"[9] In the 1990s, the term moral injury was coined by psychiatrist Jonathan Shay and colleagues based upon numerous narratives presented by military/veteran patients given their perception of injustice as a result of leadership malpractice.
[17][18] In 2019, researchers surveyed previous literature and expertise to compile a list of events that could distress civilians at a level consistent with moral injury.
Examples include causing a car accident or experiencing sexual assault, but researchers emphasize that not everyone will respond to an event in the same way.
In particular, Ludmila Praslova proposed that moral injury might be a better explanation for a segment of resignations and employee distress than burnout, and provided suggestions for organizational-level interventions.
[22] CPTSD's disturbances in self-organisation constitute the three additional clusters of symptoms distinguishing it from PTSD (i.e. emotional dysregulations, interpersonal difficulties, negative self-concepts around beliefs of worthlessness or failure and related guilt or shame).
[25] Literature on warfare emphasizes the moral anguish soldiers feel in combat, from modern military service members to ancient warriors.
[27] Soldiers in the line of duty may witness catastrophic suffering and severe cruelty, causing their fundamental beliefs about humanity and their worldview to be shaken.
[3] Those who have seen and experienced death, mayhem, destruction, and violence and have had their worldviews shattered – the sanctity of life, safety, love, health, peace, etc.
[2] The exposure to violence during war times puts the military and veteran population at a higher risk of developing moral injury.
[29] Controlling for other fear-based deployment-related stressors, exposure to such potentially morally injurious events has been related to increased prevalence of PTSD and depression in military personnel.
[1][30] During times of war, the military promotes an ethical pardon on the killing of an enemy, going against the typical moral code for many service members.
Instead, they were caught in double and triple and quadruple binds between their obligations of electronic health records, their own student loans, the requirements for patient load through the hospital and number of procedures performed.
Driven by changes in health care reimbursement structures, systems were “optimized” to the point that they were continually running at what felt like full capacity, with precious little slack to accommodate minor surges, much less one the magnitude of a global pandemic.
Support for realization of civil, political, economic, social, and cultural rights may be the results of mental health interventions.
[47] The Soul Repair Center at Brite Divinity School is dedicated to addressing moral injury from this spiritual perspective.
Fully coming "home" would mean integration into a culture where one is accepted, valued and respected, has a sense of place, purpose, and social support.
"[1] Despite this, decisions made by service members who engage in killing or violence through this cultural lens would still experience psychological and spiritual impact.
[14] This can make the identification of moral injury in a service member difficult because shame tends to increase slowly over time.
For example, many front line health workers during the COVID-19 pandemic have had to deal with extremely stressful situations in which they were unable to provide care at a level which they considered appropriate.
Those experiencing moral injury may be better served by “forward-looking” treatment that supports “adaptive disclosure”, combining acceptance of responsibility for their past choices with a focus on their ability to contribute in the future, and where appropriate, steps towards reparation.
[26] “Spiritually integrated” therapies for moral injury that deal with feelings of guilt and shame often draw upon religious traditions.
[4] In spite of the lack of research on the treatment of moral injury, factors such as humility, gratitude, respect and compassion have shown to either be protective or provide for hope.
In the 11th century, soldiers involved in the Norman conquest of England, took part in the church administered Ermenfrid Penitential, to atone for, and mentally process the violence they participated in.