When I bring up moral injury to service members, or providers caring for our veterans, the most common response I get is “Can you define moral injury?” They have often heard the term at some point, but have no working knowledge of what it means or how it could apply to them or the clients they work with.  Moral injury Moral injury is the suffering people experience when in high stakes situations, things go wrong, and harm results that challenges their deepest moral codes and ability to trust others or themselves. The harm may be something they did, something they witnessed, or something that was done to them. It results in moral emotions such as shame, guilt, self-condemnation, outrage, and sorrow (1). Original definitions created from Vietnam era veterans was focused on failure in leadership. Recently, the definition has grown from research with Iraq and Afghanistan veterans to include moral failures by the individuals.

Why should everyone be discussing moral injury? 

Because when moral injury occurs, it can result in:

  • Social Isolation
  • Addiction
  • Suicide

We have been trying to find preventative measures for the high rate of suicide amongst military service members and veterans for years. The focus has been primarily on Post Traumatic Stress but I feel we need to be spending more focus on moral injury.  Moral injury is experienced as guilt, loss, and shame. These emotions are difficult and when experienced often described as unbearable. When you are living for an extended period of time with unbearable pain, it makes sense that you would isolate, self medicate, and unfortunately consider suicide.

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. Guilt involves feeling distress and remorse regarding the morally injurious event (e.g., “I did something bad.”). Shame is when the belief about the event generalizes to the whole self (e.g., “I am bad because of what I did.”)  Disgust may occur as a response to memories of an act of perpetration, and anger may occur in response to a loss or feeling betrayed. Another reaction to moral injury is an inability to self-forgive, and consequently engaging in self-sabotaging behaviors (e.g., feeling like you don’t deserve to succeed at work or relationships) (2).

Moral injury can also impact someone’s spirituality resulting in them pulling away, isolating from their church, or challenging their belief in a higher power altogether. This adds another layer of difficulty in treatment for many who rely on their spiritual community to lift and support them.

Moral injury is not isolated to service members. Anyone is at risk for moral injury. Service members, first responders, and other medical professionals are at higher risk due to the nature of their work.  It is my goal to keep the discussion going.

Richelle Futch, LICSW creator of the workshop “Unpacking Your Emotional Ruck” is a Marine Corps veteran and current military spouse. She is an author, mental health counselor, and clinical skills trainer who specializes in dialectical behavior therapy.