Moral injury is a profound psychological, social, and spiritual distress that occurs when one’s deeply held moral beliefs and values are transgressed. Unlike PTS, which is a recognized mental health disorder, moral injury is not medically diagnosable but can significantly impact one’s mental health and quality of life. This blog explores moral injury, its implications, and how organizations, like Give an Hour, are addressing this critical issue, with insights from the Shoulder to Shoulder podcast by Grumpy Combat Veteran + Friends, and the support within.
Moral injury arises from actions or inactions that go against one’s ethical beliefs. These actions might include harming others, failing to prevent harm, or witnessing acts that violate one’s moral code. The consequences are severe and can lead to guilt, shame, and a loss of trust in oneself and others. This concept has been recognized in military contexts but also applies to various high-stakes professions like healthcare, law enforcement, and humanitarian work.
Moral injury manifests through a range of emotional, psychological, and behavioral symptoms. These can include:
Emotional Symptoms: Persistent feelings of guilt, shame, anger, sadness, and disgust.
Psychological Symptoms: Lowered self-esteem, high self-criticism, and self-destructive behaviors.
Behavioral Symptoms: Avoidance of intimate relationships, loss of faith in people, and mistrust in authority figures.
Spiritual Symptoms: A crisis of faith, questioning of previously held religious beliefs, and a loss of belief in a just world.
These symptoms can overlap with those of PTS but are distinct in their focus on moral and ethical violations rather than fear-based trauma.
Moral injury has been extensively studied in military personnel, especially those returning from combat. Veterans often face situations where they must act in ways that conflict with their moral beliefs, such as killing in combat or witnessing civilian casualties. The withdrawal from Afghanistan in August 2021, for instance, led to significant moral injury among service members who felt they abandoned their Afghan allies.
Lt. Col. Will Selber, a retired Air Force officer, exemplifies the struggle with moral injury. After nearly two decades of service, he retired in 2024, burdened by PTS, a traumatic brain injury (TBI), and the deep moral injury of witnessing the chaotic withdrawal from Afghanistan. His transition from military service to civilian life was marked by these psychological scars, leading him to co-host the Shoulder to Shoulder podcast with attorney Kate Kovarovic. Together, they explore the complexities of moral injury and offer a platform for healing and understanding.
When we spoke to Kate, she offered, “Some studies show that as many as 37 percent of combat veterans are experiencing moral injury. That’s more than a quarter of our nation’s veterans who are suffering from an injury which is widely misunderstood and significantly understudied. It’s critical that we fill this gap so that veterans don’t feel helpless or alone in their experience.” The podcast aims to bridge the civil-military gap through candid discussions about the war and its aftermath. By sharing these stories, the podcast provides a safe space for veterans and civilians to discuss their experiences and find common ground.
Moral injury goes beyond immediate emotional and psychological symptoms, affecting one’s social and spiritual well-being as well. Individuals experiencing moral injury may find themselves grappling with:
Social Isolation: A sense of alienation from peers and society due to perceived moral failures.
Existential Crisis: Questioning the purpose and meaning of life in the aftermath of moral transgressions.
Chronic Mental Health Issues: Prolonged depression, anxiety, and other mental health conditions exacerbated by moral injury.
While moral injury is most commonly associated with military service, it can affect professionals in various high-stress fields. Healthcare workers, for example, often face moral dilemmas when resources are limited, and critical decisions must be made. Similarly, social workers, lawyers, journalists, and humanitarian aid workers can experience moral injury from the challenging and often ethically ambiguous situations they may encounter.
One large example is the COVID-19 pandemic presented numerous ethical dilemmas for healthcare workers, leading to instances of moral injury. Many faced decisions about resource allocation, end-of-life care, and the prioritization of patients, which often conflicted with their moral beliefs. The emotional toll of these decisions, compounded by the high-stress environment, highlighted the need for comprehensive support systems for healthcare professionals and many other roles we see in the world, especially within the military/veteran communities.
In the most recent episode of Should to Shoulder, Kate Kovarovic and her guest, Rev Dr. Michael Yandell, discussed part of addressing moral injury means validating the moral harm, and clarifying that the problem isn’t with the person’s moral response – instead, responsibility lies with the entity which commits the harm. It isn’t a sign of moral unwellness that someone experiences moral injury, but a sign of moral health.
Coping with moral injury involves acknowledging and addressing the profound impact of these ethical transgressions. Some effective strategies include:
Peer Support: Connecting with others who have experienced similar moral injuries can provide a sense of solidarity and understanding.
Professional Help: Therapy and counseling can help individuals process their feelings and develop coping mechanisms.
Mindfulness and Self-Care: Practices such as mindfulness, meditation, and self-care routines can help individuals manage their symptoms and improve their overall well-being.
Storytelling: Sharing one’s experiences through writing, podcasts, or other forms of storytelling can be therapeutic and help in the healing process.
Give an Hour is dedicated to providing mental health support to veterans, service members, and their families. Recognizing the profound impact of moral injury, Give an Hour offers various resources and programs to help individuals cope with these challenges. One such initiative is the Peer Support Program, which provides peer support and promotes mental health awareness within military and veteran communities by connecting those with similar lived experiences.
Beginning in the Fall of 2024, Give an Hour has collaborated with Grumpy Combat Veteran + Friends, who will be hosting a year-long virtual support group supporting the military community. This group will primarily focus on moral injury. Sessions will be hosted once per month and will feature a combination of guest speakers and open dialogue.
In applying, you are committing to attend 9 out of the 12 sessions, as community continuity and willing participation are cornerstones to a successful group setting. These sessions begin September 18, 2024, and run until August 13, 2025, and are led by Give an Hour’s Military Peer Support Facilitator Rebekah Edmondson – and the best news, participation is free if you are selected to be one of the 10 participants.
In honor of the commitment, participants will be offered:
- A certificate of completion following the conclusion of the program, to confirm your experience in the realm of moral injury.
- Publication opportunities on the GCV+F website
- Speaking opportunities on any of the GCV+F podcasts
- The opportunity to contribute meaningful data to the field of moral injury, which will later be used to produce training materials to help mental health practitioners better understand the meaning and impact of moral injury in the military community.
To Apply, visit: Virtual Peer Support Group Application
As society becomes more aware of the diverse mental health challenges individuals face, it is essential to shine a light on the often overlooked but deeply impactful issue of moral injury. Moral injury is a complex and deeply personal experience that can have lasting effects on an individual’s mental health and well-being. Through initiatives like Give an Hour and platforms like the “Shoulder to Shoulder” podcast, we can better understand this complex phenomenon and explore effective support systems.
References:
Atlas Institute for Veterans and Families. (n.d.). Moral Injury.
Department of Veterans Affairs. (n.d.). Moral Injury in the Context of War.
