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Most of us are familiar with post-traumatic stress disorder, or PTSD, which is triggered by witnessing or experiencing a traumatic event. A person suffering from PTSD will often experience a constellation of mental health symptoms, such as nightmares, flashbacks, severe anxiety, and uncontrollable memories of the incident. As psychologists are starting to discover, though, in addition to PTSD (which relates to feelings of physical safety), people can also develop what is known as “moral injury”—when a person either witnesses or commits actions that go against their personal values and beliefs.

 Soul Console: Healing from Moral Injury. 

What is “moral injury”?

The idea of moral injury was first developed while treating veterans of the Vietnam War, many of whom were dealing with mental distress over actions that they either committed themselves or witnessed others doing, whether it was failing to save the life of another, engaging in or witnessing acts of violence, freezing up during a particularly dangerous moment, or failing to report ethical violations.

Although moral injury was developing in the context of treating war veterans, there are a number of other circumstances in which a person might go through a similar experience if they personally committing an action that goes against their own beliefs; experience a sense of betrayal due to the actions of a loved one, such as a parent or partner; or discover the unethical actions of a previously trusted institution, such as your church or school.

Moral injury is inherently about the loss of trust, whether it’s a loss of trust in yourself, another person, or an institution. “Betrayal is a big part of moral injury,” therapist Michele DeMarco said. “At the core of moral injury, it is very relational.”

How can you heal from a moral injury?

There still isn’t consensus on what the best treatment methods are for a moral injury and whether the strategies used for treating PTSD are also applicable. Healing is made more complicated by the fact that people suffering from moral injury tend to withdraw and isolate. “They feel like they are contaminated, or else the world is contaminated, and they need to protect themselves,” DeMarco said.

As DeMarco notes, moral injury has a way of completely upending a person’s understanding of who they are and the world they live in. “Their whole existential positioning gets completely distorted,” DeMarco said. “Ultimately, it’s a loss of innocence.”

Although we still have a lot to learn about the best ways to heal from a moral injury, DeMarco notes that part of the process inevitably has to include coming to terms with the world as you now experience it, which includes that loss of innocence.

“Sometimes it’s learning, with benevolent honesty, that sometimes things in life are just sad, and finding a way to live with that,” DeMarco said.

Another essential aspect of healing is finding ways to connect with others. “Healing very much requires reconnection and bonding,” DeMarco said. Sometimes this will also include evaluating which relationships are essential, and which ones can be let go.

In her own work, DeMarco has also found that writing can offer relief for people suffering from moral injury, as that can be a way to get people to open up, even if only to themselves, about what happened, and what the effect was.

Doing this can help people access “little kernels of truth,” which can then be used to make sense of what happened. As DeMarco puts it, the big question is: “How do I plant these [kernels of truth] in a way that doesn’t keep me in the fetal position, and allows me to grow in a new light?”



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