Military Moral Injury Psychology Sociology

Why is moral injury so dangerous?

Expanding on my previous post on moral injury, I want to emphasize why it is so dangerous. Moral injury often lurks under the radar, taking lives and leaving survivors unable to make sense of the tragedy. Since moral injury has not yet been officially adopted into the Diagnostic and Statistical Manual of Mental Disorders, mental health professionals have not been able to properly diagnose this invisible injury.

Defined as a profound experience of guilt/shame or an institutional betrayal, persons who suffer from moral injury often blame themselves for an incident they did not have control over or become disillusioned and lose a sense of identity or meaning in their lives. As previously discussed, this is common among those on the front lines of our nations conflicts who are often tasked with making life-or-death decisions amidst the fog of war.

Moral injury is so dangerous because its symptoms align with the interpersonal causes of suicide. As discussed by Thomas Joiner in his book Why People Die by Suicide, suicidal desire stems from two factors: 1) thwarted belongingness; and 2) perceived burdensomeness. Moral injury deeply impacts both of these factors by making sufferers feel isolated due to their perceived transgression, as well as making them feel like a burden on others due to their suffering or perceived lack of propriety.

Morality, the social consensus of right and wrong, is the glue that bonds social groups. Our moral community is comprised of everyone we trust to conduct themselves in alignment with a code of unwritten rules. Beyond the legal system, morality gets to the heart of our sense of identity and our ability to trust. It is like a sacred canopy we all stand under, giving meaning and purpose to our communal lives, to borrow a concept from Peter Berger’s definition of religion.

Beyond any religion, the moral code of universal human dignity largely governs us on a global scale.  As Karl Marlantes states in What it is Like to Go to War“…any conscious warrior of the future is going to be a person who sees all humanity as brothers and sisters.”

Throughout the history of human evolution, our instinctual drives recede like melting ice, exposing the fertile ground of moral consciousness. Rather than simply responding to instinctual reflexes, we now have the conscious ability to contemplate the ethical consequences of our actions.

With this development, like the spring thaw, comes the increased responsibility of cultivation. As this moral consciousness expands to embrace an ethic of universal humanity, we must now consider others beyond our local group or nation. This consciousness forces us to readjust to a moral reality where we cannot simply label outside groups as subhuman.

One form of reaction to this increasingly globalizing world may be to simply deny an ethic of universal humanity, reaffirming a strengthened ethic of exclusion to bolster an identity based on hatred. But this merely works to cut ourselves off from our own humanity. By neglecting the humanity of others, we neglect our own humanity.

In the case of moral injury, the ethic of humanity is strongly upheld. Although it is a good thing to have a “conscious warrior,” who holds a global perspective, this awareness also makes it difficult to cope with perceived moral transgressions amidst the fog of war, causing the victim of moral injury a great deal of pain due to the experience of shame.

Shame is one of the most powerfully isolating emotions. In the case of moral injury, it cuts one off from a sense of belonging to under the sacred canopy of universal humanity. It strips one of a sense of identity as a decent human being, leading to profound sense of isolation. This is why it is so dangerous.

Luckily, there is hope of recovery. Part of this recovery requires one to recognize the broader forces that contributed to the incident in order to remove the sense of self-blame. As stated in a previous post: the need to make a decision in the fog of war is something that happens to an individual. Specialist Joe Caley, U.S. Army. 1st Cavalry, 25th Infantry realized his lack of agency, stating: “It’s not what I did in the war, it’s what the war did to me. That was a self-revelation.”

In my next post, I will expand on various programs and therapies dedicated to healing moral injury. As for now, I hope this has been helpful in conveying the danger of moral injury and how understanding it will help us prevent suicides among veterans.


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14 comments

  1. This is a very interesting article, so thank you for posting it. I have little to add at this point in time but I find this to be a useful framework or schema with which to focus one’s thinking on particular instances of psychological trauma. While I realize that the particular case you applied this to and spoke about was the effect of war, I can easily see this being applied also to the loss of religion or to anything which grounds our sense of self and morality. I suppose, additionally, this could be applied to codependent relationships as well. That aside, thank you for the thought-provoking post.

  2. Hi Steve! I can’t describe how lucky I feel to be able to read what you share in this blog.
    “Moral Injury” – this is what I’ve been looking for. I kinda always wonder why in every conflict, I always end up blaming myself for everything that happens. I always have that feeling that I’m terrible because I did something wrong and shameful and it’s me, the immoral me, that ruined everything.
    I believe that knowing why we feel bad is the key to cure that bad feeling. Reading this post, it is like being given the key to one of my biggest mental problems. So, thank you Steve!

  3. Hi Steve, How great to discover you perceptive work here. Thanks for following my blog. Discovering your work is a gift to me. My heart is hurting for our Veterans even though I think we should have outgrown war and hopefully are on our way to just that. So that our young men and women do not have to experience shame, isolation and horror of moral injury, it is all our responsibility to en our collective tendency toward the isolation of a constant perception of other versus the union of Oneness. Thanks again for your good work.

  4. Hello Steve. I thoroughly enjoyed this article on moral injury. I must say, it identifies the injuries so many are suffering post 9-11, and looks at the true fight many of our veterans face as they move back countryside to re-commit to their lives. Like the tenants of Jung would profess, we all have shadows to face. And I feel deeply that it is our duty as professionals to help individuals overcome their sense of moral injury. We spent years creating the morals we honor, and when they are thwarted, we are ultimately left with a void of absence to be filled. How can we fill the void of the individuals who served us? This is the question I hope is answered with the beauty of the hypothesis you propose.

    Dr. Tom

    1. Thank you for this comment! I think the best we can do is help facilitate their recovery by providing the right kind of conditions that encourages biopsychosocial flourishing. My most recent post on moral injury discusses the social aspect of recovery.

  5. My hubby had a friend — a veteran– commit suicide a few months ago. No one saw it coming. He was successful in every area of his outer life, and was well liked by his co-workers and subordinates. What you are saying here makes a lot of sense. I’m hoping you can advise us on how to help those so isolated by shame following moral injury.

  6. Thought provoking, as usual. I don’t believe our instincts are at odds with moral consciousness. Just look at the animal and plant world. It is largely a cooperative system that facilitates natural growth, flowering, and decay. Humanity has attempted to separate itself from nature, including its own, by imposing immoral rules.

    The DSM focuses on what’s wrong, not what’s right, about a person’s life, and it doesn’t address groups at all. That may be the primary reason so many people are screwed up and believe the worst about themselves and humanity as a whole.

    The DSM also ignores some of Freud’s most poignant observations, such as “peer pressure,” “identification with the aggressor,” and the psycho-sexual phases of development. The “anal phase,” between one and three years of age (“the terrible twos”) is associated with potty-training, among other things. Successful negotiation of this phase results in a sense of autonomy, and unsuccessful negotiation leads to shame, fear, and doubt.

    I contend our culture as a whole is stuck in the anal phase. We exhibit the same addictive thinking as any substance abuser–rigidly controlled vs. out-of-control– with too many rules and the power struggles that they provoke.

    When people are induced, seduced, or reduced into performing against their better judgment, they suffer the consequences of other people’s judgment as well as their own. That our society is hypocritical enough to allow war in the first place defies common sense, but to blame those who fight those wars is a cowardly act and another example of the anal-retentiveness of society.

    I wish these vets would take a more pro-active stand for themselves, such as speaking more openly about how degrading war is, not only for them, but for humanity as a whole. I think “peer pressure” and “identification with the aggressor” stops them. They were trained to be subservient to authority, but when the “authority” is abusive, they have a “moral obligation” to speak up.

  7. Extremely interesting. You say shame is “one of the most powerfully isolating emotion”. Perhaps I am misunderstanding what you are saying, but I believe shame also allows one to become even more a part of the community for it reflects our capability to know when we have transgressed and allows us to take steps towards amending wrongs and healing. I understand shame can be so overwhelming as to lead to self-hate and self-harm but it’s a necessary part of our makeup that adds to our humanity I believe. I also believe there is not enough shame. I am thinking about politicians who shamelessly lie and promise the moon and those vile trolls found n the twitterverse and on Facebook. I have no wish to conflate the experiences of war with those worlds but I feel, regardless of the circumstances, accepting responsibility requires some sense of shame. That leads to healing. Yes, it is what the war did to Joe Caley but it does not erase what Joe Caley did in the war. I don’t think that is what you are saying. As I said, I may misunderstand what you are saying but, without shame, there is not humanity.
    Very thought provoking and very well-written.

    1. Thank you for the comment! In agree that communal belonging is a necessity precursor to shame; otherwise, there would be no meaningful moral signposts to perceive oneself deviating from. It is isolating for exactly that reason; you feel cut off from a sense of belonging to a community that structured your sense of meaning and identity.

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