Treating Moral Injury: The Experiences of Morally Injured Combat Veterans in an Innovative PTSD Treatment

• In Event: 282 - Section on Medical Sociology Paper Session. Trauma, Victimization, and Health (co-sponsored with the Section on Sociology of Mental Health)

Abstract

In contrast to other forms of Post-Traumatic Stress Disorder (PTSD) in which patients have been victimized by intensely threatening experiences, moral injury is an emotional wound suffered by those who have perpetrated acts they themselves find morally reprehensible. Contrary to some expectations [Radiner 2005, Goffman 1961], moral compunctions around killing still affect soldiers, despite their immersion in military contexts and training [Grossman 2009]. For some soldiers moral concerns about killing in combat develop into serious psychological wounds. Morally injured combat veterans participated in a pilot treatment to address the impact of their experiences with killing in combat. Based on in-depth, follow-up interviews with participants, this article presents qualitative data on the experiences of participants in this treatment. It focuses on the efficacy and acceptability of the treatment from the patients’ perspective. Though conceived as a cognitive behavioral treatment for moral injury, participants spoke of outcomes that were both relational (achieving forgiveness) and analytic (acquiring cathartic relief and self-understanding] as well as cognitive (rethinking the circumstances of their killing experiences). This presentation also includes data that illustrates what constitutes moral injury and how veterans experienced this trauma associated with killing before entering treatment. This presentation should interest researchers and mental health practitioners working with patients who wrestle with their own active experiences with killing. It should also be of interest to those concerned more broadly with the impact of violence, in this case, on those who are socially sanctioned to wield the state’s “monopoly on force” [Elias 1994].

Authors

• Phillip Noel Fucella, University of California-Berkeley

• Shira Maguen, University of California-San Francisco