Cornell University Press

Moral Injury and the Military Mental Health Crisis

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Many breathed a sigh of relief earlier this year when President Biden announced his decision to pull remaining American ground troops out of Afghanistan. And many more were heartened when, just last week, the White House signaled its support for legislation that would repeal the 2002 Authorization to Use Military Force that paved the way for the United States’s long involvement in Iraq. Taken together, these two decisions may signal the end of what has come to be known as America’s “forever wars.”

Taken together, these two decisions may signal the end of what has come to be known as America’s “forever wars.”

However, it would be folly to believe that Biden’s moves will lift the psychological burden these conflicts have left US veterans to bear. Brown University’s Watson Institute reports that more than 2.5 million American service members spent time on the ground in either Iraq or Afghanistan, and the VA indicates that between eleven and twenty percent of these conflicts’ veterans suffer from PTSD in a given year. These figures add up to a full-blown military mental health crisis.

And yet what’s worse is the fact that standard strategies for treating this mountain of trauma—many of which were developed in the aftermath of the Vietnam War—don’t seem to be working anymore. Two of the most common, prolonged exposure (PE) and cognitive processing therapy (CPT) are at best only marginally effective when used on Afghanistan and Iraq vets.

These figures add up to a full-blown military mental health crisis.

The crucial question is, why? Boston University Psychology Professor Brett Litz thinks he has at least one answer: our efforts to treat the suffering of veterans are falling short because our diagnostic tools aren’t precise enough. Indeed, Litz argues that many service members are plagued by something different from “standard” PTSD: he calls it moral injury.  Moral injury is the name given to the deep and durable psychic pain that sometimes afflicts those who breach their own closely held ethical codes. And, according to Litz and an increasing number of other specialists in the field, it is a real and under-appreciated problem.

Now, I’m no psychologist. But I do believe that one of the ways we can come to better appreciate (and understand) the moral injury of our service members is by reading the growing body of novels and poems they have written. Or, to adapt a phrase from the literary critic Geoffrey Hartman, the literature produced by veterans of our forever wars can help us “read the wound” of moral injury. 

Moral injury is the name given to the deep and durable psychic pain that sometimes afflicts those who breach their own closely held ethical codes.

That’s what I argue in one of the chapters of my new book, Sin Sick: Moral Injury in War and Literature. In that project, I suggest that novels, poems, and plays can help us “see” a novel form of psychic suffering that has gone unseen for far too long. 

Take as just one example Kevin Powers’s 2012 National Book Award finalist The Yellow Birds. That book, which draws on Powers’s own wartime experience in Iraq, focuses on a soldier named Bartle and tells the story of his time in-country and his failing efforts to settle back into some sense of normalcy after his tour is over. Some specialists describe moral injury as the state in which one’s shame switch gets stuck in the “on” position. Powers captures this sense perfectly when he describes Bartle’s attempts to come to terms with his memories of the conflict—and his own perceived battlefield sins: “Anyone can feel shame. I remember myself, sitting under neglected and overgrown brush, afraid of nothing in the world more than having to show myself for what I had become” (Powers 132). 

Some specialists describe moral injury as the state in which one’s shame switch gets stuck in the “on” position.

Powers never uses the phrase “moral injury” in Yellow Birds. But he gives us a vocabulary for talking about the concept that is as precise and as nuanced as that of any clinician. And so do other author-veterans, like Phil Klay in Redeployment (2014), Roy Scranton in War Porn (2016), or Brian Turner in his verse collection Here, Bullet (2005).

All of these literary works testify poignantly to a type of pain whose contours we are just learning to trace, but that will be with us long after the last of the troops come home. 

*Featured photo: Men in Army Uniform. Credit: Fabien Maurin.

Cover Image of Sin Sick.
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Joshua Pederson is Associate Professor of Humanities at Boston University and author of The Forsaken Son. Follow him on Twitter @joshua_pederson.

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