VETERANS
GROUND SUPPORT
There is increasing recognition of the impact of moral injury – the psychological harm caused by experiences that violate someone ’ s moral or ethical code . Those affected by it need appropriate and effective treatment , say Amanda Bonson , Gavin Campbell and Dominic Murphy
The concept of PTSD arising from traumatic experiences is widely understood . Accidents , conflict exposure , and violence can , for some , result in lingering psychological difficulties . But what about those experiences which don ’ t impact a person ’ s sense of safety , but instead threaten their deeply held moral beliefs about themselves and the world ? For those people , we talk not of PTSD , but of moral injury .
While the exact definition and application of moral injury is still
being discussed by researchers and healthcare professionals , the central features of lasting feelings of guilt , shame and anger differentiate moral injury from the classic symptoms of PTSD . Crucially , moral injury results in a breakdown in the relationship the morally injured person has with themselves , their loved ones and the world around them . This contrasts with those with PTSD who often describe a loss of feeling safe as central to their difficulties .
Military veterans in the UK and around the world have described exposure to morally injurious events during their military service , and experiencing mental health difficulties as a result . These potentially morally injurious events may include situations where a veteran is unable to prevent harm , may bring harm to others or feel deeply betrayed by a trusted authority . For example , a soldier may be unable to intervene when a child is suffering or harmed due to their rules of engagement , a drone operator may take the lives of innocent civilians when dropping a bomb to take out an insurgent , or a medic treating casualties may be left with insufficient information or equipment to treat gravely injured patients safely or effectively .
MENTAL HEALTH The impact of exposure to these events on the lives of veterans is significant . They are more likely to experience other mental health disorders such as PTSD and depression , have strained relationships with others and experience suicidal thoughts – they are also more likely to behave in a way that is selfdestructive or self-sabotaging . These veterans also tend to have poorer treatment outcomes when accessing therapy services and often feel undeserving of support or recovery , preventing them from accessing support in the first place .
Increasingly , research is also finding that it isn ’ t just military veterans who are at risk of moral injury . Journalists , firefighters , police , and veterinarians have also described similar struggles with their mental health following exposure to potentially morally injurious events . In particular , the COVID-19 pandemic shone a light on moral injury among healthcare workers . Frontline workers across roles and specialisms demonstrated being particularly susceptible to moral injury when faced with the death of vulnerable people and when they felt unsupported and unprepared for the moral load of the work they were undertaking .
Currently there isn ’ t a specialist treatment approach that therapists can draw on to target moral injury symptoms . Instead , clinicians have told us that they rely on combining a number of different approaches in an attempt to best meet
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