Moral Injuries for Military Personnel and Veterans

Kaitlin Wynia reasons that the phenomenon of moral injuries promises important insights into the value of interdisciplinary approaches to understanding health issues for military personnel and veterans.

__________________________________________

Military operations are often coloured with ethical grey areas and the harsh realities of combat exposure. In their service to Canada, military members may come face-to-face with situations that challenge deeply held moral convictions. For example, they may be forced to make difficult decisions that lead to the loss of life or bear witness to torture, cruelty, and human suffering. When moral convictions are threatened, military members may experience emotional, spiritual, relational, or psychological problems, such as social withdrawal and self-destructive behaviours. Moral injuries refer to the health problems that occur when an individual acts or bears witness to an event that transgresses their understanding about what is right and good.

Jonathan Slay, a leading American clinical psychologist and advocate for veterans, argues that it is not post-traumatic stress disorder (PTSD) that “wreck veterans’ lives, crushes them to suicide, or promotes domestic and/or criminal violence.” Moral injuries, commonly in conjunction with PTSD, can offer insight into the high rates of suicide, homelessness, and the difficult transition to civilian life often reported by combat military and veteran personnel. Moral injuries have been predominately taken up and conceptualized by religious leaders and psychologists. Conceptualizing moral injuries holistically and in a manner that reflects lived experiences is important for those seeking to facilitate the healing process.

In efforts to improve treatment, psychologists tend to observe and measure the elements of moral injuries. Moral injury is thus understood in biomedical and neurobiological terms.

(De)Facing P.T.S.D. by Danny Quirk (2014). Image description: A man dressed in military clothing sits on a stool He holds a rifle in his right hand and a mask in his left hand. The mask looks like his face with a serious or concentrated expression. Behind the mask, the man himself appears to be crying or in pain.

The concept of a moral injury was developed within the discipline of psychology during the 1980s and put forward by Johnathan Slay in the 1990s. Although this perspective can illuminate the causes and outcomes of a health problem, this perspective misses the mark when it comes to considering the broader contextual factors that shape health or illness experiences. If understanding the concept of health to encompass notions of positive wellbeing and thriving, one needs to expand their perspective beyond that of biomedicine or neurobiology.

A reliance on the biomedical model inhibits psychologists from pursuing “a thick description” of the sociocultural and spiritual factors that may lead to moral injuries. A thick description is a detailed account of a human behaviour or social phenomena that provides rich and meaningful understandings. Furthermore, a clinical psychologist’s position within the biomedical model renders them unable to question or value the morality of war and the moral assumptions held by those impacted by the experience. As the healing process can entail restructuring or restoring the moral assumptions that were transgressed during military service, this ability is imperative.

Theological inquiry promises to provide contextual knowledge that can fill in the conceptual gaps left by the discipline of psychology. Discussions around moral injuries often reside within the field of practical theology. Bonnie J. Miller-MeLemore (2012), a prominent practical theologian describes this field as the pursuit of knowledge about religious belief and God that can be applied to and influence “the day-to-day lives of individuals and communities.” Practical theologians can offer a response to questions about why a combat or war event is morally injurious. Military chaplains and other religious leaders can thus wield practical theology to shed light on the latent aspects of moral injuries inaccessible to psychologists positioned within the field of biomedicine. While theology can offer insights into the latent aspects of moral injuries, this discipline is unable to elucidate its biological components and to objectively measure treatment effectiveness.

A moral injury is thus a health phenomenon that stretches beyond disciplinary boundaries and compels both those positioned within biomedicine and theology to collaborate. In efforts to better understand root causes, symptoms, and potential treatments, of moral injuries, both psychologists and theologians can uncover different facets of the same health issue. An interdisciplinary lens can aid stakeholders in identifying and responding to the cultural, historical, economic, social, biomedical, and religious underpinnings of a moral injury. With an understanding that is reflective of the experience, both clinicians and theologians will be better equipped to aid military and veteran personnel in the healing process. As knowledge of root causes, symptoms, and treatment progresses, those committed to improving health and well-being can glean important lessons from moral injuries.

__________________________________________

Kaitlin Wynia is a first year PhD student in Health Studies in the Department of Health, Aging, and Society at McMaster University.