Moral Injury: A Handbook for Military Chaplains

Moral Injury (MI) is a term used to describe a constellation of persistent symptoms that result from transgressing moral and ethical boundaries. This is a condition that often occurs in the setting of severe trauma, affecting the perpetrator, the observer, the victim, or all three. MI involves painful and often disabling emotions that are manifested by psychological, spiritual, and religious symptoms. There is some overlap in symptoms with posttraumatic stress disorder (PTSD), which MI often occurs alongside of — yet there is growing evidence that these two conditions are distinct, both of which need treatment. Failure to recognize this may result in protracted and unsuccessful treatments for PTSD.

During combat operations Service Members may be involved in killing other human beings, committing violence to others (including de-humanizing or plundering the enemy), witnessing moral transgressions by others (especially by leaders), being placed in morally compromising positions, being the victim or perpetrator of rape or torture, or exposure to severe trauma of other types. These behaviors are often followed either immediately or sometime afterwards by distressing emotions such as guilt, shame, loss of meaning, difficulty trusting, spiritual struggles, and loss of religious faith, symptoms that may lead to or worsen other mental disorders including depression, anxiety, PTSD, substance use disorders, and family/relationship problems. As a result, MI is recognized as one of the five stress outcomes noted in the Consensus Recommendation for Common Data Elements for Operational Stress Research and Surveillance report by the U.S. Armed Forces and Veterans Administration (VA) experts. “Case identification” of MI was one of seven core components of the mental health intervention spectrum noted in that report.

We believe that military chaplains are those best suited to address MI among active-duty Service Members, in terms of prevention, identification, and treatment. In this book, we provide information for military chaplains about the diagnosis, prevention, and treatment of MI that will be particularly helpful in preparing them for this critical responsibility. We believe that the readiness of our warriors for combat operations is dependent on the role that military chaplains play in this regard. MORAL INJURY: A HANDBOOK FOR MILITARY CHAPLAINS, extensively referenced and scientifically grounded on the latest research, is designed to equip chaplains with the knowledge and tools that they will need to accomplish this mission.

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