The financial burdens of post-traumatic stress disorder (PTSD) alone on U.S. economy are estimated to range in the billions of dollars. The financial toll of PTSD does not account for the full societal and moral impact of mental health-related combat injuries. Those suffering from PTSD and traumatic brain injury (TBI) often have difficulty finding gainful employment, are prone to violent outbursts and substance abuse, experience marital problems and exhibit suicidal tendencies. These behaviors have a disruptive effect on veterans’ spouses, extended families, and communities as well. In addition, recent research suggests that PTSD is heritable through multiple generations, further expanding the long-term effects and costs of the condition. Further, psychological harm related to the conduct of hostilities impacts civilians, particularly women and children, increasing the collateral costs of war. Taking these and other consequences of combat trauma into account within traditional Just War Theory presents significant challenges for civilian and military leadership. Should mental health costs to service members and civilians in areas of conflict be included in the calculations of governments contemplating whether to engage in an armed conflict? Should battlefield commanders assess potential mental harms to civilians as part of the proportionality analysis of “collateral damage” conducted prior to each military engagement? Are mental harms commensurable with physical damage? By what metric they be included in an assessment of the costs of war?
Additionally, while PTSD continues to be perceived as the archetypical psychological combat-related syndrome, there are other less discussed combat-related psychological harms. When a service member witnesses or commits a transgression from deeply held moral beliefs and expectations, he or she may suffer from what has been termed “moral injury.” Should moral injury be recognized as a mental health concern that is distinct from PTSD? Are soldiers particularly vulnerable to moral injury while confronting non-state actors embedded in civilian population? Is the conduct of senior leaders particularly significant in contributing to moral injury?
Further questions arise in considering possible measures to prevent combat trauma instead of waiting for its otherwise inevitable occurrence and seeking treatment. Inoculating soldiers to the horrors of warfare through pre-deployment battlefield simulations or through pharmacological intervention may reduce the likelihood of trauma. Such prevention programs, however, have been criticized as desensitizing soldiers to moral indignation and reducing their capacity for sound moral decision making in combat. Additional dilemmas arise in the therapeutic context. PTSD treatment in the proximity of the battlefield facilitates expedient return to active duty, but may also decrease the potential of full long-term recovery. Likewise, certain medications may alleviate the suffering from PTSD but hinder the healing of moral injuries. Should these aspects of treatment protocols be considered, and if so how should they be weighed? Finally, there are important legal and ethical questions relating to criminal and civil liability of service members suffering from mental harms. Should war inflicted mental harms be taken into account in criminal trials? If so, should they constitute an affirmative defense, a basis for mitigation in sentencing, or as a consideration to be weighed in the exercise of prosecutorial discretion?
The purpose of this conference is to engage in two days of constructive discussion pertaining to such queries, sparked by carefully selected background readings.