Post: What is moral injury in veterans?

On Nov. 11 each year, Americans honor military veterans who have transitioned to civilian status from active duty.

The cultural transition back to civilian life goes smoothly for some, but for others it is a challenging and sometimes lengthy process. Those who have deployed overseas or spent a substantial amount of time in the military may even deal with “reverse culture shock” — that is, upon return, their home culture can feel distant and disorienting.

Along with the cultural transition, veterans may be coping with post-traumatic stress disorder. More recently, clinicians who work with veterans have identified an additional cluster of symptoms that are related to military deployment but do not fit the criteria for PTSD.

These symptoms fit with what has been called “moral injury.” What is moral injury?

Moral injury can occur when a personal moral code — one’s understanding of “what’s right” — is violated. Most individuals develop this code in childhood based on instructions from parents, teachers and religious leaders.

This sense of morality can incorporate fundamental values of religious and legal doctrines such as “Thou shalt not kill” and “Do unto others as you would have them do unto you.” Most of us occasionally stray from what our code says is right, but military service — especially in combat zones — can expose people to situations in which every available choice has morally fraught results.

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One combat veteran who served in Afghanistan, for example, told my psychology of war class that he had shot and killed a child soldier who was about to fire on his men. He knew he had made the “right” choice, but the responsibility for a child’s death was still a heavy moral burden.

The moral conflict created by the violations of “what’s right” generates moral injury when the inability to reconcile wartime actions with a personal moral code creates lasting psychological consequences.Psychiatrist Jonathan Shay, in his work with Vietnam veterans, defined moral injury as the psychological, social and physiological results of a betrayal of “what’s right” by an authority in a high-stakes situation. In “Achilles In Vietnam,” a book that examines the psychological devastation of […]

What is moral injury in veterans?