Moral Injury

In addition to PTSD, many CADIs (those who caused Accidental Death or Injury) experience a constellation of feelings and thoughts known as moral injury – the distress that comes from failing to live up to our moral standards, expectations or aspirations. Even though we did not intend harm, we no longer see ourselves as good people, which is profoundly upsetting. We no longer see ourselves as deserving of respect, support, happiness, or acceptance. We live in guilt and shame.

Dr. Rita Brock, an expert in moral injury, describes it as “a normal response to moral failure that can happen to any human being with a conscience.”

Unlike PTSD, moral injury is not a formal diagnostic category used by doctors or therapists. While it overlaps with PTSD, it is not the same. PTSD is primarily fear-based, while moral injury is guilt-based.

According to Dr. Brett Litz, moral injury symptoms fall into three categories:

  1. self-injury, such as abusing alcohol or other substances or feeling suicidal;
  2. demoralization, such as feeling worthless, feeling like your life is without meaning, despair, spiritual questioning, or a loss of faith
  3. self-handicapping, such as social isolation or not allowing yourself to experience positive emotions like happiness or pride

Moral injury includes both psychological and spiritual aspects. You can seek support and help in psychotherapy and by talking with your pastor or other clergy. Here are a few other steps you can take to support yourself.

  1. Remember that this accident, regardless of blame and fault, does not define you. We are so much more than the worst mistake we’ve ever made.
  2. Guilt is appropriate when we harm someone. It’s what we do with the guilt – how we channel or use it – that matters. Some CADIs are paralyzed by guilt and shame; others try to avoid these feelings or “get over them.” Instead, consider how you can use your guilt to fuel action that makes the world a better place. Some refer to this as making amends or reparations. We cannot make up for taking a life, but we can accept responsibility and take steps to help others.
  3. Check out our Resources page to learn more.
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