Moral Injury

For 20 years, I worked in a Department of Veterans Affairs clinic with psychologically and morally injured combat veterans. For fifteen or so of those years, continuing after retirement from the VA, I have also worked with active military service members at all ranks, not as a clinican, but as an advocate for changes in policy, practice, and culture aimed at preventing psychological and moral injury. Dialogues with active military people have partly been in an official capacity—such as performing the Commandant of the Marine Corps Trust Study for General Jim Jones, or as Chair of Ethics, Leadership, and Personnel Policy in the Office of the Army Deputy Chief of Staff for Personnel, or as the 2009 Omar Bradley Chair at the Army War College—and partly as an unpaid missionary from the veterans I served as a psychiatrist.

What I can say from my encounters with present and former military personnel is that the great Homeric narrative fictions are experiments with the moral materials of military practice. Fictions (what Aristotle would have called “poetry”) are experiments with the moral materials of a society and its practices and of the human condition. The great fictions do not cook the books; the experiments have been honestly done. Certain truths, especially in the realm of ethics, are best told through narrative fiction. So long as humans engage in the social practice of war, and of returning to domestic life afterward, the Homeric experiments will offer substantial insight.

It has been my privilege in two books on the Homeric epics to show how these experiments carry living knowledge to us today. I am profoundly grateful for the large-spiritedness and generosity with which professional classicists have responded to the observations contained in these two books, my labors of love. They examine, in particular, the social and ethical world of soldiers within the ecology of power in their own forces.

The epics teach no lesson at all to modern forces on weapons, planning, communications, tactics, organization, training, or logistics. But for those who go to war and return from it today, the epics still vibrate with meaning on cohesion, leadership, and ethics. I speak many times a year with professional military audiences, usually on what might be called jus rei militaris, “what’s right, just, equitable, and legal in the internal conduct of military matters.”

My pitch is clear, simple, and not at all new. Nothing I say is new. I say that three things protect the mind and spirit of persons sent into mortal danger: (1) positive qualities of community of the face-to-face unit that create “cohesion”; (2) expert, ethical, and properly supported leadership; and (3) prolonged, cumulative, realistic training for what they actually have to do and face. I explain why, both to win fights with the least spillage of blood (on both sides, potentially) and to abide by the simplest principle of “do unto others,” these three qualities—cohesion, leadership, and training—are ethical imperatives for military institutions. I speak to these audiences for the veterans I have served: they do not want other young kids wrecked the way they were wrecked in Vietnam.

That’s the fly-over of where I’m coming from and what I’ve been up to. Now to the topic at hand.

William Nash, a senior Navy psychiatrist (the Marine Corps Combat and Operations Stress Control [COSC] coordinator until his retirement from the Navy), Brett Litz, and Shira Maguen, and other clinician-researchers, have done an excellent job of describing a devastating form of moral injury that arises when a service member does something in war that violates their own ideals, ethics, or attachments. The diagnosis PTSD does not capture this. PTSD does a pretty good job of describing a kind of fear syndrome. Litz, et al. pointed out the central fact that PTSD, as officially defined, is rarely what wrecks veterans lives or crushes them to suicide. Moral injury as they have described it does both.

Take that in: the soul wound inflicted by doing something that violates one’s own ethics, ideals, or attachments.

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