Using Client-Generated Poetry to Explore the Moral Trauma of War

By J. Scott Janssen, MSW, LCSW

“I love writing poetry.” Jenkins’s eyes lit up as he spoke. I’d just suggested that an image he’d used during our conversation was a powerful metaphor around which a poem could be written. It’s a good lesson in not stereotyping. Why wouldn’t a U.S. Marines combat veteran write poetry? We’d been talking about the Vietnam War. In 1968 he’d been a corpsman carrying on his shoulders the weight of knowing the lives of any buddies who were wounded would, to some extent, be in his hands. For more than 40 years he’d been trying to sort out what it had all meant.

“Hold on a minute,” he said, moving gingerly around the oxygen tubing that wound its way from his nasal cannula to a tangle at his feet. He went to a filing cabinet and returned with a dog-eared manila folder labeled “Poetry,” dropping it in my lap.

Not one to seek out help after the war, Jenkins had turned to poetry, intuiting its power to give language equal to the soul-shaking immensity of the events he was struggling to comprehend.

I asked him to tell me the first poem that jumped to mind. “Don’t think about it, Jenkins. What pops into your head?”

“I Wanted to Say No,” he replied as he hardened his eyes.

I pulled out the poem, put the folder aside, and asked if I could read it aloud.
He nodded cautiously, “I’m not sure I want to go back there, but why not?”
“We’ll stand together on this one,” I said. Then I read:

Tompkins’ blood was under my fingertips.
I’d let it dry there, not wanting to let him go after the chopper
dusted him off with a bullet in his neck.

“Jenkins!” But they don’t let you grieve.
Here in the jungle when the bodies/buddies pile up
all you can do is bite your tongue and let the blood dry on your hands
while someone shouts “Jenkins!”

“You Jenkins?” He snarled. “You send this?”
Holding up a crumpled sheet of paper
as though I knew what the hell he was talking about
as the veins bulged from his neck.

Standing at attention I told him I didn’t know “Sir!”
I figured from the uniform he was HQ
as he told me I was one dumb sonuvabitch and
what the hell did I think I was doing?

I was telling the truth!
The only time in 13 months I ever did,
at least completely, in one of my reports—
Women and children killed, again.

“I have to send this to the Inspector’s Office!”
He glared as I finished his thought in my mind,
You want to get your buddies in hot water?

“Do you want to change this report?”
It didn’t sound like a question,
more like an order,
as if the Inspector General gave a damn.

I felt my voice stuff back into my throat.
I wanted to say no,
tell him to go to hell
but other words came out—“Yes, sir.”

Later I washed Tompkins’ blood away.
But there was blood I couldn’t wash out
no matter how long I tried.
I’ve seen their blood on my hands every day since.

When I finished, Jenkins was crying. His expression appeared to be a mix of emotional pain and fear that I might be sitting in judgment. I reached out my hand, gripping his hand tightly. We sat in silence, the grip getting stronger as seconds ticked by.

Moral Trauma and War
We’d talked much about the war during my visits as part of his hospice team. I had some idea of the impossible situation he and his friends had been in. The war had been fought amid a vast civilian population where it was often impossible to tell innocents from combatants. With military brass obsessively demanding high body counts, the term “enemy” had come to mean whichever Vietnamese men, women, and children were dead when the shooting stopped.

When most people think of combat trauma, they assume its origins lie in what has been done to a veteran or in what he or she has seen done to their buddies. Rarely, if ever, do we consider the potentially traumatizing nature of what these veterans have done to others, what they have seen friends do, and what horrors they have been asked to silently accept. When men and women are thrust into situations where moral bounds have been shattered and in which they are expected to commit acts that under normal circumstances would be considered criminal and immoral, we are setting them up for moral trauma. Though it is often unrecognized, such pain can cut deeply into the psyche of those who survive combat, often fueling shame, guilt, depression, anxiety, and raising questions about one’s character and worth as a human being.

In Vietnam, the nature of the warfare ensured that moral trauma would be widespread. There were free-fire zones in which everyone was considered an enemy; the burning of villages and forced relocation of civilians were common. For heavily-armed young men trained to kill and with instincts to survive (many still teenagers), placed into a war zone populated by civilians in which they were uncertain who was friend or foe, it was a recipe for disaster. Add to this a military command apt to turn a blind eye to violence against noncombatants, training that systematically dehumanized the Vietnamese, and a strategy for victory based on significantly out-killing an often invisible enemy, and multiple layers of trauma become a foregone conclusion.

A Spiral of Trauma
“You ever talk about this before?” I asked.

Jenkins shook his head, “You’re the first one that’s ever seen the poem.”

“Is it okay if we talk about it? No pressure. It’s up to you.”

When he agreed, we took the poem line by line, slowly untangling its layers of existential pain. Careful to move at a safe pace and pause when needed, a picture emerged of how complex moral trauma can be.

The poem’s first line, “Tompkins’ blood was under my fingertips,”drove home the way it often interlocks with the more easily recognized forms of combat trauma originating in blood-soaked battles and traumatic grief. That’s one of the tricky things about moral trauma. It’s typically only one aspect of a larger complex of traumatization that can overshadow, or cause professionals to overlook, its depth and potency. Also making it hard to detect is the fact that this kind of trauma is often concealed behind a wall of secrecy and shame.

We paused so Jenkins could finally express a sliver of the cumulative grief he’d never been able to process.

“Sadness and grief were seen as weakness,” he said. “If you stopped to grieve, you and the people depending on you were as good as dead.”

When we reached the arrival of the commander irate at Jenkins’s nerve to send in a report bearing witness to women and children who’d been killed, Jenkins became angry. Not at the commander but at himself. Despite his acknowledgement that he was under intense pressure to remain silent and protect his platoon from scrutiny, he was painfully aware that he had been making choices. “No excuses. I was making choices and it’s on me that I kept quiet.”

I acknowledged that this was true. He was making choices even though the consequences of speaking up could have been dangerous. Although many vets are able to contextualize such actions in ways that keep them from such self-recrimination, for others this awareness of choice and sense of personal responsibility is one of the hubs around which the pain of moral anguish can rotate. For Jenkins, denying that he was making choices would have trivialized the dilemma he was in and come across as excuse-making.

Instead, we focused on the no-win context in which these choices had been made, not to rationalize them, but to better understand what his conscience was up against. We talked about the nature of combat and the inherent moral confusion of war. We talked about how emotions—fear, rage, impulses toward vengeance—can become amplified, and the powerful protective bond that develops when young men are under fire together. We talked about the human nervous system and how it gets rewired after prolonged exposure to threat and how the need to react quickly without thought protects us but overrides any possibility of making deliberative choices when any potential threat, real or imagined, is perceived.

As it sunk in, Jenkins’s anger refocused onto military leadership in general. They had put him into an impossible situation in which the killing of civilians was not only tolerated but, as he saw it, encouraged.

Here was another horrible element in the moral trauma—his betrayal by those in power. He was betrayed by politicians he had trusted to speak honestly and only use the violence of war when absolutely necessary; betrayed by military command that established an approach to victory that encouraged moral abuses. And there was the betrayal of his homecoming to an America whose protests against the war were often directed at those like himself who had done their duty as they saw it.

The shattering of Jenkins’s moral identity in war had been compounded by the shattering of his trust in the broader morality of his nation’s leaders and in any sense of moral order in the world around him.

It was all there in his poem, the trauma of battle, layers of traumatic grief, the multifaceted moral trauma of seeing what men could be driven to, being forced to witness and remain silent about violence against innocents, and having his trust betrayed by those responsible to lead. It was a veritable spiral of trauma intensified by a hidden dimension of intense moral anguish about what he had seen done by “the good guys,” and at having “kept my mouth shut.”

Therapists as Comrades
Years ago the writer Peter Marin interviewed veterans of the Vietnam War and wrote an essay called “Living in Moral Pain,” in which he argued that in order to address moral trauma on a fundamental level, “Somewhere along the line, therapy must enter those areas in which the therapist and patient become comrades.” Comrades, he writes, in asking “fundamentally moral questions” relevant not only to the veteran as a survivor of war, but to them both as human beings. Big questions about what it means to be human, what it means to be good, what it means to kill another human being and do things in war you’d never otherwise have done, and what it means to live after seeing what ordinary, morally conscious men and women are capable of doing under stress.

Maybe this is another reason moral trauma is so often unrecognized or avoided by those in the helping professions, even social workers. We cannot ask such questions of our clients without asking them, on some level, about ourselves. What would I have done? How would I have reacted? It is easier to dismiss evidence about the true nature of war and avoid these questions entirely, lest our empathy for those who return challenge us to examine our own sense of moral identity and even that of our culture.

In his book Achilles in Vietnam: Combat Trauma and the Undoing of Character, Jonathan Shay observes that “a permanent challenge of working with those injured by combat trauma is facing the painful awareness that in all likelihood one’s own character would not have stood firm.” He goes on to point out that because of this we often have powerful conscious or unconscious motives “not to listen to the veteran’s story, or to deny its truth.”

Engaging clients as comrades, putting ourselves in their shoes and suspending judgment may threaten or alter our sense of who we are. Rather than changing the subject, blaming, or making excuses, social workers working with combat vets need to be prepared to listen and to be changed. At times we must be prepared to leave behind the comfort of familiar psychotherapeutic models and enter a realm where habitual language and lenses fail. A realm in which therapist and client join together in the search for new language, metaphors, and meaning, where the telling gesture and pregnant pause are packed with meaning and in which honesty and humanity trump professional roles and expertise.

Jenkins looks me dead in the eye and asks what I would have done. Part of me wants to deflect the question, control the conversation, hide behind the mask of clinician. Another part wants to believe that I’d have stood up and told the commander to go to hell. But I know this is the easy conceit of someone who has never been in such a pressurized and unwinnable situation.

“Jenkins, I can’t even imagine what it would be like to be in a situation like that.” I had to admit, “I’d have done exactly what you did.”

Before I left that day I asked Jenkins if there were any poems gestating, waiting to be born.

“I’ll have to think about it,” he said. Then he smiled, “I’ll see what comes up when I’m connected with my inner poet.”

A few days later I had a voicemail. It was Jenkins. He’d left me a poem. I called him back but had to leave a message. He would be dead in less than a week, the nurse speculating that he’d had a stroke or heart attack. It was the last time I ever heard him speak.

They tried to kill my voice,
stuff it into a body bag along with all the other
bloody bullet-ridden corpses.

But my voice survived
to tell the story and
scream its grief into the haunted night.

— J. Scott Janssen, MSW, LCSW, is a social worker with the Hospice and Palliative Care Center of Alamance-Caswell, Burlington, NC.