Moral injury and moral repair in war veterans: A preliminary model and intervention strategy

National Center for PTSD, VA Boston Healthcare System, United States.
Clinical psychology review (Impact Factor: 7.18). 08/2009; 29(8):695-706. DOI: 10.1016/j.cpr.2009.07.003
Source: PubMed


Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury.

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    • "Higher mentalization capability was found to be positively related to higher social competence and social support in military service members (Knetig, 2013). This process can be compromised in veterans suffering from moral injury who are more reluctant to utilize social support given that they can be actually shunned in light of their moral violation (Litz et al., 2009; Vargas et al., 2013). As a result, those veterans might appraise negative community attitudes (Koenen, Stellman, Stellman, & Sommer, 2003) and low perceived social support (Laffaye, Cavella, Drescher, & Rosen, 2008; Smith, Benight, & Cieslak, 2013). "

    Full-text · Article · Jan 2016 · Qualitative Health Research
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    • "to SI above and beyond other types of combat. Our findings resonate with the construct of " moral injury, " which has been described as " perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations " (Litz et al., 2009, p. 697), a definition that would include attempting to kill or believing one has killed another human being. "
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    ABSTRACT: Objective: Combat veterans are at risk for several adverse outcomes such as posttraumatic stress disorder (PTSD), depression, hazardous alcohol use, and most critically, suicidal behaviors. The high rate of suicide in veterans has been understood as a correlate of PTSD and depression, but it is possible that certain specific types of combat experiences may lead to suicidal behaviors. Acts committed by veterans in the context of war such as killing may evoke a "moral injury," which leads to thoughts of ending one's life. Method: The present exploratory research examined relationships between combat experiences and suicidal ideation (SI) and PTSD in a sample of 68 Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans (91% male, mean age = 32.31 years) who had screened positive for alcohol misuse. We examined firing a weapon/killing in combat (Firing/Killing) and killing in combat (Killing) alone as predictors of SI and PTSD severity in both the full sample and men only. Results: Firing/Killing were associated with SI for the full sample and men only, and Killing showed a trend toward significance in predicting SI. Hierarchical regression analyses suggested that Firing/Killing did not predict PTSD for the full sample or men only, but Killing was predictive of PTSD for both samples. Conclusions: These results indicate that there may be differences in Firing/Killing and Killing alone in OEF/OIF veterans who screened positive for alcohol misuse. Thorough screening of combat experiences and addressing moral injury in returning combat veterans may help reduce high rates of suicide and PTSD. (PsycINFO Database Record
    Full-text · Article · Oct 2015 · Psychological Trauma Theory Research Practice and Policy
    • "Moral injury is an emerging concept that comes out of the living stories of military service members and veterans in the aftermath of combat (Brock and Lettini 2012). It is defined as the Bpsychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held more beliefs and expectations^ (Litz et al. 2009, p. 700); see also (Drescher et al. 2011; Vargas et al. 2013). Moral injury can be placed at one extreme end on a continuum of moral stress, with everyday moments of moral stress at the other end. "
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    ABSTRACT: Resilience is an outcome of caregiving relationships that help people spiritually integrate moral stress. Moral stress arises from lived theologies and spiritual orienting systems—patterns of values, beliefs, and ways of coping energized by shame, guilt, fear of causing harm, or self-disgust (some of the so-called negative moral emotions that cut people off from social support). Spiritual care compassionately brings to light these life-limiting lived theologies of shame and fear shaped by intersecting social systems of oppression like sexism, classism, and racism. Spiritual care helps people co-create intentional theologies that draw upon goodness, compassion, and love—moral emotions that connect them to the web of life. This interdisciplinary approach to moral stress draws upon the living stories of moral stress and resilience by feminist theologians Bonnie Miller-McLemore and Valerie Saiving.
    No preview · Article · Oct 2015 · Pastoral Psychology
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