Freud, Lacan, and the Ethics of Care in Treating Moral Injury

The concept of moral injury—the profound rupture in an individual’s ethical or spiritual framework following catastrophic events—has gained considerable attention in both clinical and philosophical discourse. While the term itself is relatively new, its foundations can be traced back to Sigmund Freud’s reflections on war trauma during and after World War I. Freud did not explicitly speak of “moral injury,” but his exploration of war neuroses illuminates how psychic wounds are deeply entangled with moral and ethical conflict.

The central challenge of treating moral injury is not only addressing the trauma itself but helping the patient reconstruct a livable moral framework after its collapse. Today, psychoanalysts and theorists grapple with how best to approach this task. Does one focus on the symbolic and unconscious dimensions of guilt and shame, as Lacan suggests, or is it necessary to adopt a more direct stance of care—one that allows for reparation, communal support, and ethical reintegration?

This essay integrates Freud’s early insights into war neuroses with contemporary psychoanalytic perspectives, particularly Jacques Lacan’s framework in The Ethics of Psychoanalysis (Seminar VII). Both thinkers help us understand why moral trauma is so intractable, yet neither offers a fully sufficient framework for guiding patients through the process of moral repair. While Freud identifies the punitive mechanisms of the superego, he remains primarily focused on the intrapsychic conflict without articulating a structured therapeutic response. Lacan expands Freud’s insights by situating ethics in relation to desire and the Real, but he offers little in terms of practical clinical intervention. An ethics of care—particularly in treating moral injury—must resist total abstraction and instead adopt a pragmatic, multidimensional approach. By integrating Freud’s early clinical observations with a modified Lacanian framework that prioritizes therapeutic technique, we can articulate a viable path forward: one that acknowledges the complexities of moral suffering while refusing to surrender to ethical paralysis.

Freud and War Trauma: The Birth of Moral Injury

War Neuroses and the Collapse of Meaning

Freud’s wartime writings, notably Thoughts for the Times on War and Death (1915), drew attention to the psychic devastation among soldiers returning from the front. These men suffered from nightmares, flashbacks, and relentless anxiety—symptoms Freud classified as “war neuroses.” In many cases, the patient’s distress exceeded fear of death or typical traumatic recall; rather, it pointed to a deeper sense of violated values and disintegrated social norms. Soldiers had participated in or witnessed acts—killing, mutilation, betrayal of comrades—that shattered not only their sense of physical security but also their internal moral order.

Traditional psychoanalytic concepts focusing on sexual conflict or childhood fixations felt inadequate when soldiers revealed acute guilt or shame over battlefield actions. Though Freud primarily framed such conflicts in terms of ego, superego, and instinctual drives, he observed the uncanny guilt that emerged when social prohibitions (e.g., “Thou shalt not kill”) were overridden by military necessity. The inability to reconcile those actions with personal or cultural codes foreshadowed what we now label moral injury—the psychic torment occasioned by a breach in one’s moral or ethical beliefs.

The Superego’s Role in Moral Injury

Freud’s model of the psyche—the id, ego, and superego—helps us understand why moral injury is so psychologically destructive. The superego, as the internalized moral authority, dictates ethical behavior and punishes transgressions with guilt and self-reproach. During wartime, however, this moral structure is often destabilized. Soldiers are not merely exposed to death and destruction; they participate in it, sometimes in ways that directly contradict their own moral convictions. In some cases, the superego intensifies its punitive function after the fact, condemning the individual for actions that were committed under extreme circumstances.

Freud noted that many soldiers returned from war not with an explicit fear of death, but with an unbearable burden of guilt. Their psychic pain was not just about surviving battle but about what survival had required of them. They had killed, abandoned comrades, or witnessed atrocities—violations of an internalized ethical order that could not be reconciled with wartime necessity. This discrepancy between a soldier’s actions and their moral expectations produces what we now call moral injury: a profound sense of guilt and self-recrimination that cannot be explained away by traditional trauma models centered on fear conditioning or PTSD alone.

Freud’s Contribution to the Ethics of Care

Freud’s early observations provide a crucial foundation for understanding moral injury, but they do not offer a clear path for therapeutic resolution. He recognized that trauma could not be resolved merely through repression or avoidance; rather, the analyst must facilitate the patient’s confrontation with their unconscious conflicts. His method of helping patients “remember and repeat” traumatic events implicitly acknowledged the ethical dimension of trauma, suggesting that full resolution required a form of working-through—a slow process of integrating unbearable experiences into the patient’s psychic structure.

However, Freud did not articulate a structured moral therapy. He remained focused on the intrapsychic conflict between drives and prohibitions, leaving questions of ethical reintegration largely unexplored. His framework suggests that therapy must engage not only with traumatic memories but also with the deeper moral structures that sustain psychic life. This opens the door for later theorists, particularly Lacan, to refine and expand upon Freud’s insights.

Lacan and the Limits of the Symbolic: When Moral Injury Defies Integration

Moral Injury as an Encounter with the Real

Jacques Lacan, in The Ethics of Psychoanalysis (Seminar VII), moves beyond Freud’s focus on guilt and instead asks what it means to act ethically within the structures of language, desire, and the Real. For Lacan, human subjectivity is structured within the symbolic order—the realm of language, law, and social meaning. Moral injury, however, often involves an experience that resists symbolization. The unbearable weight of having committed an atrocity—or even having witnessed one—often belongs to the domain of the Real, the dimension of experience that defies articulation and integration into the symbolic.

This is why many individuals suffering from moral injury cannot “put into words” what haunts them. The unspeakable nature of their suffering does not merely indicate repression—it signals that the trauma exists outside of the linguistic structures that typically allow meaning to be made. Lacan’s famous dictum, “do not give up on your desire,” complicates the picture further: moral injury often arises because the subject has given up on their desire in some way, sacrificing personal ethical integrity for institutional obligation, survival, or duty.

Therapeutic Limitations in Lacan’s Approach

While Lacan gives us a compelling theoretical account of why moral injury resists easy resolution, he does not provide a pragmatic method for healing. If moral trauma is rooted in an encounter with the Real, what techniques can bring about therapeutic action? Lacanian analysis might suggest that the patient must find a way to re-symbolize their trauma, locating a place for it within their narrative without fully resolving its excess. But how does this translate into clinical practice?

Unlike Freud, who at least provided a method for talking through neuroses, Lacan remains elusive on how, precisely, the clinician should guide the patient toward repair. While uncovering unconscious conflicts related to the superego and symbolic law might yield insight, insight alone does not heal moral injury. The analyst must be prepared to engage in a more active form of therapy—one that involves restructuring the patient’s moral horizon, not merely interpreting its collapse.

Toward a Pragmatic Ethics of Care

An ethics of care that responds effectively to moral injury must incorporate Freud’s insight into the superego’s punitive power while also addressing the limitations of Lacanian theory. While Lacan correctly identifies moral injury as an encounter with the Real, therapy cannot remain in the realm of theoretical speculation. It must translate these insights into actionable techniques. A pragmatic ethics of care must do the following:

Acknowledge Moral Pain: The clinician must recognize that moral injury is not merely a cognitive distortion but a real crisis in the patient’s ethical being.
Provide Structure for Re-Symbolization: Therapy must offer ways to re-narrate the traumatic event within a more livable moral framework rather than leaving the patient adrift in unresolved guilt.
Reject Ethical Paralysis: While reflection is important, therapy must resist endless interpretation and instead guide the patient toward concrete steps for self-forgiveness, accountability, and ethical repair.

Healing moral injury requires more than philosophical insight—it demands a practice of care that does not retreat into abstraction but remains fully engaged with the patient’s suffering, grounded in the real work of moral reparation.