14. Twin Children of the Great War: Assessing the Effects of Moral and Spiritual Injury Today

By Timothy S. Mallard Chapter 14 | A Persistent Fire

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If World War I demonstrated anything, it was the sheer brutality, wastage, and immensity of industrial-age combat. Against this tide, the warrior in the trench or the line, in the sky or on the waves appeared to have little or no hope of coming out unscathed either in body or in soul. Indeed, the postwar social pathos for the plight of the warrior seemed to be a type of hope-filled social exercise in revaluing human life and straining against the goads of this new scale of war.1 Postwar Western societies yearned to reclaim an optimism about war—that somehow it would never again reach the scale of carnage the world had just witnessed, though this was not to be. Metaphorically, war from 1914 to 1919 crossed the Rubicon, never to return to its former land.

At least one outgrowth, however, of this post–Great War social debate about the nature of war was an appropriate revaluing of the individual warrior. Somehow, the recognition of the enduring injuries a combatant retains from war seemed to penetrate the collective social conscience, most especially with a growing understanding of the malady originally termed shell shock. Paradigmatically, World War I catalyzed a broad understanding that war produces wounds not only in the body but also in the mind and spirit of the warrior, often long retained long after he or she has left the battlefield. Through World War II and other subsequent 20th-century conflicts, multiple nations held continuing discussions about how war so continuously affected their veterans.2

This discussion continues apace today in contemporary dialogue about a type of combat injury that has found its way into our daily discourse, that of moral injury. However, troublingly I contend that the profession of arms today is operating from a reductionist appreciation of the warrior, increasingly seeing him or her from an inchoate utilitarianism as having value only in his or her ability to perform the mission. This must reverse if the profession is to retain its status as an essentially human endeavor, where the warrior and leader are both people who in body and soul exercise reflective, discreet control of the management of such violence.3

Thus, in this chapter I advance this discussion by contending (as I have previously) that there is and should be an appreciation of the boundaries drawn between moral injury and spiritual injury, as I have termed it. Admittedly, what I contend here is that both of these injuries are grounded in an ontological presupposition that all human persons are fundamentally composed of both body and soul and that spirituality is the healthful exercise of the soul in life.4 With that said, like identical twin children who are yet separate human beings, understanding the similarities and the differences between moral and spiritual injury will aid contemporary strategic military ethics in retaining a primacy on the sacred nature of the warrior, ever to be a precious resource not lightly used in the service of nations. Indeed, not only because of a century’s observed experience but also because of the nature of future warfare, moral and spiritual injury will drive themselves as ad bellum opportunity cost considerations in any future nation-states’ decision to go to war.

To begin, let us review a standard definition of moral injury from the eminent clinicians Shira Maguen and Bret Litz, who write:

Like psychological trauma, moral injury is a construct that describes extreme and unprecedented life experience including the harmful aftermath of exposure to such events (e.g. combat trauma). Events are considered morally injurious if they “transgress deeply held moral beliefs and expectations.” Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.5

Since the coinage of the term moral injury by famed clinician Jonathan Shay, the term has undergone a type of reframing in the professional discourse. Originally, Shay intended the term to capture the sense of betrayal inflicted by the chains of command on their warriors in combat, the future veterans of the Vietnam War.6 Long after that war had ended, Shay was repeatedly helping these warriors wrestle with this loss of trust as a debilitating, residual interior injury. Gradually throughout the 1990s, however, other clinicians noted a similar sense of betrayal within veterans toward themselves as they continued to assess their actions (or inaction) from the same conflict and others.7 The scholarly discourse began to center around the critical verb transgression. Scholars applied the term to note that whether a warrior’s line of moral code was crossed externally or internally, the effect was the same: warriors carried a type of debilitating internal wound separate from the established clinical diagnosis of post-traumatic stress disorder.8

Comparatively, I have more recently defined spiritual injury as:

the intra and inter-personal damage to souls brought on by significant trauma, including the rupture to foundational religious values, beliefs and attitudes, the inability to healthfully participate in an immanent human faith community, and the temporary or permanent loss of a transcendent relationship to God (manifested particularly in questions about forgiveness, doubt, truth, meaning, and hope).9

In positing this definition, I attempted to reframe the similarities and distinctions between moral and spiritual injury, categorically holding that while I concur with the concept of moral injury, I also consider that it lacks a contextualized understanding of the warrior and his or her most foundational relationships. Neither moral nor spiritual injury occurs in a vacuum, but spiritual injury can be particularized as occurring within the warrior’s soul and then emanating outward through the warrior to his or her unit, family, community, nation, and even existentially to God (or the Divine but as the warrior so defines). I framed the definition to recapture an emphasis in the profession of arms on the criticality of the warrior’s soul, as General George Marshall once rightly championed.10 Today, however, as Simon Edwards so adroitly states, the “military is exclusive in public services in understanding the importance of the soul. . . . Yet when it comes to dealing with the consequences of combat, this element is almost totally neglected.”11 Thus following Edwards’s charge, I understand spiritual injury as both polyvalent and concentric in its effects. What are some of the other markers between both moral and spiritual injury?

Distinctions and Similarities

First, since the definition of moral injury is descriptive in nature it lacks specificity and leaves it open to misapplication, which I argue is indeed happening swiftly in academic, clinical, pastoral, and most especially military settings. Essentially, the term moral injury is now being bandied about somewhat indiscriminately to capture any type of nonphysical injury a warrior may suffer in combat, whether such injuries accord with the definition or not. Indeed, as I have pressed many colleagues in the profession of arms to recount even an approximate definition of moral injury or of its purpose, most cannot do so with clarity or understanding. For a term that is gaining such traction within the Armed Forces, however, this lack of specificity is quite alarming. Clarity and precision on this term will be particularly important so that commanders and senior noncommissioned officers down to the tactical level of war understand this term and apply it appropriately only when it is called for in assessing a warrior’s interior woundedness.

A second concern is that the definition of moral injury is built on the theological verb transgress without any theological context, particularly to antecedent concepts such as “sin” or descendent concepts such as “forgiveness.” In the field of ethics, this can presumptively become an assumption that the warrior has been the agent of transgression rather than the recipient of transgression, as Shay originally observed in his analysis.12 Of course, in the treatment process for the warrior, this can and often is problematic, particularly when the warrior feels himself or herself to have been morally inculpable in any transgression against another or the victim of an unintended trauma. Indeed, it is vital that moral injury is only correctly linked to moral agency when called for by the circumstances of the originating combat trauma. When not called for, spiritual injury may be the more correct descriptive term. This is fundamentally based in the presupposition that all people are moral agents responsible for their actions. That said, if moral injury presupposes this agency, then spiritual injury also is predicated on the contention that all people are composed of both body and soul and that spiritual injury is based in the ontological reality of each person having a spiritual component to his or her being. Furthermore, what is paramount is not to unnecessarily freight the warrior with guilt that is not his or hers by virtue of their action or inaction in combat.

Third, the standard definition of moral injury seems to subsume a philosophical inversion of the concept under religious understanding, when, in fact, in philosophical history, this is clearly the other way round (so morality and ethics have, since ancient Greece, been seen as outgrowths of the Divine/human relationship rather than conceptual parents of the same).13 Put another way, religious belief and spiritual praxis have almost universally been seen as the construct under which morality resides rather than the converse.14 In our spiritually apathetic and indifferent contemporary culture, it has become de rigueur to propose that moral leadership in a democratic polity can be (and for some proponents must be) divorced from any religious or spiritual moorings, but that remains a tenuous point at the least.15 Be that as it may, correctly inverting moral injury under religious understanding will neither rob the definition of any of its descriptive potency nor risk crossing a line of uncritically endorsing religious belief. Rather, it will frame the concept within its most critical existential relationship for the warrior, where either moral or spiritual injury is often expressed in personal questions regarding guilt, forgiveness, atonement, or even reconciliation with either God or other persons.

Fourth, I have come to understand that, put baldly, the term moral injury is often driven or influenced by the pursuit of research dollars and institutional interests in the competition for advancement rather than the healing of persons. This is not a concern that arises principally out of the military medical healthcare system, where the legal appropriation of congressionally authorized research and treatment dollars is made generally in the interests of warriors and families, though not always so. Rather, this is a concern to which many colleagues in principally the Veterans Administration or the civilian corporate healthcare complex have alerted me.16 In their estimation, the term moral injury is so au courant and demarcated that it easily serves as the basis for new proposals for research grants, allocation of limited fiscal resources for treatment budgets, and the hiring of new clinical personnel to expand organizational reach and (more troublingly) perceived organizational relevance and/or importance. At best, this freights the term with perhaps an unvoiced agenda; at worst, it completely hijacks it in service to institutional interests rather than the recovery of those affected by it. Candidly, a warrior might have cause to question: “Whose aims are being served here?” Admittedly, the term of spiritual injury that I propose lacks either such institutional potency (how does one, after all, measure spiritual injury in a research project? I do not think this can be adequately done) or institutional subservience.17 That said, as I have continually used this term among warriors and families (and those who care for them, both pastorally and clinically), I have received little if any disagreement with the nature of the type of woundedness that it describes, only critiques about my own need to further clarify its nature, manifestations, or postvention techniques.

Fifth, I have also come to understand that the phenomena of moral and spiritual injury are both wounds that are today greatly exacerbated by the lack of language categories and/or moral formation of individuals that marked prior generations. For example, even my use of basic theological terms such as sin, transgression, and forgiveness might occasion quizzical or bemused responses by some as conceptual relics of a passé emphasis on religious understandings jettisoned amid a contemporary cultural fealty to the monarchy of the self. Alternatively, if I attempted to use basic philosophical constructs from Plato such as human growth along a visceral/emotional/mental trajectory or Aristotle’s delineation between hedonia and eudemonia, then most moderns would have little to no comprehension of such categories.18 While postmodern champions might see this lack of understanding as a liberation from dominant past thought constructs, as a pastoral response I generally see warriors and families with little if any ability to contextualize either their moral or spiritual injury because they do not understand themselves or natural human experiences such as pain, suffering, hope, and even death.19

Additionally in this vein, I might add that in the medical healing professions (principally the physical and clinical domains), we have bifurcated our conceptions of treating people as human beings created by God both body and soul in need of healing and redemption to only those, as one cynical doctor told me, who are the “pink bags” of physical matter deserving of prolonged physiological life. Moreover, I am troubled that this same predilection in the healing arts is driving the profession of arms to then see warriors only for their utilitarian value to the institution relative to their physical health and mission performance, with no affirmation of the person’s immanent worth beyond his or her term of military service and eternal worth as those in need of transcendent meaning and hope.20 Though I have no statistical proof for this assertion, I intuitively suspect that this particular organizational perspective produces a crisis of meaning for the warrior and his or her family when he or she can no longer perform and is jettisoned from the ranks of the uniformed, and may derivatively be a causal factor in the precipitous and sustained increase in completed suicides amongst veterans in America.21

Sixth, another prior condition that I contend has greatly attenuated the impact of moral and spiritual injury in warriors and families is the seminal change in America to the all-volunteer force in 1976 after the Vietnam War. While this move might have been politically in tune with the tenor of the electorate at the time, it profoundly rewrote the civil-military relationship that had undergirded how the Nation went to war since the founding of the republic.22 The very ideas of militias, conscription, or shared national sacrifice in the conduct of war are now replaced by a high emphasis on technical and scientific proficiency (especially in the operation of complex weapons platforms); an ever-increasing reliance on the accumulated tactical experience of a professional military class; the repetitive deployment and redeployment of those professional warriors over many years, that cycle occurring not only individually but also collectively for units but without significant ties to communities, towns, or cities (except for those units particularly in the National Guard); and a growing strategic disconnection of the profession of arms from its principal client, the American people. Indeed, and as an outgrowth of all these points, some now question whether we have unalterably divorced our military forces in America from the larger national democratic narrative or constitutional set of ideals that supposedly underlies a values-based military and the national will.23 Relative to moral and spiritual injury, American warriors now often cannot go to war with a meaningful social context or relationship to the Nation (perhaps only to the Federal Government), a type of estrangement that only exacerbates individual questions regarding warrior and family experiences in combat, particularly subsequent to suffering horrific physical, mental, emotional, moral, or spiritual injury of any kind.24 Perhaps it is an attempt to bridge this chasm that occasions the impassioned, strained pleas of many civilians to say to the warrior, “Thank you for your service,” and, concomitantly, the growing cynicism and even hostility inside many combat veterans’ hearts in response.

Seventh, and now shifting to further distinctions between the accepted concepts of moral injury and that which I propose, a chaplain colleague of mine rightly pointed out that there is a fundamental difference between the two in how they are conceptualized, to wit: moral injury is defined relative to the event, whereas I define spiritual injury relative to the individual (and subsequently that individual’s vital relationships). It seems that this can especially have important implications for treatment.25 A healing modality predicated on responding to the nature of an event in time (so moral injury) can misfocus the efforts of both clinicians and pastoral counselors on the circumstances of that event rather than the person affected by it. Certainly, many such experienced providers do not allow this to happen and willingly and courageously enter into the pain of the warrior. However, the definition of moral injury does not help them because it conceptually distances the provider from the warrior who occasioned the search for healing in the first place. Comparatively, the definition of spiritual injury that I propose primarily holds both warrior and provider in tension together and that relationship as the mechanism for the healing process, attending secondarily to the combat trauma as needed. Furthermore, this definition of spiritual injury catalogs its effects concentrically beginning with the warrior and emanating outward to a circle of his or her relationships including that warrior’s unit, family system, community, nation, world, and even God (as articulated or held by the warrior). In point of fact, this definition of spiritual injury attempts to inculcate its effects on the warrior’s most critical (and often ruptured) relationships, yet to see those relationships as keys to the warrior’s eventual healing.26 Put another way, any injury in combat does not occur in a vacuum and that warrior’s healing will not either, but only through the reconciliation of severed relationships necessary to vital human flourishing, a theological proposition, to be sure.

Eighth and finally, a critical distinction to my thinking regarding how moral and spiritual injury differ is that I conceive the latter as a fundamentally existential crisis rather than an episodic experience. I base this primarily on the pain-filled responses that warriors and families have given to me about having to live with combat trauma. For such persons, the 12 markers of spiritual injury that I formerly proposed thus call into question the whole of being and the whole of life in both a temporal and eternal sense.27 It is not only that the former understandings of self or God are even temporarily questioned but also that they are fundamentally and permanently reevaluated, perhaps even discarded. Admittedly, this is a difference by degrees between moral and spiritual injury as concepts, but in dealing with the spiritually wounded, it becomes easier to assess because their expression of that injury is marked by a pervasiveness (so whole of being) and permanence (so whole of life) that in my experience only remains with those bearing the deep wounds of spiritual injury.

Alternatively, while the physical, mental, and emotional wounds of war often heal with time, there are spiritual wounds that linger to the depth of the person for the remainder of his or her life, yet which cry out for and even drive the need for healing in that warrior and his or her family as much as any other woundedness, no doubt.28 As well, when in the wake of that warrior and family’s spiritual reevaluation process, they then permanently alter their former beliefs regarding the experience of death and eternal life—and then that woundedness can adequately be categorized as affecting the Divine/human relationship into eternity. I cannot conceive of another type of woundedness from war freighted with such immense consequences for the soul, an imperative motivation for care that should rekindle all healing professionals in their stewardship of and coordination for that warrior and family’s healing.

Effects

Due to the concentric nature of spiritual injury as I define it, this should then occasion a fundamental reassessment of both this and moral injury in the traditional ad bellum considerations of a nation’s decision to go to war. If these types of wounds emanate outward from the warrior across time and space to his or her unit, family, community, nation, world, and God long after both the battle and war cease, then it would seem self-evident that any nation must longitudinally study such effects in order to adequately assess decisions to enter into future conflicts. Indeed, one might argue that both moral and spiritual injury bear with them immense opportunity costs for the republic. What do I contend here?

Opportunity cost is an economic term defined as:

A benefit, profit, or value of something that must be given up to acquire or achieve something else. Since every resource (land, money, time, etc.) can be put to alternative uses, every action, choice, or decision has an associated opportunity cost. Opportunity costs are fundamental costs in economics, and are used in computing cost benefit analysis of a project. Such costs, however, are not recorded in the account books but are recognized in decision making by computing the cash outlays and their resulting profit or loss.29

In the military context, opportunity costs can be found in the human capital of a nation’s sons and daughters that it sends to war on its behalf. While persons are not a zero-sum game, to be sure, they are finite resources necessary to corporate human flourishing on many levels of human society (as per my definition of spiritual injury). In essence and to correlate the above definition to this chapter’s topic, warriors and their families are resources that “can be put to alternative uses,” and if a nation chooses to expend those resources in combat and afterward in enduring moral and spiritual injury, then such lost resources are not only tragic after effects of war but also opportunity costs that a nation may or may not have adequately counted prior to the decision to initiate hostilities. Should a nation not have so soberly assessed this type of war’s cost, then this lack of foresight can produce both a derivative, enduring, and deep-seated moral and spiritual injury in warriors and families. Indeed, such opportunity cost is corrosive in its very nature to the strength and functioning of any democratic polity, as America experienced in the wake of the Vietnam War. The polyvalent social effects of enduring moral and spiritual injury are long and broad indeed, extending across multiple generations.

Yet there is a second corrosive opportunity cost of moral and spiritual injury to the Nation, particularly in its historic civil-military construct. First, in a profession of arms as described above (a technically and tactically proficient force so discrete in its function that it lacks a corollary to the Nation it serves), then moral and spiritual injury can radically demoralize the force preparing for future war. What I allude to here is that if such wounded warriors remain in the ranks as the force so needs them to execute the force’s professional nature, then their presence can either produce exemplars of resilience or degradation, but not both. Resultantly, with a force such as America’s current military where the stigmatism of either perceived personal weakness or threats to career advancement often inhibit warriors from seeking care in the first place, then both moral and spiritual injury can be subsumed under the veneer of unit readiness and ironically degrade such readiness over time.

Derivatively, this can lead to a further leadership challenge in maintaining motivation of and discipline among troops. How does a leader inspire and control a formation in which one or more warriors (especially fellow key leaders) may be suffering either enduring moral or spiritual injury, particularly in an organization that already has unwittingly sent the message that such warriors are only of value to the force as long as their mission utility remains intact? There is ample evidence from the history of war that both untreated moral and spiritual injury can result in the commission of future war crimes.

In just recent U.S. history, one thinks of the tragic murders that Staff Sergeant Robert Bales committed in Afghanistan in 2012, when he walked off his combat outpost to two neighboring villages, entered several homes, and shot dead 16 men, women, and children. In hindsight, it became apparent that Sergeant Bales was suffering the deep effects not only of post-traumatic stress disorder but also potentially moral and spiritual injury and that these were exacerbated by his being under a cocktail of powerful steroids, alcohol, and a lack of sleep. Now in Federal military prison under a life sentence, Sergeant Bales is free of the drugs he was under, is receiving ongoing treatment and has experienced a self-professed spiritual renewal, but, while laudatory, these results do not mitigate the pain and suffering he committed against these families, their tribes, and their village.30

At the strategic level, when either general or flag officers exhibit moral leader failure, as it has come to be known, then this corrodes morale both within the force and outside the force among our clients, the American people. Indeed, despite many public departmental initiatives to arrest this trend, the problem has become so persistent that a recent survey of even publicly acknowledged strategic moral leader failures catalogued over 500 such instances within the U.S. joint force since 2013, including the still-ongoing “Fat Leonard” scandal within the Navy involving at least 200 career Sailors and several flag officers.31 Collectively, all this produces within the force the effect of becoming an unreflective institution in which in a leader’s professional judgment values are not measured against political aims and military objectives to produce a feasible, suitable, and acceptable course of action.32 In short, values become delinked from plans, training, and operations and, as a result, sidelined from incorporation into a command’s organizational thinking and culture and military effectiveness or in his or her advice about the same to civilian political leaders. While not wholly but perhaps only in part, all these can and do result from the degrading effects of moral and spiritual injury on a military force and are opportunity costs necessary to assess in an ad bellum, in bello, and post bellum framework.

Strategic Responses

To begin to address this, if this indeed is the contemporary landscape of moral and spiritual injury, I suggest broadly that, at least in the American context, national denominational communities and faith traditions have unconsciously abetted and exacerbated the problem. As Ed Tick has rightly noted, such faith traditions have often kept warriors and families “out of sight, out of mind,” and thus unintentionally support the aforementioned divorce between the profession of arms and the body politic. He writes, “We do not help survivors rebuild dignity and rediscover inner peace. Certainly, in contrast to traditional cultures, our modern processes do not include sacred and communal dimensions of healing.”33 If American faith communities genuinely care about this cohort of their congregations, then they must repent of this neglect and correct their course. How so? Let me offer three suggestions.

First, American religious denominations must begin a new program of intentional character formation of their adherents to prepare them for civic integration into their communities and the Nation. In only a handful of instances can I recall a major American religious denomination that intentionally and continuously plans, resources, and implements such a program to arm their confessors for their individual vocations as citizens in the Nation. Typically, either youth, family, or religious education programs treat this focus as ancillary at best, choosing instead to focus on salvific, discipleship, or church-growth strategies or programs. While these are important, such a type of vocational development for an engaged faithful citizenry would raise and maintain in adherents a continual awareness of their role in serving the kingdom of God within the kingdom of mankind.

Along this trajectory, a second suggestion is for those same religious denominations to recover and implement an ongoing program of both sending and receiving deploying warriors from their ranks with appropriate rites, sacraments, and ordinances to mark such events.34 In contrast, many such warriors are now little more than congregational ghosts who are here today and gone tomorrow, and then here today again—their families having agonized amid their deployment and celebrated their redeployment while the body of faith ambles on unaware. Public services of blessing in deployment, continual prayers, and diaconal care for separated families, and acts of prayer, confession, and even absolution upon redeployment can and should mark such times in those who serve both God and country.

Third, I suggest religious denominations, and especially their local congregations, must rediscover a corporate vocation as places of intentional healing for veterans and families. While some local congregations can and do exercise with great forethought and energy programs designed to care for veterans and their families, again I can count not a single larger denominational entity that does so on a consistent, broad-based basis. While some such denominations actively support their military chaplains—and this is wholly vital to such servants’ ministries—I cannot name a single such national faith tradition that even attempts to offer similar support to veterans and their families amid their congregations. To call such pastoral neglect an oversight is a gross understatement; it is instead a pastoral dereliction of duty.

Turning to the profession of arms, I offer some further suggestions for recovering the criticality of this topic. First, I suggest that, broadly speaking, the field of theological ethics needs to be reintroduced to the field of military ethics.35 Put bluntly (at least in the American context), the legal separation of church and state deriving from the non-establishment clause of the First Amendment has been too broadly applied culturally to enforce a divorce of faith from culture in general. Rather, leaders in the profession of arms need to do one thing here: exhibit the moral courage to welcome and integrate theological ethics into nuanced, respectful, yet candid discussions about some of the multiplicity of issues facing the profession, such as the rise of artificial intelligence, strategic moral leader failure, or inculcating values in warriors who come from a morally and ethically deconstructed social context.

A second suggestion is for those uniformed chaplains in the profession of arms to follow their civilian denominations in leading military faith communities to become, as Pf. Dietrich Bonhoeffer called for, the Sanctorum Communio.36 I assess that many chaplains have generally, and in response to the aforementioned cultural divorce between faith and society, receded in their own pastoral leadership of such military faith communities. The net result of this for the warrior and family is that whether they attend a civilian or military congregation, they often feel an estrangement between their faith and the costly issues or effect of their collective calling to serve both God and country.

A third suggestion is that the profession of arms needs to make the considered study, understanding, and treatment of moral and spiritual injury a topic of import at the tactical, operational, and strategic levels of war. Here I contend that leaders appreciating this topic will not be enough; neither will it be enough for first-term enlistees to do. Rather, from private to general, warriors at every level of the professional military education system must consistently delve into this topic both in theory and in practice, including in leading their formations. Additionally, this effort must be linked institutionally from the joint force to the Veterans Administration, particularly focusing on studying the long-term effects of both moral and spiritual injury on warriors, families, the force, and the Nation. Only by conducting such a study can the Nation’s civilian and military leaders adequately assess the opportunity cost of these injuries on the profession of arms and inculcate such knowledge into future decisions to engage in war.

Conclusion

Moral and spiritual injuries remain profoundly similar yet distinct injuries in warriors and families, but our understanding of the latter’s causes, effects, impacts, and healing is growing. To marshal some of this growing understanding, however, I contend that at least here in the American context, we need concerted leadership and institutional change on the part of the clinical healing complex, the profession of arms, and the Nation’s faith communities and traditions. In short, a societal problem of such immense proportion will require a societal solution of like proportion.

Let me close with a hope-filled, theological ideal that has arisen within my own pastoral treatment of warriors and families. I want to propose that neither moral nor spiritual injury are ends unto themselves but are separate means to a single end, a pain-filled path toward growth in a warrior’s depth of character. This may seem ironic, if not insulting, for how can such pain achieve generative effects in anyone? Without oversimplification, I hold that either deeply held moral or spiritual injuries that seem like insurmountable obstacles in one’s life could be redeemed as a way of growth in both temporal and eternal life. Warriors and their combat units, families, communities, nation, and even the world need not be subsumed by the seemingly crushing effects of these injuries arising from war. Rather, with the aegis of the Divine and utilizing our own increased understanding, determination, leadership, and continued care, we may help our warriors and families be redeemed from moral and spiritual injury in ways that benefit them now and in the future.

Notes

1 Here I am considering the post–World War I proliferation of poetry and prose that sought to capture the warrior’s experience and its cost, such as famed writers like Erich Maria Remarque and Ernest Hemingway and poets like Siegfried Sassoon and Wilfred Owen. The writings of these and others evocatively shaped the postwar attitudes of their generation. A helpful critical anthology remains Paul Fussell, The Great War and Modern Memory (Oxford: Oxford University Press, 1975).

2 In my work among contemporary military chaplaincies, this professional dialogue is continuing among the United States, Great Britain, Australia, New Zealand, and France, to name but a few. Critical new ground is being broken particularly in Australia, where there is an emerging scholarly cooperation among chaplains and clinicians on studying the issues of moral and spiritual injury and on collaborating on new treatment models and further longitudinal research. See Lindsay B. Carey et al., “Moral Injury, Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources,” The Journal of Religion and Health 55, no. 4 (August 2016), 1218–1245. Beyond chaplaincy studies, see Edgar Jones, Nicole Fee, and Simon Wessely, “Shell Shock and Mild Traumatic Brain Injury: A Historical Review,” American Journal of Psychiatry 164, no. 11 (2007), 1641–1645.

3 Samuel P. Huntington, The Soldier and the State: The Theory and Politics of Civil-Military Relations (Cambridge: Harvard University Press, 2002), 15. Huntington famously contends that the “management of violence” remains the sole province of officership in the profession of arms.

4 Cf. Patrick Sweeney, Jeffrey E. Rhodes, and Bruce Boling, “Spiritual Fitness: A Key Component of Total Force Fitness,” Joint Force Quarterly 66 (3rd Quarter 2012), 35–41, who relate the Joint Staff’s taxonomy of Total Force Fitness along the eight domains of physical, medical, environmental, social (including family), behavioral, spiritual, psychological, and nutritional health. They define spirituality as “the continuous journey people take to discover and develop their human spirit. It is the process of searching for the sacred in one’s life; discovering who one is; finding meaning and purpose; establishing interconnectedness with others and, if one so believes, with the divine; and charting a path to create a life worth living.” Moreover, the difference between this and religion is that “they are two distinct concepts. Spirituality is both a process and path people use to discover their inner selves and develop their human spirit. Religion refers to institutions that propose and promote specified belief systems.” However, note that these concepts come from the field of behavioral psychology and betray a lack of theological understanding about both terms. For instance, lost in both their definition and distinction is a comparison of either immanence or transcendence (of both the Divine to humanity and vice versa) or of religion as a sociological institution that can (and in many non-Western societies does) order all human culture.

5 Shira Maguen and Brett Litz, “Moral Injury in the Context of War,” U.S. Department of Veterans Affairs National Center for PTSD, February 25, 2016, available at <www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp>. See also their scholarly treatment in Maguen and Litz, “Moral Injury in Veterans of War,” Research Quarterly 23, no. 1 (2012), 1–6. I have great appreciation for Maguen and Litz’s work and acknowledge its continued evolution, as well as their current call for greater incorporation of spirituality into the healing modalities of morally injured veterans.

6 Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 2003), 3–102. See also his “Moral Injury,” Psychoanalytic Psychology 31, no. 2 (2014), 182–191.

7 For example, cf. Larry Dewey, War and Redemption: Treatment and Recovery in Combat-Related Posttraumatic Stress Disorder (Burlington, VT: Ashgate Publishing Co., 2004); Ed Tick, War and the Soul: Healing Our Nation’s Veterans from Post-Traumatic Stress Disorder (Wheaton, IL: Quest Publishing, 2005); and R.N. Brock and G. Lettini, Soul Repair: Recovering from Moral Injury After War (Boston: Beacon Press, 2012).

8 American Psychiatric Association, “Definition of Posttraumatic Stress Disorder,” Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 1st ed. (Washington, DC: American Psychiatric Publishing, 2013), 265; 271–280.

9 Timothy Mallard, “The (Twin) Wounds of War: Delineating Moral and Spiritual Injury,” Providence, vol. 5 (Fall 2016), 50–56. In this article, I noted both these initial distinctions with moral injury and further posited 12 markers of spiritual injury, principally along theological lines. In this chapter, points one, two, and three are taken from this original article. Without settling on a single definition, Carey et al., “Moral Injury, Spiritual Care and the Role of Chaplains,” contend that the term spiritual injury was first coined by G.E. Berg in 1992, and so prior to the advent of the term moral injury in 2016.

10 George C. Marshall, “Speech at Trinity College, June 15, 1941,” in The Papers of George Catlett Marshall, ed. Larry I. Bland, Clarence N. Wunderlin, Jr., and Sharon Ritenour Stevens, vol. 2, “We Cannot Delay,” July 1, 1939–December 6, 1941 (Baltimore: Johns Hopkins University Press, 1986), 534–538.

11 Simon Edwards, Soldier of Hope: Lessons from the International Community in Recovery and Growth from Battlefield Trauma and Mental Health (London: The Winston Churchill Memorial Trust, 2016), 27. I am indebted to Revd. Dr. David Coulter, OBE, Chaplain General of the Royal Army Chaplains Department of the British Army, for alerting me to Edwards’s important monograph. Edwards’s work is a comprehensive review across Western militaries regarding current thinking around post-traumatic stress disorder, moral injury, and appreciatively as above the potential for chaplains and spiritual healing to play a greater role in this area of holistic warrior health.

12 Shay, Achilles in Vietnam, explored how the pervasive and consuming nature of moral injury in the warrior’s soul can, if not treated, lead to a full mental break with reality.

13 For an example of how this trend continues, see Duane Larson and Jeff Zust, Care for the Sorrowing Soul: Healing Moral Injuries from Military Service and Implications for the Rest of Us (Eugene, OR: Cascade Books, 2017), 9–10. Without precisely defining moral injury, Larson and Zust presume that it somehow is predicated on the attendant guilt of ethical failure on the part of the warrior. This conflation of act with person, to my mind, thus undercuts their otherwise fine “two mirror” treatment modality, though not their subsequent calls for fresh appreciation of the phenomenon within the profession of arms or their call for greater theological integration into the warrior healing process.

14 James H. Burtness, Consequences: Morality, Ethics and the Future (Minneapolis: Augsburg Fortress Press, 1999), 27ff.; and Tom Beauchamp, Philosophical Ethics: An Introduction to Moral Philosophy (New York: McGraw-Hill, 1982), 21ff.

15 Cf. Timothy Challans, Awakening Warrior: Revolution in the Ethics of Warfare (Albany, NY: SUNY Press, 2007), 43ff. Challans believes that military chaplains should be removed from all ethical professional military education because he believes chaplains have an inability to present philosophical theories about ethics without infusing the same with religious bias. For a counterview and recent scholarly treatment, see Don M. Snider and Alexander P. Shine, A Soldier’s Morality, Religion, and Our Professional Ethic: Does the Army’s Culture Facilitate Integration, Character Development, and Trust in the Profession? Professional Military Ethics Monograph Series, Vol. 6 (Carlisle Barracks, PA: Strategic Studies Institute, 2014).

16 Due to the perhaps inflammatory nature of such assessments, I defer here from citing the multiple individuals who have provided me them amid our professional discourse. Not without some irony, most of those who have made this observation to me are clinicians (either psychiatrists, psychologists, or licensed clinical social workers) working in Veterans Affairs itself.

17 Carey et al., “Moral Injury, Spiritual Care and the Role of Chaplains,” are collaborating on just such a longitudinal research project.

18 My colleague Revd. Lt. Col. Alan Steele (Ret.), MBE, of the Royal Army Chaplains Department, has attempted to use such nonreligious constructs to overcome potential antireligious bias of students in teaching basic military ethics. Still, the fact that he (and other military chaplains across many allied forces) must resort to such tactics in order to accomplish basic pedagogical goals is perhaps instructive of how much mostly Western forces have segregated theological concepts and discourse from the contemporary profession of arms.

19 A frankly illogical example of this is the notion that moral courage is a neurological phenomenon of right brain evolutionary development that can be physiologically stimulated and trained within the warrior. See Matthew Anderson, “Moral Courage: Behind the Magic of Leaders Making the Right Choices,” in The Role of Leaders in Building a Culture of Moral Courage: The Proceedings of the Centre for Army Leadership’s 2017 Conference, ed. William Meddings (Sandhurst, UK: Robinson House, 2018), 37–45.

20 It is not without some irony that I repeat here the U.S. Army’s current (and reductionist) “Performance Triad” for optimizing the readiness of this professional military class: nutrition, exercise (or activity), and sleep. Note that there is absolutely no incorporation of the warrior’s soul or spiritual health.

21 Office of Mental Health and Suicide Prevention, VA National Suicide Data Report, 2005–2015 (Washington, DC: Department of Veterans Affairs, June 2018).

22 Adrian Lewis, “Conscription, the Republic, and America’s Future,” Military Review (November–December 2009), 15–24.

23 Ibid. However, see also the trenchant questions of John Mark Mattox, “The Moral Foundations of Army Officership,” The Future of the Army Profession, ed. Don M. Snider and Lloyd J. Matthews, 2nd ed. (New York: McGraw-Hill, 2005), 387–408.

24 Regarding the present conflicts in which the Nation finds itself, David Wood evocatively states, “These wars demanded the intense and prolonged participation of a tiny fraction of the Nation’s youth in sustained campaigns built on the intentional violation of the ancient sanctions against killing. Those who returned did so without the healing rituals of cleansing and forgiveness practiced by past generations.” See his What Have We Done: The Moral Injury of Our Longest Wars (New York: Little, Brown and Company, 2016), 9.

25 I am grateful for Chaplain (Lieutenant Colonel) Doug Swift’s observation during a class on this subject at the U.S. Army Medical Department Center and School, Fort Sam Houston, TX, on June 28, 2017. The Command Chaplain’s Office at this institution has done groundbreaking work on repeatedly addressing this topic within the uniformed services, including through multiple mobile training teams who have exported the course across Asia and Europe as well as the United States.

26 A helpful example of this comes from the genre of the short story. Ernest Hemingway, himself a veteran ambulance driver of World War I and ultimately a victim of suicide, catalogued this in his arresting work titled “Soldier’s Home.” In this compact piece written in 1925, the recently returned American Expeditionary Forces Infantryman Harold Krebs struggles in his closest familial, social, communal, and spiritual relationships. Without any hint of physical woundedness in the protagonist, Hemingway explores the complex nature of such ruptured relationships in the wake of war. It is likely intentional that Hemingway chose to name his character Krebs, which is ironically a German word for cancer and seems to indicate the author’s assessment of the corrosive nature of postwar moral and spiritual injury. See Ernest Hemingway, “Soldier’s Home,” The Complete Short Stories of Ernest Hemingway: The Finca Gigía Edition (New York: Charles Scribner’s Sons, 1987), 111–116. I am most grateful to Professor Ed Barrett at the U.S. Naval Academy for facilitating my participation in 2017 in a National Endowment for the Humanities colloquy that explored the potential for the arts—particularly prose, poetry, and plays—to connect to warriors locked in extended moral injury, at which time I first encountered Hemingway’s arresting piece.

27 Mallard, “The (Twin) Wounds of War.”

28 Though he categorizes his persistent and pervasive self-doubt as neither moral nor spiritual injury, the reflections of Medal of Honor recipient Staff Sergeant Clint Romesha on his decision at the Shura House in the Battle of COP Keating reflect one moment’s enduring ethical and psychic impact on the warrior. See his Red Platoon (New York: Dutton, 2016), 323–324.

29 See BusinessDictionary.com, available at <www.businessdictionary.com/definition/opportunity-cost.html>.

30 To be sure, Sergeant Robert Bales has publicly admitted to his crimes and their enduring impact and continues to express not only remorse for them but also the necessary justice of his sentence rendered at court martial. See Brendan Vaughan, “Sergeant Bales Speaks: Confessions of America’s Most Notorious War Criminal,” GQ.com, October 21, 2015, available at <www.gq.com/story/robert-bales-interview-afghanistan-massacre>.

31 Tom Vanden Brook, “Senior Military Officials Sanctioned for More Than 500 Cases of Serious Misconduct,” USA Today, October 24, 2017, available at <www.usatoday.com/story/news/politics/2017/10/24/generals-sex-misconduct-pentagon-army-sanctions-hagel-gillibrand/794770001/>. However, force awareness of this trend is not new. See also Clark C. Barrett, Finding “The Right Way”: Toward an Army Institutional Ethic (Carlisle Barracks, PA: Strategic Studies Institute, 2012); and Craig Whitlock, “Pentagon Probe Finds Three Army Generals Committed Misconduct,” Washington Post, April 5, 2013.

32 As a corrective to the organizational effects of moral and spiritual injury (and a general lack of ethical development among leaders), I cite with admiration the 10 small group recommendations to build a culture of moral courage within the contemporary British armed forces. See William Meddings, “Observations of the Conference: Developing Morally Courageous Leaders,” in The Role of Leaders in Building a Culture of Moral Courage, 48–52.

33 Tick, War and the Soul, 104.

34 Ibid. However, this suggestion only draws on the communal aspect of war regnant in the larger major denominational traditions represented in the contemporary military chaplaincy, such as the broad framework of the just war tradition.

35 Theological ethics may be broadly equated to moral theology and as opposed to the corollary field of moral philosophy, which seeks to segregate the discipline of ethics from any theological roots. However, my contention is that relative to moral and spiritual injury, this often segregates the warrior from his or her theological roots as well, the source of moral formation for so many under arms today.

36 Dietrich Bonhoeffer, Sanctorum Communio: A Theological Study of the Sociology of the Church, ed. Clifford Green and trans. Reinhard Krauss and Nancy Lukens (Minneapolis: Fortress Press, 1998). In this first work of the German pastor turned martyr to Nazi hegemony, Bonhoeffer explores the necessity of the people of God being God in action for a broken, sin-filled world.