An open access publication of the American Academy of Arts & Sciences
Summer 2011


Jonathan Shay

Privation and disease have mainly killed soldiers until very recently. Now that enemy action predominates, faster and better control of bleeding and infection before and during evacuation spares ever more lives today. This essay focuses on psychological war wounds, placing them in the context of military casualties. The surgeon’s concepts of “primary” wounds in war, and of wound “complications” and “contamination,” serve as models for psychological and moral injury in war. “Psychological injury” is explained and preferred to “Post-Traumatic Stress Disorder,” being less stigmatizing and more faithful to the phenomenon. Primary psychological injury equates to the direct damage done by a bullet; the complications–for example, alcohol abuse–equate to hemorrhage and infection. Two current senses of “moral injury” equate to wound contamination. As with physical wounds, it is the complications and contamination of mental wounds that most often kill service members or veterans, or blight their lives.

JONATHAN SHAY served as a staff psychiatrist at the Boston Department of Veterans Affairs Outpatient Clinic for twenty years. He is the author of Achilles in Vietnam: Combat Trauma and the Undoing of Character (1994) and Odysseus in America: Combat Trauma and the Trials of Homecoming (2002). Through the end of 2012, he is a MacArthur Fellow.

The veterans I served for twenty years were rigorous, generous, and patient teachers on what had wrecked their lives and what might be done to protect the new generation of American kids who go into harm’s way for our sakes.1 They made me their missionary to the U.S. forces on prevention of psychological and moral injury. So, practicing full disclosure, this essay has the veterans’ missionary agenda as its energy source, and speaks with my personal voice, not detached, god-speak from the edge of the universe.

Some history puts current physical casualties in context. In 1861, the French civil engineer Charles Minard published a brilliant, if misleading, graphic of losses from Napoleon’s army during its hellish round trip from the Polish border to Moscow and back, 1812 to 1813. Most non-historians today know of this chart through Edward R. Tufte’s classic, The Visual Display of Quantitative Information. The subzero cold prevailing during the retreat from Moscow rivets attention, both because of the black, dramatically thick, but rapidly thinning line drawn westward across a map of Russia to graphically represent troop strength during the winter retreat, and . . .


  • 1In addition to my experience working as a psychiatrist for veterans, I have served in various capacities for the U.S. military, including Commandant of the Marine Corps Trust Study (1999–2000); Chair of Ethics, Leadership, and Personnel Policy in the Office of the U.S. Army Deputy Chief of Staff for Personnel (2004–2005); and 2009 Omar Bradley Chair of Strategic Leadership, U.S. Army War College (2010). I have also worked with Canadian Forces, U.K. Royal Marines, U.K. Royal Navy, Bundeswehr, other NATO, and Israel Defense Force personnel.
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