For those who work with military combat veterans, Dr. Jonathan Shay has been a strong voice and advocate for the recognition of Moral Injury; its conceptualization, and how this type of injury comes about. In part I of his brief orientation, he illuminates the ancient phenomenon of Moral Injury and psychological wounding due to war and killing; moving away from the more narrow diagnosis of PTSD.

Dr. Shay discusses three main avenues of addressing Moral Injury: ethical and effective military leadership, increased awareness of what Moral Injury is, and helping military veterans and their families to adjust, as they re-enter the civilian world. Shay admits that his efforts when addressing the Department of Defense and the Department of Veterans Affairs has often been met with silence and in some cases resistance. What is evident in Part II of his video series is the absence of “how” to treat Moral Injury in a sustainable way. There is enough discussion and anecdotal evidence to suggest that we now understand “what” Moral Injury is and “how” one struggles with it, but have yet to help our military veterans with its life-robbing and debilitating effects.

The Center for Post Traumatic Growth is certainly grateful for the passion and work of Dr. Shay and other early pioneers in the identification and discussion of Moral Injury. However, we suggest that a viable treatment approach is available; one which does not subscribe to the current “quick fix” therapies available for PTSD, and more directly for Moral Injury. In fact, we are making a claim the successful healing from Moral Injury will help to reduce the stagnant suicide rates among our veterans. Moral Injury is not a preventable wound, as Dr. Shay may imply in his video series. The Department of Defense cannot develop a simple “prophylactic” or preventable mindset included in its training and preparation for war, and the Department of Veterans Affairs cannot continue to overlook and disregard Moral Injury in favor of a superficial diagnosis of PTSD, with treatment approaches that only target fear, anxiety, and other neurobiological symptoms of trauma; although important. Dr. Keenan explains that there are “three ways and individual leaves combat: a little crazy, numb, or dead.” She expands in her past lectures on related guilt and shame; byproducts of Moral Injury, that those “without a conscience don’t get Moral Injury, and that often those with the deepest values for human life and moral principle are the one’s with the severest moral injuries, and therefore could not avoid completely becoming morally injured in war; that it is not preventable or simply cured with medication and cognitive-behavioral therapies. In our study of war and human trauma over the last 50 years we have come to understand that good people do bad things in war; for they must if they are to come home alive. The conditions of warfare and the need to survive often take the warrior to hell and back.