An evolutionary theory of moral injury with insight from Turkana warriors

Clinicians in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies are rethinking whether Post-traumatic Stress Disorder (PTSD) is caused solely by exposure to life-threatening experiences, or also by moral injury—witnessing or participating in acts that violate moral beliefs. However, while there are evolutionary hypotheses explaining PTSD as a response to physical danger, the evolutionary roots of moral injury lack an explanation. We posit that a subset of symptoms of combat-related PTSD is associated with moral injury and that these symptoms evolved in tandem with human's norm-psychology. We can examine this hypothesis by comparing societies with different moral beliefs about warfare, norm enforcement mechanisms, and spheres of moral concern. To illustrate the utility of this framework, we describe combat trauma, war norms, and norm enforcement among Turkana pastoralist warriors in Kenya who participate in highly lethal raids of neighboring ethnic groups. We previously showed that depressive PTSD symptoms in Turkana warriors are more strongly associated with experiencing moral violations in combat, and that Turkana warriors with comparably high overall PTSD symptom-severity experience lower rates of depressive symptoms than US combat veterans. Here we detail aspects of Turkana warfare, moral beliefs, and post-battle rituals that differ from WEIRD societies, and that may ameliorate the symptoms of moral injury in Turkana warriors. Our findings highlight how further studies of combat trauma outside of WEIRD militaries can help evaluate this theory and illustrate the importance of cross-cultural research for identifying the evolutionary roots of combat stress and best practices for prevention and recovery.