Moral injury, coherence, and spiritual repair

Moral Injury

“…Furthermore, individuals who have endured perpetration-based and morally injurious traumatic experiences encounter sequelae that are distinct from the sequelae encountered by those with life-threat traumatic experiences. While life-threat traumas typically arouse fear and elicit hyperarousal difficulties and symptoms of PTSD, perpetration-based and morally injurious traumas tend to be characterized by feelings of shame, guilt, anger, and/or self-blame and elicit reexperiencing, avoidance, self-injurious behavior, and meaning making difficulties, including spiritual struggles and a shattering of one's assumptive and/or spiritual world (Antal & Winings, 2015;Currier et al, 2019;Drescher et al, 2011;Farnsworth et al, 2014;Frankfurt & Frazier, 2016;Griffin et al, 2019;Harris et al, 2015;Held et al, 2019;Hodgson & Carey, 2017;Kopacz et al, 2016;Kopacz et al, 2015;Litz et al, 2009;Maguen & Litz, 2012;Neria & Pickover, 2019;Sreenivasan et al, 2014;Starnino et al, 2019;Steinmetz et al, 2019;Vargas et al, 2013;Yeterian et al, 2019;Zerach & Levi-Belz, 2019).…”

“…Counterinsurgency guerilla warfare, especially in urban contexts, involves unconventional features "that produce greater uncertainty, greater danger for noncombat troops, and generally greater risk of harm among non-combatants" (Litz et al, 2009, p. 696). The conditions also yield a greater likelihood of service members using their weapons, acting unnecessarily aggressive with enemy or civilian non-combatants, violating rules of engagement, being aware that they killed a member of the enemy troops, and being aware that they killed or harmed non-combatants (Drescher et al, 2011;Kopacz et al, 2016;Sreenivasan et al, 2014;Starnino et al, 2019;Vargas et al, 2013). The use of guerilla warfare, along with the fact that combatants are deployed for longer periods of time, means there is a greater likelihood that service members will encounter a potentially morally injurious traumatic experience (Litz et al, 2009;Vargas et al, 2013).…”

“…Additionally, those developing treatment models targeting moral injury recognize the stigma surrounding pathology in the military and have accordingly adjusted the way that they frame and name their treatments (Litz et al, 2016;Maguen et al, 2017;Nieuwsma et al, 2015). They also appreciate the communal, brotherly ethos of the military, which is reflected in the communal nature of many moral injury-targeted treatments (Doehring, 2019;Fawson, 2019;Graham, 2017;Harris et al, 2011;Liebert, 2019;Ramsay, 2019;Starnino et al, 2019;Yandell, 2019).…”

“…Though growth after moral injury is commonly referred to as "moral repair" in both the clinical and pastoral fields (Carey et al, 2016;Litz et al, 2009), many of the pastoral researchers and clinicians also refer to the growth process as "spiritual repair" or "soul repair" in their suggestions for treatment (Antal & Winings, 2015;Graham, 2017;Hodgson & Carey, 2017). Pastoral treatment models tend to treat the "soul" and religion/spirituality as central to the moral injury healing process and often suggest the use of rituals or religious/spiritual figures (i.e., chaplains, clergy, or spiritual care providers) to aid the recovery of moral injury Carey et al, 2016;Doehring, 2019;Graham, 2017;Hodgson & Carey, 2017;Liebert, 2019;Meador & Nieuwsma, 2018;Ramsay, 2019;Starnino et al, 2019). Many of the pastoral treatment models emphasize the importance of lamentation, specifically sharing anguish, interrogating causes, and reinvesting hope (Doehring, 2019;Graham, 2017;Liebert, 2019;Ramsay, 2019).…”

“…This individual treatment model allows individuals to describe, reflect upon, and reconstruct their morally injurious experience with the guidance of a chaplain, hopefully leading to the restoration and renewal of their moral conscience. SFM follows a similar confessional process that takes place over eight sessions guided by a VA chaplain, except in a group therapy setting (Starnino et al, 2019). Though PND and SFM are structured and professional models of treatment, they still provide culturally sensitive and contextualized care.…”