Moral injury: why it matters for veterans and families
Associate Professor Jon Lane
Chief Psychiatrist
Department of Veterans’ Affairs
When people think about the impacts of military service, they often think of physical injury or post-traumatic stress disorder (PTSD). However, some experiences can also leave a different kind of wound, sometimes described as “moral injury” (MI).
MI can happen when a person is involved in, witnesses, or is affected by events that go deeply against their values and sense of what is right. For veterans, this may arise in combat, training, leadership situations, or other high-pressure environments. It can also affect families, who may continue to see the emotional and relationship impacts long after service has ended.
DVA’s current working definition of MI is:
Moral Injury is a trauma-related syndrome affecting serving members, veterans and their families, caused by the physical, psychological, social and/or spiritual impact of grievous transgressions, violations, or betrayal of deeply held moral beliefs and/or ethical standards, that disrupt one’s understanding of right and wrong, or sense of goodness of oneself, others or institutions.
A helpful way to understand moral injury is to start with what researchers call a “potentially morally injurious event”. In plain language, this is an experience that feels like a serious breach of a person’s moral code. This may include doing something, or feeling unable to stop something from happening, that goes against deeply held personal beliefs. It can also include witnessing cruelty or injustice, or feeling betrayed by trusted leaders, peers, or institutions.
MI events or incidents are referred to as transgressions, and so someone can be a perpetrator, a witness, or a victim of transgressions. What often makes these experiences so distressing is that it is not only the event itself, but it’s also the way it can affect a person’s sense of self, trust in others, and view of the world.
The effects of moral injury can be wide-ranging, depending on the intensity and severity of the MI and the subsequent impacts on the person involved. A person may experience guilt, shame, anger, grief, disappointment, or a deep loss of trust in themselves, others, or institutions. Some people withdraw from relationships, struggle with self-worth, or feel that life has lost meaning and purpose.
A person may experience guilt, shame, anger, grief, disappointment, or a deep loss of trust in themselves, others, or institutions.
These types of experiences that shake our beliefs, identity, or sense of meaning can affect emotional wellbeing, connection with others, family life and day-to-day functioning. This is what we mean when we talk about the spiritual impact of MI. For some people, there may also be a religious impact, particularly if the experience has shaken their belief in God, or their faith construct, or understanding of self.
Moral injury can sit alongside PTSD, depression, anxiety, or grief, but it is not the same thing. PTSD is often linked to fear and danger, while moral injury is more closely related to guilt, shame, betrayal and loss of trust. A person may continue to think not only about what happened, but what it means about them, other people, or the institutions around them. This is important because support may need to focus not only on reducing distress, but also on rebuilding trust, connection, identity and a sense of purpose.
This is especially relevant for veterans and families of veterans. Military service can involve situations where loyalty, responsibility, safety and survival are in tension, and where there may be no easy choices. Some veterans may carry distress related to actions they took, actions they could not prevent, or betrayals they experienced.
Families may notice withdrawal, anger, numbness, relationship strain, self-blame, or a loss of connection with community, faith, or identity. Understanding moral injury can help make sense of these reactions and support a more compassionate response at home and in services.
MI is not recognised as a formal disorder at this stage though. It has been recognised as something that impacts a person’s mental health and functioning, and is described as a condition, such as chronic fatigue syndrome, or fibromyalgia. In other words, even though it isn’t a formal diagnosis per se, it is absolutely recognised as an important target for intervention.
In fact, MI and its impacts were recognised by the Royal Commission into Defence and Veteran Suicide, which recommended that Defence and the Department of Veterans’ Affairs should work collaboratively to develop an agreed approach to minimising the negative impacts of moral injury, including the risk of suicide and suicidality for serving and ex-serving members (Recommendation 78).
DVA and Defence are working jointly to respond to this recommendation.
The positive message is that moral injury can be recognised and support is available through Open Arms for veterans and families of veterans, and especially through the chaplains working with both Open Arms and Defence.
Recovery may take time, but with the right care, people can rebuild trust, connection, self-respect, and meaning. Support may include chaplains, counsellors, psychologists and other trusted professionals. For veterans and families of veterans, having language to describe moral injury can be an important first step. It can help people feel understood, reduce isolation, and open the way to healing and recovery.