How organizations and leaders may contribute to or protect against moral injury.
Posted March 10, 2018 | Reviewed by Abigail Fagan
In recent years, the concept of moral injury has emerged to describe a cluster of symptoms — similar to those associated with posttraumatic stress disorder (PTSD) — that result from personal experiences, which violate a person’s deepest and most closely held values and principles.
In 2014, I was invited to write an article for the journal Ethics and Armed Forces that compared moral injury with PTSD. The article was in response to popular press reports of PTSD-like symptoms in pilots of unmanned aerial vehicles (UAVs) that are similar in prevalence to PTSD rates among military personnel involved in direct combat. Pilots of UAVs are often based halfway around the world from where the drone they are flying is engaging a target and the death and destruction that result from destroying a target is therefore something of an abstraction for the UAV pilot. This is in sharp contrast to ground soldiers, who directly sense (hear, see, smell) the impact of their own actions.
I suggested that moral injury is more associated with an existential crisis, stemming from the violation of values pertaining to the sanctity of life, than with trauma. Moral injury, from this perspective, involves a more abstract cause than PTSD, which is thought to occur after direct contact with a traumatic event. The infantry soldier directly sees the impact of his or her actions, available through all of the sense organs. The UAV pilot knows their actions have caused loss of life, but the nexus between their own actions and consequences are less direct.
It is interesting that these two quite different scenarios are impactful to the point of producing similar stress reactions. Whether moral injury is something different from PTSD has not been resolved, but if they are different, then different strategies may be needed to prevent and treat moral injury and PTSD.
Organizations and their leaders may provide a layer of protection against moral injury. In the US Army, elite units like Rangers and Special Forces experience less than half the PTSD rates of regular combat units, despite having more frequent and often more intense engagements with enemy forces. Soldiers volunteer to serve in elite units, must pass stringent tests to be admitted to them, and must maintain high standards to remain in these units. The esprit de corps is high. These organizations have clearly defined values and missions, and combat units are led by officers and non-commissioned officers who are competent and of high character. This combination of expertise and high standards combine to provide a protective function against combat stress.
There is a flip side to this as well — not all military organizations and units are equally well-led. A few years ago, I was conducting interviews with officers who had just returned from combat, looking for their insights into both PTSD and possible positive aftereffects of combat deployments, such as posttraumatic growth (PTG). These officers had led their units in direct combat in Iraq and Afghanistan, and had been involved in deadly combat action.
Most of the officers I interviewed coped well with their experiences. However, several had not fared so well. Two asked to spend additional time talking with me about their experiences. Both of these officers had clear PTSD symptoms, but neither had sought professional help. In both cases, their problems could best be described as resulting from moral injury or an existential crisis caused by toxic leadership.
These two officers entered combat with idealistic views of their mission, but were shocked to find themselves working for leaders who were incompetent, dishonest, and untrustworthy. They told me they could learn to deal with the harsh reality of combat, but could not come to terms with working for such so-called “leaders.” In an unrelated case, an officer I knew committed suicide after serving for a commander that he believed to be dishonest and dishonorable. These cases did not result from exposure to traumatic events, per se, but are related instead to violations of moral standards and beliefs, with an attendant pervasive sense of powerlessness and hopelessness, factors that have long been known to be related to depression and other pathologies.
These are anecdotal, but I would like to direct your attention to a new book — War and Moral Injury: A Reader — that explores the concept of moral injury in detail. Individual chapter authors address the similarity and differences between moral injury and PTSD, how their symptoms differ, and whether moral injury is a spiritual or a psychological disorder. Most notably, the book is organized into chapters written from different perspectives. These include poets and novelists, warriors and national security specialists, reporters, chaplains, and scholars. I find this unusual approach to understanding a phenomenon like moral injury to be refreshing and enlightening. These disparate perspectives, taken together, offer real insight into an important psychological phenomenon.
Moral trauma is not confined to military personnel. People who become law enforcement officers to help make society and their communities safer, but who find themselves working in a corrupt organization experience moral trauma. Workers in corporations, who believe in the intrinsic value of the product or services the corporation sells, may experience moral trauma when they come to understand that the corporation puts profits above health and safety concerns of customers or even the employees themselves.
The military has learned, and other organizations can do so as well, that positive institutional values can diminish vulnerability to moral injury. The Army’s mission is to fight and win wars, but not by using any method or at any cost. Clearly articulating how its organizational values link to its mission statement, inculcating positive organizational standards, and reinforcing values-based decision-making help individual soldiers deal with the difficult choices and actions they must sometimes make.
When military organizations fail to live up to their values, the consequences may be profound. In his description of the impact of the Abu Ghraib atrocities perpetrated on Iraqi prisoners of war by US military personnel in 2004, military psychologist Paul Bartone clearly illustrates the adverse impact on individual soldiers and the entire Army when a military unit fails to adhere to its values and principles of conduct. Organizations — military and civilian alike — that fail to heed these lessons do so at their own peril, and to the peril of the well-being of their individual members.
Note: The views expressed herein are those of the author and do not reflect the position of the United States Military Academy, the Department of the Army, or the Department of Defense.
 Matthews, M. D. (2014). Stress among UAV operators: Posttraumatic stress disorder, existential crisis, or moral injury? Ethics and Armed Forces: Controversies in Military Ethics and Security Policy, 1, 53-57.
 Meagher, R. E. & Pryer, D. A. (Eds.), (2018), War and Moral Injury: A Reader, Eugene, OR: Cascade Books.
 Bartone, P. T. (2005). The need for positive meaning in military operations: Reflections on Abu Ghraib. Military Psychology, 17(4), 315-324