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Farnsworth JK, Borges LM, Nieuwsma JA. What Ought We to Do With "Thick Terms"? A Response to Frankfurt & Coady's "Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation". Journal of traumatic stress. 2019 Aug 1; 32(4):642-644.
Abstract: We respond to the commentary by Frankfurt and Coady (this issue) regarding the descriptive-prescriptive framework for partially distinguishing between posttraumatic stress disorder (PTSD) and moral injury (Farnsworth, 2019). In their commentary, Frankfurt & Coady raise concerns about the application of R. M. Hare's (2014) philosophical approach of prescriptivism to military-related moral injury (MI) and the potential philosophical and ethical implications that may follow. In this response, we clarify that Farnsworth's descriptive-prescriptive framework is not tied to or aligned with Hare's prescriptivism and, as a result, many of Frankfurt and Coady's critiques become tangential to Farnsworth's original argument. We go on to clarify that Farnsworth's descriptive-prescriptive framework does not deny the utility of all cognitive therapies for moral injury, nor does it attempt to fully separate descriptive and prescriptive cognitions from one another, as was asserted by Frankfurt and Coady. We also provide a counterargument to Frankfurt and Coady's ethical concerns regarding the potential of Farnsworth's framework to enable militarism and instead assert its value for increasing peace and understanding. Finally, we address the relevance of "thick terms" for MI, highlighting their potential strengths and clinical weaknesses. We conclude by joining with Frankfurt and Coady in expressing our hopes for future research on the association between PTSD and MI. We argue that future research must go beyond defining content-level boundaries between the two constructs and instead grapple with the processes that give rise to them and the philosophical, empirical, and professional questions that they imply.