War and Redemption — Treatment and Recovery in Combat-Related Post-Traumatic Stress Disorder

Larry Dewey was Chief of Psychiatry at the Boise VA Medical Center for over twenty years and treated combat veterans across that span — Vietnam, Korea, World War II, and the first Gulf War. The book grew out of that single-clinician caseload over a long career; methodologically it is closer to Achilles in Vietnam in its use of extended veteran case material than to anything in the post-2009 clinical-research literature. It was published by Ashgate in 2004 and re-issued by Routledge after the Ashgate imprint was absorbed into the Taylor & Francis group; the book remains in print but has been substantially under-cited relative to its significance.

The argument has three parts. The first describes the standard clinical picture of combat PTSD as the VA was treating it through the 1990s and early 2000s, with attention to the limits of the diagnostic frame. The second introduces a developmental account of how combat veterans relate to and adapt around their experiences over the long arc of post-deployment life. The third — the part that gives the book its place in the moral- injury genealogy — explores sin, confession, mercy, forgiveness, redemption, and love as treatment categories, drawing on the veterans' own use of those terms in their accounts and on Dewey's explicitly Christian theological vocabulary. The argument is that the diagnostic category PTSD does not capture what most of his patients are wrestling with, and that what they are wrestling with is more accurately named in moral and theological terms than in psychiatric ones.

Dewey wrote the book five years before the Litz 2009 paper gave the construct its current clinical-research vocabulary, and three years before Tick's War and the Soul (2005). It is the most thorough early articulation from inside VA clinical practice of the argument that would become moral injury. The reason it has been under-cited is mostly publication-side: Ashgate's distribution did not approach what Clinical Psychology Review gave Litz, and the explicitly Christian theological framing meant the book did not slot easily into the later clinical-research conversation. Reviews in the religion-and-mental-health literature were positive; reviews in the mainstream clinical psychiatry journals were sparse.

The stake is clinical-pastoral. Dewey is working from the position of a Christian VA clinician with both a theological vocabulary and a long working caseload, and the book argues for the integration of moral and spiritual treatment categories into VA psychiatry. The argument is not unfunded: the case material is extensive, the patients' use of the moral and spiritual vocabulary is on the page in their own words, and the treatment outcomes Dewey is reporting are positive and stable across his caseload. Sympathetic readers see this as the most honest account of what actually works inside the VA system; sceptical readers note the absence of randomised-trial methodology and the difficulty of distinguishing Dewey's personal pastoral skill from the treatment frame he is recommending.

For the moral-injury corpus War and Redemption is the under-cited prior text that the post-2009 literature should have engaged more substantially. It belongs on the same shelf as Tick (2005) and Shay (1994/2002) as a pre-Litz articulation of the construct from inside VA clinical practice — and it is the only one of the three written from a specifically Christian theological frame.