Trauma, Suspicion & the Anatomy of War: From PTSD to Moral Injury

Sanaullah Khan//

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Flight medic Sgt. Cole Reece checks the vital signs of the wounded Afghan boy before transporting him to the hospital at Kandahar Air Field on Oct. 10. (Source: http://projects.huffingtonpost.com/projects/moral-injury/healing)

The history of trauma has been steeped in a recurring language of suspicion. Beneath the 20th century survivor’s words and silences lurks suspicion, which presents itself in different ways in different conflicts. The doubt involved in transforming a soldier into a  patient, through various diagnostic categories, keeps re-emerging in different forms every time in the history of warfare when medical symptoms, especially psychiatric, are catalogued, re-evaluated and readjusted. In this short article I want to trace a brief history of trauma in which some scholars have located questions of authenticity of the soldier’s word in relation to the shadow of doubt that lurks in the background shaping diagnosis whenever it finds a place. For this we first must consider how psychiatric discourses need to constantly humanize their subjects. This need, I suggest, is part of the impulse behind the study of the “unconscious” in various psychoanalytical discourses, especially as psychiatry establishes itself as a discipline in modern America.  If psychiatry attempts to wrest itself of the brutalities of war, then what steps does it take when its humanism comes into conflict with the structure of war, which honors particular forms of violence? What does psychiatry do under the requirement of extricating itself from having to justify the horrors of war? For this it must leave outside its fold the soldier who sustains the architecture of warfare by inflicting violence on civilians and the enemy. It is the “proud” soldier, following the Vietnam War, who has been the greatest problem for the field of psychiatry and is the reason why doubt and suspicion toward the survivor in the discourses on trauma could never truly disappear.

The story starts in the early 1900s when shell-shocked soldiers were diagnosed with war psychosis (Myers 1915; 316-330).  Shortly afterwards, many of the soldiers who had battled on the front were given compensation to help with societal reintegration. In their book The Empire of Trauma (2019), authors Didier Fassin and Richard Rechtman show how this compensation was enacted through various compensatory schemes enabled by insurance. The model followed that of insurance companies dealing with physical accidents—railroad accidents, for example, where micro lesions in the brain could be evidence that one had deserved compensation. Trauma remained defined in terms of a physical injury caused by an accident. As soon as the compensatory scheme began to provide soldiers and people involved in accidents a chance to prove their injuries and claim benefits, there was, inevitably, a strain on the resources required for sustaining the infrastructure of war. Through the finite resources injury was brought into relationship with the structure of war. There emerged the figure of the soldier who feigned his injury to claim compensation. This was, as Fassin and Rechtman (2019) show, the first moment when suspicion was anchored at the site of compensatory structures responsible in rehabilitating the soldiers who had participating in the war.

This is beginning of trauma’s longstanding association with the malingering soldier. There was a realization among psychiatric circles that illness itself had some kind of association with the need for compensation, and the need was for shifting the focus to ‘cure’. With this in the background emerge the various discourses around the unconscious, which decenter the occurrence of the psychiatric impairments from the ‘event’ to an individual’s personal history (Foucault 2003; Fassin & Rechtman 2009). With the unconscious the traumatic “event” itself is relegated to a distant past which is difficult to single out. For Fassin and Rechtman (2009), it is not until psychoanalytical discourses respond to the criticism about not doing enough to respond to child abuse that the event again emerges as central in understanding the psychological wellbeing of a person. What also contributed to this was perhaps the fact that the speech and silence both emerged as testimony of what the survivor had experienced.

The history of PTSD as a diagnostic category, however, still remains steeped in suspicion of a different kind, contrary to what the above paragraph may have suggested. Consider the veterans of the Vietnam War. This time, however, the consideration is whether the soldier committed acts of aggression even when alternative choices were available. In other words, the question about suspicion had to settle how much one had to witness without consenting to be privy to the horrors of war (Young 1996). It was a spectrum in which on the one hand there was witnessing and on the other perpetration. The more a person moved toward perpetration in the availability of alternative choices, the more difficult the diagnosis of the PTSD became. Here, the intention of the soldier emerged as an important marker to consider whether one’s experiences of war were worthy of compensation. For those who had intentionally committed acts horror, their pride could be located in a pre-service tendency, but the event itself became progressively difficult to locate in the war itself. However, if such individuals who were at the forefronts in completing the objectives of nations were considered inhumane by the psychiatric discourses which were supposed to valorize them and help them in the integration of the society, there is necessarily required a new category through which acts of perpetration are turned into mere witnessing just so psychiatric discourses are no longer at loggerheads with the objectives of war and its infrastructure.

It is to secure the soldier who walks the fine line between patriotism and war crimes that psychiatry has to create a new concept—the moral injury (Wood 2014). Moral injury is sanitized of perpetration and is replaced with the acts of ‘witnessing.’ The characteristic feature of this witnessing, i.e. the lack of available choices to avoid participation in the horrors of war progressively displaces one’s intentional participation under the pretext of the requirements and exigencies of the situation. Moral injuries are expansive in that they encompass the ethical and moral conundrum a soldier is likely to face in the battlefield, but in its attempt to sanitize war of its horror, still has to grapple with the the soldier who had inflicted horrors even when he had a choice to escape. Suspicion about the soldier emerges with a different valence—this time no longer through the figure of the malingerer, but that of the murderer whose figure exceeds the violence required by the architecture of war.

Bibliography

Fassin, D. & Rechtman R. (2009), The Empire of Trauma, Princeton University Press.

Foucault, M. (2003) Abnormal: Lectures at the College de France, 1974-1975. Lectures 1-2, 5-6, 9-10.

Myers, C.S.  (1915) “Contribution to the Study of Shell Shock”, The Lancet, 185 (4772), 316-330.

Young, Allan (1996) “Technologies of Diagnosis” Harmony of Illusions: Inventing Post-Traumatic Stress Disorder, Princeton University Press.

Wood, David (2014), “‘I’m A Good Person and Yet I have Done Bad Things’: A Warrior’s Moral Dilemma,” Huffingtonpost, http://projects.huffingtonpost.com/projects/moral-injury

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