Military Life January 22, 2020

Moral Injury: The Invisible Wound of War

Maggie K., Senior Editor

Moral injury is a new term for an age-old phenomenon. It refers to the damaging effects to one’s conscience when they commit, witness or fail to prevent actions that go against their personal values.

While anyone can experience moral injury, Service members and Veterans are at a higher risk because of the nature of their job. From taking lives to witnessing horrific scenes, the images and emotional anguish that arise during wartime are intense and distressing. Unfortunately, these are memories that last a lifetime and that change a person at their very core.

Leaders can help Service members and Veterans better understand their emotions by informing them about moral injury and guiding them on a path to self-forgiveness.

Moral Injury Triggers

During wartime, a Service member's values may go against what they are ordered to do. Here are some examples:

  • Knowingly or accidentally causing the death of civilians in combat
  • Following orders that are illegal or immoral
  • Giving orders that result in the injury or death of a fellow Service member or civilian
  • Failing to provide medical assistance to an injured civilian or Service member
  • Neglecting to report a sexual assault committed against a civilian or Service member

According to one study, 27% of deployed Soldiers reported experiencing an ethical dilemma to which they were unsure of how to respond. (Gaudet, Camille; Sowers [2016])

Recognizing Moral Injury

Moral injury can present itself in many emotional and behavioral ways anytime after a traumatic event:

  • Anxiety
  • Guilt; shame
  • Anger
  • Worthlessness, helplessness
  • Self-blame or blaming others
  • Loss of faith/belief
  • Self-deprecation (“I am weak”); self-condemnation (“I am evil”)
  • Increased post-traumatic stress disorder (PTSD) symptoms (nightmares, intrusive thoughts)
  • Self-isolation; withdrawal from others
  • Feeling “haunted”
  • Substance abuse (drugs, alcohol)
  • Self-harm (cutting, burning skin)
  • Suicidal ideation; suicide attempt

If you are thinking about suicide, call the National Suicide Prevention Lifeline for 24/7 free, confidential support:  800-273-TALK (8255) (press 1)

Are moral injury and PTSD the same?

Moral injury often appears at the same time as PTSD and the two share some common symptoms (e.g., anger, depression, sleep issues, suicide risk). However, they are not the same thing. PTSD is a mental disorder that requires a diagnosis, while moral injury is not a psychiatric diagnosis and can be experienced at any time.

Forgiveness & Moving Forward

While it’s impossible to change the past, it is possible to move forward. Although the best treatment for moral injury is still unclear, it is understood that the key to helping a person is treating the root cause of the internal conflict. With the right tools and support, a person can learn to accept the situation, forgive themselves for their moral/ethical transgressions and continue to live a good life.

For more information on various Military Health & Wellness products available to purchase for your community, browse the QuickSeries® library of guides.

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