Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress their own moral and ethical values or codes of conduct.

Within the context of military service, particularly regarding the experience of war, “moral injury” refers to the emotional and spiritual impact of participating in, witnessing, and/or being victimized by actions and behaviors which violate a service member’s core moral values and behavioral expectations of self or others. Moral injury almost always pivots with the dimension of time: moral codes evolve alongside identities, and transitions inform perspectives that form new conclusions about old events.

While the concept itself is not new—throughout history, philosophers, poets, and warriors themselves have long wrestled with the ethical dilemmas inherent in war—the term “moral injury” is more recent, and is thought to have originated in the writings of Vietnam War veteran and peace activist Camillo “Mac” Bica (Brock & Lettini, 2012; Bica, 1999, 2014).

Moral injury is increasingly a focus of discussion and study across disciplines and settings. Returning veterans, and those who care for them, are struggling to understand and respond effectively when experiences of war result in levels of anguish, anger, and alienation not well explained in terms of mental health diagnoses such as Post-Traumatic Stress Disorder (PTSD.)

Drescher et al. (2011) define moral injury as “disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner” (p. 9). Litz et al. (2009) describe moral injury as “the inability to contextualize or justify personal actions or the actions of others and the unsuccessful accommodation of these… experiences into pre-existing moral schemas” (p. 705). Silver (2011) speaks of, “a deep soul wound that pierces a person’s identity, sense of morality and relationship to society” (para. 6).

 

EXAMPLES OF MORAL INJURY IN WAR:

 

  • Using deadly force in combat and causing the harm or death of civilians, knowingly but without alternatives, or accidentally
  • Giving orders in combat that result in the injury or death of a fellow service member
  • Failing to provide medical aid to an injured civilian or service member
  • Returning home from deployment and hearing of the executions of cooperating local nationals
  • Failing to report knowledge of a sexual assault or rape committed against oneself, a fellow service member, or civilians
  • Following orders that were illegal, immoral, and/or against the Rules of Engagement (ROE) or Geneva Convention
  • A change in belief about the necessity or justification for war, during or after one’s service

 

WHAT ARE THE CONSEQUENCES OF MORAL INJURY?

Moral injury can lead to serious distress, depression and suicidality. Moral injury can take the life of those suffering from it, both metaphorically and literally. Moral injury debilitates people, preventing them from living full, healthy lives.

The effects of moral injury go beyond the individual, impinging on the family system and the larger community. Moral injury must be brought forward into the community for a shared process of healing.

In the context of a soulwith respect to the diversity of beliefs, including religion, held by those involved with Moral Injury, consider this perspective:

Moral injury is damage to the soul of the individual. War is one of, but not the only thing that can cause this damage. Abuse, rape, and violence cause the same type of damage. “Soul repair” and “soul wound” are terms already in use by researchers and institutions in the United States who are exploring moral injury and paths to recovery.

 

WHY HAVEN’T WE HEARD ABOUT THIS BEFORE?

Traumatic brain injury (TBI) and post-traumatic stress disorder (PTS or PTSD) became household terms over the last decade thanks to the maturation of attitudes about the costs of war; moral injury is now the object of growing focus by researchers and academics in the same manner.

Moral injury does not, by its nature, present itself immediately. Some will experience questions of moral injury days after an incident; for many others, difficulties will not surface for years. An experience with potential for moral injury is typically realized after a change in personal moral codes or belief systems.

 

WHAT SHOULD WE DO ABOUT MORAL INJURY?

Moral injury must be acknowledged in the same way that we acknowledge the physical and mental costs of traumas experienced in war and other place of danger. Moral injury is subjective and personal. Research on moral injury is younger than research on PTSD – the definitions, ideas and practices we’re working with are both experimental and varied.

Trauma of a type and severity that cause PTSD* are likely to cause moral injury, too. This does not mean treating PTSD will “treat” moral injury, nor vice versa. We favor the tenet that “treatment” of moral injury must be defined by the individual according to their beliefs and needs. Outlets for acknowledging and confronting moral injury include talk therapy, religious dialogue, art, writing, discussion & talking circles, spiritual gatherings, and more.

Therapists, counselors, social workers, and clergy are often at the front lines of addressing moral injury; however, the larger community can also take part. Consider that moral injury affects, and is affected by the moral codes across a community. In the case of military veterans, moral injury stems in part from feelings of isolation from civilian society. Moral injury, then, is a burden carried by very few, until the “outsiders” become aware of, and interested in sharing it. Listening and witnessing to moral injury outside the confines of a clinical setting can be a way to break the silence that so often surrounds moral injury.

*PTSD is a clinical diagnosis, identified and treated according to criteria and methods prescribed by the American Psychiatric Association (APA). The APA last updated its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.

 

SO, WHAT ARE WE DOING?

  1. Fostering public dialogue about moral injury.
  2. Providing opportunities for veterans to design and participate in programs that explore moral injury.
  3. Researching and educating on moral injury.

Raising awareness is prerequisite to creating change. We are building the space and capacity for those who have moral injuries to start their search for healing. This is not just an academic pursuit. We are addressing the needs of the wounded through multiple healing modalities. Our endeavor is unique in this regard; through the use of artistic and literary formats for public engagement, we can serve those who need healing while addressing the public need for understanding of this topic.

17 thoughts on “What is Moral Injury

  1. Art Labrousse says:

    While this is couched in the military difficulties also arise for other professions, law enforcement is one of the main ones.
    We have seen this when an officer is forced to take the life of another person in particular.
    The training and reason for being a police officer is to protect people, not kill them; and even though they know that time might come, they find themselves unprepared for the results on their personal soul.
    I am glad that Moral Injury is becoming understood so that they officer can receive help that will allow them to continue with their lives.


  2. […] to you because the APA has not yet defined it but as an alternative here is the definition from the Moral Injury Project at Syracuse University “Moral injury is the damage done to one’s conscience or moral compass when that person […]


  3. Rod Wicks says:

    Moral Injury is not confined to war- nor should the focus be confined to war. While soldiers may experience periods of extreme violence/moral conflict many civilian workers face constant daily workplace violence and abuse. When the Manager of Residential Care is in bed with the child client- and (most) other workers and the ‘protective systems’ fail/refuse to respond= “a deep soul wound that pierces a person’s identity, sense of morality and relationship to society” result. One looses faith/belief in god, people, systems and self.


  4. John deChadenedes says:

    I am very interested in this subject and have, for the past couple of years, been thinking a lot about the idea of moral injury at the national level. This leads me to questions like, “Is it possble for a people to collectively experience moral injury if their leaders and their military enagage in acts that violate their deepest values? What happens to a sensitive person born into a society that has in the past engaged in terrible acts of violence and that continues to do so in the present, while presenting itself as upholding lofty humanitarian values?” I think this is possible and that most of us in the US already suffer from some degree of moral injury, from the long history of violence, genocide, war, and intolerance that makes up our collective past. The bombing of Hiroshima and Nagasaki, for example, cannot be reconciled with our image of ourselves as compassionate and rational people. How we balance this contradiction and how it affecrts each of us is an interesting question. I am particularly interested in how moral injury may make it difficult to form sound moral judgments. I would like to talk to others who may share – or disagree with – my thoughts on this.


  5. Charles Isaac says:

    I am a non-combat Vet who is also a hospice chaplain. I see this all the time and am thankful for away to look and do.

    Question: Can and how would this apply to gang members who shoot each other and innocent people.


    1. Mary Donovan says:

      This is such an excellent point. I work with incarcerated veterans in two California prisons, in a program founded by a Marine serving a life sentence. He and others at San Quentin have raised the point that though circumstances appear different between the – say – 19 year old man who is conscripted to kill by those up the chain of command in a military context, and the 19 year old gang member, in fact, much is the same. Reasons for joining in both cases might include a need to belong, to prove one’s manhood, to make a livelihood; consequences might include PTSD, moral injury, and death. http://veteranshealingveterans.org


    2. Anne says:

      Dear Chaplain Isaac:
      It might be useful to look into Fr. Greg Boyle’s work with gangs in Los Angeles. His book is called, “Tattooes on the Heart.”

      My very best to you,

      Anne


    3. C. Dunn says:

      I am responding as a convicted felon and former drug dealer who has lived the “street life”, hurt people, been shot, and been in federal prison. Honestly, many of us deal with the same issues, especially AFTER we decide to turn away from a life of crime and live productive lives.


  6. Thomas C Davis III says:

    The resources in this short, annotated bibliography will help communities of faith understand moral injury and help veterans suffering from it:

    http://bit.ly/2i4p4rs

    — TCDavis
    Founder, Interfaith Veterans’ Workgroup
    Wilmington, Delaware, http://www.ivw.website


  7. Thomas C Davis III says:

    I am the convener of the Interfaith Veterans’ Workgroup in Delaware. Our mission is to help veterans come home and share their warrior wisdom in order to promote non-violence in their communities. We are working on field testing the use of AVP with veterans as a way of treating depression related to moral injury. See http://avpusa.org. So far AVP has been tested only with incarcerated veterans. It has reduced anger and decreased recidivism in those populations. Now we intend to test it with veterans in general. I would appreciate being in touch with your project.


  8. Mariposa McCall says:

    As a psychiatrist who has heard many stories about war and trauma aftermaths, moral injury is the big elephant in the room that is the most difficult to process yet the most essential key to healing…Thank you so much for bringing this to the forefront…It needs to be included as a criteria for ptsd……Respectfully, Mariposa McCall, MD


  9. Tribe book review | Thinking, Talking says:

    […] ex-service personnel from their civilian counterparts, including classical PTSD but also ‘moral injury‘ and the loss of the group as described in Tribe. However, in my opinion the book portrays […]


  10. Harry Quiett says:

    Volunteers of America, one of the nations largest human services agencies is also now working on researching and developing approaches to Moral Injury. in a series of dialogues hosted around the country we have listened to veterans and caregivers and thought leaders on this issue. A White Paper will be issued in the fall with the findings. We are working closely with Dr. Rita Brock, author of “Soul Repair” to develop a path to understanding MI in Veterans and in other situations.


    1. Ed Deabler says:

      I am a retired United Methodist Clergy person. This is a new approach of understanding an old troubling, set of remembrances. How does a person deal with those situations that have nagged us for years. I think that naming it is helpful. Rev. Ed Deabler


  11. Stephen Taylor says:

    I am deeply committed to working with men and women whose suffer from moral injury. Many veterans whom I know are in such great need and find no comfort for moral injury. I dedicated my life to this, to teach, preach, speak, and write.


  12. Alex Alvarado says:

    Thank you for creating this website. I was actually told about this from Kelly Denton-Bourhaug, professor at Moravian College in PA. I read her book U.S. war-culture, sacrifice and salvation, and it validated my lived experience and thoughts I was having about the popular discourse after 9/11 and during my military service. After my departure, I had to recover almost everything, hence why I study history and religion. I would love to be part of this in any way I can!


    1. Eileen Schell says:

      Alex, I hope you might take part in our Moral Injury Healing Retreat on June 11th. Email me for a registration form at eeschell@syr.edu


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