Recovering from Moral Injury after War
Excerpt from the book Soul Repair: Recovering from Moral Injury after War discusses how moral injury is not Post Traumatic Stress Disorder (PTSD), but often overlaps with it.
The journey home to peace is perilous after war. It does not have to be. We can make it less lonely and lethal. The veterans’ stories that unfold in this book describe a newly-named wound of war called “moral injury.” The stories reveal the lifelong struggle of veterans to live with its scars, the impact on their families, and the various ways our communities can support the recovery of those who experience moral injury.
Moral injury is not Post Traumatic Stress Disorder (PTSD), but often overlaps with it. Many books on veteran healing confuse and conflate them into one thing. The difference between them is partly physical. Post-Traumatic Stress occurs in response to prolonged, extreme trauma and is a fear-victim reaction to danger. It produces hormones that affect the parts of the brain that are involved with responses to fear, the regulation of emotions, and the connection of fear to memory. A sufferer often has difficulty forming a coherent memory of a traumatic event or may even be unable to recall it.
The moral questions emerge after the traumatizing symptoms of PTSD are relieved enough for a person to construct a coherent memory of his or her experience. We organize emotionally intense memories into a story in the brain's prefrontal cortex, where self-control, planning, reasoning, and decision-making occur. The brain organizes experiences and evaluates them, based on people's capacity to think about moral values and feel empathy at the same time.
The suffering of moral injury is grounded in the basic humanity of warriors. That humanity lies deeper in them than its betrayal in war. Whether people are religious, spiritual, or secular, most of us are trained to respect others, to relate to a world bigger than ourselves, and to feel compassion for those who suffer. For many families, a military career is one way to embody core moral values like love of country and service to others. The psychological and emotional effects of combat are often referred to as the “hidden wounds of war.” But given veteran rates of suicide, homelessness, unemployment, divorce, depression, poverty, and imprisonment, how can such wounds really be invisible or hard to detect?
What would it mean to claim our personal and collective moral integrity? It means understanding that some wounds of war, such as PTSD, require treatment, but, it is not just an individual diagnosis. It is part of a larger social consequence of war, and therefore, not simply a private problem that can be solved by therapy. To address it requires engaging moral questions about decisions to go to war with families, communities, and society.