Even the most cynical of people must admit that for the majority of humans, there is a powerful, innate aversion to killing other people. In fact, militaries have had severe difficulty in getting their soldiers to actually try to kill the enemy! Dave Grossman’s On Killing: The Psychological Cost of Learning to Kill in War and Society is a compelling and well-researched book that details the history of this phenomenon, and how the military has been successful at overcoming our innate reluctance to kill.
However, this solution, while possibly great for “winning” wars, comes at an enormous cost to the service-member who actually has to perform the killing. I actually think the VA defines the concept of moral injury best in its PTSD research quarterly: “An act of serious transgression that leads to serious inner conflict because the experience is at odds with core ethical and moral beliefs is called moral injury.”
The injury that occurs cannot be seen, but can be more biting and crippling than any shrapnel. We have certain expectations about the world that we have constructed as we grow from toddler to service-member: notions of what it means to be human, what it means to be loved and to love, what is right and wrong, and that our country, military, and the cause we fight for are inherently just and good. We also try and figure out exactly where we fit in this worldview, building a mental model of ourselves and the world around us. When we perpetrate or witness an act that severely contradicts this model, it can feel as if we’re torn in two. It may feel as if there is an “old” half who remains frozen in time at the moment of the incident, and a “new” half which continues on, a shell of our former self. We cannot reconcile what we believe and what we’ve seen. “How can someone who has done so many good things with great intentions take a life? How can I be that same person?”
PTSD and moral injury are often conflated; however one can have PTSD without moral injury, and moral injury without PTSD. In fact “moral injury” is NOT a mental disorder. Moral injury is a perfectly normal reaction to a perfectly abnormal situation. It is not the result of a broken mind, or a chemical imbalance. This being said, the result of moral injury often overlaps that of other mental disorders like PTSD, depression, or anxiety: Intense feelings of shame and guilt, suicidal ideation, re-experiencing the event, excessively thinking about the event, and self-medication with drugs and alcohol. Treatments often overlap as well, such as group therapy, and with regards to disability claims, this injury will need to be claimed as PTSD or another compensable disorder.
However, we cannot simply dismiss moral injury, or lump it in with PTSD, as understanding moral injury for what it is helps veterans to better understand themselves. Veterans need to understand this guilt, shame, and depression is not because they are “bad” or “immoral” people, but specifically because they are so inherently good in a world that sometimes isn’t.