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A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. [1] It produces profound feelings of guilt or shame , [ 1 ] moral disorientation, and societal alienation. [ 2 ]
It is not fear but exposure that causes moral injury – an experience or set of experiences that can provoke mild or intense grief, shame and guilt. The symptoms are similar to PTSD: depression and anxiety, difficulty paying attention, an unwillingness to trust anyone except fellow combat veterans.
Moral injury is a relatively new concept that seems to describe what many feel: a sense that their fundamental understanding of right and wrong has been violated, and the grief, numbness or guilt that often ensues. Here, you will meet combat veterans struggling with the moral and ethical ambiguities of war.
But in war, asking troops to meet the ideals and values they carry into battle – always be honorable, always be courageous, always treat civilians with respect, never harm a non-combatant – may itself cause moral injury when these ideals collide with the reality of combat. Accomplishing the mission may mean placing innocent civilians at risk.
Perpetrator trauma is similar but distinct from moral injury, which focuses on the psychological, cultural, and spiritual aspects of a perceived moral transgression which produces profound shame. As a psychiatric disorder
Moral injury is a distinct syndrome from (but often co-morbid with) PTSD and is one of the primary themes for the veterans described in his books, often leading to personality changes and obstructing successful treatment. [20] [21] Shay writes that his "current most precise (and narrow) definition of moral injury has three parts.
“Moral injury is a touchy topic, and for a long time [mental health care] providers have been nervous about addressing it because they felt inexperienced or they felt it was a religious issue,” said Amy Amidon, a staff psychologist at the San Diego Naval Medical Center who oversees its moral injury/moral repair therapy group.
However, the systemic issues facing physicians often cause deep distress because the patients are suffering despite the physician's best efforts. This concept of moral injury in healthcare [48] is the expansion of the discussion around compassion fatigue and burnout.