The importance of our moral understanding of right and wrong, good and evil, cannot be overstated. It shapes our actions, evaluations, and overall sense of integrity. When this moral concept is disrupted by something we have done, witnessed, or been subjected to, it can lead to feelings of guilt, shame, and confusion.
The idea of “moral injury” or “moral pollution” resulting from engaging in, witnessing, or experiencing misconduct is prevalent in societies and has been explored in great literature throughout history. Psychologists have only recently started using the term ‘moral injury’ to describe the state caused by a disturbance in one’s moral beliefs. Early descriptions came from veterans’ experiences, with further development in the scientific literature by researchers like Brett Litz, highlighting the unique aspects of moral injury compared to PTSD.
In nursing literature, a similar phenomenon known as ‘moral distress’ has been described, where nurses feel constrained by institutional limitations from acting in alignment with their moral beliefs. These experiences can give rise to significant moral turmoil.
While there has been considerable research on moral injury and moral distress, much of it has been developed independently. The focus has primarily been on the context of committing wrongdoing or witnessing it, with less attention given to the experiences of victims. However, victims can also experience moral injury, which can profoundly shake their understanding of right and wrong.
Researchers at Harvard’s Human Thriving program have been working to develop a unified approach to understanding moral injury and moral distress that applies to perpetrators, witnesses, and victims. By bringing together experts in the field, they published a paper on moral trauma, aiming to improve clinical attention to these issues.
The concept of a “moral trauma spectrum” was introduced to encompass the range of moral distress and injury experiences. Moral need was defined as arising from personal experiences that challenge one’s sense of goodness or beliefs about right and wrong. If this suffering persists, it may escalate to moral injury, and in severe cases, moral injury disorder.
The comprehensive definitions allow for a common assessment of moral trauma, including various symptoms such as guilt, shame, betrayal, anger, and loss of trust. The goal is to enhance understanding and promote better clinical care for individuals experiencing moral distress and injury.
In a significant development, the American Psychiatric Association included “moral problems” in the DSM-5-TR, recognizing the impact of moral distress and injury on mental health. This acknowledgment opens up opportunities for increased awareness and treatment of these issues.
As individuals, we are not just physical and mental beings but also social, moral, and spiritual. Addressing social, moral, and spiritual challenges is essential for holistic care. Recognizing and addressing moral distress and injury is crucial for providing personalized care and promoting overall well-being.
In conclusion, greater awareness and reflection on moral issues are necessary in patient care and society as a whole. By acknowledging and addressing moral distress and injury, we can better navigate the challenges of suffering and promote growth and healing on both individual and societal levels.