PTSD vs. Moral Injury

From What the Taliban Told Me, by Ian Fritz (Simon & Schuster, 2023), Kindle pp. 222-224:

ACCORDING TO MY OFFICIAL Air Force records, I do not have, and in fact have never had, PTSD. Formally receiving this diagnosis would have required an official admission that what I did and saw and heard was in fact traumatic and that it wasn’t normal, which would only have served to justify my reasons for not wanting to go back. You can see why the powers that be wouldn’t want to admit this. And while this diagnosis wasn’t true when the Air Force made it, it might be now. Time doesn’t heal all wounds—some simply can’t be treated—but eventually your mind can bring the edges together, and while the scar is ugly and imprecise, the gaping hole has, finally, closed. These days I can listen to Pashto without breaking out in a cold sweat, get on a plane without thinking about the guns that ought to be attached to it, and talk about war without wanting to curl up in a ball and die. This, then, is understood as meaning that my PTSD has been cured (never mind that curing something that was never supposed to have existed creates some mild metaphysical stickiness).

In the time since I wasn’t diagnosed, the military has embraced a different terminology to attempt to describe the turmoil that I and so many others experienced: moral injury. The idea of moral injury has been around since at least the 1980s, though the explicit term was coined by Jonathan Shay in the nineties, when his work with Vietnam veterans led to his writing Achilles in Vietnam. Today, Syracuse University’s Moral Injury Project not only defines moral injury but attempts to explain why and when it happens:

Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.

This is a good definition; it is thorough while simultaneously casting a wide enough net to embrace the myriad reasons any warfighter could suffer such an injury. Being a DSO allowed for perpetration, witnessing, and failure. Certainly, my moral code was violated. But I don’t think moral injury fully encompasses just what happened. It’s not that I, along with almost every other Pashto DSO, wasn’t morally injured. We were. But it’s not entirely accurate to say that there was “damage done to [my] conscience or moral compass.” It’s more like, along with the many men I killed, my consciousness was blown the fuck up.

With the exception of spies mythical and real, most warfighters throughout history have not been tasked with killing people they know. Even in our modern wars, in Iraq and Afghanistan, the majority of killing is done by complete strangers. There is, I assume, a feeling of knowing associated with killing someone in close combat, even though you may have no knowledge of anything that defines that person as a unique human. But this is different from understanding what makes that person a person, from killing someone you know. With modernity came the ability to have this knowledge.

The most famous of these warriors are drone operators. These men and women face issues that I can’t begin to understand, as the cognitive dissonance that they experience is so strange as to be something out of science fiction. If anything, it seems that their injury is arguably worsened by the moral contradiction of being so far away from the “threat.”