What Are The Risks Of Over-Romanticizing Moral Injury In Mental Health?

What you need to know

• Moral injury refers to psychological, social and spiritual suffering that occurs when someone’s moral expectations are violated by their own or others’ actions
• While moral injury is an important concept, over-idealizing it can create problems for both research and treatment
• The concept needs to be integrated with existing trauma research rather than treated as entirely separate from PTSD

Understanding Moral Injury

Moral injury has become an increasingly important concept in mental health, particularly for people in high-stress occupations like military service, healthcare, police work, and humanitarian aid. It occurs when someone experiences profound psychological distress after witnessing or participating in actions that violate their moral beliefs and expectations.

Unlike post-traumatic stress disorder (PTSD), which is often triggered by life-threatening situations, moral injury specifically involves ethical and moral dimensions of trauma. For example, a soldier might develop moral injury after being ordered to take actions that harm civilians, or a healthcare worker might experience it after having to make impossible choices about patient care during a crisis.

The Risk of Oversimplifying PTSD

One common problem in discussions of moral injury is the tendency to oversimplify PTSD in comparison. Many descriptions suggest that PTSD only deals with fear responses to life-threatening situations, ignoring that PTSD research and treatment already address moral emotions like guilt, shame, and anger.

The current diagnostic criteria for PTSD explicitly include symptoms like self-blame and blaming others. Many PTSD treatment approaches already work with guilt-related trauma. When we present moral injury as entirely separate from PTSD, we risk:

• Ignoring existing valuable research on trauma-related guilt and shame
• Missing opportunities to build on established knowledge
• Creating unnecessary divisions in trauma research and treatment

The Complexity of Responsibility

Another risk comes from oversimplifying the experience of people with moral injury. Some researchers and advocates portray morally injured individuals solely as victims or even as having special insight into ethical problems. While this may seem supportive, it can actually conflict with what many affected individuals need.

Research shows that people with moral injury often:

• Want to take appropriate responsibility for their actions
• Need to acknowledge when they’ve done something wrong
• Seek to maintain their sense of being a moral person while dealing with their actions

Completely removing their sense of responsibility can be as harmful as blaming them entirely, as it may prevent them from processing their experiences in a healthy way.

The Problem of “Gains”

An often-overlooked challenge in treating moral injury involves what psychologists call “gains” - benefits that can paradoxically make recovery more difficult:

Primary and Secondary Gains

These are direct and indirect benefits that someone might get from having moral injury:

• The ability to view oneself as someone who suffers because they have a conscience rather than as a “bad person”
• Validation of their need for recognition or compensation
• A way to understand their experiences without accepting a mental illness label

While these benefits might seem positive, they can sometimes trap people in their suffering. If someone’s identity becomes tied to being “morally injured,” they might struggle to envision or work toward recovery.

Tertiary Gains

These are benefits that third parties get from the concept of moral injury. For example:

• Advocacy groups might use moral injury to support various causes
• Organizations might use it to promote certain political viewpoints
• Different groups might appropriate the concept for their own ideological purposes

This can lead to misrepresenting the actual experiences of people with moral injury and potentially distracting from their real needs.

Conclusions

• While moral injury is a valuable concept, we need to be careful not to romanticize or oversimplify it
• The concept should be integrated with existing trauma research rather than treated as completely separate
• Treatment approaches need to balance acknowledging responsibility with avoiding excessive blame
• We must be aware of how various “gains” might actually hinder recovery
• The concept should serve the needs of affected individuals rather than third-party agendas