MORAL INJURY

Moral injury results from having to make difficult moral choices under extreme conditions, experiencing morally anguishing events or duties, witnessing immoral acts, or behaving in ways that profoundly challenge moral conscience and identity and the values that support them. Moral injury is found in feelings of survivor guilt, grief, shame, remorse, anger, despair, mistrust, and betrayal by authorities. In its most severe forms, it can destroy moral identity and the will to live. The struggle of combat veterans to return to civilian life can be even more difficult than serving in war and last a lifetime.

While moral injury is an ancient wound of war that is documented in literature, in modern times, moral injury has remained largely unaddressed or inadequately addressed because it is confused with post-traumatic stress (PTSD is a fear-victim reaction to trauma from damage to the fear suppression areas of the brain). In addition, clinicians who treat PTSD are not trained in theology or moral philosophy, and when veterans ask moral or religious questions, they are usually referred to clergy. Finally, soldiers and veterans are more likely to seek counseling from clergy than clinicians. Moral injury emerges from activity in a healthy pre-frontal cortex, the executive function areas of the brain.

Near the end of 2009, Veterans Affairs clinicians offered this definition of moral injury:
Moral injury is perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. This may entail participating in or witnessing inhumane or cruel actions, failing to prevent the immoral acts of others, as well as engaging in subtle acts or experiencing reactions that, upon reflection, transgress a moral code.. . Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. (Brett Litz, et al. �Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.� Clinical Psychology Review 29, no. 8 (2009): 695�706.)

Many warfighters who participate in combat suffer the loss of someone who is loved, sometimes dearly. The attachments young warriors have for each other are infused with an intensity that has few parallels in civilian life, coming closer to the attachment a parent has for a child than the bonds of siblings or mere friends'Hence, grief in war can be one of the most traumatic forms of grief. (C.R. Figley and W. P. Nash, Combat Stress Injury Theory, Research, and Management, Routledge 2007)