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Experts convene at Penn Law to discuss combat trauma, PTSD, and “moral injury”

December 09, 2015

From December 3–5, the Center for Ethics and the Rule of Law (CERL) at the University of Pennsylvania Law School convened 42 experts for an interdisciplinary conference, Preventing and Treating the Invisible Wounds of War: Combat Trauma and Psychological Injury. The gathering united mental health practitioners, military leaders, veterans advocates, legal scholars, and philosophers, as well as veterans affected by post-traumatic stress disorder (PTSD), to discuss both scholarly and practical advances in the effort to combat psychological injury from armed conflict.

A central theme of the conference was the psychological and social burdens of PTSD on both veterans and society, as well as an assessment of how those burdens should figure in the costs of war. Conference participants were in broad agreement that the effects of PTSD should inform political decisions to enter war, military decisions to engage the enemy, and civilian decisions to treat wounded soldiers upon return. The conference also explored ethical dilemmas that arise in the prevention and treatment of combat-based mental health injuries, and experts debated the merits of different treatment modalities. 

“If mental health injuries are to be understood as a real cost of war, then our estimates of the worth of war, and our judgments about which acts are justifiable in war, may call for reconsideration,” said Professor Claire Finkelstein, Founder and Director of CERL and the Algernon Biddle Professor of Law and Professor of Philosophy at University of Pennsylvania, in her opening remarks.

Conference participants — among them Penn’s own Dr. Edna Foa, Founder and Director of the Center for Anxiety Disorder; trauma specialist Bessel van der Kolk; clinical psychiatrist Jonathan Shay; and Pulitzer Prize-winning author Eric Newhouse — also broached the topic of “moral injury.” 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.” Conference participants considered whether moral injury should be recognized as a mental health concern that is distinct from PTSD, whether soldiers are particularly vulnerable to moral injury while confronting non-state actors embedded in civilian populations, and whether the conduct of senior leaders is particularly significant in contributing to moral injury.

The prevention and treatment of PTSD and “moral injury” also emerged as a topic of discussion. “Various empirical and ethical issues exist about therapeutic measures to address traumatic injury,” said Connie Rosati, Professor of Philosophy at the University of Arizona and a moderator for the conference.  “Are there practical and moral reasons to favor prevention over treatment? Treatment over prevention? What if preventive measures cause moral insensitivity or impair recovery from trauma and ‘moral injury’? How are the costs and benefits of therapeutic measures to be assessed?”

A central recommendation to emerge from the conference was a consensus that greater resources must be directed towards the psychological welfare of soldiers returning from combat. Participants also suggested that we develop a concept of “mental fitness,” comparable to physical fitness, which can inform pre-deployment military training.

Finally, participants considered the obligations that nations have to take into account the psychological well-being of non-combatants in the context of war. “The legal and ethical concept of jus post bellum requires that an occupying army provide the local population with all of the civic services expected of a government, such as hospitals, schools, and police,” said Jens David Ohlin, Associate Dean for Academic Affairs and Professor of Law at Cornell Law School. “This might also include psychiatric care for trauma suffered during the war. If this is correct, then arguably as a nation we not only need to treat our own soldiers for PTSD, we also need to be treat the civilians who are caught in the middle when two belligerent parties meet each other in battle.”

The Center plans to publish the proceedings of the conference in a volume of original papers.

CERL is a non-partisan interdisciplinary institute dedicated to the preservation and promotion of the rule of law in twenty-first century warfare and national security. The only center of its kind housed within a law school, CERL draws from the study of law, philosophy, and ethics to answer the difficult questions that arise in times of war and contemporary transnational conflicts. CERL represents the vision of its Founder and Director, Professor Claire Finkelstein, University of Pennsylvania Law School Algernon Biddle Professor of Law and Professor of Philosophy, in uniting scholars and policymakers in multi-disciplinary conversations on some of the most challenging issues of our time.