Dr. Shay discovered that, among his Vietnam Veteran psychiatric patients, the greatest part of their emotional and mental suffering came from the term he coined as “moral injury.”  You won’t find this term in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard manual for diagnosis of emotional and psychological disease.  But it is a term that is gaining clout among many professionals that have been treating PTSD in veterans for decades through several wars.  It is this “moral injury,” this egregious violation of “all that is right” and good that seems to be at the heart of the persistence of the emotional and mental wounds for so many years after the end of battle.  I know that the first time I read Shay’s Achilles in Vietnam, the truth of this concept hit me so hard that my PTSD symptoms went off the charts for several days.  I felt like I was just returning from my deployment and was plunged back into that world of despair, grief, shame, bewilderment, and overwhelming emotional pain that completely consumed me for the first two years.  With the reading of that book, I felt like someone finally understood me, and someone could finally explain what was happening in my mind, my heart, and my seemingly shattered life.

From www.onbeing.org, this March 14, 2013, article “Beyond PTSD to ‘Moral Injury’” centers on Dr. Shay and his studies. 

They explain, “PTSD in service members is often tied to being the target of an attack — or being close in relationship or proximity to that target.  Moral injury, Dr. Shay says, can happen when “there is a betrayal of what’s right by someone who holds legitimate authority in a high-stakes situation.”  That person who’s betraying “what’s right” could be a superior — or that person could be you. Maybe it’s that you killed somebody or were ordered to kill. Or maybe it was something tragic that you could have stopped, but didn’t. Guilt and shame are at the center of moral injury. And, as Dr. Shay describes it, so is a shrinking of what he calls “the moral and social horizon.” When a person’s moral horizon shrinks, he says, so do a person’s ideals and attachments and ambitions.

It is this moral violation of the highest order that causes a complete shattering of the protective world view that we all construct to make sense of the world.  Our world view is comprised of all our values, beliefs, experiences, and explanations that make it possible for us to get through the day and to interact with and trust others.  When someone does something that is so horrible, so egregious, such a violation of their moral obligations, then the victim, the perpetrator, and even the observers of this horrific act can all be deeply wounded by the violation, resulting in the shattered world view.  At that point, nothing makes sense anymore, and there are no words that can explain what happened.  There is nothing left but pain, grief, shame, and guilt.  And the wounds can be so deep that the victim may never completely recover.

Of course, this has ramifications not just for combat veterans.  Such moral injury can occur to almost anyone anywhere.   For instance, the child abuse victim experiences moral violation of the highest order, because the violation of the innocent, the weak, and the helpless is one of the greatest evils that we know in our human experience.  Moreover, the moral violation is even worse when it comes from a parent or someone else who is charged with the responsibility to care for the child.  Good turns to evil,  when, instead of caring for the child, they take advantage of their position of authority to harm the unsuspecting, defenseless child.  It is a complete reversal or a complete shattering of the most sacred obligation, the most sacred trust, between parent and child.  This is just one example.  There are many other situations in which people may experience moral injury.  I’m sure that holocaust survivors and prisoners of war, for instance, also experience this deep emotional and mental wound from the moral injury.

If any of you have experienced moral injury from someone or from some experience in your past, I pray for God’s peace that passes all understanding and His comfort that knows no limits to heal you, to give you hope and a future.



06/13/2015 4:00am

What a great blog. Its inspirational and mouthwatering all at the same time.


Great information, you have a wonderful blog and an excellent article.

08/02/2016 1:58am

In Vietnam many people are facing diseases. They are suffering from moral and mental injury. This also termed as moral injury. The main requirement is to make solution for such disease. People must work for the remedial action.


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    I'm a retired soldier, having spent 23 years of my life serving our country, actually 30 years when you count the reserve and National Guard time as well.  I believe in servant leaders, following the example of our Lord, and I believe in giving back to the troops once one has attained a certain status or level of success in life.  But I also believe in fighting back against corruption and incompetence wherever you find it if it hurts people.  Our national values were worth dying for.  They are also worth living for.  A man or woman can actually live a life by these principles of humility, service, love, duty, and honor, and have a significant impact on the world around them...if you have the dedication to see it through. 


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