Moral Injury
Moral injury is a term used to describe the psychological, spiritual, and moral conflict experienced by individuals as a result of their involvement in or witnessing of an experience or event that is at odds with their personal values. It is a form of psychological trauma that can result in long-term mental health issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). Studies of veterans and active duty military personnel suggest that moral injury is a significant contributor to psychological distress (Shay, 2014; Maguen et al., 2016). Other research has suggested that the experience of moral injury may be more closely associated with psychological distress than PTSD symptoms (Litz et al., 2009; Currier et al., 2013).
Moral injury symptoms may include feelings of guilt, shame, anger, grief, isolation, and depression. Other symptoms may include anxiety, flashbacks, irritability, sleep disturbances, difficulty concentrating, and increased substance use. Current evidence-based therapies that can assist in alleviating moral injury symptoms include cognitive-behavioral therapy, narrative therapy, mindfulness-based interventions, and psychodynamic therapy. Cognitive-behavioral therapy helps to identify and challenge negative thoughts and beliefs, and to replace them with more positive and helpful ones. Narrative therapy assists in understanding the story of one’s life, and how this story can be reframed in order to achieve a more positive outlook. Mindfulness-based interventions emphasize present-moment awareness and acceptance, and help to reduce stress and anxiety. Finally, psychodynamic therapy helps to explore the underlying emotions and conflicts that may be contributing to one’s symptoms. These therapies can help to create a space for individuals to process their traumatic experiences in a safe and supportive environment, and to develop healthy coping skills and insight into their psychological distress.
When a veteran is suffering from moral injury, they may need a variety of things from a therapist to help them heal. First and foremost, they need a safe and supportive space to process their traumatic experiences and emotions. They need to be able to talk openly and honestly about their experiences, and to express their feelings without fear of judgement or criticism. They also need a therapist who can help them to understand their moral injury and its impact on their life, and to develop healthy coping skills and insight into their psychological distress. A therapist can help the veteran to identify and challenge unhelpful thoughts and beliefs, and to develop healthier ways of thinking. Additionally, a veteran may need support in navigating the challenges of reintegrating into society and finding a sense of purpose and meaning in their life. A therapist can help them to work through any guilt or shame that they may be feeling, and to develop a sense of pride in their accomplishments. Finally, a veteran may need a therapist who can provide them with resources and referrals for additional support, such as peer support groups and other community resources.
Overall, when a veteran is suffering from moral injury, it is important for them to find a therapist who can provide them with the support and guidance they need to heal and to move forward in their life.
References
Currier, J. M., Holland, J. M., & Young-Xu, Y. (2013). Moral injury and psychological distress in combat veterans: An examination of the relationships. Journal of Traumatic Stress, 26(5), 590-596.
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.
Maguen, S., Litz, B. T., Metzler, T., & Marmar, C. R. (2016). Moral injury and complex PTSD: An empirical review of the evidence. Clinical Psychology Review, 48, 1-14.
Shay, J. (2014). Moral injury and the soul of a nation: The cost of an American life. New York, NY: St. Martin’s Press.