What is moral injury?

Moral injury is when one feels they have violated their conscience or moral compass when they take part in, witness or fail to prevent an act that disobeys their own moral values or personal principles.

 

What is moral injury in the context or war?

According to the Department of Veterans Affairs (VA), moral injury in the context of war comes from participation in actions related to combat warfare, such as killing or harming others. Moral injury can also come indirectly from acts like witnessing a death or others dying, failing to prevent similar immoral acts, and granting or receiving orders that can be viewed as immoral or inhuman.

 

Are post-traumatic stress disorder (PTSD) and moral injury the same?

The symptoms and concepts of Moral Injury and PTSD fall along the same line, but each has their own unique constructs. According to the VA, PTSD is “a mental disorder that requires a diagnosis” while moral injury is considered “a dimensional problem” with no definable threshold for its presence. A veteran with moral injury could have a mild or severe appearance of moral injury.

 

How do you know if you or a loved one suffers from moral injury?

Unlike PTSD moral injury is not a disorder that can be diagnosed medically. To know if you or a loved one might suffer from moral injury, the symptoms below are generally concurrent with moral injury.

 

Symptoms:

Persistent Negative Emotions – Veterans who experience moral injury can be overwhelmed by negative feelings. Feelings of guilt, shame, remorse from past acts that violated their code of morals. Often times they feel disinterest in previously enjoyable activities, or genuinely find it hard to feel happy. A veteran may feel like they can’t trust anyone, because they have seen how dangerous the world is or feel emotionally numb.

Reliving the event – Awake or asleep, a trigger can cause painful memories to surface and make the sufferer feel as though they are experiencing the event demoralizing event all over again.

Avoidance – Veterans will often avoid situations that remind them of the event. For example, many veterans avoid crowded places, because they learned overseas that crowds were targets and being in a crowd made you a target. Some veterans will even avoid talking about the incident that affects them.

Trust Issues – Veterans feel like they have lost the ability to trust others and question whether every decision is right. Often veterans will withdraw themselves from society as if they feel like they do not fit in with society’s fabric.

Drug/Alcohol Abuse – Some veterans may turn to drugs and alcohol when faced with moral issues and dilemmas that linger in their past. They see the drugs and alcohol as a way out from facing the moral guilt built from war or past trauma.

 

Does moral injury have to control you?

No, moral injury should not have to control you nor should you let it control your way of life. There are many ways to cope with moral injury and not let it control your everyday life. Outlined below are ways to manage and control moral injury.

Lifestyle changes – Interacting with other trauma survivors and other veterans who have experience with moral injury, exercising, eating healthy, volunteering, avoiding drugs and alcohol, spend more time with loved ones and practicing optimism are all helpful.

Mindfulness – To be mindful is to be aware of and concentrate on the present instead of dwelling on the past. It can be breathing exercises or focusing on a singular thing in your present—like the taste of a piece of chocolate—and intensely focusing on that one thing.

Practicing optimism – Hunt for the good stuff in your life, the things that create joy and a sense of peace or happiness. At some point in your day, reflect on the good things that have happened to you in the last 24 hours. It can be a small as finding your favorite ink pen or the birth of a child. Whatever brings you joy.

Peer groups – Finding others who have experienced similar events can help you feel comfortable talking about the events and working through the intense emotions associated with it.

Emotional support animals – Many veterans who struggle with moral injury have adopted emotional support animals, usually dogs who help veterans feel more at ease and comfortable in situations that may otherwise cause them undue stress.

Professional help – Sometimes correcting emotional or chemical imbalances in the brain requires the help of professionals. There is no shame in asking for help with your moral injury symptoms, it does not make you weak. It takes strength to ask for help.

Exploring the options – There are many different ways to gain control over moral injury, those that work for you may not work for someone else, and those that work for someone else may not work for you. Exploring the different options and being open minded to new and potential solutions is helpful.

Reach out to civilians – At times the best way to deal with an injury similar to moral injury is to reach out to those who have not had similar experiences and see a new perspective on how they might see things. Reaching out to a civilian who might have no idea what combat or war is like might be refreshing and helpful to see how to control moral injury and gain new insights.

 

What resources are available for a veteran struggling with moral injury?

https://www.ptsd.va.gov/professional/co-occurring/moral_injury_at_war.asp