In a recent Veterans group, a senior Army officer talked about soldiers in her brigade who died in the Middle East. She expressed some survivor’s guilt but was more saddened by their loss and felt anger towards those above her for not taking proper security precautions.
I asked her if she had ever heard the term Moral Injury.
Moral Injury is caused by a violation of core moral beliefs. It is not a DSM diagnosis. It is different from PTSD, as it is meaning-based instead of fear-based. It often accompanies PTSD though. The core elements of Moral Injury are guilt, shame, betrayal and identity disruption. One does need to have all of them to experience a Moral Injury.
As one summary of the research put it, moral injury is not primarily about fear or safety, but about the loss of trust – in oneself, in others and in institutions.
Jonathan Shay is the psychiatrist who came up with the term. He taught at the Navy War College, won a MacArthur Genius Grant and wrote two books about Vietnam Veterans and PTSD.
Dr. Shay wrote that “Moral Injury is present when (1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation.”
Brett Litz is a psychologist in the Boston VA system who expanded upon Dr. Shay’s definition to include personal transgressions, failure to act to prevent awful behavior and witnessing atrocity.
Some History
After the Trojan War, Ajax was filled with grief and guilt over the death of Achilles. He was furious that the Greek generals gave his armor to Ulysses instead of him; he felt it as a devastating betrayal. He got drunk and slaughtered a bunch of cows, thinking they were the Greek generals. When he sobered up, he was so humiliated that he killed himself.
After the Norman conquest in 1066, the Bishops of Normandy issued the Penitential Ordiance. For every man that a warrior killed, he was ordered to do a year’s penance. This served as both a moral accounting and a way to reintegrate the warriors into the community. Those Bishops understood what killing someone in combat does to the victor, even if they did with the Church’s sanction and orders from the King.
After the My Lai Massacre, U.S. Soldiers stated that they were horrified by the wanton murder of elderly Vietnamese civilians, the mass rape of women and the killing of children. One Warrant Officer did what he could to save a number of children, but most soldiers in authority there not only refused to stop the atrocity, but led it. It is one of the most disgraceful acts in US military history, and while writing this, I feel a sense of shame even though I hadn’t been born yet. Because it violated what United States and the Army claim to stand for and how I was raised.
Afghanistan
Moral Injury is not limited to what someone did in combat. It can also come from what was done in their name. After the U.S. withdrawal from Afghanistan, many Veterans reported distress tied to the abandonment of Afghan interpreters and allies. These were people who fought alongside them, often saving American lives. One Marine told me through tears of rage “We didn’t honor our commitment. They lied. They made me a liar.” This fits a core element Dr. Shay’s concept of Moral Injury: a betrayal of what’s right by those in authority in a high-stakes situation.
George Packer wrote a devastating piece for The Atlantic in March about an Afghan couple who worked with our military and were promised that they would be able to eventually come to the United States. That promise has not been kept. The family is currently living in hiding in Pakistan and are fearful that they will be forced to return to Afghanistan. If they are, they believe they will certainly die. Packer has communicated with them for years and shared his own powerlessness, fear and shame about their situation. A situation that he is in no way responsible for.
Responsibility
In Shakespeare’s Henry V, the King goes out in disguise to talk to his Soldiers on the eve of the Battle of Agincourt. One of the Soldiers argues that if the cause is unjust, the moral burden rests with the king and that the Soldiers’ souls are at risk because of decisions made above them. Henry rejects this, insisting that each man is responsible for his own actions. Shakespeare doesn’t resolve the tension, but he frames it clearly: responsibility in war is both individual and hierarchical. When those levels come into conflict, the burden does not disappear. It settles on the person who has to live with it.
I thought about that discussion when I read about Secretary Hegseth’s immoral language and glorification of violence: “no quarter, no mercy.”
A New York Times article from mid-March offers up the problem between Hegseth’s rhetoric and the service members who are tasked with actually fighting:
To the pilots flying missions and sailors firing missiles into Iran, the bellicose rhetoric is, for now, most likely background noise. They are focused on the immediate, and often dangerous, task at hand.
But over the longer term, couching wars in moral terms, such as defending democracy or protecting civilians, gives troops a framework to understand why they are being asked to kill. “Moral language acts as a psychological scaffolding for service members,” said Michael Valdovinos, a former Air Force psychologist and author of the forthcoming book “Moral Injuries.” “When that disappears, it can leave troops carrying the moral burden alone.”
One question is whether a war waged without a clear moral purpose and with mixed support from the American public will weigh heavier on the troops fighting it after the shooting stops.
“Some might say at least they’re being honest about the fact that it’s just sheer brute force,” said Elliot Ackerman, who led Marines in the second battle of Falluja in Iraq and now writes novels and nonfiction works that frequently focus on the moral complexity of war. “But it’s also very dangerous. You’re asking people to die for the ambitions of a president and a moral calculus that’s no greater than might makes right.”
Moral justifications and public support matter to troops taking lives on behalf of their country.
“I can tell you from experience on the back end, it doesn’t feel very good to have participated in a war that everybody thinks was a disaster,” Mr. Ackerman said.
My Moral Injury
Last year I experienced a different kind of Moral Injury. Not from something I did, but from what I believe my country is doing in relation to what I was taught it stood for.
I was hiking in Mexico when I received a series of messages about a public exchange between Donald Trump and Volodymyr Zelensky. That moment was deeply morally injurious to me. It has taken me over a year to process it. I felt embarrassment, anger and something deeper: disorientation. It conflicted with the moral framework I had internalized about alliances, honor, responsibility and the role of the United States in the world.
Part of my identity has been built on the belief that the United States, while imperfect, has tried to act with a degree of responsibility and restraint in the world. I was not raised to believe we were flawless but that we have often tried to use our power in cooperative ways: building alliances, supporting global health efforts, taking in refugees and responding to disasters. When that belief is disrupted, the impact is not abstract or political for me. It is personal. It forces a confrontation between what I thought I was part of and what I now see.
Since then, a series of actions and statements toward Ukraine, toward NATO allies and toward neighboring countries have deepened that reaction. I experience these not as routine policy disagreements, but as violations of the values that I was taught to uphold.
The strike on a primary school in Minab, Iran reinforced that sense of disorientation. On February 28, 2026, a missile strike destroyed a school and killed over 150 civilians, including more than 100 children. Multiple investigations have indicated that U.S. forces were likely responsible, though the full accounting remains ongoing. Even allowing for the fog of war, the scale of civilian death and the questions about targeting and accountability are not morally neutral. I experience that not simply as tragedy, but as a failure that demands moral accounting.
If Moral Injury forms when individuals are asked to live with actions they cannot reconcile, it can also form when a citizen is asked to reconcile actions carried out in their name.
This is less acute than combat-based moral injury, but it follows the same structure: a perceived gap between stated values and observed actions. For me, that gap has been destabilizing.
I am not the only one who has experienced it this way. David Brooks described a similar reaction as “moral shame”—the pain of watching what he perceived as a loss of national honor. That language is closer to my experience than standard political disagreement.
Part of what has made this difficult is where it has led. Over the past year, I have found myself questioning not my own values, but the decency of others – how many people actually share the framework I thought was common. That is a destabilizing place to be. It narrows your view of the world. It makes trust harder. It pulls you toward a more cynical understanding of people than you want to hold. That erosion of trust is not the same as anger. It is quieter, and in some ways more corrosive.
I am not speaking for all Veterans. We are not a monolith. There are many who see these events differently. But disagreement does not eliminate the experience. Moral Injury does not require consensus. It requires a perceived violation of what is right.
Other Institutions
So far I’ve only written about Moral Injury in the context of the military. But I know it also applies to other professions that have explicit moral codes. I have been treating and training teachers, law enforcement officers and medical professionals for well over a decade. These are all people who have entered into fields that try to make the world a little bit better.
I have worked with teachers who feel completely unsupported by those above them. Criticised and attacked by some parents. Governor Christie occasionally demonized the profession throughout his time in office.
Cops in New York, New Jersey and Pennsylvania told me that they felt betrayed by the public during the defund the police rhetoric of 2020. “I used to wear my Trooper sweatshirt when I was off-duty, but I don’t anymore because I don’t like the dirty looks I get from people,” one told me a few years ago.
Nurses and doctors have expressed outrage about having to rush through seeing patients or fighting with insurance companies to pay for needed procedures. “All the good I do in this poor Bronx neighborhood isn’t even 1/10,000th offsetting the damage that Robert F. Kennedy does to the US everyday,” one NY doctor told me earlier this year.
The writer and show-runner David Simon said that in portraying the lives of cops, longshoremen, politicians, teachers and journalists on The Wire, he sought to show how modern American institutions betray those they are supposed to serve and those that serve those institutions. Devastating.
A distinction that often comes up is the difference between moral outrage and Moral Injury. Moral outrage is directed outward; anger at something wrong in the world. Moral Injury is different. It turns inward. It raises questions about one’s own role, identity or what one has been part of. It is not just “this is wrong.” It is “what does this mean about me, and how do I live with it?” That is why it is more destabilizing.
Clinical Presentation
Some clients are guilty over what they did or what they weren’t able to prevent from happening. Others present as shameful of who they have become. Many professionals have lost trust in their bosses or companies or fields. Some express moral confusion (“I don’t even know what is right anymore”). A sense of betrayal is common. A majority withdraw and have become more isolated.
I have treated law enforcement officers who felt betrayed by their own departments, as they were investigated or disciplined for actions they believed were consistent with their duties. I have also worked with Marines who were discharged for substance misuse after being prescribed those very medications to manage PTSD. In both cases, the injury was not just about the outcome, but about what they felt the institution did to them and what that meant for their identity.
I believe that where there is Moral Injury, there is an increased risk of suicidal ideation. This does not mean that most people who experience Moral Injury are suicidal, but rather, it’s a risk factor. Like relationship problems, substance misuse, gambling or health problems.
A lot of clinicians make a mistake of mislabeling Moral Injury as PTSD. They are different, though they often accompany each other. Most clinicians don’t have Moral Injury in their vocabulary.
Another mistake that therapists make is to just reassure the morally injured that it isn’t that bad or that it’s in the past or “you did the best you could.” None of that helps.
Therapists often address it as a cognitive distortion only and fail to talk about the moral dimension.
Addressing Moral Injuries
I’ve been clean and sober for over 30 years. I found great comfort, help and guidance in the rooms of Alcoholics Anonymous. It was there that I learned the power of peers and groups. I have created groups for Veterans, cops and therapists. I have watched people begin to heal when someone else expresses their exact pain. I have witnessed the reversal from isolation. Shared experiences and language are immensely important.
In Poland, I treated a Soldier who spent a decade blaming himself for the deaths of his platoon mates. When he described what happened, it became clear that he had not been in a position to prevent it. The decision that led them there had been made above him.
He had taken full responsibility for something he did not control. The group helped redistribute that responsibility. That was the beginning of change.
In individual therapy, people can parse out guilt, shame, betrayal and identity disruption. Usually, people don’t even have the language to express what they are feeling. Once they have it, they can explore the context of their Moral Injury.
Writing helps. Journaling. Letters.
I believe in the restorative action of service and mentorship. Helping others and specifically working with those who have struggled with the same issues is a fantastic way to begin to feel better about oneself, society and the world.
Many people find comfort in attending religious services and meeting with members of the clergy. Some utilize confession and seek penance, while others benefit solely from being around others and feeling welcome. Much like the Norman warriors of 1066, it can offer a path to reintegration.
For Veterans, I think that organizations such as the American Legion and the Veterans of Foreign Wars are a great way to engage with peers, serve the community and, in some cases, advocate for policy change. I have been an American Legion member for years but only recently went to a local hall to become an active member. This was read at the end of my first meeting:
Till we meet again let us remember that our obligation to our Country
can be fulfilled only by the faithful performance of all duties of
citizenship. Let service to the community, state and nation be ever a
main objective of The American Legion and its members. Let us be ever
watchful of the honor of our Country, our organization and ourselves,
that nothing shall swerve us from the path of Justice, Freedom and
Democracy.
I was moved to tears. Because it was so comforting to hear other people express their “service to the community, state and nation” as their main objective.
It was identity affirming.