EASY-TO-UNDERSTAND SUMMARY: MORAL INJURY
What is Moral Injury?
“Moral Injury” is a type of mental health injury that can arise after being forced to do something that contradicts one’s own moral code, or witnessing someone else act in such a way and failing (or being unable) to stop it. Examples of this could be a soldier following orders to do something during wartime that they would never consider doing outside of war (e.g., torture, killing someone, sexual assault), or an employee feeling unsupported or betrayed by their institution (e.g., a police officer feeling their mental health struggles are being disregarded).
A recently relevant example of moral injury could take place during the COVID-19 pandemic, when a healthcare provider might have only one ventilator but two patients who need it, and they must choose which patient gets the life-saving treatment. Their choice may mean that the other patient dies. These are often impossible situations with no satisfactory options, and moral injury can be the result. We’re exploring this important topic in a couple of our ongoing studies. Stay tuned for the results of those studies, below.
What does research show about how military service is associated with moral injury, guilt and shame?
Nazarov A, Jetly R, McNeely H, Kiang M, Lanius R, McKinnon MC. (2015). Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatr Scand , 132: 4–19.
For this paper, we were interested in better understanding how military operations affect the mental health of its personnel. This article offers a summary of the existing research (as of 2015), investigating how personal morals might be connected to experiences of guilt and shame, and consequently, to overall mental health in military personnel – and more specifically, to moral injury. Within the context of war, certain (previously unthinkable) actions might seem necessary for the greater good.
Review of the research suggests that experiencing a moral injury during military service is associated with symptoms of guilt and shame, and that these particular symptoms play a significant role in the development of mental health issues, such as PTSD and Major Depressive Disorder. Interestingly, these associations remained the same regardless of how much combat the individual had seen.
This suggests that it is very important for us to recognize moral injury (and its relation to guilt and shame) as a significant source of psychological trauma, in addition to the more traditional fear-based events, such as combat. This understanding will help us develop more effective treatments, and ideally, help us identify potential ways to prevent such significant mental health consequences.
