What is Moral Injury?

Moral injury occurs when an individual experiences social, psychological, and
spiritual harm due to a betrayal of their core values. Here are some ways in which
moral injury can happen:
1. Acts of Commission: These occur when a person actively engages in behaviors that
conflict with their moral beliefs. For example, a soldier who must shoot an enemy
combatant may experience moral injury if they later discover personal details about the
deceased, such as seeing a picture of the dead man’s children 1 .
2. Acts of Omission: Moral injury can also result from failing to prevent harm or
wrongdoing. Imagine a situation where someone witnesses an injustice but feels
powerless to intervene. The guilt and shame from not taking action can lead to moral
injury 2 .
3. Acts of Betrayal: This type of moral injury often involves leaders or authority figures.
When those in positions of trust fail to protect their subordinates or violate ethical
norms, it can profoundly wound a person’s conscience. For instance, doctors facing
ethical dilemmas within the healthcare system may experience moral injury when
business interests conflict with patient care 1 .
4. High-Stakes Situations: Anyone caught in a life-or-death scenario with no good
choices can suffer moral injury. This includes therapists, human rights workers, first
responders, and survivors of abuse or violence. Even doctors, faced with decisions that
impact patients’ survival, may grapple with moral conflicts 13 .
In the military context, moral injury is widespread and linked to anxiety, depression,
PTSD severity, and suicide risk. Over 90% of veterans with PTSD exhibit symptoms of
moral injury, emphasizing its significant impact 1 . Similarly, doctors today face moral
dilemmas due to conflicts between healthcare practices and their deepest values 14 .


Remember that moral injury arises from circumstances, not character, and it can fundamentally alter a person’s worldview and ability to trust others.
TIPS for healing
Healing moral injury is a complex and deeply personal process, often requiring time,
effort, and support. Here are some tips that may help:

• Seek Professional Help: Consider seeking support from a therapist or counselor experienced in treating moral injury. They can provide guidance and tools tailored to your specific situation.
• 2. Self-Reflection: Take time to reflect on the events or experiences that have caused moral injury. Journaling or engaging in introspective practices like meditation can help you process your feelings and thoughts.
• 3. Seek Understanding: Try to understand the circumstances that led to the moral injury, including the choices and actions of others involved. This can help contextualize your feelings and promote empathy, forgiveness, or acceptance.
• 4. Connect with Others: Seek support from trusted friends, family members, or members of your community who can offer empathy, understanding, and companionship as you navigate your healing journey.
• 5. Engage in Meaningful Activities: Participate in activities that align with your values and bring you a sense of purpose and fulfillment. This can help rebuild a sense of meaning and identity that may have been affected by the moral injury.
• 6. Practice Self-Compassion: Be gentle with yourself and recognize that experiencing moral injury is a normal response to challenging situations. Treat yourself with kindness and understanding as you work through your feelings.
• 7. Explore Spiritual or Religious Practices: For some individuals, spiritual or religious practices can provide comfort, guidance, and a sense of connection to something greater than themselves.
• 8. Advocate for Change: If your moral injury stems from systemic issues or injustices, consider getting involved in advocacy or activism efforts aimed at addressing the underlying causes and promoting positive change.
• 9. Set Boundaries: Establishing healthy boundaries can help protect your emotional well- being and prevent further harm. This may involve distancing yourself from triggering situations or individuals, setting limits on your involvement in certain activities, or seeking support in enforcing boundaries.
• 10. Give Yourself Time: Healing from moral injury is a process that takes time and patience. Be patient with yourself and trust that with time and effort, you can find healing and peace.

By Tandy Hale, LCMHC, ATR-BC, NCC