Moral Injury: Understanding, Healing, and Moving Forward with Acceptance and Commitment Therapy…

Monday, April 29, 2024. This piece on moral injury is for KAM. I’m happy to be fairly acknowledged, even if anonymously…. but I was hardly returning the favor… I guess you’ll never muster the common decency to say my name.. You’d rather just erase me. So be it.

On the other hand, you’ve accomplished remarkable things. You’ve changed the very face of couples therapy. No one can dispute that simple fact. Peace.

In recent years, the concept of moral injury has gained increasing attention in the field of marriage and family therapy.

Coined originally in the context of combat veterans, moral injury refers to the psychological, social, and spiritual harm that arises from actions, or the lack thereof, that transgress deeply held moral beliefs and expectations.

It can occur in various contexts beyond the military, such as in healthcare, law enforcement.

We see it playing out on Ivy League campuses, and even within intimate, personal relationships.

Let’s explore the concept of moral injury, its impact, and how Acceptance and Commitment Therapy (ACT) offers a framework for understanding and addressing it.

Let’s also consider the insights of critical thinkers in the field, including Wyatt Evans, Kent Drescher, and Jacob Farnsworth.

Understanding Moral Injury

Moral injury is distinct from post-traumatic stress disorder (PTSD), although the two can co-occur. The notion of Betrayal Trauma is a close cousin.

While PTSD often arises from fear-based traumatic events, moral injury is more closely linked to experiences that violate deeply held moral or ethical beliefs. These experiences can include, but are not limited to, witnessing or participating in acts of violence, betrayal, or failure to prevent harm.

The impact of moral injury can be profound, leading to feelings of guilt, shame, anger, and a loss of meaning or purpose. Humans may struggle with intrusive thoughts, difficulty trusting others, and a sense of alienation from their pre-injury selves.

Left unaddressed, moral injury can significantly impair one's mental health and overall well-being.

Acceptance and Commitment Therapy (ACT): A Framework for Healing…

ACT is a form of cognitive behavioral therapy that emphasizes acceptance of difficult thoughts and feelings, while also committing to actions aligned with one's values.

It is rooted in the belief that suffering is a natural part of life, and that attempting to avoid or control painful experiences often leads to further distress.

Instead, ACT encourages humans to clarify their values and take committed action, even in the presence of discomfort…

Acceptance and Commitment Therapy (ACT) is a unique and rich form of psychotherapy that owes much to the ancient Stoic tradition.

ACT blends mindfulness strategies with behavior-change techniques to help humans develop psychological flexibility. The most well-known thought leader behind ACT is Stephen Hayes.

Unlike traditional therapies that aim to eliminate or control uncomfortable thoughts and feelings, ACT teaches folks to embrace these experiences and commit to actions aligned with their values.

Through a process called "acceptance," clients learn to make room for difficult emotions, thoughts, and sensations, while "commitment" involves taking action toward a meaningful life.

ACT is not about getting rid of negative feelings; instead, it focuses on changing one's relationship with them to live a more fulfilling and purposeful life.

ACT offers several fundamental principles that can be particularly relevant to addressing moral injury:

Cognitive Defusion: ACT teaches techniques to help humans step back from their thoughts and see them as transient mental events, rather than absolute truths. This can be helpful for individuals struggling with intrusive thoughts related to moral injury, allowing them to create some distance and reduce their impact.

Acceptance: Central to ACT is the idea of accepting difficult thoughts and emotions, rather than trying to suppress or avoid them. This can be challenging for those dealing with moral injury, as it requires facing and sitting with feelings of guilt, shame, and regret.

However, by accepting these experiences as part of their internal landscape, humans can begin to move toward healing.

Values Clarification: ACT emphasizes the importance of clarifying what is truly important and meaningful. This can be a crucial step for those struggling with moral injury, as it can help them reconnect with their sense of purpose and direction.

Committed Action: ACT encourages individuals to take action in alignment with their values, even when it is difficult or uncomfortable. This can also be empowering for folks dealing with moral injury, as it allows them to regain a sense of agency and control in their lives.

Insights from Wyatt Evans, Kent Drescher, and Jacob Farnsworth…

Wyatt Evans, a clinical psychologist and researcher, has conducted extensive work on moral injury, particularly in the context of military veterans. He emphasizes the role of moral emotions, such as guilt and shame, in the experience of moral injury, and the importance of addressing these emotions in the healing process.

Kent Drescher, a clinical psychologist and Navy veteran, has focused on the concept of "moral repair" as a key component of recovery from moral injury.

He highlights the importance of acknowledging wrongdoing, seeking forgiveness, and making amends as crucial steps toward healing.

Jacob Farnsworth, a researcher and advocate for veterans' mental health, has highlighted the need for a holistic approach to addressing moral injury, one that includes not only individual, family, or couple therapy, but also community support and societal change.

Final thoughts

Moral injury is a complex and challenging experience that can have profound effects on mental health and well-being. A client of mine told me how medics worked on him as his wife watched with onlooking strangers. He left her a few months later.

However, folks can begin to heal and move forward, especially by understanding the inter-personal nature of moral injury, and utilizing approaches like Acceptance and Commitment Therapy. Nothing clarifies your values like a moral injury.

The insights of the good doctors Wyatt Evans, Kent Drescher, and Jacob Farnsworth (as well as other thinkers in the field) can provide valuable guidance in this process, offering hope and support to those struggling with the wounds of moral injury.

Be Well, Stay Kind, and Godspeed.