Kalmbach, K. C., Basinger, E. D., et al. (2023).
Psychological Services. Advance online publication.
Abstract
War zone exposure is associated with enduring negative mental health effects and poorer responses to treatment, in part because this type of trauma can entail crises of conscience or moral injury. Although a great deal of attention has been paid to posttraumatic stress disorder and fear-based physiological aspects of trauma and suffering, comparatively less attention has been given to the morally injurious dimension of trauma. Robust themes of moral injury were identified in interviews with 26 post-9/11 military veterans. Thematic analysis identified 12 themes that were subsumed under four categories reflecting changes, shifts, or ruptures in worldview, meaning making, identity, and relationships. Moral injury is a unique and challenging clinical construct with impacts on the individual as well as at every level of the social ecological system. Recommendations are offered for addressing moral injury in a military population; implications for community public health are noted.
Impact Statement
Military veterans who experienced moral injury—events that violate deeply held moral convictions or beliefs—reported fundamental changes following the morally injurious event (MIE). The MIE ruptured their worldview, or sense of right and wrong, and they struggled to reconcile a prior belief system or identity with their existence post-MIE. Absent a specific evidence-based intervention, clinicians are encouraged to consider adaptations to existing treatment models but to be aware that moral injury often does not respond to treatment as usual for PTSD or adjacent comorbid conditions.
The article is paywalled, with the link noted above.
My addition:
The thematic analysis identified 12 themes related to moral injury, which were grouped into four categories:
- Changes in worldview: Veterans who experienced moral injury often reported changes in their worldview, such as questioning their beliefs about the world, their place in it, and their own goodness.
- Changes in meaning making: Veterans who experienced moral injury often struggled to make meaning of their experiences, which could lead to feelings of emptiness, despair, and hopelessness.
- Changes in identity: Veterans who experienced moral injury often reported changes in their identity, such as feeling like they were no longer the same person they were before the war.
- Changes in relationships: Veterans who experienced moral injury often reported changes in their relationships with family, friends, and others. They may have felt isolated, misunderstood, or ashamed of their experiences.
