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Moral injury

The following material is drawn from an interview with Professor Tom Frame. They are ideas meant to prompt discussion and to provoke debate, and represent an attempt to move beyond the familiar narrative of the ‘broken’ veteran being betrayed by an indifferent government bureaucracy.

The concept of ‘moral injury’ continues to be the subject of research and reflection but has been associated with a disturbance, disruption or diminution of a uniformed person’s moral outlook and the depletion, degradation or disorientation of their moral compass as a consequence of operational service. A morally injured person will question the validity and necessity of moral values; chastise discontinuities between the idealised moral self and the realised self; and, wrestle with assertions of universal moral logic.

Moral injury is not synonymous with PTSD. The incidence of moral injury is not predicated on a traumatic experience. A traumatic event may cause moral injury, but a person can be morally injured—an injury manifested in personal guilt and shame, or indifference to human pain and suffering—without the causal event being traumatic. Moral injury does not flow from external stress, but from internal reflection. It has to do with what a person makes of what they see, hear, smell, touch and taste. Two people can experience the same thing: one will be unaffected, while the other will be injured. The difference is how they interpreted their experience in terms of the value structures ordering and regulating their inner being.

The usual narrative (echoed by both the media and the parliament) runs as follows: ‘these young men and women have served their country faithfully and well. Defence has broken them in body and mind and DVA has failed to look after them adequately. Something needs to be done. We (those indicted are never completely defined) have failed these veterans and the system is broken’. Against this backdrop, PTSD has found its way into the popular imagination as the accepted description and the agreed phenomenon that captures the experience of so many who have been negatively affected by their uniformed service or operational deployment. This narrative is highly problematic in a number of ways.

Problems with PTSD itself

All negative experience resulting from a military career is not usefully described practically or conceptually as PTSD. The term ‘moral injury’ may explain some negative fallout, but there may be a myriad of other useful ways to understand the effects of military service on the human mind. PTSD has become the ‘catch all’ complaint for anyone working in emergency services, including the police. It is not specific to the ADF and yet, curiously, its operating parameters are very different in the non-Defence community. Hence, the importance of research into moral injury. PTSD is not well explained (it is described, more than defined), and suffers from an unstable diagnostic foundation (witness changes in the definition between DSM III, IV and V). Its application by the profession of psychology reflects an almost complete reliance on this branch of behavioural science at the expense of multi-disciplinary approaches. Routine ‘diagnosis’ of PTSD appears to facilitate, if not encourage, compensation claims where the disorder is worsened by the process of litigating unsuccessful claims. The goal here is not to absolve the government of responsibility, but to broaden the conversation about what that responsibility might look like. Rather than deny culpability, the discussion could instead turn to how best the military can meet the challenge of looking after its people.

The need for a realistic narrative on military ‘service’

Given the messages conveyed in recruitment advertisements and the way in which newly-joined personnel are encouraged to see a deployment as a career highlight and the chance to validate their training, the military may be encouraging a mindset that resembles that of state-sanctioned mercenaries where career-minded individuals believe going to war will offer personal/professional development opportunities rather than primarily serving a noble cause—the defence of the nation and its people. A career in the military is depicted as a personal challenge, not service of the common good. War is no longer about protecting Australia or serving our nation; professional soldiers receive a generous deployment allowance and medals in exchange for the work they have done. Their service is voluntary and they are remunerated on the basis that they are on deployment. In essence, increased allowances are the ‘pay off’ for accepting increased danger. This is what the DFRT [Defence Force Remuneration Tribunal] determines. It may therefore be helpful to formalise the ‘assumed’ moral contract of service. For example, the UK Government has a ‘covenant’ between the state, the nation and the armed forces to make explicit the relationship between society and the service person, setting out obligations and responsibilities on both sides.

Limitations of the entitlement narrative

An entitlement mentality, visible well beyond the uniformed community, where every element of human interaction is potentially susceptible to compensation, will deplete social capital and destroy communal solidarity. In the context of uniformed service, regardless of the outcome of a ‘DVA battle’, it will not replace the next phases of life with the support of family and friends and community, and taking responsibility for oneself. A more realistic attitude to a military career and a degree of frankness about its character, coupled with a willingness of recruits to prepare themselves and take responsibility for what happens, may create the circumstances where an injured person is more likely to be healed. Refugees have often experienced horror, but their lack of a feeling of entitlement means they work hard and build lives for themselves. They were, and are, animated by a different narrative—they are not victims, but survivors whose experiences have strengthened rather than depleted them—for the greatest part. With enough retelling of a story, it has a way of becoming reality. The problem may not be PTSD; it may be that an individual is angry and bitter in a way that is not fully known to themselves. This only highlights the need to create a positive and productive narrative.

Nor does the ‘slipped through the cracks’ narrative explain the situation. At what point can the state intervene in a preventative way when someone has chosen to self-exclude. In a voluntarist society which remains sceptical of state intervention, personal help is sought and not imposed. The issue here is that neither society nor government can prevent all harm; the narrative of the ‘government needing to do something’ is part of the assumption that whatever happens to an individual, it is eventually and ultimately the responsibility of the state. Whereas, in reality, individuals need to prepare themselves for life and accept the need to respond personally to the challenges associated with everyday living. The state cannot provide what an individual declines to provide for themselves. The nature of the relationship which exists between the state and the individual is clearly at issue. Yet, it is rarely discussed. We are somewhere between the UK and the US when it comes to defining the essential elements—somewhere between covenant and contract.