The Hidden Wound and Understanding Moral Injury in Everyday Life
Updated: Aug 15
Written by Arian Guedes, Registered Psychologist
Arian Guedes is a Registered Psychologist, Clinical Director, and Founder of NewVista Psychology & Counseling Services. Arian is a trauma-focused therapist with years of experience. She is also a speaker, workplace well-being and burnout expert.
Sarah has been a nurse for fifteen years. She has held countless hands and comforted countless families. But during the pandemic, she was ordered to keep a dying man's wife from entering his room. She followed the policy, and she has never forgiven herself.
Sarah is a fictional composite created to illustrate moral injury. This is not simply burnout. It may overlap with Post-Traumatic Stress Disorder (PTSD), but it reflects another kind of suffering: moral injury.
Moral injury is the lasting distress that can occur when an event violates who we believe ourselves to be. The wound does not arise only from what happened, but from what the experience seems to say about our values, our choices, or the people and institutions we trusted.
What is moral injury?
Moral injury can occur when someone perpetrates, fails to prevent, or witnesses actions that deeply conflict with their moral or ethical beliefs, or experiences betrayal by trusted individuals or institutions. It is not a formal psychiatric diagnosis. Rather, it is a psychological, social, and sometimes spiritual wound often marked by guilt, shame, anger, loss of trust, and a diminished sense of meaning or purpose.
Moral injury and PTSD are distinct but can overlap. PTSD can follow exposure to death, serious injury, or sexual violence and may involve intrusive memories, avoidance, hyperarousal, and changes in mood and beliefs. Moral injury centres more specifically on moral conflict, guilt, shame, or betrayal. A person may experience either one or both.
How common is it?
Although moral injury was first studied extensively in military populations, it is increasingly recognised among healthcare workers, first responders, and others in high-stakes roles. A recent U.S. study found that more than 40 percent of combat veterans, healthcare workers, and first responders reported exposure to a potentially morally injurious event. A smaller but meaningful proportion reported clinically significant symptoms.
The Coronavirus Disease 2019 (COVID-19) pandemic brought this issue into sharper focus. Among surveyed Veterans Affairs (VA) healthcare workers, 39 percent reported morally distressing experiences and 30 percent felt betrayed by healthcare leaders, coworkers, or others. In a British Medical Association survey, 78.4 percent of responding doctors said moral distress resonated with their experience at work, and 51.1 percent said the same of moral injury.
Moral injury in everyday life
“The wound hurts because the values are real.”
Moral injury is not confined to the battlefield. It can emerge whenever people care deeply but feel unable to act in accordance with their values:
The healthcare worker: A nurse required to isolate critically ill patients from their families under policies that conflict with her values.
The first responder: A paramedic unable to save a child because of inadequate equipment or staffing.
The teacher: An educator who watches a student be failed by a broken system despite her efforts to intervene.
The parent: A mother who cannot provide for her children as she believes a good parent should during a financial crisis.
These are not necessarily failures of character. They are often moments when a person's ability to uphold their values is exceeded by the constraints around them. Yet guilt and shame may persist long after the event.
Signs to watch for
Common experiences may include:
Persistent guilt or shame
Withdrawal from loved ones or loss of trust in others
Feeling betrayed by leaders or institutions
Loss of meaning or purpose in work or life
Difficulty forgiving oneself
A different kind of healing
Moral injury calls for care that addresses guilt, shame, responsibility, betrayal, and meaning. Treatment may include approaches such as Cognitive Processing Therapy and Eye Movement Desensitization and Reprocessing (EMDR), particularly when PTSD is also present, tailored to the individual and the nature of the morally injurious experience.
Healing often involves examining perceived responsibility more fairly, processing painful memories, reconnecting with values, and learning to hold accountability without turning it into permanent self-condemnation.
Understanding our limitations
Even the best therapy cannot fully heal a wound that is continually reopened by impossible expectations. One of the most powerful steps is accepting our human limits.
People who experience moral injury are often deeply caring. They hold themselves to high standards and feel devastated when they believe they have fallen short. The wound hurts because the values are real.
Healing requires moving beyond the belief that we can fix everything. A doctor cannot save every patient. A soldier cannot prevent every casualty. A first responder cannot be everywhere at once. Recognising these limits is not complacency. It means separating our worth from outcomes we did not create and could not fully control.
This is radical self-compassion: carrying responsibility without allowing it to crush us, remaining accountable while also forgiving ourselves for being human.
Understanding our limitations does not excuse broken systems. Organisations must address understaffing, inadequate resources, and cultures that silence ethical concerns. Individual healing and systemic change must go hand in hand.
A commitment to nuanced care
At NewVista Psychology, we recognise that moral injury may involve psychological and existential pain that cannot be reduced to a single diagnosis. Healing is not about silencing guilt or erasing the past. It is about placing responsibility in context, rebuilding trust and meaning, and reclaiming the future.
Even in the face of profound moral pain, the capacity for connection, self-compassion, and purposeful action remains.
Read more from Arian Guedes
Arian Guedes, Registered Psychologist
Arian Guedes is a Registered Psychologist, Clinical Director, and Founder of NewVista Psychology & Counseling Services. Arian is a trauma-focused therapist with years of experience. She is also a speaker, workplace well-being and burnout expert. She serves as a part-time Professor of Ethics for the City University of Seattle in Calgary, Alberta.
