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Moral Injury: A Wound of War

  • Synopsis: Published: 2015-03-08 (Revised/Updated 2017-06-26) - The lasting impact of morally injurious experience in war remains chiefly un-addressed - Thomas C. Weiss (Disabled World).
Moral Injury

The concept of Moral Injury refers to an injury to an individual's moral conscience resulting from an act of moral transgression which produces profound emotional shame. The concept of moral injury emphasizes the psychological, cultural, and spiritual aspects of trauma. Distinct from pathology, moral injury is a normal human response to an abnormal event. The concept is currently used in literature on the mental health of military veterans who have witnessed or perpetrated a morally transgressive act in combat.

Main Document

Quote: "Treatment of soldiers with moral injury, according to Mr. Litz, demands a very caring and respectful therapeutic relationship and a dialog with a benevolent moral authority."

Moral injury is a wound of war and the Veterans Administration is pursuing information about it. A group of mental health experts is providing, 'moral injury,' as the name of the guilt and remorse soldiers experience when they do or see things during war. The group says failure to recognize and acknowledge exposure to military or civilian carnage in both Iraq and Afghanistan sets soldiers up for post-traumatic stress disorder (PTSD), which is a severe and often times disabling anxiety disorder affecting one in five combat soldiers.

The findings by experts on the emerging war wound will be discussed at a combat stress conference. A study of the issue was first published in, 'Clinical Psychology Review.' Moral injury is not officially recognized at this time as a mental health issue. The main author of the moral injury paper, Dr. Brett Litz, stated that he and his colleagues are calling for large-scale research into moral injury in order to validate its existence and ways it might lead to PTSD.

Moral injury is something that may happen due to what a person has done or witnessed, according to Mr. Litz, who is a professor, clinical psychologist and counselor for the Department of Veterans Affairs (VA). Mr. Litz states, "I've been seeing veterans for 24 years, and when people who seem well-adjusted and doing fine really talk about their war experiences, what often emerges is sadness about the loss and what they saw. That is moral injury." Mr. Litz and his collaborators specifically define moral injury as:

  • Perpetrating
  • Failing to prevent
  • Bearing witness to
  • Or learning about acts that transgress deeply-held moral beliefs and expectations

Mr. Litz and cohorts argue that soldiers who do not talk to their loved ones, clergy members, or another confidant will become convinced that what they did is unforgivable - leading to recognized symptoms of PTSD such as withdrawal, avoidance and self-condemnation.

Moral Injury Treatment

Treatment of soldiers with moral injury, according to Mr. Litz, demands a very caring and respectful therapeutic relationship and a dialog with a benevolent moral authority. Treatment should also involve doing good deeds as a means to make amends. Experts state, "The lasting impact of morally injurious experience in war remains chiefly un-addressed.' The nature of insurgent wars, where the enemy blends in with the general population, aggravates the average stresses related to combat according to Mr. Litz.

Chart showing soldiers with PTSD or TBI from war
About This Image: Chart showing soldiers with PTSD or TBI from war
Wars might be creating an added risk for exposure to morally questionable or ethically ambiguous situations. A number of soldiers may mistakenly take the life of a civilian thought to be an insurgent. They may directly responsible for the deaths of enemy combatants and unexpectedly see human remains or dead bodies, or see sick or hurt women and children who they found themselves unable to help.

A presentation at the U.S. Naval Center's Combat Operational Stress Control conference represented the first official approach of moral injury as a war wound. The conference is the second time moral injury has been presented in the city of San Diego. The conference draws hundreds of Navy and Marine officials, as well as dozens of clinicians who are charged with monitoring and treating soldiers who experience PTSD, traumatic brain injuries, as well as related consequences.

Approximately 20,000 Marines among the 300,000 plus who have seen combat in Iraq and Afghanistan have developed PTSD. Around 60,000 have experienced mild traumatic brain injury due to repeated exposures to explosions. The mental health and support needs of families of soldiers will also be addressed as the Marine Corp continues to witness an increase in its rate of suicides.

The number of Marines who have taken their own lives has increased from about 13 per 100,000 in the year 2006 to 24 per 100,000 according to Marine Corp officials. The officials stated that a Camp Lejeune corporal who worked in public affairs is believed to have committed suicide when he was hit by a freight train, for example. The highlighting of moral injury comes after thousands of locally-based Marines deployed to Afghanistan, where civilian casualties increased as the war presented few signs of being resolved.

Chart showing percentage of combat soldiers from Iraq/Afghanistan who committed questionable acts
About This Image: Chart showing percentage of combat soldiers from Iraq/Afghanistan who committed questionable acts
A number of Marines were in their second, third, or even fourth combat deployment and studies have shown that despite their training, soldiers subjected to repeated combat deployments were more likely to be involved in what Mr. Litz and cohorts call, 'wrongful acts.' A field study of soldiers conducted in Iraq in the year 2006 discovered that 17% thought all civilians should be treated as insurgents. Mr. Litz also cited a similar study conducted in the year 2007 that found 31% had cursed at or insulted civilians. Approximately 5% of soldiers in Iraq acknowledged mistreating civilians, while 11% admitted to unnecessarily damaging private property.

Formal recognition of moral injury as an issue and precursor to PTSD is long past due, according to President of the Oceanside-based American Combat Veterans of War and counselor to soldiers haunted by their combat experience, Mr. Bill Rider. He stated, 'It is absolutely a forerunner to PTSD. We have a lot of young women and men who are angry as a direct result of what they did and witnessed in war. Many of these soldiers do not know what to do about it. Mr. Rider said, 'The services need to address this and it needs to be validated.'

According to Mr. Rider, moral injury has always been a part of war - one that is often times dismissed by military commanders. He said, 'All you have to do is look at history. Look at how many Vietnam veterans committed suicide.' America has a lot of Marines who get into trouble because of their behavior when they come home and it is often attributed to them being, 'bad Marines,' when the fact is it stems from the moral injuries they experience. Moral injury has always been a part of war, Rider said, and is often dismissed by military commanders.

Awareness: Yellow Ribbon for Troops

Yellow awareness ribbonYellow ribbons began appearing in large numbers after the Gulf War when the U.S. began sending large numbers of troops overseas to the Middle East.

For a long time ribbons have been kept as a symbol of remembrance of men and women who served in places far from home. They have been kept especially by wives, mothers and sisters in times of war in memory of their soldier boys abroad.

Related Information:

  1. Senior Veterans and Their Spouses Benefits for Assisted Living or Home Care Costs - Independence - Veterans Benefits Professionals - (2015-02-25)
    https://www.disabled-world.com/news/veterans/spouses.php
  2. CoQ10 Helps Veterans Relieve Symptoms of Gulf War Illness - University of California - San Diego - (2014-11-04)
    https://www.disabled-world.com/news/veterans/coq10.php
  3. Agent Orange Contaminated C-123 Planes May Have Affected Reservists Health - National Academy of Sciences - (2015-01-11)
    https://www.disabled-world.com/news/veterans/c-123-aircraft.php


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