MORAL INJURY: WHAT IS IT AND HOW CAN PROFESSIONALS ASSIST?

Imagine you’re a Service member. Your commanding officer has reason to believe that certain civilians are making bombs at home and will use them against the public. Your unit is tasked with breaking in and finding the bombs. Entering the home is necessary to the mission – but you’ve been told your entire life that breaking into a person’s home is wrong and a violation of their privacy (not to mention against the law). However, you have a mission to fulfill. So, you break in, regardless of your inhibitions.

The above scenario is one example of an event that could lead to moral injury. Moral injury is any act, whether perpetrated or witnessed, that may conflict with personal morals or beliefs (Douglas, 2022). While we often think of this conflict in the context of war, other examples of potential moral injury include abuse, rape, and violence (Moral Injury Project, n.d.). And although moral injury may have lasting effects on someone’s life (Litz et al., 2009), it’s still a concept of which many people aren’t fully aware. This article will explain moral injury and discuss some ways that mental health professionals can help Service members and Veterans work through issues related to it.

Moral injury is more common than we realize among Service members and Veterans, and it can lead to negative outcomes, such as co-occurring PTSD (Maguen et al., 2022). In one study, 41.8% of veterans reported experiencing at least one form of moral injury; the majority had been betrayed by others or suffered a transgression (Wisco et al., 2017). Dealing with extreme levels of guilt and regret without understanding what you’re going through can be confusing. At the same time, being able to talk to your provider about what you’re dealing with and learning that it’s not abnormal are helpful for Service members (Douglas, 2022). Professionals familiar with the concept of moral injury and with therapeutic approaches that focus on acceptance and self-forgiveness can be beneficial for people working through the effects of moral injury (Maguen & Norman, 2022).

Finding a therapist is like test-driving a car – it’s okay to take your time finding the best fit. It’s important for you to express your experiences freely without having to constantly explain details (e.g., defining acronyms, describing job-specific duties) that are well-known to those in the service (Douglas, 2022). Seek out a therapist . who understands military culture and your unique experience as a Service member or Veteran.

Therapists and counselors are trained to help Service members work through moral injury. In addition, military chaplains (i.e., U.S. military’s educated, religious leaders who provide services to Service members and their families) will talk with you regardless of your faith or beliefs. Chaplains combine their knowledge of military culture with their own resource awareness to help those in need. Connecting with a chaplain could benefit you during your healing process.

According to Chesnut and colleagues, moral injury can lead to the potential impairment of social well-being, social support, and social relationships (Chesnut et al., 2020). Re-engaging with your communities, friends, and family, and increasing your social support may help you in your struggle with moral injury.

Moral injury is difficult to deal with due to its negative psychological effects. Nonetheless, there are ways to work through the challenges – such as receiving mental health services – and continue moving forward. If you feel you may be struggling with decisions your service requires of you, surround yourself with your support system and know that there are trained professionals who can help you work through these emotions. To continue learning about moral injury, check out the Military REACH library and access current research summaries, reports, and other educational resources, released monthly.

Chesnut, R. P., Richardson, C. B., Morgan, N. R., Bleser, J. A., Perkins, D. F., Vogt, D., …. Finley, E. (2020). Moral injury and social well-being: A growth curve analysis. Journal of Traumatic Stress, 33 (4), 587-597 https://doi.org/10.1002/jts.22567

Douglas, C. V. (2022). A phenological study and investigation of moral Injury with veterans. [Doctoral dissertation, Liberty University]. Digital Commons. https://digitalcommons.liberty.edu/doctoral/3722

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29 (8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003

Maguen, S., Griffin, B., Copeland, L., Perkins, D., Richardson, C., Finley, E., & Vogt, D. (2022). Trajectories of functioning in a population-based sample of veterans: Contributions of moral injury, PTSD, and depression. Psychological Medicine, 52 (12), 2332-2341. https://doi.org/10.1017/S0033291720004249

Maguen, S., & Norman, S. B. (2022). Moral Injury National Center for PTSD. 33 (1), 1-9. https://www.ptsd.va.gov/publications/rq_docs/V33N1.pdf

The Moral Injury Project. (n.d.). What is moral injury? Syracuse University. https://moralinjuryproject.syr.edu/about-moral-injury/the-moral-injury-project/

Wisco, B. E., Marx, B. P., May, C. L., Martini, B., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2017). Moral injury in U.S. combat veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 34, 340–347. https://doi.org/10.1002/da.22614