From Mental Illness to Moral Injury: Psychological and Philosophical Perspectives on the Harm of Sexual Violence

Abstract

Since its introduction into the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic category of post-traumatic stress disorder (PTSD) has dominated public and legal discourse about the harm of sexual violence against women. There is, however, disagreement among some clinical psychologists and philosophers over whether a PTSD diagnosis further harms the victim. Clinical psychologists claim that focusing on a PTSD diagnosis risks undermining a victim’s agency and subjectivity if therapists neglect the victim’s own voice and experiences. Philosophers who acknowledge PTSD in identifying the harm of sexual violence look to victims’ experience of PTSD symptoms rather than how it is used in clinical practice. They conclude that PTSD symptoms are compatible with agency and subjectivity insofar as they help illuminate what it is to be an agent and a subject. I argue that the latter are too optimistic and the former are too pessimistic. An examination of these conflicting views traces the disagreement to unacknowledged discipline-specific boundaries. I conclude with the very tentative suggestion that moral injury could bridge these boundaries.