’s work to understand this distinction. Ultimately, he concluded his patients’ suffering was “moral injury”, which he believed is a “soldier’s intense psychological conflict…from the betrayal of ‘what’s right’”.64

In 2011 Shay offered a more precise description: Moral Injury results “when (1) there has been a betrayal of what's right (2) by someone who holds legitimate authority (3) in a high-stakes situation.”65 He claimed that “when all three conditions were present, Moral Injury was present and that our bodies coded it in much the same way it coded a physical attack.”66 A recent empirical study by the Israeli Defense Force supported Shay’s clinical observations. This research showed that 20 percent of reservists who “served in the occupied territories had moral objections to their orders, and that their moral objections had significant implications on their psychological and organic well-being.”67

In “Recovering Lost Goodness”, Nancy Sherman touched on the impacts of these “moral objections” by recounting the story of Jeffrey Hall, who she says “found himself...inadequately supported and unclear of the cause or mission.”68 “You have to understand” said Hall, “My PTSD had everything to do with moral injury. It was not from killing, or seeing bodies severed or blown up. It was from betrayal, from moral betrayal.”69

Recently, researchers expanded Moral Injury to more than just the betrayal of ‘what’s right’ by a commander or another legitimate authority. Brett Litz explained that this broader conceptualization was due, in part, to research on the psychological cost of moral choices. They stated that “throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerrilla wars amplify these challenges.”70

concludes that “Some of [Moral Injury] manifestations...may overlap with PTSD. There is, however, value in distinguishing it from PTSD.” Michael Freidman, the former Director of the U.S. National Center for PTSD states: “I really think that we are beginning to recognize that sweeping everything under one PTSD rug may be more than one rug can cover, or should cover.” 64 Jonathan Shay, Odysseus in America, (Scribner, 2010), 240. 65 Jonathan Shay, "Casualties," Daedalus, July 01, 2011, 183. 66 Ibid. 67 Gilad Ritov and Zion Barnetz, "The Interrelationships between Moral Attitudes, Posttraumatic Stress Disorder Symptoms and Mixed Lateral Preference in Israeli Reserve Combat Troops," International Journal of Social Psychiatry 60, no. 6 (2013): 608. 68 Nancy Sherman, "Recovering Lost Goodness,” Psychoanalytic Psychology 31, no. 2 (2014): 218. 69 Ibid. 70 Brett Litz et al., 2009, 697.

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Many service members may mistakenly take the life of a civilian they believed to be an insurgent, be directly responsible for the death of enemy combatants, unexpectedly see dead bodies or human remains, or see ill/wounded women and children who they are unable to help.71

Put differently, in war, the enemy often uses the innocent – men, women and children – as both camouflage and prey. Many choices and actions, therefore, to stop the enemy from killing may hurt the very people you are dedicated to protect.

Acknowledging these moral challenges and, therefore, the increased likelihood of moral transgressions, Litz offered the most widely accepted definition of Moral Injury:

The lasting psychological, biological, spiritual, behavioural, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.72

Drescher and colleagues provided a more accessible understanding. Moral Injury, they claimed, is the “Disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner.”73 Moral Injury, they continued, is “brought about by bearing witness to perceived immoral acts, failure to stop such actions, or perpetration of immoral acts, in particular actions that are inhumane, cruel, depraved, or violent, bringing about pain, suffering, or death of others.”74

Building on this expanding conversation, Nash and Litz later provided a more concise understanding, that Moral Injury is “The psychological trauma through violation of deeply held moral beliefs.”75 Nash then gave an impassioned explanation: “moral injury is not some form of damage to beliefs as ideas, themselves, nor is moral injury merely the loss of faith or trust in any particular belief or expectation. Moral Injury is what happens when a basically good person is made responsible for bringing goodness out of an impossibly bad situation.”76 Other

71 Ibid. 72 Ibid. 73 Kent Drescher et al., "An Exploration of the Viability and Usefulness of the Construct of Moral Injury in War Veterans.," Traumatology 17/1 (2011): 9. 74 Ibid. 75 Nash and Litz, "Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members,"365. 76 Nash, Introduction,8.

15 practitioners speaking from personal experiences have also contributed to this evolving conversation.

Douglas Pryer, a retired US Army lieutenant colonel and veteran of Iraq and Afghanistan, tells how the sound of gunfire, engines backfiring, and fireworks distress him. But then asked: “Was I traumatized by enemy fire? No, at least not deeply…My most significant combat experiences are sewn together with a thread other than extreme, life-threatening violence. This thread is moral dissonance.”77

Peter Fromm, a retired U.S. Army officer who taught English, philosophy, and ethics at the U.S. Military Academy, West Point, said his “Moral Injury came from the visceral aftereffects of moral dissonance [which] crippled me as an adult trying to make my way in a conflicted profession.78

Tyler Boudreau, a former Marine Corp officer and author of “Packing Inferno”, asked “about the times when the searches I led were not so benign, about the orders I gave, from time to time, to use a heavy hand…about the patrols I dispatched that returned to base with young Marines in body bags. What about the approval I issued to snipers over the radio one night to shoot a man armed only with a shovel?” 79 Boudreau said Moral Injury is about “the damage done to our moral fiber when transgressions occur by our hands, through our orders, or with our connivance. When we accept these transgressions, however pragmatically (for survival, for instance), we sacrifice a piece of our moral integrity. That's what Moral Injury is all about.”80

These accounts demonstrate diverse understandings about Moral Injury, and how our understanding has evolved. The notions behind the injury, however, are timeless: Moral Injury results when the self, when other people, or when the world, do not live up to a person’s deeply held ideals. When these ideals are contradicted, the cognitive dissonance can be so profound that it literally changes how a person thinks and feels. For some, the experience is as if some vital portion of the core self was stolen, as if their goodness were ripped away.

Military professionals unconsciously refer to the forces that can result in Moral Injury when they use the euphemism “hard decision-making”. When using this common phrase, they

77 Pryer, What We Don't Talk About When We Talk About War,63. 78 Thomas Ricks, "Hazing vs. Leadership," Foreign Policy, August 31,2012. 79 Tyler Boudreau, "The Morally Injured," ed. Robert Meagher and Douglas Pryer, in War and Moral Injury: A Reader (Cascade Books, 2018),49. 80 Ibid.

16 unconsciously acknowledge a truth that many would prefer remain implicit: that war requires a person to make difficult moral choices, these choices result in death and suffering (too often to innocent men, women and children), and these experiences are emotionally and spiritually agonizing.

Sometimes these experiences are so painful, so cognitively dissonant, that they result in the loss of normal functioning. In other words: war is a moral minefield, and every step – every choice – can feel like dying a little death.

Our understanding of Moral Injury, however, is incomplete if we only consider the social rituals, or the many different views on conditions and causes for this injury. To fully appreciate the enormity of this wound, one must also explore the many adverse symptoms and outcomes.

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SYMPTOMS AND OUTCOMES: WHY SHOULD I WASTE MY BEAUTIFUL MIND... ON SOMETHING LIKE THAT?

…why should we hear about body bags, and deaths, and how many? I mean, it's, it's not relevant. So, why should I waste my beautiful mind on something like that?81 - Barbara Bush

Father Sean Levine is an Army Chaplain and war veteran who believes “We need to stop telling our warriors they have nothing to be ashamed of and start listening to their shame, their guilt, their loss, their inner emptiness.”82 Father Levine claims “We do not listen to such tales because they threaten our illusions and assault our easy-won comfort, but we should listen, and in listening, we should help carry, own, share, and grieve rather than deny the burdens of war.”83 The tragic story of Noah Pierce is proof of Father Levine’s wisdom.

As a young U.S. soldier, Noah accidently crushed an Iraqi child under his Bradley Fighting Vehicle.84 Written on the back of his first letter home were the words “War is horrible”.85 Noah continued:

We came in and invaded this country and murdered a lot of innocent people. So tell me how we are heroes. Hopefully, I will be able to forget most of it someday, but I doubt it.86

Noah’s mother said that her son “couldn’t forgive himself for some of the things he did” and that the kind of wound Noah had “kills you from the inside out.”87 Noah’s journal from Iraq ended with these final words: “I am a bad person.”88 In 2007 Noah took his own life. Noah’s

81 "Barbara Bush 'Beautiful Mind' Quote," September 14, 2008. Shortly before her husband ordered U.S forces to invade Iraq, the former first lady made this remark on national television. 82 Sean Levine, "Legal War, Sin, and “Moral Injury” in the Age of Modern Warfare," in War and Moral Injury, ed. Meagher and Pryer (Eugene, OR: Cascade Books,2018), 225. Levine serves as a Chaplain on active duty, and has deployed twice to Iraq and twice to Afghanistan. 83 Ibid. 84 Ashley Gilbertson et al., "The Life and Lonely Death of Noah Pierce," VQR Online. For additional information on Noah’s story and moral injury, see Robert Meagher, Killing From the Inside Out (Cascade Books, 2014), 4. Meagher, a theologian, believes that war’s profound invisible wounds are due, in part, to our “unthinking and all-but-universal acceptance of Just War Doctrine.” 85 Ibid. 86 Ibid. 87 Ibid. 88 Ibid.

18 step-father later said that “It’s kind of like the devil followed him home and wouldn’t let him be.”89 Meagher explained Noah’s anguish this way: “It’s titanic pain that these men live with. They don’t feel that they can get that across, in part because they feel they deserve it, and in part because they don’t feel people will understand it.”90

What is it then that “kills from the inside out”? What causes so much suffering? What is it that stalked Noah home and killed him? The research of David Anderson, a neurobiologist at Caltech who studies the connection between the brain's circuitry and how we feel, provided a possible answer to Noah’s stepfather’s implied question: the “devil” was emotion; emotion follows the warfighter home and does not let them go. “Our perceptions, our decision-making, our actions, our planning – everything” says Anderson “is affected by emotion. Emotion is absolutely central to understanding everything that happens in our brain.”91

From this perspective, moral injuries are an emotional injury, and the intense emotions from a warfighter’s shattered beliefs can impact everything – their decision-making, their planning, their perceptions, and their actions. Understanding how this is possible begins at an unlikely location: with research that used hypothetical thought experiments to study the effects of cognitive dissonance.

Researchers commonly use hypothetical scenarios to study how human beings handle moral dilemmas. In 1969, Lawrence Kolberg studied the stages of moral reasoning by asking children when it is morally acceptable to steal.92 Almost twenty years later, Judith Thomson built on Kolberg’s research by extensively analysing the Trolley Problem to “examine the role of biology in moral decision-making.”93 This thought experiment asked participants if they would kill a pedestrian by pushing them off of a footbridge if that pedestrian’s death would later save five lives. This and other similar thought experiments were designed to create moral dilemmas, deliberately pitting strong moral beliefs against one another. This is Cognitive Dissonance, which Elliot Aronson explained “is the state of having inconsistent thoughts, beliefs, or attitudes, especially as relating to behavioural decisions and attitude changes.”94

89 "Wartorn 1861-2010", Home Box Office,2010. 90 Gilbertson,Ibid. 91 "What Can Fruit Flies Tell Us About Human Emotions?" NPR, November 06, 2015. Anderson directs the David Anderson Research Group at Caltech. 92 Lawrence Kohlberg, "Stage and Sequence: The Cognitive-developmental Approach to Socialization," ed. David A. Goslin, in Handbook of Socialization Theory and Research (Chicago: Rand McNally,1969). 93 Judith Jarvis. Rights, Restitution, and Risk: Essays in Moral Theory (Cambridge, MA: Harvard University Press,1986). 94 Elliot Aronson, "The Theory of Cognitive Dissonance," Advances in Experimental Social Psychology, Volume 4,1969.

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The purpose of thought experiment research is to artificially create cognitive dissonance and self-doubt in the participants, and to then examine the psychological consequences.95 Jacob Farnsworth tells us, however, that cognitive dissonance – moral dilemmas and their psychological impacts – are neither abstract nor hypothetical for warfighters.96

In order to better understand the effects of real-world cognitive dissonance, Kent Drescher asked religious leaders, mental health officials, and military leaders what they believed were the symptoms and outcomes of Moral Injury.97 Their responses were compiled: social and behavioural problems, psychological problems, self-deprecation, spiritual and existential issues, and trust issues:

The social and behavioural problems possibly connected with moral injury were social withdrawal, alienation, aggression, misconduct, and sociopathy. Possible spiritual and existential symptoms included loss of trust in morality, loss of meaning, loss of religious faith, and fatalism. Possible psychological symptoms included anger, anxiety, depression, and…the characteristic self-deprecating emotions and cognitions thought to be associated with moral injury included feeling damaged, self-loathing, guilt and shame.98

According to other researchers, the last two emotions, those of guilt and shame, have until recently received only marginal attention in trauma literature.99 Guilt and shame, however, are absolutely central to a warfighter’s experiences. “Given that shame and guilt are both negative responses to transgressions, it is no surprise that colloquially the two terms are often used interchangeably and the two emotions are often experienced simultaneously.”100 These two emotions, however, are neither synonymous nor similar, and examining these distinctions sheds light on why shame, rather than guilt, is why Moral Injury is so harmful to a person’s well-being.

95 Joshua Greene, "Cognitive Neuroscience and the Structure of the Moral Mind," ed. Peter Carruthers et al., in The Innate Mind Structure and Contents (Oxford University Press, 2005), 338. Greene is an experimental psychologist, neuroscientist, and philosopher at Harvard University. 96 Jacob Farnsworth et al., "The Role of Moral Emotions in Military Trauma," Review of General Psychology 18/4 (2014):249. 97 Drescher et al., An exploration of the viability and usefulness of the construct of moral injury in war veterans,11. 98 Ibid. 99 Maria Steenkamp et al., "How Best to Treat Deployment-Related Guilt and Shame,”Cognitive and Behavioral Practice,20/4 (2013):471. 100 Sana Sheikh and Ronnie Janoff-Bulman, "The “should” and “should Nots” of Moral Emotions," Personality and Social Psychology Bulletin 36 (2010):213.

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THE MORAL EMOTIONS: SHAME IS A SOUL EATING… EMOTION

Shame is a soul-eating emotion. Shame is one of the scars of trauma.101 - Carl Jung

According to Jonathon Haidt, guilt and shame are moral emotions, a type of emotion that is related to and results from a moral event.102 When a warfighter feels guilt for a moral transgression, they feel the behavior was bad.103 Ivan Urlic explained, however, that shame results in the belief that you have let yourself down, the anguish of judging yourself, and then finding yourself wanting.104 A Jungian researcher explained the distinctions this way:

Guilt comes from violating a rule or standard, committing an offense, a trespass. Guilt is about what we do; it motivates confession, it deserves punishment, and it is relieved by restitution and forgiveness. Shame is something deeper. It is about who we are; it motivates concealment, it deserves dismemberment, there is no restitution.105

This research clarifies the distinctions between the felt causes of guilt and shame. The research of June Tangney, however, examined a warfighter’s different felt responses to these emotions. What she claimed is that the emotion of guilt is “associated with beneficial actions including confessions, apologies, and undoing the consequences of the behaviour.”106 Guilt has the potential to motivate the warfighter to take corrective action and to atone for past transgressions, and because such amends can result in some good being accomplished, the original feelings of guilt can often be reduced. “On the whole, empirical evidence evaluating the action tendencies of people experiencing shame and guilt suggests that guilt promotes constructive, proactive pursuits, whereas shame promotes defensiveness, interpersonal separation, and distance.”107

101 Claude-Helene Mayer, "Shame: A Soul Feeding Emotion," 2017,277. 102 Jonathan Haidt, "The Moral Emotions," in Handbook of Affective Sciences (Oxford Univ. Press, 2009),855. 103 Dombo et al., The Trauma of Moral Injury,201. 104 Ivan Urlic, "Working Through Shame in Groups for Victims of Trauma and War," International Journal of Group Psychotherapy, 59/2 (2009):171. 105 Sean Fitzpatrick, "Shame," Reflections on Psychology, Culture, Life, October 2013,4. 106 June Tangney, et al., "Moral Emotions and Moral Behavoirs," National Institute of Health, 2007,350. 107 Ibid.

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While both guilt and shame then are associated with negative internal attributions and destructive responses, shame results in more intractable responses.108 One of the most harmful consequences of shame is that “care-providers may not hear about moral injury because service members' or veterans' shame and concern about adverse impact or repercussions (e.g., being shunned, rejected, misunderstood) prevent disclosures.”109 The reason is that, because a warfighter believes they should and will be shunned by the world, “shame elicits a desire to escape and hide.”110 Other researchers described this more viscerally; “shame often prompt[s] people to…essentially want to sink into the floor and disappear.”111

Regardless of being true or not, shame leaves the warfighter increasingly isolated. Isolation leads to an increase in chronic stable internal and global attributions (e.g., long-term, unchanging, self-directed and all-consuming negative judgments), which then causes withdrawal and behavioral inhibition, leading to further isolation.112 Consequently, many “[morally injured] manage mostly out of sight and on their own.”113

For some warfighters, healing Moral Injury takes seconds, the time it takes to shift attention to another enemy. For others, healing can take months if not years. For too many, however, the harmful cycle – moral transgression leads to shame, shame leads to isolation, isolation leads to increasingly chronic, stable, internal and global attributions, which lead to greater isolation – follows them to the grave.114

Understanding why moral injuries have such an outsized impact on a warfighter’s psyche, and so many adverse outcomes, begins with an examination of the unique nature of moral choices made during war.

108 William Nash, "Combat/Operational Stress Adaptations and Injuries," 37. 109 Ibid. 110 Ibid. 111 "Interview With June Tangney About Shame," interview by American Psychological Association, 2011. 112 Litz et al., Moral Injury and Moral Repair,704. 113 Wood, Moral Injury: The Grunts,2. 114 It is important to note that shame is not only toxic; shame may be evolutionary necessary and can be beneficial. Since shame impacts our sense of self-worth, it can motivate one to change those aspects about themselves which are the source of self-condemnation. Additionally, since shame, more than guilt, lingers for years, incentives to change linger as well. Shame may, therefore, motivate someone to embark not only on a difficult self-changing journey, but to use those painful experiences as incentive to bring about good in the present and future. From this perspective, morally injuries may have value.

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MORAL INJURIES ARE TIRELESS: I DON’T KNOW IF I’LL EVER HAVE… CLOSURE

It’s been hard over the years coming to terms with what actually happened over there. I don't know if I'll ever have closure.115 - Jonathon Millantz

Why exactly can a moral choice be so traumatic? Why are moral injuries so harmful to a warfighter’s wellbeing, even decades after the experience? Answering these questions begins with understanding the nature of morality and why moral choices in war have immense consequences.

Morals are “the personal and shared familial, cultural, societal, and legal rules for social behavior, either tacit or explicit…about how things should work and how one should behave in the world.”116 According to Hauke Heekeran, our moral “decision-making, the evaluation of the actions of another agent or our own actions made with respect to these norms and values, is…central to everyday social life.”117 Just or unjust, good or bad, right or wrong; these fundamental rules have enormous implications for our own wellbeing.118

When a person goes to war they enter into an environment where choices have grave consequences: war often tests and contradicts the norms and values that are central to the harmonious integrity of the mind, heart, and soul.119 The noted military ethicist Manuel Davenport commented about this alternate universe: “The military has a unique obligation to be constrained by moral integrity…precisely because of their state-granted powers of ultimate destruction”.120

Acting on a moral code during war, therefore, has outsized impacts, for in war, moral choices often have life and death consequences.121 When faced with a morally difficult decision (i.e. do

115 Josh Phillips, "Torturing Tortures the Soul," ed. Robert Meagher and Douglas Pryer, in War and Moral Injury (Eugene, OR: Cascade Books, 2018), 158 116 Litz, et al., Moral Injury and Moral Repair, 699. 117 Hauke Heekeren et al., "Influence of Bodily Harm on Neural Correlates,” NeuroImage 24, no. 3 (2005): 890. 118 David Cremer, "Ch 1: Psychology and Ethics," ed. David Cremer, in Psychological Perspectives on Ethical Behavior and Decision Making (Information Age Pub., 2009), 3. 119 Nash, Introduction, 6. 120 Megan Thompson, "Moral Injury in Military Operations," April 23, 2018, 2. 121 It is not only in war, however, that moral choices have life and death consequences, and which can result in moral injuries. Dr. Bill Neely was an emergency room doctor for over 30 years, and says that his career as an emergency room doctor was “filled with episodic 'missions' up to 50 hours long, which I

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I shoot or not), it is common for all choice options to fall along a continuum of wrong. Often every choice results in a negative consequence and these choices impact more than just the enemy. Frequently, a choice hurts and kills innocent men, women and children. Deciding not to choose is a choice too, and this choice often results in the most harm done.122 Then, when a decision is made, often in a split second, one has no choice but to touch, smell, hear, and see the life and death consequences of a decision. When these real, and forever, decisions are made the warfighter cannot just leave and go home. Instead they must try to sleep, wake up, and to repeat these same hard decisions, and because of this moral traumas can accumulate and have a cumulative effect. For many this cycle does not end when they return home with their invisible injuries. Instead, choices and the grave consequences, often repeat forever. It is noteworthy, however, that despite the outsized impacts of moral choices in war, the nature of morality is eternal.123

The future is unclear everywhere, at any time. Even the most careless, seemingly innocuous action in peacetime can, like the butterfly effect, have some devastating future effect on someone. In war, however, making a choice often has an immediately observable and grave consequence. “War morality”, then, is when the moral clarity felt during peacetime is a harder delusion to hold onto. When warfighters go off to war this delusion can instantly disappear.

When U.S. Marine Timothy Kudo came back from Afghanistan he faced the painful dissonance of “war morality” head-on. Kudo looked around at the civilian and was unconsciously angry for lost tribal membership and the bliss of his former moral clarity, and then furiously thought out- loud: “You have no idea what right and wrong are.”124 Another veteran described his loss differently:

always referred to as the trenches. I never knew what was coming, but I was in overload much of the time. There was death, a lot of trauma, people not at their best, and always decisions, many of which were moral in nature. The decisions had to be made fast, often with life and death consequences. Sometimes I had to hurt patients to help them. Often when I decided not to 'hurt' them with some procedure, I regretted it later. I was a good doctor but never perfect, never without regrets, and those regrets are burdens that stay with me.” William Neely, e-mail message to the author, May 20, 2018. 122 This assertion is based on the author’s own wartime observations and experiences. 123 Researchers and observers often comment that the moral “nature” of war has changed. The “nature” of war, however, is eternal and unchanging. Character, however, is changeable, and war can change moral character. 124 Timothy Kudo, "On War and Redemption," The NY Times, November 08,2011. When citizens become warfighters, and then return, they gained, and then often abruptly lost not only the delusion of moral clarity but their “membership” to a small group defined by loyalty, belonging, meaning, and clear purpose and understanding. They often lose their “Tribe” – something which often did not happen in past societies – and this loss is extremely dissonant, and may be a factor in the present epidemic of Moral Injury in warfighters. See Sebastian Junger, Tribe (Fourth Estate, 2017).

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I saw many different things that you really don't see in the U.S…Beheadings…people getting blown up. It wasn't until several people told me after getting back that I've changed.125

It is, hopefully, apparent that moral choices in war are emotionally, spiritually, behaviorally, and psychologically painful and harmful, but why does the hurt often never leave? The answer has to do with the nature of traumas, not just traumas that result in Moral Injury.

When a shattered belief is of sufficient perceived magnitude the warfighter moves into a crisis state.126 They think “how am I going to deal with this?” They create memories which carry intensely powerful emotions, feelings, and body sensations that they then associate with the morally traumatic experience.127 These memories intrude when they are both awake and asleep, and sometimes these invasions are continual.128

It is not, however, the injury itself that is crucial to understanding the cause, or causes, of Moral Injury. What is important, regardless of whether the injury is the result of one’s own actions or inactions, or those of others, is whether the warfighter can make sense of their shattered belief.129 In other words, can they create a causal explanation for a moral transgression? If they cannot, they may then spend an inordinate amount of energy trying to make sense of their overwhelming experience. If a causal narrative remains hidden, they may try to avoid the painful dissonance that occurs each time the memory intrudes. For many, the unanswered remains elusive and, therefore, the memories continue to overwhelm, to intervene when both awake and asleep, which begins a cycle of self-destructive responses.130 James Spira and colleagues explain: “When a combat veteran returns from the most intense experience of his life, those intense experiences continue to ‘play’ over and over in his mind.”131

When confronted by intrusive painful memories, most try to evade or deny the memories and feelings connected with Moral Injury. “Vivid images of traumatic experiences intrude,

125 Emily Baucum, "Local Doctors Make Medical Breakthrough in PTSD Treatment," Nov,2016. 126 For an overview of psychological trauma and mindfulness techniques to alleviate suffering, see Ronald Siegel, "The Science of Mindfulness," Overcoming, 2014,17. This description is based on this research. 127 Ibid. 128 Ibid. 129 Annabelle Bryan et al., "Moral Injury, Suicidal Ideation, and Suicide Attempts in a Military Sample.," Traumatology 20, no. 3 (2014): 5. 130 Siegel, The Science of Mindfulness, Ibid. 131 James Spira, et al., "Experiential Methods in the Treatment of Combat PTSD," in Combat Stress Injury, ed. Nash and Figley (Routledge, 2015),399.

25 unwanted, into dreams and conscious awareness and the individual struggles to avoid recall of these perpetually distressing memories.”132 They try to suppress these emotions. As noted previously, it is beneficial to block these emotions in order to face the immediate demands of a war.133 But indefinitely suppressing a painful memory will likely exacerbate harmful consequences.134 The reason is that avoiding and suppressing the memory of a shattered belief(s) deprives the warfighter of the benefits of experiential learning that provides cognitive reorganization.

There is extensive research that shows that denying or suppressing a painful emotion increases suffering, which then increases negative outcomes and consequences.135 “If a reaction is suppressed [the affect] stays attached to the memory”136 This observation from the founder of psychoanalysis, Sigmund Freud, reinforces this point:

It may therefore be said that the ideas which have become pathological have persisted with such freshness and affective strength because they have been denied the normal wearing-away processes by means of abreaction and reproduction in states of uninhibited association.137

Expressed differently, “Memories from war never just fade away. If left alone, they come alive to seep and reach through time with searching and grasping claws. Ignored, memories consume…”138 The psychologist and Zen master Ben Bobrow used this powerful axiom to say the same thing:

What we cannot hold, we cannot process. What we cannot process, we cannot transform. What we cannot transform, haunts us.139

132 Nash, Combat/Operational Stress Adaptations and Injuries,52. 133 Siegel, The Science of Mindfulness, Ibid. 134 Nash, Introduction, 17-18. 135 Bessel Van Der Kolk, "Posttraumatic Stress Disorder and the Nature of Trauma," US NIH, 2000. 136 Ibid,8. 137 Sigmund Freud, "On the Psychical Mechanism of Hysterical Phenomena: A Lecture (1893)," PsycEXTRA Dataset, 1971. 138 Bill Edmonds, "God Is Not Here," in War and Moral Injury, ed. Robert Meagher and Douglas Pryer (Eugene, OR: Cascade Books, 2018), Ch. 12. 139 Joseph Bobrow, "Waking Up From War, Part 2," The Huffington Post, November 11,2016.

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As this saying infers, ‘when we bury our feelings, we bury them alive,’ and warfighters often ‘bury’ their painful memories connected with a Moral Injury.140 They are trained to numb, distract, and suppress – to ‘just get over it’ or ‘suck-it up’, to ‘just move on’.141 These external messages are often a barrage, but the three adaptive responses to a physical difficulty help us to better understand our instinctual cognitive responses to a painful memory: “(1) to change oneself to accommodate to the challenge faced, (2) to neutralize or eliminate the challenge, or (3) if neither of the first two tactics are possible, to disengage cognitively or emotionally from the source of the stress, in order to become numb to it.”142

Unfortunately, the latter adaptive response, “to disengage cognitively or emotionally from the source of the stress, in order to become numb to it”, is too often the natural reaction to the violation of a deeply held ideal. Often, this is a way to escape the intense pain of the moral emotion of shame, and the messages a warfighter receives is that their emotional pain is a bad thing, that they should distract, suppress, deny, or even medicate it. They should run from it.143 For many, they have learned that if they can just stop feeling bad they will by definition start feeling good.144 The research of psychologist John Briere, however, shows that this is not how the mind works.145

“The way the mind actually works is a ‘pain paradox’, and the implications are significant”.146 If a warfigher can more directly experience their emotional pain (as will be later argued, through the Buddhist practice and psychology of Dependent Origination) they may find a way to actually be with their emotionally painful memories. They will then experience less distress over time. According to John Briere and Catherine Scott:

The approaches that encourage awareness of one’s ongoing experience, that allow access to non-overwhelming amounts of painful memory, and that encourage growing insight into the basis for ongoing suffering, will be helpful – whereas medications that only numb or mask

140 Susan Pollak, Sitting Together (Guilford, 2016), 25. 141 Callie Brockman et al., "Relationship of Service Members Deployment Trauma and PTSD Symptoms," Journal of Family Psychology 30/1 (2016): pg. 52-62. See also Briere and Scott, Principles of Trauma Therapy. 142 Nash, Information Gating,4. 143 Jamie Reno, ""Medicating Our Troops Into Oblivion": Prescription Drugs Said To Be Endangering U.S. Soldiers," International Business Times, April 21,2014. 144 Siegel, The Science of Mindfulness, Ibid. 145 Briere and Scott, Principles of Trauma Therapy, Ch.4 146 Ibid.

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unwanted emotional states, or therapies that distract, focus merely on support, or even teach avoidance, may be less efficacious.147

So, by ‘holding onto’ emotional pain, the warfighter can “integrate their perceptions, feelings, and thoughts at the moment of traumatic injuries with the rest of their identities.”148 Consequently, their memories or feelings need not invade their consciousness.149 This research shows that when a person experiences emotional pain, they should directly feel the non-overwhelming painful memories and to re-think the painful thoughts. This is especially true with regards to a Moral Injury, for when a person’s beliefs are violently contradicted and then shattered, the painful memories work tirelessly to consume attention, to cause the warfighter to isolate, deny, suppress, withdraw, and to become numb to it, which then prevents them from “being with” their painful memories, the very memories that they need to put in their past.

It is essential then to find a way to view the events that shattered a belief, the associated body sensations and the attached emotions that arise and pass in the moment, as impersonal. Practicing “being with” painful emotions and feelings decreases the memory’s capacity to harm. The less disturbing memory then requires less avoidance, which then increases “repeated and prolonged engagement, revisiting, and processing of the trauma memory.”150 Based on the research of Robert Siegel, a virtuous cycle can then be created that eventually helps the warfighter to integrate their painful memories.151 This helps a warfighter develop ‘metacognitive awareness’, which is to see their ‘thoughts as mere thoughts’.152 Or, as John Teasdale claimed, the person develops a “cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self.”153

This is also referred to as therapeutic change; “reactivating old memories; engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts.”154

147 Ibid. 104 148 Nash, Combat/Operational Stress Adaptations and Injuries, 52. 149 Ibid. 150 Lori Zoellner et al., "Teaching Trauma-focused Exposure Therapy for PTSD," Psychological Trauma: Theory, Research, Practice, and Policy 3/3 (2011): 1. 151 Siegel, The Science of Mindfulness, 17. 152 Ibid. 153 John Teasdale et al., "Metacognitive Awareness and Prevention of Relapse in Depression," Journal of Consulting and Clinical Psychology 70/2 (2002). 154 Lane et al., Memory Reconsolidation, Emotional Arousal, and the Process of Change, 1.

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As the warfighter begins to practice experiential learning that provides a cognitive reorganization, they may begin to see their painful memories as mere ‘words’ and ‘images.155 Eventually, “instead of seeing these intrusions as data about reality” the warfighter “may come to interpret painful memories as ‘movies about the past’, at which point their perceived acuity and overwhelming nature may diminish, requiring less emotional regulation and need for avoidance strategies.”156 There is, however, an important factor that determines the degree a warfighter is able to practice therapeutic change: the perceived first-order cause of a shattered belief.

Extensive research shows, conclusively, that the source of the distress can affect the severity of the trauma: was the event natural or man-made, and was it non-intentional or intentional?157 How a warfighter answers these questions will determine the degree they are able to practice therapeutic change.158 This is the conclusion of researchers who studied 2,537 peer-reviewed articles: it is more difficult to integrate human-caused and intentional trauma then trauma that results from natural disasters.159 It is even more difficult to “hold onto”, to process, and to then transform painful memories, if the morally injured is also the perpetrator. Simply put, if a person blames themselves, those memories may be even more painful and longer lasting.160

When a traumatic event is natural and non-intentional, however, there is no one else to blame, and the emotional painful experience is not a personal event. The trauma is experienced as impersonal, which usually affected a wide number of people. This, however, is likely not the case in moral injuries. Moral Injuries are often caused by humans, and often the actions were intentional and malevolent. The intensity and pervasiveness of Moral Injury, then, is in the nature of the warfighter’s causal explanation (their narrative), and in Moral Injuries, the injured and perpetrator is often one and the same. Charuvastra and Cloitre explained:

Exposure to human-generated traumatic events (typically interpersonal trauma) result in more toxic impact and distress than exposure to harm alone because human-generated events represent a breakdown of social norms in addition to diminished expectations of safety. 161

155 Ian Evans, "What Is Therapeutic Change?" How and Why People Change, 2012 156 Briere and Scott, Principles of Trauma Therapy, 224. 157 Patcho Santiago et al., "A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations," PLoS ONE 8/4 (2013). 158 Ibid. 159 Ibid. 160 See McNair, 2002; Maguen et al., 2010. 161 Litz et al., Moral Injury and Moral Repair, 699.

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Therefore, when the “altered beliefs about the world and the self becomes deeper and more global, an individual with Moral Injury may begin to view him or herself as immoral, irredeemable, and un-reparable or believe that he or she lives in an immoral world.”162 Consequently, they withdraw. Moral injuries are, therefore, especially resistant to integration and long-term healing.

Zachary Moon, an assistant professor of theology at Chicago Theological Seminary, explained the converse: “The first step toward recovery [from a Moral Injury] is accessing the memories and being able to tell the story enough times that the person experiencing moral injury can gain perspective on their experience.”163

This discussion, therefore, drives us to ask several fundamental questions: “Is it possible to alter one’s perspective of a morally traumatic experience? Can a person shift their viewpoint to such a degree that the painful memories of a human-generated event can instead become impersonal? If such a shift in perspective were possible there would be less shame and, therefore, less need to avoid or deny – to escape – those memories. If this were possible, the morally injured could finally confront their greatest enemy, their painful memories. When this becomes possible, we could then revise the saying cited previously to the following:

What we can hold, we can process. What we can process, we can transform. And what we can transform, no longer haunts us.

Such a radical shift in perspective, however, is difficult. In fact, being able to confront the memory of Moral Injury is often so painful that the warfighter could benefit from a hand, a “compassionate nudge”: the ancient Buddhist practice and psychology of Dependent Origination.

162 Ibid. 698 163 Christine Scheller, "What Is Moral Injury?" The Center for Technology and Society, October 13, 2017.

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DEPENDENT ORIGINATION: THE STRUGGLE FOR AND AGAINST IS… THE MIND’S WORST DISEASE

If you want the truth to stand clear before you, never be for or against. The struggle between for and against is the mind's worst disease.164 - Seng-ts’an

Jonathon Haidt, the Harvard moral psychologist cited earlier, claims that after decades of research into morality, the above two stanzas contain “the deepest insights that have ever been attained in moral psychology.”165 These insights from Zen Master Seng-ts’an may also provide clues to healing Moral Injury.

One interpretation of Seng-ts’an’s saying is that our mind’s worst disease is judging…when we struggle for or against. Dependent Origination, however, allows the warfighter to stand separate from their existential battle. By viewing a morally traumatic experience through the lens of Dependent Origination166, we may see Moral Injury as less personal. When this becomes possible the warfighter may, once again, begin to view themselves or other people as moral, redeemable, and reparable. They may begin to believe, once again, that they live in a good world and that life makes sense. However, as noted previously, this shift in perspective – this creation of a new life-saving narrative – is immensely difficult. Before exploring the practice of “compassionate nudging,” therefore, it is necessary to learn what a “nudge” is and why it is necessary.

Richard Thaler, a behavioural economist, summarized his simple but powerful idea that won him the Nobel economics prize:167

If you want to encourage people to do something, make it easy. A Nudge…is any aspect of the choice architecture that alters people’s

164 Jonathan Haidt, The Righteous Mind (Vintage Books, 2013), xvii. See also Jonathan Haidt, "The Moral Roots of Liberals and Conservatives," TED, March 2008. 165 Ibid. 166 Dependent Origination is explored in detail beginning page 34. 167 Niklas Pollard, "We're All Human: 'Nudge' Theorist Thaler Wins Economics Nobel," Reuters, October 10, 2017. The noble award citation states: Thaler’s research “built a bridge between the economic and psychological analyses of individual decision-making.” It will be later argued that a “compassionate nudge” builds a similar bridge, between a painful memory of a Moral Injury and a new less emotionally painful reinterpretation of that experience.

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behaviour without forbidding any options or significantly changing their…incentives. 168

The importance of Nudge Theory is that it helps us understand how small changes in the words we use or the way we think can have an immense impact on outcomes. In the words of another expert, Nudge research has shown that:

Small changes in the environment can facilitate behaviors and decisions that are in people’s best interest. For example, a change in the way choices or requirements are framed may elicit greater self- control or increase the likelihood of making positive choices.169

So, yes, a Nudge – or, as will be later argued, ‘a compassionate nudge’ – may shift a warfighter’s choice architecture. But how could this small change improve well-being, even possibly, healing Moral Injury? Answering this begins with a discussion about the immense power of emotions, and how our emotions may not be what we think. For a better understanding about the power of emotion, consider the almost 400 year old story of a homesick Swiss student:

In the late 17th century, there was a dedicated student in the Swiss university town of Basel. This student suddenly stopped showing up to his lectures and his friends became worried. So they paid him a visit and found him feverish, having heart palpitations, and strange sores covered his body. The friends called a doctor who thought the illness was so serious that the local church prayed while the doctor prepared to return the dying student to his parent’s home 60 miles away. As the student began his trip, his breathing became less labored. As the stretcher reached the gates of the student’s hometown, he is nearly fully recovered, and that is when the doctor realized the student was suffering from a powerful form of homesickness. It was so powerful, in fact, that it nearly killed him. In 1688, the young doctor, Johannes Hofer, heard of this case and others like it and described the illness as “swiss homesickness” because of the frequent occurrence of similar symptoms in Swiss mercenaries who fought in France and Italy. In his dissertation, Hofer

168 Richard Thaler, Nudge: Improving Decisions about Health, Wealth, and Happiness (Penguin Books, 2009), 6. 169 Lashawn Richburg-Hayes, et al., “Behavioral Economics and Social Policy," U.S. Health and Human Services, 2014.

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coined the illness “nostalgia”, and the diagnosis resonated within European medical circles.

Almost 200 years after Nostalgia was first described in a doctor’s dissertation, soldiers were being diagnosed with Nostalgia in the American civil war. Though Nostalgia slowly vanished as a medical category, American armed forces recognized Nostalgia during the First and Second World Wars, and tremendous effort was made to study and understand this condition which so affected American warfighters.170 The last person to die from Nostalgia was an American soldier fighting in France in World War I.171

As this story demonstrates, emotions are powerful, and our numerous attempts over the next hundreds of years to describe emotion’s various impacts on the warrior’s psyche attest to emotion’s potency:

Nostalgia eventually becomes Soldier’s Heart or Irritable Heart during America’s Civil War, which then becomes Europe’s Railway Spine. During World War I we see Shell Shock and War Neurosis, which then becomes World War II’s Battle Fatigue or Combat Stress Reaction. In 1952, these change to Gross Stress Reaction which becomes an official diagnosis, which then changed to Adjustment Reaction to Adult Life. Then, after an exhaustive study of Vietnam Veterans, PTSD emerges from the emotional forest of war.172 Over time, the un-blinking eye on PTSD, and the ensuing continuous wars to find and kill terrorists and insurgentss, revealed that there so much more we do not understand: enter Moral Injury.

And yet, as mentioned earlier, emotions are not what we think: they are so powerful they can even kill. But, more importantly, is the research which shows we have more control over our powerful emotions than we may think.

Lisa Barrett, a psychologist and founder of the professional journal Emotion Review, studies emotions and her research confirmed: “It may feel to you like your emotions are hardwired and they just trigger and happen to you, but they don't.”173 It may feel as if killing a child caused such anguish that dying seemed preferable, but Barrett’s research showed that the never-

170 The Century of the Self, dir. Adam Curtis (BBC, 2002). 171 Tiffany Smith, "The History of Emotions" (TED Talk; Germany). Smith, the author of The Book of Human Emotions, is a researcher at Queen Mary University of London. 172 Michael Freidman, "History of PTSD in Veterans," National Center for PTSD, July 05, 2007. 173 Lisa Barrett, et al., Handbook of Emotions (New York: Guilford Press, 2018).

33 ending psychological pain may be only the brain’s guess about what our body sensations meant. This research, however, also showed we are not at the mercy of our painful emotions, for our brains create them: “Emotions are guesses that our brain constructs in the moment where billions of brain cells are working together to understand what our body sensations mean.”174 This research suggests that when we are morally injured, and when there is a deluge of overwhelming body sensations, our brain makes a leap, a guess at what these sensations may mean: “relief”, “self-disgust”, “excitement”, “guilt”, “anger”, “regret”, or, perhaps, “shame”?

But more importantly, Barrett’s research showed that we have more control over our brain’s guesses than we might imagine. In fact, each of us has the capacity to decrease suffering, and we can do this by learning how to guess differently or to later change a guess we already made. This may seem radical because “we all like to assume that if we feel something, it tells us something true about the world, something that happened to me.”175

But moral injuries do not happen to us; they are self-constructed.176 But this ground-breaking research does not mean that moral anguish is not real, or that suffering should not be recognized and relieved. Barrett’s research showed only that “the problem has much more to do with concepts in your head created by and based in our culture. And those aren't inevitable. Those can be changed.”177 We can, therefore, learn to construct – and re-construct – our emotions differently.

Our teacher is Dependent Origination, and the first lesson is that “shame” may due to inadequate information. In fact, the antecedent of shame, blame, may be misattributed. The burden of shame, then, could be shared more evenly. As noted previously, Dependent Origination is thought to be the “most fundamental metaphysical view of Buddhist thought and it is intimately linked to the Buddhist notion of causation.”178 This principle asserts that all phenomena occur because of other phenomena; nothing occurs independently of other factors. Based on this idea, “things and events come into existence only by the dependence on

174 Lisa Barrett, "You Aren't at the Mercy of Your Emotions -- Your Brain Creates Them," TED, December 2017. 175 Ibid. 176 Moral injuries can only happen to someone whose goodness – their strong sense of right and wrong, just and unjust, bad and good – is intrinsically interwoven with their core-self. Put more simply, only a self- described moral person can be morally injured. In some sense, therefore, when a person goes to war (however necessary, just, or fleeting), they “step out of their skin,” and Moral Injury is the conscience’s recompense. The key, then, is to allow the painful restitution to propel us forward and not downward. 177 Ibid. 178 Karma-glimpa, et al., Meditations on Living, Dying, and Loss (Viking, 2009), 6.

34 the aggregation of multiple causes and conditions.”179 According to a prominent Theravada Buddhist monk, human suffering is the result of a chain of causes: “all things arise from concrete conditions and sustaining causes, which, themselves, arise from other causes and conditions.”180 Put differently, “all events occur because of the effects of previous events: no event occurs independently or in isolation.”181

“This view accords with the basic principles of Western psychology: that people do things because of the influence of other things.”182 This principal finds voice when a warfighter utters the slang “shit happens.” When this occurs, as it often does, they are making a simple existential observation that life is full of unpredictable events. Consequently, an enlightened warfighter practicing Dependent Origination may voice a deep understanding about the most fundamental view of Buddhist psychology: “shit happens because other shit happened.” The implication is that the morally injured practicing Dependent Origination may come to realize that their conclusions of badness or unworthiness of self, others or the world, may be due to inadequate information.183

This perspective is based on ancient eastern insight, and this awareness is partly responsible for Western psychology’s recent radical transformation: that our relationship to emotional pain is a key factor in how much we suffer.184 How much we agonize, therefore, may depend largely on our attitude toward our anguish. For example, Cognitive Behaviour Therapy works to create a wide, genuine space for our experience, and this less avoidant relationship to our thoughts and feelings can ease suffering.185 Charles Popper, who is regarded as one of the 20th century's greatest philosophers of science, expressed this view with the saying: “thoughts are thoughts not facts’’.186

When looking through the lens of Dependent Origination we may more clearly see that our “thoughts are thoughts, not facts”. Or, by practicing this Buddhist psychology the warfighter may be better able to understand the “whys” of other people’s or their own choices. When this

179 Ibid. 180 Bhikkhu Bodhi, In the Buddha's Words (Boston, MA: Wisdom Publications, 2015), 47. 181 John Brier, "Mindfulness, Insight and Trauma Therapy," in Mindfulness and Psychotherapy, ed. Christopher Germer and Ronald Siegel (Guilford Press, 2016),221. 182 Ibid. 143. 183 Ibid. 184 Jon Kabat-Zinn, Full Catastrophe Living (Delacorte Press, 1990). Kabat-Zinn, the founder of the mindfulness movement, is a Professor at the University at Massachusetts Medical School. 185 Ibid. 186 Karl Popper, "Objective Knowledge," The Philosophical Review 84, no. 1 (1975). Popper’s research shows that truth exists independently of our conceptual scheme.

35 becomes possible, they open the door to forgiveness and, then, the healing of painful emotions becomes imaginable. We should, however, never underestimate – and always remember – the numerous painful emotions to overcome and, therefore, the obstacles to recovery.

It is vital, then, to find a way to gain this new perspective. The first step is for the warfighter to acknowledge their Moral Injury, and to then accept the helping-hand of a “compassionate nudge”.187

187 Shifting perspective – changing choice architecture to assist therapeutic change – may also be possible through LSD. For recent ground-breaking research see Michael Mithoefer et al., "3,4- methylenedioxymethamphetamine (MDMA)-assisted Psychotherapy for Post-traumatic Stress Disorder in Military Veterans, Firefighters, and Police Officers," The Lancet Psychiatry, 2018. Similar to this research, a “compassionate nudge” may encourage a change in choice architecture. See also Michael Pollen, "Fresh Air for May 15, 2018: Michael Pollan On The 'New Science' Of Psychedelics," digital image, NPR, May 15, 2018. For those who prefer (or need) a non-psychotropic approach, explore CBT, Adaptive Disclosure, Mindfulness-based stress reduction (MBSR), and even Alcoholics Anonymous (AA). Or, continue reading about a Compassionate Nudge. Returning to AA: Joe Brett, a Vietnam Veteran and the author of "A Personal Perspective: Damage and Recovery" believes that AA was taken from Buddhism, and that following the twelve steps healed his Moral Injury.

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CONCLUSION: WHAT YOU SEEK, YOU ALREADY… ARE

What you seek, you already are.188 - Deepak Chopra

When accepting a nudge, a warfighter must first find a safe, non-judgmental and compassionate space to open up to a painful memory: only then, can they gradually re- examine painful experiences without judgment.189 When revisiting the painful event, notice the responses of both the body and mind. While paying attention, remind yourself that “bad” feelings are useful, and these feelings are beneficial. Kabat-Zinn termed this as full catastrophe living: “The complete ‘owning’ and ‘inhabiting’ of each moment of your experience, good, bad, or ugly” which reduces emotional suffering.190 Premature closure191 or forgiveness192, however, is not the objective but purely about ‘embracing’ the pain, especially the moral emotion of shame, which is a perfectly reasonable human response to a shattered belief.

Next, simply explore the facts of the experience, about what exactly happened, and then review the conclusions we formed about ourselves, about others, or the world. The goal is to really see things as they are, including all of our judgmental and critical deductions.193 The focus has, so far, been on the relative truth, which Shakespeare in Hamlet summarized: "There is nothing either good or bad, but thinking makes it so."194

188 Deepak Chopra, The Book of Secrets (New York: Three Rivers Press, 2004), 47. 189 Dr. John Briere addresses the consequences of “premature” exposure and how timing is vitally important. The morally injured must be able to manage feelings before exploring them. As van der Kolk states: “Although traditional exposure therapy can be very helpful in overcoming traumatic intrusions, it needs to be applied with care. Some patients, on recalling their trauma, may become flooded with both the traumatic memories. Increased activation…may be associated with increased shame, guilt, aggression, and an increase in alcohol and drug use.” Briere identifies two versions of safety: physical safety and psychological safety, and latter is crucial when re-experiencing morally traumatic experiences. Therefore, it is essential that the injured be surrounded (literally and figuratively) by a safe, non-judgmental, and supportive environment of family, a therapist or, even more helpfully, friends or a veterans group who shares the touchstone of like experiences. 190 Kabat-Zinn, Full Catastrophe Living, xxxvii. For a superb overview, see Rob Grellman, "Processing Through Difficult Thoughts and Emotions." 191 Brett Litz et al., Adaptive Disclosure (New York: Guilford Press, 2017), 60-97. 192 Deniz Cerci, "Forgiveness in PTSD after Man-made Traumatic Events," Traumatology 24, no. 1 (2018). Cerci states: “…forgiveness can help…to overcome man-made traumatic experiences. Forgiving a transgression is different from pardoning, condoning, excusing and forgetting.” Forgiving is not even about another person. Research shows: forgiveness heals the forgiver. 193 Ibid. 194 William Shakespeare, Hamlet (Amazon Classics, 2017), Act 2, Scene 2.

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Next is absolute truth: “Can we step back and look at things not from a personal perspective but as impersonal factors and forces unfolding in the world?”195 When these facts are explored, we can then begin to re-examine the painful memories through the lens of Dependent Origination.196 Understanding how our perceptions are related to the degree of suffering, however, must begin with an examination of the western concept of blame, and even of good and evil.197

When does “evil” begin?198 If an infant pulls a trigger and kills their nearby sibling, we do not try and untangle their intentions. When this same child turns 4, we still do not judge them.199 When this child turns 8, we go back and forth on whether or not to explain the behavior as indicative of the child’s nature; should we consider their intentions malevolent, their actions a moral transgression? By the time the child becomes a teenager, it becomes easier to judge, to label the teenager as a bad person. When that child becomes a warfighter, it is very easy to judge and assign blame. Actually it feels instinctual to say “they’re evil” for an act of omission or commission that violated an ideal.200 It is, however, even easier to judge if the violator is yourself, to say “I’m evil”.

Our varied tendencies to judge and attribute malevolent intentions are directly linked to the western concept of evil.201 “Evil is predicated on the idea if we had the exact same genetics,

195 Siegel, The Science Of Mindfulness, Lecture 17. 196 At this point, an important tangent is necessary: Attention. Attention is our wilful ability to direct the brain’s resources. Attention is powerful, it effects perception, and it is a massive commodity, as the titans of marketing and social media will attest. The converse of attention, however, is spontaneous thought, which is generative and produces positive moods. Both attention and spontaneous thought are flip-sides of the same coin, are beneficial, but extremely toxic when practiced in extremes. There is extensive research that supports these observations. Based on this, one can view the painful memories of a Moral Injury as both all-consuming of attention and powerfully preventive of spontaneous thought, both of which are immensely harmful to a person’s well-being. For millennia, people have understood these principals and have, therefore, trained their minds to improve attention and focus, which can, counterintuitively promote spontaneous thought. This training – which is also referred to as ‘mindfulness’ – helps people to feel better, and western scientists are only now identifying the link between brain circuitry, meditation and mindfulness, attention and focus, spontaneous thought, and well-being. A body of research shows; meditation and mindfulness makes brain networks stronger which then make us happier and healthier. Therefore, when a warfighter “embraces” a Moral Injury – “focusing, noticing and engaging” – they are, logically, simply exercising. For a discussion that supports these conclusions, see Guy Raz, "Attention Please," in TED Radio Hour, NPR, May 25, 2018, May 25, 2018. 197 Philip Zimbardo, "The Psychology of Evil," TED, February 2008. 198 This thought experiment is modified from Siegel Science of Mindfulness, Lecture 17. 199 Ewan Palmer, "A 4-year-old Boy Has Shot a 7-month-old Baby in Texas," Newsweek, March 23, 2018 200 Mairi Levitt, "Perceptions of Nature and Nurture," Life Sciences, Society and Policy 9, no. 1 (2013). 201 Simon Baron-Cohen, "I Want to Banish Evil," New Scientist 210, no. 2807 (2011). Baron-Cohen, an expert in developmental psychopathology at Cambridge University is “…not satisfied with the term ‘evil’. We’ve inherited this word…but [this word isn’t] much of an explanation.”

38 and the exact same environmental history, we would somehow behave differently.”202 Yet, experts who try and explain a person’s behavior say that “our actions result from the interaction of genetics with the environment over the course of a lifetime.”203 To paraphrase the father of Western philosophy, Aristotle: “The idea of evil resides in the notion that people can freely choose to do things that they otherwise should not.” 204 Or, put more simply, “evil is thought to arise independently, operating as its own First Cause.”205

There are, however, other impersonal forces that influence choice. When we re-examine our own or other’s actions through the cognitive lens of the Buddha’s wisdom, we come to realize that something else is going on, that all our actions result from first order causes and conditions.206 With help from a ‘compassionate nudge’, a warfighter can begin to alter their choice architecture, making it easier for them to ask different questions about the nature of a shattered belief. Do the circumstances drive different conclusions? Are there alternative explanations for their experiences? Were there other reasons for why events happened – these are not justifications, just non-judgmental explanations – or were they or the other person really intrinsically evil?

Over time, compassionate nudging may lead to therapeutic change; “from seeing ourselves as having deserved or caused the event” that causes so much heartache, to seeing ourselves and the other person as acting under difficult forces or conditions.207 When we accept a “compassionate nudge” we may begin to see that our injury arose not only from susceptibilities, difficulties or adverse histories, but from war’s moral impossibilities.208 When this becomes possible, we may be capable of embracing a profound insight:

I can affect change by transforming the only thing that I ever had control of in the first place, which is myself.209

This is the very definition of compassion, and compassion for oneself and for others allows the warfighter to slowly reconstruct a new moral identity – to create a new life-saving narrative –

202 Siegel, Science of Mindfulness, Lecture 17. 203 Ibid. 204 Ibid. 143. Brier paraphrases Aristotle in Aristotle, The Basic Works of Aristotle, ed. Richard McKeon (Brantford, Ont.: Resource Services Library, 2009). 205 Ibid 206 Siegel, Science of Mindfulness, Ibid. 207 Siegel, Ibid. 208 Nash, Introduction, 7. As cited earlier, the “moral impossibility” is when “a good person is asked to bring goodness out of an impossibly bad situation.” 209 Chopra, The Book of Secrets, 28.

39 from the remains of a shattered core-self. Slowly, the world can, once again, become a good place. Gently, they can, once again, become a good person. Life can, once again, make sense.

With a “compassionate nudge” from the ancient Buddhist practice and psychology of Dependent Origination, the warfighter may learn to forgive, and according to Archbishop Desmund Tutu, only then can Moral Injury mend, for:

“Forgiveness is an absolute necessity for continued human existence.”210

210 Desmund Tutu, "Without Forgiveness There Is No Future" (Univ. of Wisconsin Press, 1998), xiii.

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