by Nancy Sherman
Oxford University Press, 2015
Review by Ashley Cheff and Şerife Tekin on Feb 23rd 2016
Afterwar: Healing the Moral Wounds of Our Soldiers by philosopher Nancy Sherman focuses on the psychological injuries of soldiers who serve in a war zone, including feelings of guilt and shame, as well as a sense of responsibility for their actions. In particular, she engages with the moral dimensions of soldiers' injuries. To respond effectively, she says, we need to provide more than the resources now offered by psychology and medicine.
Sherman argues moral injuries are more than just the symptoms of Post-Traumatic Stress Disorder (PTSD), as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a diagnostic and research guide used in North America and around the world. In this guide, the psychological distress of most war veterans is individuated under PTSD, diagnostic criteria for which include a history of exposure to a traumatic event and specific symptoms from each of four symptom clusters. First, the individual must experience intrusion, such as the traumatic event persistently and involuntarily re-experienced in the form of memories, nightmares, flashbacks, etc. Second, the individual must show effortful avoidance of distressing trauma-related stimuli after the event. Third, there must be negative alterations in cognition and mood, along with, fourth, alterations in arousal and reactivity, such as the inability to recall key features of the traumatic event or markedly diminished interest in (pre-traumatic) significant activities (APA 2013). While these diagnostic criteria give clinicians and caregivers a direction to begin addressing veterans' psychological struggles, for Sherman, they are insufficient and cannot embrace the complexity of those struggles.
Sherman highlights the personal aspects of psychological injuries and their effects on the soldier's/ veteran's self-concepts and self-understanding, as well as their views on the society. These injuries may include feelings of guilt and anger, shadowing the veteran's true self-understanding and personal growth. In addition, mistrust of society and resentment may make it challenging for the returning veteran to continue to nurture existing relationships with loved ones or to develop successful, trusting relationships with others. The challenge in engaging with these issues is that DSM-led clinical interventions only target the "personal" aspects of such injuries; in Sherman's view, we, as a society must work to heal moral wounds. Scientists or clinicians alone cannot do so effectively.
Overall, Sherman makes a thought-provoking contribution to the literature, in both her content and methodology. Her argument that society does not fully grasp veterans' moral injuries and chooses, perhaps from ignorance, to ignore them is a convincing one. To cite one example of her argument, she takes issue with established rituals on how to speak to and act around war veterans. Words such as "thank you for your service" are spoken almost on cue, but for Sherman, they do not relay a sense of appreciation for service. To illustrate this point, Sherman uses the stories of soldiers returning from Iraq and Afghanistan. She shows how these rituals worsen moral injuries and increase negative feelings, such as resentment. Sherman argues veterans prefer to be treated as they really are -- people who have just returned from a horrific war. Avoiding the topic of war when engaging with them, or simply dismissing it with a formulaic phrase, is not a helpful strategy. Soldiers do not want to hear "thank you"; rather, they seek to be heard. They want real conversations about war and normal everyday interactions, not interactions that involve tip-toeing around the subject.
Sherman points to the general lack of acknowledgment of the horrifying realities of war. She argues returning soldiers need, want, and deserve more. Specifically, they need better access to VA hospitals, they need court programs to help them when their journey to recovery takes them down the wrong path, and they need a normalized homecoming where a simple conversation with another person does not make them feel like damaged remains. Sherman argues our current ritualistic way of dealing with soldiers does not help to heal their moral injuries; it may actually make them worse.
Sherman's choice of title is interesting. It is a metaphor for the war soldiers continue to fight after returning home. This war is an internal one, fought by a soldier against herself while she is trying to become "normal" in everyday life and to heal her moral injuries.
This work offers a strong new perspective on an old issue. While research and work has already been done on topics such as PTSD and resources that should be made available to returning soldiers, there are few conversations about everyday interactions and how these affect the healing process. Sherman explains how important these interactions are; she assigns them the same weight that has been put on the availability of physical resources.
Ultimately, Sherman's book is an insightful and valuable resource for philosophers who want to develop effective ethical responses to the moral wounds of soldiers returning from war zones and also for veterans, their families, health care professionals, and policy makers.
© 20016 Ashley Cheff and Şerife Tekin
Ashley Cheff is a senior at Daemen College, NY, majoring in Political Science with minors in Philosophy, Psychology and Criminal Justice. Şerife Tekin is a philosophy professor at the Department of Philosophy and Religious Studies at Daemen College, NY.