Understanding Moral Injury: Causes, Implications, and Coping Strategies

A man sitting at a table in front of shuttered windows.

Whether they’re a veteran on the front lines or a civilian living through a traumatic event, people are faced with moral conflicts daily. As a result, they may find themselves dealing with moral injury.

Syracuse University, a pioneer in the field and home to the Moral Injury Project, defines moral injury as damage to a person’s moral beliefs, values, or conscience.

This happens when a person sees an action, performs an action, or fails to prevent an action that transgresses their moral foundations, breaking the personal ethical code they have. As a result, they are left with negative thoughts and feelings, impacting their well-being and health.

Research shows us that in its initial uses in mental health care discussions, moral injury was used by mental health professionals supporting military veterans.

Today, moral injury can be applied to all kinds of people who experience traumatic events with moral conflicts, whether military veterans, healthcare workers, or someone in law enforcement.

As human beings increasingly live through traumatic events marked by moral dilemmas (like the recent pandemic), moral injury becomes more and more relevant to mental health discussions. Let’s take a closer look at what moral injury is, its impact, and ways we can cope with it.

Symptoms of Moral Injury

To better understand how moral injury impacts us, let’s take a closer look at how it might look in daily life. The most common symptoms people will experience include:

  • Feelings of guilt, shame, anger, or sadness
  • Increased negative thoughts/beliefs about yourself
  • A loss of trust and belief in others
  • A loss of faith and belief in wide society
  • Increased self-isolation
  • A loss of identity
  • Increased feelings of anxiety and/or stress

What Causes Moral Injury?

A woman covering her face in front of a window.

As mentioned above, moral injury is something that happens as a result of a traumatic event that conflicts with a person’s moral compass. The acts of trauma have caused a moral dilemma, leaving a person with feelings of grief, guilt, and shame to work through.

This can happen for a number of different reasons. Some of which include:

Military Combat

Many combat veterans can find themselves dealing with moral injury as a result of their profession. Many of the actions faced by veterans require ethical dilemmas, moral courage, and working through traumatic events and violence.

Witnessing Traumatic Events

Being involved in or even witnessing a traumatic event can lead to moral injury. For example, surviving situations like natural disasters, terrorist attacks, or an accident can lead to a conflict in moral values. Memories about witnessing violence/cruelty, guilt over perpetuating it, or even feelings like survivor’s guilt can all be linked to moral injury.

Professional Ethical Dilemmas

There are also many different professions where individuals encounter ethical dilemmas that can result in moral injury. For example, healthcare professionals often have to witness traumatic events and experience moral dilemmas around life and death. For some individuals, ethical challenges can lead to moral injury-related harm.

How Does Moral Injury Impact Us?

Moral injury can deeply impact us, affecting various aspects of daily life. Some of the more common ones include:

Psychological and Emotional Impacts

One of the biggest concerns healthcare professionals have with moral injury is its impact on a person’s psychological and emotional well-being. Feelings of shame and guilt can manifest into conditions like depression, anxiety, or PTSD, impacting mental health.

A group of military men sitting around a table.

Impact on Relationships

Moral injury can also impact relationships with others, as individuals often struggle with emotional intimacy and trust and increasingly deal with self-isolation. This social disconnection can greatly impact personal and professional relationships, causing them to deteriorate.

Effect on Self-Esteem and Identity

When dealing with moral injury, people may struggle with self-esteem and identity. As a person struggles with their internal moral views, they may be unable to reconcile their actions with their sense of self, causing a crisis of identity or reduced self-esteem.

Using Negative Coping Behaviors

Sometimes, a person struggling with moral injury may turn to destructive behaviors to help. Things like substances and other self-destructive behaviors can be used to numb emotional pain and forget experiences, causing a negative impact on daily life.

What Are Good Coping Strategies for Moral Injury?

Coping with the impacts of moral injury can be complex. The exact help a person needs varies depending on many factors, including the nature of their traumatic event, specific symptoms, and goals for healing or recovery.

Here are some of the strategies I would recommend to those looking to address moral injury:

Seeking Professional Help and Therapy

For many individuals, the best way to work through moral injury is with the help of a professional in therapy. Therapeutic intervention can do wonders with treating moral injury, especially for those experiencing mental illness symptoms or worsened mental health.

I encourage individuals to seek out a qualified mental health professional working in a safe and supportive therapeutic environment. Therapies such as cognitive behavioral therapy (CBT) and EMDR can be especially useful interventions for moral injury.

These therapies address negative thought patterns linked to traumatic memories, reframing experiences and working through emotional distress.

Meaningful Dialogue and Peer Support

Peer support is an underrated tool for addressing moral injury.

For many individuals, moral injury can lead to things like self-isolation, low self-esteem, or a loss of belief and trust in others. One of the best ways to change these patterns is to directly challenge them, finding support through connections with others.

Things like support groups (especially veterans organizations for military personnel) can be an excellent resource. Connecting with others allows you to share experiences, validate your emotions, and create a space of communication and empathy. These are all things that will serve you well on the path to healing.

Self-Care and Self-Compassion Practices

With moral injury impacting a person’s identity and self-esteem, self-care practices are naturally a good fit for healing moral injury. It’s important to challenge negative thoughts, seeing yourself as a person worthy of compassion and care even if a moral injury is telling you otherwise.

Basic self-care practices, like prioritizing healthy eating and exercise, can help individuals release endorphins and combat feelings of anxiety and stress. Relaxation techniques like personal hobbies, being creative, or even rest can also do wonders to improve feelings of self.

No matter what self-care tactic an individual chooses, it’s important they are rooted in self-compassion and working towards forgiveness of self. This is what is ultimately needed to move through healing.

Learning to Cultivate Resilience and Post-Traumatic Growth

Resilience is a tool that will serve individuals well as they heal through moral injury.

But how do you build resilience? By recognizing your own personal strengths, focusing on the positive attributes of yourself, and finding purpose. If you are to grow through trauma, you need to see moral injury as the catalyst for personal growth and transformation that it can be.

This does not mean ignoring the impact of trauma and burying feelings. In building resilience, we embrace our circumstances, find strength and forgiveness, and grow to be better. This is not something that happens overnight but is possible when a person fully commits to the healing process.

Frequently Asked Questions

These are the most frequently asked questions individuals have about moral injury:

What is the difference between moral injury and guilt?

While moral injury and guilt are closely linked, they are separate concepts.

Moral injury is a condition that refers to feelings of psychological and emotional distress in individuals who have had traumatic experiences that lead to conflicts with held moral beliefs and values.

Guilt is a specific feeling or emotional response characterized by a feeling of remorse for one’s actions. Often, individuals who deal with moral injury will find themselves experiencing the feeling of guilt.

Can moral injury occur outside of military contexts?

Yes, it can. While moral injury is a term first coined in response to military veterans, it is now recognized as a condition that impacts any individual who has experienced a traumatic event characterized by a moral conflict or dilemma.

How can moral injury affect someone’s mental health?

A moral injury can lead to feelings of guilt, shame, stress, and anxiety, greatly impacting an individual’s mental health. In some cases, individuals with a moral injury can develop or experience symptoms of things like PTSD, depression, and anxiety or struggle with intrusive thoughts, flashbacks, and nightmares.

Are there any medications specifically prescribed for moral injury?

Medication used to treat moral injury will vary depending on an individual’s specific symptoms and experiences.

In some cases, an individual may need to treat moral injury symptoms of anxiety or depression with medications like SSRIs or other psychiatric medications. This should always be discussed with and prescribed by a healthcare professional.

Can moral injury be overcome or healed?

Yes, moral injury can be overcome and healed with time! It is possible for people affected to heal and recover with help and support. The healing process will vary from person to person.

Embracing the Healing Process

If you believe you’ve been impacted by moral injury, you are not alone.

Every day, individuals are moving through the world, impacted by ethical and moral dilemmas and the moral injuries that can result from them. With proper support and resources, it is possible to move through feelings of isolation and shame, finding resilience and healing on the other side.

As a life coach, I am dedicated to helping my clients embrace the waves of life and feel empowered to make changes to better themselves.

Want to learn more? Click here to learn more about how a life coach can help you. Or click here to book an introductory session with me today.

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