Moral injury is a specific type of trauma that arises if you face a situation that deeply violates and damages your conscience or core values. When you have a vision of the world as a fair and good place and something you’ve done or witnessed destroys that vision. If your moral compass has been turned upside down by witnessing, failing to prevent or perpetrating acts that go against your values and ethical code of conduct, you are suffering from moral injury.
For example, infidelity violates your core values. Another example is when your boss asks you to lie about something in an official document. That might mean following his direction or getting fired. This is a no-win situation. If you lie, you violate your own ethical code, but if you don’t, you will lose favor with your boss and risk being fired.
A third example is witnessing abuse. You know it’s wrong, but especially if you were a kid, you may not have been able to do anything about it. You no longer see the world as fair and a good place when you witness abuse. On top of that, you feel guilt and shame over your inability to act morally. Even when you are powerless to do anything,, this can still cause moral injury and trauma.
Dealing with moral injury creates a profound struggle with guilt, anger, and a sense that you can’t forgive yourself or others. It can affect many people in various situations. Moral injury keeps you stuck in trauma and stagnant grief over the disconnect between your moral principles and the reality of what is happening or what has happened.
You can start to feel like you don’t know who you are anymore. Your entire value system is upended and called into question. The distress this causes is genuine and intense. Working with a therapist like me can help you identify and clarify your feelings. I can help you work through the trauma that occurs from moral injury.
Who Can Suffer Moral Injury?
Many different types of people can suffer moral injury. Survivors of abuse or witnessing abuse of a sibling, parent or friend can result in moral injury. Health care workers, first responders and veterans can all face dilemmas concerning the inability to prevent suffering and/or death. Any time you are caught in the role of witnessing or are a victim of others’ moral wrongdoing, you might find yourself suffering moral injury. You might have to violate your own moral code in order to survivie.
Moral injury involves betrayal of what you held to be ‘right’, usually by someone in authority.
Healthcare Workers
Doctors, nurses and other health care workers can feel the strain of moral injury. Physician burnout may actually come from deep frustration with ethical problems presented by the modern healthcare system. Feeling helpless to do anything in the face of suffering was a common problem during COVID-19. There wasn’t space in hospitals, and people had to be turned away, even though they needed care. Having to let people down when it’s your job to help leads to soul damage.
Healthcare workers often feel constrained to squeeze complex care of patients into short office visits. So, they feel they can’t do their job well and have to rush patients instead of giving them the time they need. To stop moral injury, clinicians need time and healing environments to care for sick and dying patients well. Companies are often unwilling to spend the extra money to create a supportive, caring space.
Abuse, Violence and Rape Cause Moral Injury
Moral injury caused by war, abuse, rape and violence can cause soul wounds that aren’t easily healed. You might enter the situation with an idealistic view of how you are going to help people. But, the reality of the situation might make that very difficult to actually achieve.
You might be shocked to find yourself working for leaders, or having parents, who were incompetent, dishonest and untrustworthy. The harsh reality of what you sometimes have to deal with in life is made almost impossible to face when confronted with dishonorable parents or bosses.
Moral Injury Versus PTSD
Rather than exposure to a traumatic event being the problem, instead violations of moral standards and beliefs lead to a sense of powerlessness and hopelessness. This can then lead to depression and anxiety.
Moral injury is a condition different from PTSD and depression. PTSD Post Traumatic Stress Disorder occurs when your life or safety is threatened.. This life threatening experience leads to chronic hypervigilence and fear. It is difficult to ever feel safe.
Moral injury has nothing to do with a direct personal threat. It is related to mounting guilt and hopelessness, and involves the loss of trust. With PTSD, intrusive images of the past are associated with threats. Moral injury memories don’t trigger fear, but instead create shame, guilt, rage, disgust, emptiness and despair. The self-loathing and distrust of others can lead to depression, anger, aggression and suicidal thinking.
What Helps Heal Moral Injury
Realize that what you are going through is a reasonable response to having your ethical compass thrown off track. You will have to process what happened with a therapist and/or trusted relative or friend. Engaging and sharing stories about the events that caused it is the first step.
Working with a therapist like me can help you identify and articulate exactly what the moral injury is. How did this happen and what do you do if it happens again? How do you heal?
Trauma Therapy for Moral Injury
Moral injury can be seen as a trauma. Trauma therapy such as EMDR Eye Movement Desensitization and Reprocessing, neurofeedback and somatic experiencing help you work through moral injury. You don’t have to go into every detail if you’re not ready for that. Maybe you’ll never want to do that. There are methods that I use in therapy that really help.
There are several techniques that can help heal your nervous system. Don’t blame yourself. This is not your fault. Your nervous system has been injured by trauma, and just like you would have to seek treatment if you broke your leg, seeking good trauma treatment is key to recovery.
Neurofeedback Therapy
Neurofeedback heals the nervous system and helps calm the emotional reactivity that trauma brings on. It helps calm the feelings of fight, flight or freeze that you feel physically, as well. Neurofeedback helps build resiliency and self-regulation. You feel calm and at ease. This makes it easier to process what happened.
This structured therapy is not talk therapy, but rather a therapeutic process that works with your brain’s waves to help your brain build new neural pathways. This “new” response to stress is what causes you to be more resilient in the face of life’s ups and downs.
EMDR For The Trauma Of Moral Injury
EMDR Eye Movement Desensitization and Reprocessing is also an excellent technique for healing moral injury. In this method, you hold an image of the traumatic event in your mind while watching the therapist do a back and forth hand movement. You move your eyes back and forth, and this helps process trauma between the two sides of the brain.
Therapy also needs to focus on trauma reactions in the body. This creates a feeling of wanting to lash out or run away. You can also feel frozen in place, or trapped. EMDR and Somatic Experiencing helps you process these body memories.
Forgiveness
After we address the trauma, forgiveness will get a little easier. Forgiveness does not mean forgetting. If you refuse to forgive yourself, and feel you deserve to suffer because you are bad or unworthy, this prevents healing and recovery. Harshly criticizing yourself can prevent you from giving and receiving love and care for/from your family and friends.
Working through your self-loathing and criticisms in therapy will help you forgive and move on. Avoiding dealing with what happened and suppressing the pain does not help to work through moral injury. I can support you with neurofeedback and EMDR. Using these tools, I can guide you as we work together to help you build forgiveness.
Self-Compassion
Self-compassion is paramount in recovery from moral injury. Life is hard, and in the face of that struggle if you are criticizing, attacking, and rejecting yourself and your pain, this just brings more suffering. Try to respond to your pain with compassion. The greater the moral injury, the more compassion is needed. Again, trauma therapy can really help.
Making Changes, If Needed
You might have to make some hard decisions about your employer. Some companies won’t implement systematic solutions so you don’t have to keep making decisions that violate your ethics, compounding the moral injury. You may not be able to continue abandoning your own standards and watch people suffer as a result. Moral injury can destroy your ability to trust others, so staying in a bad situation can really be a problem.
You may need the guidance of a therapist to move through such a traumatic and complex experience as moral injury. If you’d like to try tools that can help, such as EMDR and neurofeedback, please contact me. I have two office locations, Torrance and Santa Monica, Ca. Please contact me if you think I can help. My phone is 310-314-6933 or email me a mindy@mftherapy.com.
