The scenes of military helicopters and cargo planes evacuating Americans from Kabul look horrifyingly familiar. Once again, service members and veterans bear witness to a hasty and disorderly withdrawal from a war zone where they have been fighting for years. Some may say that the withdrawal from Vietnam in 1975 played out differently than this pullout from Afghanistan, but the history of what followed is instructive. Many warriors who fought in Vietnam continued to suffer for the rest of their lives. We cannot repeat the fallout from Vietnam.
The politics of Vietnam and Afghanistan certainly differ, but the impact on the troops who slogged through the day-to-day fighting is proverbial. For thousands of years, men and women have been thrown into combat and exposed to common agonizing experiences — seeing comrades die and horrific mayhem. Ever since the long Trojan War, historians have chronicled the enduring damage to the warriors and societies in the years following the fighting. Unfortunately, effective treatment for Vietnam veterans lagged for years. Even today, many still feel that they are not getting what they need. The challenges in helping the veterans of Afghanistan and Iraq, are more complicated. The impact on their lives hits deeper than the standard protocols for PTSD and other emotional problems. The fighting has tattooed their souls.
Warfighters carry the moral burden of a nation at war. Soldiers wrestle with mixed emotions of guilt, shame, grief, and anger, as well as pride in doing their duty. The veterans of Afghanistan and Iraq have a growing awareness of the moral ambiguity that has wreaked havoc on their conscience. There was no easy “right and wrong” in Afghanistan and Iraq. Making the wrong choices or living with the aftermath of necessary action with unforeseen consequences have tormented even the most highly trained troops. The chaos and frenzy of the scenes of hasty departure will seed disturbing emotions of abandonment, betrayal, and distrust. It is a good guess that enduring emotions will undermine confidence in military and civilian leadership.
The growing awareness of the moral ambiguity among veterans of Afghanistan and Iraq burdens them with sensibilities of moral injury. Moral injury occurs when a person perpetrates, fails to prevent, bears witness to, or is the victim of an act that affronts their deeply held beliefs and expectations regarding human dignity. Service members are expected to trust that the orders from their civilian and military leaders are aligned with American values. The frantic withdrawal from Afghanistan and abandonment of vulnerable people leaves service members asking whether their sacrifices were in vain and if their actions are consistent with American values.
Supporting and treating the veterans of Afghanistan and Iraq goes beyond the typical approaches. Current standardized programs adhere to so-called evidence-based treatments that limit the number of sessions and follow rehearsed scripts. As a result, the “best” treatments for PTSD and other emotional problems help barely more than half of the patients. This is unacceptable, especially when confronting the more profound moral and ethical distress of this generation of warfighters.
If we are to avoid the mistakes made after Vietnam, then we must stand up as a country and speak to the moral significance of two decades of fighting that ended in embarrassing withdrawal. Our soldiers and the frontline leaders have carried the burden of the political and senior military decision-makers. They need to know that the country will energetically step up to help them in the face of the fallout of American power.
It took too long to build up the treatment and support programs for the Vietnam veterans. The urgent challenge is to stretch beyond just treating PTSD and emotional problems in the standard ways. We must help our veterans cope with the legacy of moral injury that they carry. If the country does not step up and relieve their burdens, then why would any young Americans join the military if they believe their blood, sweat, and tears will be in vain?
Stephen N. Xenakis, a psychiatrist and retired Army brigadier general, is on the Executive Board of the Center for Ethics and Rule of Law at the University of Pennsylvania.
Jesse D. Hamilton is an Iraq War veteran and former advisor to the Iraqi Army who is currently a philosophy Ph.D. student at the University of Pennsylvania.