On "moral injury': Psychic fringes and war violence

This article is concerned with theories and therapeutic practices that interpret post-traumatic combat stress as a moral injury' produced by the shock of carrying out lethal violence in uncertain battlefield conditions. While moral injury is said to share many symptoms with post-traumatic stress disorder (PTSD), its proponents - military and Veterans Health Administration clinical psychologists, chaplains, and some psychiatrists - are concerned by PTSD's inability to account for the meaning-based moral and ethical distress that counterinsurgency battlefields in Iraq and Afghanistan are allegedly especially prone to produce in US soldiers. Moral injury theorists seem to want to describe a phenomenon that is both more profound than PTSD but which, as clinical psychologists Shira Maguen and Brett Litz state, is not itself a mental disorder. In this article, I examine the links between moral injury theory's fringe diagnostic status and the fringe status of the kinds of violence it understands as uniquely injurious to soldiers' psyches. Moral injury valorizes war-fighting and military culture while casting war as a source of almost inevitable psychopathology. I argue that moral injury theory represents an effort to carve out a distinct domain of psychological expertise but also a negotiation of the tension between war violence's normal' practice and its excessive or morally hazardous manifestations - both of which link mental illness directly to the politics of war violence and post-war care.