On Being Blog

The United States Marine Corps Wounded Warrior Regiment provides and facilitates assistance to wounded, ill and injured Marines, sailors attached to or in support of Marine units, and their family members in order to assist them as they return to duty or transition to civilian life. (Photo by Cpl. Tyler L. Main)

“I really don’t like the term ‘PTSD,’” Department of Veterans Affairs psychiatrist Dr. Jonathan Shay told PBS’ “Religion & Ethics Newsweekly” in 2010. “He says the diagnostic definition of “post-traumatic stress disorder” is a fine description of certain instinctual survival skills that persist into everyday life after a person has been in mortal danger — but the definition doesn’t address the entirety of a person’s injury after the trauma of war. ”I view the persistence into civilian life after battle,” he says, “… as the simple or primary injury.”

Dr. Shay has his own name for the thing the clinical definition of PTSD leaves out. He calls it “moral injury” — and the term is catching on with both the VA and the Department of Defense.

We’re turning our attention to this idea of moral injury and the limits of the PTSD diagnosis to explore what happens to a person who has experienced combat.

There are no clean lines separating PTSD from moral injury (which is not a diagnosis) — there is no Venn Diagram, as with PTSD and traumatic brain injury – but Dr. Shay explains a fundamental difference by using a shrapnel wound as an analogy.

“Whether it breaks the bone or not,” he says, “that wound is the uncomplicated — or primary — injury. That doesn’t kill the soldier; what kills him are the complications — infection or hemorrhage.”

Post-traumatic stress disorder, Dr. Shay explains, is the primary injury, the “uncomplicated injury.” Moral injury is the infection; it’s the hemorrhaging.

PTSD in service members is often tied to being the target of an attack — or being close in relationship or proximity to that target.

Moral injury, Dr. Shay says, can happen when “there is a betrayal of what’s right by someone who holds legitimate authority in a high-stakes situation.”

That person who’s betraying “what’s right” could be a superior — or that person could be you. Maybe it’s that you killed somebody or were ordered to kill. Or maybe it was something tragic that you could have stopped, but didn’t. Guilt and shame are at the center of moral injury. And, as Dr. Shay describes it, so is a shrinking of what he calls “the moral and social horizon.” When a person’s moral horizon shrinks, he says, so do a person’s ideals and attachments and ambitions.

I first came across Dr. Shay’s name — and his concept of moral injury in combat veterans — in a heart-smashing profile of Noah Pierce published by the formidable Virginia Quarterly Review.

“The Life and Lonely Death of Noah Pierce” tells the story of an Iraq War veteran from Sparta, Minnesota, who shot himself in the head in 2007 at the age of 23.

From Ashley Gilbertson’s profile of Pierce:

“When Noah went missing in July 2007, after a harrowing year adjusting to home following two tours in Iraq, police ordered a countywide search. His friend Ryan Nelson thought he might know where to look. When he pulled up to the spot, he immediately recognized Noah’s truck. Inside, Ryan found his friend slumped over the bench seat, his head blown apart, the gun in his right hand. Half a bottle of Jack Daniel’s Special Blend lay on the passenger seat, and beer cans were strewn about. On the dash lay his photo IDs; he had stabbed each photo through the face. And on the floorboard was the scrawled, rambling suicide note. It was his final attempt to explain the horrors he had seen–and committed.”

Gilbertson told Noah’s story to Jonathan Shay. Again, from the article:

“Shay, a psychiatrist who has worked with combat vets for twenty years and authored two books about PTSD — or psychological and moral injury, as he insists it should be known — told me by phone from his Newton, Mass., office, ‘It’s titanic pain that these men live with. They don’t feel that they can get that across, in part because they feel they deserve it, and in part because they don’t feel people will understand it.’

“‘Despair, this word that’s so hard to get our arms around,’ he said. ‘It’s despair that rips people apart [who] feel they’ve become irredeemable.’

“I told Dr. Shay about Noah’s experiences in Iraq, in particular the killing, the loss of comrades, the nightmares. He sounded saddened on the phone, but unsurprised. ‘The flip side of this fellow’s despair was the murderous rages he experienced on his second tour,’ he said. ‘In combat, soldiers become each other’s mothers. The rage, need for revenge, and self-sacrificial commitment toward protecting each other when comrades are killed [are] akin to when a mother’s offspring are put in danger or killed.’

“Dr. Shay explained the nightmares and sleeplessness were one of the major issues. ‘The lack of sleep contributed directly to a loss of control of his own anger, a loss of control of things he felt morally responsible for.’”

Treating moral injury in combat veterans, Dr. Shay said in the PBS interview, happens not in the clinic, but in the community.

“Peers are the key to recovery — I can’t emphasize that enough,” he said. “Credentialed mental health professionals like me have no place in center stage. It’s the veterans themselves, healing each other, that belong at center stage. We are stagehands — get the lights on, sweep out the gum wrappers, count the chairs, make sure it’s a safe and warm enough place…”

He doesn’t write off clinical care, though he does disparage “cookie-cutter treatments.”

“We’re certainly doing a lot of things,” he says, “but whether we’re actually preserving vets’ capacity to have a flourishing life after war, I don’t know. I just don’t know.”

Jeff Severns Guntzel is senior reporter for the Public Insight Network (PIN). He has reported from the Middle East and points all over the United States for a cadre of publications and news organizations that are not usually mentioned in the same sentence, including Punk Planet Magazine, National Catholic Reporter, Village Voice Media, MinnPost.com, and GOOD. He also did time as an editor at Utne Reader.

Read more of Jeff's reporting as part of the Public Insight Network's veterans health project on vets and all those working to help them navigate life after combat.

Students discuss the Congressional Civil Rights Pilgrimage at 16th Street Baptist Church in Birmingham, Alabama. (Photo by Sandi Villarreal)

If you could stand in someone else's shoes... Hear what they hear. See what they see. Feel what they feel. Would you treat them differently? A video that speaks to the connections we all need.

Phil Lakin (@phlakin) of Tulsa, Oklahoma watched and responded with this observation:

It's unlikely you will have dry eyes after watching this. If I ever had a superpower, I would want the power to heal.

And on our Facebook page, Minneapolitan Krista Pearson wondered:

Beautiful indeed and so much sadness. Holding the paradoxes of life in balance can be a challenge (at least for the sensitive). Is it possible to empathize too much?

I ask you. What would be your reply? Rejoin her on the discussion thread.

Laura Rushing's photo paired with these words from John O'Donohue's Anam Cara: A Book of Celtic Wisdom rippled throughout our social spheres this week:

"All the possibilities of your human destiny are asleep in your soul. You are here to realize and honor these possibilities. When love comes in to your life, unrecognized dimensions of your destiny awaken and blossom and grow. Possibility is the secret heart of time."

And, this past Friday on International Women's Day, an exploration of notions of womanhood through the great lyrical voices of Rilke, Whitman, and de Chardin in remembrance of guest contributor A.E. Lefton's mother:

"I believe women will hold our heads higher, despite the heaviness of our crowns, once we begin to see ourselves the way Rilke and Whitman saw us — but grounded in the good earth of our own lives."

These sketchnotes capture Fr. Greg Boyle's ideas about kinship and service.

"The day will never come when I am as holy as the people I serve."

If you haven't had a chance, sit down with them while listening to Krista's interview with the Jesuit priest. See what you hear differently as you peruse these visual notes. Tell us about it.

By bike?!

"I love that Lyon's Cardinal rides bike to Vatican. I'd love it more if he traded briefcase for basket with baguette."

Chicago Tribune religion reporter Manya Brachear (@tribseeker) is soaking in the events of the papal conclave that is scheduled to begin this Tuesday, now that the final cardinal has arrived. Her Twitter feed is a rich flow of serious reporting and whimsical asides. She's definitely worth following.

And Ms. Brachear's tweet just might be the answer to Krista's (@kristatippett) question in response to suggestions from listeners after last week's show:

Our listeners seem insistent that Fr. Greg Boyle should be the next pope. Now how to reach the cardinals...

There was some fun to be had. Jonathan Fields (@jonathanfields) from New York City chimed in:

Wondering if the Vatican would be down with Homeboy Industries Italia. ;-)

And Cincinnati's own Todd Henry (@toddhenry) pounced on Krista's Berlusconi reference with this clever retort:

If Fr. Boyle could sway Berlusconi, it may count as his first miracle needed for sainthood.

Read the entire thread and weigh in with your playful thoughts if you like.

Looking for more inspirational words and images to buoy your weekend? Here are a couple that people shared and spread across the Internet, starting with this passage from Neil Gaiman's Instructions and Eric Vondy's stylized scene:

"Remember your name. Do not lose hope — what you seek will be found. Trust ghosts. Trust those that you have helped to help you in their turn. Trust dreams. Trust your heart and trust your story."

Or these inspiring words from Nelson Mandela:

"I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one's head pointed toward the sun, one's feet moving forward.

There were many dark moments when my faith in humanity was sorely tested, but I would not and could not give myself up to despair. That way lay defeat and death."

As I mentioned in last week's capsule, Krista interviewed Congressman John Lewis this past Saturday during the Congressional Civil Rights Pilgrimage in Alabama. We spoke to so many good people, witnessed so many profound moments. A few observations from Krista on the pilgrimage road:

In D.C. today. To Alabama tomorrow for Civil Rights pilgrimage. Will tweet as possible. Moved to be doing this, and with my son.

At U of AL. Just experienced sister of Vivian Malone with daughter of George Wallace, who barred Vivian and James Hood in 1963. Redemptive.

In Birmingham, Montgomery, Tuscaloosa, standing on Holy Ground. Transformative and simply not tweetable.

Heading to Selma to retrace the march, and Betty Mae Fikes is on this bus. #humbling #amazing

This little light of mine. I'm going to let it shine. -Harry Dixon Loes

A magnificent time with @repjohnlewis on Civil Rights Pilgrimage. Mind- opening, heart-expanding. And the singing. Show to come at Easter.

"Nonviolence is confrontational. It is not silent, but creatively maladjusted to the problems and conditions of this world." John Lewis

May we all be "creatively maladjusted" to the problems of this world. (Inspired by John Lewis and A.J. Heschel)

I'm relishing the idea that Krista's interview with Congressman Lewis will be aired on Easter weekend. It's the Easter message embodied. Look for the podcast on Thursday, March 28th!

Photo of the author's mother with one of her former students. (Photo courtesy of A.E. Lefton)

"...these girls are the rightful heiresses of the bygone women who wore beautiful, heavy crowns." ~Rainer Maria Rilke

What is a woman? And what "beautiful, heavy crowns" are worn by the girls and women of today?

I have heard and read the answers — such beautiful, contradictory answers — given mostly by men. The three answers I think are closest to the truth were written by men who speak in the language of poetry and the sacred: Rainer Maria Rilke, Walt Whitman, and Teilhard de Chardin.

In Letters to a Young Poet, Rilke writes of the evolution of womankind into those "girls and women whose name will no longer signify merely an opposite of the masculine, but something in itself, something that makes one think, not of any complement and limit, but only of life and existence: the feminine human being."

Teilhard de Chardin, in his essay "The Eternal Feminine," speaks in the voice of Inspiration, the female counterpart of Creation:

"I open the door to the whole heart of creation. I, the Gateway of the Earth, the Initiation."

Similarly, in "I Sing the Body Electric" Whitman addresses women as the doorway to both physical and spiritual worlds:

Be not ashamed, women—your privilege encloses the rest, and is the exit of the rest;
You are the gates of the body, and you are the gates of the soul.

When I read these words, the pain of finding one's voice, identity, and confidence are stripped away and the essence of womanhood shines out. Yet even in these writings, which represent the very pinnacle of male descriptions of the female, there is a lack.

There is a lack because, for all its intense beauty, their prose is abstract, elevated, mystical, and not, at the same time, paired with that very particularity and red-bloodedness that gives history its long succession of "great men." Their women are the essence of life itself, yes. But they are not living.

To strike a balance between the social and political necessity of writing real women back into history, and the spiritual reality of the "feminine human being," is something I hope new generations of writers, male and female, will attempt. I believe women will hold our heads higher, despite the heaviness of our crowns, once we begin to see ourselves the way Rilke and Whitman saw us — but grounded in the good earth of our own lives.

In one sense, there is no clear answer to the question, What is a woman? Or rather, there are as many answers as there are women in the worlds of today, yesterday, and tomorrow. At the same time, I feel there is some urgency to answer this question now, or at least to provide the foundation for an answer, because of all the pretend, impossible, and dangerous "answers" media and society are offering our daughters as truth.

If we live in a fractured world, then women reflect the most broken part of it — the most vulnerable, shattered lives. At the same time, women hold the seed of unity, like a sliver of broken mirror that cannot help but reflect a whole, unbroken landscape.

I feel these twin forces at work in myself. It is as if I were both the crushed mirror lying in the street, and also the woman who leans over to see her own jagged reflection multiplied — her own identity and power multiplied because she is no longer afraid of the worst. She has experienced the worst, and though it did indeed kill her, it also sewed her back up with the waters of life thrumming deep inside her veins.

Isis and Osiris. That is what women are. We carry the burden of the old world cut into pieces inside us. And yet we are healers — self-healers too. Lizards who can sever their own limbs, and starfish who can grow new ones.

And I only allow myself to speak in the same abstract, elevated, slightly mystical manner as the three great men I mentioned earlier for one reason, which is this:

If you ask me, I can tell you, in as much detail as you need, exactly and specifically:
how I carried the broken world,
how it killed me,
and how I am learning — slowly, halting —
to sing myself back to life.

For my mother, Jacqueline Táhirih Lefton, 1951—2010

A.E. Lefton is a poet, journalist, and educator currently living in Budapest, Hungary. She is a programs manager at the Romedia Foundation, which works to change perceptions of Europe's Roma people through film, advocacy, and education. You can read more of her thoughts on education and social justice on her blog FireWired.

Fans watch TobyMac perform live at Winter Wonder Slam. (Photo by Susan Lloyd / Flickr, cc by nc-sa 2.0)

Commenting on "Christian Pop," if one is not at home in it, is precarious and will doubtless reveal how out of it the commentator is. So I wander in with a sense of mission. If "public religion" is the field of our notice, overlooking "trendy hip-hop, dubstep, funk, and synch pop beats" would be to miss some very public expressions. Allison Stewart pointed to the music styles just mentioned when commenting on rapper TobyMac, whose album "Eye On It" was only the third "Christian" product ever to have debuted as No. 1 on Billboard's "top ten" charts.

Stewart, in an interview: "The lines between Christian and secular music are so porous now—do you think the distinction even matters?" Answer: "I think the walls are coming down between genres of music in general, and especially Christian music."

The rapper's responses are cogent, modest, and to the point, as he delineates lines between the "vulgar" and "clean versions." I won't pursue this further, lest my ignorance and unfamiliarity be paraded vulgarly. We move on now to comment on the "porous" lines between Christian and secular music or most anything else in the arts line.

I was drawn to this topic while researching for a forthcoming lecture before Chicago Chorale's March 24 Passion According to Saint John by Bach. Whenever I am called, or freed, to wander in the fields of classical sacred music, I find that sooner or later — usually sooner, now — the subject of how "Christian and secular music" inter-relate comes up.

I've been hearing Bach for over 80 years, having been child sat near my father's organ bench while mother was in the small town church choir. And I've been reading musicologists, theologians, and other Bach scholars for three fourths of those years, again and again pondering the lines and distinctions. Sections and strains from Bach's sacred cantatas can sound much like his Coffee Cantata and its kin, until one hears the words. What makes the music religious, Christian, or sacred, and what is "secular?"

Rather than deal with such questions musicologically, I'll turn in the few lines ahead to the questions of esthetics-politics-and-culture. Try as I might, I can't be moved by hip-hop, dubstep, funk, and synth pop beats labeled Christian. And I have to admit that my kind doesn't even try very hard. Yet as in so many areas, the porousness of the line between Christian or religious and secular is welcomed. True confession: of course, sacred and secular lines are blurred or sounds blended in the fields of folk music, and many of us classics-lovers are at home with it, as are composers of choice. A step further: Where is the line between Christian and secular in jazz, and should we worry about it? I am in the company of those, dwarfed by Christian pop adherents, who cherish jazz by Mary Lou Williams, Dave Brubeck, or close-to-home-and-almost-in-the family Andy Tecson, who for years have rendered the old line porous.

What many of us are learning is that some of the choices are simply matters of taste, however rationalized. And those of us who pay attention to how religion or specific faiths like the Christian might best be furthered, fostered, and delighted in musically are learning tolerance. But, wait a minute: what's that I hear? Bach! A-a-a-a-a-a-h.

Martin E. Marty is the Fairfax M. Cone Distinguished Service Professor Emeritus at The University of Chicago. He’s the author of many books, including Pilgrims in Their Own Land and Modern American Religion.

This essay is reprinted from Sightings from the Martin Marty Center at the University of Chicago Divinity School.