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.
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 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.
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. Avoiding talking about it is not going to help.
Forgiveness and self-compassion have been reported to bring about significant improvement in anxiety and depressive symptoms. Also, doing exercises to help you define your value system and purpose going forward is key to finding new meaning in life.
Forgiveness
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 for you and those connected to you. Harshly criticizing yourself can prevent you from loving and caring for your family.
Working through your self-loathing and criticisms will help you forgive and move on. Avoiding dealing with what happened and suppressing the pain does not help to work through moral injury. The support of a therapist is very important.
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.
Choosing to be compassionate is a way towards healing, restoring your relationships and creating community. Instead of punishing yourself, practice self-compassion. Develop a caring compassionate observer self. This will lead to healing.
You might have to make some hard decisions about your employer, if the company won’t implement systematic solutions so you don’t have to keep making decisions that violate your ethics, which only compounds 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 difficult and complex an experience as moral injury. There are many tools that can help, such as EMDR and neurofeedback. 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.