Military Moral Injury, Violence, and the Parable of the Guinea Worm

Yves here. With videos and photos of Israel’s torture and genocide providing sustained and horrifying evidence of the depth of human depravity, it is hard for written pieces to adequately convey the impact of violence, here on reluctant or conditioned perpetrators. The high suicide rate in the IDF says that even in maniacal Israel, there are many who can’t stomach carrying out their orders. The piece below describes the struggle of US vets, who have inflicted seemingly more routine harm on the US enemy of the day, and struggle with the psychological blowback. Many readers have recounted how World War II vets in their family, who could presumably take solace in fighting in an allegedly moral conflict, flat out refused to discuss their combat experience. The assumption is that they found it too gut-wrenching to revisit.

As US society becomes more and more callous, we see moral injury on a widespread basis in the medical profession, where doctors in corporate settings are required to spend too little time with patients to provide adequate diagnosis or advice. And that’s before getting to new professional indignities of having patient care shunted to too-often inadequate physician assistants, nurse practitioners, and increasingly AI.

Yet Trump increasingly relishes in his ability to use violence. Is this his drunkenness with power or dementia speaking? Normally-wired people don’t know how to respond to open displays of blood lust, and that seems to enable the savagery enthusiasts to go even further.

By Kelly Denton-Borhaug. Originally published at TomDispatch

It’s been a while since I’ve written for TomDispatch and there’s a reason for that. About 16 months ago, I experienced a catastrophic car crash. An SUV veered across the double yellow line of the highway I was traveling on and hit my little Chevy Spark head-on — on the driver’s side. I’ve been told that I’m lucky to be alive. I was left with multiple injuries and have been on the slow road to recovery.

I’ve always seen myself as a person who pushes forward to overcome obstacles. Since the collision, however, doing so has become more complicated, because I’m learning that recovery is a long road, filled with detours I couldn’t have predicted. Time and again, my expectations have been turned upside down. I’ve had to take deep breaths, sit back, and pay close attention.

A few months into recovery, I was invited to attend a day-retreat organized by a local veterans’ moral leadership group. Those vets live with what’s known as military moral injury (in some cases going back decades). For years now, I’ve been researching and writing about the devastating consequences of the militarization of this country and the armed violence we loosed on the world in the twenty-first century. I’ve been listening carefully and trying to more deeply understand the stories of veterans from America’s disastrous wars in my own lifetime.

Now, given my own condition, a new window has opened for me. I can’t help but see more clearly the visceral experience of recovery, including moral recovery. So, I found myself sitting in that circle of a dozen vets, the only woman among them. And I soon had to catch my breath, because, as I briefly described what I was experiencing, they responded in a way I hadn’t expected, expressing their own profound vulnerability, understanding of, and empathy for my plight. I probably shouldn’t have been surprised at how they “got it” in a way that even my loved ones struggled to grasp when it came to my own journey through the challenging nature of recovery.

Intolerable Suffering

Most civilians know little or nothing about the experiences of vets who live with what’s become known as “military moral injury.” It’s been described as “intolerable suffering” that arises from a deep assault on one’s moral core. Think about facing horrific suffering caused by violence you not only had to witness, but could do nothing to stop. You probably were even trained and mandated to perpetrate it. Sooner or later, such a dystopian world invariably slices through whatever bedrock values you’ve been taught and begins dissolving your sense of self. That’s military moral injury and it’s been linked to the epidemic of self-harm and suicide among former members of the U.S. military that continues to this day.

Over the years, I’ve come to understand that military moral injury is rooted in being exposed to unsparing violence. It erupts as a consequence of witnessing violence, perpetrating it, and/or being on the receiving end of its death-dealing forms of betrayal. Moral injury bursts forth as people find themselves powerless to stop the suffering violence begets. War is a deep assault on life itself (both figuratively and literally) and violence isn’t a tool that a person picks up or sets down without consequences.

Admittedly, in this century, we in this country became woefully adept at denying the impact of our own violence on ourselves and the rest of the world. Psychiatrist Robert Jay Lifton called that phenomenon “psychic numbing.” We tend to minimize the violence we’ve committed globally and avoid facing what it’s done to our own soldiers, burying any awareness of it deep in our subconscious minds. It’s too painful, too scary, too horrible to live with (if you don’t have to) and, when we’ve been so deeply mixed up in it, too shameful to stay with for any length of time.

Nonetheless, the penetrating cultural and systematic violence of American militarism and militarization globally has shaped all our lives, even if it’s only the 1% of us who have actually done the dirty work and suffer the most. My own work has helped me see how the militarized violence of the post-9/11 period, orchestrated by my own country, is now being turned inward with increasingly violent military incursions into our nation’s cities.

In my research, I’ve investigated the obscene level of material resources this country has dedicated to militarization in this century, our unparalleled “empire” of military bases (domestically and internationally), and the ways that the violence of militarism has dripped into our own lives, culturally and institutionally. And make no mistake, subterranean forms of violence regularly burst into direct armed violence. We tell ourselves that violence is like a coat that you can put on and take off when you choose, but that’s a tragically mistaken way of thinking. Violence works its way into your body, even into your soul. Then it festers there, eating away at your capacity for being human — your longing for loving, honest relationships; your care for yourself and others; and your deep connection to other living beings. Even worse, in a culture that glorifies violence and has made it into something sacred, such dynamics are excruciatingly hard for us to see clearly.

Nevertheless, the veterans I sat with that day were in recovery from just such an exposure to violence and they understood me. They recognized what was happening to me because of their own struggles to grasp and admit their injuries, especially their moral injuries, and get themselves on the highway of healing and repair.

Moral Injury and the Guinea Worm

These last years, I’ve been trying to find words that truly describe the experience of military moral injury. In that context, let me share a story with you. Some weeks ago, I was driving and listening to NPR on the radio when I heard a reporter launch into a story about the near-eradication of a terrible plague, Guinea worm disease, or GWD. At one point, that parasitic malady had debilitated an estimated 3.5 million people living in 20 different African and Asian nations.

A “searingly painful” disease, Guinea worm infects people who drink water tainted with its larvae. Those eggs then grow into worms that can be up to three feet long inside the human body (including children’s bodies). Think of them as long thin ropes. Eventually, the worms break through the skin in burning blisters, bursting out of the body. One sufferer said that it was “more painful than childbirth,” and the process of extraction can take weeks as the worm spools out like something from a horror film.

The pain is so awful that some people in natural settings will seek out water in streams or ponds for relief from the burning sensation. But as they plunge their limbs in, they release thousands more Guinea worm larvae, contaminating the water. Then, the cycle repeats itself as others drink that same water.

As I listened to the story that day, I could feel my face twisting into a grimace. What a horrific and frightening affliction, I thought.

The Dream That Visited Me

Reaching home, I continued with my day’s work — a new book focused on a set of in-depth interviews with military veterans living with moral injury. I hope to shine a stronger light on their voices, while tracing their journeys of reparation, recovery, and the renewal of hope. But that night, a dream about the Guinea worm awakened me.

It was as if my subconscious had made a connection too awful for me to make consciously. In the dark of night, I realized that violence is like the Guinea worm. In the United States, people thoughtlessly — even in a celebratory fashion — drink it in, absorbing it into their bodies and generally thinking little of being exposed to it.

One common theme from the interviews I’m conducting with veterans is how many of their fathers and mothers encouraged them to enlist in the military when they were teenagers, some just 17 years old. Their parents obviously didn’t wish them to be hurt. They just believed that such service and the discipline that went with it would “make a man out of you,” while giving them a useful trade in life or earning them money to go to college or buy a home. They generally weren’t prepared to consider how encouraging their children to enlist might lead to exposure to relentless violence in their lives (if, that is, their children even lived through it). It really was akin to taking their child to a stream to drink water infected with the Guinea worm.

The violence their children, now the veterans I was dealing with, would witness, or even mete out and absorb, had melted their humanity. As one veteran put it, “I became cold, unfeeling.” It wasn’t until decades later, when his daughter accompanied him to a therapy appointment and, weeping, told him about the impact his iciness had on her, that he began to grasp the cost of war not only to his own life, but to hers as well.

When I asked another veteran, “What exactly was injured in you?” he responded, “I became cruel, unnecessarily.” He had been acclimated into a military culture where soldiers in training were “disciplined” by those of slightly higher rank through regular physical assaults, being slapped, hit in the head or groin, having things thrown at them. He became very good at such behavior himself, even reveling in it, until, many years later, his life fell apart, and he saw what he had both done and lost.

Another veteran described to me the results of the violence in his life this way: “My heart was broken, and it was as though poison was injected into me.” That veteran had enlisted at the age of 17 in the military’s “delayed entry program” and endured three deployments to war-torn Iraq. When he enlisted, he hoped to use his military benefits to become a pediatrician later in life. But after his service, being in the presence of children shamed and devastated him. And there was no one he knew who understood what he was experiencing.

Military moral injury is like the Guinea worm that festers in a person’s body until it begins to burst out, painfully and devastatingly. And we’re now in a culture and society in which all too many of those we claim to esteem, our servicemembers and veterans, are living with just such pain. They say it’s like “losing your soul.” Interviewing them, I now understand that perhaps the worst part of that pain is the isolation they experience. Their fellow citizens simply don’t understand what they’re going through and, in fact, regularly avoid dealing with it.      

Eradicating the Violence That Worms Its Way into Our Souls

A new documentary tells the story of how Guinea worm disease, “born out of poverty and perpetuating poverty,” has been nearly eradicated. Even more surprising, the overcoming of that devastating parasite did not happen through the development of fancy medicines or vaccines, but by distinctly “low-tech” means. Activists on the ground tirelessly used the power of education and discussion, so that those potentially most affected could learn how to both filter the water they used and avoid spreading the larvae through water. Jimmy Carter and the Carter Center devoted funding to and publicized support for the campaign to bring the disease under control, and that cause remained front and center for Carter until his death.

One such activist is Garang Buk Buk Piol, a former child soldier in Sudan. “Carrying an AK-47 when he was 12 years old, he learned how to slay another human being.” But according to the documentary’s director, “That child turned into a Guinea worm warrior, a philanthropist and an activist amongst his people.” He has spent his life as a teacher in South Sudan’s schools, building programs to fight Guinea worm disease, “waging peace and building hope.”

In a country that engaged in so many disastrous wars in this century (with another one in Venezuela possibly looming on the horizon), the veterans I’ve been interviewing were left in the unavoidable position of having to “swallow” violence alone, intimately, and on a profound scale. Today, like Buk Buk, many in the moral engagement group have taken up the work of healing, reparation, and community building, even while they still struggle with the consequences of their own violence and that of others in their lives.

And what about the rest of us? I experienced the violence of a serious car crash and my life won’t ever be the same as before. But the crushing collision with violence that too many of our veterans are still dealing with is so much more horrible than anything I (or most of the rest of us) could possibly imagine. Meanwhile, the growing violence of my country (and these days, in my country) since 9/11, continues to — yes! — worm its way into our bodies and souls, even if so many of us aren’t really aware of it.

We’ve become accustomed to believing that there is no other way except through violence. But that is patently false. This Veterans Day, I’ll be thinking about the sort of acts I can muster to respond to the latest assaults of violence that are penetrating our lives, city streets, workplaces, courts, universities, federal institutions, access to healthcare, food security, and all too much else. Instead of responding with fear, collusion, or apathy, I’m making plans to resist violence with others through acts of healing, humor, love of neighbor, and building hope. I hope you are, too.

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18 comments

  1. Earl

    The essay’s author shares her conservations with damaged victims of and perpetrators of military violence. Sadly, these veterans’ experiences are only the most recent examples of a timeless condition described in Simone Weil’s essay “The Iliad or Poem of Force.” The Iliad describes the recurring calamities of the destruction of a city, Troy/Gaza and a people Trojans/Palestinians. Force transforms both victims and perpetrators. It intoxicates and dulls reason and pity. Force deludes those who use it to think that they can handle it. Trump and his cartoonish ensemble of sycophants are only the current version of our amoral ruling class. If only Trump and Lindsey Graham were unique. Hubris invites nemesis, and the United States is long overdue for justice.

    Reply
    1. lyman alpha blob

      Caroline Alexander makes the argument that the Iliad with its graphic depictions of slaughter and suffering is the first anti-war literature in her book The War That Killed Achilles . I don’t know if I’d go that far since Homer also often talks about the ‘kleos’ (glory/fame) of the warriors, but there is a reason that the first word of the epic is ‘wrath’.

      Reply
  2. ocypode

    This is an important, if difficult, piece. I think it’s no coincidence that some of the largest cultural artifacts of American society are glorifications of war and violence, be it in video games or movies. Without wanting to moralize or preach, I think it’s naive to think there is no association between what is depicted as good and heroic and its shadow side in practice, that of making people into “cold, unfeeling” machines (that being said after Vietnam there used to be a lot of movies criticizing war…)

    Though of course this shouldn’t cloud anyone’s eyes over: the real misery of having someone made into a killer is hardly comparable to those that are suffering a genocide. Otherwise this can end up in the sort of discourse that goes “look at what our boys were made to do” without thinking much about whom it was done to (something I’ve seen a lot in debates about the morality of the Iraq War or, of course, the genocide in Gaza). Another point that shouldn’t be overlooked is that this isn’t a new phenomenon: at the end of The Wretched of the Earth, Fanon does retell some cases he dealt with as a psychiatrist in which pied-noir torturers end up torturing their wives or hearing the screams of the people they tortured in their nightmares.

    Reply
  3. Ignacio

    Thank you for this article. War drums go well beyond the instant damage done and have consequences lasting a few generations. Probably, the younger that one goes to fight in war the bigger the impact, the injury. And here, in high-moral CW we have seen de spectacle of senators, congress-critters, and others asking for Ukrainians to send their younger to fight Russia and, with that, kill the remaining, if smallish, perspectives Ukrainians might have for a future.

    In 1997 in the Bay Area, I was standing in the street near a marketplace when a Vietnam veteran came to me and started showing me his physical injuries and saying things which i didn’t understand very well in a way that showed his anger though he was polite, clearly not aggressive. I was speechless and too young or to unknowing to react properly.

    Reply
  4. MicaT

    The NYT have an article or at least the head line about Ukraine men in hiding but it needs them for the war front.
    To die for a foreign country and for a losing cause.
    The Dems have been for far too long long a war mongering party, ad yes the Republicans too.
    What did happen to diplomacy and finding ways besides war to work things out?

    Reply
  5. The Rev Kev

    It was when reading the book “The Big Red One” by WW2 combat vet Samuel Fuller that I learned something that should have been obvious. In war, it is not just killed, wounded and survivors but you have ‘sent crazy’ as well. You would have men go nuts in the middle of a battle and I think that they were nicknamed blowtops. This must be true going back to ancient Greek hoplites and earlier. Vets keep their stories to themselves or other vets. I was reading of two vets of the Zulu War of 1879 having a meet up and the first thing they did was send kids and others away so that they could talk in private. It was a hard war. People find it hard to deal with raw violence and mostly do not want to take the lives of others. I believe that a post WW2 study was done which found that most men shot their rifles randomly rather than at another human being. So in a way perhaps all these vets having so many difficulties is a sign that our humanity is still salvageable.

    Reply
  6. Wukchumni

    My dad was 14 when the goose steppers came into Prague without knocking and 20 when they marched out, and growing up ‘what did you do in the war, daddy?’ stories always led to nothing much, with the only indication being Hogan’s Heroes, which he refused to watch.

    We loved it, WW2 & comedy, plus nobody really gets hurt.

    He’d linger towards the back of the living room in the opening montage and utter something like (now imagine your dad sounding very much like Henry Kissinger…)

    ‘they weren’t so dumb, you know…’

    And then make a hasty exit.

    Fast forward to the turn of the century and the whole family is on vacay in Prague, and you can still see the bullet holes in the marble @ the church where the Heydrich assassins breathed their last.

    Hard to say how many regular Joe citizens of Prague were killed in retribution, maybe thousands.

    So i’m walking with daddy-o, and he casually points at this most unassuming wall about 150 feet away from the street, and mentions that’s where the innocents met their fate, rat-a-tat-a-tat-a-tat.

    He would’ve been 17 when this was happening.

    What could I compare in my life at 17?

    I see now why he sheltered us from his memory storm~

    Reply
  7. JonnyJames

    Personal related anecdote: This reminds me of my grandfather who fought in the Pacific during WWII. I would curiously ask him about the medals I found next to a book on the shelf. He always avoided talking about it saying that war was a terrible thing and should not be glamorized. Of course as a kid, I was fascinated by WWII, and the fact that my grandad was a “hero” fascinated me even more. But he never talked about it.

    It was not until after he died, and I read his memoir that I realized. He had to kill people and was nearly killed himself. A Japanese grenade had blown up near him and he took shrapnel. He saw some very gruesome things and saw his friends killed. When he was cremated, we found chunks of metal in the ashes. He carried the pieces of metal in his leg for decades and never complained about the pain. I understand now why he didn’t want to talk about it, brag about it. War is terrible, horrific and should not be tolerated, but sadly humans collectively don’t learn.

    Reply
    1. playon

      My father also fought in the Pacific in WWII. When I was a kid I would ask him about it but he would never talk about being in the army other than “the food wasn’t very good”. He was a navigator in a bomber that dropped bombs on the Philippines and later was stationed in Tokyo during the allied occupation, so he got a chance to see the results of bombs. He was lucky in that he didn’t have to live through any combat but the war must have deeply affected him.

      Reply
  8. judy2shoes

    I want to bring up something relevant to this article that I’ve recently discovered because it’s happening to me, and others here may be experiencing something similar. I will try my best to be succinct, but that’s difficult for me because I’m so detail oriented.

    There’s something else that soldiers (and non-soldiers) have experienced: a little recognized problem called hyperventilation syndrome (HVS). As far as I can tell, it was first described in the u.s. as soldier’s heart during the Civil War, because the symptoms a doctor observed in some 300+ soldiers appeared to be caused by something related to the heart.

    I’ve been under an extreme amount of stress for various reasons, but the genocide in Gaza, combined with the helplessness I feel about it, caused me to develop a disordered breathing pattern early last year. I recognized it right away when I was going on my daily walks (my stress reducer!), but I was unable to disrupt the pattern. I ended up in ER in early June due to pre-syncope (near fainting), and I was convinced the problem was cardiac, since I could see the arrthymias going on in real time on my watch (my background is in cardiac rehab). At the same time, other symptoms popped up that seemed unrelated. Long story short, there was nothing in the tests that indicated that this was cardiac related.

    This year, I ended up in ER again in late September with far-worse pre-syncope. The arrthymias, too, have gotten much worse, but again all the testing for cardiac issues showed nothing that would be causing the near-syncope. However, during a nuclear stress test, something a nurse said to me about how I was breathing, while confusing at the time, popped up in my brain a few days later. I wondered if the disordered breathing pattern had something to do with what was going on with me. I did a search using the terms “disordered breathing patterns + syncope” and up popped papers about HVS, how it’s often missed by clinicians for various reasons, and how the patient is sent away with no diagnosis at all (me) or is misdiagnosed with something else. It was my Eureka moment, because since last year, I still have most of the symptoms described in the papers. I told this to my friend and neighbor, a nurse practitioner with whom I had worked in cardiac rehab, and she was completely resistant.

    I ended up in ER again this past Wednesday due to a dangerously low heart rate. My neighbor above took me to ER, and I had to convince her to leave because I wanted to discuss HVS with the ER doc and I wasn’t going to be comfortable discussing it with her present. I told the doctor what I thought was going on, how I arrived at that conclusion, and then demonstrated the breathing pattern. I asked her if she thought there was any way I could be walking any distance at all with that pattern, much less the miles I put in everyday, and NOT be hyperventilating. She said no, and ordered venous blood gas (VBG) testing along with other tests. The VBG showed I am in respiratory alkalosis, which would be caused in my case by HVS.

    Getting the help I need is going to be a challenge, due to resistance from practioners, but what is happening to me as a result of the violence we are all witnessing in real time, is nothing compared to what the Palestinians are going through. It’s extraordinarily difficult to witness, much less imagine how it would feel to be in Palestine right now. If you’ve gotten this far, thank you for putting up with this long-winded comment, but I hope it will help someone going through something similar. Solidarity!

    Reply
    1. JonnyJames

      I’m sorry to hear about your experience judy, thanks for describing HVS, I had not heard of it.

      I’m largely ignorant of things medical, but could this be caused by psycho-social stress, leading to anxiety, which leads to HVS? No matter, the horrific atrocities being perpetrated by our governments is deeply disturbing to say the least. Add the domestic social decay, political/legal dysfunction, institutional corruption, declining quality of life, dysfunctional medical system etc. and we have a very disturbing picture, even for those relatively well-off materially.

      The effects of all this on general mental health in the wider public should be studied further. Mental health is an area that appears to be woefully neglected, and stigmatized in our culture.

      I know folks who have to distance themselves psychologically from current events as it will cause great mental anguish. Fort others, this is not possible and presents more than one dilemma.

      I would think that many more people out there have experienced trauma or stress given the factors mentioned. I wish you all the best in getting help to cure the HVS. I have not experienced that, but have had issues (and I would guess others here as well) with anger and depression. In fact, sometimes my anger gets me into trouble when I comment on certain issues.

      Reply
      1. judy2shoes

        “psycho-social stress, leading to anxiety”

        Yes, exactly, as I was trying to indicate but did a poor job of.

        Thank you for reading and for your entire comment, JonnyJames. It’s very helpful and comforting to me.

        Reply
    2. Offtrail

      judy2shoes, good luck to you. You might be interested in trying basic Buddhist sitting practice, shamatha practice. In that you simply breathe and put attention on that, not trying to change anything.

      Reply
      1. judy2shoes

        Thank you for your comment, Offtrail, and your support. Buddhist practices are what I’ve been gravitating to for most of my life, and I’ve had far more success with those than any talk therapy. Right now, even those practices, which I always experience as a feeling of coming home, are eluding me. My return to them is inevitable, though.

        Reply
        1. judy2shoes

          Adding, as one might imagine, it is exceedingly difficult to have to focus on one’s breathing in order to get it to stop syncing with one’s steps on daily walks. However, I ran across this little brief poem attributed to Alan Watts (perhaps he mentioned it in one of his books):

          “The centipede was happy, quite,
          until a toad in fun said, ‘Pray, which leg goes after which?’ This worked
          his mind to such a pitch, he lay
          distracted in a ditch, considering how to run.”

          I’m glad I’m not a centipede, and the fact that I can laugh about something/anything shows me that at least my sense of humor remains relatively intact.

          Reply
  9. David in Friday Harbor

    Good post to honor Veterans Day.

    My own father was a WW2 vet who spoke very little about his experiences in three long years as a “non-combatant” medical supply sergeant at frontline mobile field hospitals in New Guinea, the Dutch East Indies, and the Philippines, some of the ugliest campaigns of the war. Shortly before he passed away my then 20-year old child asked him what he most remembered 70 years on. He replied, “the screaming.”

    Reply
  10. john brewster

    From a recent essay of mine

    A short list of violence porn

    Violence is always about winners and losers. Tough guys and wimps, with the invitation to vicariously imagine that you too are a tough guy. In areas where reality can be suspended, especially science fiction and fantasy, technically enhanced humans or people with magical powers can battle forever without getting tired or being knocked out of action by injuries. Violence never leaves people damaged for life, or screaming in pain for hours until they die. Violence is neat and clean and cathartic. Its all part of the delusional worldview.

    America is marinating in violence – in movies, TV, books, and video games. Here is a llst that is long enough to prove my point, and short enough not to be TL:DR.

    If it bleeds, it leads news coverage

    American football

    UFC/WWE cage fighting, mixed martial arts.

    First person shooter video games (Call of Duty)

    Millitary scifi books at the individual/squad level (Ann Leckie -The Ancillary series)

    Military Scifi movies at the dueling empires level (Dune, Avatar)

    Enhanced-human scifi books with sadistic, nihilist anti-heroes (Richard Morgan, the Altered Carbon series; Neal Asher, the Agent Cormac series)

    Enhanced-human spy movies (Jason Bourne)

    Jingoistic military and spy movies (Top Gun, Fast and Furious, Zero Dark Thirty, and just this week, “House of Dynamite”)

    Gangster movies (Godfather, Goodfellows, The Sopranos, Boardwalk Empire, Breaking Bad)

    Bloodfests (John Wick, Kingsman, Jack Reacher)

    Violent movies and TV set in the past ( Gladiator, Game of Thrones, The Last Kingdom)

    All this stuff teaches that violence is not merely acceptable, but that anything less than violence is a losing proposition.

    Reply

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