Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating effective health and wellness programs.

Moral injury is a powerful subject because it connects mental health, personal values, institutional leadership, health care, military service, faith communities and the loss of trust. Moral injury is defined as "the lasting psychological, emotional, behavioral and spiritual harm that occurs when someone perpetuates, fails to prevent, witnesses or is the target of actions that deeply violate their core moral beliefs or ethical code."

It may occur when someone:

• Participates in an action that violates their conscience.
• Witnesses wrongdoing but feels powerless to intervene.

• Fails to prevent harm, whether through choice or circumstance.
• Experiences betrayal by a trusted leader, institution or person in authority.
• Is forced to choose between competing moral obligations.

Groups at high risk:

• Military members and veterans. Combat choices, civilian casualties, difficult command decisions or failing to protect peers.

• Health care workers. Triggered during crises by forced resource allocation, life-or-death triage, systemic failures and the inability to save patients.
• First responders. Police officers, firefighters, EMTs and rescue personnel.

MENTAL HEALTH RECOGNITION

In September 2025, the American Psychiatric Association updated the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) to formally include moral injury as a diagnosis.

CONSEQUENCES OF MORAL INJURY

Moral injury is increasingly studied because its consequences can extend far beyond emotional distress. Research has associated it with depression, anxiety, suicidality, social withdrawal, spiritual struggles and impaired relationships, along with feelings of guilt, shame and inner conflict. It can be debilitating and often prevents individuals from living full and healthy lives. Moral injury goes beyond the individual and can destroy one’s capacity to trust others, impinging on the family system and the larger community. A caregiver can face an impossible decision about a loved one’s treatment and later feel ambivalent about it, despite having made the best decision possible considering the circumstances.

HOW HEALING TAKES PLACE

First, moral injury must be acknowledged in the same way we acknowledge the physical and mental cost of traumas. Potentially helpful approaches to recovery include psychological treatment when needed, compassionate listening, opportunities to process feelings of guilt or betrayal and rebuilding meaningful relationships. The feelings are subjective and personal, so a variety of therapies may be considered, such as art, music, writing, group discussion and family support. Although therapists, counselors, social workers and clergy are often on the front lines of addressing moral injury, the wider community can be beneficial for support and compassionate listening. Faith communities can be of enormous support and spiritual healing.

CONCLUSION

One measure of a healthy community is not simply how well we care for physical wounds, but how we respond when trust, conscience and human dignity have been injured. Moral injury can affect the whole person — physically, emotionally, socially and spiritually.

Dr. Cheryl Christy is a Baldwin County resident and registered nurse with nearly 30 years of experience. She holds master's degrees in nursing education and nursing practice and a doctorate in nursing practice. She is a member of Sigma Theta Tau, Phi Pi Chapter, a certified lay counselor and the author of "Voices for Healthcare," a healthcare blog.

Read her previous column titled "Lifestyle medicine" on www.GulfCoastMedia.com. Her blog can be found at https://substack.com/@dnprn.