Experiences of moral injury in UK military veterans

Abstract: For many years, researchers have looked at the impact of traumatic events which threaten life and limb and may contribute towards the onset of post-traumatic stress disorder (PTSD). But until recently, feelings of deep shame and guilt, stemming from doing, or not preventing, incidents that one believes are “wrong”, and which are often a feature of trauma exposure, have not been studied to any great extent. Moral injury can be defined as the psychological distress that results from actions, or the lack of them, which violate one’s moral or ethical code (1). Unlike PTSD, moral injury is not a mental illness. However, moral injury can lead to negative thoughts about oneself or others (for example, “I am a terrible person” or “my colleagues don’t care about me”) as well as deep feelings of shame, guilt or disgust. These, in turn, can contribute to the development of mental health difficulties, including depression, PTSD and suicidal ideation (2). Moral injury is not unique to any particular profession. However, to date the majority of the evidence of moral injury, and its impact on wellbeing, has stemmed from studies conducted with US military personnel and veterans. Research in this population has shown moral injury can be caused by a range of experiences including committing harmful acts, failing to stop the harmful acts of others or bearing witness to human suffering (3). These studies have shown that moral injury can be linked to poor mental health outcomes. Despite this, a formal investigation of military-related moral injury exposure and its impact on wellbeing has yet to be conducted in the UK. There is currently no manualised treatment for moral injury-related mental health difficulties and the experiences of clinicians in providing care to those affected by moral injury remains poorly understood. Given the body of evidence supporting the existence and adverse impact of moral injury on psychological wellbeing in Armed Forces (AF) personnel/veterans in other countries, and given the specific culture of the UK military, an investigation of moral injury in UK AF context is overdue.