Combat Trauma and Moral Fragmentation — A Theological Account of Moral Injury

Warren Kinghorn holds the unusual joint qualification of MD (Harvard) and ThD (Duke Divinity School), and practises VA psychiatry at the Durham VA Medical Center while teaching pastoral and moral theology at Duke Divinity. His doctoral supervisor was Stanley Hauerwas, and the article is recognisably Hauerwasian in argumentative style — narrative- ethics framing, scepticism of liberal-individualist moral theory, attention to the way practices constitute moral formation. The paper appeared in the Journal of the Society of Christian Ethics — the peer-reviewed flagship of the SCE — in 2012, in the same year Soul Repair was published; the two are the founding pair of the academic-theological engagement with the construct.

The structure of the argument has three moves. First, Kinghorn credits the Shay / Litz clinical literature with naming a real phenomenon that the contemporary diagnostic system had missed; he is not writing against the clinical literature but with it. Second, he argues that the phenomenon — moral fragmentation, the term he prefers to moral injury — exceeds what the clinical frame can adequately address: the kind of repair the construct names requires truthful, contextualized narration of and healing from morally fragmenting combat experiences, and that narration is constitutively a communal practice rather than an individual-psychotherapy procedure. Third, he sketches what those communal practices might look like, drawing on the Hauerwasian vocabulary of the church as a community of practice — chaplaincy, confession, sacramental practices, the re-narration of the soldier's experience inside a community that takes it morally seriously.

The journal Society of Christian Ethics has the editorial filter of an academic theological-ethics quarterly; the audience is divinity-school faculty and Christian-ethics graduate students, and the tone of engagement is internal to that field. Articles in it are not widely cited outside theological education — but Kinghorn's piece has been an exception, partly because of his joint medical credentials and partly because the moral-injury literature is itself a place where theological and clinical readers meet. The paper is the most-cited academic-theology piece on the construct.

The stake is theological-ecclesial. Kinghorn is arguing that the church — particularly the mainline-Protestant and Catholic churches he is implicitly addressing — has theological resources for moral repair that the clinical system cannot supply, and that those resources have been under-deployed for veterans relative to the church's historic pastoral role. The argument is not that clinicians should hand veterans off to chaplains; it is that the two disciplines need to work alongside each other, with theology and chaplaincy contributing what they have rather than deferring to the clinical frame. The 2024 follow-up book Wayfaring extends this argument into a broader theological psychiatry.

For the moral-injury corpus this paper is the academic- theological complement to Soul Repair: where Brock and Lettini wrote documentary-pastoral theology, Kinghorn writes academic Christian ethics in dialogue with the clinical literature itself. Read both together as the field's theological corner.