What is moral injury? How does it compare, and differ from PTSD? Similar to PTSD, moral injury is grossly under reported. It is a phenomenon that has been around as long as war, but like most psychological war wounds, is not addressed. It has been lumped in with PTSD, but this is ultimately unhelpful. It was not until the Vietnam war that Dr. Jonathan Shay, a physician and scholar, began to classify and define moral injury. Recently, Rita Brock has discussed the spiritual aspect of moral injury. Basically, moral injury is the result of making decisions that go against one’s moral/spiritual fibers. For the purposes of this post (and my research interests overall) I want to focus on those decisions that occur in a combat setting. Moral injury, like trauma, stays with the individual. In 2009 the V.A. defined moral injury as:
perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. This may entail participating in or witnessing inhumane or cruel actions, failing to prevent the immoral acts of others, as well as engaging in subtle acts or experiencing reactions that, upon reflection, transgress a moral code. (“Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy”)
It is easy to identify a few potential decisions that go against one’s moral fibers. This article in GQ highlights the new trauma effects on drone pilots. However, it could be the transition and psychological impacts of killing. This typically startles people, aren’t you trained to specifically do this? There is still a psychological and physiological impact resulting in taking another life. I have counseled numerous people who can still remember everything about that day: the smells, the tastes, the visuals. Although it may be a “good kill” this doesn’t always eradicate the feelings. This is where, I think, the role of the chaplain can be of use.
The role of a chaplain may be of more use than a traditional clinician? Why? I think a big reason for this is the chaplain’s ministry of presence. This fancy parlance is used often to mean the chaplain is where the Soldiers are. If a Soldier is deployed in a foxhole then the chaplain is also there. This level of involvement earns the chaplain’s place as a trusted ally who has been there – or at least knows enough about the structure to support. It is precisely this reason that I still think clergy need to be in the military – uniformed chaplains – instead of what some propose in having civilian clergy minister. It is not that the civilian clergy are bad per se, but there is an element of the system that a chaplain lives and understands.
This seems like a good place to stop for today. I am working on a piece about ideology and trauma. How does a tattered view of freedom affect not only the Veteran but also the community? What does the community do with Veterans? What do they do when the Veteran doesn’t fit the overall projection of what a “Veteran” should be. The effects of PTSD and moral injury are directly related to the ever increasing homeless population among our Veteran community, and the church for one should have something to say about this. Until then, peace.