Military Moral Injury: An Evidence-Based and Intercultural Approach to Spiritual Care

Moral Injury

“…Foremost, the moral injury model considers how military culture fosters a specific moral and ethical code of conduct that differs from the moral and ethical rules typically accepted in a civilian context. In war and combat, being violent and killing is sanctioned and normal, and military training prepares service members to participate in and bear witness to the violence and killing in war (Antal & Winings, 2015;Doehring, 2019;Drescher et al, 2011;Farnsworth et al, 2014;Harris et al, 2015;Litz et al, 2009). In order to survive in such a threatening and intense context, service members must be nonreactive, make quick decisions, put their lives at risk, and perform acts that would otherwise be illegal or unethical in most other contexts (Davies et al, 2019;Drescher et al, 2011;Farnsworth et al, 2014;Held et al, 2019).…”

“…Most warriors are able to assimilate their actions and the atrocities witnessed during war into their self-and world-schemas because of their "training and preparation, the warrior culture, their role, the exigencies of various missions, rules of engagement and other context demands, the messages and behavior of peers and leaders, and the acceptance…by families and the culture at large" (Litz et al, 2009, p. 697). However, once warriors return home and reintegrate into civilian culture, they face a starkly different moral system that firmly rejects the violence and killing viewed as normal or acceptable during combat (Antal & Winings, 2015;Doehring, 2019;Farnsworth et al, 2014;Held et al, 2019;Houtsma et al, 2017;Litz et al, 2009). The distinction between the moral and ethical values ingrained in military culture versus civilian culture is essential to understanding the moral dissonance that occurs in service members and veterans after encountering a morally injurious experience at war.…”

“…Pastoral definitions move beyond a psychological framework and refer to the damage done to the soul and spirit, experiences of existential despair, ancient insights, God and the divine, conceptions of good and evil, and the moral self (Brock & Lettini, 2011;Doehring, 2019;Graham, 2017;Hodgson & Carey, 2017;Liebert, 2019;Moon, 2019;Ramsay, 2019;Yandell, 2019;Zust, 2015). Examples are as follows:…”

“…Additionally, those developing treatment models targeting moral injury recognize the stigma surrounding pathology in the military and have accordingly adjusted the way that they frame and name their treatments (Litz et al, 2016;Maguen et al, 2017;Nieuwsma et al, 2015). They also appreciate the communal, brotherly ethos of the military, which is reflected in the communal nature of many moral injury-targeted treatments (Doehring, 2019;Fawson, 2019;Graham, 2017;Harris et al, 2011;Liebert, 2019;Ramsay, 2019;Starnino et al, 2019;Yandell, 2019).…”

“…Moreover, moral injury treatment models' integration of spirituality/religion into their approaches to care further attends to the spiritual/religious cultures of service members and veterans. The models' awareness of warriors' spiritual/religious cultures allows providers to address spirituality/religion's role in shaping warriors' interpretations of their wartime moral transgressions (Barnes et al, 2019;Carey et al, 2016;Doehring, 2019;Frankfurt & Frazier, 2016;Graham, 2017;Griffin et al, 2019;Harris et al, 2011;Hodgson & Carey, 2017;Koenig et al, 2019;Kopacz et al, 2016;Liebert, 2019;Meador & Nieuwsma, 2018;Ramsay, 2019;.…”