Complex Moral Injury: Shattered Moral Assumptions.

Area of Science:

• Psychology
• Trauma Studies
• Military Mental Health

Background:

• Standard moral injury (S-MI) is often linked to perpetration and violation of moral beliefs.
• Previous research explored paradoxical circumstances inflicting moral injury (MI) in wartime.
• There's a need to expand MI research beyond perpetration to include events shaking core beliefs about self and the world.

Purpose of the Study:

• To introduce an infographic model distinguishing complex moral injury (C-MI) from S-MI.
• To define C-MI as a worldview discrepancy-induced form of MI.
• To explore the mechanisms and potential therapies for C-MI based on existing theories.

Main Methods:

• Conceptual paper introducing an infographic model.
• Review of definitional, scale, and qualitative studies on moral injury.
• Integration of theories on assumptive worlds and meaning-making.
• Illustration using case studies from a Veterans Administration hospital.

Main Results:

• Evidence supports a nuanced, complex form of MI (C-MI) characterized by moral disorientation.
• C-MI arises from disrupted foundational moral beliefs failing to appraise ethical problems or inform moral identity.
• Interrelations between MI, assumptive world, and meaning theories illuminate C-MI mechanisms.

Conclusions:

• The proposed model differentiates C-MI from S-MI, expanding the understanding of moral injury.
• Clinical implications include recognizing events that shatter fundamental moral assumptions.
• Chaplains may play a role in C-MI recovery through acceptance and meaning-making.
• A plausible scale for future empirical research on C-MI is discussed.