I’m indebted to Jonathan Shay for showing me a new dimension of moral injury, or a wounded soul, as I prefer to call it.

For years, I’ve argued that the traditional definition of post-traumatic stress disorder only covers half the problem. It diagnoses and treats what others are trying to do to you: typically working very hard to maim or kill you. But the other half of PTSD isn’t recognized by the mental health community yet. That’s the moral injury: what you are doing to others, or what you have failed to do for others.

That might include shooting and killing a boy who looks like he’s carrying a grenade, but it turns out to be something totally innocent. Or it might be misreading the tactical situation and blundering into a fierce firefight in which a couple of your buddies were killed.

But I had dinner in Philadelphia a few nights ago with Shay, the retired VA psychiatrist who coined the term moral injury. We had both been invited to participate in a conference, Preventing and Treating the Invisible Wounds of War: Combat Trauma and Psychological Injury, at the University of Pennsylvania Law School’s Center for Ethics and the Rule of Law.

And Shay suggested a whole new aspect of moral injury that I’ve seen repeatedly … but never really recognized.

Shay argued that moral injury is also present when there has been a betrayal of what is right by a person in a position of legitimate authority in a high-stakes situation. “Both forms of moral injury impair the capacity for trust and elevate despair, suicidality and interpersonal violence,” he wrote in an article, “Moral Injury,” published last year in the journal of Psychoanalytic Psychology.

It’s a major step forward because it involves betrayal, something I’ve witnessed often over the years, but never really connected the dots. I’ve noticed that when patriotic soldiers sent into a battle begin to realize the conflict is unjust, they develop anger, bitterness and cynicism. They no longer trust authority in government or in their workplace. That often leaves them unemployed and homeless, with a marriage shattered beyond repair.

And it’s something that usually happens after the soldier returns home because military morality differs from civilian morality.

Take the lead driver in a military convoy who has been told to stop for nothing because it might be a trap leading to an ambush. He sees a small boy sitting in the road and hesitates because this seems so wrong, but then obeys the order and drives over the boy. In Iraq, he’s a good soldier, but at home, he’s a baby-killer.

Nancy Sherman, a philosopher and psychologist at Georgetown University, cited another example in an article, “Recovering Lost Goodness,” also published last year in the journal of Psychoanalytic Psychology.

She cites a civilian family in Iraq driving home from church which got caught in the crossfire of a U.S. attack on a high-value target. The father was killed instantly, and the mother and son were thrown from the car and also killed. A major who was first on the scene and gathered body parts was ordered to find the family and make amends.

However, Paul Bremer’s American occupation administration stymied the officer at every turn, convinced that the family members were insurgents. They sent him to deliver $750 to the family for damages, an insulting amount that the family rejected by throwing the bills on the floor and stalking out. The bodies sat in the heat for a month or more awaiting death certificates to authorize the burials. When the certificates came, they were marked in red ink “ENEMY.”

That moral injury can be devastating to a soldier, much more so than bullets and bombs.

“How does moral injury change someone?” asked Shay. “It deteriorates their character; their ideals, ambitions and attachments begin to change and shrink. Both flavors of moral injury impair and sometimes destroy the capacity for trust. When social trust is destroyed, it is replaced by the settled expectancy of harm, exploitation and humiliation from others.”

And that may be one of the reasons for the soaring suicide rates among veterans and active-duty service members.