By Klaus Jahn: Australian Institute of International Affairs

Recognition of Post-Traumatic Stress Disorder, or PTSD, acknowledges the mental distress suffered by veterans of war. Tine Molendjik argues that despite the benefits, recognition does not go far enough in unpacking the moral injuries of war.

In the years following the end of the Vietnam War, those providing medical and psychological aftercare to combatants recognised what had long been known about combatants, namely that many have a tendency to suffer mental distress. Earlier known variously as “shell shock,” the “soldier’s heart,” and “war neurosis” (névrose de guerre, or Kriegsneurose), war distress became officially known as Post Traumatic Stress Disorder (PTSD) following the publication in 1980 of the third edition of the Diagnostic and Statistical Manual (DSM-III), published by the American Psychiatric Association.

Clearly the recognition of PTSD was of enormous benefit to those party to the horrors of war (and more recently, to others who have suffered trauma), with access opening to improved treatment, services, disability benefits, and in some cases compensation. Yet, in the intervening years, some scholars and clinicians have recognised certain limitations of the PTSD paradigm. Most notably, PTSD is reductionist in limiting the harms of war and trauma to a medical and institutional condition.

These scholars began to consider the mental distress experienced by combatants in terms of moral harm, “a concept that puts forward a particular psychological definition of the moral dimension of deployment-related suffering (a mental wound yet distinct from PTSD), a particular cause (transgression of the [sic] own moral code) and particular solutions (including therapy focused on self-forgiveness).” Tine Molendjik’s Moral Injury and Soldiers in Conflict makes a novel and valuable contribution to the extant literature on this complex concept.

Molendjik’s book unfolds in three uneven parts. The rather brief first part sets the stage with an introduction, and a second chapter that situates Molendjik’s work relative to various interdisciplinary perspectives taking up issues of trauma, morality, and the socio-political facets of mental distress experienced by combatants. Chapter two serves primarily to lay out the relationship between PTSD and moral injury, highlighting how PTSD can be included in discussions of moral harm, but also how the two are to be differentiated. It has the virtue of both showing the limitations of PTSD to address the mental distress of combatants, as well as indicating both the promises and the limitations of the move to addressing this distress through the lens of moral injury. This chapter is both well-informed by exemplars from the extant literature, and at the same time rightly critical, promising to make an important contribution to the theory of moral injury.

The longer second part, entitled Soldiers in Conflict, represents the core of the text, and it is here that Molendjik makes a genuinely novel contribution. Molendjik’s book, which emerged from her PhD research, is structured around interviews conducted with roughly 100 former Dutch service personnel deployed as part of two international conflicts. The first of these deployments was termed “the Dutchbat,” which involved a battalion of soldiers which contributed to the United Nations Protection Force’s peacekeeping operation from 1992-1995.

These “blue helmet” forces were sent to execute the United Nations Security Council Resolution 819 in Bosnian Muslim enclaves and to enforce the safe zone of Srebrenica in the war in Bosnia. The second of these deployments was the Task Force Uruzgan (TFU), which was the Dutch (and Australian) contribution to NATO’s Regional Command South International Security Force in Afghanistan. While the Dutch contribution was leading one of four Provincial Reconstruction Teams, the reality was that the deployment was a “green helmet” operation involving Dutch personnel participating in combat operations.

This section contains raw anecdotes drawn from veterans of both conflicts and reveals the curiously shared traumas experienced by veterans of two ostensibly very different actions. This account, unfolding over the course of four chapters, is gripping despite being occasionally repetitive. Molendjik’s interviewees – drawn from both enlisted personnel and combat officers – evoke images of soldiers who do not view themselves as especially patriotic or concerned with human welfare, but rather just “getting on with a job.” Chapter three, entitled “That’s just the way it is: Uncomplicated Soldiering,” sets this scene, while chapters four and five describe the deep moral disorientation that arises in the face of the genuine ethical struggles associated with allowing horrific harms to non-combatants to occur. Such harms are described as coming about either through a lack of adequate resources or the deeply confused and confusing mandates characteristic of both Dutch missions.

Molkendjik’s interviewees also recount their feelings of abandonment by those Dutch political actors responsible for sending them into Bosnia and Afghanistan. First, they suffered while on mission under an unclear mandate, issued by ignorant and incompetent bureaucrats, and then, upon return, the bureaucracy that systemically ignored the reality of the severe moral harms it had caused their countrymen. Finally, the interviewees describe the reactions they faced by the Dutch citizenry, which oftentimes vilified those returning from duty, and how this led to self-estrangement, and so caused further moral harm. The candour shown to Molendjik in collecting these accounts is astounding, and a clear testament to her skills as a social scientist working in the field with interviewees.

The book concludes with a much shorter part three, in which Molendjik sets out to look at the theoretical and practical implications of her work, first looking at mechanisms by which to address, ameliorate, and prevent moral harms that future personnel may encounter in conflicts, and finally returning to an interdisciplinary conceptualisation of moral injury as a manifestation of latent tensions. I will confess, while the practical proposals are to be welcomed, and some seem like excellent avenues for addressing moral harms, the theoretical aspect of the conclusion seemed a bit wanting and had the feel of being tacked on. This seems – in part – a function of the fact this is a re-worked PhD thesis, and sophisticated theoretical proposals normally are not a necessary feature of such projects, but I look forward to Molendjik developing this as she goes forward. That said, the work merits attention, primarily to access the tragic accounts of survivors of moral harms suffered in times of war.

This is a review of Tine Molendjik, Moral Injury and Soldiers in Conflict (Routledge, 2021). ISBN: 9780367546359.

Klaus Jahn is an associate lecturer in Philosophy at the University of Melbourne, and a researcher at the Dianoia Institute of Philosophy at the Australian Catholic University, Melbouurne. His primary research is focused on ethics, and social and political philosophy. 

This article is published under a Creative Commons License and may be republished with attribution.