Meaghan Mobbs

The Debrief

The Psychological Ramifications of the 'Afghanistan Papers'

How moral injury can arise long after the battlefield.

Posted Dec 16, 2019

Last week The Washington Post released the “Afghanistan Papers,” a trove of documents that are touted to “reveal[s] that senior US officials failed to tell the truth about the war in Afghanistan, making rosy pronouncements they knew to be false and hiding unmistakable evidence the war had become unwinnable.”

Meaghan Mobbs, 16 December 2019
Search return for Google, 'Afghanistan Papers'
Source: Meaghan Mobbs, 16 December 2019

While there is certainly an argument to be made that the documents fail to establish widespread and coordinated misdirection and deliberate deceit, many people will never make it past the sensationalistic headline, the first paragraph, or a 280 character Twitter take on its conclusions. This is not an indictment of effort, but where pain lies, so too avoidance goes.

Much in the way massive confirmation bias led to poor decision-making and the characterization of progress for leaders in Afghanistan, for those who already wrestle with the part they played in America’s ‘Longest War’ or felt they lost a loved one needlessly, this has the potential to crystallize and exacerbate pain, grief, anger, shame, guilt, and distress.  

The unfortunate reality is damage was done the moment the headline hit the news cycle and probably, most deeply, to those who already struggling.

Whether or not The Washington Post successfully argued for and established that there was a coordinated effort to mislead the public is a mostly academic exercise—a necessary one that has real value for many, but little for those who are suffering and still attempting to make sense of their pain. For them, this likely feels like insult to injury, betrayal after loss.

While posttraumatic stress disorder (PTSD) and depression can arise from exposure to potentially traumatic events, a different type of psychological wound, moral injury, manifests around the fracture of one’s conscience or moral compass when one engages in or is associated with acts that run counter to their belief system, values, and ethics.

Moral injury does not carry with it time strictures or the somewhat arbitrary limitations or criterion so often found with some psychological disorders. In fact, it is not a disorder at all.

You will not find it in diagnostic manuals and it carries no International Classification of Diseases (ICD-10) code—but you will find it anywhere and everywhere there has been war.

If PTSD is an injury of the mind, moral injury is one of the soul.  

Uniquely, moral injury potentially possesses a temporal dimension. As moral codes evolve alongside identities, these transitions alter perception and perspective, resulting in new conclusions about old events. Crucially, this development and change over time may contribute to transition stress, which occurs when service members leave active service and reenter civilian life—and those in the first year are particularly vulnerable to suicide. Moreover, the calling card of moral injury is shame, which is "more prominent than guilt in the dynamics leading up to suicidal thoughts and behaviors." 

Shame, in particular, is hard to recognize and even harder to treat. Shame is a debilitating emotion and it can feel disturbing and disruptive in ways other emotions don't. Shame is a rupture within, it is a chasm between selves—the self you wanted to be and the self you were. Paradoxically, it longs to be healed but often gets in its own way.  

Moral injury is not a new phenomenon. Johnathan Shay, a clinical psychiatrist, wrote extensively about the experiences of Vietnam veterans, comparing them with the descriptions of war and homecoming in Homer's Iliad and Odyssey. Moral injury is as old as war, and philosophers, writers, and doctors continue to wrestle with its form and presentation. While there are symptoms unique to moral injury, it does not lend itself well to categorical diagnostics. Arguably, PTSD doesn't either, and the current criteria allow for more than 636,000 ways to qualify for the label. However, what makes moral injury injurious is the source of the injury, not its symptoms. 

In his conceptualization over vast analyses and studies, Shay (2014) emphasizes the dangerous repercussions of leadership failure and that moral injuries occur when there is a “betrayal of what’s right, by a person who holds legitimate authority in a high stakes situation.”

Perhaps that might be a more fitting and accurate headline than the one chosen by The Washington Post.

References

Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182.