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Moral Injury - The Therapist's Bookshelf

Moral Injury

“Moral injury results when soldiers violate their core moral beliefs, and in evaluating their behavior negatively, they feel they no longer live in a reliable, meaningful world and can no longer be regarded as decent human beings. They may feel this even if what they did was warranted and unavoidable. Killing, torturing prisoners, abusing dead bodies, or failing to prevent such acts can elicit moral injury.” Rita Nakashima & Gabriella Lettini in Soul Repair: Recovering from Moral Injury after War.

Many clinicians serving veterans not believe that moral injury should receive the same clinical and research attention as PTSD because it so greatly impacts our service people.  The following resources have been recommended by therapists for soldiers and / or those who serve them.

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Soul Repair: Recovering from Moral Injury after War by Rita Nakashima & Gabriella Lettini 

Although veterans make up only 7 percent of the U.S. population, they account for an alarming 20 percent of all suicides. And though treatment of post-traumatic stress disorder has undoubtedly alleviated suffering and allowed many service members returning from combat to transition to civilian life, the suicide rate for veterans under thirty has been increasing. Research by Veterans Administration health professionals and veterans’ own experiences now suggest an ancient but unaddressed wound of war may be a factor: moral injury. This deep-seated sense of transgression includes feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs.

Rita Nakashima Brock and Gabriella Lettini, who both grew up in families deeply affected by war, have been working closely with vets on what moral injury looks like, how vets cope with it, and what can be done to heal the damage inflicted on soldiers’ consciences. In Soul Repair, the authors tell the stories of four veterans of wars from Vietnam to our current conflicts in Iraq and Afghanistan—Camillo “Mac” Bica, Herman Keizer Jr., Pamela Lightsey, and Camilo Mejía—who reveal their experiences of moral injury from war and how they have learned to live with it. Brock and Lettini also explore its effect on families and communities, and the community processes that have gradually helped soldiers with their moral injuries.

moral injury adaptive disclosure

Adaptive Disclosure: A New Treatment for Military Trauma, Loss, and Moral Injury by Brett T. LitzLeslie LebowitzMatt J. Gray, & William P. Nash 

A complete guide to an innovative, research-based brief treatment specifically developed for service members and veterans, this book combines clinical wisdom and in-depth knowledge of military culture. Adaptive disclosure is designed to help those struggling in the aftermath of traumatic war-zone experiences, including life threat, traumatic loss, and moral injury, the violation of closely held beliefs or codes. Detailed guidelines are provided for assessing clients and delivering individualized interventions that integrate emotion-focused experiential strategies with elements of cognitive-behavioral therapy (CBT). Reproducible handouts can be downloaded and printed in a convenient 8 1/2″ x 11″ size.

 

 

moral injury afterwar

Afterwar: Healing the Moral Wounds of Our Soldiers by Nancy Sherman

Trained in both ancient ethics and psychoanalysis, and with twenty years of experience working with the military, Sherman draws on in-depth interviews with servicemen and women to paint a richly textured and compassionate picture of the moral and psychological aftermath of America’s longest wars. She explores how veterans can go about reawakening their feelings without becoming re-traumatized; how they can replace resentment with trust; and the changes that need to be made in order for this to happen-by military courts, VA hospitals, and the civilians who have been shielded from the heaviest burdens of war.

 

 

 

Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and Their Families by Keith Armstrong, Dr. Suzanne Best, & Dr. Paula Domenici

The bravery displayed by our soldiers at war is commonly recognized. However, often forgotten is the courage required by veterans when they return home and suddenly face reintegration into their families, workplaces, and communities. Authored by three mental health professionals with many years of experience counseling veterans, Courage After Fire provides strategies and techniques for this challenging journey home.
Courage After Fire offers soldiers and their families a comprehensive guide to dealing with the all-too-common repercussions of combat duty, including posttraumatic stress symptoms, anxiety, depression, and substance abuse. It details state-of-the-art treatments for these difficulties and outlines specific ways to improve couple and family relationships. It also offers tips on areas such as rejoining the workforce and reconnecting with children.

moral injury beyond ptsd

Beyond PTSD: The Moral Casualties of War by Camillo Mac Bica

Camillo Mac Bica, Ph.D. is a former Marine Corps Officer, a Vietnam Veteran who has spent many years recovering and helping others recover from their experiences in combat, and a philosopher with a focus on ethics and war. In this series of essays, Dr. Bica argues from both a pragmatic experiential and a theoretical philosophical perspective that “troubled” veterans returning from war are not mentally ill but combat wounded, suffering from what he terms PEM Injuries, the “Psychological, Emotional, and Moral injuries of war.” “Beyond PTSD” is the second book of the War Legacy Series, in which Dr. Bica works to provide a greater understanding of the reality of war, its impact upon the warriors and their families, specifically, moral injury, and to dispel the mythology of nobility and heroism, which he argues, as indicated by the unconscionably high rate of veteran suicides, accomplishes nothing other than to complicate and make perilous, the readjustment and healing process.

 

If you are interested in better treating or understanding moral injuries, we highly recommend looking through the resources at The Soul Repair Center at The Brite Divinity School.  They have tons of book recommendations as well as free videos, webinars and podcasts.

If you know of another book that belongs on this list let us know here or tell us about it in the comments. Make sure you’re also following The Therapist’s Bookshelf on Facebook and Instagram.

 

Many therapists enjoy recommending books to their clients to supplement the work they are doing together. We also use books to help ourselves grow as people and practitioners. Remember though that books are never a replacement for real human connection or for therapy when it’s needed. If you find yourself needing a therapist, a great place to start is Psychology Today. If you are having thoughts of hurting yourself or someone else, please contact the National Suicide Prevention Hotline.

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