Is and Ought: Descriptive and Prescriptive Cognitions in Military‐Related Moral Injury

Abstract

Debate exists regarding the most appropriate way to address moral injuries that stem from involvement in war and other military conflicts. In recent years, some researchers have suggested that existing treatments for trauma may be inadequate to address moral injury and have thus proposed novel interventions to help mitigate these concerns. In response, advocates of more traditional approaches have argued that standard trauma interventions are generally sufficient for moral injury, and investment in new interventions may be premature. This conceptual article draws from research findings and current theories of moral injury to demonstrate that there is merit on both sides of this debate, and further clarifying the types of cognitions involved in moral injury can guide effective treatment planning. In particular, the most recent diagnostic criteria for posttraumatic stress disorder is used to distinguish the objectively falsifiable descriptive cognitions often associated with trauma from the subjectively determined prescriptive cognitions that characterize moral injury. Scenarios from war zone deployments have been used to highlight the relevance of this distinction for moral injury, and a general treatment framework that shows how existing and novel interventions may complement one another is presented. Research suggestions for assessing descriptive and prescriptive cognitions in moral injury and empirically validating this treatment framework are discussed.

Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation: Commentary on Farnsworth (2019)

“…Farnsworth () draws on the work of R. M. Hare, to whom we owe the idea that moral utterances are prescriptive (Price, ). According to Hare, a prescriptive utterance, such as “You ought not to kill” is prescriptive just because it entails the imperative “do not kill.” So moral prescriptions, though they are not themselves imperatives, do still entail imperatives.…”

“…The question motivating Farnsworth () is important: What is the association between military‐related MI and PTSD? It is difficult to answer as (a) both have military‐related events as their putative etiological factor, and some events may be simultaneously traumatic and morally injurious (Litz et al., ); (b) the most commonly cited schematic definition of MI includes reexperiencing and avoidance symptoms ( DSM‐5 PTSD Criteria B & C; Litz et al., , pp.…”

What Ought We to Do With “Thick Terms”? A Response to Frankfurt & Coady's “Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation”

“…In their commentary in this issue, Frankfurt and Coady () critique Farnsworth's () recent article distinguishing between descriptive and prescriptive cognitions in posttraumatic stress disorder (PTSD) and moral injury (MI). In our response to their commentary, we first clarify several points before turning to the ethical implications of Farnsworth's framework and the relevance of “thick terms” for the descriptive‐prescriptive distinction in moral injury.…”

“…First, Frankfurt and Coady conflate Farnsworth's () argument with Hare's prescriptivism despite that at no time is either Hare or the specific philosophical approach of prescriptivism referenced in the original article. This is because Hare's particular attempt to extend the implications of the is–ought dichotomy with his prescriptivism framework embodies a relatively narrow focus on how moral talk functions to exert social influence.…”

“…Second, Frankfurt and Coady () state that Farnsworth () denies the utility of cognitive therapy for MI. However, a reading of the original article reveals that Farnsworth chose to focus specifically on two major cognitive behavioral treatments for PTSD rather than the field of cognitive therapy as a whole.…”