Moral Injury: An Extremely Damaging Phenomenon

People who attack or make fun of your values might accuse you of being too sensitive. However, moral damage is a form of aggression and no one should cross this line. In fact, the psychological cost can be extremely high.
Moral Injury: An Extremely Damaging Phenomenon
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 21 December, 2022

Moral injury is a wound, an attack from the environment on your system of beliefs, principles, and values. Do you have a job where you have to do things that go against your principles? That’s a blow to your morale. Do you have a relationship in which your partner boycotts your opinions? That’ll also damage your morale.

Moral injury isn’t discussed much. One group that has a tendency to suffer from this particular psychological reality is health professionals. That’s because many of them find themselves in the position of having to face important ethical dilemmas in the midst of a health system that often fails them. In fact, they can’t always do their jobs the way they really want to.

Hospitals and health centers have many deficiencies which means that the care offered isn’t always adequate. Indeed, even if doctors, nurses, or assistants want to, they can’t always give their best. This causes immense suffering.

An investigation conducted by Antonio Ventriglio and colleagues claimed that the rate of doctors who choose to take their own lives is double that of the general population. That’s because they experience extreme mental wear and tear and their value systems become annihilated. Unsurprisingly, the effects are immense. This corrosive form of sadness and exhaustion shouldn’t be neglected. It proves that moral injury can destroy us.

“It is your job to comport yourself humbly and to consistently hew to your moral ideals. Cling to what you know in your heart is best.”

-Epictetus-

A sad man looks sitting in the living room from the balcony of his house thinking about when they touch our morals
The violation of deeply rooted values shakes our identity.

Moral injury

As humans, we’re not what we possess, we’re everything we believe in. For this reason, when your morals are damaged, you feel more than simple offense or annoyance. In fact, when the values that are rooted in your very being are attacked or contradicted, the core of your identity and your self-concept fracture. Nothing could be more harmful.

However, today, we all live in a state of constant moral tension that completely undermines our fundamental principles and what we consider to be ethical. For example, war, in any of its forms, is an attack on morality. As are injustices, discrimination, lack of freedom, etc.

Maybe you know what moral injury is but you haven’t given it enough importance. That’s because you don’t necessarily have to be physically assaulted or insulted to feel hurt. Contexts such as work, a relationship, or a family environment can also cause this type of injury. Therefore, it’s important to listen to yourself and know how to detect its effects.

You experience threats to your integrity and identity in a really similar way to physical threats.

The symptoms and consequences of moral injury

When you experience continuous moral injury, your brain changes. You start to interpret the experience as a threat similar to physical aggression. It’s the violation of those moral pillars that, for you, were apparently unbreakable, yet they’ve collapsed. Either because of you or the influence of third parties.

Failing at work, making a serious mistake with someone, doing something that goes against your values because of outside pressure, or being in an abusive relationship breaks you. They’re assaults on your morality that you experience in the same way as a physical attack. The effects are usually as follows:

  • Emotions such as guilt, self-disgust, shame, anger, rage, sadness, and anxiety appear.
  • Self-loathing is a constant and extremely harmful feeling.
  • You experience feelings of deep disillusionment with institutions, people, and yourself.
  • You suffer an existential crisis that often leads to depression.
  • Countless psychosomatic effects occur. For instance, insomnia, muscle pain, headaches, gastrointestinal disturbances, weakness, exhaustion, etc.

Moral injury is often translated into an ‘acute stress response’, an effect similar to post-traumatic stress disorder.

Man doing therapy for when our morals are touched
Somatic therapy can be helpful in dealing with situations where a person is dealing with moral injury.

Healing the wound of moral injury

When our morals suffer long-term bombardment, we tend to become blocked. In fact, our emotions are so intense and painful that we become numb. This happened a great deal during the pandemic. Many medical professionals found themselves in extreme situations, with hardly any resources and completely overwhelmed. This meant that their patients couldn’t be treated properly which affected the medics deeply.

The trauma experienced was (and is) immense. The same happens with those who deal with any other extreme work situation, also with people who suffer harmful family or partner ties. Moral injury distorts who they are and what they believe in and this paralyzes them.

For this reason, it’s good to start with somatic therapy, aimed at ensuring that emotions attached to the body and that cause pain and illness end up being externalized and verbalized. Breathing and relaxation techniques and movements or stretching achieve that connection and, ultimately, a catharsis.

Later, conversational therapy begins, in which the lived experiences, the thoughts that accompany them, and the emotions that cause suffering are treated.

Healing these experiences takes time. Self-compassion and forgiveness will facilitate an adequate journey toward liberation and well-being.

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  • DeMarco, M. (2020). The PTSD-like Affliction That’s Traumatizing Health Care Workers. Elemental. https://elemental.medium.com/the-ptsd-like-affliction-thats-traumatizin…
  • Nieuwsma, J.A., O’Brien, E.C., Xu, H. et al. Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers. J GEN INTERN MED 37, 2033–2040 (2022). https://doi.org/10.1007/s11606-022-07487-4
  • Ventriglio A, Watson C, Bhugra D. Suicide among doctors: A narrative review. Indian J Psychiatry. 2020 Mar-Apr;62(2):114-120. doi: 10.4103/psychiatry.IndianJPsychiatry_767_19. Epub 2020 Mar 17. PMID: 32382169; PMCID: PMC7197839.

The contents of Exploring Your Mind are for informational and educational purposes only. They don't replace the diagnosis, advice, or treatment of a professional. In the case of any doubt, it's best to consult a trusted specialist.