The Role of Moral Emotions in Military Trauma: Implications for the Study and Treatment of Moral Injury

Abstract

Moral injury, a term coined to represent the potential negative outcomes following transgression of deeply held moral values and beliefs, has recently gained increased recognition as a major concern among military service members exposed to trauma. However, working definitions of moral injury have not yet fully clarified the mechanisms whereby violations of conscience result in these outcomes or their co-occurrence with posttraumatic stress disorder (PTSD). In this paper, advances from the field of moral psychology are used to integrate cognitive, affective, and social dimensions of the emerging moral injury construct, while also pointing to new possibilities for clinical intervention. After reviewing the salience of moral injury for military and veteran populations, the presence of negative moral emotions (e.g., guilt, anger, disgust) are examined within the context of trauma and military-related PTSD. Next, social functionalist accounts of moral emotions are used to explain the development of moral injury and are linked to potential etiologies of PTSD that emphasize both fear and nonfear emotions. Finally, the clinical importance of positive moral emotions for existing and emerging trauma-focused interventions is discussed. Future directions for research and clinical interventions are identified highlighting the importance of utilizing community support.

Emosi Moral dan Empati pada Pelaku Perundungan-siber

“…Semakin merasa malu maka semakin kuat keinginan individu menarik diri, menyembunyikan diri dari dunia nyata, bahkan pada beberapa kasus malu yang dialami kaum veteran perang terdapat ide bunuh diri (Farnsworth, et al, 2014). Dengan kata lain, malu mendorong individu menarik diri dari kehidupan sosial sehingga terjauh dari kecenderungan melakukan perundungan-siber.…”

“…Hasil studi ini tidak mendu-kung hipotesis yang diajukan karena nampaknya makna malu sebagaimana dikemukakan oleh Fessler (1999) antar budaya perlu dicermati kembali. Sebaliknya, Farnsworth, et al (2014) mencantumkan bahwa individu yang merasa malu seakan kehilangan harga dirinya dan terlalu fokus kepada hal-hal negatif pada dirinya, ketidaknyamanan emosional yang dialaminya sehingga ia akan menarik diri dari kehidupan sosial dan kurang dapat berempati kepada orang lain bahkan terlibat dalam penyalahgunaan obat, mudah marah, dan agresif.…”

“…Kedua emosi moral terkait rasa bangga ini memberikan masukan positif tentang diri sendiri, sebagai seorang yang berperilaku baik, kompeten, dan bijak. Penelitian yang dilakukan Farnsworth, et al (2014) juga menemukan bahwa emosi moral positif ini berperan dalam menenangkan hati dan menyembuhkan rasa sedih dan sakit hati yang dialami selama peperangan. Dengan demikian, walaupun dimunculkan oleh sebab yang berbeda, emosi moral bangga merupakan variabel penting untuk melemahkan kecenderungan perilaku perundungan-siber.…”

Development and evaluation of the Expressions of Moral Injury Scale—Military Version

“…Notwithstanding these important distinctions, MI should not be conceptualized as a distinct syndrome that will someday replace PTSD or other prominent mental health diagnoses in military populations (e.g., major depressive disorder [MDD]). Instead, from a social functionalist view, emphasis on psychiatric symptoms following PMIEs may threaten to pathologize adaptive moral reactions that occur in the aftermath of events that violate moral beliefs/values necessary for maintaining community cohesion (Farnsworth et al, , ). In fact, when considering unavoidable ethical challenges of national defence, the presence of painful moral emotions and cognitions might indicate an intact and well‐functioning social–moral system in many veterans.…”

Sources of moral injury among war veterans: A qualitative evaluation

“…() proposed a conceptual model of moral injury in which they define morally injurious experiences as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” For example, a service member who believes “thou shalt not kill,” but then is faced with situations in which, either through acts of commission or omission, he or she is complicit with the act of killing may experience a moral injury. In response to a morally injurious event, an individual may experience enduring regret, guilt, shame, outrage, or anger (Bryan et al., ; Farnsworth, Drescher, Nieuwsma, Walser, & Currier, ); whereas fear as traditionally conceptualized within a PTSD framework, if present at all, may play a less significant role.…”