Can Medications Prevent Moral Injury in Soldiers? Exploring the Ethics and Risks

What you need to know

• Moral injury occurs when people feel intense guilt and shame about actions that violated their moral beliefs
• Some medications could potentially prevent moral injury by dampening emotional responses or changing moral reasoning
• While these drugs might prevent trauma, they risk causing a different kind of moral injury by reducing appropriate emotional responses

The Hidden Wounds of War

Imagine two pilots involved in the bombing of Hiroshima. One seems unaffected and even participates in reenactments. The other is haunted by guilt, has nightmares, attempts suicide, and spends years apologizing to victims. This stark contrast illustrates a profound psychological wound called moral injury - when people feel such intense guilt and shame about their actions that they struggle to function in daily life.

Understanding Moral Injury

Moral injury goes beyond typical combat trauma. It occurs when someone’s actions severely violate their own moral code, leaving them feeling irredeemable. This can happen from direct actions (like harming civilians), failing to prevent harm, or witnessing morally troubling events. Even seemingly minor incidents, like searching a civilian home, can trigger moral injury if they involve domination or power imbalances that feel morally wrong.

The Pharmaceutical Approach

Researchers have identified several types of medications that could potentially prevent moral injury:

“Numbing agents” like Propranolol and Adderall can reduce emotional reactions to morally distressing events. They work by blocking stress hormones or increasing positive feelings about difficult tasks.

“Bonding agents” like oxytocin can strengthen in-group loyalty while potentially reducing concern for outsiders. This might make it easier to harm perceived enemies for the sake of protecting one’s own group.

Testosterone boosters might promote more utilitarian moral reasoning - focusing on the “greater good” rather than individual moral rules.

The Ethical Dilemma

While these medications might prevent the psychological trauma of moral injury, they raise serious ethical concerns. Making it easier for soldiers to harm others without emotional distress could lead to more civilian casualties and war crimes. More fundamentally, reducing appropriate emotional responses to violence might itself be a form of moral injury - what the author calls “moral degradation.”

What This Means for You

For military personnel and families, this research highlights the complex nature of moral injury and the challenging ethical questions around preventing it. While reducing psychological trauma is important, maintaining appropriate emotional and moral responses is also crucial for mental health and human dignity.

For healthcare providers working with veterans, understanding these different aspects of moral injury can help provide more nuanced and effective treatment approaches.

Conclusions

• Moral injury can manifest both as traumatic guilt/shame and as emotional numbness to violence
• Medications that prevent traumatic moral injury might cause a different kind of moral harm
• More research is needed to understand the full implications before implementing pharmaceutical approaches