“Opening a Door to a New Life”: The Role of Forgiveness in Healing From Moral Injury

Abstract

For military veterans struggling with moral injury, forgiveness can become both an animating concern and a potential path to healing. In this perspective piece, we draw on our clinical work and research findings to examine why forgiveness matters to veterans who feel guilt and shame about their actions in war, what type of forgiveness is attainable and meaningful, and what role clinicians can play in facilitating forgiveness. We conclude by reflecting on the potential, as well as the limits and tensions, of forgiveness work in the context of military moral injury.

Moral Injury and PTSD: Often Co-Occurring Yet Mechanistically Different

“…A recent meta-analysis of the neural correlates of guilt identified multiple areas, primarily in the left hemisphere (red circles) (6). (9)(10)(11). Two studies of healthy individuals have identified neural correlates related to forgiving others for transgressions (12,13).…”

“…Several treatment approaches designed specifically to promote healing from moral injury have been developed, and preliminary studies suggest value (11,65). One challenge is recognition that in some cases the patient's beliefs and judgements about their experiences are factually correct (9,10,66). Thus, acknowledgment of the past moral/ethical violations (i.e., opening up) may be essential to begin the healing process (9)(10)(11).…”

“…One challenge is recognition that in some cases the patient's beliefs and judgements about their experiences are factually correct (9,10,66). Thus, acknowledgment of the past moral/ethical violations (i.e., opening up) may be essential to begin the healing process (9)(10)(11). A small study of veterans in a residential PTSD treatment program supports the potential of addressing moral injury in a group setting using acceptance and commitment therapy (67).…”

“…It is noteworthy that all veterans had previously completed prolonged exposure therapy for PTSD. Self-forgiveness and making amends are key intervention targets to restore spiritual well-being (9,68). This is also the goal of Building Spiritual Strength, a group intervention for PTSD designed to be facilitated by either mental health providers or chaplains experienced in mental health counseling (69).…”

“…FIGURE 3. A common theme of interventions to promote healing from moral injury is the importance of forgiveness(9)(10)(11). Two studies of healthy individuals have identified neural correlates related to forgiving others for transgressions(12,13).…”