Understanding Moral Injury: A Crucial Aspect of Veteran Mental Health

Combat and military service can leave more than just physical scars. While many are familiar with Post-Traumatic Stress Disorder (PTSD), fewer people recognize moral injury—a different but deeply impactful psychological wound. Though the two may overlap, understanding the difference is crucial for effective healing, especially for veterans and service members who feel unseen by traditional mental health labels.

What Is PTSD?

If you wish to learn about PTSD, read my article, Not All PTSD Looks the Same: Why That Matters to define and understand the different types, levels, symptoms, and stages of PTSD.

What Is Moral Injury?

Moral injury is not a clinical diagnosis, but it’s very real. It refers to the psychological, emotional, and spiritual distress resulting from doing, failing to prevent, or witnessing something that violates deeply held moral beliefs.

Examples of Moral Injury

Moral injury can manifest in various ways. Here are some examples:

• Ordering actions that result in civilian casualties.

• Feeling complicit in unjust missions or systemic failures.

• Surviving when others did not, often referred to as "survivor’s guilt."

• Experiencing betrayal by leaders or institutions.

  
  

Emotional Consequences

Moral injury often leads to:

• Shame, guilt, and anger.

• Loss of trust in oneself, others, or higher powers.

• Spiritual or existential crises.

• Deep isolation and emotional numbness.

  
  

Can You Have Both PTSD and Moral Injury?

Yes! Many veterans and service members experience both PTSD and moral injury, and they often reinforce each other. For example, a soldier might have PTSD from a violent incident and moral injury from feeling responsible for what happened. Treating only the trauma without addressing the moral conflict can lead to incomplete healing.

Why Recognizing Moral Injury Matters

Recognizing moral injury in veterans and service members is essential because it addresses a dimension of suffering that traditional PTSD diagnoses often overlook. While PTSD centers on fear-based trauma (what happened to someone), moral injury focuses on what happens within someone when their actions or experiences violate deeply held moral beliefs.

Many veterans struggle not just with what they witnessed, but also with decisions they made, orders they followed, or the guilt of surviving when others did not. Without acknowledging this, treatment can feel incomplete, and veterans may feel misunderstood or even resistant to therapy.

The Importance of Acknowledgment

Acknowledging moral injury is a vital step in the healing process. When veterans can articulate their experiences, it helps to reduce stigma. This acknowledgment fosters a sense of connection and humanity. It allows veterans to feel seen and heard, which is crucial for their recovery.

Healing Is Possible, But It Must Be Honest

When moral injury goes unaddressed, it can lead to profound isolation, a broken sense of self, and, in severe cases, an increased risk of suicide. However, when it’s named and recognized, it can significantly improve the healing journey. Ultimately, recognizing moral injury ensures veterans are not only treated for their symptoms but also supported in ways that honor their full experience, including their pain, values, and capacity for healing.

Conclusion

In summary, understanding both PTSD and moral injury is essential for providing comprehensive care to veterans and service members. By recognizing the unique challenges posed by moral injury, we can create a more supportive environment for healing. This understanding can lead to better mental health outcomes and a stronger sense of community for those who have served.

By fostering open conversations about these issues, we can help veterans find the support they need. Healing is possible, and it starts with recognition and understanding.