Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology , 20 (3), 154.
Moral injury describes the damage that occurs to a person’s moral compass or conscience when that individual fails to prevent, perpetrates, or witnesses acts that transgress their own ethical and moral code of conduct or values. Within the military service, especially after an experience of war, moral injury describes the spiritual and emotional impact of being victimized by actions, participating in, and witnessing behaviors and actions that violate or break the service member’s behavioral expectations, and moral values of others or self (Bryan et al., 2014). Moral codes are dependent on self-identities. The notion of moral injury is not new, and various warriors, philosophers, and poets in history have faced ethical dilemmas during wars. However, its effects have been carefully documented by war veterans of the Vietnamese war.
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Moral injury has become a center of discussion across various settings and disciplines in the country increasingly because of the wars in Iraq and Afghanistan. The returning veterans and the nurses, family, or friends who take care of them have struggled to respond effectively and understand the experiences of war and its results such as alienation, anguish, and anger. Some of the effects have not been adequately explained regarding mental diagnoses such as PTSD (Post Traumatic Stress Disorder). Furthermore, it disrupts their expectations and confidence and may affect their capacity and motivation to act in an ethical and just manner (Bryan et al., 2014). The author describes it as a deep soul wound that may pierce their relationship to society, personal identity, and sense of morality.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology , 31 (2), 182.
The author explains some of the causes of moral injury. Some of the reasons include a change in belief about the justification or necessity for war especially after or during their service. The use of deadly force during combats that may cause death or harm to civilians accidentally or knowingly but without any alternative. Complying with orders that were against the Geneva Convention, against the Rules of engagement, were illegal, or immoral may also cause moral injury (Shay, 2014). Also, giving orders in combat that led to death or injury of a service member may have immense ethical issues. Other issues include failing to report rape or sexual assault offenses committed against civilians or fellow service members.
The author insists that moral injury may result to serious suicidal tendencies, distress, and depression. It can take away the lives of the people suffering from it both literally and metaphorically. It can affect their personal lives in ways that prevent them from living fully healthy lives. The effects go beyond the individual and may affect the family and the community. The community should take a lead role in the healing process of individuals affected by moral injury. Some of the terms used by researchers to explain the condition are “soul wound” and “soul repair” (Shay, 2014). Moral injury has adverse effects on a person’s soul. Some of the common factors that cause the damage include violence, war, rape, and abuse.
Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2015). Initial psychometric evaluation of the Moral Injury Questionnaire—Military version. Clinical psychology & Psychotherapy , 22 (1), 54-63.
Moral injury has received growing focus by academics and researchers over the past three decades. Other costs of war include post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The authors explain that the effects of moral injury may not occur immediately. Some people may experience the effects a few days after the occurrence, but for many others, the effects will surface many years after the incident. The authors argue that moral injury should be acknowledged in the same manner as the mental and physical trauma that occurs in war (Currier et al., 2015). Moral injury is often personal and subjective. Furthermore, research on moral injury is still far much young in comparison to PTSD, and the approach to its treatment are varied and experimental.
Some researchers argue that some traumas such as PTSD may also cause moral injury. However, treating moral injury may not treat PTSD in an individual or vice versa. The treatment of moral injury should be based on the individual needs and beliefs. Some of the avenues for confronting and acknowledging moral injury include spiritual gatherings, talk therapy, talking circles, religious dialogue, discussion, art, writing, and many more techniques (Currier et al., 2015). Some of the people who are in the frontline of addressing moral injury include the clergy, therapists, social workers, and counselors. The treatment of moral injury should involve all community stakeholders. Some of the moral injury among war veterans emanate from emotions such as isolation from civilian society.
Litz, B. T., Lebowitz, L., Gray, M. J., & Nash, W. P. (2017). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury . Guilford Publications.
The authors argue that moral injury can be healed despite the fact that military engagement may always involve ethical dilemmas. Some of the preliminary research insists that mental health treatment is essential in treating a moral injury. Cognitive Behavior Therapy (CBT) may treat some issues in moral injury such as reducing shame, guilt related thoughts, and depression (Litz et al., 2017). Other forms of treatments are available. Some psychotherapists have organized trips to Iraq and Vietnam for the war veteran to meet their affected counterparts in an attempt to heal some of the decade-long wounds. Every person should not be a trained psychotherapist to make the necessary changes. Social connections are necessary for assisting war veterans to heal their moral injuries.
The authors carry out a series of interviews with war veterans. Most of the veterans were exposed to events that could cause moral injury. There were consistent differences between those with fewer symptoms and those with higher levels of suicidal thoughts and depression. Those with higher symptoms levels often lacked support by peers, friends, and family and they felt isolated. On the other hand, the veterans with fewer symptoms often feel supported by their community, family, peers, and friends (Litz et al., 2017). All people should find a way of thanking the military for their service and having a meaningful exchange. Positive psychological connections are not only beneficial for the war veterans but for their families, peers, and communities as well. Veterans should not just be appreciated on Memorial Day but on various occasions.
Flipse Vargas, A., Hanson, T., Kraus, D., Drescher, K., & Foy, D. (2013). Moral injury themes in combat veterans’ narrative responses from the National Vietnam Veterans’ Readjustment Study. Traumatology , 19 (3), 243-250.
As Americans remember those who died on Memorial Day, over the past decade, a large number of the deaths have been related to suicides. The popular media has always associated PTSD and military suicides. However, research has revealed another causative factor that is related to both suicide risk and military deployment, but it does not fit the PTSD criteria (Flipse Vargas et al., 2013). The moral conflict is generated by the perceived breaking of moral codes during wartime actions may create lifelong psychological consequences. The authors also give a scenario where one veteran was forced to kill a boy who was firing at him. He believed that he should have shot him in the arms or legs instead of killing him.
The transgressive acts may cause haunting states and highly aversive states of inner turmoil and conflict. Some of the emotional responses include anger about betrayal, shame that emanate from global self-attributions, anxiety regarding possible consequences of their actions, and guilt. Some of the behavioral manifestations include self-handicapping behavior such as drug abuse, social instability, self-harming behaviors such as suicide, self-condemnation, and withdrawal (Flipse Vargas et al., 2013). Few people can differentiate PTSD and moral injury. Moreover, moral injury is believed to result in avoidance symptoms, re-experiencing, and emotional numbing of PTSD. Killing may cause moral injury but not all killing can cause moral injury. Killing can only cause moral injury if it goes against a person’s moral compass.
References
Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology , 20 (3), 154.
Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2015). Initial psychometric evaluation of the Moral Injury Questionnaire—Military version. Clinical psychology & Psychotherapy , 22 (1), 54-63.
Flipse Vargas, A., Hanson, T., Kraus, D., Drescher, K., & Foy, D. (2013). Moral injury themes in combat veterans’ narrative responses from the National Vietnam Veterans’ Readjustment Study. Traumatology , 19 (3), 243-250.
Litz, B. T., Lebowitz, L., Gray, M. J., & Nash, W. P. (2017). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury . Guilford Publications.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology , 31 (2), 182.
