Explaining moral injury

Veterans may experience moral injury during their careers, and distress resulting from moral injury may be more likely to occur due to experiences that occur while on deployment. It may result from seeing the consequence of orders that are contrary to their values, or witnessing injury they believe was avoidable.  

Harm that results from a lack of action, inappropriate action, or error, can create strong feelings of betrayal and cause psychological injury. This often presents as anger, guilt, and shame, and impacts an individual’s view of the world, themselves, and others. 

Symptoms of moral injury 

Symptoms of moral injury may appear similar to PTSD, but the person may not report having directly experienced a traumatic event that involves actual threat of death or injury to themselves or others. Additionally, moral injury generally doesn’t involve the increased hypervigilance or constant alertness that is common with PTSD. 

Moral injury may impact all aspects of a person’s life, including family relationships, work, and study, and symptoms that may occur include: 

• Strong emotions, including anger and sadness 
• Changes in behaviour 
• Avoidance 
• Intrusive thoughts 
• Strong feelings of guilt, shame, or horror 
• Unwillingness to forgive themselves 
• Feeling unworthy of love or care 

Who experiences moral injury? 

Anyone can be affected by moral injury, however, exposure to war and combat can increase the possibility of moral injury occurring. Moral injury in veterans often stems from:

• Killing or harming others (although under orders to do so)
• Making decisions that affect the survival of others, even from a distance such as operating unmanned combat drones
• Being unable to take care of those who have been harmed
• Failing to complete a duty that would have protected others
• Engaging in or witnessing excessive violence

Moral injury can occur in peacetime or combat and has been seen in troops involved in peacekeeping as well as other non-combat roles, such as medical professionals and first responders. 

Treating moral injury 

While moral injury may occur with PTSD and make symptoms more severe, it is not recognised as a mental health condition by itself and cannot be medically diagnosed.  

Treatment for moral injury can include seeing a therapist to talk through and process the distressing experience and resulting emotions. A therapist can also help identify strategies to address unhelpful thinking patterns that may arise as a result of moral injury. 

Support at Mates4Mates 

Mates4Mates provides veterans and families access to mental health and wellbeing services, and our psychologists, counsellors, and social workers can provide a non-judgmental and safe space to talk about distressing experiences. 

Many people with moral injury and/or PTSD find it difficult to engage in therapy because of shame around their actions or feelings, or concern about how others will respond to them. However, talking about these concerns can be a starting point to addressing them and finding effective ways to manage these unhelpful thoughts and behaviours. 

Mates4Mates also offers social connection activities, providing veterans and family members with a safe and supportive community to make connections with others who may have similar experiences and can support you through mateship and camaraderie. 

To find out more, reach out to Mates4Mates on 1300 4 MATES (62 837) for a confidential chat.   

 

Written by Clare Mitchell, Mates4Mates Clinical Program Manager