What Do You Believe About Moral Injury: Highly Detailed Series of Articles In Huffungton Post

Moral injury is a relatively new category of injury, and VA is only starting to recognize it, but it's a huge issue for many people. Just because a war is justified does not mean that it won't create internal conflicts for warriors who are in the middle of it.

As a novice chaplain, I met a Navy Seal who had served in Nam. He recounted to me that his unit went on a special kill mission, and that the RC priest had granted the unit absolution. Nonetheless he was wracked with guilt about having killed during this operation. Compounding this was that he was going to a Pentecostal minister, who had told him he was damned for having killed in war.

After all, this minister said, the Bible says (Sixth Commandment) "Thou shall not kill..." Of course, it says "Do not MURDER" no "do not KILL" but nonetheless, this particular Seal's knowledge of religious teaching caused him grievous harm, because he honestly and truly believed he had sinned irreparably by killing in war.

That the Bible allows war, and that killing in self defense are allowed does not help; people with very strong moral compasses can be very profoundly and negatively affected, by the actions they see and do during combat. This is true in a defensive war - one in which the country is attacked. It is much more so true during what in Jewish tradition is considered a voluntary war, one in which the country is on the OFFENSIVE rather than DEFENSIVE. This would be the case in Korea, Nam, Iraq and Afghanistan, Grenada, Panama, etc. In none of these wars did the countries we attacked directly attack us, making it even more difficult for our troops to reconcile the moral disconnect.

Traditionally this has been considered part of PTSD, and given that the mental health professions have traditionally NOT explored moral or religious concerns in therapy, it has gone untreated for far too long. It's vital to hear the patient/client's concerns about what they saw/did, and help them to find a way to understand that what they did wasn't a sin, and help them to reconcile these actions.

Even in a voluntary war, when you are serving in combat, it's "Kill or be killed" so every action is, in the end, defensive even if it feels offensive. Still, though, it can be devastating to the psyche and the soul of many in war.

Moral Injury often involves the theme of betrayal. A young SGT recalls the violated trust when while on deployment their CSM had raped this individual. The command did not believe the individual, the marriage collapsed, and their sense of purpose and self identity was shattered.

Moral Injury goes back to the Bible and David had combat PTSD, and he would struggle with shame and guilt. Helplessness and hopelessness is a dynamic duo that leads to depression.
Iraq and Afghanistan also show symptoms of extreme stress beyond what is encompassed
by PTSD, including depression, anhedonia and dysphoria, guilt, poor readjustment to
civilian life, extreme affect and impulse dysregulation, pathological dissociation,
somatization, marital distress, and alterations in beliefs about the self and relationships
(Ford, 1999; Foy et al., 1984; Henning, & Frueh, 1997; Hoge et al., 2004; Kashdan,
Elhai, & Frueh, 2006; Kashdan, Elhai, & Frueh, 2007; Kaylor, King, & King, 1987;
Kulka et al., 1990; Maguen et al., 2009; Martz, Bodner, & Livneh; 2009; Renshaw,
Rodebaugh, & Rodrigues; 2010). Additionally, some veterans may display a change in
their spirituality and ethical attitudes and behaviors (Drescher et al., 2011). Although
some of these symptoms are included in the associated features for PTSD, experts in the
trauma field agree that PTSD is not sufficient to cover these symptoms, and that the
concept of moral injury is necessary to encompass symptoms including psychological,
social and spiritual problems (Drescher et al., 2011).