A Moral Injury

Moral injury can seem mysterious as it's not a term that would usually make its way into everyday conversations. And still, many of us recognise the experience the moment we hear it described. Moral injury refers to the deep emotional and psychological impact that can happen when we are involved in, witness, or are unable to prevent something that goes against our core values. The things that we believe are right, fair, or humane.

So it would be unfair to label moral injury as any particular "diagnosis" or "disorder". Because moral injury is a human response to a situation that we've witnessed or been part of that has violated something important within us.

Broken values

Moral injury can appear when we feel that we needed to act against our own internal moral compass. It may also refer to moments where we have been placed in a situation that puts us in direct conflict with our personal sense of integrity. It can both come from doing something, as well as from not being able to do something. In some cases it can be even our participation in a system which causes harm despite our best intentions.

Therefore, when we suffer from moral injury, we can feel it in very different ways, such as a sense of self-betrayal, or a feeling of guilt or shame that, when compared to the facts, can seem out of proportion. We can get angry at systems, institutions, the circumstances in which we find ourselves, we can feel out of place where we are, or even lose trust both in other's and in ourselves.

All these signs mean that our values matter deeply to us.

More than stress or burnout

We can often confuse moral injury with burnout, but they’re not exactly the same. Burnout is more about depletion, whereas moral injury is about violation. It touches something internal, a sense of identity, ethics, or purpose.

The contexts in which it may happen are different, but can be seen, e.g., in healthcare or caring professions, in the military, in emergency services, workplaces where demands keep conflicting, family situations which push us into impossible choices or systems where harm is seen as something "normal".

The moral injury happens when we feel responsible for something over which we had little or no control at all.

“I should have...”

Something that we can see quite often in moral injury is the presence of internal "shoulds" that keep on appearing.

“I should have done more.”“I should have stopped it.”“I should have known.”“I should have been stronger.”

They pop in our head even when we were doing whatever we could in circumstances that were impossible. Because moral injury isn't about the facts, the results coming from our actions, but about the meaning that we give to them. And that meaning carries weight.

A wound in our identity

When we suffer from moral injury, we can notice that something within us has ruptured. We may become disconnected from who we were before it all happened, or we may be unsure how to reconcile the action (or the lack of it) with who we believe ourselves to be.

All these elements can lead us to actually question our own identity. We can become alienated from other people and struggle with trust. Not to speak about the sense of guilt for who were before it all happened. We are trying to make sense of an experience that touched something fundamental within us.

A deeply human response

Every one of us has their own sense of ethics. We do care about what we believe to be right or wrong and we want to act in accordance to our values. However, when external circumstances make that impossible, or when we find ourselves in situations that are in direct conflict with our integrity, then the impact on us can be considerable.

When we realise that those responses come from a moral injury, it slowly supports us in changing the focus from one of blame to one of broader context. It helps us understanding the humanity of our response.

Making meaning

Moral injury often involves a process in which we need to make sense of what happened, understand what were the pressures and constraints. This allows us to then reconnect with the values that this experience broke or strained. We don't want to erase the experience or go through a tick box exercise. The aim is to integrate what we've been through in a way that we recognise as honest and compassionate.

Moral injury is a sign that our values matter. It shows that we care and feel responsibility. It is a sign that we hold ourselves to a standard that takes roots in our integrity. We need to give it and ourselves the same care to understand it.

Dom

Integrative Counsellor (Trauma‑Informed)

Specialising in Trauma, ADHD, Narcissistic Abuse, Burnout, PTSD/CPTSD and Moral Injury

Practising in Malvern, Hereford, and Online