As research for Hooper’s War: A Novel of WWII Japan I encountered people suffering in ways they had a hard time describing but which they wrestled with God over everyday. They told me they went away to fight with an idea “we’re the good guys, they’re not” that did not always survive the test of events. They spoke of a depth of pain that needed an end, some end, and for too many, as many as 22 a day every day, any end, even suicide.
That’s to scratch at describing what we now know as moral injury. The term is fairly new, especially outside of military circles, but the idea is as old as war — each person sent into conflict finds their sense of right and wrong tested. When they see something, do something, or fail to do something, a transgressive act, that violates their most deeply held convictions, they suffer an injury to the soul, the heart, their core. There are lines inside us which cannot be crossed except at great price — ignoring a plea for medical help, shooting a child in error, watching friends die in a war you have come to question, failing to report a sexual assault witnessed, a sense of guilt simply by presence (documented well in Tim O’Brien’s iconic Vietnam War book, The Things They Carried), can cause moral injury. Moral injury is represented well in documentaries such as Almost Sunrise, and though not by name, in films like William Wyler’s 1946 The Best Years of Our Lives and Oliver Stone’s 1986 Platoon.
Society once expressed skepticism toward such ideas; well, perhaps not skepticism, for that implies more of an open mind than calling sufferers cowards, or dismissing them by saying it’s all in their heads, have a drink, take some time off. Now sister illnesses to moral injury such as Post Traumatic Stress Disorder (PTSD) are not only acknowledged as real, but new MRI technology can pinpoint their effects inside the brain.
Moral injury differs from PTSD in that it is tied to the parts of a person that decide right and wrong, and applies guilt, regret or shame as a penalty. PTSD is fear-based, and includes stresses like hyperalertness that worked well over there in war (quite valid adaptations in the mind and body, such as hitting the ground when hearing loud noises, to the real situation of other people trying to kill you), but are dangerous, exhausting, and frightening back here. The flight-or-fight response just won’t shut off, even in the absence of threat. PTSD to many is a loss of safety, but not a loss of self. Moral injury might be thought of as a disconnect between one’s prewar self and a second self develops in the face of death, action, or inaction. Moral injury jumbles these two selves which cannot in fact live well together inside one body.
There is a formal definition of moral injury, “the lasting psychological, biological, spiritual, behavioral and social impact of perpetuating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and…