DOCSLIB.ORG

Exploring Moral Injury: Theory, Measurement, and Applications

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Exploring Moral Injury: Theory, Measurement, and Applications Military Behavioral Health ISSN: 2163-5781 (Print) 2163-5803 (Online) Journal homepage: https://www.tandfonline.com/loi/umbh20 Exploring Moral Injury: Theory, Measurement, and Applications Hazel R. Atuel, Ryan Chesnut, Cameron Richardson, Daniel F. Perkins & Carl A. Castro To cite this article: Hazel R. Atuel, Ryan Chesnut, Cameron Richardson, Daniel F. Perkins & Carl A. Castro (2020): Exploring Moral Injury: Theory, Measurement, and Applications, Military Behavioral Health, DOI: 10.1080/21635781.2020.1753604 To link to this article: https://doi.org/10.1080/21635781.2020.1753604 Published online: 17 Apr 2020. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=umbh20 MILITARY BEHAVIORAL HEALTH https://doi.org/10.1080/21635781.2020.1753604 RESEARCH ARTICLE Exploring Moral Injury: Theory, Measurement, and Applications Hazel R. Atuela, Ryan Chesnutb, Cameron Richardsonb, Daniel F. Perkinsb, and Carl A. Castroc aCenter for Innovation and Research on Veterans & Military Families, University of Southern California (USC), Center for Innovation and Research on Veterans & Military Families, Los Angeles, California; bClearinghouse for Military Family Readiness, The Pennsylvania State University (PSU), Clearinghouse for Military Family Readiness, University Park, Pennsylvania; cSchool of Social Work and Psychology, University of Southern California, Los Angeles, California ABSTRACT KEYWORDS This research brief summarizes and highlights presentations on moral injury related to the- Moral injury; theory; ory, measurement, and applications. The overall was to identify current gaps and propose measurement; applica- next steps to advance the science of moral injury. tions; research During the writing of this research brief (late March event or series of events that have moral implications. 2020), our world is facing a new normal. On a global Whether or not this outbreak, particularly focusing on level, the coronavirus outbreak has disrupted how we the human factors at work (e.g., decisions made at work, interact with each other, engage in mundane various levels, rhetoric used to frame the event), will activities, and participate in community life. Our daily eventually fall under the rubric of moral injury will be lives had to change. And, in a relatively short period a topic of later discussions. For now, we would like to of time, we were compelled and propelled to accom- acknowledge and note that these historic events might modate alternative ways of living to survive. We had force us to reconsider our current knowledge of moral to change. As we explore new ways or continue old injury in the foreseeable future. Stated differently, ways of thriving in newly defined individual and what we are going through is perhaps an invitation to social spaces, one thing is clear: the experience of move us beyond what we already know and have change is both personal and communal. Personal applied to a subset of the population to a more because each of us had unique ways of readjusting expanded understanding that will have wider implica- and communal because this pivoting is a shared tions to the varieties of human experience. experience with others who are proximal and distal to With that said, let us now turn to what we initially us. Ultimately, this experience has changed both our set out to do. personal stories and community histories. What does this reflection on the coronavirus pan- Toward a science of moral injury demic have to do with a research brief on moral injury? Because as social scientists, we simply could In the Fall of 2019, we at the University of Southern not help ourselves but think, try to make sense of, or California’s Center for Innovation and Research on even go as far as to find purpose in this chaos. We Veterans & Military Families (USC) and the could conceive of this unprecedented worldwide event Pennsylvania State University’s Clearinghouse for as a real-world experiment on our response to the suf- Military Family Readiness (PSU) were in the planning fering or death we read in our news feeds, or possibly stages of a military research summit to be held in know of directly or indirectly. How are we changed early February 2020. What emerged from our conver- by the knowledge or experience of our own or others’ sations was that we were leaning toward building a suffering as well as the death of others? We are raising science of moral injury. Admittedly a very ambitious this critical question upfront because some of the research agenda, that prompted us to ask each other, issues at the heart of moral injury speak to the human “where do we even start?”. We chose to answer three capacity and ability to respond to an adverse singular basic questions: (1) what do we already know, (2) CONTACT Hazel R. Atuel [email protected] Center for Innovation and Research on Veterans & Military Families, University of Southern California (USC), Center for Innovation and Research on Veterans & Military Families, Los Angeles, CA 90089-0001, USA. ß 2020 Taylor & Francis Group, LLC 2 H. R. ATUEL ET AL. what else do we need to know, and (3) what are the importance of the relational component of moral scientific building-blocks needed to move the field injury. As she explained, a person suffering from forward? Guided by these queries and reined in by moral injury has a broken relationship with self, with what can be done in a one-day summit, we decided to another person, and/or with a higher being or power. focus on identifying gaps in and advancements for the When spirituality or religiosity is salient, there is the current knowledge base in terms of theory, measure- possibility of receiving treatments other than or above ment, and applications. We do not need to belabor and beyond the traditional offerings made available at you, the reader, on the importance of theory and Veterans Affairs Medical Centers, specifically measurement in laying the conceptual foundation of a Cognitive Processing Therapy (CPT; Resick et al., particular field, coupled with the critical role of appli- 2017) and Prolonged Exposure Therapy (PE; Foa cations in empirically demonstrating the robustness et al., 2007). Second, developed in conjunction with and utility of a particular construct. What was import- chaplains, spiritually integrated treatments focus on ant for us was to set the conceptual and empirical moral injury dimensions (e.g., shame, moral concerns, footings as parallel tracks within this budding scien- religious struggles, loss of faith) that are not part of tific field. secular treatment modules. When tailored this way, Considering that the majority of research has healing is postulated to occur at the level of the soul focused on the clinical correlates of moral injury (see and involves engaging in traditional spiritual or reli- Griffin et al., 2019 for the most recent review), we gious acts such as lament, repentance, confession, decided to convene researchers and practitioners who and atonement. offered alternative explanations or presented on rela- Dr. Hazel Atuel (USC) presented on a virtue-based tively new findings that had direct consequences to definition of moral injury (Atuel & Castro, 2019; theory, measurement, or practice (in terms of preven- Atuel, Jones, Greenberg, Williamson, Barr, Vermetten tion and intervention). Our deliberate choice to hear et al., in preparation) that borrows from moral phil- divergent perspectives was driven by a desire to pro- osophy (e.g., Nichomacean Ethics; trans. 2006), moral mote conversations that would forge new ways of psychology (e.g., Strohminger et al., 2017), character conceptualizing and measuring moral injury, as well psychology (e.g., Lapsley & Stey, 2014), and social as its cross-cultural applications. Hence, on February psychology (e.g., Brewer, 1991). This multidisciplinary 11, 2020, USC and PSU hosted the joint research framework advances a broader theoretical foundation summit titled, “Exploring Moral Injury: Theory, that is not defined by and does not necessarily reflect Measurement, and Applications” in Los Angeles, clinical impairments. This framework provides a char- California. What follows are summaries and highlights acter pathway that is differentiated from the trad- of the different presentations shared at the summit. itional clinical pathway by defining moral injury as a psychological state that arises in the aftermath of Theoretical frameworks on moral injury moral failure. To have an effect on an individual’s Dr. Donna Ames (University of California, Los character and identity, the moral failure experience Angeles and the Los Angeles Veterans Affairs Medical has to be of significance, often involving suffering or Center) presented on the spiritual dimension of moral death. The definition of suffering, however, is not lim- injury – ranging from measurement (Koenig et al., ited to traumatic events (e.g., war trauma, sexual 2018) to spiritually integrated treatments (Pearce assault). Rather, suffering is argued to stem from a et al., 2018). This work is in collaboration with Dr. wider range of behaviors or interactions reflecting the Harold Koenig whose work on moral injury is based lack of human goodness (or human excellence in on the intersection of spirituality, theology, and terms of the Aristotelian moral virtues), with simple health. First, based on the validation studies of the acts (e.g., apathy or meanness toward another person) Moral Injury
Load more

Recommended publications
  • Caring Connections C O N T E N T S
    VOLUME 10 NUMBER 1 Winter 2013 An Inter-Lutheran Journal for Practitioners and Teachers of Pastoral Care and Counseling CARING CONNECTIONS C O N T E N T S Light in the Darkness: Hope, Resilience and Moral Injury 3 The Purpose of Caring Connections 4 Editorial Chuck Weinrich 6 Spiritual Care and Moral Injury in Service Members George Handzo 9 Spiritual Resiliency and Moral Injury: Community, Advocacy, and Care Janet Ramsey 13 Martin Luther’s Consolation: An Approach to Pastoral Care for the Morally Injured William R. Russell 18 Self-Inflicted Harm Among Military Veterans: Our Militarized Society’s Cry for Help: Part Two Amy Blumenshine 21 Remedy for Moral Injury Mark Schreiber 24 Sacrifice, Moral Injury, and the Work of Healing after War Kelly Denton-Borhaug 28 Moral Injury: Learning from and Caring for the Sufferers Mel Jacob 32 Resources, Announcements, Events Book Review by Brian McCaffrey 34 How to Subscribe THE PURPOSE OF CARING CONNECTIONS Caring Connections: An Inter-Lutheran Journal for Practitioners and Teachers of Pastoral Care and Counseling is written by and for Lutheran practitioners and educators in the fields of pastoral care, counseling, and education. Seeking to promote both breadth and depth of reflection on the theology and practice of ministry in the Lutheran tradi- tion, Caring Connections intends to be academically informed, yet readable; solidly grounded in the practice of ministry; and theologically probing. Caring Connections seeks to reach a broad readership, including chaplains, pastoral counselors, seminary faculty and other teachers in academic settings, clinical educa- tors, synod and district leaders, others in specialized ministries and — not least — concerned congregational pastors and laity.
    [Show full text]
  • Role of Morality in the Experience of Guilt and Shame Within the Armed Forces
    Act a Psychiatrica Scandinavica Acta Psychiatr Scand2015: 132: 4-19 © 2015 John Wiley & Sons A/S. Published by John Wlley & Sons Ltd All rights reserved ACTA PSYCHIATRICA SCANDINAVICA DOlFlO. 1111/acps. 12406 Review Role of morality in the experience of guilt and shame within the armed forces Nazarov A, Jetly R, McNeely H, Kiang M, Lanius R, McKinnon MC. A. Nazarov1:2, R. Jetly3-4,. Role of morality in the experience of guilt and shame within the armed H. McNeely1'5, M. Kia'ng1-8-7,. forces. R. Lanius8; M. C. McKmnon1-2-9 Department of Psychiatry and Behavioral Objective: Despite advances in our understanding of mental health Neurosciences, McMaster University, Hamilton, ON, issues among military forces, a large proportion of military personnel 2Mood Disorders Program, St. Joseph's Healthcare continue to exhibit deployment-related psychological issues. Recent Hamilton, Hamilton, ON, Department of National work has identified symptoms of guilt and shame related to moral Defence, Government of Canada, Ottawa, ON, injury as contributing significantly to combat-related mental health ''Department of Psychiatry, University of Ottawa, issues. This systematic scoping review explores the association between Ottawa, ON, 'Clinical Neuropsychology Sen/ice, St. morality and symptoms of guilt and shame within military forces. Joseph's Healthcare Hamilton, Hamilton, ON, Method: A search of the literature pertaining to guilt, shame and Department of Psychiaby, University of Toronto, Toronto, ON, Centre for Addiction and Mental Health, morality within military samples was conducted. Toronto, ON , Department of Psychiatry, University of Results: Nineteen articles were selected for review. There is strong Western Ontario, London. ON and Homewood evidence linking exposure to and the perceived perpetration of moral Research Institute, Guelph, ON, Canada transgressions with experiences of guilt and shame.
    [Show full text]
  • The Story of Moral Injury in the Context of War
    La Salle University La Salle University Digital Commons Th.D. Dissertations Scholarship 4-11-2018 Echoes In The Depths Of Conscience: The Story Of Moral Injury In The Context Of War William Barbee La Salle University, [email protected] Follow this and additional works at: https://digitalcommons.lasalle.edu/religion_thd Recommended Citation Barbee, William, "Echoes In The Depths Of Conscience: The Story Of Moral Injury In The Context Of War" (2018). Th.D. Dissertations. 5. https://digitalcommons.lasalle.edu/religion_thd/5 This Dissertation is brought to you for free and open access by the Scholarship at La Salle University Digital Commons. It has been accepted for inclusion in Th.D. Dissertations by an authorized administrator of La Salle University Digital Commons. For more information, please contact [email protected]. La Salle University School of Arts and Sciences Graduate Program in Theology and Ministry Dissertation Echoes In The Depths Of Conscience: The Story Of Moral Injury In The Context Of War By William T. Barbee (B.A., David Lipscomb College; M.Div., Oakland City College; M.S. Tarleton State University) Submitted in partial fulfillment of the requirements for the degree Doctor of Theology 2018 Copyright © 2018 by William T. Barbee All rights reserved For all the men and women who have worn the cloth of our Nation and have borne the wounds and scars of her wars. May they find hope, healing, and home. For all the families who have stood beside their soldier, sailor, marine, or airman and held them in their hearts.
    [Show full text]
  • Moral Injury and Moral Repair in War Veterans: a Preliminary Model and Intervention Strategy
    Clinical Psychology Review 29 (2009) 695–706 Contents lists available at ScienceDirect Clinical Psychology Review Moral injury and moral repair in war veterans: A preliminary model and intervention strategy a,b, a a c c Brett T. Litz ⁎, Nathan Stein , Eileen Delaney , Leslie Lebowitz , William P. Nash , a d Caroline Silva , Shira Maguen a National Center for PTSD, VA Boston Healthcare System, United States b Boston University, United States c Newton, Massachusetts, United States d San Francisco VA Medical Center, University of California at San Francisco, United States article info abstract Keywords: Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional Moral injury and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to Iraq War prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in Afghanistan the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). OIF Although there has been some research on the consequences of unnecessary acts of violence in war zones, the OEF 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. Published by Elsevier Ltd. Contents 1. Introduction .............................................................. 696 2. What might be potentially morally injurious in war? ........................................... 696 3. Research on military atrocities and killing ................................................ 697 4. What aspects of existing theory might explain moral injury? ....................................... 698 5.
    [Show full text]
  • Litz Et Al (2009)
    Clinical Psychology Review 29 (2009) 695–706 Contents lists available at ScienceDirect Clinical Psychology Review Moral injury and moral repair in war veterans: A preliminary model and intervention strategy Brett T. Litz a,b,⁎, Nathan Stein a, Eileen Delaney a, Leslie Lebowitz c, William P. Nash c, Caroline Silva a, Shira Maguen d a National Center for PTSD, VA Boston Healthcare System, United States b Boston University, United States c Newton, Massachusetts, United States d San Francisco VA Medical Center, University of California at San Francisco, United States article info abstract Keywords: Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional Moral injury and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to Iraq War prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in Afghanistan the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). OIF Although there has been some research on the consequences of unnecessary acts of violence in war zones, the OEF 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. Published by Elsevier Ltd. Contents 1. Introduction .............................................................. 696 2. What might be potentially morally injurious in war? ........................................... 696 3. Research on military atrocities and killing ................................................ 697 4. What aspects of existing theory might explain moral injury? ....................................... 698 5.
    [Show full text]
  • Effects of Resilience Strength Training on Constructs Associated with Moral Injury Among Veterans
    Barth, T. M., et al. (2020). Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans. Journal of Veterans Studies, 6(2), pp. 101–113. DOI: https://doi.org/10.21061/jvs.v6i2.199 RESEARCH Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans Timothy M. Barth1, Charles G. Lord1, Vishal J. Thakkar1 and Rita N. Brock2 1 Texas Christian University, US 2 Volunteers of America, US Corresponding author: Timothy M. Barth ([email protected]) Resilience Strength Training (RST) is a peer specialist program that incorporates a military squad model of group trust and bonding to address problems specific to moral injury (typically involving collapse of meaning or faith, loss of trust, self-isolation, and the failure of relationships). The training program was offered to 97 male and female veterans (ages 24–73) at two Volunteers of America (VOA) affiliates. The veterans com- pleted measures related to moral injury prior to RST training, immediately upon completion, and 6 months after the training. RST significantly improved their reported post-traumatic growth, perceived meaning in life, propensity to trust, dispositional optimism, positive attitudes toward themselves, personal self-esteem, and sleep quality, while decreasing their dependence on both alcohol and sleep medications. These improvements were more pronounced immediately after RST but remained significant on most measures 6 months after training had ended. The results are interpreted as supportive of RST as a vehicle for addressing moral injury in veterans through development of self-calming strategies, communication skills, and self-esteem, as well as development of a peer-supported community with shared experiences.
    [Show full text]
  • Moral Injury
    MORAL INJURY Rita Nakashima Brock, Ph.D. Senior Vice President and Director of the Shay Moral Injury Center Volunteers of America, 1660 Duke St., Alexandria, VA 22314 703-341-5000 • [email protected] voa.org Moral Identity and Meaning Increasing evidence from neuroscience 4. Rituals and psychology that human beings are a. Deliver meaning system by enacting born moral and that moral conscience important values in symbolic ways or is part of human empathy, pattern via stories so that they are part of body- making, and social existence. memory as well as conscious memory. “As moral injury takes Content of moral systems and b. Teach meaning and values through individual identity have at least five repeated behavior that includes stories its place in the common dimensions (See Seligman, A, R. P. or other forms of delivering meaning. Weller (2012) Rethinking Pluralism: c. Often bodily re-enactment of a parlance, we need to Ritual, Experience, and Ambiguity. ritual can evoke the emotions of the Oxford.): meaning system. ask what it provides our 1. Habits d. Provide opportunities to enact a. Learned by mimicry, repetition, aspirational aspects of meaning— practice, and coaching. Largely performing ideal self v. real self. consciousness and what subconscious behavior that determines e. Used to integrate ambiguity or daily human interactions. Habitual threats to meaning via story, myth, and behaviors carry moral content. Embed it limits, and how we connection to ideal self. gender, culture, race, and context. 5. Experience could more fully address b. Difficult to change and constitute most moral behavior on a daily basis. a.
    [Show full text]
  • Moral Injury
    Moral Injury: A systematic literature and resource bibliography for the Australian Defence Force Chaplaincy Branch Lindsay B. Carey, MAppSc, PhD. Palliative Care Unit/ School of Psychology and Public Health La Trobe University/ IVTelbourne/ Victoria/ Australia. Timothy J. Hodgson, MIntSecStud, MTh. School of Historical and Philosophical Inquiry University of Queensland/ St. Lucia/ Queensland/ Australia. Rachel Y. Soh, BHSc, DipNs. Palliative Care Unit/ School of Psychology and Public Health La Trobe University/ Melbourne/ Victoria/ Australia. Taranjeet K. Singh, BHSc. Palliative Care Unit/ School of Psychology and Public Health La Trobe University/ Melbourne/ Victoria/ Australia. Annie-Rose Armour, BHSc. Palliative Care Unit/ School of Psychology and Public Health La Trobe University/ Melbourne/ Victoria/ Australia. February 2015 ISBN: 978-0-9925522-4-4 Cai-ey, Hodgson, et al (2015) Moral Injury: Literah-u'e & Resources Bibliography, p. 2 PREFACE Title: Sponsor: 1. PCU-La Trobe University 1. Moral Injury: A systematic literature and 2. COM CHAP - ADF JHC resource bibliography for the Australian Defence Force Chaplaincy Branch Key Word Focus: Moral Injury, Soul Injury, Soul Repair, Moral Repair,- -Chaplaincy, Religious, Pastoral & Spu-itual* Care © Palliative Care Unit, La Trobe Umversity ISBN: 978-0-9925522-4-4 Search Commenced: 02 FEB 2015 DOI: 10.13140/2.1.4747.0889 Search Completed: 27 FEB 2015 Update: 28 FEB 2015 Total Search Allocation: 700 HRS Referencing System; APA 6th Edition Publication Reference: TBA POC Details: Authorised Researcher: Authorising Sponsor/s: Dr. Lindsay B. Carey, MAppSc, PhD, 1. Dr. Brace Rumbold, MSc, PhD. Deputy Course Director, BHSc, Palliative Care Unit, Research Fellow, Palliative Care Unit, La Trobe University, School of Psychology and Public Health 215 Franklin Street, La Trobe University Melbourne, Australia 3000.
    [Show full text]
  • Diagnosing the Invisible Wounds of War: an Exploration Into the Nature, Causes, and Symptoms of Moral Injury
    Diagnosing the Invisible Wounds of War: An Exploration Into the Nature, Causes, and Symptoms of Moral Injury Keith Dove Religious Studies Faculty advisor: Dr. James Deitrick Here is a story to break your heart. 1 Mary Oliver “Lead” War is hell, but that’s not the half of it, because war is also mystery and terror and adventure and courage and discovery and holiness and pity and despair and longing and love. War is nasty; war is fun. War is thrilling; war is drudgery. War makes you a man; war makes you dead. 2 Tim O’Brien The Things They Carried War has been a constant presence throughout the history of humankind. Many of the most notable ancient texts include, or even focus on, the problem of war and its effects on those who participate in it. This includes Homer’s The Iliad and The Odyssey, the Hebrew Bible or Old Testament, the Bhagavad Gita, and Sun Tzu’s The Art of 1 Mary Oliver, “Lead” in New and Selected Poems, vol. 2 (Boston: Beacon Press, 2005), 54. 2 Tim O’Brien, The Things They Carried (New York: Broadway Books, 1998), 80. CLA Journal 4 (2016) pp. 95-161 96 Dove _____________________________________________________________ War. Even today, there is no shortage of literature or films that focus on war. One of the effects of war, which can be seen in both ancient and contemporary texts, is moral injury. However, moral injury has only been isolated and explored in detail in the recent past. Most work on the subject has been written since the United States invaded Afghanistan in 2001 and Iraq in 2003.
    [Show full text]
  • Running Head: Moral Judgment and Moral Injury 1
    RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 1 © 2019, American Psychological Association. This paper is not the copy of record and may not exactly replicate the final, authoritative version of the article. Please do not copy or cite without authors' permission. The final article will be available, upon publication, via its DOI: 10.1037/tra0000518 Moral Decision Making, Religious Strain, and the Experience of Moral Injury Steven L. Lancaster* and Maggie Miller Bethel University, St Paul, MN *Corresponding Author: Department of Psychology Bethel University 3900 Bethel Drive St Paul, MN 55112 Office: 651-638-6895 Fax: 651-638-6001 Email: [email protected] RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 2 Abstract Objective: Moral injury is the lasting psychological, spiritual, and behavioral effects of having perpetrated acts that transgress moral boundaries. Contemporary models of moral injury in military veterans examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined appraisals of one’s acts and religious strain as potential mediators of the link between transgressive acts and symptoms of moral injury. Further, given the inherent importance of moral cognitions in the appraisal process, we tested whether the acts to appraisals link was moderated by altruism in military veterans. Method: An online survey, distributed using crowdsourcing software, was completed by military veterans. The survey included measures of transgressive acts, appraisals of these acts, religious strain, altruism, and self- and other-directed symptoms of moral injury. Mediation and moderated serial mediation were used to test the hypotheses.
    [Show full text]
  • Moral Injury and Moral Repair in War Veterans: a Preliminary Model and Intervention Strategy
    Clinical Psychology Review 29 (2009) 695–706 Contents lists available at ScienceDirect Clinical Psychology Review Moral injury and moral repair in war veterans: A preliminary model and intervention strategy Brett T. Litz a,b,⁎, Nathan Stein a, Eileen Delaney a, Leslie Lebowitz c, William P. Nash c, Caroline Silva a, Shira Maguen d a National Center for PTSD, VA Boston Healthcare System, United States b Boston University, United States c Newton, Massachusetts, United States d San Francisco VA Medical Center, University of California at San Francisco, United States article info abstract Keywords: Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional Moral injury and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to Iraq War prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in Afghanistan the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). OIF Although there has been some research on the consequences of unnecessary acts of violence in war zones, the OEF 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. Published by Elsevier Ltd. Contents 1. Introduction .............................................................. 696 2. What might be potentially morally injurious in war? ........................................... 696 3. Research on military atrocities and killing ................................................ 697 4. What aspects of existing theory might explain moral injury? ....................................... 698 5.
    [Show full text]
  • An Exploration of Moral Injury As
    AN EXPLORATION OF MORAL INJURY AS EXPERIENCED BY COMBAT VETERANS A dissertation presented to the faculty of ANTIOCH UNIVERSITY SANTA BARBARA in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY in CLINICAL PSYCHOLOGY by Marjorie M. McCarthy, J.D., M.A. 2016 ProQuest page…. ii AN EXPLORATION OF MORAL INJURY AS EXPERIENCED BY COMBAT VETERANS This dissertation, by Marjorie M. McCarthy, has been approved by the committee members signed below who recommend that it be accepted by the faculty of Antioch University Santa Barbara in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY in CLINICAL PSYCHOLOGY Dissertation Committee: ____________________________ Ron Pilato, Psy.D. Dissertation Chair ____________________________ Sharleen O’Brien, Psy.D. Second Faculty ____________________________ CAPT William P. Nash, M.D., MC USN (Ret.) External Expert iii Copyright © 2016 Marjorie M. McCarthy All rights reserved. iv Abstract War-zone stressors among Service members can lead to adverse psychological consequences that fall outside the scope of post-traumatic stress disorder. Combat stressors can also result in moral injury. Moral injury is an emerging psychological construct. One proposed definition of moral injury is the perpetration of, failure to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations. The current study used this proposed definition to conduct a qualitative phenomenological investigation of the lived experience of moral injury among combat Veterans of the wars in Iraq and/or Afghanistan. Eight male combat Veterans who self-identified as having the experience of moral injury as put forth in the proposed definition, were individually interviewed.
    [Show full text]