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Book Review: ‘Afterwar’ offers a way to talk with veterans about moral injury


 

“Afterwar” is not a light book to read for an escapist afternoon. The subject – the return to civilian life after war – is heavy. The writing is thoughtful and serious. Most daunting, or exciting, are the philosophical questions raised.

Nancy Sherman, Ph.D., is professor of philosophy at Georgetown University in Washington. The philosophical lens, which she focuses on our returning service members, helps to frame the current difficulties many have in reintegrating into civilian society. Dr. Sherman seeks to bring the war back home to us through the in-depth stories of several who have served and whom she has come to know well through extensive interviews. She often ties their stories to those told by the Greek tragedians and philosophers. Sophocles, one of the greatest Greek tragedians, was himself a Greek general, and his plays written after he returned from the Peloponnesian War, like “Ajax” and “Philoctetes,” shed light on our own current homecomings.

About 2.5 million service members have served in the conflicts in Iraq and Afghanistan. That number, however, represents only about 1% of the U.S. population. There are currently deep cultural divides between the military and civilian populations in America, a theme repeated often in “Afterwar.”

Post-traumatic stress disorder (PTSD), suicide, and traumatic brain injury (TBI) have been headline news for many years. There is increasing focus on “moral injury.” The question of moral injury is the central theme of this book.

What does the term mean? Usually, moral injury refers to a sense of shame and guilt. Shame at not being able to save a battle buddy. Guilt that one has survived and one’s buddies have not. It also may encompass a sense of having been betrayed by the government or military in which the service member has invested his or her whole life. Literally

This is an important concept, in the context of the seemingly never-ending wars in Iraq and Afghanistan. It also illuminates other troubled conflicts, especially the Vietnam War. Parenthetically, that war began 50 years ago, but the disability claims from Vietnam veterans were the highest ever last year.

About 15% of the military is female. The stories of women in the service are just beginning to be told. Women who join the military are often unconventional. Dr. Sherman articulates their voices in this volume.

Why should psychiatrists read “Afterwar”? For all kinds of reasons.

Again, 2.5 million service members have served in the conflicts since Sept. 11, 2001. The vast majority have returned home and separated from the military. About half will get care through the Veterans Health Administration. Some of these, plus the other half, will also go to the plethora of civilian providers, through school or work, or the public mental health systems. So civilian psychiatrists will see veterans.

This book does not outline treatment regiments for PTSD or TBI, but it does offer a way to talk to veterans about their military service and the moral injury they may be struggling with. And, hopefully, that should reduce the alarmingly high suicide rate.

Dr. Ritchie serves as professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., and at Georgetown University in Washington. She also is coeditor of “Women at War” (New York: Oxford University Press, 2015).

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