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RESEARCH
ABSTRACT
Military personnel can be exposed to events such as killing or human suffering that can
breach or violate their core moral frameworks. The breaching or violation of one’s core
moral framework can create moral trauma—often termed “moral injury.” Moral injury has
gained increased attention during the last decade due to its links to military suicide. The
core characteristics of moral injury have not yet reached a universal consensus but can
include deep feelings of shame, guilt, distrust, anger, and self-condemnation. Few studies
have focused on moral injury in Australia. This paper is one of several published from a
larger PhD study. The purpose of this paper is to understand participants’ experiences
of moral injury. Analysis of the data revealed the overarching theme—walking forwards
with moral injury—describing participants’ experiences of living with a moral injury
and how they navigated and made meaning of their experience. From this overarching
theme, three sub-themes emerged: (a) meaning-making and moral injury, (b) narratives
of transformation, and (c) leading the charge. The study found that to continue “walking
forwards” a transformation of identity was needed. The transformation happened when
an understanding of the meaning underpinning identity occurred, and when validation
and reconciliation of the experience were achieved. These findings enhance knowledge of
the mechanisms needed to better support veterans living with moral injury in Australia.
Outcomes from this work may assist clinicians or those working with military veterans in
providing more appropriate care to those experiencing moral injury.
CORRESPONDING AUTHOR:
Nikki Jamieson
University of New England, AU
njamies4@une.edu.au
KEYWORDS:
moral injury; veterans;
qualitative; morality; military;
suicide
TO CITE THIS ARTICLE:
Jamieson, N., Usher, K.,
Ratnarajah, D., & Maple, M.
(2021). Walking Forwards with
Moral Injury: Narratives from
Ex-serving Australian Defence
Force Members. Journal of
Veterans Studies, 7(1), pp.
174–185. DOI: https://doi.
org/10.21061/jvs.v7i1.214
NIKKI JAMIESON
KIM USHER
DOROTHY RATNARAJAH
MYFANWY MAPLE
*Author affiliations can be found in the back matter of this article
Walking Forwards with
Moral Injury: Narratives
from Ex-serving Australian
Defence Force Members
175Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
The Australian Defence Force (ADF) is one of Australia’s
largest employers. Employing around 80,000 people,
the ADF consists of three core branches: Australian
Army (Army), Royal Australian Navy (RAN), and Royal
Australian Air Force (RAAF). The core duty of the ADF is
to protect Australian land, air, and sea, and the citizens
who live within Australia. To perform this duty requires
a collective mentality and adherence to predetermined
codes of group behaviour. From recruitment, individual
moral values are reimaged with military codes and values
(Beneda, 2012; Molendijk et al., 2018). Individualism is
replaced with collectivism through stringent military
training regimes, a command structure, and ritualisation.
Values such as a team-first ethos, honour, loyalty, and
courage become deeply entrenched throughout military
training and culture. Veterans are defined here as military
personnel who “are serving or have served” (Parliament
of Australia, 2019).
A veteran’s role is to listen, understand, and execute
orders (MacLeish, 2018). Actions required of veterans can
demand split-second decision-making. These decisions
can affront existing moral frameworks resulting in moral
injury (Currier et al., 2015; Shay, 2014). Moral injury
can occur through self-directed (one’s own action or
inaction) or other-directed (witnessing, or as a victim of
another’s action or inaction) transgressions (Drescher
et al., 2011). Literature on moral injury postulates that
self- or other-directed violations of deeply held moral
beliefs can cause several psychosocial challenges such as
betrayal, guilt, shame, loss of meaning, loss of belief (e.g.,
spiritual, religious, world views), distrust, self-condemning
behaviours, and heighten the risk of suicide (Bryan et
al., 2016; Drescher et al., 2011; Farnsworth et al., 2014;
Jamieson et al., 2020; Jinkerson, 2016; Jordan et al., 2017;
Kelley et al., 2019; Litz et al., 2009; Nash & Litz, 2013; Shay,
2014; Wortmann et al., 2017).
In the ADF, suicide and self-harm causes more deaths
and injuries post-service than in overseas operational
service (Department of Defence, 2016). The number of
veteran suicides in Australia has more than doubled from
19 in 2001 to 42 in 2017 (Australian Institute of Health
and Welfare, 2019). Notable increases in military suicides
have led to increased military suicide research globally.
Traditional military trauma and suicide research has
predominantly focused on post-traumatic stress disorder
(PTSD). Contemporary theorists are now exploring moral
injury and its links to suicidality (Bryan et al., 2018; Carey,
Hodgson & Cohen, 2016; Jamieson, Usher et al., 2020;
Jamieson et al., 2020; Jinkerson, 2016; Jordan et al., 2017;
Kelley et al., 2019; McCarthy, 2016).
Most research into moral injury stems from the USA and
has been military-focused (Bryan et al., 2016; Drescher
et al., 2011; Griffin et al., 2019; Koenig, 2018). However,
non-military sectors, such as first responders, police, and
healthcare personnel, can also be affected (Ford, 2019;
Haight et al., 2016; Murray & Gidwani, 2018). More recently
moral injury research has surged due to the links between
healthcare personnel and moral injury during the COVID-19
global health pandemic (Dean et al., 2020; Haller et al.,
2020; Williamson et al., 2018).
Globally, the prevalence of moral injury remains
unknown. Therefore, assumptions about presentations of
moral injury would need to be carefully considered until
a suite of rigorous and robust tools become available to
determine the population affected. There has also been
limited exploration into treatment approaches for moral
injury. Therefore, more research is needed.
As a contribution to the field, this study explored how
participants narrate their experience of moral injury
post-ADF service and what mechanisms supported them
whilst living with moral injury. This paper’s purpose is
to build knowledge derived exclusively from veterans’
perspectives. Outcomes from this work could assist
with the development and delivery of more appropriate
veteran support. This paper focuses on the theme “walking
forwards with moral injury” that explores how participants
make meaning of their experiences of living with moral
injury post-ADF.
METHODS
A qualitative design was deemed most appropriate to
address the research aims of examining how veterans
narrate their experiences of moral injury post-ADF service,
and what mechanisms supported them when living with
moral injury in Australia. This approach is considered useful
in researching complex human science and behaviour such
as moral injury (Finlay, 2011; Liamputtong, 2009; Leavy,
2014; Walter, 2006, Webster & Mertova, 2007). The first
author’s own networks, social media, and purposive and
snowball sampling methods were used to recruit former
members of the ADF who met the study’s inclusion criteria:
that participants had left the ADF, had identified as having
experienced moral injury and previous suicidality, and were
able to converse freely in English and participate in a face-
to-face in-depth interview. A brief pre-screen questionnaire
was conducted prior to the interview to determine
participants’ eligibility (Brace, 2018). Participants who were
experiencing severe psychological symptoms (e.g., severe
nightmares, flashbacks, suicidal ideation, plans, and or/
attempt) as well as those who did not meet the inclusion
criteria were excluded. Ethics approvals were obtained in
2018 from both the Department of Defence and Veterans’
176Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
Affairs Human Research Ethics Committee (035-18) and
the University of New England Human Research Ethics
Committee (HE18-218). Eligible participants were provided
with study and consent information as well as Guidelines
for Volunteers from the Department of Defence and
Veterans’ Affairs Human Research Ethics Committee. A list
of resources outlining several mental health resources was
also provided.
In-depth interviews were chosen to acquire an
understanding of participants’ perspectives of their
lived experiences (Minichiello et al., 2008). Interviews
lasted on average two and a half hours and were audio
recorded and transcribed verbatim. Transcriptions were
then sent to participants for review. All were returned
without edit. Transcripts were manually coded using
highlighting and hardcopy transcripts. Transcripts were
then electronically coded, first using Microsoft Excel then
Quirkos© data analysis software. Thematic analysis was
undertaken using Braun and Clarke’s (2013) thematic
analysis framework. Themes were then cross-referenced
with the supervision team and co-authors. Findings are
reported following the Consolidated Criteria for Reporting
Qualitative Research (COREQ) guidelines (Tong et al.,
2007).
RESULTS
Eleven participants, seven males and four females, from
Queensland, New South Wales, Victoria, and the Northern
Territory agreed to participate in the study, with a combined
total of 86 years of military service experience across the
three core branches (see
Table 1
). All participant quotes
used are provided verbatim and numbers were allocated for
confidentiality and to protect the identity of the participants.
FINDINGS
The findings of this study summarise participants’
experience of living with moral injury as a civilian post-ADF.
One overarching theme and three inter-related sub-themes
were identified from the data (
Table 2
). Whilst each theme
is discussed separately, they are also interwoven, resulting
in a better understanding of how participants navigated
their life post-ADF with moral injury.
WALKING FORWARDS WITH MORAL INJURY
The notion “walking forwards” emerged from the desire,
drive, and motivation that participants described when
PARTICIPANT AGE YEARS IN SERVICE BRANCH DEPLOYED Y/N IDENTIFIED GENDER (M/F)
1 30 2 Army N M
2 30 7 RAAF N F
3 30 4.5 Army Y M
4 33 7 Army Y M
5 40 9 RAN N F
6 41 10 Army Y M
7 26 3.5 Army N F
8 45 6 Army Y M
9 46 23 RAAF N F
10 40 6 Army Y M
11 28 8 Army Y M
Table 1 Participants.
WALKING FORWARDS WITH MORAL INJURY
THEME OVERVIEW
1 Meaning-making and moral injury Describes the importance of understanding through validation, acceptance, and reconciliation
2 Narratives of transformation Describes narratives of personal change and growth
3 Leading the charge Describes the importance of helping others
Table 2 Study Themes.
177Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
discussing how they navigated their new normal. The
term “walking forwards” was first described by Participant
5 when discussing how moral injury affected them post-
service:
I think moral injury is not something you get
better from, it’s not something that you can sit
in a therapist or see a psychiatrist and get drugs
for, or see a psychologist and get CBT [Cognitive
Behavioural Therapy] for, it’s not that. Moral injury is
about assisting a person to empower themselves, to
pull that shattering back together into a story they
can walk forward with.
Participant 5 described the ability to both name the
experience and accept moral injury became part of their
new normal, enabling them to walk forwards whilst living
with moral injury. Similarly, participant 3 said, “… accepting
that I have got this, but it’s not going to kill me, my life isn’t
over, and I can grow from it,” highlighting their journey of
acceptance and willingness to continue to walk forwards in
life, providing they have the right mechanisms in place to
support their journey.
MEANING-MAKING AND MORAL INJURY
In order to manage and accept their new normal,
participants described undergoing a variety of processes
to help them make meaning of their experience and
re-establish themselves. This theme describes how
participants made meaning of their experience, highlighting
important factors in their meaning-making journey. When
examining the individual narratives, a common thread
of loss was revealed. Participants described losing their
military identity: “… it seems that, you know, it takes away
who you are, what you can do, you know, it takes away your
career. The Army’s your whole life” (Participant 6). Others
described how losing their military identity heightened
other areas of loss in their lives:
I have lost who I was as a soldier, don’t like who
I am turning into. I’m failing as a parent and
husband—wife will leave you; you will never see
your wife and kids; you will lose your house—was
all going through my mind. So, I didn’t feel there
was much point being here, so I started to consider
means of suicide. (Participant 4)
For all participants, these losses were wide-ranging and
devastating, including the deaths of colleagues or friends,
loss of relationships, finances, career, and identity. All
participants provided examples of their losses but indicated
identity loss was the hardest to reconcile:
I have lost a good decade— probably longer—of a
career and it’s not just that loss of career. It’s that
loss of life trajectories, you know, everything that
comes with it, employment, financial stability …
marriage and children, everything. (Participant 9)
Through these losses, participants discussed how eventually
they began to make sense of their loss, describing several
processes that helped them to do so.
Validation
Participants described emotional, moral, and ethical
challenges with orders that were against their moral beliefs
or did not make sense to them. For example, Participant
4 described his internal struggle with guilt and shame
following an order that consequently resulted in significant
injuries to a colleague, saying: “I should have said more, I
should have done more, I should have fought harder for the
boys.” When such events occurred, participants described
needing these experiences to be validated “I just wanted
an acknowledgement, I just wanted someone to say, ‘I
understand, and I believe you, I believe that this happened
to you, and I’m sorry’” (Participant 9).
For female participants, the need for validation of their
negative experience was more prominent, highlighting the
potentially gendered differences relative to moral injury.
Women reported a lack of compassion or support: “There
was a complete lack of care or understanding of you know
… I haven’t really felt support by anybody really, I guess
some of that is the lack of connection or a willingness to
understand” (Participant 5). In contrast, male participants
focused on the need for validation directed towards
specific roles, actions, or positions within the ADF. Both
genders described needing validation from external
sources, especially from their leaders and government
services for veterans. What was commonly experienced for
participants was a need for the recognition of and validation
of their mental health needs when they arose. However,
few experienced this sense of recognition and validation,
therefore opted to avoid accessing support through fear of
career limitation and stigma. Instead, participants often
looked to each other to validate their experiences and
feelings: “We were the first to experience loss on our trip.
So, when it happened, and it happened to mates, we sort
of took, like a guidance, helping-type role and acknowledge
what they had been through” (Participant 3).
Acceptance and Reconciliation
Participants were often left questioning their experiences,
searching for valid reasons to be able to accept their
experience, for example partaking in deployments that
resulted in many deaths or injuries. As participants 3 and
178Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
5 described earlier, their acceptance of their moral injury
as their new normal, providing a sense of reconciliation
for them. Participant 1 also described how acceptance
helped him to reconcile his experiences and commence the
meaning-making process stating:
I’m healed as best I can but by doing, I take fucking
ownership of it. No, but this one thing I learned. You
need to be entirely responsible for everything that
you do and your own journey in rehab, whatever.
Taking ownership requires courage and reconciliation. Here
reconciliation is used to describe the process veterans used
to reconcile their identity and experiences of loss. When
reconciliation is achieved, a renewed sense of focus and
confidence can follow. Participant 1 wanted to reconcile
his perceived or actual inaction that underpinned his moral
injury, saying:
I have been to every single one of the boys’ houses
and apologised to them, you know, I was just
something I had to do … I just felt like I morally had
to do a responsibility, you know.
Participants described a desire to walk forwards, and in
doing so, knew that changes were required. These changes
started with acceptance, validation, and reconciliation that
often became the catalyst for future growth.
NARRATIVES OF TRANSFORMATION
Narratives of transformation describes the process of
reframing, reclaiming, and repurposing participants
experiences to help them move through life with moral
injury. Military transformation was the process of intensively
training individuals to defend the nation, instilling values
such as loyalty, collectivism, commitment, and honour.
However, after service, the transition back to a civilian
was problematic: “They’re good at training people to do
one thing and they’re shit in helping anyone do anything
else, or recover, and transition is awful” (Participant 1).
Transitioning from the ADF is often beset with challenges
and can be morally traumatic, and negatively impact
upon mental health: “I got diagnosed with adjustment
disorder, mixed anxiety, and depression, alcohol and opiate
dependence” (Participant 1). Some participants suggested
needing the time to “unfuck yourself and have a little bit
more of a relaxed wind-down” in doing so they can then:
“sort yourself out and reset” (Participant 11). Post-ADF
transformation differed for each person, however, the
processes of reframing, reclaiming, and repurposing of their
experiences were emergent as necessary components for
a “reset” and transformation to occur.
Reframing
During this process participants began to reframe the
negative aspects of their experience and reclaim the
positive ones, finding new ways to express them in their
new civilian identity. When reframing, the facts of the
experience remained the same, but the way participants
viewed it was shifted: “I wouldn’t have possibly learned
the life lessons I’ve learned if I hadn’t been in such a shit
environment” (Participant 8).
Reclaiming
For many, the reclamation of their new identity was
about goodness (i.e., doing good or feeling good about
themselves). For Participant 2, after years of bullying, when
reflecting on her journey she reclaimed her experience,
saying, “it’s put me on a path that I’m on now … I started
doing some post-grad study … has changed my life.”
Reclaiming their identity also helped participants to counter
any feelings of failure, hopelessness, and worthlessness,
helping them to understand their own journeys, and
providing an opportunity to learn and grow from their
experiences:
So, it’s actually reclaiming that and recognising
my story. You know, I have lost a good decade—
probably longer—of a career and it’s not just that
loss of career, it’s that loss of life trajectories,
you know everything that comes with it, your
employment, your financial stability, everything.
(Participant 5)
Repurposing
To repurpose is to take one thing and reuse it as something
else. The search for repurposing was personal for
participants and followed reclamation. Participants shared
their feelings of uselessness, and how they no longer
felt a sense of meaning and purpose. Despite significant
challenges for all participants when leaving ADF service,
stories of hope through re-finding purpose were described:
Most of all is something to focus on or somewhere,
you know, something that, like a light at the end
of the tunnel, just something that I could move
towards. You know, something to give you purpose.
(Participant 6)
For some, finding secure employment very quickly gave
them purpose: “When I got home, I bought my family’s
business out of liquidation, which gave me a job to leave …
and my four years was up, so made it an easier path out”
(Participant 3). Repurposing could also be in the form of
taking on a new hobby, ceasing to self-medicate, advancing
179Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
education, or training their mind to think differently:
I’ve set programs in place for recovering veterans
and had really well-documented results on the
benefits of free diving, you know, because it changes
the way your brain works … all the noise stopped
when I was underwater. (Participant 8)
Participant 1 discussed how growth was a key feature in
their repurposing journey, saying, “I’m going to … period
of growth, through it, and the stuff I’m doing now is all …
is a result of all of this happening, you know, so this has
really been, like, the defining feature of my life” (Participant
1). Participants described how they made meaning of their
experience and then used their experience as a platform for
transformation through processes of reclaiming, reframing,
and repurposing. This transformation helped participants
to continue to walk forwards. Helping others and creating
positive change became the primary repurpose tool for
participants.
LEADING THE CHARGE
The last theme that emerged focusses on leading the
charge. Leading the charge refers to the ways in which
positive change occurred for participants. From a military
perspective, leading the charge means inspiring others to
follow, even while the terrain may be treacherous. Here,
leading the charge can be equally as treacherous, yet
ultimately resulted in participants deciding to approach life
differently, taking charge of their lives, and occurred when
participants had reclaimed and repurposed their identity.
While participants spoke of the impacts from their military
experiences, all described engaging in activities that
helped them repurpose and transform and continue to
walk forwards in life. Participants described incorporating
healthier practices that they previously did not have:
I can tell you right now, exercise and meditation,
without a doubt … when I am exercising daily and
practicing meditation at least once a day for half an
hour, it’s the best I have ever been since the thing
(moral injury). (Participant 3)
The ultimate resolution for participants was helping others
to lead their own charge out of the military and into new
ways of living.
All participants described repurposing their experiences
as a vehicle to help others: “I think I was made to
experience it so that I could go and be used as a tool of
healing for others” (Participant 8). Similarly, Participant 8
described how he helped others saying: “I wrote a book
to help, a thing that took me 10 years to figure out might
help others.” Others were keen to share their stories to
encourage others to come forward:
Biggest thing I picked up was that no-one ever
talks about it and the people that did talk about it
were usually the ones that told somebody else’s
story, so I made it a valid point that I was going
to be completely open about my experiences.
(Participant 3)
All participants noted how participating in studies such
as this were fundamental to the repurposing of their
experiences. The need to reclaim and repurpose was
important in transforming participants lives, through
providing purpose and meaning. Yet for some, simply
finding their voice was a way in which to lead the charge:
“I’m trying to be a voice for those who might not be able
to” (Participant 10). This was especially pertinent for female
participants, who often discussed feeling voiceless in their
military experience: “I never had a voice; I have a voice
now. And it’s about how you use that” (Participant 5).
The message of helping others was often discussed, for
some helping others was through targeted advocacy with
participants describing a need to appeal for changes to
stop actions or behaviours that had negatively impacted
themselves or others:
I still feel wholly responsible for what happened to
the other boys. You know, that was the … I mean,
like, I don’t really care about what happened to me
too much, at least that’s within … I can deal with
all that, you know, I have support and I’m looked
after, but the other boys are not, so I got on my high
horse about this and started going to politicians and
senators. (Participant 1)
For others this was described as a desire for systemic and
organisational change:
So, for me it’s not about blaming Defence [ADF],
not blaming anybody, it’s about: ‘So how can you
change the system so other people don’t have to
go through this?’ is the most significant for me.
(Participant 5)
Throughout the narratives of walking forward with moral
injury, participants made several suggestions that they
believed would have helped them and or would help others
who may be facing or have faced similar circumstances. The
most provided advice was the need for positive and authentic
alliances. Veterans can often feel stigmatised when seeking
support, particularly if previous experiences were negative
180Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
and created feelings of distrust and withdrawal for them.
They often rely on recommendations from other veterans
before help-seeking. Positive alliances with others (e.g.,
trusted health providers, veterans, and non-veterans) was
an integral part of the participants’ transformation journeys.
Participant 6 noted the importance of building good
relationships with clinicians highlighting his experience of
one clinician, saying “… could not speak highly enough, even
the boys, a lot of the boys, have followed her out to her civvy
practice. She gives a fuck!” An authentic alliance is critical for
veterans and can determine whether a veteran continues
with treatment or not. For Participant 9, “having people that
genuinely sit down and talk to you and care about you” was
the most crucial factor when seeking support.
All participants described experiencing problems either
accessing or participating in appropriate therapeutic
support, both in and out of service. Some expressed
the need for flexible, alternative approaches, such
as methylenedioxymethamphetamine (MDMA) trials
(Participant 3). Participants 9 and 11 also explained the
importance of alternative methods, and how flexible, multi-
modal support benefited them: “I was at this health retreat
thing … I was exposed to art therapy, music therapy, equine
therapy, so there were other avenues I could express myself”
(Participant 9). Participant 11 described the benefit of using
the Soldier Recovery Centre: “So I did the six … the six-week
program there, and that, that was absolutely awesome”.
The need for appropriate peer support and practical help
to re-establish their identities as civilians were commonly
described. Participant 11 stated:
… talk to other people, you do some courses, so you
have time to unfuck yourself and you have some
appointments with people, and they teach you
mindfulness and meditation and assist you, and
where there’s other veterans and where they assist
you with helping you write a resume.
The themes above outline how participants narrated their
experience of walking forwards with moral injury. Feeling
validated and understood is important for meaning
making. Meaning making is integral for acceptance and
reconciliation, without these, the process of transformation
could not occur. The process of helping others and
advocating for change was also an essential component in
many participants transformation journeys.
DISCUSSION
The purpose of this study was to explore participant’s
experiences of living with moral injury and how they
made meaning of those experiences. Three themes were
developed that revealed the central role of meaning
making, the capacity to transform through acceptance,
and validation and using transformation to support and
advocate for other veterans.
The findings of this study offer three conclusions
that provide insight into what has been garnered from
participants’ stories. The first conclusion is that all
participants had experienced a moral injury resulting
from either actions or inactions (by oneself or others),
but particularly from those in positions of power, for
example, chain of command or clinicians. Their moral
injury manifested through feelings of betrayal, distrust,
anger, shame, guilt and self-condemning thoughts and
behaviours including suicide behaviours, aligning with
contemporary moral injury literature (Ames et al., 2019;
Brock et al., 2012; Bryan et al., 2018).
The second conclusion focusses on identity and the
importance of meaning-making to enable participants to
understand and improve their self-identity (Currier et al.,
2015; Moon, 2016; Smith & True, 2014). Research into
military identity states military personnel frequently view
their military identity as their dominant one (Higate, 2001;
Lancaster et al., 2018; Smith & True, 2014). Recent advances
in identity theory suggest that the purpose of self-identity is
as a value and meaning-making agent, and for information
processing (Baumeister & Landau, 2018). Therefore, when
one’s core identity is threatened, especially if founded in
trauma such as killing or military sexual abuse for example,
a person’s meaning-making agency and self-identity can
also be damaged (Beneda, 2012; Jones, 2020; Vargas,
2012). Such damage can heighten the risk of negative
feelings and suicide behaviour in veterans (Farnsworth et
al., 2014). When examining the development of stories
across each interview, it seemed that veterans may also
be experiencing feelings of inadequacy. They described the
problems they faced relative to their feelings of inadequacy
or the inadequacy of others. Scholars have linked these
feelings of inadequacy to the mental and physical wounds
veterans may have suffered, any stigma that may be
associated with the wounds, or with military service in
general (Blevins et al., 2011; Sayer et al., 2014). Thus, how
veterans make meaning of their experience is an important
consideration in suicide prevention approaches.
The third conclusion is that transformation is possible,
presupposing several important considerations. For
transformation to occur, acceptance, reconciliation, and
validation are needed. Acceptance and reconciliation
were multi-layered for participants; first, they had to
accept themselves in their new identity, in doing so meant
accepting what others or they themselves had done
or not done. This is not to say that acceptance meant
181Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
healing: quite the opposite, as participants described
moral injury as being lifelong and something one learns to
live with. Their acceptance was based on navigating and
reconciling their self-identity journeys whilst living with
moral injury (Brock, 2020). Reconciliation on the other
hand, is a global, universal, and multidimensional reality
that can help to reconstruct a person’s self-identity (Lee,
2018; Samson et al., 2015). Trauma theorists postulate
that acceptance is a key part of the reconciliation journey
(Lee, 2018, p. 73). Through their narratives, veterans
perpetuated the values and ideals of the culture of which
they were a product and described their difficulties in
trying to reconcile these ideals with the civilian cultural
identity they now found themselves living. Moral injury
is difficult to articulate and often goes unvalidated,
hindering treatment approaches. Moral injury, therefore,
can only be accepted and validated when: “the individual
is permitted and empowered to voice their experience;
the listener is allowed to listen, believe, and remember;
and the listener is allowed to repeat what they have
heard to others” (Meyer et al., 2018, p. 1274).
For those interviewed, re-finding purpose was also
pivotal to the transformation of their identity. Held et al.
(2019) identified re-finding purpose as a way of ascribing
redemptive meaning to injuries and suffering. However,
the identity journey was not straight forward, there was
not one pivotal moment in their lives that drove them from
severe identity difficulties into a life filled with purpose and
meaning; in fact, it was quite the opposite. Participants
described their battles with drug and alcohol misuse,
relationship difficulties, and financial difficulties, describing
how they had often sought treatment or had been
encouraged to seek treatment. For some, the treatment
(e.g., psychologist) helped them to walk forwards again.
However, many reported adverse experiences. The nature
of service in the ADF results in a sense of kinship between
veterans; however, this can also make help-seeking difficult
beyond veteran-specific services for structured support
as well as among veterans for social support. The process
of looking for a community to belong to after service was
common. Usually, this began with reconnecting with other
veterans, producing an immediate kinship because of their
shared defence experiences, and using peers for support
and validation. The participants in this study identified that
frequently their support was found outside their professional
psychotherapeutic help, rather via other veterans or
veteran-centric support networks. This is an important
finding for future treatment and practice approaches.
The stories of every participant revealed how exiting
the military meant restarting their new life as quickly
as possible. These women and men were intensively
trained to keep moving forward. They described how they
moved rapidly from an important, highly trained, goal-
directed, and regimented environment to an isolated and
alien environment where they were unable to support
themselves or their families. These significant changes
resulted in increased mental health problems and suicide
risk (Corona et al., 2019).
The study found that to continue walking forwards,
positive transformation was required. This transformation
occurred through understanding and validating the meaning
ascribed to participants’ identity and then reconciling
the experience. However, to date, very little research has
adequately explored how to support veterans through these
processes. Despite the challenging experiences described,
participants’ drive for purpose and change was a catalyst for
walking forwards. They were able to see how they were living
and made changes that often meant becoming involved in
activities not previously engaged in. For participants, these
activities included participation in advocacy, alternative
therapeutic approaches, and public speaking. This drive
for purpose and helping others served as a key protective
mechanism for participants. Further research would benefit
from exploring this area in more detail.
LIMITATIONS
As with most studies, limitations exist. Here, the study
sample size was relatively small, therefore, findings are
not generalisable. It is acknowledged that the researcher’s
background and loss of a veteran son to suicide may
have inadvertently influenced veteran responses in some
way. All participants were Australian, with a higher male-
to-female ratio. Participants were recruited mainly from
metropolitan areas where there are more psychosocial
supports available. Demographic differences may have
resulted in different outcomes. Participants were more likely
to be comfortable in telling their stories across a variety of
forums. Further research is needed to ascertain similarities
or differences across other groups and demographics.
CONCLUSION
The study addressed the aims of examining how veterans
narrate their experience of moral injury post-service, and
what mechanisms support veterans living with moral
injury in Australia. The findings from this study add
another dimension to the moral injury literature. By using
participants’ lived experience, a plethora of evidence that
supports the study aims has emerged with implications
for future clinical practice. Scholarly recognition has been
given to understanding the lived experiences of veterans,
182Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
however previous consideration had not been shown
to this select group of Australian veterans. Until the
completion of this study there was no Australian literature
that described the contextual and motivational factors
of veterans living with moral injuries. Now that we have
evidence to substantiate their experiences, it is timely to
consider how we can use these outcomes to inform future
policy and practice.
CLINICAL RELEVANCE
Reshaping identity includes processes that are often
embedded in one’s cultural, familial, and spiritual
backgrounds. The integration of religious or spiritual
practices within traditional trauma-related modalities
may be pertinent and timely to the treatment of moral
injury (Currier et al., 2019; Drescher et al., 2013). However,
clinicians may not be accustomed to the impacts of
moral injury among veteran clients. Common tests and
procedures do not yet adequately assess anxiety or trauma
stressors include betrayal, which is a key antecedent and
attribute of moral injury (Jamieson Maple et al., 2020). It
is important for all who work or engage with veterans to
understand the veteran context and population, and how
their training, conditioning, and service exposure can lead
to both betrayal and the development of moral injury.
Additionally, it is beneficial for clinicians to understand the
core constructs and implications of moral injury fully, as
well as understanding what works for veterans with moral
injury. This paper provides useful signposts for clinicians
and those working with veterans to use when navigating
and supporting veterans with moral injury.
ETHICS AND CONSENT
Department of Defence and Veterans’ Affairs Human
Research Ethics Committee: 035-18 approved 10 July 2018–
9 July 2020. University of New England Human Research
Ethics Committee: HE18-218 approved 6 September 2018–
30 June 2020.
FUNDING INFORMATION
This research received funding from Suicide Prevention
Australia and the Research Training Scheme Scholarship.
COMPETING INTERESTS
The authors have no competing interests to declare.
AUTHOR CONTRIBUTIONS
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/recommendations/)]: substantial
contributions to conception and design, acquisition of data,
or analysis and interpretation of data; drafting the article or
revising it critically for important intellectual content.
AUTHOR AFFILIATIONS
Nikki Jamieson orcid.org/0000-0003-3410-4599
University of New England, AU
Kim Usher orcid.org/0000-0002-9686-5003
University of New England, AU
Dorothy Ratnarajah
University of New England, AU
Myfanwy Maple orcid.org/0000-0001-9398-4886
University of New England, AU
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185Jamieson et al. Journal of Veterans Studies DOI: 10.21061/jvs.v7i1.214
TO CITE THIS ARTICLE:
Jamieson, N., Usher, K., Ratnarajah, D., & Maple, M. (2021). Walking Forwards with Moral Injury: Narratives from Ex-serving Australian
Defence Force Members. Journal of Veterans Studies, 7(1), pp. 174–185. DOI: https://doi.org/10.21061/jvs.v7i1.214
Submitted: 05 October 2020 Accepted: 05 April 2021 Published: 27 May 2021
COPYRIGHT:
© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source
are credited. See http://creativecommons.org/licenses/by/4.0/.
Journal of Veterans Studies is a peer-reviewed open access journal published by VT Publishing.
