Though moral injury and post-traumatic stress-related disorders can affect anyone, veterans and military service members are at a higher risk of developing such conditions due to the nature of their service.
“We appreciate that these groups are exposed to higher rates of potentially traumatic events than are civilians,” says Lorraine Smith-MacDonald, a post-doctoral fellow with the Heroes in Mind, Advocacy and Research Consortium (HiMARC) in the Faculty of Rehabilitation Medicine.
Finding ways to help people recover from moral wounds is critical. According to a recent article, forgiveness practices could play an important role. Researchers including Smith-MacDonald and HiMARC director Suzette Brémault-Phillips highlighted how such interventions could be incorporated into the process of recovery.
Moral injury cuts deep
Moral injury can occur when a person “knows what they want to do or what they fundamentally believe to be the right thing, but is unable to do that for whatever reason. It can also occur when a person transgresses their deeply held morals and values, or witnesses someone else doing so,” explains Smith-MacDonald.
Finding ways to help those with moral injury recover is critical because of the potential wide-ranging physical, psychological and social damage that can result, she says. Particularly, relationships with oneself and others can be significantly impacted. “If moral injury is left untreated, it is likely that consequences will arise in each of those domains.”
Moral injury is also commonly associated with other disorders such as PTSD, major depressive disorder, generalized anxiety disorder and substance use disorder.
According to Smith-MacDonald, there’s already a precedent in the scientific literature for why forgiveness may be important and how it affects health more generally.
“We know better psychological and emotional health outcomes are associated with people who are able to forgive.”
While some feel that psychological tools alone are needed to support recovery from moral injury, a holistic approach that incorporates spiritual or religious practices may be beneficial for some, she notes.
Vertical and horizontal forgiveness may both be equally important for relational repair. Horizontal forgiveness involves forgiveness of yourself and between yourself and others, whereas vertical forgiveness is between yourself and some higher power. Though such spiritual forgiveness may not apply to everyone, for many it may be a key step in recovery.
“Some evidence has shown that struggles with spirituality can be part of moral injury—not necessarily religious struggles, but those with things like meaning and purpose, one’s place in the world, and questions of good and bad.”
And while many may think of forgiveness as something that either happens or doesn’t, Smith-MacDonald says it’s possible to build your capacity for forgiveness with regular practice.
“It’s not necessarily innate. Some people may have a disposition to be more forgiving, but it’s not something you either have or don’t have,” she explains. “You can actually cultivate it, just like you can cultivate optimism or gratitude or any of these other kinds of practices.”
In addition to strengthening forgiveness skills, people may want to begin by tackling smaller issues and moving toward larger areas of struggle as they hone those forgiveness skills through practice, Smith-MacDonald says.
“Relational repair doesn’t mean people are always going to come together and reconcile, especially when there is potential for harm in re-engaging,” she says. But as a potential practices for moral injury, forgiveness could hold a lot of promise because it enables people to remember and acknowledge morally painful experiences while also providing a means for them to recover.
“Ultimately, the goal with forgiveness is to allow people to let go of painful memories of their past and be able to reconcile those in a way that they can move forward.”