Preventing and Treating the Invisible Wounds of War: Combat Trauma and Psychological Injury

The financial toll of PTSD alone
on U.S. economy is estimated to range in the billions of dollars, however it fails to account for the full societal and moral impact of mental health-related combat injuries. Those suffering from such injuries often have difficulty finding
gainful employment, are prone to violent outbursts and substance abuse, and exhibit suicidal tendencies. Further, psychological harm related to the conduct of hostilities impacts civilians, particularly women and children, increasing the
collateral costs of war. Taking these and other consequences of combat trauma into account within traditional Just War Theory presents significant challenges. Should mental health costs to service members and civilians in areas of conflict be
included in the calculations of governments contemplating whether to engage in an armed conflict? Should battlefield commanders assess potential mental harms to civilians as part of the proportionality analysis of “collateral damage” conducted
prior to each military engagement? Additionally, 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.” Should moral injury be
recognized as a mental health concern that is distinct from PTSD? Are soldiers particularly vulnerable to moral injury while confronting non-state actors embedded in civilian population? 

Further questions arise in considering possible measures to prevent and treat combat trauma.  Inoculating soldiers to the horrors of warfare through pre-deployment battlefield simulations or pharmacological intervention may reduce the
likelihood of trauma.  Such programs, however, have been criticized as desensitizing soldiers to moral indignation and reducing their capacity for sound moral decision making in combat.  Similarly, PTSD treatment in the proximity of the
battlefield facilitates expedient return to active duty, but may also decrease the potential of full long-term recovery. How should these aspects of prevention and treatment protocols be considered, and weighed? Finally, there are important legal
and ethical questions relating to criminal and civil liability of service members suffering from mental harms. For instance, should war inflicted mental harms be taken into account in criminal trials, and to what extent? This conference will
bring together policymakers and high-level experts from the military, academia, and the mental health community, to engage in a multifaceted conversation on the legal, moral and practical dimensions of these dilemmas. 

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