“Essentially, a Moral Injury is feeling responsible for the death, harm, or trauma to others for something you did or failed to do, ultimately leading to self-condemnation”.
What is a “Moral Injury”?
Often mislabeled as fear-based “Trauma”, a shame-based Moral Injury is less about a disruption of the mind-body connection (often associated with physiological trauma responses such as hyper-vigilance or dissociation) and more so about self-condemnation and a disruption to our core value system. A Moral Injury may share similar symptoms as Trauma (such as intrusive thoughts, nightmares, and avoidance of event reminders) but it is a different issue in its nature. According to Dr. Norman, in a traumatic or unusually stressful circumstance, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations. Essentially, a Moral Injury is feeling responsible for the death, harm, or trauma to others for something you did or failed to do, ultimately leading to self-condemnation.
How does it impact us?
Moral Injury may include an “act of commission” such as doing something that goes against our beliefs, an “act of omission” such as failing to act on our beliefs, or even a deeply rooted sense of betrayal that can occur from acting on or witnessing behaviors that go against our values. While traditional “Trauma” can be defined as a threat to our sense of safety, a “Moral Injury” is a threat to our sense of self that can occur with or without a life threating situation. It is often referred to as a spiritual wound, marked by guilt (“I did something bad”), shame (“I am something bad”), disgust, and anger. And differentiating guilt from shame is critical to understanding the self-forgiveness process. Left untreated, a moral injury can lead to shame-based cognitive changes, depression, hopelessness, and even suicidal ideation.
How do I heal?
In my professional experience, healing from a Moral Injury always happens through self-forgiveness: a willingness to abandon self-resentment in the face of one’s own acknowledged wrongdoing. And, perhaps most importantly, it must be achieved without excusing, passing blame, or removing guilt. However, genuine self-forgiveness is a long process that requires commitment to honestly reflecting on the event, the people that were harmed, the emotions involved, and any rationalization of wrong doing. Self-forgiveness is also a highly individualized process achieved through acceptance of responsibility, processing feelings of remorse, and shifting negative thoughts and feelings toward self-compassion.
In this respect, the most important part of the healing process must encompass a strong understanding of empathy as opposed to sympathy. I have also discovered this understanding to be a foundational tool in building a strong group therapy process. While sympathy is often described as feeling “for” (and may include unsolicited advice or judgement disguised as concern), empathy is most often described as feeling “with” –recognizing and sitting with another’s pain and discomfort. As opposed to sympathy, which drives disconnection, empathy is a process that fuels connection. An empathetic response calls on us to see the world through a different perspective, without judgement, and to recognize and communicate an understanding of emotions that underpin another’s experience. It calls on us to restrain our “righting reflex” (that urge to stop or “fix” another person’s “negative” emotions) and instead sit with their discomfort and painful emotions. It is crucial to understand empathy as a working skill because it is an essential part of building resilience to shame, the hallmark of Moral Injury. So long as we remain driven by our innate human need to form connected attachments, we are susceptible to experiences of shame and feeling unworthy of belonging. However, through resilience-building, we can learn to move through shameful emotions and experiences without sacrificing our values.
The understanding and practice of guilt (as opposed to shame), empathy (as opposed to sympathy), and self-forgiveness (without excusing, passing blame, or removing guilt) can facilitate the healing process and begin alleviating the heavy burden of self-condemnation inherent in a Moral Injury -so often misunderstood as a symptom of Trauma rather than its own unique issue.
To learn more about the healing process, please feel free to explore my resources on these topics:
- Guilt vs Shame = “Healing the Shame that Binds You” by John Bradshaw
- Empathy vs Sympathy = “Dare to Lead” by Brene Brown
- Moral Injury = “Soul Repair” by Rita Nakashima & Gabriella Lettini