‘It’s not easy to take a life’: is coping with PTSD harder for US soldiers?

When anthropologist Sarah Mathew traveled to the borderlands of Kenya and South Sudan in 2008 to study warfare, she asked an interview subject if he had ever been shot. She did not expect to be shown a completely fresh gun wound.

“He had just gotten it two days ago," sy het gese. The wound was raw, pink and oozing yellow pus.

“My research assistant and I were shocked that he would have come to this interview," sy het gese. '[It] was a reminder to us about how accustomed people” were to warfare.

Mathew worked with the Turkana, a group of pastoralists who engage in deadly cattle raids. Armed with AK-47s and G-3 automatic rifles, the Turkana go either on stealth raids – in which teams of men covertly steal cattle – or on battle raids, in which hundreds of warriors attack enemies to seize land, capture livestock or retaliate for past violence. “Half of adult male mortality is from warfare,” said Mathew. Of warriors she interviewed, 40% had sustained bullet injuries.

Mathew knew that raiding was traumatic. She saw the wounds. She heard about slaughtered children. She understood that some men were forced to abandon their injured friends rather than carry them with enemies in pursuit.

But she was struck by how the Turkana responded to these events.

Instead of ignoring the past, or finding it too painful to speak about, conversations overflowed with memories of past raids. In dances, men sang about the cattle they had seized. Warriors and their female relatives wore scars commemorating kills.

The local attitude to warfare left Mathew wondering: do the Turkana, one of the world’s poorest and most marginalized peoples, leave warfare less traumatized than service members in western, industrialized countries? If they do, what are the lessons for treating trauma in places like the US, where hundreds of thousands of veterans suffer from crippling and often long-lasting PTSD symptoms?

This might seem an extreme, even inappropriate, comparison. Few peoples with combat experience are more dissimilar than Turkana warriors and US veterans. But as Shane Macfarlan, an anthropologist at the University of Utah, explains: people have waged war for thousands of years. To overlook comparisons with people like the Turkana is to ignore the diverse solutions humans have developed to cope with trauma. “It’s myopic – [the way] we tend to be ethnocentric," hy het gesê.

Comparing US veterans and Turkana warriors, Mathew and anthropologist Matt Zefferman, a US air force veteran who trained in identifying PTSD, found startling differences in the two groups’ abilities to lead normal lives after war.

Compared with US veterans, Turkana warriors are less likely to explode at minor snubs. They are less likely to lose interest in activities they once enjoyed. They suffer less shame and are less detached from loved ones. Byna 90% of US veterans with high-severity PTSD scores had problems concentrating, compared with only 26% of Turkana raiders with similar scores. While all suffered from many of the quintessential PTSD symptoms like flashbacks, nightmares, hypervigilance and an amplified startle response, Turkana warriors left war seeming less depressed than their American counterparts.

When we look at the resources poured into each area, this shouldn’t make sense. In 2019, the US government funded 110 grants, totaling more than $50m, into researching PTSD. It spends another $4bn a year in disability compensation to veterans with PTSD: a sum roughly equivalent to the GDP of South Sudan.

The Turkana, intussen, live in one of the harshest and most undeveloped regions in the world. Yet as far as we can tell, they come away from warfare less psychologically disturbed. How is this possible? How is the world’s largest economy leaving its veterans more detached, angry and ashamed than does a tribe of nomadic pastoralists?

“I feel very sad sometimes,” said a Vietnam war veteran in a focus group organized by the psychologist Shira Maguen. “It’s hard to be a soldier. It tears away from your moral fiber.”

Maguen started working with US veterans in 2001, trying to understand the contours of their PTSD. Over years of clinical work and research, she discovered something simple but profound: killing is traumatic.

Early in her career, Maguen was treating veterans at the National Center for PTSD in Boston when she saw that the best available treatments failed to heal some people. Soldiers underwent months of cognitive behavioral therapy, yet still they continued to suffer. These veterans were racked with guilt and shame. They avoided family, hobbies and reminders of war. Many lost their religious faith. Most notable, egter, was a combat experience they shared: they had taken a life.

Maguen remembered a man who had killed a child. He returned to the US and watched his own kid grow up. Raising a child became “a consistent reminder” of the damage he had caused. It forced him to think about everything he denied the dead child – a family, an education, the experience of meeting the world. Whether or not his trauma was deserved, it didn’t stem from a life-threatening experience. It resulted from his perceived immorality.

Op daardie stadium, there was little research to make sense of the veterans’ distress, so Maguen and her peers analyzed datasets of US veterans. Soldiers who killed in Iraq suffered higher rates of depression, PTSD, alcohol abuse and relationship problems. For Vietnam veterans, the act of killing predicted a slew of mental health consequences, from violence to PTSD and dissociative symptoms.

In 2009, Maguen and her colleagues published a now-seminal paper describing what they called “moral injury”, or trauma caused by perpetrating or failing to prevent moral transgressions. The paper kicked off an explosion of research and, in turn, a revision in how we think about combat trauma.

As the war reporter David Wood observed in his 2016 book What Have We Done, “It is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans.”

Will Hopkins, an American veteran who spent 11 months in Iraq, still doesn’t know if he killed in combat. He knows he fired over a hundred rounds, and he has seen pictures of himself “standing next to bodies I can’t remember”. But the firefights he remembers were all at night and at a distance. If he shot someone, they died in anonymous darkness.

The possibility he killed haunted him. “There was a sense that I was irredeemable," hy het gesê. Those feelings were made worse by his participation in what seemed like brutal desolation. “Driving around Iraq, you could tell that it was at one point a fully built-up society. Baghdad was a modern city. But it was so –” He paused. “It was destroyed. You could see the tired trauma of people who had to live through the American invasion. Knowing I’d been a part of that made me feel really ashamed.”

He struggled when he came home. He felt naked without a gun and was possessed by a “pervasive and constant” fury. He remembers going to the mall and “just having such complete rage” at all the happy, oblivious people.

Hopkins was never OK with going to Iraq. He joined the national guard the summer before 9/11, thinking of it as a straightforward way to get in shape and get money for school. He never expected to be deployed. When he got deployment orders, he learned that refusing them could land him in jail. So, he did as he was told.

A big reason US veterans come home traumatized, he explained, is that the military creates killers and then expects them to function normally.

“It’s not easy to take a life. It’s not supposed to be easy.” Soldiers are trained to override their basic instinct not to kill. “The drill sergeant will say, ‘1-2-3-4,’ and you say, ‘Shoot to kill,’ and then they’ll say, ‘1-2-3-4,’ and you say, ‘Kill I will,’” explains Hopkins. By the time he saw muzzle flash in Iraq, he had lost any trace of hesitation. “I was shooting with intent to kill.”

In Iraq, he was able to focus on the job. But at home, he realized he had hurt in ways that could not be fixed.

“I had put more death and destruction into the world than I could undo," hy het gesê.

Soldiers are told, “Now go home back to your life. But that doesn’t work, because you’re still carrying something that humans aren’t designed to do.”

The hardest part about coming home was “trying to learn to be human again”.

Moral injury isn’t unique to US veterans. If a Turkana man becomes rageful and antisocial – if he avoids dances and footraces and responds to slights with a violent wrath – he probably believes he has engaged in immoral actions during a raid. Yet the Turkana seem to experience fewer depressive symptoms.

Whether someone suffers from moral injury depends on a web of factors, like their emotional resilience and moral values. But “there’s no question that the community can really impact how an individual sees themselves,” explains Maguen.

For Mathew and Zefferman, the psychological differences between the Turkana and US soldiers boils down to how the Turkana treat warriors. If a Turkana warrior kills in a raid, he undergoes special treatment. His head is shaved and rubbed with oil and red clay. In one protective ritual, his identity is erased and reconstructed. He strips naked and is washed and given new clothes. Like a child encountering the world anew, he’s told the names of everyday objects and introduced to people he has known all his life.

The rituals are therapeutic. One, akipur, prevents warriors from “wasting away”. Another, ngitebus, is said to repel ghosts who haunt a warrior in his sleep, sometimes decades after a battle. One warrior, plagued by his victims’ souls, underwent ngitebus 11 times over a 20-year period.

These rituals signal community endorsement. Through the ceremonies, the Turkana signal to each warrior that, “even though they’ve done this morally weighty thing, they’re still an accepted member of society,” said Zefferman.

American soldiers, on the other hand, are vaguely thanked for their service. They are awarded for valor and bravery. “But the killing isn’t really acknowledged,” said Zefferman.

Ekt’s not like the rituals used to help heal the Turkana have not been considered in the US. They have. In 2013, a student at the Maxwell air force base in Alabama even published a paper subtitled “Is the warrior’s purification ritual needed or possible in modern America?”

But our moral ambivalence towards endorsing war seems to restrain us. The same moral compass that tortures veterans, that leads them to brand themselves as “murderers” or “irredeemable”, also makes us uneasy about acknowledging moral violations lest we normalize them.

“As long as we are not collectively OK with engaging in war,” said Shane Macfarlan, the University of Utah anthropologist, “it becomes a lot more difficult to help people be absolved of committing morally traumatic events.”

Our resistance to normalizing killing follows from our most sacred moral principles – that people everywhere are free and equal and endowed with a fundamental right to life.

And yet, the combined strength of the US army, the national guard and the reserves is over 1 million soldiers. Soldiers fight wars, kill, and those service members are left traumatized. We use a slew of ritual techniques, from chanting to sleep deprivation, to turn civilians into military personnel, Macfarlan said. “Yet we have no comparable system for bringing people back home.”

Hopkins opposes focusing on rituals like those of the Turkana as a solution to the deeply troubling set of PTSD symptoms US veterans experience. “Just because it would help heal, it doesn’t do away with the problem – that we’re making people do unjust things in the first place – horrible, unjust, enormous things.”

Although Hopkins still carries scars of his trauma, he has recovered from much of it. After completing his six-year term in the national guard, he became a peace activist. In 2009, he became the director of New Hampshire Peace Action, a position he still holds today.

“Doing something to fix the world," hy het gesê, was “probably the most healing thing I have done in my own recovery from the trauma of war.” When he talks to senators and representatives, “they listen to me with a different sense of respect, because I’ve been there and done that," hy het gesê. He’s been able to transform his combat experience, to “make some sense of it by using it to do good”.

Experiences like Hopkins’s are potent for recovering from moral injury, Maguen told me. We want to be moral. But when we kill, we jeopardize this image of ourselves.

One way to restore that image is to help people deal with the feelings of moral corruption. Another is to build and inhabit a new moral life. “A part of healing is working with each person to understand what is the life consistent with their morals and values," sy het gese.

Whatever solution we choose for treating moral injury, it can have undesired consequences. A society where killing is honored, where shame is erased through purification, is not necessarily a society many people want. But what do we do when we create killers yet refuse to accept them – when, through our moral contradictions, we perpetuate despair?

“You can’t have a war and not have morally injurious events,” said Maguen. “That’s the tension: are we going to send troops abroad to fight in wars, or are we not? I think the cascade goes from there.”

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