Moral Injury and Definitional Clarity: Betrayal, Spirituality and the Role of Chaplains

Abstract

This article explores the developing definition of moral injury within the current key literature. Building on the previous literature regarding 'Moral Injury, Spiritual Care and the role of Chaplains' (Carey et al. in JORH 55(4):1218-1245, 2016b. doi: 10.1007/s10943-016-0231-x ), this article notes the complexity that has developed due to definitional variations regarding moral injury-particularly with respect to the concepts of 'betrayal' and 'spirituality'. Given the increasing recognition of moral injury and noting the relevance and importance of utilizing a bio-psycho-social-spiritual model, this article argues that betrayal and spirituality should be core components for understanding, defining and addressing moral injury. It also supports the role of chaplains being involved in the holistic care and rehabilitation of those affected by moral injury.

No Guilt, No Shame: Discerning Signs of Post-Conflict Moral Injury in Atmospheres of Political Impunity

“…4 Despite the concept's circulation, a definitive definition for moral injury remains elusive. Indeed, Hodgson and Carey (2017) describe moral injury as an exploratory term for "a complex phenomenon that requires a holistic approach beyond any one discipline" (p. 1223). Warning against the tendency to reduce moral injury to psychological trauma (and, one might add, perhaps even the newer neologism of perpetrator trauma [Mohamed, 2016]) they caution that "[a] predominantly psychiatric and/or psychological paradigm can obscure [other] factors associated with moral injury" (Hodgson & Carey, 2017, p. 1223).…”

“…Indeed, Hodgson and Carey (2017) describe moral injury as an exploratory term for "a complex phenomenon that requires a holistic approach beyond any one discipline" (p. 1223). Warning against the tendency to reduce moral injury to psychological trauma (and, one might add, perhaps even the newer neologism of perpetrator trauma [Mohamed, 2016]) they caution that "[a] predominantly psychiatric and/or psychological paradigm can obscure [other] factors associated with moral injury" (Hodgson & Carey, 2017, p. 1223). 5 These factors include theological concerns such as spirituality and faith, as well as social relationality (Beckham, Feldman, & Kirby, 1998;Hodgson & Carey, 2017;Kopacz, Ducharme, Ani, & Atlig 2017;Tietje, 2018;Yandell, 2019).…”

Military moral injury: A concept analysis

“…2015a; Drescher et al . 2011; Hodgson & Carey 2017; Jinkerson 2016; Litz et al . 2009; McCarthy 2016).…”

Moral Injury

“…Furthermore, individuals who have endured perpetration-based and morally injurious traumatic experiences encounter sequelae that are distinct from the sequelae encountered by those with life-threat traumatic experiences. While life-threat traumas typically arouse fear and elicit hyperarousal difficulties and symptoms of PTSD, perpetration-based and morally injurious traumas tend to be characterized by feelings of shame, guilt, anger, and/or self-blame and elicit reexperiencing, avoidance, self-injurious behavior, and meaning making difficulties, including spiritual struggles and a shattering of one's assumptive and/or spiritual world (Antal & Winings, 2015;Currier et al, 2019;Drescher et al, 2011;Farnsworth et al, 2014;Frankfurt & Frazier, 2016;Griffin et al, 2019;Harris et al, 2015;Held et al, 2019;Hodgson & Carey, 2017;Kopacz et al, 2016;Kopacz et al, 2015;Litz et al, 2009;Maguen & Litz, 2012;Neria & Pickover, 2019;Sreenivasan et al, 2014;Starnino et al, 2019;Steinmetz et al, 2019;Vargas et al, 2013;Yeterian et al, 2019;Zerach & Levi-Belz, 2019).…”

“…But service providers did not have a clear conceptual apparatus or tools to help the returning soldiers understand and cope with the experiences of potentially morally injurious events. PTSD only accounts for the fear-based dimension of their distress, leaving out the moral dimension, and the techniques used to treat distress after a fear-based traumatic event are less effective at treating the guilt, shame, and spiritual distress now understood to be prevalent in presentations of moral injury (Blinka & Harris, 2016;Drescher et al, 2011;Farnsworth et al, 2014;Griffin et al, 2019;Hodgson & Carey, 2017;Jones, 2018;Kopacz et al, 2016;Kopacz et al, 2015;Litz et al, 2009;Meador & Nieuwsma, 2018;Steinmetz et al, 2019;Vargas et al, 2013).…”