Moral Injury Killed My Cousin

By Lynne Santiago

A few weeks back, I had the privilege of being invited to view a live performance of Speed Killed My Cousin, a new play by Linda Parris-Bailey and The Carpetbag Theatre, during a rehearsal showing at University of South Florida, Tampa. The play was shown in an intimate venue to a small audience. This enabled us to have meaningful discussion together, along with the cast and director, Andrea Assaf, after the performance. Driving home that night, my mind was racing with thoughts, as the play is provocative and seems to really tap into one’s existential core. My mind has not settled since, and has persuaded me to write this article.

The play is billed to be “rooted in the story of an African-American female soldier and her struggle with post traumatic stress disorder.” I am compelled to assert that this description is incomplete, and does not make clear what this play is really about.

We, in the audience, are given a rare opportunity to sit close with the soldier’s struggles, close enough to actually feel her inner turmoil and feel her pain. And a small venue is perfect in creating this experience. We learn, through the powerful monologues and the dialogue between the characters, that true healing begins from a willingness and ability to tell the story about what happens in war. And we are shown, quite effectively, the generational impact of keeping these secrets.

It is implied that the psychological effects of the war experience develop into post traumatic stress disorder (PTSD), and in being able to tell one’s story, the process of healing can begin. It suggests that the inability to tell one’s story contributes to the difficulties in re-integrating back into society; it contributes to the distress, isolation, and for some, the belief that suicide is the only way out. As a psychotherapist who has worked with survivors of all types of trauma, I agree with this premise. But what is striking to me about this play is that the trauma that most likely kick-started PTSD within the soldier, Debra, is not what is really haunting her. This play exposes a profoundly deeper wound.

Post traumatic stress disorder is the result of being exposed to an event that one perceives as life-threatening. Not all people who experience these types of events develop PTSD, however when one is living constantly in a life-threatening environment, PTSD is most likely to develop; and so this is true with our service members who have been deployed into combat zones. Debra’s experience of driving along in a convoy is a perfect example of how PTSD can develop in our soldiers who have been deployed to Iraq and Afghanistan. Our brain’s response to a potentially life-threatening event is a necessary survival mechanism we all have and need. It is a physiological response that prepares and enables our bodies to respond to the threat – most commonly known as the ‘fight-flight response’. In a combat zone, life threatening events are occurring daily. You don’t have to have a ‘combat’ type job (i.e. infantry gunner, special forces) to be exposed to life-threatening events while in war, especially the type of warfare we have seen in the Middle East and even in Vietnam.  Many of our service members have had non-combat jobs (like driving supplies to different installations), yet these jobs keep the ‘fight/flight’ response constantly ‘on’. That is, the body is in constant readiness, being flooded with neurotransmitters and hormones that are needed to act. After a while, these chemicals change the brain and result in the symptoms we label PTSD.

So when I watched Speed Killed My Cousin, it was clear what contributed to Debra’s PTSD and, again, she told us that story early on. Yet she continued to struggle with something more –  something that she believed she could not tell us. We must wait until the very end of the play for Debra to tell us what is really haunting her. When she finally does tell us, what she tells is not about something someone did to her; rather, she reveals what she did to another.

What is exposed is not so much about PTSD, but rather about Moral Injury.

This play is a story about a female African-American veteran of the Iraqi war, her struggles with post-traumatic stress disorderand the moral injury that haunts her.

This is why this play is so important.  Because it speaks about something we, as a society, don’t really want to know about. It is much easier to understand and empathize with someone who suffers the devastating effects of some horrific thing that was done to them. Yet, if we really want to help our returning combat veterans, we have no choice but to open ourselves up to some appalling realities.

You see, we would much rather believe that events such as those exposed at the POW camps in Guantanamo Bay, or seeing photos of U.S. marines urinating on the dead bodies of Iraqi soldiers, are isolated incidences. Society does not want to believe that our young, ‘boys and girls’ are capable of such ‘crimes against humanity’. Or we solace ourselves with the belief that little Johnny or Annie (or Debra) would surely stop such a thing from happening. How can a soldier speak openly about his or her war experiences when society is operating in such denial?

Even fellow soldiers have difficulty talking about these things amongst themselves. This is portrayed in the brief exchange between Debra’s father and cousin, when the cousin pleads to the father – “Look at me! Look at what I’ve done … You’re the only one who can see it.” This cousin eventually ended his own life while speeding in his car, much like Debra is doing in the play. Hence, the title:  Speed Killed My Cousin.

I want to share with you a few excerpts from a letter left by a soldier who ended his life. You may already be familiar with it. The letter went ‘viral’ and is often used as an example of the consequences of PTSD, yet there are clearly parts of the letter that point to Moral Injury.  The whole letter can be found here.

“You must not blame yourself. The simple truth is this: During my first deployment, I was made to participate in things, the enormity of which is hard to describe. War crimes, crimes against humanity. Though I did not participate willingly, and made what I thought was my best effort to stop these events, there are some things that a person   simply cannot come back from.

“Since then, I have tried everything to fill the void. I tried to move into a position of greater power and influence to try and right some of the wrongs. I deployed again, where I put a huge emphasis on saving lives. The fact of the matter, though, is that any new lives saved do not replace those who were murdered. It is an exercise in futility.

“Then, I pursued replacing destruction with creation. For a time this provided a distraction, but it could not last. The fact is that any kind of ordinary life is an insult to those who died at my hand. How can I possibly go around like everyone else while the widows and orphans I created continue to struggle? If they could see me sitting here in  suburbia, in my comfortable home working on some music project they would be outraged, and rightfully so.”

There is much talk about the growing trend of suicides in our military soldiers that started in about 2004, and continues today despite the genuine efforts of many people who are trying to understand it and find ways to stop it. I’d like a moment to clarify that most of those suicides did not occur with combat veterans who have PTSD, as the media would like to purport. Rather an overwhelming number of those suicides occurred with service members who never deployed. And substance abuse, not PTSD, is most strongly linked. However, suicides are happening in our veterans who have been deployed, sometimes long after they return home and hang up their uniform for the last time. It is believed that more Vietnam veterans have died by suicide over these past 30-40 years than who had died while in combat. I believe we have to look at the idea of Moral Injury if we want to really understand what may be haunting our veterans to the point of wanting to end their own lives.

Brett Litz, the leading researcher on Moral Injury stated:

“Self-harm might arise because you feel unforgivable and damned and you may feel at a very deep level that you deserve to suffer,” Litz said. “So how is someone going to behave if they feel that they deserve to suffer? They may abuse drugs, they may drive dangerously, some may not even care whether they live or die.”

I first learned of Moral Injury about two years ago, when searching the internet for information about suicide, and came upon an interview with Col. Herman Keizer. Keizer is a 34-year retired Army Chaplain who served during both Vietnam and Persian Gulf wars and is the co-founder of the Soul Repair Center. In the interview, Keizer recommends the book Soul Repair: Recovering from Moral Injury after War by Rita Nakashima Brock and Gabriella Lettini, to gain better understanding. They write that Moral Injury comes from having transgressed one’s basic moral identity and violated one’s core moral beliefs.

Currently, it seems that the only organizations truly willing to talk about Moral Injury are faith-based. The Department of Veterans Affairs is finally taking notice, but I work at a VA, and I can tell you that moral injury is not something that is openly acknowledged or talked about —certainly not like PTSD, which is an all too familiar term. And Litz has reported that treatment targeted at PTSD is not necessarily effective for Moral Injury.

The Veterans Affairs website now has a page about Moral Injury and explains that “the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.”

It is assumed those the most capable to respond to moral injury are clergy or people trained by faith-based organizations.  It is these organizations that have taken up the plight, viewing the effect of war as “injury to the soul” or “soul injury.”
So, back to Speed Killed My Cousin …

I am excited about this play because it has the potential to open up the discussion and provoke the audience to face the realities of what our combat veterans have experienced, and why it is so necessary to be willing to hear their stories — every chapter. It takes Moral Injury out of the hands of government, medicine and religion, and gives us another forum to approach the subject and, perhaps, take some responsibility.

If we want to help our service members we (as a society) have to be willing to listen to the stories and accept that these are the realities of war (ALL wars). We have to acknowledge that it is the morally injurious experiences that are haunting our sons, daughters, husbands, wives, sisters and brothers (and cousins!). Educating communities about PTSD is necessary, but not sufficient. It is my hope that Speed Killed My Cousin is presented in playhouses nationwide, and that the concept of ‘Moral Injury’ is included in the details when marketing the play, so that the we can finally start to talk about it for what it is, and help others face the realities of war.

To end, I’d like to thank Linda, Andrea and their colleagues (The Carpetbag Theatre and Alternate ROOTS) for the incredible work they are doing with our veterans. I have witnessed how their veteran program has inspired and effected positive change in veterans who are challenged with mental illness. I know they are making a difference.

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Lynne A. Santiago, PhD, LMHC, serves on the James A. Haley Veterans Hospital Suicide Prevention Team in Tampa, FL, providing individual and group therapy to veterans at risk of suicide. She recently worked with the Department of Veteran Affairs (VA) assisting in the development of their Suicide Prevention Program. She has worked with veterans from all eras (Vietnam, Peace Time, and OIF/OEF), and has gained valuable experience working with military trauma.  Additionally, she has been extensively involved in providing trainings to the VA staff as well as non-VA organizations, professional associations and academic institutions (i.e. University of South Florida, Troy University, Saint Leo University, Hillsborough Community College). She regularly provides the Suicide Awareness and Prevention briefings for US Army Reserve units newly home from a deployment at their Yellow Ribbon Events. As an Army veteran herself, this work has been rewarding and she feels privileged to have the opportunity to serve our warriors.  She also has her own private practice, and is available for consulting: http://www.lynnesantiagolmhc.com/.

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