Casualties

Abstract

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. © 2011 by the American Academy of Arts & Sciences.