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And most of US are not suffering mental disorder so worry about yourself A holes

The Grunts: Damned If They Kill, Damned If They Don’t (Part1) By David Wood, The Huffington Post

How do we begin to accept that Nick Rudolph, a thoughtful, sandy-haired Californian, was sent to war as a 22-year-old Marine and in a desperate gun battle outside Marjah, Afghanistan, found himself killing an Afghan boy? That when Nick came home, strangers thanked him for his service and politicians lauded him as a hero?

Can we imagine ourselves back on that awful day in the summer of 2010, in the hot firefight that went on for nine hours? Men frenzied with exhaustion and reckless exuberance, eyes and throats burning from dust and smoke, in a battle that erupted after Taliban insurgents castrated a young boy in the village, knowing his family would summon nearby Marines for help and the Marines would come, walking right into a deadly ambush.

Here’s Nick, pausing in a lull. He spots somebody darting around the corner of an adobe wall, firing assault rifle shots at him and his Marines. Nick raises his M-4 carbine. He sees the shooter is a child, maybe 13. With only a split second to decide, he squeezes the trigger and ends the boy’s life.

The body hits the ground. Now what?

“We just collected up that weapon and kept moving,” Nick explained. “Going from compound to compound, trying to find [the insurgents]. Eventually they hopped in a car and drove off into the desert.”

There is a long silence after Nick finishes the story. He’s lived with it for more than three years and the telling still catches in his throat. Eventually, he sighs. “He was just a kid. But I’m sorry, I’m trying not to get shot and I don’t want any of my brothers getting hurt, so when you are put in that kind of situation … it’s shitty that you have to, like … shoot him.

“You know it’s wrong. But … you have no choice.”

Almost 2 million men and women who served in Iraq or Afghanistan are flooding homeward, profoundly affected by war. Their experiences have been vivid. Dazzling in the ups, terrifying and depressing in the downs. The burning devotion of the small-unit brotherhood, the adrenaline rush of danger, the nagging fear and loneliness, the pride of service. The thrill of raw power, the brutal ecstasy of life on the edge. “It was,” said Nick, “the worst, best experience of my life.”

But the boy’s death haunts him, mired in the swamp of moral confusion and contradiction so familiar to returning veterans of the wars in Iraq and Afghanistan.

It is what experts are coming to identify as a moral injury: the pain that results from damage to a person’s moral foundation. In contrast to Post-Traumatic Stress Disorder, which springs from fear, moral injury is a violation of what each of us considers right or wrong. The diagnosis of PTSD has been defined and officially endorsed since 1980 by the mental health community, and those suffering from it have earned broad public sympathy and understanding. Moral injury is not officially recognized by the Defense Department. But it is moral injury, not PTSD, that is increasingly acknowledged as the signature wound of this generation of veterans: a bruise on the soul, akin to grief or sorrow, with lasting impact on the individuals and on their families.

Moral injury raises uncomfortable questions about what happens in war, the dark experiences that many veterans have always been reluctant to talk about. Are the young Americans who volunteer for military service prepared for the ethical ambiguity that lies ahead? Can they be hardened against moral injury? Should they be?

With widespread public impatience to move beyond the long war years, it’s easy to overlook the pain that endures among service members and their families. Experiences like those of Nick Rudolph and tens of thousands of others are theirs to bear. Many have found peace and acceptance: I did what I had to do, and I did it well and honorably. Others struggle to reconcile the people they have become with those innocent selves who jubilantly enlisted just a few years before. Either way, they manage mostly out of sight and on their own.

Yet a glimpse into their world also raises troubling questions for those of us outside the military – about wartime morality, about the accountability of those who encouraged or tolerated the decisions to go to war. What is the culpability of those who engineered the wars? Of those who approved the funding that enabled the fighting to go on, year after year? What of those who demanded the end of the draft in 1973 and its replacement with a professional fighting force? This “all-volunteer” military excused almost all Americans from service, while its relatively small numbers mean those who do serve must deploy again and again, and again.

MULTIPLE DEPLOYMENTS FOR TROOPS IN RECENT WARS

Frequent deployments to Afghanistan and Iraq have become routine for American soldiers – raising the risk of lasting mental trauma.

As the broad moral injury of these wars is acknowledged, what is our part in the healing?

“Maybe people don’t want to talk about or know about what can happen to some of our sons and even some of our daughters when they go defend the country. It’s not politically correct. It’s not attractive,” said Michael Castellana, a psychotherapist who provides moral injury therapy at the U.S. Naval Medical Center in San Diego. “But it’s the truth.”

‘Bad Things Happen In War’

Until now, the most common wound of war was thought to be PTSD, an involuntary reaction to a remembered life-threatening fear. In combat, the physical response to fear and danger – hyper-alertness, the flush of adrenaline that energizes muscles – is necessary for survival. Back home, it can be triggered suddenly by crowds, noise, an argument – causing anxiety, anger, sleeplessness and depression. PTSD can be quickly diagnosed, and therapy at last is more widely available.

It is not fear but exposure that causes moral injury – an experience or set of experiences that can provoke mild or intense grief, shame and guilt. The symptoms are similar to PTSD: depression and anxiety, difficulty paying attention, an unwillingness to trust anyone except fellow combat veterans. But the morally injured feel sorrow and regret, too. Theirs are impact wounds caused by the collision of the ethical beliefs they carried to war and the ugly realities of conflict.

WAR TRAUMA SYMPTOMS

The definition of Post-Traumatic Stress Disorder doesn’t cover all the symptoms of moral injury, the lasting wounds to the soul caused by participation in morally ambiguous combat events. Here are the symptoms of each, and those that overlap.

Most people enter military service “with the fundamental sense that they are good people and that they are doing this for good purposes, on the side of freedom and country and God,” said Dr. Wayne Jonas, a military physician for 24 years and president and CEO of the Samueli Institute, a non-profit health research organization. “But things happen in war that are irreconcilable with the idea of goodness and benevolence, creating real cognitive dissonance – ‘I’m a good person and yet I’ve done bad things.’” Most veterans with moral injury, he said, “self-treat or don’t treat it at all.”

A moral injury, researchers and psychologists are finding, can be as simple and profound as losing a loved comrade. Returning combat medics sometimes bear the guilt of failing to save someone badly wounded; veterans tell of the sense of betrayal when a buddy is hurt because of a poor decision made by those in charge.

The scenarios are endless: surviving a roadside blast that strikes your squad, but losing lives for which you felt responsible. Watching as your dead friends are loaded onto helos in body bags. Being wounded and medevaced yourself, then feeling burdened with guilt for leaving behind those you had sworn to protect. Seeing evil done and being unable, or unwilling, to intervene.

TROOPS SEE THINGS THEY CAN’T FORGET

A study of 3,761 paratroopers and Marines after their return from combat in Iraq in late 2003 found grim results about troops’ exposure to morally damaging events.

“An individual on a mission may at the end have questions about the morality of what went on, and most guys reconcile that fairly rapidly,” said Thomas S. Jones, a retired combat-decorated Marine major general. He is fiercely fond of young Marines and runs a retreat for the wounded, Semper Fi Odyssey, where he sees many cases of moral injury. He speaks with a parade-ground staccato, occasionally punctuating his thoughts with a concussive “Hell-fire!”

The majority of moral injury cases go much deeper, he said. “They’re more about survivor’s guilt, death of children, death of civilians, that are just part and parcel of combat action. We continue to see guys four, five years on, still struggling.

“This is experience talking! Hell-fire!”

Dr. James Bender, a former Army psychologist who spent a year in combat in Iraq with a cavalry brigade, saw many cases of moral injury among soldiers. Some, he said, “felt they didn’t perform the way they should. Bullets start flying and they duck and hide rather than returning fire – that happens a lot more than anyone cares to admit.” Bender found himself treating anxiety and depression among soldiers “doubting the mission, doubting the fundamental nature of who they are – pretty deep stuff.”

‘We Did It All For Nothing’

Moral injury is as old as war itself. Betrayal, grief, shame and rage are the themes that propel Greek epics like Homer’s Iliad, and all have afflicted warriors down through the centuries.

But during the Iraq and Afghanistan wars, it proved especially hard to maintain a sense of moral balance. These wars lacked the moral clarity of World War II, with its goal of unconditional surrender. Some troops chafed at being sent not to achieve military victory, but for nation-building (“As Iraqis stand up, we will stand down”). The enemy, meanwhile, fought to kill, mostly with the wars’ most feared and deadly weapon, the improvised explosive device. American troops trying to help Iraqis and Afghans were being killed and maimed, usually with nowhere to return fire. When the enemy did appear, it it was hard to sort out combatant from civilian, or child.

At home, as the rest of America gradually decided to oppose the wars aswrong and unjustified or futile, it became difficult for troops and their families to justify long and repeated deployments.

Navy Cmdr. Steve Dundas, a chaplain, went to Iraq in 2007 bursting with zeal to help fulfill the Bush administration’s goal of creating a modern, democratic U.S. ally. “Seeing the devastation of Iraqi cities and towns, some of it caused by us, some by the insurgents and the civil war that we brought about, hit me to the core,” Dundas said. “I felt lied to by our senior leadership. And I felt those lies cost too many thousands of American lives and far too much destruction.”

Dundas returned home broken, his faith in God and in his country shattered. In addition, he was diagnosed with chronic severe PTSD. Over time, with the help of therapists, friends and what he calls his ”Christmas miracle,” his faith has returned.

As the wars dragged on, it became clear that the campaigns to win hearts and minds were not working, and often not appreciated. For some who fought, the memories of their sacrifices have since become tempered by the recent deterioration of security in Iraq and Afghanistan. “We did it all for nothing,” said Darren Doss, 25, a former Marine who fought in Marjah, Afghanistan, and lost friends in battle.

In both wars, context made it tricky to deal with moral challenges. What is moral in combat can at once be immoral in peacetime society. Shooting a child-warrior, for instance. In combat, eliminating an armed threat carries a high moral value of protecting your men. Back home, killing a child is grotesquely wrong.

Guys like Nick Rudolph ended up torn and confused, feeling unhappy and out of place, perhaps guilty and ashamed, or disturbed by their own numbness. Many newly returned veterans simply shrink from civilian society, unable to craft an answer to a jaunty “Thanks for your service!” or “So how was Afghanistan?”

Or the worst: “Did you kill anyone?”

“I can’t go to a bar and start talking about combat experience with somebody – people look at you like you’re crazy,” said a Navy combat corpsman who served in both Iraq and Afghanistan and asked not to be identified by name. He returned burdened with guilt over the lives he couldn’t save. “People say, ‘Thanks for your service.’ Do you know what I did over there? It just seems like you’re being patronized. Don’t do that to me.”

Afraid or unwilling to be judged by civilians, many new veterans isolate themselves, never speaking of their wartime experiences. Unable to explain, even to a wife or girlfriend, the joy and horror of combat. That��yes, I killed a child, or yes, soldiers I was responsible for got killed and it was my fault. Or yes, I saw a person I loved get blown apart. From there it can be an easy slide into self-medication with drugs or alcohol, or overwork. Thoughts of suicide can beckon.

“Definitely a majority” of returning veterans bear some kind of moral injury, said William P. Nash, a retired Navy psychiatrist and a pioneer in stress control and moral injury. He deployed as a battlefield therapist with Marines during the battle of Fallujah in 2004. “People avoid talking about or thinking about it and every time they do, it’s a flashback or nightmare that just damages them even more. It’s going to take a long time to sort that out.”

That’s certainly true for Nick Rudolph. Back home at Camp Lejeune, N.C., in January 2012, after three deployments – a total of 16 months in combat – he was sinking in a downward spiral. Drinking so heavily that he picked up a DUI and got busted a rank, losing his prized position as a squad leader. Seeking help, he snuck off-post to see a civilian therapist. There, he was prescribed sleeping pills and twice slept through morning formation, getting slapped with two unauthorized absences. All this added up to what the Marine Corps considers a “pattern of misconduct.”

At war, he’d been exposed to IED blasts six times and shot once, while he was manning a machine gun in a firefight. He’d risked his life, led men he loved in combat and seen some of them die. And now that he’d come home sick at heart, the Marine Corps, which he also loved, meant to kick him out.

Let’s pick him up now, a year or so later, in Philadelphia. Despite his earlier trouble, he’s been honorably discharged from the Marine Corps and is rooming with Paul Rivera, a Marine buddy from Afghanistan. Nick is working as a bodyguard for a security firm. His physical wounds have healed. Physically he is here. But the sounds and sensations and urgency of battle keep puncturing the peaceful civilian reality he’s trying to occupy.

“Coming back, I didn’t know what could help, like … how do I get those feelings to stop?” Nick said. He can be out in public and then comes something like a panic attack: He feels the adrenaline rush of combat, the crazy excitement, the hyper-alertness … and watches again as the boy comes around the wall. “The feeling hits you and like … I don’t want to be like that.

“I just want to be normal.”

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