Injuries of the mind, body, and soul : an exploration of moral injury among military service members and veterans

Military service often requires engaging in activities, witnessing acts, or immediate decision-making that may violate the moral codes and personal values to which most individuals ascribe. If unacknowledged, these factors can lead to injuries that can affect the physical, psychological, social, and spiritual health of military men and women. The term moral injury has been assigned to these soul-ceasing experiences. Although researchers have attempted to define moral injury and what leads to such experiences, inconsistencies across definitions exist. In addition, nearly all existing definitions have lacked empirical support. Thus, an in-depth literature review, systematic review, and phenomenological qualitative study were completed to explore how moral injury has been conceptualized and defined across the literature and to respond to the need for an empirically-based, veteran-informed definitional understanding of such injuries. Findings from a qualitative study with United States veterans revealed that moral injuries can be conceptualized by chronic, deep-rooted experiences of (a) betrayal, (b) moral ambivalence, (c) soul injuries, and (d) lack of reconciliation. Recommendations for future research and clinical practice with moral injury must consider the systemic roots and implications for these injuries of the soul. Rather than viewing moral injury as a construct distinct to the field of psychology, trauma, or theology, applying a more systemic framework may be most appropriate for capturing the multi-level implications. For instance, a biopsychosocial-spiritual lens may support the cellular to society and spiritual implications of moral injuries. Additionally, Bronfenbrenner's ecological theory was proposed as a potentially influential theory in grounding future assessments and interventions for the constructs by emphasizing the interplay between context, personal characteristics/values, and multi-level systemic influences on the development of moral injury