Recently, I had the opportunity to attend another veteran wellness retreat with an organization known as Mission Flexible. The group jokingly refers to themselves as MF’ers, and if you have any affiliation with the military community, you know that this is not only hilarious but welcomed in so many ways. The retreat, over 3-4 days, focuses on mental, emotional, and physical resilience. The focus is also cultivating camaraderie amongst veterans who have possibly isolated or felt unwelcome in their community, office, etc. These retreats never seem long enough.
During this most recent retreat, we discussed a topic which I had never heard of before, ‘Moral Injury’. Moral Injury is the lasting psychological distress that can occur when individuals engage in, witness, or learn about actions that violate their deeply held moral beliefs and values. This injury can result in moral pain or trauma that potentially leads to feelings of guilt, shame, anger, and even betrayal. It has the potential to impact someone’s worldview and even how they view themselves.
I had never heard of a Moral Injury before, but this topic stuck with me over the entirety of the weekend. As a public affairs representative in the military, I can say honestly that this is a very real concept. The term ‘woo woo’ feelings or thoughts, snowflakes, weaklings, etc., can feel like the first reaction to hearing a term like this. But give me a moment to put this into perspective.
A real unknown
According to the VA’s website, ‘Most research to understand Moral Injury has been with military service members and Veterans, as the nature of war and combat create situations where people may have experiences that contradict the values they live by in civilian life’. The website continues saying that ‘examples of potentially morally injurious events in the context of war include killing or harming others, when officers have to make decisions that affect the survival of others, when medics are not able to care for all who were harmed, freezing or failing to perform a duty during a dangerous or traumatic event (for example, falling asleep on patrol), failing to report an event that violates rules or ethics, engaging in or witnessing acts of disproportionate violence and feeling nothing or exhilaration while causing harm to or killing others.’
The VA’s website continues by stating that Moral Injury has a great deal of overlap with PTSD. Guilt and shame are the core features of both diseases, as well as a loss of trust and feelings of betrayal. Having both Moral Injury and PTSD can cause a greater likelihood of suicidal intent and behaviors.
When it comes to testing for Moral Injury, it’s essential to identify exposure to a ‘potentially morally injurious event’ (PMIE) and directly link symptoms to that event rather than assessing symptoms in isolation. The Moral Injury Outcomes Scale (MIOS) and the Moral Injury and Distress Scale (MIDS), both of which measure shame, trust, and distress across high-risk populations like veterans and healthcare workers, are ways of validating if a Moral Injury has occurred. Other tools, such as the Moral Injury Questionnaire (MIQ), Moral Injury Events Scale (MIES), and Expression of Moral Injury Scale (EMIS), focus on war-related experiences and emotional responses like guilt, shame, and betrayal. These tools are how facilities like the VA are identifying what events are causing Moral Injury in our military community.
The Afghanistan Withdrawal
One such event that is a recent catalyst of Moral Injury is the ‘end’ of our involvement in Afghanistan. In August of 2021, due to a previously struck deal between the U.S. and the Taliban, there was a significant withdrawal of American forces from the country of Afghanistan. A short timeline and a lot of bad decisions led to a scrambled maneuver by our government to withdraw from the country quicker than planned. On August 26, there was a bombing at the Kabul Airport that killed 13 U.S. service members and over 170 Afghan civilians. The poorly handled withdrawal created a perfect opportunity for the Taliban to regain control of the country, marking a significant shift in power.
As all of this was occurring, service members, veterans, and their families all began to think, ‘what was it all for then?’ Why did we just spend the majority of our lives deployed, away from our families, putting our lives at risk, and losing good people, if at the end of the day, we were just going to hand it all back to them on a silver platter?
These thoughts and questions caused a lot of significant emotions in those who have any connection to these conflicts. According to a publication by the National Veterans Foundation, “the fact that the long conflict in Afghanistan is over is simply unavoidable. Likewise, the feelings of anger, frustration, and sadness many Veterans feel after seeing images of the US withdrawal are just as unavoidable. So many of these images are already heartbreaking and upsetting to civilians who view them; for Veterans of the Afghanistan conflict, these are often much worse.”
The feelings and emotions of the military community witnessing the conclusion of 20 years of conflict in such a way are nothing short of a perfect definition of Moral Injury. The inability to speak up, to feel heard, to feel seen, is traumatizing.
Military Sexual Trauma
MST can lead to Moral Injury in every corner of the military community, both for survivors and those around them. The trauma is amplified when the perpetrator is a trusted leader, peer, or subordinate. When it is someone who was supposed to have their back. The sense of betrayal intensifies when the military, an institution founded on values like honor, respect, and loyalty, fails to protect them or respond appropriately. Many survivors report feelings of abandonment, especially when they are retaliated against after reporting the assault. The injury deepens if they are forced to continue serving alongside or under their abuser. This leads to ongoing psychological harm.
Moral Injury also impacts witnesses or peers who are aware of the assault but feel powerless to intervene. These service members, veterans, friends, etc., may carry guilt for not acting or experience anger at a system that silences victims and shields the perpetrators. This creates an internal moral conflict, forcing them to choose between what they know is right and what is expected by the military hierarchy.
Leadership can also suffer and may feel torn between doing the right thing for their soldiers and following the institution’s guidance or protecting its reputation. Some leaders later come to regret their inaction or complicity, leading to deep disillusionment with the system they once believed in. Many times, we think that leaders in the military are complicit and just want to ‘sweep’ the incident under the rug. We don’t often think that they might be afraid as well.
HOW DO WE BOUNCE BACK?
Treating Moral Injury requires a holistic approach that extends beyond traditional trauma therapy. While PTSD is primarily rooted in fear-based responses, Moral Injury stems from the violation of deeply held moral beliefs, often resulting in emotions such as guilt, shame, betrayal, and a profound loss of trust. Effective treatment must address this internal conflict by restoring meaning and rebuilding trust—both in oneself and in others.
The healing journey begins with acknowledging the Moral Injury itself. This means naming the injury, identifying its connection to the emotional pain, and recognizing the inner struggle of those affected. Trauma-informed therapy plays a critical role here, with modalities such as Cognitive Processing Therapy, Acceptance and Commitment Therapy, and Eye Movement Desensitization and Reprocessing offering focused interventions. Because Moral Injury often involves spiritual or existential distress, spiritually integrated care is also important—chaplains, pastors, and counselors can help individuals reconnect with lost meaning and trust.
Group therapy and peer support are invaluable, as sharing experiences fosters validation, connection, and the opportunity to be both witnessed and heard. This process can strengthen identity and assist in restoring trust. Additionally, narrative and meaning-making approaches—such as openly discussing the injury and exploring one’s moral framework—can help individuals reclaim the significance of their stories. Acts of service or restitution, like volunteering, mentoring, advocacy, or education, offer a pathway to reaffirm personal values and rediscover purpose, acting as powerful tools for repair.
Moral Injury is not something that is simply “cured.” It must be acknowledged, understood, and compassionately navigated. Healing is often about the restoration of personal identity, values, and relationships, all of which take time and support. Reaching out to those who served alongside you, to those impacted, or even to those unaware of the harm they experienced, can be a courageous and healing act. We must honor the reality that service members invest their hearts and souls in their missions—and when those missions lead to dissonance or betrayal, whether on a global scale or within a tight-knit unit, the resulting impact can reverberate through their moral core, affecting not just their operational readiness but their entire sense of self.
