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Moral injury
The following material is drawn from an interview with
Professor Tom Frame. They are ideas meant to prompt discussion and to provoke
debate, and represent an attempt to move beyond the familiar narrative of the
‘broken’ veteran being betrayed by an indifferent government bureaucracy.
The concept of ‘moral injury’ continues to be the subject of
research and reflection but has been associated with a disturbance, disruption
or diminution of a uniformed person’s moral outlook and the depletion,
degradation or disorientation of their moral compass as a consequence of
operational service. A morally injured person will question the validity and
necessity of moral values; chastise discontinuities between the idealised moral
self and the realised self; and, wrestle with assertions of universal moral
logic.
Moral injury is not synonymous with PTSD. The incidence of
moral injury is not predicated on a traumatic experience. A traumatic event may
cause moral injury, but a person can be morally injured—an injury manifested in
personal guilt and shame, or indifference to human pain and suffering—without
the causal event being traumatic. Moral injury does not flow from external stress,
but from internal reflection. It has to do with what a person makes of what
they see, hear, smell, touch and taste. Two people can experience the same
thing: one will be unaffected, while the other will be injured. The difference
is how they interpreted their experience in terms of the value structures
ordering and regulating their inner being.
The usual narrative (echoed by both the media and the
parliament) runs as follows: ‘these young men and women have served their
country faithfully and well. Defence has broken them in body and mind and DVA
has failed to look after them adequately. Something needs to be done. We (those
indicted are never completely defined) have failed these veterans and the
system is broken’. Against this backdrop, PTSD has found its way into the
popular imagination as the accepted description and the agreed phenomenon that
captures the experience of so many who have been negatively affected by their
uniformed service or operational deployment. This narrative is highly problematic
in a number of ways.
Problems with PTSD
itself
All negative experience resulting from a military career is
not usefully described practically or conceptually as PTSD. The term ‘moral
injury’ may explain some negative fallout, but there may be a myriad of other
useful ways to understand the effects of military service on the human mind.
PTSD has become the ‘catch all’ complaint for anyone working in emergency
services, including the police. It is not specific to the ADF and yet,
curiously, its operating parameters are very different in the non-Defence
community. Hence, the importance of research into moral injury. PTSD is not
well explained (it is described, more than defined), and suffers from an
unstable diagnostic foundation (witness changes in the definition between DSM
III, IV and V). Its application by the profession of psychology reflects an
almost complete reliance on this branch of behavioural science at the expense
of multi-disciplinary approaches. Routine ‘diagnosis’ of PTSD appears to
facilitate, if not encourage, compensation claims where the disorder is
worsened by the process of litigating unsuccessful claims. The goal here is not
to absolve the government of responsibility, but to broaden the conversation
about what that responsibility might look like. Rather than deny culpability,
the discussion could instead turn to how best the military can meet the
challenge of looking after its people.
The need for a
realistic narrative on military ‘service’
Given the messages conveyed in recruitment advertisements
and the way in which newly-joined personnel are encouraged to see a deployment
as a career highlight and the chance to validate their training, the military
may be encouraging a mindset that resembles that of state-sanctioned
mercenaries where career-minded individuals believe going to war will offer
personal/professional development opportunities rather than primarily serving a
noble cause—the defence of the nation and its people. A career in the military
is depicted as a personal challenge, not service of the common good. War is no
longer about protecting Australia or serving our nation; professional soldiers
receive a generous deployment allowance and medals in exchange for the work
they have done. Their service is voluntary and they are remunerated on the
basis that they are on deployment. In essence, increased allowances are the ‘pay
off’ for accepting increased danger. This is what the DFRT [Defence Force
Remuneration Tribunal] determines. It may therefore be helpful to formalise the
‘assumed’ moral contract of service. For example, the UK Government has a ‘covenant’
between the state, the nation and the armed forces to make explicit the
relationship between society and the service person, setting out obligations
and responsibilities on both sides.
Limitations of the
entitlement narrative
An entitlement mentality, visible well beyond the uniformed
community, where every element of human interaction is potentially susceptible
to compensation, will deplete social capital and destroy communal solidarity.
In the context of uniformed service, regardless of the outcome of a ‘DVA
battle’, it will not replace the next phases of life with the support of family
and friends and community, and taking responsibility for oneself. A more
realistic attitude to a military career and a degree of frankness about its
character, coupled with a willingness of recruits to prepare themselves and
take responsibility for what happens, may create the circumstances where an
injured person is more likely to be healed. Refugees have often experienced
horror, but their lack of a feeling of entitlement means they work hard and
build lives for themselves. They were, and are, animated by a different
narrative—they are not victims, but survivors whose experiences have strengthened
rather than depleted them—for the greatest part. With enough retelling of a
story, it has a way of becoming reality. The problem may not be PTSD; it may be
that an individual is angry and bitter in a way that is not fully known to
themselves. This only highlights the need to create a positive and productive
narrative.
Nor does the ‘slipped through the cracks’ narrative explain
the situation. At what point can the state intervene in a preventative way when
someone has chosen to self-exclude. In a voluntarist society which remains
sceptical of state intervention, personal help is sought and not imposed. The
issue here is that neither society nor government can prevent all harm; the
narrative of the ‘government needing to do something’ is part of the assumption
that whatever happens to an individual, it is eventually and ultimately the
responsibility of the state. Whereas, in reality, individuals need to prepare
themselves for life and accept the need to respond personally to the challenges
associated with everyday living. The state cannot provide what an individual
declines to provide for themselves. The nature of the relationship which exists
between the state and the individual is clearly at issue. Yet, it is rarely
discussed. We are somewhere between the UK and the US when it comes to defining
the essential elements—somewhere between covenant and contract.