Review by Chaplain Darren Cronshaw
*Dr Lewis Jeffery Lee, Moral Injury Reconciliation: A Practitioner’s Guide for Treating Moral Injury, PTSD, Grief, and Military Sexual Trauma through Spiritual Formation Strategies. London: Jessica Kingsley, 2018. ISBN. 9781785927577. Paperback. 223pp, AUD$47.73
Wars are a health hazard for those who fight in them—at physical but also psychological and unseen spiritual distress levels. Research since the 1990s has assisted health practitioners and others understand that things done or undone during military service can lead to a syndrome of symptoms including depression, aggressive behaviour, isolation, guilt, anger, shame, self-harm, a loss of trust in religion or spirituality and declining ethical attitudes. What has become labelled as ‘moral injury’ can come from different causes and contexts for different soldiers but includes betrayal, incidents with civilians, disproportionate levels of violence, including within- rank violence (sexual trauma or friendly fire).
Dr Lewis Jeffery Lee is a retired US Navy Seal, licensed therapist and Mental Health Chaplain. He identifies moral injury as ‘a wound received when one’s belief system or expectations about right or wrong have been violated’ (p.80) or an ‘invisible psychic wound caused by a violation to one’s moral code’ (p.104). Lee offers helpful background on existing frameworks for understanding and treating moral injury. He explains that soldiers can recover from war’s horrors and griefs as long as ‘what’s right’ is not violated, as seminal writer Jonathan Shay and others have suggested. However, when soldiers perform, witness or experience things they didn’t expect, especially when ‘what’s right’ is violated, they often need extra support or treatment.
Health professionals have developed and used therapies such as cognitive behaviour and cognitive processing therapy (CBT/CPT) with stoic philosophy, and acceptance and commitment therapy with mindfulness practices. However, researchers and therapists are still only beginning to understand the depths of moral injury and its relationship to other conditions such as PTSD and how treatments might overlap with sexual trauma and grief therapies. There is also much to learn from recent work on emotional intelligence and family systems. Lee explains how his approach to therapy, especially therapeutic support groups, draws on all these insights.
Moreover, what is distinctive about Lee’s Moral Injury Reconciliation treatment process or model is how it addresses and draws on religion and spirituality. He suggests that killing, even when justified, has a spiritual toll. The complex and various other causes of moral injury are similarly spiritual in nature and therefore require spiritual interventions. For some soldiers, moral injury can include a dissonance between their religious values and their actions. Traditional religious practices such as lament, confession and forgiveness can thus help them heal and re-orientate to their value system. But even for the majority of soldiers who are not religious, Lee has found his approach helps soldiers not just to alleviate their symptoms but catalyse second-order change and healing. We may live in a predominantly ‘secular’ society, but there is a spiritual domain of personhood that Lee argues needs attention.
Lee describes his approach as similar to spiritually integrated psychotherapy. Distinctive elements that I appreciated include:
- Starting with the story of a person, with more of a ‘salutogenic’ model and less of a pathogenic or disease-first
- Overcoming any divide between psychological and theological disciplines and resources, and seeking to integrate both with a transdiagnostic
- Framing the healing journey around the theological themes of reconciliation and spiritual
- Utilising a wide range of accessible spiritual practices as healing resources such as spiritual awareness, humility, lament to identify past trauma, confession, forgiveness as a path to freedom, community, resilience know-how and altruism for hope-generation for the
- Recognising the potential role of sacred literature in meaning-making.
- Reminding participants of psychological and physical remedies, including the basics of sleep, nutrition and
The book is a practitioner’s guide, explaining the program of treatment Lee has developed over nine weeks. It includes stories, sample therapist dialogues with group members, exercises and homework. The program is structured around three phases that address past, present and future:
- Movement I starts with self and practices spiritual awareness and processes the specific
- Movement II teaches communication skills for rejoining family and community, including keeping qualities such as selflessness and courage but letting go of the hypervigilance and exaggerated mistrust of others.
- Movement III encourages altruism and benevolent service to others to restore self-good.
The program integrates psychological and theological disciplines and resources, not to offer or pretend a miraculous cure is available, but to suggest that proven ancient practices can help the journey to wholeness with a sense of hope:
While there is much work left, no one need fear moving forward. Cherishing loved ones, enjoying simple pleasures, or putting committed faith in our meaning-making system empowers one’s life for real and lasting transformation. Such new thinking may bring joy, though the past we cannot erase. Finding meaning and purpose in our lives will forever remain an enterprise that brings about a sense of coherence. (pp. 204-205)
Moral Injury Reconciliation is a specialist book that would be useful for mental health professionals convening similar programs or for commanders, chaplains and other spiritual care providers supporting veterans and soldiers on a path to wholeness. Its central tenet is that spiritual practices are potential healing resources that complement other therapies in order to help move soldiers and veterans up and out of moral injury.
Reviewer: Chaplain Darren Cronshaw is a member of the Part-time Army serving in 2021 at 1st Recruit Training Battalion, Kapooka and Army School of Transport, Puckapunyal. His civilian work is pastor of Auburn Baptist Church and teacher of leadership and research methods with Australian College of Ministries (Sydney College of Divinity).
The views expressed in this article are those of the author and do not necessarily reflect the position of the Australian Army, the Department of Defence or the Australian Government.
Corresponding Author: Darren Cronshaw, darren.cronshaw@defence.gov.au
Authors: D Cronshaw1,2
Author Affiliations:
1 Australian Army
2 Australian College of Ministries, Sydney College of Divinity
