We spend a great deal of time talking about the impact of trauma and adversity in the mental health field – and rightly so. Trauma and adversity are common causes of mental health deficits. Yet there is another type of psychological experience that also has significant impact on the mental health of individuals, particularly in veterans, law enforcement and healthcare personnel.
In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations. When someone does something that goes against their beliefs this is often referred to as an act of commission. When they fail to do something in line with their beliefs that is often referred to as an act of omission. Individuals may also experience betrayal from leadership, others in positions of power or peers that can result in adverse outcomes. Moral injury is the distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to such events. A moral injury can occur in response to acting or witnessing behaviors that go against an individual’s values and moral beliefs.
In order for moral injury to occur, the individual must feel like a transgression occurred and that they or someone else crossed a line with respect to their moral beliefs. Guilt, shame, disgust and anger are some of the hallmark reactions of moral injury. It can feel like a huge loss of trust and even some damage to one’s identity or integrity.
I think of some of our veterans who were in situations where they had to take another’s life, or make decisions that impacted someone under their leadership with physical or psychological harm. I think it also can be a part of varied caregivers’ guilt when they attempt to help someone who does not respond positively to that help. First responders can also be impacted by moral injury when they attempt to rescue or help someone and the outcomes are not successful. That kind of moral injury penetrates deeply into someone’s psychological perspective and can feel overwhelming.
Moral injury also typically has an impact on an individual’s spirituality. For example, an individual with moral injury may have difficulty understanding how one’s beliefs and relationship with God can be true given the horrific event the person experienced, leading to uncertainty about previously held spiritual beliefs. In this way, moral injury can have deep consequences to one’s life perspective and can leave one feeling unstable and even fatalistic.
Our political turmoil and ensuing violence are deeply related to moral injury, which can occur if an individual’s beliefs and values feel compromised. If an experience is deeply violating a person could feel significantly betrayed and their reactions could be intense, angry and even violent. If those issues continue and/or grow in frequency, deeply felt reactions could leave someone feeling like their life is out of control.
If someone is suffering from a moral injury it could be helpful to process it with a therapist – although that may be difficult if there is a great deal of shame or anger. In a bit of a different way than therapeutic sessions and symptom reduction, moral injury is more about repairing damaged meaning and values. There should be an emphasis on forgiveness, reconnecting with our values, making amends where appropriate and spiritual reflection. It is a type of healing that is hard to achieve alone, so it is important that there are some trustworthy listeners that can encourage a healthy resolve and recovery. Moral injury can create significant psychological disruption and should be proactively addressed once we realize that it has happened to us.
Gerry Vassar
President/CEO
