Listening again, digging deeper, & hearing moral injury

The authors of the recently published article “Oral History, Moral Injury, and Vietnam Veterans,” available online, share their thoughts on and experiences with “moral injury.” 

By Philip F. Napoli, with contributions from Thomas Brinson, Neil Kenny, and Joan Furey.

As part of the research for my book, Bringing It All Back Home: An Oral History of New York City’s Vietnam Veterans, published in 2013,  I interviewed approximately 200 Vietnam veterans from the New York City area. Out of those veterans, I ultimately profiled sixteen in the book. Over the years it took to research and write, I developed lasting relationships with a number of my interviewees, including Thomas Brinson, Neil Kenny, and Joan Furey.

At the time we recorded the original interviews, between 2003 and 2007, the principle intellectual tool available for understanding the psychological problems experienced by returning service personnel was post-traumatic stress disorder. PTSD entered the psychological lexicon in 1980 when the Diagnostic and Statistical Manual, then known as DSM III, acknowledged that significant anxiety and emotional distress caused by the existence of a stressor “outside the range of usual human experience” could produce symptoms rising to meet the standard of an “anxiety disorder.”

Of course, veterans like Brinson, Furey, and Kenny had struggled for years in the absence of such a clinically recognized condition, as they returned from Vietnam in the late 1960s and early 1970s. By the 1990s, post-traumatic stress was becoming an increasingly accepted psychiatric diagnosis and not just for combat veterans, but among the survivors of all kinds of traumas, including sexual abuse.

Indeed, Jonathan Shay, a psychiatrist whose principal group of patients were Vietnam veterans, published a groundbreaking work, Achilles in Vietnam, Combat Trauma and the Undoing of Character in 1995 that made it clear that the difficulties suffered by American military personnel on their return from Vietnam were not abnormal, singular or even very surprising. Shay persuasively argued that in Homer’s Iliad, a careful reader can identify many of the very same response patterns to combat among the characters of the great epic poem that American soldiers reported in clinical encounters. PTSD, Shay suggested, is deeply rooted in Western culture.

The United States invaded Iraq in 2003. As the war proceeded, and Shay’s work with veterans continued, he became increasingly convinced that the concept of post-traumatic stress did not capture or explain all of the causes or features of emotional distress that he was seeing in his clinical practice. Drawing on his earlier work with Homer’s narrative, he began to theorize something new- the concept of “moral injury”. Eventually, he articulated its features as including:

• A betrayal of what’s right.
• by someone who holds legitimate authority (e.g., in the military—a leader).
• in a high stakes situation.
• All three

By 2009 scholars were beginning to write and publish about the idea. I first encountered it at a public lecture given by Shay that NYU in the fall of 2013, where he explained the concept. As a consequence, I began to reconsider the stories of the veterans that I had been collecting, by that time, for the better part of a decade. Could, I wondered, find instances of moral injury in the hundreds of hours of recordings I had collected? I thought so, but in an important way, identifying moral injury—as I understand it —depends at least as much on the interviewee as it does on the interviewer. An interviewee should, I believe, understand an episode of trauma as one not grounded in terror, which lies at the heart of the PTSD diagnosis, but as a ‘violation of what’s right,’ that is to say, a moral transgression.

While in some instances it may be justifiable for a historian to interpret the documentary record produced by the oral history interview in a way that does not emerge directly out of the interview experience, in this instance it seemed to me only right and fair to ask my interviewees if the traumas that I thought might be attributed to moral injury seemed to them, in fact, correctly described in that way.

I wanted us both to listen again to the recordings we made together perhaps find new meanings in them.

“I wanted us both to listen again to the recordings we made together perhaps find new meanings in them.”

In 2014, I approached Kenny, Furey, and Brinson and asked if they would be willing to reengage in our conversations about their experiences in the light of this new concept, and potentially to co-author an article with me about it. I wrote to Thomas Brinson, a retired clinical social worker, the following:

Recently I’ve been thinking about the concept of “moral injury” as proposed by psychiatrist Jonathan Shay. Because you are a clinical social worker, I feel pretty sure you know about this already, but in brief, this idea suggests that while the notion of PTSD is valuable, it doesn’t really capture the entirety of the psychological consequences of combat. As Shay says, moral injury “is what happens when there is a high-stakes violation of ‘what’s right’ by someone holding legitimate authority in a high-stakes situation.” Reflecting on the conversation we held so many years ago, it appears to me that the story you told illustrates shay’s “moral injury” idea very well. What I would want from you is a statement about whether or not you think I’m right concerning your story, and if I am, how the idea of moral injury relates to the person you became after Vietnam. If you think I’m wrong, and your story does not connect with the notion of moral injury, then I think you should say that.

With Thomas Brinson, I was thinking about this moment of our interview, in particular:

If you listen, I believe you can hear something of the depth of the pain Brinson experienced both in 1968, and in the moment of retelling in 2007. As Brinson wrote in the article, he understands the concept of moral injury as providing a better interpretive lens for the long-term consequences of this incident than that provided by the concept of post-traumatic stress.

I wrote similar notes to Neil Kenny and Joan Furey. All three agreed to co-author an article with me on the subject. The OHR article resulted. After the publication of the article, I had the opportunity to sit back down with Neil Kenny to talk about the concept of moral injury. Here, Kenny explains his understanding about the difference between PTSD and moral injury:

 

In the following clip, in very cinematic language, Kenny describes one of several incidents that took place in 1968 when he was called home from Vietnam on emergency family leave. His grandfather had passed away and the family was gathering for the funeral. Kenny felt deeply connected to his grandfather as the only family member who had both acknowledged the dangerous reality of Kenny’s Vietnam service and indicated an anxious anticipation of his safe return home.

Here, he recalls a scene at the funeral home in which a family member verbally disrespects Kenny’s experience and knowledge of the situation in Vietnam.

In the second clip, Kenny reflects on the meaning of this family’s reaction to his return for the funeral.

As Kenny has said many times, in an important sense, his post-Vietnam journey into alcoholism began with this brief trip home to bury his grandfather. It wasn’t combat and its violence that created the most important trauma that he endured. In fact, in an important way Kenny felt morally equipped to participate in war because of his religious upbringing and because of his family’s tradition of military service. The devastating trauma, the one that could barely be endured, was a violation of “what is right” by the people he trusted most to do the right thing—his family. Violence and killing in the context of war was acceptable. Rejection was not.

More recently still, I asked each of my co-authors for a final reflection about their experience being interviewed by me, about the fact that I keep going back to them, asking them to dig deeper, opening up past wounds to explore their history and lives.

While each author responded, Joan Furey offered what I think is a wonderful articulation of the transformative potential embedded in the oral history enterprise of sharing authority.

Here are her written comments, in full.

“Participating in this oral history project really helped me to see that, as one gets older you begin to see your life, not so much as a series of ‘snapshots’ but more of ‘landscape’ painting. When I first started talking about Vietnam I focused on specific incidents, points in time, the snapshot of the experience. Over time I finally began to see how inter-related everything is. In sharing my story, my whole story with Dr. Napoli, I once again began to see and understand myself, my life, and how my experiences in Vietnam influenced so many of the decisions that I made. I’ve truly come to appreciate that that one year in my life impacted me so greatly. For too long I focused on the ‘one year of my life’ as a scene not a journey. When you can finally put it all together it’s a very powerful experience and a very healing one. I guess that’s one of the reasons why I am so committed to sharing my story. I feel very blessed that I am in such a good place in my life.

“There were times when it could have gone either way. My years in therapy, in working with other vets, in sharing has helped me to really develop this picture. I think involvement in this project was a culmination of that work and helped me to put it all together.

“Over time I finally began to see how inter-related everything is. In sharing my story, my whole story with Dr. Napoli, I once again began to see and understand myself, my life, and how my experiences in Vietnam influenced so many of the decisions that I made.” – Joan Furey

“Not everyone has had that opportunity or, if they did, was afraid to act on it. I know that feeling because I was there once and if I hadn’t had taken that first step, and began to talk about it, I’d probably still be there. I want people to know how important taking that first step is and see where it can lead you. I feel very good about my life today. I’m in a very good place. I feel I’ve lived a very meaningful life. I’ve done some good things. There are some things I wanted for myself that I didn’t get. I’ve had to deal with that over the years. Regrets, I have a few, don’t we all. But I’ve gotten to a place where I’m okay with that and cherish what I do have. There was a time when I didn’t think that would ever be possible. So, all in all, it’s been a pretty awesome journey.”

---

Philip F. Napoli is an associate professor of history at Brooklyn College, a part of the City University of New York. He is also the author of Bringing It All Back Home: An Oral History of New York City’s Vietnam Veterans, published in 2013 by Hill and Wang.

Featured image: Twentieth Century “Angel of Mercy” — D. R. Howe (Glencoe, MN) treats the wounds of Private First Class D. A. Crum (New Brighton, PA), “H” Company, 2nd Battalion, Fifth Marine Regiment, during Operation Hue City. National Archives and Records Administration.