Vaknin, O., & Ne’eman-Haviv, V. (2025).
European Journal of Trauma & Dissociation, 9(3), 100569.
Abstract
Recent research has increasingly focused on the role of moral frameworks in understanding trauma and traumatic events, leading to the recognition of "moral injury" as a clinical syndrome. Although various definitions exist, there is still a lack of consensus on the nature and consequences of moral injury. This article proposes a new theoretical model that broadens the study of moral injury to include diverse populations, suggesting it arises not only from traumatic experiences but also from conflicts between moral ideals and reality. By integrating concepts such as prescriptive cognitions, post hoc thinking, and cognitive flexibility, the model portrays moral injury as existing on a continuum, affecting a wide range of individuals. The article explores implications for treatment and emphasizes the need for follow-up empirical studies to validate the proposed model. It also suggests the possibility that moral injury is on a continuum, in addition to the possibility of explaining this process. This approach offers new insights into prevention and intervention strategies, highlighting the broader applicability of moral injury beyond military contexts.
Here are some thoughts:
This article proposes a new model suggesting that moral injury is not just a result of clear-cut moral violations (like in combat), but can also arise from everyday moral dilemmas where a person is forced to choose between competing "rights" or is unable to act according to their moral ideals due to external constraints.
Key points of the new model:
Core Cause: Injury stems from the internal conflict and tension between one's moral ideals ("prescriptive cognitions") and the reality of a situation, not necessarily from a traumatic betrayal or act.
The Process: It happens when a person faces a moral dilemma, makes a necessary but imperfect decision, experiences moral failure, and then gets stuck in negative "post-hoc" thinking without the cognitive flexibility to adapt their moral framework.
Broader Impact: This expands moral injury beyond soldiers to include civilians and professionals like healthcare workers, teachers, and social workers who face systemic ethical challenges.
New Treatment Approach: Healing should focus less on forgiveness for a specific wrong and more on building cognitive flexibility and helping people integrate moral suffering into a more adaptable moral identity.
In short, the article argues that moral injury exists on a spectrum and is a broader disturbance of one's moral worldview, not just a clinical syndrome from a single, overtly traumatic event.
