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A GUIDE TO

MORAL INJURY

What is Moral Injury?

Moral injury is a type of traumatic stress injury; a psychological, social and spiritual wounding that can occur in high-stakes situations that deeply challenge the integrity of personal values, expectations and social norms.

Potentially morally injurious events (PMIEs) can include:

  • Acts that transgress one's sense of what is morally right

  • Feeling let down or betrayed by superiors, colleagues, or the public

  • Gross injustice or systemic failure

  • Exposure to human vulnerability, suffering and indignity

Exposure to morally injurious events is very often associated with Post Traumatic Stress (PTSD), but one can also experience moral distress or moral wounding without PTSD. Although caused by threat to one's core moral beliefs rather than physical safety, moral injury may be encoded by the body as an 'assault' equivalent to a direct physical attack. Indeed, one possible explanation for the strong link between moral injury and PTSD is that morally injurious events can erode one's sense of safety in the world in just as powerful a way as threats to physical safety, but with moral injury this occurs through erosion or damage to fundamental pillars that create order and safety in society.

 

However, where life threatening events involve intense feelings of fear, terror and helplessness, morally injurious events provoke deep feelings of horror, anger, injustice, betrayal, embitterment, shame, guilt and loss. Most descriptions of moral injury tend to highlight guilt and shame, but the other feelings noted above are often just as present and important to address for healing. Sometimes feelings like anger or guilt cover other feelings that indicate the deeper injury.

 

While much attention and research has focused on moral distress in veterans returning from war, there are a number of other populations exposed to PMIEs. Those who work in emergency response, law enforcement and child protection experience high rates of exposure to morally challenging events and the global COVID-19 pandemic has drawn increasing attention to the potential for moral distress faced by frontline medical staff. Moral injury has also been studied in refugee populations affected by large scale injustice, persecution and torture and, although not researched specifically, there is valid speculation about the potential for moral injury in other professional groups such as educators or in marginalised groups such as indigenous populations.

Current mental health diagnoses and associated treatments do not adequately account for the depth of suffering and alienation experienced by those grappling with moral injury. Over the last decade, a broad distinction has emerged between self-focused (perpetration-based) and other-focused (betrayal-based) moral injury. In this site, we look beyond these broader constructs to step inside the lived experience of moral injury in order to promote understanding of the mechanisms of injury and pathways to recovery.

Moral injury may be encoded by the body as an 'assault' equivalent to a direct physical attack.

MORAL INJURY IN DEPTH

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WHAT CAUSES MORAL INJURY?

There are three broad pathways to traumatic stress injury: threat, traumatic loss and moral injury. This page outlines various types of moral injury and how they can cause deep and lasting psychological injury. It also highlights the importance of the psychosocial context in which trauma occurs, both for injury and recovery.

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WHAT DOES MORAL INJURY FEEL LIKE?

Moral injury is a violation of your sense of what is right and a loss of trust in yourself and others. This page outlines the very personal and specific hurt associated with the different types of moral injury. Understanding the complex emotions associated with moral wounding helps point the way to healing.

Navigating in Woods

RECOVERY

MORAL INJURY

RECOVERING FROM MORAL INJURY

When struggling with moral injury, it can be hard to know what to do or where to turn. This page outlines some of the core principles in moral injury treatment and includes tips on what to look for when reaching out for professional support.

In Depth

PURPOSE OF THIS SITE

This site is a response to a thirst for clear information about moral injury that resonates with the  lived experience of moral injury and trauma more broadly.

While the field is still trying to establish a clear consensus about what moral injury is and where it fits,  the deliberate and unapologetic aim of this site is to be as inclusive as possible, both in terms of the range of traumatic stress experiences and the people that are affected by them. 

Who is this site for?

The information on this site is designed primarily for anyone exposed to PMIEs and those who care for them (which includes family members, religious communities and clinicians).

Purpose

News and events

October 2016

Essay on Pathways to PTSD published in volume on Trauma Related Stress in Australia.

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November 2015

Chapter on dealing with horror published in Moral Injury: Unseen Wounds in the Age of Barbarism.

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March 2015

Grateful to be part of ABC Four Corners' important program: Bringing the War Home.

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News & Events
About Me
Leaves Shadow

Dom Hilbrink, Clinical Social Worker

About
ME

 I am a therapist who has specialised in the area of trauma for 20 years. I’m a social worker by training; but a social worker raised by psychologists and Vietnam veterans.

I found my way into a treatment service for war related PTSD very early in my career. In one of my very first group sessions with the Vietnam vets, they decided it was important that I be instructed in how to properly set an ambush. I can’t say this has been directly useful in my work since (but if we’re ever in a war together, you’re safe with me; I know which way the claymores go!)

 

But something useful I did learn from this experience was that veterans wanted their therapist to understand and enter into their lived-experience of war. And this has really been my journey from there to hear. I’ve worked with veterans, first responders and other high trauma-exposed populations and over those 20 years I’ve been in the dirt with them in some of the major battles, massacres, disasters and accidents that have occurred in our history since the second world war.

 

The goal has always been to understand the very specific and personal nature of the wounding they have experienced in order to try to find a way out of the darkness together.

 

This site represents some of the distilled knowledge from all that experience, where the brave and honourable men and women have taught me at least as much as I hope I have been able to help them.

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