A consistent question in the study of moral injury is whether it should be treated as a medical condition. In his essay “The Morally Injured,” Tyler Boudreau (an American veteran who self-identifies as morally injured) offers a paradigmatic argument against the medicalization of moral injury. Boudreau posits that treating moral injury as a mental illness depoliticizes and privatizes it, shifting conversations about moral betrayals in war to the private sphere, and absolving the American public of any responsibility in facilitating the moral injury of veterans. As Lisa Hickman observes, many veterans resist the language of disability when discussing moral injury; perhaps as a result, discourse around medicalization of moral injury has largely not used the concept of disability, and scholars have overlooked possible contributions from disability studies and mad studies (Hickman 12). Nevertheless, veterans with moral injury, through their treatment by clinicians, undergo processes of medicalization and psychiatrization, which have been well-theorized and critiqued by these fields. Using Boudreau’s argument as a starting point and drawing on insights from scholars in disability studies and mad studies, I argue that medicalization harmfully depoliticizes the experiences of soldiers, both in the sense that it conceals the conditions that lead to moral injury and disqualifies the emotions of soldiers and veterans as a source of potential ethical insight.
A key insight of disability studies (and the disability rights movement out of which the field arose) is that disability is not an inherent fact of the body, but is produced by a society arranged for able-bodied people; this idea is the basis of the social model of disability. Therefore, disability must be of concern to all of society, rather than being “the individual’s or at most the family’s problem,” as Simi Linton notes that it is under a medical model (Linton 134). Understanding moral injury through the lens of disability, we can see the role that the military and American society as a whole have in creating the conditions that lead to moral injury. Recognition is a necessary precursor to critically analyzing and righting these conditions, as Boudreau argues we must. As Raewyn Connell observes, disability is produced by unjust social processes and distributed unequally between dominant and marginalized groups (Connell 1373). Boudreau’s analysis suggests that the same can likely be said of moral injury.
Boudreau argues that moral injury should be the subject of public dialogue, in which soldiers and veterans can be full participants; he writes that the privatizing effects of medicalization prevent this. Furthermore, the norms of psychiatry mean that clinical discussions of moral injury all but exclude serious moral and political questions. Many clinicians admit that they feel unequipped to talk about issues of morality with patients; thus, the emphasis of treatment must be on normalization, rather than the “struggling, searching, digging, aching to know whether their personal actions and their wars were just or unjust” which Boudreau describes as a necessary part of dealing with moral injury (Boudreau 749). Boudreau’s observation of psychiatry’s depoliticizing effect has precedents in mad studies, where scholars have observed that psychiatrized people often struggle to conceive of their issues as political.
Even beyond the limitations imposed on psychiatric treatment itself, psychiatrization can discredit a person’s perspective, thus excluding them from ethical and political discourses. Maria Liegghio argues that psychiatrized people undergo epistemic violence, by which they are disqualified as “knowers” (Liegghio 123). When certain beliefs lead to a psychiatric diagnosis, these beliefs also get excluded from public discourse. Specifically in the realm of ethics, Shelley Tremain has observed that disabled philosophers’ contributions are often taken less seriously than those of their nondisabled peers (Tremain 8). Veterans with moral injury have unique knowledge based on their experiences, and it is important that this knowledge be included in public discussion of the ethics of war and military structure. If discussion of moral injury is confined to apolitical clinical spaces, and veterans’ reactions to moral injury are treated as evidence of pathology, this inclusion cannot happen.
The observations of disability rights and Mad Pride activists about the risks of medicalization form a strong case against the medicalization of moral injury. However, given the Department of Veterans Affairs’ and the psychiatric establishment’s adoption of moral injury as a medical term, it seems likely that this medicalization has already happened. Even still, the discrediting of people with moral injury and the depoliticization of their struggles demonstrates that they have much in common with disabled and psychiatrized people. There is potential for political alliances between these groups to fight for their assessments of their own needs to be taken seriously, and for the institutions that serve them to take those assessments into account. Moral injury has the potential to start important conversations about the distribution of ethical responsibility in war, but a purely medical model of moral injury will inhibit these conversations from happening in public or with proper attention to the insights of veterans with moral injury.
Boudreau, Tyler. “The Morally Injured.” The Massachusetts Review, vol. 52, no. 3/4, 2011, pp. 746-754.
Connell, Raewyn. “Southern Bodies and Disability: re-thinking concepts.” Third World Quarterly, vol. 32, no. 8, 2011, pp. 1369-1381.
Hickman, Lisa. A Disability Theology of Limits for Responding to Moral Injury. 2018. PhD dissertation, Duquesne University.
Linton, Simi. Claiming Disability: Knowledge and Identity. New York University Press, 1998.
Tremain, Shelley Lynn. “When Moral Responsibility Met My Philosophy of Disability.” Feminist Philosophy Quarterly, vol. 10, no. 1/2, 2024, pp. 1-29.
A consistent question in the study of moral injury is whether it should be treated as a medical condition, and a consistent focus of mad studies and disability studies is the downsides of medicalization. Despite this, moral injury has largely not been analyzed through the lens of disability. Taking Tyler Boudreau’s paradigmatic argument against the medicalization of moral injury as a starting point, this paper argues that the insights of mad studies and disability studies provide strong additions to the argument against this medicalization. As Boudreau argues, psychiatry tends to privatize discussions of moral injury and avoid real political or ethical grappling with the conditions that lead to moral injury; medicine similarly privatizes and depoliticizes the social conditions that create disability. Psychiatrized people are also discredited as knowers, which excludes the insights of veterans with moral injury from public discourse.