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Moral injury has been defined as a manifestation of certain painful moral emotions,
beliefs, attitudes, and behaviors and is often characterized by painful feelings of
pervasive shame and guilt; beliefs or attitudes about being unlovable, unforgivable, and
incapable of moral decision-making; it includes feelings of anger and moral disgust,
mistrust of others and at times, revenge fantasies (Currier et al., 2019a; Currier et al.,
2019b). “Often a painful emotion or thought and feeling from an internal conflict that can
not be resolved, these struggles may emerge directly from religious beliefs, practices, or
relationships in a way that causes or perpetuates morally injured veterans suffering”
(Currier et al., 2019b). Many become angry at God, at their faith families and religion
itself. It is a deep-rooted pain that can be intertwined with the symptoms of posttramtic
stress disorder (PTSD) (Currier et al., 2019b). As Adsit (2008) stated “when a person
experiences a horrible event, when evil triumphs, when the innocent are harmed, when
a random, unexpectant incident results in destruction and death, it’s a natural human
tendency to ask where was God” (p. 11).
Post-traumatic growth is beneficial in that it helps us to grow out of adversity. Instead
of getting stuck in the pain we are able to use that trauma to draw closer to Christ
(Dees, 2011). “While there are many factors that promotes posttramatic growth (PTG),
spiritual elements are unquestionably central to one’s ability to choose the harder but
more rewarding path of growth” (Dees, 2011, p. 65). Through this growth one can grow
spiritually and grow in hope (Dees, 2011). One thing that every believer can hold fast to
is that “all praise to God, the Father of our Lord Jesus Christ. God is our merciful Father
and the source of all comfort. He comforts us in all our troubles so that we can comfort
others. When they are troubled, we will be able to give them the same comfort God has
given us” (2 Corinthians 1:3-4, NLT, 1996).
Sonya,
I think PTSD and MI go hand-in-hand and they are seemingly co-dependent upon each other. In
a study composed by Griffin et al. (2019), part of their research noted that the moral injury may
in fact include symptoms of posttraumatic stress disorder (PTSD). Moral Injury has also shown
to include self-harming behaviors, self-handicapping behaviors, and demoralization. Griffin et al.
(2019) also make it known that there is a major challenge, and counselors need to take heed,
when interpreting the associations between PTSD and moral injury because of the types of
trauma and how they coincide with one another. The goal of cognitive processing therapy (CPT)
is to improve PTSD symptoms by challenging dysfunctional thoughts and produce realistic
beliefs. One style of challenging dysfunctional thoughts that has proven effective is Socratic
questioning because it forces the client to investigate and explore their thoughts in order to
promote emotional growth (Griffin et al., 2019).
Upon reading a study by Mark et al. (2018), I found it interesting that repeated exposure (to
combat) and post-traumatic growth were connected- positively. The reason this is positively
correlated I the thought of repeat exposure will build stress and trauma tolerance (resilience)
which ultimately leads to the development of skills that a service member can draw upon in order
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to cope with situations. I think this new-found coping skill is what Dees (2011) is trying to point
out when someone experiences PTG both psychologically and religiously.
References
Dees, R. (2011). Resilient warriors. Creative Team Pub.
Griffin, B., Purcell, N., Burkman, K., Litz, B., Bryan, C., & Schmitz, M. et al. (2019). Moral
Injury: An Integrative Review. Journal of Traumatic Stress, 32(3), 350-362.
https://doi.org/10.1002/jts.22362
Mark, K., Stevelink, S., Choi, J., & Fear, N. (2018). Post-traumatic growth in the military: a
systematic review. Occupational and Environmental Medicine, 75(12), 904-915.
https://doi.org/10.1136/oemed-2018-105166
Moral injury happens when a person feels like a violation has occurred to their moral
beliefs. In turn they would react with guilt, shame, disgust or in anger with moral injury.
Research has uncovered (Norman, S. B. et al. 2020) an association about moral injury
with military service members and veterans dealing with the nature of war and combat
in creating situations where military personnel may have events that contradict their
values they learned in civilian life. A common moral injury disorder with veterans and
active duty military is post-traumatic stress disorder (PTSD). This type of trauma results
in an inner conflict as a "soul injury." According to the study of Koenig, H. G. et al.
(2018), the soldier or veteran with moral injury may have symptoms of PTSD,
hyperarousal, hypervigilance, re-experiencing events, and avoidance of people and
crowds. They may also suffer with spiritual and ethical conflicts. Most event that military
personal deal with results with the soldier feeling like they committed, or bared witness
to an event that deeply held their moral beliefs together (Dees, R. F. 2011). These inner
conflicts may result in negative emotional states, bitterness, and un-forgiveness toward
self and others.
The studies dealing with post-traumatic growth are shown to occur following a range
of traumatic experiences (Mark, K. M. et al. 2018). Post-traumatic growth examines an
individual before traumatic event. It also examines the individual’s social, financial,
mental health and demographic factors. Interestingly, growth has also been linked to
higher levels of social support and lower levels of depression. Looking at the military-
related post-traumatic growth, studies also used data concerning various past conflicts
and military service subgroups. However, there has not been a systematic test dealing
with the presence of post-traumatic growth, or factors associated with the issue, in
military personnel and veterans.
