War traumas are commonly associated with the dangers faced in battle or the loss of a fellow soldier. Although this is true for many veterans, it is only part of the problem. Brett Litz recognizes three broad categories of combat injuries: life-threat trauma, traumatic loss, and the recently recognized concept of moral injury. Brett Litz defines moral injury as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
The concept of moral injury has been gaining attention in recent literature on veterans health. I argue that this emerging literature on moral injury can be divided into three areas of primary focus: psychological, spiritual, and cultural.
Brett Litz can be credited for major developments on the psychological aspect of moral injury, focusing on its cognitive, behavioral, and emotional aspects in a preliminary conceptual model.
Major developments in the spiritual aspect of moral injury can be credited to Rita Nakashima Brock and Gabriella Lettini in their book Soul Repair. Their book emphasizes moral injury as “…souls in anguish, not a psychological disorder.” This occurs when veterans struggle with a lost sense of humanity after transgressing deeply held moral beliefs. The Soul Repair Center at Brite Divinity School is dedicated to addressing moral injury from this theological perspective.
The cultural aspect of moral injury has been developed in the work of Jonathan Shay. In Odysseus in America, he defines moral injury as stemming from the “betrayal of ‘what’s right’ in a high-stakes situation by someone who holds power.” Upon transition to civilian life, the unhealed wound of moral injury is deepened by cultural differences. Shay uses the story of Odysseus’ return home as an example:
“He’s a castaway on civilian shores…. What in wartime is a heroic amphibious landing, is in peacetime a criminal pirate raid. What in war is bold and courageous, in peace is reckless and irresponsible; in wartime resourceful, in peace lawless.”
Although the person has physically returned, mentally and emotionally coming home requires a process of adjustment. This process, according to Shay, should consists of “purification” through the communalization of trauma. Moral injury can only be absolved when “the trauma survivor… [is] permitted and empowered to voice his or her experience….” For this to occur, there needs to be openness on the part of civilians to hear the veterans’ experiences without judgment. Fully coming “home” means integration into a culture where one is accepted, valued and respected, has a sense of place, purpose, and support.
The above psychological, spiritual, and cultural perspectives each focus on a different aspect of healing from moral injury, but they all share a common cause: moral transgression. In my social perspective on moral injury, I argue that moral transgression is not necessary for moral injury to occur. Rather, moral injury may also occur from moral transition. This takes place in the transition to civilian life where a veteran looses their sense of group solidarity, leaving them feeling isolated, lacking identity and purpose. Sociologist and WWI veteran, Willard Waller, takes this social perspective in his 1944 book The Veteran Comes Back. He writes:
The ex-soldier’s cynicism is in great part a reaction to the thing that he had once and misses now. When he was one of a group of comrades his life had purpose and meaning, and he resents the fact that such sacred things could end so badly… for many veterans, the comradeship in war remain the high point of their lives.
I explore this seemingly universal fact about war in my post, War is Hell, Civilian Life is Worse. Waller argues that it is not enough to focus on getting veterans jobs and benefits; the veteran will not keep the job if they are not properly integrated back into a local community where they gain a sense of belonging. As stated in my post on Finding Meaning and Purpose, Waller believes “human beings are always reaching out to find something that might save their lives from utter meaninglessness.” A sense of social solidarity is the source of meaning that saves us from this meaninglessness.
In reference to man’s drive to solidarity, Waller cites two psychiatrists of his time, Ginker and Spiegel, whose observations anticipate a great deal of the recent work on moral injury. They observed the importance of guilt reactions in their veteran patients, finding that many experienced self-blame for the death of a comrade, followed by intense guilt. They found that the guilt reaction not only applied to self-accusations (similar to the contemporary concept of moral injury in the three perspectives discussed above) but also to those who experience separation from their squadron. This separation, I argue, is a form of moral injury that can occur on its own, or in conjunction with a perceived moral transgression.
Within the squadron, a tight moral bond forms between the individuals. In his book, War, Sebastian Junger tells us that injured soldiers designated to rear bases often become deserters, leaving their position before fully recovered in order to rejoin their combat unit at the front. Upon transition to civilian life, this moral bond formed in combat is lost. Coming from a situation where one is willing to give up one’s life for a group, the veteran is morally injured by loosing this bond. Moral commitments are necessarily social commitments, making individuals transcend their self-interest to discover the greater fulfillment of social belonging. Moral commitments not only bind the individual to the group, but they also provide direction and purpose. The isolation and disorientation experienced by veterans in transition to civilian life is a form of moral injury that should be recognized alongside moral injuries caused by perceived moral transgression. In both scenarios the individual experiences a profound detachment from communal life.
The literature on moral injury has made significant gains in recent years, covering the psychological, spiritual, and cultural aspects of the issue. With my sociological research on Canadian veterans returning of Afghanistan, I hope to contribute to this growing field when I start interviews this Fall.