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Moral Injury What Is It?

Written by: Richard Hilton, Executive Contributor

Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.

 

Over the past few weeks, I have been talking to various people about a little-known condition that affects a lot of people. This has a term but, as of yet no clinical diagnosis. This is Moral Injury.

Beaten and broken heart. Paper knuckle and scrunched paper.

Unlike Post Traumatic Stresses, whether that is a singular or a multitude of traumatic events. Moral Injury cuts deep into the core of the person. Some liken it to damaging the soul of the person. The term is believed to have originated by Vietnam Veteran Camillo “Mac” Bica. The idea isn’t new. It stems all the way back through to ancient times and all cultures.

Moral Injury refers to the lasting effects of something that has gone against your moral compass. This is known to harm you psychologically, emotionally, spiritually as well as behaviourally. Put simply they are violations of your own personal code.

Which not only can affect you but the damage can also harm family, friends, work colleagues, etc. As it will change you as a person and how you view the world such as “Can I trust the X to do the right thing?” or “Will that person face justice for the wrong they caused me?”

Moral Injury can be considered as a significant breach of personal boundaries, where the person affected could believe that they have little or no option in a particular circumstance or set of circumstances. This breach of boundaries leads to the self-questioning of core areas such as identity and Values.


Studies on Moral Injury define it as:

  • Drescher et al. (2011) define moral injury as “disruption in an individual’s confidence and expectations about one’s own or other motivation or capacity to behave in a just and ethical manner” (p. 9)

  • Litz et al. (2009) further describe the moral injury as “the inability to contextualize or justify personal actions or the actions of others and the unsuccessful accommodation of these... experiences into pre-existing moral schemas”

  • Shay (2014) emphasizes leadership failure and a “betrayal of what’s right, by a person who holds legitimate authority in a high-stakes situation.”

  • Silver (2011) speaks of “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society” (para.6).

Examples of Moral Injury:

  • The use of deadly force and causing injury or death to civilians, with the full knowledge that there is no other option than to use lethal force. The action can also be done accidentally as well, by mistaking a target for someone else.

  • The boss allows someone to get away with violating company policy but reprimanding other employees for doing the same thing.

  • Not reporting an assault that happened to you or not being believed by a family member. Or if the assault has been reported the justice system does nothing about it.

  • In a healthcare setting, help to save the lives of patients that have a highly infectious disease and come home to your family hoping that they won’t catch it.

Some of the consequences or impacts of Moral Injury:

  • Increased risk of distress, depression, and Suicide. It can lead to people not being able to lead a fulfilling and rewarding life.

  • It destroys trust in others, whether that is family, friends, the community, or the workplace.

  • Isolation and loneliness which further triggers more isolation and loneliness, quickly spirals downward.

  • A perceived lack of support from the people or the organisation around you after the event. There is something called Post Depression Crisis which leaves a person vulnerable to further conflict or assault.

  • Maladaptive behaviours or coping strategies, e.g., over-exercising, abusing drugs/alcohol, gambling, etc.

As of writing, there is no recognised therapy that deals with Moral Injury, but there may be therapies out there that can assist with the healing process of the injury because that Moral injury can be related to C/PTSD, or it can help with anxiety, depression helping to resolve those issues.

The timespan for Moral Injury can occur after a few days. Or it can be lay hidden like a festering wound deep under the skin. Then years later it surfaces. This could be due to a change in how the person views the world and a change in their own moral code.


Ways that you can help yourself if you are suffering from Moral Injury:

  • Forgiveness to yourself and acceptance of what happened

  • Self-Compassion you deserve to treat yourself like the worthy person that you are.

  • Seek advice from a religious or spiritual practitioner and they may be able to help and guide you through this situation.

  • Find peer support, from friends, colleagues, etc.

  • Find a therapist that knows and understands Moral Injury, if you have a practitioner that doesn’t understand, they could make the situation worse and not help to resolve the problem.

With Moral Injury there is the potential for Sanctuary trauma and betrayal trauma. Sanctuary trauma is where someone is in a place to support and heal or in some cases a person in authority and that person doesn’t listen to their client. For example, a traumatised person goes to see a therapist and tells them that they are going to complete suicide and they have the item ready to do it. The therapist then goes and tells the person something along the lines of “You’ll be ok. Just go and hid it. I’ll see you next week” The client leaves and they may feel unsafe. The therapist is unsafe to share details with and the organisation the therapist works at is unsafe.

Betrayal trauma is what happens when a person/s, organisation or institute causes you harm. The idea is that when something has been in your life for a long time and the person is unaware of what is happening to them because that has become the person’s “normal.” Other people can see what is going on and don’t necessarily understand why that person isn’t able to move away from that environment.


Symptoms:

  • Alexithymia: not recognising one’s own emotions or being able to describe them

  • Physical: the brain and body are affected as in the book “The body keeps the Score” by Bessel Van der Kolk. The body and physiologically the trauma is remembered but the mind wants to forget

  • Disassociation: Not being in your body and having some vague sense of feelings and emotions

  • Anxiety: This can be either relationship anxiety or a generalised state of anxiety depending on who or what caused the harm

  • Depression: The person isn’t able to recognise and/or express emotions

If a person is suffering from betrayal trauma for a long period of time this can lead to hyper-independency and trust issues. As this particular trauma is meant to be a temporary coping solution. Which gives you the skills and strategies to heal.


Some ideas to heal:

  • Set healthy boundaries

  • Take care of yourself

  • Physical activity

  • Build healthy relationships

  • Seek therapy

If you are suffering from anxiety, depression, or PTSD, email me here and find out how I can help you.


This article is not to be used for diagnosis. It is purely for information only. If you are suffering from a Mental Health condition, please go and speak to a qualified medical practitioner or qualified therapist.


Follow me on LinkedIn, and visit my website for more info!


 

Richard Hilton, Executive Contributor Brainz Magazine

Richard is a former member of the British Army. Upon leaving the military he studied extensively in self-defense, Conflict Management. Due to going through a difficult period on leaving, he realised that he needed to make major changes in the direction of his life He then began to study NLP and Hypnosis. He is now helping veterans and first responders with the difficulties and challenges that they are facing on a daily basis. He has also self-published his first book "Whispers over Windermere"

 

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