Graduate Theological Union

Hidden in Plain Sight: Moral Injury as a Wound of War

By Gabriella Lettini

Originally posted on Huffington Post for Veteran's Day

War does not end when peace is declared and the troops come home. It continues to affect the bodies, psyches, souls, lands and communities of everyone involved. War's tragic legacy passes on from generation to generation, more dangerously so when it is ignored and left unattended.

The psychological and emotional effects of combat are often referred to as the "hidden wounds of war." However, given veterans' rates of suicide, depression and homelessness, to mention only some of the issues affecting our returning combat people, are such wounds really invisible or hard to detect? World literature is full of stories about the difficult coming home of warriors deeply wounded by the terrible acts they perpetrated, they were subjected to or were unable to stop. The arts and hushed family secrets have witnessed the torture war inflicts on the souls of veterans. Odysseus is one of such tragic figures; his homecoming ends in a bloodbath. Virginia Woolf in "Mrs. Dalloway" portrayed the suicidal anguish of Septimus Smith after surviving the trenches of WWI. In 1946, John Houston's "Let There Be Light" documented the brokenness and moral anguish of War World II veterans in a military hospital in Long Island. Unfortunately, the U.S. Army refused to release the documentary it had commissioned, and it was unavailable until 1981.

Societies have many strategies for hiding the wounds of war: suppression of facts, idealization of combat and soldiers, historical amnesia, diversion and censorship, to name a few. Favoring therapeutic and clinical approaches that only pathologize individual soldiers for their reactions to war instead of looking at the larger and more complex issues of the costs of war is one of the ways society skirts its responsibility towards soldiers and its involvement in war. To focus on addressing Post Traumatic Stress Disorder (PTSD) is of pivotal importance, but human reactions to war cannot be considered as just any other trauma response. The spiritual and ethical questions raised by victims of rape, natural disasters and train wrecks are not necessarily the same as those who have participated in killing of innocent civilians and acts of torture commanded by their superiors.

PTSD is a fear-based reaction to being a victim of any extreme life-threatening conditions. Moral injury, however, is a negative evaluation of the use of personal agency in such conditions -- and though it is not PTSD, it can provoke or intensify it. It comes from having a sense of empathy for others and from understanding moral reasoning and values. Killing, torturing prisoners, abusing human remains or failing to prevent such acts can elicit moral injury. The wars in Iraq and Afghanistan, especially, have created terrible moral dilemmas for engagement because the lines between civilians and combatants are invisible; the absence of clear battle lines makes every situation potentially lethal. Even women, children and family pets can be dangerous. Many veterans recount with anguish stories about shooting reflexively at unarmed civilians.

Seeing someone else violate core moral values or feeling betrayed by persons in authority can also lead to a loss of meaning and faith: moral injury is related to the betrayal soldiers feel when the motivations for going to war given by their government and superiors are discovered to be false. It can even emerge from witnessing a friend being killed and feeling survivor guilt. Even medics and body baggers have reported moral injury. In experiencing a moral conflict, soldiers may judge themselves as worthless. They may decide no one can be trusted and isolate themselves from others and may abandon the values and beliefs that gave their lives meaning and guided their moral choices.

The consequences of violating one's conscience, even if the act was unavoidable, can be devastating. Responses include overwhelming depression, guilt and self-medication through addiction to alcohol or drugs. Moral injury can lead veterans to feelings of worthlessness, remorse and despair; they may feel as if they lost their souls in combat and are no longer who they were. Connecting emotionally to others becomes impossible for those trapped inside the walls of such feelings. When the consequences become overwhelming, the only relief may seem to be to leave this life behind. Clearly PTSD treatments have not been able to satisfactorily deal with the sense of anguish and moral alienation of many veterans.

This Veteran's Day, let's honor veterans and all people affected by war by striving to understand and address moral injury and the ever-lingering and far reaching consequences of war. The process of healing cannot start unless we can engage what truly ails us.

Gabriella Lettini, Ph.D., is Aurelia Henry Reinhardt Professor of Theological Ethics and Dean of Faculty at Starr King School for the Ministry. Her new book, "Soul Repair: Recovering with Moral injury After War," co-authored with Dr. Rita Nakashima Brock (former visiting scholar at SKSM), has been recently released by Beacon Press.

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