Understanding Moral Injury

What is Moral Injury? 

Moral Injury (MI) refers to the experience of sustained and enduring negative moral emotions - guilt, shame, contempt and anger - which results from the betrayal, violation or suppression of deeply held or shared moral values.  First observed in military members and veterans, MI frequently involves a particular sense of self-condemnation and the loss of a sense of meaning or faith in religious, moral and societal institutions.  Jonathan Shay, an American psychiatrist who brought the term into the modern lexicon, noted that it was present when there had been “a betrayal of what’s right by a person in a position of authority in a high-stakes situation.”  We generally refer to these situations as ‘morally injurious events’ and are recognizing that they can occur in many settings – military, healthcare, law enforcement, veterinary work, and many others.  While it can occur alongside Post-traumatic Stress Disorder (PTSD), it is distinctly different, as it is not our body or mind’s reaction to traumatic stress, but is centred around a deep moral disquiet about our individual and collective actions, inactions and core values. 

How did you come to specialise in this area? 

 I’m a veteran of the US Air Force, having served with Army units in Iraq and Afghanistan.  I would say that I have experienced MI as a result of my service, yet in a profoundly less acute form than many others.  When I separated from the Air Force, I went to seminary and graduate school in theology, attempting to reconcile my own experiences of wartime violence – including the suicide of several friends and brothers in arms - with my faith.  I discovered a profound expression in the language of theology that, for me, could hold together both the injustice and agony of a broken world as well as point the way towards authentic hope.  As a systematic theologian, I write about the ways that theology can articulate frameworks of meaning in which those who are morally injured might be able find solace.

Why do you think it is an important area of research?  

The more we study moral injury, the more we realize how corrosive it is to our sense of self, our capacity for relationships, and our ability to perceive ourselves as “good people.”  Multiple studies suggest that it is existentially dangerous when we experience strong and totalizing self-condemnation, as this can be linked to suicide and suicidal ideation.  Several studies even suggest that in military veterans who suffer both PTSD and moral injury, the severity of MI is the greatest predictor of suicide.  So the better we can understand moral injury and explore potential pathways to healing, the better care we can offer to those who suffer from it, and the better we can understand where we may need to have national and societal conversations about our cultural values and how they contribute to MI.  

How can people benefit from a greater understanding of moral injury? 

For those suffering from moral injury, a greater capacity to understand their moral emotions, express them and find positive and safe spaces in which to do so can be a life-saving relief valve and eventually open potential avenues for recovery.  For clergy, chaplains, clinicians and others who care for those experiencing MI, a greater understanding of MI can mean a greater set of resources to draw from in doing so, leading to better long-term care and more positive trajectories for the morally injured.  For the general public, a greater understanding of moral injury and the moral traumas of war can collapse the distance between the rather simplistic moral language used in the political discourse around conflict and the experience of veterans, creating a more supportive environment in which military members may return from conflict and feel neither valorised nor vilified, but appreciated and supported by a community willing to help bear their burdens.   

What have been your biggest challenges in this area of research? 

Moral injury defies simple and concise definition.  Because it has so many facets, there is valuable work being done on it in multiple contexts and different fields of research and practice.  Yet much of the work being done is atomized and can be difficult to discover.  One of the objectives of the ICMI is to serve as a hub that can link researchers in different areas with each other in order to produce more synergized efforts.  Additionally, because work is being done in clinical fields of psychology and psychiatry, alongside humanities work in religion, theology and philosophy, there can be profound disagreements about what even constitutes moral injury.   

What are you working on currently?

I am currently working on a second book that will explore the power or resurrection hope and within the Christian tradition to point towards a meaningful future which models divine justice in a way that night inspire our imaginations in a morally injured world.  I’m working on articles exploring the connections between ritual concepts of penance and lament and recovery from perceived moral failure, and that weigh the conceptions of divine forgiveness in understanding moral injury.  I’m also working with an interdisciplinary group of researchers from the Universities of Portsmouth and Southampton on a project (currently in consideration for funding) that would measure moral injury in retired military chaplains to determine how their duty to attend to the moral trauma of military members may be morally injurious to them, and if their perception of divine forgiveness is impactful in recovery from MI. 

Find out more 

Join the launch Webinar on Thurs 10 November: Trajectories of Moral Injury: Future Research, Tensions, and Cross-Cultural Collaborations 

Revd Dr Brian Powers will also be taking part in the Moral Costs of the War in Ukraine taking place at the Gala Theatre on Fri 11 November.  

International Centre for Moral Injury  

Study in the Department of Theology and Religion