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| Moral Struggles 2025 Geoffrey W. Sutton / AI Image |
Moral injury is a profound psychological, emotional, and spiritual response to actions, inactions, or events that violate an individual's deeply held moral beliefs. Unlike PTSD, which is rooted in fear-based trauma, moral injury stems from ethical and existential conflict; however, moral injury can be highly correlated with PTSD symptoms. Moral injury can lead to guilt, shame, loss of trust, spiritual distress, and the loss of meaning in life. Psychosocial effects may include anger, anxiety, depression, rumination, dysfunctional relationships, self-harm, and suicidal thoughts. This post explores moral injury experienced by different groups of people including military personnel, healthcare professionals, first responders, spiritual or religious workers, and LGBTQ+ people (Sutton, 2025).
CITE THIS POST
Sutton, G. W. (2025, October 2). Moral injury and psychology. Psychology Concepts and Theories. https://suttonpsychology.blogspot.com/2025/10/moral-injury-and-psychology.html
MORAL INJURY IN VARIOUS CONTEXTS
Early research into moral injury focused on the experience of military veterans (Litz et al., 2009; Shay, 1994) exposed to a highly distressful action, which is called potentially morally injurious event or PMIE. Various definitions have been proposed (e.g., Carey & Hodgson, 2018). For a review, see VanderWeele et al. (2025). Today, moral injury is recognized as a common experience (Koenig & Al Zaban, 2021).
MORAL INJURY IN MILITARY CONTEXTS
Military personnel often face morally injurious events (PMIEs) during combat, such as killing in war, witnessing civilian casualties, or feeling betrayed by leadership. These experiences can lead to deep psychological and spiritual wounds (Litz et al., 2009). According to Beech et al. (2024), moral injury in veterans is associated with PTSD, depression, and suicidal ideation. The betrayal of what is right by authority figures is a common theme (VanderWeele et al., 2025).
MORAL INJURY IN HEALTHCARE SETTINGS
Healthcare workers may experience moral injury when systemic constraints prevent them from providing adequate care. During the COVID-19 pandemic, many faced impossible choices, such as rationing ventilators. Rimon & Shelef (2025) found that moral injury among medical personnel is linked to burnout, anxiety, and impaired professional functioning. Organizational factors like poor leadership and lack of resources exacerbate these effects.
MORAL INJURY AMONG FIRST RESPONDERS
First responders, including police, firefighters, and paramedics, frequently encounter traumatic events. Knobloch & Owens (2024) describe moral injury as a byproduct of their roles, involving helplessness, guilt, and spiritual distress. Interviews with trauma healing course graduates revealed diminished self-esteem, isolation, and suspicion of others. Support networks and open dialogue are crucial for recovery.
MORAL INJURY IN RELIGIOUS AND SPIRITUAL LEADERS
Religious and spiritual leaders such as clergy, chaplains, and missionaries may experience moral injury when their actions or observations conflict with their spiritual and ethical values. This includes witnessing cultural harm, feeling complicit in unethical practices, working with unethical colleagues or for unethical supervisors, or struggling with faith in the face of pervasive suffering. Betrayal by sending organizations or internal conflict over evangelism can lead to guilt, shame, anxiety, depression, spiritual disorientation, distressful deconstruction, and potential deconversion. Currier et al. (2021) emphasize the role of religious and spiritual struggle in moral injury.
MORAL INJURY AND LGBTQ+ PEOPLE
A scoping review highlights that LGBTQ+ people are at heightened risk of moral injury due to experiences such as family rejection, faith‑based condemnation, institutional betrayal, and systemic discrimination (Vargas et al., 2024). These harms often manifest in depression, suicidality, substance use, and fractured community ties, underscoring the need for survivor‑centered interventions (Vargas et al., 2024). The authors emphasize that clinicians and advocates must recognize religious and spiritual trauma as a form of moral injury and create affirming spaces that validate LGBTQ+ narratives while fostering both individual healing and community repair. This emerging scholarship calls for urgent, expanded research to better understand and address moral injury among LGBTQ+ populations.
COPING WITH MORAL INJURY
First responders report various coping strategies they have found to be effective. A common theme is to talk about the injury, seek help, and build a support network (Knobloch & Owens, 2024).
Professional recommendations for coping with moral injury emphasize a combination of therapeutic, relational, and self-directed strategies. Evidence suggests that psychotherapy, particularly trauma-focused approaches such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), can help individuals reframe guilt and shame while addressing maladaptive beliefs (Litz et al., 2009; Norman & Maguen, 2021). Group therapy and peer support are also recommended, as sharing experiences with others who have faced similar moral conflicts can reduce isolation and foster validation (National Center for PTSD, 2023). Practices that cultivate self-compassion and forgiveness are critical, since moral injury often involves harsh self-judgment and difficulty with self-forgiveness (Griffin et al., 2019; 2021). Creative and expressive therapies, including art and writing, provide alternative avenues for processing moral pain and rebuilding meaning (Taylor, 2023). Spiritual or existential counseling may also be beneficial, especially when moral injury is tied to religious or value-based conflicts, as it allows individuals to reconstruct a sense of coherence and purpose (Currier et al., 2018). Finally, resilience-building practices such as mindfulness (Kelley et al., 2022) and cultivating post-traumatic growth (Hoover & Metz, 2024) are recommended to support long-term recovery and reintegration
CONCLUSION
In sum, moral injury is not only a clinical or academic concept but a lived reality that disrupts meaning, trust, and belonging across diverse communities. Whether experienced by veterans, healthcare workers, faith leaders, or LGBTQ+ individuals, its impact underscores the urgent need for survivor‑centered recognition and response. By naming moral injury and acknowledging its roots in betrayal, exclusion, and systemic harm, we create space for collective healing and accountability. Moving forward, the challenge is not only to support individuals in their recovery but also to confront the institutions and cultural narratives that perpetuate these wounds. In doing so, we affirm that repair is possible—not through silence or avoidance, but through truth‑telling, solidarity, and the rebuilding of communities grounded in dignity and care.
SHORT THOUGHTS ON MORAL INJURY
“Moral injury isn’t just a military term—it’s a lived reality for LGBTQ+ people, healthcare workers, and faith communities. Naming it is the first step toward healing. Geoffrey W. Sutton
“When institutions betray the very values they claim to uphold, the result is moral injury: shame, loss of trust, and fractured meaning. Geoffrey W. Sutton
“Moral injury is what happens when our deepest values are violated. It’s not fear—it’s betrayal. And it leaves lasting scars.” Geoffrey W. Sutton
“Moral injury thrives in silence. Healing begins with truth‑telling, solidarity, and accountability. Geoffrey W. Sutton
“Moral injury = when betrayal cuts deeper than fear. Geoffrey W. Sutton
Note
This page is for education and not personal advice. Consult health care providers for the most recent information and personal concerns.
Post Author
REFERENCES
Beech, E. H., Mackey, K. M., Parr, N. J., Baltich Nelson, B., Young, S., & Belsher, B. E. (2024). Moral Injury and Mental Health Among US Military Service Members and Veterans: A Systematic Review and Evidence Overview. Department of Veterans Affairs. https://www.hsrd.research.va.gov/publications/esp/moral-injury-report.pdf
Carey, L. B., and Hodgson, T. J. (2018). Chaplaincy, spiritual care and moral injury: considerations regarding screening and treatment. Frontiers in Psychology, 9, 1–10. doi: 10.3389/fpsyt.2018.00619
Currier, J. M., Carroll, T. D., & Wortmann, J. H. (2021). Religious and spiritual issues in moral injury. In J. M. Currier, K. D. Drescher, & J. Nieuwsma (Eds.), Addressing moral injury in clinical practice (pp. 53?70). American Psychological Association. https://doi.org/10.1037/0000204-004
Griffin, B. J., Cornish, M. A., Maguen, S., & Worthington, E. L., Jr. (2021). Forgiveness as a mechanism of repair following military-related moral injury. In J. M. Currier, K. D. Drescher, & J. Nieuwsma (Eds.), Addressing moral injury in clinical practice (pp. 71–86). American Psychological Association. https://doi.org/10.1037/0000204-005
Griffin, B. J., Purcell, N., Burkman, K., Litz, B. T., Bryan, C. J., Schmitz, M., Villierme, C., Walsh, J., Maguen, S., & Nash, W. P. (2019). Moral injury: An integrative review. Journal of Traumatic Stress, 32(3), 350–362. https://doi.org/10.1002/jts.22362
Hoover, T. D., & Metz, G. A. S. (2024). What Comes after Moral Injury?—Considerations of Post-Traumatic Growth. Trauma Care, 4(3), 219-228. https://doi.org/10.3390/traumacare4030020
Kelley, M. L., Strowger, M., Chentsova, V. O., Bravo, A. J., Gaylord, S. A., Burgin, E. E., Vinci, C., Ayers, K. L., & Agha, E. (2022). Mindfulness to Manage Moral Injury: Rationale and development of a live online 7-week group intervention for veterans with moral injury. Contemporary clinical trials communications, 30, 101011. https://doi.org/10.1016/j.conctc.2022.101011
Koenig, H. G., & Al Zaben, F. (2021). Moral Injury: An Increasingly Recognized and Widespread Syndrome. Journal of religion and health, 60(5), 2989–3011. https://doi.org/10.1007/s10943-021-01328-0
Knobloch, L. K., & Owens, J. L. (2024). Moral injury among first responders: Experience, effects, and advice in their own words. Psychological Services, 21(3), 500?508. https://doi.org/10.1037/ser0000838
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
Rimon, A., & Shelef, L. (2025). Moral Injury Among Medical Personnel and First Responders Across Different Healthcare and Emergency Response Settings: A Narrative Review. International Journal of Environmental Research and Public Health, 22(7), 1055. https://doi.org/10.3390/ijerph22071055
Shay J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Scribner.
Taylor, G. (2023, September 7). Coping with moral injury: A guide for veterans and their families. National Veterans Homeless Support. https://nvhs.org/coping-with-moral-injury-a-guide-for-veterans-and-their-families/
VanderWeele, T. J., Wortham, J. S., Carey, L. B., Case, B. W., Cowden, R. G., Dufee, C., ... & Koenig, H. G. (2025). Moral trauma, moral distress, moral injury, and moral injury disorder: definitions and assessments. Frontiers in Psychology, 16, 1422441. https://doi.org/10.3389/fpsyg.2025.1422441
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