Injustice and Internal Injuries: Varied Forms of Veterans' Suffering

Over the past decade, some veterans contrast the established medical diagnosis of PTSD with an emerging, alternative term: “Moral Injury.” This move may seem puzzling to many because PTSD offers an established and legitimating framework for discussing the psychological aftermath of war. These veterans, however, use media interviews to object to the limited scope of the PTSD diagnosis, and to its current assumption that their suffering has nothing to do with the moral stakes of the current wars. This paper assesses both constructs, investigating their respective scope, historical developments, associations, and effects. For example, PTSD posits that soldiers’ distress is mainly a response to the shock and stress of combat (or any other life-threatening situation); Moral Injury, in contrast, posits that moral violations—committed either by the soldiers themselves, others, or resulting from broader military and government policies—have the capacity to cause disabling psychological harm. While the underlying premise of all versions of Moral Injury is that suffering can illuminate ethical problems, the precise source and nature of those ethical problems is variable: sometimes the ethical discussion focuses on the war itself, and at other times the way the war is fought, or how soldiers are treated. This variability within the construction of Moral Injury creates different opportunities for discussing the justifiability of war. The term was initially used in the mid-1990s to focus attention of the well-being of veterans and their potential vulnerability in ways that exclude engagement with questions of the ethics of the war itself, but, as more recently examples suggest, with small adjustments in meaning, it can be used to sharpen critiques of a war’s legitimacy by presenting suffering as a symptom of war’s underlying unethical nature. The paper argues that this variability in associations and effects can be discerned throughout the historical developments of both Moral Injury and PTSD. And tracing these effects reveals a striking reversal: while Moral Injury emerged in a VA-clinic setting where critiques of the U.S. war in Vietnam were considered taboo, it has most prominently developed into a construct used in advocacy efforts that are critical of post-9/11 wars. PTSD, in contrast, was initially promoted in the late 1970s in a context replete with anti-war associations, but, because of subsequent clinical and cultural developments, in most contemporary settings it has the effect of limiting critiques of war.