World War I represents one of the first modern occasions that militaries systematically addressed the link between combat and its psychological effects on combatants. The term “shell shock” appeared in 1915 because of attempts by military psychologists to uncover the etiology of trauma symptoms related to war.Footnote 1 In contemporary terminology, this combat-related trauma is often described as post-traumatic stress disorder (PTSD), a trauma- and stressor-related psychological disorder. Diagnostic criteria for PTSD include a history of exposure to certain types of traumatic events, including death, serious injury, and sexual assault, which must cause “clinically significant distress or impairment in the individual's social interactions, capacity to work or other important areas of functioning,” and not be “the physiological result of another medical condition, medication, drugs or alcohol.”Footnote 2
But PTSD only captures one possible response to trauma. In the past few decades, researchers have begun exploring a related yet distinct response to trauma called moral injury. Although there is no single definition, “moral injury” can be described as a psychological injury that occurs when an individual experiences an event or series of events that cuts against her deeply held spiritual or ethical beliefs.Footnote 3 While moral injury is closely related to and can coexist with PTSD, it does not have PTSD's diagnostic emphasis on fear and the lingering fight-or-flight instincts that persist when one has directly experienced or witnessed traumatic events. Moral injury instead encompasses a different and distinct kind of trauma, where an individual can possess such feelings as guilt, shame, and regret, but need not feel the same kind of stress and fright commonly associated with PTSD. Just as PTSD can occur in both civilians and soldiers, so too can moral injury.
The early research on moral injury largely occurred in the field of clinical psychology, specifically by researchers who explored its relationship to combat. Philosophers later explored moral injury in wider terms. The stock-in-trade of philosophy is making distinctions and conceptual clarifications, the application of which to moral injury would aid in building a comprehensive theory of the subject. In the first half of this essay, I will show how these clarifications could help inform clinical research and practice, particularly when it comes to members of the military. I will then argue that a greater philosophical analysis of moral injury can help illuminate the normative implications of acknowledging moral injury in debates within just war theory over traditionalist and revisionist interpretations.Footnote 4
Moreover, the relationship between moral injury and jus ad bellum's just cause criterion is indeterminate. Particularly underexplored are the conceptual and empirical implications of the possibility that wars lacking a just cause may result in numerically larger cases of moral injury and/or more severe instances of it. This is a possibility that should be of interest to psychology and philosophy alike. In the rest of the essay, I discuss further avenues of potential research based on some conceptual distinctions that may aid researchers in pinpointing certain key questions.
The Just War Tradition
Much of the contemporary scholarship in the just war tradition has focused on a debate between traditionalist and revisionist accounts of just war. This debate centers on determining which agents can ethically participate in war and under what conditions. According to traditionalist accounts, the morality of when a war can be waged (jus ad bellum) is independent from the morality of how a war can be fought (jus in bello). Combatants are permitted to fight for an unjust cause insofar as they abide by in bello principles such as proportionality and discrimination. Traditionalist accounts maintain that it is not the responsibility of combatants to make evaluative normative judgments about the wars in which they fight in order for it to be morally permissible for them to engage in combat. Nor does the justice of their cause have a material bearing on their ethical permissibility to fight; they must fight well, but they need not fight for the good.
While traditionalist accounts treat the moral rules of war as sui generis, revisionist accounts reject the claim that war is morally exceptional. In the terminology of the literature, revisionists often subscribe to “reductive individualism.” They are revisionist in the sense that they claim to be revising many of the tenets of traditionalist accounts of just war theory.Footnote 5 They are reductive in the sense that they argue that the moral rules governing war are those that govern individuals in ordinary peacetime life. And they are individualists in the sense that they believe individuals, not collectives, are the proper unit of ethical analysis. In combination, these differences between revisionist and traditionalist accounts lead to significant disagreement on who can be justifiably harmed or killed in war and why.
Ethical acts in war can be further distinguished with respect to whether their justification is fact-relative or evidence-relative.Footnote 6 A fact-relative account maintains that the justness of an action depends on its objective truth. As Helen Frowe notes, “It does not matter whether the combatant (or the political leader) knows these truths. If her action is fact-relative unjustified, she will act wrongly in performing it. What she believes or has evidence of might furnish her with an excuse, but it won't provide her with a justification for acting.”Footnote 7 The justification for an act is evidence-relative when the available evidence gives an individual reason to believe and then act as if those beliefs are true, even if the evidence leads an agent to make a fact-relative moral mistake.
Moral Injury
Similar distinctions can be found in the literature on moral injury albeit with different terminology. For example, philosopher Nancy Sherman defines “moral injury” as “experiences of serious inner conflict arising from what one takes to be grievous moral transgressions that can overwhelm one's sense of goodness or humanity.” She goes on to say, “The sense of transgression can arise from (real or apparent) transgressive commissions or omissions perpetrated by oneself or others.”Footnote 8 In this account, the precipitant of injury is evidence relative; there is no condition under which the transgressions are objectively true—that is, fact relative. Jonathan Shay, a psychologist and pioneer in research on war fighters and moral injury, defines moral injury as “a betrayal of what's right by someone who holds legitimate authority (e.g., in the military—a leader); in a high stakes situation.”Footnote 9 In contrast to Sherman, Shay posits that moral injury results from a violation of what is right (fact relative), not what one believes to be right (evidence relative).
This epistemic distinction in just war captures the way in which moral injuries can occur in situations described as evidence relative, such as when the available evidence gives an individual reason to believe a transgression has occurred, even when making a fact-relative moral mistake. For example, a soldier may kill an individual in combat and later watch camera footage from a particular angle that seemingly indicates the person was a noncombatant, even though additional aerial footage unavailable to the soldier proves that the individual killed was in fact a combatant. Given the available evidence, it is intuitively plausible that the soldier could believe that she killed a noncombatant, and such belief could lead to moral injury. Understanding the different situations in which individuals may develop moral trauma can have a practical bearing on an individual's medical diagnoses, treatment, and health outcomes. Disagreements over whether individuals can be said to develop moral injury in one circumstance but not in another may lead to different treatments: in one instance they may be treated for moral injury, and in another for trauma that is separable from the diagnostic criteria of moral injury.
Whereas writers on the subject, such as Sherman and Shay, diverge on the role that fact-relative and evidence-relative acts or omissions play in moral injury, they converge on the idea that first-person moral injury can result from the actions of a second party. Again, this conceptualization is intuitively plausible. Suppose that a female officer witnesses sexual harassment being perpetrated by someone in her unit against another female officer. Further imagine that the female officer who has witnessed the harassment reports the case to her superior, who in turn does nothing. It is a reasonable expectation of the reporting female officer that her superior would properly address the reported sexual harassment. If the superior fails to do so, that person has violated the trust of the female officer to do the right thing. It is conceivable that such a violation—a transgression committed by a second party but impacting the first party—could result in moral injury.Footnote 10 Craig Bryan and colleagues have suggested that “differentiating between the agent of perceived transgressions (that is, self vs. other) may also hold important conceptual and empirical value.”Footnote 11 It would be beneficial for empirical researchers to further explore this conceptual distinction since empirical studies on PTSD already suggest a “separate phenomenology and pathway to PTSD” between perpetration and betrayal-based events in combat veterans.Footnote 12
These conflicting concepts of moral injury, combined with early empirical findings, raise important normative and epistemic questions that call for greater clarity as well as empirical data on the concept of moral injury. Some further questions to explore include: What counts as a transgression? Who transgresses and causes injury? How do individuals’ beliefs function in determining moral injury (that is, is it fact relative or evidence relative)? Is there a meaningful conceptual and empirical distinction between self-perpetrated transgressions and the betrayals perpetrated by others? Answers to these questions could help develop a broader theory of moral injury. Such clarification would not be merely “academic”; the bases upon which one defines moral injury could very well also inform clinical diagnoses, treatment, and veteran health insurance coverage. We have witnessed similar implications for the formulation of diagnostic criteria for PTSD.
Moral Injury and Revisionist Just War Theory
If philosophical moral injury could contribute to clinical psychology, how might it inform just war theory? Here we return to a core area of fundamental disagreement between the traditionalist and revisionist accounts—whether, all things equal, fighting for an unjust cause is morally wrong. One need not be a revisionist to accept that killing in war can lead to moral injury, at least insofar as one accepts the possibility that killing may transgress a deeply held moral belief even when done justifiably. But if killing by combatants who fight on the unjust side of a war is fact-relative unjustified, such an argument logically entails that wars contain larger amounts of unjustifiable killing when compared to traditionalist accounts. If killing unjustifiably has a positive correlation with moral injury, then there is a possibility that fighting for an unjust cause may lead to numerically more cases of moral injury, and this may provide an additional consideration for just war criteria.
Suppose Combatant A returns from fighting in a war in which her side's cause is unjust, she knows her side's cause is unjust, and she has killed opposing enemy forces who were justifiably resisting her. She is presented with two accounts of justified killing in war—a traditionalist account and a revisionist account. Under the former account, the killing she engaged in was not morally wrong; under the latter, it was. The two accounts will lead Combatant A to different ethical judgments about her own conduct, and such conclusions may lead her to believe she perpetrated moral transgressions, which could then result in moral injury. However, it is unknown how the account of justified killing in war to which one subscribes impacts the pathway, onset, or severity of moral injury. This is an area that empirical study could shed light on. Such empirical findings could inform considerations in just war theory, particularly if we care about and want to account for the psychological and moral costs that engaging in warfare can have on its participants.
In addition to it being unclear how killing unjustifiably may impact moral injury in combatants, so too is the effect of being betrayed by political leadership. Suppose that Combatant A accepts a revisionist account of killing in war. She remains in the military and is ordered to a second combat deployment in a different war. She believes that the cause for this war is just and that she is engaging in a fact-relative justified killing of opposing enemy forces. Now further suppose the leader of Combatant A's country falsely and intentionally claims the just cause as a pretext, but evidence later makes clear to Combatant A that the cause was unjust.
What is the response of Combatant A? She could feel betrayed. She had the reasonable expectation that she could trust her political leadership to not intentionally lie about such grave matters, and her trust was violated. If moral injury can result from transgressions committed by a second party, this betrayal may be a morally injurious event regardless of whether one adopts a traditionalist or revisionist account of killing in war. Recall that most traditionalist accounts argue that the moral responsibility of just cause lies with the political leadership. Consequently, an everyday soldier might accept the moral exceptionalism of war—that is, believing that she does no wrong when fighting an unjustified war—and still believe her political leadership betrayed her. While a traditionalist account may accept that moral injury can occur through such a betrayal, it rejects that a fact-relative wrong was committed through the combatant's killing; traditionalist conceptions maintain that a soldier does no wrong when fighting and killing even without a just cause. But in keeping with a revisionist account, the breach of trust would also have led to fact-relative unjustified killing by Combatant A. Under this view, Combatant A is betrayed twice—first because of the breach of trust and second because the betrayal led to fact-relative unjustified killing.
Whether betrayals lead to moral injury is a question that could be explored by, for instance, looking at the effect of the weapons of mass destruction pretext used to justify the invasion of Iraq by the United States. More broadly, empirical findings could clarify the relationship between betrayal, just cause, moral injury, and accounts of just war. The possibility that fighting for an unjust cause may impact moral injury, both as a result of killing unjustifiably and as a result of being betrayed by an individual in a position of leadership, should be of particular interest to scholars focusing on revisionist just war theory. It should also be a concern to supporters of the traditionalist view, since the deference granted to leadership in determining whether to go to war may be a previously unacknowledged source for moral injury.
Conclusion
This essay has briefly addressed some of the areas of interest in which moral injury and the just war tradition overlap. It concludes with two broad observations. The first is that it agrees that “research on transgressive acts and moral injury is complicated by the lack of conceptual clarity regarding definitions, causes, mechanisms, and outcomes.”Footnote 13 What is needed to achieve greater conceptual clarity is multidisciplinary research that includes the humanities, social sciences, and medicine. There are two immediate and low-hanging fruitful avenues of inquiry for future research on moral injury that rest at the axes of philosophy and psychology. The first is conceptual: revisionist accounts of just war should more fully consider the connection between just cause and moral injury, or revisionism and moral injury more generally. The second is empirical: the relationship between combat veterans’ beliefs of ad bellum just cause and moral injury should be studied. In the language and context of this essay, if a soldier believes she fights for an unjust cause, how does this impact the pathway, susceptibility, onset, and severity of moral injury? Does the distinction between fact-relative and evidence-relative justifications for killing in war impact moral injury?
The second observation involves a concern about conceptual creep.Footnote 14 The consideration here is that the concept of moral injury could become expansive to the point of being almost meaningless because of an ever increasing list of what constitutes a potentially morally injurious event. In addition, if moral injury can result from the conduct of multiple agents, both the individual and a second party (for example, a political leader), then this may also widen the net of those subject to moral injury. Perhaps the deployed cook or the undeployed logistics officer may not believe that they have taken part in an individual transgression, but they may still feel betrayed by a commander in chief. Perhaps even civilians whose democratically elected leaders authorize war may be affected. In the end, it may happen that everyone suffers from moral injury. Perhaps this is true; perhaps it is simply a fact that life is morally injurious, albeit some lives suffer more and worse injuries than others.
