Moral injuries of war can be just as harmful, even deadly, as physical wounds or PTSD and just as detrimental and costly to families and society, says a Southern Illinois University Carbondale researcher who is leading an effort to change policy and remove barriers to treatment.
“In the course of war, members of the military sometimes have to do things to accomplish their missions that have profound impacts on them,” said Justin McDaniel, associate professor of public health in the School of Human Sciences. “And sometimes they can’t forgive themselves even if they were just following orders. A classic example is a war mission that results in the death of an innocent civilian. Many military personnel are overcome with guilt. As a result, they suffer psychological and moral injury.”
“Everyone knows people can lose life or limb in a war, but what about the invisible wounds of war? That’s our focus.”
McDaniel, who holds joint appointments in the neurology department and the population science and policy department at the SIU School of Medicine, said veterans can subsequently suffer flashbacks, nightmares, substance use issues, increased suicide rates and other problems. Data that McDaniel’s team has analyzed thus far indicates moral injuries may be “much more prevalent than post-traumatic stress disorder, and the symptoms are distinct.” For instance, some data suggests that PTSD affects about 8-13% of veterans while some 37% or more are affected by moral injury.
Yet, moral injury is not recognized by the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). It’s also not included in the Veterans Affairs disability rating, McDaniel notes, so there is no way to get an official diagnosis or services for it through the VA.
That’s why he and his team are promoting solutions and continuing their research. They’ve established a lab to spearhead their efforts and are accepting donations through the SIU Foundation.
“We are advocating and urging the policy makers to make changes, to recognize moral injury as the significant detrimental health condition it is and diagnosis it and provide funding for treatment,” McDaniel said.
New book goes in depth
McDaniel is the lead author of a recently published book that highlights moral injury research and advocacy efforts. “Preventing and Treating the Invisible Wounds of War: Combat Trauma, Moral Injury, and Psychological Health (Ethics, National Security, and the Rule of Law)” was published by Oxford University Press. Co-authors are Evan R. Seamone, a retired Army lawyer who is a fellow of the National Institute of Military Justice, and Stephen N. Xenakis, retired Army brigadier general. Michael Mullen, 17th chairman of the Joint Chiefs of Staff under George W. Bush, wrote the forward.
The chapters by experts and researchers across the country examine a variety of conditions, including many not previously recognized, such as moral injury, military sexual trauma and remote combat trauma and how they can be precursors to more serious mental health disorders. The goal is to ultimately treat the issues. In addition, the book examines several other costs of war:
- Financial costs for providing treatment of mental health conditions.
- The long-term, intergenerational impact that combat trauma has on families.
- Criminal justice system involvement for some veterans who don’t receive treatment due to military misconduct discharge.
Other contributors from SIU include:
- Daniel Brown, researcher with the STEM Education Research Center.
- Harvey Henson, director of the STEM Education Research Center and associate professor with joint appointments in curriculum and instruction in the School of Education and geology in the School of Earth Systems and Sustainability.
- Jennifer Koran, professor of quantitative methods in the School of Education.
- Kevin Sylwester, professor and director of the School of Analytics, Finance and Economics.
- Tim Ting, associate professor of practice and distinguished teacher in the paralegal studies program in the Public Policy, Justice and Social Issues Programs.
- Yurino Kawashima, SIU sociology doctoral graduate.
- Eric R. Black, clinical psychiatrist and associate professor of clinical psychiatry at the SIU School of Medicine
Evidence-based activism
McDaniel has established the Veteran Education, Transition, Empowerment, Research and Advocacy Network (VETERAN) Lab, which conducts research to benefit members of the military and veterans and to inform evidence-based policy recommendations.
Donations to support the lab can be made through the SIU Foundation. Visit siuf.org/give and search for “Veterans Advocacy Fund.”
In addition, the lab is conducting grant-funded research. The National Science Foundation (NSF) awarded a three-year grant for just over $341,600 in September 2023 to McDaniel and the lab for “Rural Veteran Personality, Delay Discounting and the Interference Preservation.” The project focuses broadly on helping rural veteran students transition from the military, into college, and then into a civilian job.
McDaniel was also recently awarded another $32,654 in NSF funding to supplement the first grant, which he will be using to train a military veteran doctoral student and add a peer-mentoring component to the parent grant award. In addition, McDaniel has received three consecutive contracts totaling nearly $181,790 from the U.S. Department of Veterans Affairs to assist its efforts characterizing and evaluating a program that aims to rehabilitate service members and veterans with traumatic brain injuries via an innovative two-week assessment and treatment program.
Learn more
Learn more about the Veteran Education, Transition, Empowerment, Research and Advocacy Network (VETERAN) Lab.
Media Contact: Christi Mathis, public information associate, 618-453-6707
