Abstract
Post-Traumatic Stress Disorder (PTSD) is the DSM category that is used to describe all traumas that have a long-term impact. It was observed that returning war veterans suffered not only with symptoms of PTSD but were also fighting scars resulting from conflicts arising from tenets of their faith. How to treat these scars are not clearly specified in mental health treatment in the secular framework and therefore are often not addressed in the counseling room. It was thought that the pastor/priest of the person would attend to the moral and spiritual issues arising from traumas of war. Moral injury, a term coined by Jonathan Shay, is a way of understanding levels of trauma (that involves killing another human) that affects someone at the religious or spiritual level.
Moral injury is the violation of an individual’s core religious/spiritual beliefs, and often involves shame in the person’s eyes as well as in the eyes of society. Very often there are elements of cognitive dissonance faced by the person who is trying to deal with the evil act committed. These result from the inner conflict that occurs from the committed evil act, which clashes with the moral values of the person. The presence of moral injury is proof of original moral health, and testifies to a still functioning human conscience. The evil act remains evil in the moral scheme, and is not to be downplayed in the path to recovery. What is done is to help the person understand the act in context and to realize that the act is not the only defining factor of the person. This allows for repair and restoration.
Therefore, an understanding of how a person’s moral life is disturbed because of the conflict between killing in the work situation, and faith life, necessitated deeper study and reflection. This edited book by Joseph McDonald, brings together many authors who address moral injury from various perspectives. Most of the articles in this edited book situate a person suffering from moral injury in a religious or a spiritual tradition. The ideas presented are broad, educating the reader about the authors’ approach first, before going into an explanation of the moral issues. The introduction by Joseph McDonald, the editor, gives an overview about the different interdisciplinary articles which draw from Christianity, Judaism, Islam, Buddhism, and US civil religion.
Some of the articles use biblical stories to explain moral injury. They inform the reader using Christian and Jewish lenses, that issues of moral injury are not necessarily limited to just persons but also affect family and society at large. There are articles written from other faith traditions’ perspectives. The articles introduce the faith tradition first before dealing with that tradition’s perspective on moral injury. Articles are also written from the US civil religion point of view, without negating the dimension of religion and/or spirituality. Each of the chapters broadens the knowledge base of the field, in its respective sphere. Addressing the impact that killing has on a person’s soul presupposes a faith tradition, and a conscience.
The article “Soul Repair” by David Blumenthal, a Jewish perspective, I think is the summary article of the whole book, as it addresses some dimensions of repair, like guilt, repentance, and forgiveness. The article presupposes that the conscience is affected in anything related to morality, as the conscience is associated with the soul which in religious traditions is the deepest part of the human person. This article demonstrates using religious language how moral injury can be addressed in the counseling room, whatever the cause of moral injury, not necessarily limiting the issue to returning war veterans. Understandings of guilt, repentance, and forgiveness and their impact on a person’s life are essentials for any counselor who is working towards repair and recovery, with faith-based clients. Very clear indications of how Jewish Scripture can be used in practical ways are shown, as is evident in the explanation of the three kinds of forgiveness, mechilaí [forgoing of moral debt], selichaí [forgiveness of mercy and grace], and kapparaí/tahoraí [atonement]. Forgiveness is also one of the most researched values in secular (without the faith or religious/spiritual dimension included) counseling as well. As the lead article of the book, this article sets the tone for the others, giving the readers perspectives from which to read the other articles, even though forgiveness, repentance, and guilt are not specifically treated in those articles.
The book’s authors show that persons who have moral struggles, because of decisions made in war conditions, and which went against their faith traditions, can have their faith restored and that they could be forgiven in the eyes of God, and in their own eyes. The strengths of the book are an exploration of the issue of moral injury as a way of helping returning war veterans. It also develops perspectives from different faith traditions. There are no clear markers on how to identify moral injury (as opposed to PTSD). I think this is a strength, as the problem might present differently in different persons, and depending on the faith traditions. The book does not touch upon other types of moral injury such as those resulting from killing someone outside of war, those who have had abortions, or have broken the tenets of defined faith deliberately, other than in war.
The article titled “Civil Religion and the Moral Wounds of War” seems to be a contradiction of sorts. Civil equates secular in ordinary understanding, and secular separates itself from religion. The article takes an ethical standpoint (ethics can change depending on groups, societies, and over time), drawing from early American history, and writers who espoused secular values. The ideas advocated in this article seem to be different from the others in this book. They would probably not fit into the definitions of moral injury as defined by Shay and others. Also, ideas of conscience would perhaps be difficult to explain when looked at from this point of view. The article makes use of a lot of religion as well in the development of its ideas.
This book is an excellent introduction to moral injury considered from different points of view. It gives many indications on how repair of moral injury can be addressed. Readers will be able to follow clearly through the flow in the articles as well as the arrangement of the articles, how moral injury can be understood as well as how to adopt an approach towards a person with moral injury. Although clear markers are not given (as for PTSD in the DSM), any person who is familiar with his or her faith tradition would relate to the article written from within that faith tradition. A follow-up book would be warranted which could look at many more effects of moral injury (like guilt and shame) drawn from religious and spiritual traditions and specifically at the practical aspects in dealing with the repair process. This would mean discussing more interventions that work vis-à-vis forgiveness, repentance, and so on, because treatment of moral injury would be different from that of PTSD. This book is a must read for those who integrate spirituality and/or religiosity into clinical practice.