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It is well documented that experiencing combat is associated with decreased ability to carry out basic life tasks and increased mental health symptoms.  However, it is not clear what types of combat events are responsible for these negative effects.  Is it the killing?  Is it the life threat? Such results can inform training and treatment for the potentially life changing aftereffects of combat.
A new article by Krauss and colleagues in the Journal of Traumatic Stress proposes and tests a new perspective on combat stress based on justice in war doctrine, which predicts the long-term well-being of warfighters.  Justice in war doctrine (jus in bello) is an ancient theological and philosophical tradition on moral conduct in war, regardless of how the war began (jus ad bellum).  The justice in war tradition provided much of the theoretical underpinning of modern international agreements on the Law of War, such as the Geneva Convention.  
The justice in war perspective starts with the concept of a “perfectly just war”.  In a “perfectly just war”, warfighters from each side attempt to kill each other with lawful means while protecting all non-combatants from harm.  Still, philosophers and theologians have also recognized that real wars do not live up to this ideal, primarily because non-combatants are affected by war either directly or indirectly.  However, the impact of just and unjust war events on combatants’ wellbeing has not previously been addressed. 
Krauss and colleagues posit that actions consistent with the concept of a just war, such as killing of the enemy and receiving fire from the enemy, are normal parts of combat that professional soldiers should be prepared to face and should not be associated with poor mental health outcomes.  In contrast, unjust war events, events that are not consistent with the concept of a perfectly just war, are tragic events that are likely to be psychologically distressing for professional soldiers.  Examples of unjust war events are feeling responsible for killing non-combatants, being unable to help children or families in need, and observing/participating in unnecessary brutality and other potential war crimes.
Krauss and colleagues created new measures to determine which soldiers have been exposed to events that are consistent and inconsistent with justice in war, and then tested their predictions in a longitudinal study of 402 soldiers from a recently deployed unit.  These soldiers completed two surveys 13 months apart in which they were asked about their experiences with both just and unjust war events during their last combat deployment. 
When asked about just war events, 96% reported at least one life threatening experience, and 40% reported feeling responsible for killing an enemy combatant.  After controlling for other combat events, Krauss and colleagues found that the just war events of killing enemy combatants and the life threat caused by enemy combatants did not predict long term performance impairment or negative mental health symptoms.  Although experiencing life-threatening events (that align with just war practices) predicted poorer mental health at the start of the study, this relationship was not significant 13 months later.  In terms of feeling responsible for killing an enemy combatant, there was no pattern of negative mental health on the first survey or again 13 months later. Furthermore, the killing of enemy combatants, but not life threat, was associated with signs of adaptation, such as pride in having fought. In short, soldiers showed resilience in the face of just war experiences. 
Unjust war events were reported by 35% of soldiers, with soldiers most commonly reporting being unable to help women and children in need. These experiences were associated with poorer performance and mental health across all 12 measures at the initial assessment point, including increased suicidal ideation and decreased ability to carry out basic life tasks.  While this association with distress was weaker when assessed 13 months later, experiencing unjust war events was continually associated with a wide array of indicators of poor mental health.  
In short, professional soldiers appear resilient to what can be considered just war events, but these same soldiers appear to struggle with unjust war events. It may be that the moral injuries inflicted by unjust war events account for much of the negative impact associated with combat. Training that can prevent such events may not only support just war doctrine but may also be essential to the health and functioning of service members; clinical interventions may need to consider how these risks can be addressed in the implementation of effective treatment.
Note: The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army or the Department of Defense.

Reference Article

Krauss, S. W., Zust, J., Frankfurt, S., Kumparatana, P., Riviere, L. A., Hocut, J., Sowden, W. J. & Adler, A. B.  (2020). Distinguishing the effects of life threat, killing enemy combatants, and unjust war events in U.S. service members.  Journal of Traumatic Stress.

Discussion Questions

  1. What types of combat events have the largest impact on mental health?
  2. Are all types of killing in combat the same psychologically?
  3. Why do morally-relevant events have such an impact on people?

About the Authors

Stephen W. Krauss, PhD is a US Army Research Psychologist (Captain) currently serving as Chief of Operations at the Research Transition Office in the Walter Reed Army Institute of Research, where he leads projects relating to moral injury, resiliency, and the successful transitioning of evidence-based solutions to the Warfighter. Captain Krauss has written 20 articles and a book, and can be reached at: stephen.w.krauss.mil@mail.mil
Jeffery Zust, MDiv, MAT, MTh, MS is a retired US Army Chaplain (Colonel) and Lutheran Pastor, who has taught ethics and leadership at the United States Sergeants Major Academy and the National Defense University. He has written multiple articles and a book about moral injuries in the military. He is currently a doctoral student at the University of Denver and can be reached at:  zustjeff@gmail.com
Amy B. Adler, PhD is a research clinical psychologist serving as Senior Scientist at the Center for Military Psychiatry and Neuroscience at the Walter Reed Army Institute of Research, where she oversees research and advises senior leaders on the psychological health and resilience of Soldiers.  She has published over 100 journal articles and six books, and is a fellow in the American Psychological Association. She can be reached at: amy.b.adler.civ@mail.mil

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