Moral Injury--Personal, Organizational, and Divine Betrayals

By Pete Kilner, Ph.D.
version: 1-10-2018
original posted: 11-1-2016

Currently, the academic literature on moral injury recognizes two causes of moral injury. I think that it’s largely overlooking a third cause, one that involves religious belief and the mystery of evil.

I think the evidence shows that combat-related moral injury is caused not only (1) by feeling betrayed by an authority figure and (2) by doing (or failing to prevent) actions that violate your own moral beliefs, but also (3) by encountering large-scale, senseless violence and suffering.

Comparing Three Causes of Moral Injury
Level of violation
Personal
Organizational
Divine
The perceived violator of moral goodness
Soldier him/her-self
Leader who wielded authority over the soldier (e.g., section leader, commander, POTUS)
Whoever is responsible for the world, aka, God.
Victim’s response
“I did something terrible. I’m a bad person.”
“I was screwed by ‘higher.’ I trusted them literally with my life but was used and abused. I risked my life and took others’ lives, and my buddies died, for someone who didn’t care.”
“No real God would allow this situation to take place. This is irrational, horrifying, unfair, more than I can handle. This world sucks.”
Likely symptoms
Guilt, shame, self-harm, risky behavior.
Anger at the organization, cynicism, loss of faith in human institutions, inability to trust.
Anger at God, loss of faithin God, doubt goodness of world, demoralization.

substance abuse, suicidality


  1. One catalyst of moral injury is feeling deeply betrayed by a legitimate authority. This thesis was initially put forth in the 1990's by Dr. Jonathan Shay, a Veterans' Administration psychiatrist who had worked with Vietnam War veterans for decades. Shay argues that moral injury is caused by three elements:
    • A betrayal of what’s right
    • By someone who holds legitimate authority (e.g., in the military--a leader)
    • In a high-stakes situation


2. Over the past seven years, a second catalyst of moral injury has been discussed--where the injury is caused by the soldier’s own actions that violated his/her deeply held moral values. This view was first published in peer-reviewed journals by Litz, Nash, Maguen, and others in 2009. See https://www.ptsd.va.gov/professional/co-occurring/moral_injury_at_war.asp

In the decade previous, I'd written about this form of moral injury--calling it PTSD or PITS--in non-peer-reviewed media:


"Military Leaders’ Obligation to Justify Killing in War" (JSCOPE 2000, Military Review 2002)

"The Military Leader’s Role in Preventing Combat-related, Perpetration-Induced, Psychological Trauma" (JSCOPE 2005)

"A Moral Justification for Killing in War" (Army Magazine 2010)

3. A third catalyst of moral injury is recognized by many military chaplains but has not been studied by researchers; it is moral injury that results from encountering evil so base and widespread that it shatters soldiers' assumptions about human goodness and ultimate justice. Overwhelmed by the injustice and suffering of war, combat veterans struggle with what theologians call “the mystery of evil” and experience moral injury.

Instances of senseless, unfair evil that have been described to me include: good people dying horrible deaths and bad people escaping death, due to “luck”; the carnage after a VBIED, including innocent children grievously wounded or blown literally into pieces; encountering the victims of sectarian cleansing, tortured to death by power drills to their heads or other inhumane methods.

A framework that accounts for all three catalysts of moral injury would be:

    • A betrayal of what’s right
    • By "someone" you previously trusted, which may be:
      • yourself--your own moral judgment/courage; and/or
      • a legitimate authority in your chain of command (from NCO to President); and/or
      • God
    • In a high-stakes situation such as war


A definition of moral injury, then, might be…
Moral injury is the psychological, social, and/or spiritual harm that results from experiencing a violation of a deeply held moral belief, perpetrated by a trusted authority, in a high-stakes situation such as war.


The “trusted authority” who betrays and loses that trust can be:
  1. the soldier, when he/she does something that violates their own moral code.
  2. a leader (or entire chain of command), when he/she disregards the humanity of the soldier.
  3. God, or the soldier's sense of the divine, when the soldier encounters senseless, unfair suffering.

Moral injury can be acute (resulting from a particular incident) or cumulative (resulting over timer from a series of incidents).

Army Chaplain (COL) Timothy Mallard has made a similar point, arguing that while "warriors often do experience moral injury as currently defined [definitions 1 and 2, above], they also often suffer something else"—what he calls 'spiritual injury'. He concludes, "Moral injury and spiritual injury are sibling twins of the same mother, yet they are undoubtedly distinct; like all twins, they must be treated as individuals."

Perhaps that is the case, or perhaps all moral injury is spiritual injury.  Moral and spiritual injury may be the same phenomenon, looked at through different lenses. After all, if God is the foundation of morality, then even definitions 1 and 2 implicate God. 

I recommend Mallard's entire article, The (Twin) Wounds of War," available at https://providencemag.com/2017/02/twin-wounds-war-spiritual-injury-moral-injury/

Also, if you're interested in how leadership can prevent or reduce moral injury, I invite you to read "Military leaders' role in mitigating moral injury" posted here on Veterans Day 2016: http://soldier-ethicist.blogspot.com/2016/11/the-military-leaders-role-in-mitigating.html

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