Moral Injury: Modern Approaches to the Definition of the Concept, Etiology, Diagnosis, and Psychotherapy
https://doi.org/10.21603/2078-8975-2021-23-2-438-446
Abstract
In this article, the authors reviewed foreign publications on the issue of moral injury, its causes, diagnosis, and psychotherapy. Foreign experts do not consider this phenomenon as a mental pathology. They define it as a syndrome characterized by a sense of shame, guilt, and obsessive thoughts as a consequence of one’s inability to prevent one’s own actions or the actions of other people. The authors made an attempt to compare and contrast the concepts of "post-traumatic stress disorder" and "moral injury". The review also featured psychotherapy of moral injury and methods of psychological first aid to different categories of people, e.g. psychologists, medical workers, and others. Unfortunately, the issue of moral injury still remains largely understudied in domestic science.
About the Authors
R. V. Kadyrov
Pacific State Medical University
Russian Federation
Russian Federation
Vladivostok
O. B. Dmitrieva
Pacific State Medical University
United Arab Emirates
United Arab Emirates
Vladivostok
References
1. Bélanger S. A. H., Cramm H., Fletcher K., Demers J.-S. PTSD vs. moral injury: a scoping review. Journal of Military, Veteran and Family Health, 2018, 4(1): 2–4. DOI: 10.3138/jmvfh.4.1.002
2. Williamson V., Murphy D., Greenberg N. COVID-19 and experiences of moral injury in fron-tline key workers. Occupational Medicine, 2020, 70(5): 317–319. DOI: 10.1093/occmed/kqaa052
3. Williams R. D., Brundage J. A., Williams E. B. Moral injury in times of COVID-19. Journal of Health Service Psychology, 2020, 46(2): 65–69. DOI: 10.1007/s42843-020-00011-4
4. Bartzak P. J. Moral injury is the wound: PTSD is the manifestation. Medsurg Nursing , 2015, 24(3): 10–11.
5. Litz B. T., Contractor A. A., Rhodes C., Dondanville K. A., Jordan A. H., Resick P. A., Foa E. B., Young-McCaughan S., Mintz J., Yarvis J. S., Peterson A. L. Distinct trauma types in military service members seeking treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 2018, 31(2): 286–295. DOI: 10.1002/jts.22276
6. Beard M. T. Distinguishing PTSD from moral injury: conceptual and experiential approaches. The Australasian Association of Philosophy, at Macquarie University on July 9th, 2015. Available at: https://www.academia.edu/13862065/ (accessed 12 Apr 2021).
7. Papazoglou K., Chopko B. The role of moral suffering (moral distress and moral injury) in police compassion fatigue and PTSD: an unexplored topic. Front. Psychol., 2017, 8. DOI: 10.3389/fpsyg.2017.01999
8. Drescher K. D., Foy D. W., Kelly C., Leshner A., Schutz K., Litz B. An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology, 2011, 17(1): 8–13. DOI: 10.1177/1534765610395615
9. Maguen S., Lucenko B. A., Reger M. A., Gahm G. A., Litz B. T., Seal K. H., Knight S. J., Marmar C. R. The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. Journal of Traumatic Stress, 2010, 23(1): 86–90. DOI: 10.1002/jts.20434
10. Caplan P. J. When Johnny and Jane come marching home: how all of us can help veterans. Cambridge, MA: MIT Press, 2011, 282.
11. Rozek D. C., Bryan C. J. A cognitive behavioral model of moral injury. Addressing moral injury in clinical practice, eds. Currier J. M. , Drescher K. D., Nieuwsma J. American Psychological Association, 2021, 19–33. DOI: 10.1037/0000204-002
12. Litz B. T., Stein N., Delaney E., Lebowitz L., Nash W. P., Silva C., Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clinical Psychology Review, 2009, 29(8): 695–706. DOI: 10.1016/j.cpr.2009.07.003
13. Silver D. Beyond PTSD: Soldiers have injured souls. 3 Sep 2011. Available at: https://truthout.org/articles/beyond-ptsdsoldiers-have-injured-souls/ (accessed 12 Apr 2021).
14. Jameton A. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall, 1984, 331.
15. Shay J. Moral injury. Psychoanalytic Psychology, 2014, 31(2): 182–191. DOI: 10.1037/a0036090
16. Williamson V., Stevelink S. A. M., Greenberg N. Occupational moral. Br J Psychiatry, 2018, 212(6): 339–346. DOI: 10.1192/bjp.2018.55
17. Stein N. R., Mills M. A., Arditte K., Mendoza C., Borah A. M., Resick P. A., Litz B. T. A scheme for categorizing traumatic military events. Behavior Modification, 2012, 36(6): 787–807. DOI: 10.1177/0145445512446945
18. Ramage A. Е., Litz B. Т., Resick P. А., Woolsey M. D., Dondanville K. A., Young-McCaughan S., Borah A. M., Borah E. V., Peterson A. L., Fox P. T. Regional cerebral glucose metabolism differentiates danger- and non-danger-based traumas in posttraumatic stress disorder. Soc Cogn Affect Neurosci, 2016, 11(2): 234–242. DOI: 10.1093/scan/nsv102
19. Sun D., Phillips R. D., Mulready H. L., Zablonski S. T., Turner J. A., Turner M. D., McClymond K., Nieuwsma J. A., Morey R. A. Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder. Depress Anxiety, 2019, 36(5): 442–452. DOI: 10.1002/da.22883
20. Jones E. Moral injury in a context of trauma. Br J Psychiatry, 2020, 216(3): 127–128. DOI: 10.1192/bjp.2020.46
21. Farnsworth J. K., Drescher K. D., Nieuwsma J. A., Walser R. B., Currier J. M. The role of moral emotions in military trauma: implications for the study and treatment of moral injury. Review of General Psychology, 2014, 18(4): 249–262. DOI: 10.1037/gpr0000018
22. Griffin B. J., Purcell N., Burkman K., Litz B. T., Bryan C. J., Schmitz M., Villierme C., Walsh J., Maguen S. Moral injury: an integrative review. J Trauma Stress, 2019, 32(3): 350–362. DOI: 10.1002/jts.22362
23. Currier J. M., Holland J. M., Rojas-Flores L., Herrera S., Foy D. Morally injurious experiences and meaning in Salvadorian teachers exposed to violence. Psychol Trauma, 2015, 7(1): 24–33. DOI: 10.1037/a0034092
24. Haight W., Sugrue E., Calhoun M., Black J. A scoping study of moral injury: identifying directions for social work research. Children and Youth Services Review, 2016, 70: 190–200. DOI: 10.1016/j.childyouth.2016.09.026
25. Feinstein A., Pavisian B., Storm H. Journalists covering the refugee and migration crisis are affected by moral injury not PTSD. JRSM Open, 2018, 9(3). DOI: 10.1177/2054270418759010
26. Frankfurt S., Frazier P. A. A review of research on moral injury in combat veterans. Military Psychology, 2016, 28(5): 318–330. DOI: 10.1037/mil0000132
27. Hodgson T. J., Carey L. B. Moral injury and definitional clarity: betrayal, spirituality and the role of chaplains. J Relig Health, 2017, 56(4): 1212–1228. DOI: 10.1007/s10943-017-0407-z
28. Cunningham K. C., Davis J. L., Wilson S. M., Resick P. A. A relative weights comparison of trauma-related shame and guilt as predictors of DSM-5 posttraumatic stress disorder symptom severity among US veterans and military members. Br J Clin Psychol, 2018, 57(2): 163–176. DOI: 10.1111/bjc.12163
29. Vermetten E. J., Jetly R. A critical outlook on combat-related PTSD: review and case reports of guilt and shame as drivers for moral injury. Mil Behav Health, 2018, 6(2): 156–164. DOI: 10.1080/21635781.2018.1459973
30. Zerach G., Levi-Belz Y. Moral injury process and its psychological consequences among Israeli combat veterans. J Clin Psychol, 2018, 74(9): 1526–1544. DOI: 10.1002/jclp.22598
31. Frankfurt S. B., DeBeer B. B., Morissette S. B., Kimbrel N. A., La Bash H., Meyer E. C. Mechanisms of moral injury following military sexual trauma and combat in post9/11 U.S. war veterans. Front Psychiatry, 2018, 9: art. 520. DOI: 10.3389/fpsyt.2018.00520
32. Currier J. M., McCormick W., Drescher K. D. How do morally injurious events occur? A qualitative analysis of perspectives of veterans with PTSD. Traumatology, 2015, 21(2): 106–116. DOI: 10.1037/trm0000027
33. Nash W. P., Carper T. L. M., Mills M. A., Au T., Goldsmith A., Litz B. T. Psychometric evaluation of the moral injury events scale. Military Medicine, 2013, 178(6): 646–652. DOI: 10.7205/MILMED-D-13-00017
34. Wood D. Healing. Can we treat moral wounds? Moral Injury, 20 Mar 2014. Available at: http://projects.huffingtonpost. com/moral-injury/healing (accessed 6 Mar 2021).
35. Bryan C. J., Bryan A. B. O., Anestis M. D., Anestis J. C., Green B. A., Etienne N., Morrow C. E., Ray-Sannerud B. Measuring moral injury: psychometric properties of the moral injury events scale in two military samples. Assessment, 2016, 23(5): 557–570. DOI: 10.1177/1073191115590855
Review
For citations:
Kadyrov R.V., Dmitrieva O.B. Moral Injury: Modern Approaches to the Definition of the Concept, Etiology, Diagnosis, and Psychotherapy. The Bulletin of Kemerovo State University. 2021;23(2):438-446. (In Russ.) https://doi.org/10.21603/2078-8975-2021-23-2-438-446
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