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Background: Moral injury (MI) is similar to PTSD in roles and DSM-IV criteria with the exception that emotions displayed are guilt, shame and anger and the person experiences a loss of trust (Shay, 2014). MI can be defined as a psychological violation of one’s deeply held moral beliefs which result in feelings of despair and betrayal. Until the turn of the century, the negative impact of MI on veterans had not been heavily researched with veterans. The impact of moral injury has been studied exhaustively with nurses and medical staff (Schluter, Winch et.al.,2008). The first documented study of moral injury on military personnel came from the lived experiences of military nurses. (Fry, Harvey et al., 2002) followed by a dearth in veteran research until 2009 (Litz, Steinet.al., 2009).
Methods: This qualitative interpretive meta-synthesis (QIMS) harnessed the amassed qualitative work with veterans and presents their findings in a collective and novel thematic display with new and emerging ideas which can be extrapolated for further use and applied to other theories. The QIMS method was developed specifically for social work and involves synthesizing the results of multiple qualitative studies on a specific topic into a new synergistic understanding. We started by conducting a broad search of qualitative research focused on the specific topic of moral injury. We narrowed it down to eight studies which meet the criteria. We combined quotes from these eight studies and searched for new emerging themes.
Results: We conducted a meta-synthesis using eight previously published interviews from the United States, Canada and the Netherlands. From there, we read deeper into the voices to extrapolate new themes and view the qualitative data in a new way. We found that the veterans described the impact of their moral injury with three main themes of individual incongruence, social incongruence, and spirituality. They described how they knew they had changed personally, and how they were received back in society by non-military members. Responses from veterans display an unwelcome reception resulting in isolation, loss of identity and a longing for some veterans to return to the connections they shared while serving in the military.
Implications: While medicine has moved to diagnose and treat traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), this QIMS hopes to inform clinicians and spiritual leaders how to recognize moral injury among veterans. Similar to PTSD, moral injury has an impact on a veterans social and emotional well-being. As researchers get close to identifying diagnosing criterium for moral injury, it is important for clinicians to know how to identify and treat veterans with symptoms of MI.