Understanding the Elephant in the Room – Moral Injury

“To understand moral injury and address its effects, we need to recognize that it exists,” Thomas Gibbons-Neff writes. (PATRICK BAZ/Getty Images)

Within the last decade, there have been several experts who have addressed the realities of moral injury; Jonathan Shay, Brett Litz, Rita Nakashima Brock, and Gabriella Lettini. The concept is currently used in literature on the mental health of military veterans who have witnessed or perpetrated a moral transgression in combat. Each of these scholars and behavior health professionals have researched the effects of moral injury from a psychological, cultural, and spiritual perspective. However, men and women have returned from war broken, and their diagnosis is wrongly labeled due to not recognizing the wound or injury.  Often the wound is understood to be Post Traumatic Stress Disorder (PTSD) rather than moral injury.

Thomas Gibbons-Neff, a former Marine and combat veteran approaches moral injury from a warrior perspective in his article in the Washington Post, “Haunted by their decision in war.” He reflects on the challenge that the Veterans Administration and the returning warrior have in understanding the difference between PTSD and moral injury. He writes, “Moral injury is discussed in academia but is rarely talked about – and is often misunderstood – among those suffer from it. It isn’t really a part of the ‘returning veteran’ lexicon; instead, veterans use PTSD as a convenient catchall. Yet there is a danger in conflating post-traumatic stress and moral injury. While in many cases they can overlap, differentiating the two allows the returning veteran to understand not only the trauma he or she experienced but also the damage left by the decisions made in war.”

It is through the story of Jeff, one of Thomas’ battle buddies in Afghanistan, that Thomas poignantly shares the devastating long term effects of moral injury. Jeff struggled with suicidal thoughts following his killing of a 15-year-old Afghan boy who had picked up a Kalashnikov. Jeff was broken because of intense guilt. Recognizing Jeff’s wounds as moral injury is the first step toward a diagnosis. Thomas concludes by saying, “To understand moral injury and address its effects, we need to recognize that it exists.”

Click here to read the full article on the Washington Post website.


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