The deepest war wound may be the anguish of moral injury

'Moral injury' in war may be the deepest wound

When the Greek playwright Sophocles came home from war, in the 5th century BC, trust and betrayal must have been on his mind. He wrote “Philoctetes,” about a wounded Greek warrior abandoned by Odysseus on the way to Troy.

The stench of Philoctetes' wound and his wails of distress made him a liability. That is, until Philoctetes' sacred bow, a gift from the god Heracles, turned out to be the Greeks' last hope for defeating the Trojans. Odysseus returned to rescue Philoctetes (or at least his bow), but he dared not show his face to the man he had left behind. Hidden, he coached a young soldier, Neoptolemus, on how to build rapport with Philoctetes in order to exploit it to get the bow. The twist in the play is that real trust is cultivated instead; and with it, hope that heals.

The ancient Greeks understood Philoctetes' agony and salvation in the context of the Peloponnesian War. Modern Americans can apply it to the longest conflicts in American history: the wars in Afghanistan and Iraq, in which 2.7 million troops have served. Many are bringing home the weight of resentment and betrayal, and often guilt and shame, even if it's masked by a stoic military demeanor. Like Philoctetes, some feel betrayed by commanders or unit members; some by civilians who've been “at the mall while we've been at war”; and some by politicians they think have failed to take full responsibility for the wars they started.

The term “moral injury” resonates with these troops. It's an old concept. The notion of a wound that is moral, or occasioned by “contempt” and “injustice,” is the centerpiece of sermons by Bishop Joseph Butler in early 18th century England. From the philosopher's perspective, the concept is a way of talking about anguish caused by wrongdoing (real and perceived ) — others toward you, you toward others, others toward others, you toward yourself. Agent, victim and witness are all players in the moral conscience.

And transgression isn't the only issue at the heart of moral injury. So is falling short of the lofty ideals of military honor. That the military code — never abandon a buddy, bring all your troops home, don't put innocents at risk — is impossible to meet doesn't always register deep down. The result may be shame, and all too often suicidal shame.

Moral injury is distinct from post-traumatic stress disorder, which is generally thought of narrowly as a fear-conditioned syndrome marked by hyper-vigilance and flashbacks. The prevailing treatment for PTSD is therapy to “decondition” the fear response. But guilt, shame, raging resentment and betrayal are different from fear. To overcome them requires relationships that rebuild a soldier's sense of trust in himself and others, no small order given the effects of war.

Take Sgt. Eduardo “Lalo” Panyagua. He joined the Marines as a way out of a tough life in an L.A. barrio. At high school he met Donna Hernandez, a dark-haired, dark-eyed Goth girl with street smarts and a bookish sensibility. Fast forward a few years. She ended up at Georgetown University and he joined the Marines, deploying to Fallujah in Iraq, and later to Marjah, in Afghanistan. Before that last deployment, in 2009, they eloped. In her senior year, she became my student, and I met Lalo, home from Afghanistan, working at Quantico Marine Base and struggling with stateside life.

His desk job was nothing like the combat roles he excelled at. His physical wounds required treatment and his commander read it as malingering. His flashbacks had him flinging his wife across the room and wielding a knife for her protection.

At Donna's insistence, he went to see the “wizard,” Marine talk for a counselor, but it wasn't enough. He was treated, correctly, for PTSD, replaying his story over and over, trying to desensitize himself from his adrenaline-fueled fear and rage. But what really wracked him was guilt and shame. He felt he had betrayed three of his “baby birds,” Marines who didn't make it home.

“I was in charge of guys,” he told me, “and my biggest fear out there was losing any one of them. They're all like little brothers who I trained.”

One incident stood out. In a convoy near Marjah, Panyagua's unit had been emplacing ground sensors. Cpl. Justin Wilson needed a pit stop. Wilson jumped off his armored vehicle, found himself an empty hut for privacy, and got pulverized. Lalo literally picked up the pieces. That was bad enough, but what really ate at him was this: Whenever one of his guys stepped off an MRAP, he had reminded them to be careful, to open their eyes. But he wasn't sure he repeated the mantra that day.

Lalo is lucky in having Donna. Patiently, authentically, in a way reminiscent of the young soldier in “Philoctetes,” she has bootstrapped trust and hope in her husband, answering his self-reproach with a corrected vision of who he was in the war, what he did, and who he can be now.

“Everyone falls in love with Lalo,” she says, meaning not just that he charms but also that he is worthy of love. She reminds him of the truth he has trouble seeing: He was a good Marine; he surpassed expectations in every mission he was assigned. At her request, he was in full regalia at her graduation from Georgetown, an acknowledgment of his honors and his capacities. Her enduring support is rescuing a self-marooned warrior.

There is a final link to the Philoctetes story. Like Neoptolemus, Donna has had to scheme to confiscate Lalo's weapons. First it was a knife — gone. Then he took up archery. “He can't really hurt anyone with a bow and arrow,” Donna laughs, but even that is over now. Their relationship provides him with a different kind of protection, the kind that saved Philoctetes and that so many of our veterans need.

Nancy Sherman is the author of "Afterwar: Healing the Moral Wounds of our Soldiers." She is a professor of philosophy at Georgetown University.

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