Moral injury and the potential utility of art therapy in treatment

Abstract: Moral injury is defined as profound psychological distress that is experienced after an event(s) that violates one’s deeply held moral or ethical code. Morally injurious events typically include acts of omission, commission or betrayal by trusted others. Unlike ‘classically’ traumatic or frightening events, potentially morally injurious events (PMIEs) do not necessarily involve a threat to life. Nonetheless, PMIEs can cause feelings of significant shame, guilt, anger and worthlessness and can contribute towards negative appraisals about the self (eg, ‘I am a terrible person’, ‘I am a failure’) and others (eg, ‘my colleagues don’t care about me’). These alterations in beliefs and affect can in turn contribute towards the development of a range of mental health difficulties, including post-traumatic stress disorder (PTSD), depression and suicidal ideation.