Understanding Moral Injury

Suicide among veterans now outpaces combat death. This stunning fact is something to be taken seriously and understood if we are to arrest the trend. Jonathan Shay, a psychiatrist who has studied and written extensively about this attributes the deep unrest to a condition he calls Moral Injury. He states that this type of injury (not illness) is sustained when “there has been a betrayal of what’s right by someone who holds legitimate authority in a high stakes situation.”


The distinction between Moral Injury and Post Traumatic Stress Disorder, another recognized result of time spent around combat, is that PTSD happens to a soldier. It is not a stretch to imagine witnessing death or dismemberment of comrades being traumatizing. Human beings cannot simply switch off the emotions that arise from this, nor can they shut down the responses that have developed over a period of months as an absolute survival mechanism in an extraordinarily taxing environment.


Moral injury is about the inner conflict that surfaces as veterans examine the role they play in the killing that occurs, whether it is giving the order, relaying communication about where and when to drop bombs, or direct assault of another. This cannot be new. For as long as there have been wars, there must be some individuals who question their responsibility and grapple with what is right and who defines that.


Even with clear orders, what we are learning is that soldiers and officers still have feelings about the result of their own actions. This should not be a surprise. As a country, we prize our individuality highly, and nurture the ability to think for ourselves and even to learn how to think. How many movies and books celebrate the rogue officer or PI who refuses to accept the status quo and insists on justice that he or she can live with? It would naturally follow, then, that even in a situation where there has been months of training to conform, to be uniform, that there would be at least a residue of self driven thought.


We must always balance what we are taught by the reigning authority with our own sense of what is right. I am not advocating for us all to make our own rules. If we are able to truly hear our own voices, this could shift what happens in groups, in mobs, even in war. The extreme example and research following World War II and the questions around how people could execute mass murders demonstrated how the power of expectation and critical conditions moved people to suspend their own judgment.


It is this demand to relinquish judgment that opens the crack in the wall of belief. There is a built in challenge to the whole system. As it should be. This is not animation; it is not inconsequential: it is not about deciding to pick up wheat bread instead of rye, or meeting at 6 instead of 7. We are talking about people’s lives. If personnel in the medical field must struggle with proper treatment, even when that mandate is at the forefront of their stated values, how could the question around decision be absent from the equation for  military personnel?


People like Jonathan Shay are working to develop treatments for this deep seated strain.


This essential work brings to light the most fundamental questions about the impact of war and our place in it. Each of us must ask the questions, knowing that soldiers cannot anticipate all that will arise, usually until they are long out of the situation itself. The more we are able to flesh out and articulate these struggles, the better we can help them and others to prepare.


As long as we are sending young men and women into situations that require them to question the heart of who they are, we must be ready to hear what they have to say at each step of the way. I don’t know where that will lead but it is no longer acceptable to demand that people submerge their moral compasses. They are paying for this with their lives. The price is too great for us all.

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About Meg

Meg is a licensed independent clinical social worker with over thirty-five years clinical experience. She holds a Master’s Degree from the Boston University School of Social Work and a Bachelor of Arts from the State University of New York at Binghamton.