Why does this book matter?

War and Moral Injury is the first international anthology to showcase the works of many of the most authoritative authors on Moral Injury, what may be the “signature” invisible wound of modern warfare. The volume highlights verse from antiquity to the modern day, and the range of expertise displayed in its essays is breathtaking: contributors come from the fields of psychology, theology, philosophy, psychiatry, law, journalism, neuropsychiatry, classics, poetry, and the profession of arms. 

This profoundly moving collection looks at an atypically broad range of sources of invisible wounds. There are not only stories of death and destruction, but there are also tales of what can happen to those who witness or commit torture, suffer military sexual assault, are cruelly hazed, participate in nuclear preparedness exercises, feel the failure to protect comrades, loved ones, or civilians, and minister to the broken. Amidst all this sorrow and despair there are also stories of healing. It is these stories that are the volume’s most important ones, for the hope they can inspire among those afflicted with Moral Injury (and who care for those so afflicted).

The selected essays are written accessibly so that that a wide readership—the morally injured, caregivers, military leaders, students, and scholars—can benefit from the volume’s expertise. This accessibility lends itself to further energizing the growing international conversation on Moral Injury—a critically important conversation for which we must summon every ounce of courage and clarity we possess.

What is Moral Injury?

What you believe Moral Injury to be depends on how you see the universe. Do you believe in God and the immortal human soul? If you do, you are likely to view Moral Injury as an especially harmful sin that damages the soul—even damns the soul, without recourse to divine forgiveness. If your view is secular, you’re likely to see Moral Injury as a kind of trauma: when morally injured, your identity is damaged, and you struggle to see yourself, your community, and/or the universe in the positive way that you once did. What War and Moral Injury makes clear is that, while there are differences of opinion as to how to define Moral Injury, experts generally agree upon its causes (severe moral transgressions or sins) and its effects (feelings like guilt and depression and self-destructive behaviors like alcohol abuse and suicide). What this volume also makes clear is that religious concepts such as “penance” and “redemption” can have value to morally injured veterans with a secular perspective, and vice versa, empirical concepts like “injury” and “physical health” can help those with a religious perspective. There is, in short, much everyone can learn from the various experts who study Moral Injury, whether those experts be priests or psychologists, lawyers or humanities professors, philosophers or soldiers.

What is the difference between Moral Injury and PTSD?

In the popular press, media, and general public Moral Injury and PTSD are often identified with each other, as if they were two names for the same phenomenon. This is a mistake, though an understandable one. The same event or experience may occasion both, just as an explosive device or rifle round can be the cause of both a gaping physical wound and a deep psychological trauma. Clearly, however, they call for very different treatments, the one by a trauma surgeon, the other by a therapist. 

How do the root causes of Moral Injury differ from those of PTSD?



It has been suggested by some veterans and clinicians that powerlessness in the face of lethal force lies at the heart of PTSD, while the exercise of overweening destructive force is what inflicts Moral Injury. This comes down to a line between “victim” and “perpetrator,” if any such line can be sharply and consistently drawn in war. This view gave rise to the misleading term “Perpetration-induced PTSD” for Moral Injury which had a short life in recent decades. While it is true that some Moral Injury is the offspring of power and its abuse and might be likened to a warrior’s “karma” if you will, this is far from the truth of other many forms of Moral Injury. Consider the Moral Injury of those who only train, rehearse, and inwardly embrace actions that they never in fact perform. Or the transgressions of deeply held truths and values that the morally injured only witness. Finally, there is the profound betrayal of service members who are the victims of military sexual assault and the compounded crimes against them that all too often descend on them when they report these assaults and seek justice. The pages of the Reader are sadly replete with testimony to all the above. Indeed, all the stories of Moral Injury that need to be told to reveal its full reach and many fierce faces are far from having yet been told.

Although we run the risk of oversimplifying complex realities, the common symptoms of PTSD and Moral Injury can be usefully described as anger, depression, anxiety, insomnia, nightmares, as well as addictive and other self-destructive behaviors. Symptoms more specific to PTSD, on the other hand, are flashbacks, fear, memory loss, hyperalertness, and startle reflex, while those suffering from Moral Injury are far more likely to experience grief, sorrow, regret, alienation, despair, and shame. It is important to remember that combat veterans commonly suffer from both PTSD and Moral Injury.

How do the symptoms of Moral Injury differ from those of PTSD?

Most theologians and chaplains (as well as many others) think it unhelpful to medicalize Moral Injury. They think to do so risks misunderstanding the core problem and causing harm to those afflicted with this soul-damaging wound. To them, PTSD—a psychological ailment rooted in physical trauma and physiological effects like flashbacks—does not belong in the same conversation with Moral Injury. Some scientists view PTSD and Moral Injury as two different things: PTSD, they believe, is a physical ailment caused by the rush of extreme fear-producing hormones that affects my brain’s amygdala and hippocampus (the areas that regulate emotions), resulting in fears being linked to specific memories and perceptions, while Moral Injury is a problem rooted in the cerebrum that is not as easily observed or managed with pharmaceuticals. Other scientists see Moral Injury as part of PTSD, arguing that the definition of what makes an event “traumatic” must be broadened to adequately address all the sources of Moral Injury. All these views are well-argued and well-represented in War and Moral Injury.

Does the study and treatment of Moral Injury best belong to religion or science?

“Wrong” and “unacceptable” are not the same thing. Judging whether an act is right or wrong is a matter of moral insight and understanding; but accepting or not accepting it is a deliberate decision. The truth is that violence, even killing, in a violent and murderous world, can be “necessary” without being right or good. Dietrich Bonhoeffer came to believe that “innocence” is not the only or highest calling of a Christian and that to be “sinless” in a sinful world can be irresponsible. Thomas Merton too struggled with pacifism and responsibility and was concerned not to be a “guilty bystander.” Neither governments nor churches are empowered to offer moral “waivers” or licenses to kill.

Does the existence of Moral Injury mean that all killing is wrong and unacceptable?

The traditional and mostly unquestioned answer to this question is that there can’t be. The idea that dutiful service to one’s country in a just war can be simply “wrong,” putting at risk one’s humanity and very soul, is blasphemous and unthinkable to nearly everyone except those who have experienced it to be the case. It is an idea that many or most veterans are unwilling to express, for they know the anger and resentment they will provoke with their words.

The answer to this question lies in the very nature of war. War is about killing and destruction. In the West, the concept of Just War has been misleading and widely misunderstood from its inception in the Christian Roman empire of the 4th century. “Just,” the Latin ius, is primarily a legal term connoting legitimacy, action in keeping with an oath taken, a pact made, or a law passed. Just killing, then, is killing according to accepted rules, killing for which one cannot or should not be prosecuted, decriminalized killing. Just killing, then, is legalized killing, killing within the law; and the law, as recognized by Plato long before the dawn of Christianity, mostly enshrines the self-interest of the powerful. The enduring question here is whether any permit or license to kill, issued by a secular or a religious authority, or both, can effectively waive or absolve the violation involved in taking a human life.


How can there be Moral Injury in a just war? 

To suffer from Moral Injury does not suggest that one has committed a war crime. What we must recognize is that war sets its own rules and recalibrates the conscience of those engaged in combat. What is a crime back home can be a duty in a warzone. This “recalibration” is easier said than done. The deeper one ponders that fact and the longer one listens to veterans laboring to reconcile the dissonance war entails, the more personally compassionate and the less judgmental any civilian is likely to become. In practice, when wars are fought, what matters most to the morally injured is not whether an action is wrong but whether it seems so profoundly wrong that it shatters the conscience, the identity, the peace of soul of the veteran, possibly forever. We must also emphasize that the recognition of Moral Injury does nothing to deny or impugn the extraordinary selflessness, commitment, valor and sacrifice displayed by so many of our men and women in uniform. Those who go to war know well that they are placing their lives, their limbs, and their psyches at risk. The recognition of Moral Injury simply adds to this list the acknowledgement that engaging in combat can also place one’s very soul and humanity in peril.

Doesn’t Moral Injury impugn the virtues of military service?

Throughout history, warriors of all cultures have had to deal with Moral Injury. This truth is evident throughout the range of world literature, from the ancient war epics of Greece, India, and the Middle East to the modern day. The English expression “Moral Injury” is of relatively new coinage, now and again surfacing in primarily clerical circles, such as in the sermons of Bishop Joseph Butler in 1720s England. Since at least the 1960s, the condition has been described in mental health studies, though such studies did not call it “Moral Injury” until recently: typically, what we now know to be “Moral Injury” was associated in these studies with the causes and symptoms of PTSD. It was a contributor to War and Moral Injury, the psychiatrist Jonathan Shay, who popularized the term “Moral Injury” and began the process by which the condition become the focus of scientific interest as well as renewed theological interest. It was only this century that the mental health community began specifically addressing Moral Injury in empirical studies, studies that are increasing in both number and quality. 

Moral Injury is still not listed in the Diagnostic Statistical Manual of Mental Health Disorders (DSM), and there is much debate as to whether it should be. Clearly, more research is needed to determine if, how, and to what degree Moral Injury should be medicalized. In America, the concept is gaining traction within both the US Veterans Administration and the US military. Chaplains are playing a key role within the ranks in promoting, applying, and teaching the concept. Some even attend formal military courses on the topic. Among the services, it is probably accurate to describe the US Marine Corps as leading the charge to better understand and deal with Moral Injury. This is due at least in part because Bill Nash, one of the world’s leading researchers on Moral Injury and the co-author of the “Foreword” to War and Moral Injury, serves as the Marine Corps’ Director of Psychological Health.

How long has Moral Injury been talked about and researched?

Nowhere is data being systematically collected that could tell us the extent of Moral Injury in veterans. This is at least in part because Moral Injury is not in the DSM: the US government, for example, routinely collects data related to DSM disorders like PTSD on service members and veterans. 

We can safely assume, though, that Moral Injury is widespread among veterans. This assumption is safe in part because of the “small” wars that western militaries are engaged in across the world. In such wars, insurgents often hide among civilians, leading counterinsurgents to commit many honest mistakes that lead to civilian deaths and injuries. Also, since non-combatants and enemy combatants often look and act the same to service members, there is the risk that service members will mentally lump the two groups together. As in infamous cases like Haditha, such mental conflation can encourage service members to misdirect rage and violence against civilians—a fact these service members may later have a tough time living with. Another modern circumstance that encourages Moral Injury is the physical and psychological distance between civilian life and the battlefield: is it any wonder, for example, that drone operators can struggle to reconcile their wartime and civilian identities, when, a couple hours before they might take their kids to soccer games, they were firing missiles at insurgents in Afghanistan?

In short, while there is strong reason to believe that Moral Injury is the signature invisible wound of modern armed conflict, the truth of this statement is a finding that awaits systematic research. 

How widespread is Moral Injury among service members and veterans?