When I began teaching college classes on the Vietnam War in the late 1980s, many students thought the war’s greatest shame was not the unspeakable violence the United States unleashed on that distant people and land, nor even its shocking defeat, but the hostile home-front reception accorded to returning American soldiers. Only a few students had heard of the 1968 My Lai massacre, when US troops murdered more than five hundred unarmed and unresisting Vietnamese civilians. Yet most had heard that homebound GIs were routinely spat on by antiwar protesters and that American POWs were held captive in Vietnam long after the war ended. Those two myths, and others, created an image of US soldiers and veterans as victimized heroes who deserved unconditional respect and deference.

From the 1980s onward, the dominant public injunction about the Vietnam War — and the many wars that followed — was to honor those who served without scrutinizing and judging the morality or justice of the wars they waged. American culture, especially since 9/11, has been saturated with endless reminders that respect for the military is essential not just to the well-being of our troops but to the health of the nation. The larger message was always clear, at least implicitly: to question the causes, conduct, and consequences of war might thwart the greater need to heal from the wounds of war and to continue the fighting. A half century ago, that proposition would have struck many as ethically bankrupt. After all, a 1971 poll found that 58 percent of Americans believed the war in Vietnam was not just misguided but immoral, and many millions said so — clearly, defiantly, and without fear of offending soldiers or veterans, many of whom had themselves joined the ranks of the antiwar movement.

Nadia Abu El-Haj’s important new book, Combat Trauma: Imaginaries of War and Citizenship in Post-9/11 America, shines an original and welcome light on this nation’s long-standing proclivity to envision war almost entirely through the experience of its own troops and, increasingly, through the figure of the traumatized American soldier or veteran. National gestures of sympathy and support for the military have grown in tandem with the “forever wars” of this century, which have depended on multiple tours of duty by the tiny fraction of Americans (less than 1 percent) who have joined the all-volunteer military. Underneath the ritualized tributes to the troops lies a perverse and largely unspoken bargain: civilians agree to thank the military for fighting on behalf of all Americans and even to accord soldiers and veterans special status as “ideal citizens” (President Ronald Reagan’s phrase) as long as civilians do not have to share the sacrifices of war or even give it more than a passing thought. A key part of the bargain, almost never said aloud, is that no one — civilian or soldier — should draw attention to the millions of Iraqis, Afghans, and others who have suffered from US imperialist warfare.

Nadia Abu El-Haj is an acclaimed professor of anthropology at Barnard College and Columbia University as well as codirector of Columbia’s Center for Palestine Studies. While her anthropologist’s eye centers the subject, her work intersects with political philosophy, the history and practice of psychiatry, and the history of contemporary US militarism and imperialism. Her fieldwork for the book included attendance at a variety of conferences, workshops, panel discussions, and theatrical readings, most of them focused on how to define, diagnose, and treat the war-related psychological trauma of American soldiers and veterans.

Although her focus is on the twenty-first century, one of Abu El-Haj’s most significant contributions is to recover the efforts of antiwar Vietnam veterans and psychiatrists who came together in 1970s “rap groups” to explore the cluster of war-related conditions that they first described as “post-Vietnam syndrome” — including guilt, shame, anger, hopelessness, isolation, substance abuse, and intrusive memories. Many of those veterans felt deeply betrayed by the government for lying to them about a war they came to view as unjust, even criminal, but they also held themselves accountable for their participation in aggressive war and, in some cases, clear-cut war crimes. Together with activist psychiatrists like Robert J. Lifton, they rejected therapeutic approaches that sought to evade or minimize the war’s hard realities or blame them on others. They took it as axiomatic that any real healing required a full and honest reckoning with the wrongdoing and the suffering inflicted on the Vietnamese. More than that, they viewed political activism as therapeutic — a way to redirect war-related trauma to positive ends; a way, in Lifton’s formulation, to “animate guilt” toward meaningful purposes, a process he describes in his landmark book Home from the War (1973).

Abu El-Haj finds in this linkage between antiwar activism and psychological therapy a “radical model worthy of revisiting,” a “clinical articulation of an anti-militarist politics.” The efforts of these antiwar veterans, therapists, and psychiatrists played a key role in the formal recognition of post-traumatic stress disorder (PTSD) by the American Psychiatric Association, which, in 1980, included it in its bible of psychological conditions, the Diagnostic and Statistical Manual. Ironically, however, this triumph of activism marked the beginning of what Abu El-Haj views as a dangerous transformation in common conceptions of war-related trauma. Over the next four decades, PTSD was stripped of the political analysis that had been so central to those who first formulated the diagnosis in the 1970s. Increasingly, it was understood primarily as a “condition of victimhood.” Lifton and the veterans he worked with were appalled by the ways PTSD became a basis not for challenging unjust wars but promulgating an image of American veterans as innocent victims deserving of nonjudgmental sympathy.

With the 1982 opening of the Vietnam Veterans Memorial in Washington, DC — which intentionally omits any explicit political statement about the Vietnam War — Americans were told they should learn to “separate the warrior from the war.” The implicit meaning was clear: whatever criticisms you may have of a particular war, you should always honor the Americans who waged it. Abu El-Haj forthrightly challenges the integrity of that distinction. Can we really separate the two? Should we? What about warriors who serve in unjust wars, or commit war crimes in just wars? Should they be honored? Can we offer credible criticism of a war without holding the military accountable for its conduct? Would we be comfortable honoring Adolf Hitler’s warriors by keeping their service separate from the Nazi war they waged?

One of Abu El-Haj’s most original interventions widens our understanding of how US political culture developed an idea of military veterans as innocent victims. It was not just post-Vietnam revisionism. She specifically cites two contemporaneous movements that called attention to violence-related trauma among people other than veterans. One was organized by liberal-left feminists who organized to expose and resist sexual violence and to support its victims. The other was the primarily conservative anti-crime movement that called for “victims’ rights” and a clampdown on perpetrators. While representing very different cultural and political agendas, both movements contributed to a growing tendency to link trauma and innocence. When applied to military veterans, Abu El-Haj argues, the focus on traumatized innocence supplants consideration of the foreign victims of US wars and the conduct and agency of US troops.

After September 11, 2001, the concept of “moral injury” made a major claim on understandings of combat-related trauma and eventually gained traction in the US Department of Veterans Affairs and the Department of Defense. The simplest definitions of moral injury describe it as an “injury to the soul” or a “wound to the conscience” caused by witnessing or engaging in acts that betray deeply held believes about what is right and wrong. Moral injury is often regarded as a relatively new insight about war, but an early framing of it was provided by psychiatrist Jonathan Shay in his 1994 book Achilles in Vietnam: Combat Trauma and the Undoing of Character. According to Shay, moral injury (or what he sometimes called “complex PTSD”) was particularly likely to befall soldiers whose sense of right was betrayed by once-trusted leaders who failed to uphold ethical standards and even demanded the opposite.

There was no easy medical or psychiatric fix for the feelings of guilt and shame produced by moral injury, and Shay, like his predecessors in the 1970s, understood that any serious effort to treat these symptoms was inherently political, requiring an effort to understand the historical context in which immoral actions were licensed by official and unofficial military policies. Thus, the advent of moral injury as a diagnosis opened the door for a return to the politicized therapy of the ’70s.

In common practice, however, Abu El-Haj found that most clinicians who treat moral injury avoid a serious engagement with political questions. They may encourage patients to take responsibility for their actions, and even to find ways to make amends, but not often in ways that challenge the legitimacy or justice of US foreign policy or call for reparative justice for the foreign victims of US warfare. One therapist cited by Abu El-Haj compared the treatment of moral injury to Catholic confession. You ask for forgiveness and move on. This is quite different, she argues, from the ’70s model of antiwar therapy in which “radical political action and psychological healing were cut from the same cloth.” Antiwar veterans and therapists “organized and acted to end the war. As they understood it, repairing the self and ending imperial harm went hand in hand.”

Abu El-Haj finds no evidence that moral injury analysis and treatment have posed a serious challenge to US foreign policy and ongoing militarism. She found that many PTSD experts and therapists uncritically accept the US military’s claims about its devotion to the highest possible ethical standards and its adherence to strict rules of engagement. One group of widely cited clinicians write, “It is important to appreciate that the military culture fosters an intensely moral and ethical code of conduct.” US troops may perform entirely within the rules of war but still suffer from moral injury. Some therapists even argue that psychological wounds are exacerbated because Americans must fight against enemies who don’t share the same scrupulous code of contact. Did these experts somehow miss the coverage of Abu Ghraib and the other notorious dark sites of US torture, the many civilian casualties of US bombing and drone strikes, the kidnapping of suspects (“extraordinary rendition”), the “kill or capture” night raids on private homes, the stories of US troops mutilating and urinating on corpses, the Haditha massacre?

Perhaps the most disturbing finding of Abu El-Haj’s fieldwork is the absence of serious engagement with the brutality of US warfare. More widespread, she argues, is a willingness of clinicians to support the military’s goal of “force protection” — the effort to heal troops so they can return to war. “Diagnosing and treating PTSD has become but one more chink in the armor of prosecuting war.”

Abu El-Haj makes her major points forcefully, but readers may struggle a bit through the deep dives into definitional and therapeutic debates that rely on abstract professional lingo far removed from the life-and-death realities underlying the conditions being treated. It would have been helpful to have more candid translations of this language into ordinary speech, or for her to have addressed some more examples that challenge her argument. What, for instance, might she say about National Bird, Sonia Kennebeck’s 2016 documentary about three US whistleblowers who spoke out against drone warfare? One of them, Daniel Hale, was a young air force veteran who became a National Security Agency intelligence analyst and was sent to Afghanistan to identify targets for drone assassinations.

The film calls attention to the psychological trauma suffered by the three whistleblowers, but not in a way that casts them as innocent victims. It also focuses on the Afghan victims and survivors of US drone warfare. Hale is now serving a forty-five-month sentence under the Espionage Act for giving classified documents about the drone program to the Intercept. The film comes close to recovering the 1970s radical model of politically engaged therapy lauded by Abu El-Haj. If only the exception that proves her rule, it is nonetheless worthy of our attention and a work to build upon.

Abu El-Haj rightly insists that the persistent representation of US soldiers and veterans as traumatized innocents has dire consequences. It serves to marginalize and silence critical thinking about US imperialism — no small thing given the fact that the United States continues to occupy more than 750 military bases on foreign soil, spends more money on the military than the next nine most militarized nations combined, and conducts military operations and exercises in two-thirds of the world’s nations every year.

Abu El-Haj certainly agrees that soldiers and veterans suffering from trauma should receive the care they need. However, they should not be treated as super-citizens deserving of special entitlements and a waiver of individual accountability. If we are to have serious public debates about US imperialism, a first step would be to reject the reflexive assumption of American exceptionalism that imagines US military power as a force for good in the world. And if we are serious about reducing war-related trauma within our own military and among its foreign victims, the most important clinical measure is preventative: stop waging wars.