Conceptual Properties of Moral Injury: Expanding the Concept of MI Beyond the Military Experience

Moral injury encapsulates the psychosocial repercussions from involvement in morally transgressive events as perpetrator and/or victim. Historically, moral injury (MI) research centered work with combat veterans, but emerging research focuses on MI from a non-combat perspective. Defined as “…lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations (Hoffman & Nickerson, 2020)� MI is an evolving concept. For victims, it is an injury linked to suffering from violation of dignity, physical, social or emotional assaults, especially for members of marginalized groups. Expanding the conceptualization of moral injury beyond the military prioritizes marginalized and vulnerable individuals, placing them at the forefront of research, policy development, and approaches to heal the injury (Kellison, 2021). Furthermore, failure to acknowledge victim suffering inflicts moral injury, as the anguish of being ignored is an afront to one’s humanity (Kellison, 2021). This roundtable seeks to uncover common elements of MI across groups of people and experiences resulting in similar injuries; and approaches to healing, drawing from a review of the literature and a scoping review co-authored by several of the presenters. Reviewed publications included conceptual papers, qualitative and quantitative research, including grey literature. The majority of papers concentrated on MI, potentially morally injurious experiences (PMIEs) and associated factors, conceptual properties of the injury, symptomatology and treatment modalities associated with military personnel or war veterans. Fewer papers focused on victims of non-military populations. These included members of high stress professions, such as health care workers, epidemiological scientists, teachers in a post Covid reality, police officers, US Immigration enforcement personnel, and victims of rape and IPV. Conceptual properties of MI cluster around four interlocking experiences: betrayal, loss of trust, shame and guilt. At the core of MI is an act of real or perceived betrayal. Betrayal can be in the form of an overt action, a physical assault, a micro-trauma or trans-generational narrative. It may come in the form of disrespect in the Hegelian sense, (Honneth, 1996), social exclusion, gaslighting or eraser experiences. The resultant experience is a sense of shame, guilt and disillusionment that strikes deep into the psyche or soul of the victim, shaking their sense of self. Symptoms often mimic PTSD, but MI, unlike PTSD, does not have a precipitating event, and is more often associated with on-going lived experiences, an application most apropos to marginalized groups. Importantly, MI is also viewed as an injury and not a disorder. This panel includes five speakers that explore potentially morally injurious events (PMIE) among various populations, non-tribal Native American descendants, post-Apartheid South African Blacks living in rural townships, US police officers, and providers of services to immigrant refugees, refugees and asylum seekers. Culturally grounded strategies for healing are also explored in the context of the populations impacted. The roundtable is designed to share our thinking with participants as a means of expanding the discussion, obtaining feedback, and advancing social work’s recognition of and capacity to respond to MI.