What is moral injury?
In this article we’ll look at moral injury – how you can identify it, acknowledge its impact and look after yourself if experiencing it. We will discuss it within the context of workplaces, but much of the information below can be applied to all aspects of our lives.
What is moral injury?
Psychiatrist Jonathan Shay introduced moral injury around 2012 and went on to define it as “a betrayal of what’s right by a person in a position of authority in a high-stakes situation.”
Moral injury is a relatively new term in the psychological and academic lexicon, mostly due to Shay, and predominantly only discussed in the context of military wellbeing, as that is where he recognised it. However, the majority of us will have experienced many moral injuries throughout our lives, even if we were unable to recognise them for what they were at the time.
Although morals are inherently individualistic and therefore subjective, many morals are unofficially governed by unspoken, societal rules (queuing is a great example) whilst some are governed by official policies (such as ‘morality clauses’ in contracts), or even law (hate crimes).
Moral injury tends to occur in one of three ways:
- It was something you did or failed to do, which caused harm to yourself and/or others
- You saw someone (or a number of people) do something that went against your morals/ethics which caused harm
- You were directly impacted by someone else’s actions or inactions which, again, go against your own moral codes
The significant issue with moral injury is that it is incredibly difficult to concisely define, as what one person may accept morally, another would find injurious. Moral compasses, the foundation in which we govern ourselves and each other with, will differ depending on a vast array of life influences on us as individuals.
It’s important to remember that moral injury is not currently recognised as a mental illness and, although it shares many of the same symptoms as post-traumatic stress disorder (PTSD), it’s separate from PTSD even if the impact of moral injury can be just as significant.
It’s one of the reasons we always advocate that you don’t need to wait (or even seek) an official mental illness diagnosis before recognising you need support from a moral injury.
How moral injury shows up in the workplace
There are a great many examples of how moral injury can show up in the workplace, not just hierarchically (i.e. managers to supervising individuals) but even as peers.
Despite wishing it weren’t the case, bullying is still rife in the workplace with studies evidencing it range anywhere from 15% to 47% of employees observing and/or experiencing it. It’s important to remember, however, that much like morality, ‘bullying’ can also be difficult to define as most personnel policies acknowledge it is the victim’s perception of behaviours or actions which define it.
Unfortunately, bullying often gets minimised and dismissed as the childhood connotation of ‘playground bullies’ perseveres into adulthood. However, here at For Our Men, we advocate that if we replace the word ‘bullying’ for ‘abuse’ we begin to recognise the potential severity of what we are subjected to and the impact it has on our mental and emotional health.
However, moral injuries are most common when an individual feels that someone (or a team/department) has ‘failed to do the right thing’ for a person or situation or unjustly caused harm to others.
If you work in a team, for example, and one individual is always late and consistently does the ‘bare minimum’, facing no disciplinary or corrective action, therefore forcing the rest of you to pick up their slack, it can be morally injurious to one or several of you.
Moral injuries can potentially be more detrimental when you work in an organisation seen to be moralistic, such as uniformed services, as they are founded by the ideology of service to others. Therefore, a collective (though, unspoken) drive to ‘do the right thing’ for the greater good of the organisation and wider society, can be more injurious when broken by behaviours and actions of peers and/or leaders. Indeed, “…moral injury has been found to be one of the greatest challenges reported by UK National Health Service frontline health-care staff” (Williamson et al 2021).
Organisational injustice, employees’ perceptions of fairness in the workplace, can lead to singular or repeated moral injuries and though moral injury is not a mental illness in of itself, can lead to pathological mental illness if left unacknowledged and addressed. This could present as anxiety and depression, PTSD or even post-traumatic embitterment disorder (PTED), which is similar to PTSD/complex PTSD but is majoritively based on moral injury instead of a specific trauma event(s).
We know, for example, that moral injury is now a (if not, the) leading cause of mental ill health of both the police, NHS, ambulance service and military and yet, little is done to address it (apart from blaming it on the individual to ‘be more resilient’) because it would take systemic change and too many people benefit from the current status quo.
It’s also our experience that moral injuries within uniformed services are often more chronic in nature due to the difficulty in changing a person or situation or removing yourself from either. Though there is no study to evidence it, the above is one of the reasons we believe we see so many ‘bitter’ ex-police and military veterans. It’s not because they haven’t enjoyed their career but because they have chronic, unresolved moral injuries due to their organisation, leaving them with trauma, including feelings of betrayal.
Once again, morals are highly subjective so, what may injure one person won’t hurt another. This is why it’s sometimes difficult to gain validation for your injury because another person may not understand the injury or why it’s so significant to you.
As the saying goes, before you diagnose yourself with depression, first make sure you are not surrounded by arseholes.
Symptoms of moral injury
Moral injury is not a diagnosable mental illness and therefore definitive symptomatology isn’t available, but we do know some of the ways in which it can feel and/or present:
- Feelings of guilt
- Shame
- Anger
- Depression
- Anxiety
- Low self-esteem
- Sense of betrayal
- Change in world view
- Distrusting of others
- Loss of faith in people/situations
- Lack of intimacy
- Loss of faith (religious/spiritual)
- Social withdrawal
- Nightmares/disturbed sleep
- Self-medicating (substances)
- Suicidal ideation
Moral injuries can be both deep and life-altering and, sometimes, life ending. Depending on the injury itself, it can affect our entire world view (known as the ‘just-world hypothesis’ Lerner, 1960) in which we believe, often subconsciously, that the world is just and fair i.e. people get what they deserve. Therefore, to receive a significant moral injury, can allow us to not only feel as if our personal world is falling apart but that the world itself is against us.
Suddenly, ‘everything we believed in’ can come crashing down around us which can be devastating on our mental and emotional psyches. A single moral injury can have us questioning our entire lives historically, presently and futuristically.
You might recognise many of the above symptoms to also be present in diagnoses of PTSD and similar trauma pathology, which is why we believe it’s hard, even for professionals, to differentiate it from other mental illnesses and why it’s not (yet) a diagnosis in its own right.
How to recover from a moral injury
Notice how we said ‘recover’ and not ‘cure’ or ‘fix’? That’s because moral injuries can be complicated and long-lasting.
Think of it in terms of a broken leg versus a ruptured soft tissue. A broken leg is often an acute injury that, with correct treatment, will never cause issues again. Soft tissues, on the other hand, often have more protracted treatment and recovery times and you’ll always remain susceptible to further injuries.
The impact of a moral injury can range from mild annoyance to life-long trauma symptomology and even suicide, and therefore should not be minimised or dismissed, by yourself or others.
Recovering from a moral injury, similarly to being injured to begin with, is a highly personal and therefore subjective experience. The injury may be life-long or something you can move through relatively quickly, depending on your sense of self and view of the world. Similarly, it will depend if the injury was a singular incident or ongoing (if it’s a person or situation that can’t be resolved).
1. Acknowledge it and its impact
Though it may sound stupid, half the battle with a moral injury is acknowledging it and its impact to begin with.
Are there people or situations at work that continually trigger you? Is it because they go against one of your morals or core beliefs? Then start calling it an ‘injury’.
Naming it for what it is means you can start to acknowledge that it is something you’re being subjected to, and not a ‘personal failure’ to feel the way that you do. You’d be amazed how many uniformed men we help by encouraging them to realise there are external factors to being depressed (e.g) and that how they feel is not a personal failure.
Think of it as a physical injury that can worsen and needs addressing to recover, if that helps you externalise and acknowledge it better.
2. Talk to someone
Getting yourself into some counselling or even talking to peers who can relate to, and understand, what you’re being subjected to is vital as it can not only normalise your experience, so you realise you’re not alone, but venting to supportive people can reduce the impact of the injury, certainly in the long term.
It might be that there are dedicated confidential peers in your organisation, or an occupational health team or employee assistance programme who can listen to your injury and its impact if you feel the need for formal support.
If you don’t feel like physically talking to someone, journaling is something we really recommend. It can be a document on your computer or a physical notepad but getting your thoughts and feelings down, without judgement, can be a really powerful way to vent.
3. Take steps to address it
Compromising your morals is often necessary in life but if you start sacrificing them, certainly often or repeatedly, it can lead to further injury and mental illness so, do what you can to address and rectify the situation.
Could you have a quiet word with your peer who is always making jokes at your expense? Do you need to become a whistleblower in the hopes to address a serious issue?
This is not to say that addressing a moral injury will be easy or comfortable, certainly if it is a specific person causing it, but ask yourself if staying silent will injure you more or less.
4. Remove yourself from the person and/or situation.
This is easy in theory but can be extremely difficult, if not impossible, to put into practice. However, if you can, remove yourself from the person or situation causing you injury if you’ve done what you can to satisfy your own morals and things still aren’t improving.
Yes, it can feel as if the situation or person is ‘winning’ if we leave but we always remind our men that sometimes, people are twats and they don’t do the right thing. It feels shit to witness or be on the receiving end of, but our men’s life is more important than losing it to bitterness when the other person doesn’t care enough to apologise for, or change, their behaviour.
Moral injuries are everywhere but being able to recognise and acknowledge them and their impact goes a long way in being able to externalise the cause of your mental ill health instead of blaming yourself.
