Moral Injury and Moral Repair  ¢â‚¬“ the emerging discussion within the armed forces.

Tim Dyer from John Mark Ministries has been facilitating discussion on moral injury at this year ¢â‚¬â„¢s  Australian Defence Force  chaplain ¢â‚¬â„¢s in service seminars.  

Every once in a while, a scientist or clinician describes something apparently for the first time and it immediately appears obvious and valid, as if we had always known it.   There is something of this feeling in the emerging discussion of  ¢â‚¬Ëœmoral injury ¢â‚¬â„¢ within military contexts.   We have known and dealt with it for a long time, yet the subject is now being examined in a new context.

Until now, almost all of the psychological reflection on conflict trauma has focussed on  ¢â‚¬Ëœpost-traumatic stress ¢â‚¬â„¢ either as a syndrome or as a disorder (PTSD) of brain function.   While PTSD has clear clinical diagnostic criteria including flashbacks, nightmares, hyper-vigilance and   dissociation, in itself, it does not appear to be a direct causal indicator for the profound inner distress, loss of meaning and anger which haunt many veterans of military service.   The mounting concern over the number of veterans who choose to take their own lives rather than live with the symptoms of their post-combat trauma, is currently causing a significant rethink of the nature of PTSD, its symptoms and the links to loss of purpose and meaning.

PTSD is a sub-conscious reactive process where trigger events or stimuli connect to significant amounts of unresolved fear, energy and pain which can overwhelm a person and render them unable to function normally.   The ordinary processes which allow a person to recall a painful memory and to suppress the emotions attached to it, are for many reasons not in place.

A number of other symptoms however tend to cluster around the strict criteria of PTSD.   Many of these have a different quality about them.   These include survivor guilt, distrust, anger, shame, despair, addiction, depression, a need to make amends, and a loss of the desire (and sometimes the perceived ability) to continue to live.   What marks these symptoms as different to classic PTSD is the element of responsibility and personal agency involved.   PTSD is conceived primarily in terms of a victim reaction.   Trauma it is something that happens to a person usually outside of their control.   Many of the symptoms in the cluster relate more self judgement on an action, or a failure to act.   These self-evaluations reveal a significant sense of violation of a person ¢â‚¬â„¢s inner sense of morality, ethics, values or beliefs.   Sometimes the evaluation is of having been morally betrayed, placed in a situation where in spite of seeking to do right, wrong was done or justice was not preserved.     It can involve seeing oneself as having failing to act in a way which could have prevented someone from being injured or killed. It may be having witnessed an intentional injustice or inhumane act perpetrated by one ¢â‚¬â„¢s own side.   This connected cluster of symptoms have been defined in the last three years as  ¢â‚¬Ëœmoral injury ¢â‚¬â„¢.   The elements of responsibility, self judgement, shame, remorse, loss of meaning and moral or ethical violation are important in this definition.   Unlike PTSD, moral injury is dependent on a relatively coherent and integrated memory narrative upon which moral judgements, appropriate or inappropriate, have been made[1].

As  ¢â‚¬Ëœmoral injury ¢â‚¬â„¢ is more an existential and spiritual crisis than a psychological dysfunction, psychologists have pointed out the  limited therapeutic impact that standard cognitive interventions can offer.   The suggestion that effective assistance for moral injury involves some sort of confession and forgiveness within a moral framework has moved the discussion into territory usually covered by chaplains.   The implicit faith-based and moral set of assumptions which under-gird pastoral transactions in chaplaincy are precisely what appears to be needed in repairing moral injury.  [2]

While it is early days in the discussion of  ¢â‚¬Ëœmoral injury ¢â‚¬â„¢, research in the USA points toward the validity of the concept, the likely events which contribute to it and some initial pathways of response.   While we recognise that Australia and North America are very different cultures with different spiritual attitudes, Australian military chaplains have largely endorsed the concept as valid within their own experience of dealing with service personnel.   Our challenge now is to understand more of the dynamics of this condition within our own environments and to explore effective ways to both minimise its occurrence and minister to those who are impacted by it.

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[2]       http://uwf.edu/cap/HCWMS/materials/Drescher   ¢â‚¬“  Suggestions for Including Spirituality in Coping with Stress and Trauma.pdf   Online Presentation,, Kent Drescher, National Center for PTSD,   accessed July 2012

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Tim Dyer serves with the John Mark Ministries network (Established by Rev Dr Rowland Croucher and later joined by Rev Les Scarborough) as a national trainer of church consultants, mentors and leaders.

Tim trained in psychology at Melbourne and Monash Universities before researching and publishing on Youth Homelessness as a staff worker with Scripture Union Victoria.

Tim is married to Merran, a GP with interests in nutritional medicine and women ¢â‚¬â„¢s health. They have 2 adult sons doing tertiary studies and 2 teenage daughters at high school.