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Moral Injury

Moral Injury and the Complexities of Adoption

Adoption originates with profound trauma and loss. The fallout is real.

Key points

  • Moral injury occurs when deeply held beliefs and expectations about moral and ethical conduct are transgressed.
  • Moral injury correlates closely with betrayal and post-traumatic stress disorder (PTSD).
  • Moral injury can be found in many professions and circumstances (outside of the military).
  • Alienation, mistrust, and isolation are the byproducts of the shame felt by those suffering from moral injury.
Photo cred: Pixabay
Source: Pixabay

How do you feel when you are put in a position that doesn’t feel quite right? What kinds of emotions creep in when you know—deep in your gut—that something is off but you feel compelled to proceed anyway? You’re smart enough to understand that the best course of action isn’t clear-cut, yet there you are. You’re knee-deep in the muck of nuanced complexity, wading through systems that aren’t equipped with the time, the energy, or the resources to deal with it.

You feel responsible. You may even feel noble, but you also feel caught. Solutions and answers whirl around in your head like the balls in a rotating bingo cage with a rigged game card. Somewhere along the line, you might have felt violated or lied to. Maybe you went into a situation thinking you knew what you were getting into until you found yourself slogging through the trenches of confusion and regret because you trusted someone or something—only to feel angry and disheartened in the ways things shook out.

Questions, thoughts, and projections from the outside world arise in your mind. “You made this decision—you knew what you were getting into.” “Maybe you’re not strong enough.” “Suck it up, buttercup.” A pervasive sense of shame begins to permeate your world.

These issues are at the core of moral injury—a field of study that has emerged in the fields of healthcare and other human-service-related industries. It’s not unique to them, however, because as an adoptive mom (who happens to also work in healthcare) I know the experience well. I live with moral injury within the walls of my home.

Defining moral injury

Dr. Johnathan Shay defines moral injury as “the violation of what is right by someone in authority in a high stakes situation.”1 Litz,, describes moral injury as “a syndrome of shame, self-handicapping, anger and demoralization that occurs when deeply held beliefs and expectations about moral and ethical conduct are transgressed.”2

In the years since Vietnam, we’ve learned that while post-traumatic stress disorder (PTSD) is a huge byproduct of soldiers returning from war, moral injury—the emotional shame and psychological damage incurred when a soldier has to do things that violate their sense of right and wrong—is the wound that continues to fester.

Moral injury and adoptive families

To make the leap from the horrors of war into the home of an adoptive family might seem far-fetched, but it’s not. Adoption starts with (largely unacknowledged) profound loss. It’s heralded as something noble and beautiful while rooted deep in trauma. Hidden behind the veil, both birth and adoptive families often are left tending to what Nancy Newton Verrier calls a primal wound—the grave psychological and emotional injury of maternal abandonment.3,6

Please understand, I love my children fiercely. But at my core, I know the truths about their buried pasts will never go away. Unprovoked tidal waves of rage and fear and terror are stored within the cells of their being. They will always be searching. Questioning. Mourning. How could they not?

While understood at a cognitive level, my son’s serious attachment and behavioral challenges have manifested in ways that have had irreversible physical, emotional, and financial consequences for me and my family. Treatment costs. Lost wages due to the need to stay home to tend to his intense needs. Estranged friends and family members who couldn’t handle his challenging behaviors (or my hypervigilance—post-traumatic stress from the fallout of the trauma.)

Trying to build a relationship with a child who has resisted attachment to me since he was placed in my arms has left me feeling empty and depleted. That said, I am painfully aware that these issues pale in comparison to the horrors our son suffered in his earliest years of abandonment and neglect. My heart aches for children and families like ours—saddled with generations of painful trauma and shame, plopped into our laps under the eyes of smiling bureaucrats and others whose motives were pure, yet perhaps misguided.

My heart aches for the mothers of our children who also felt caught. Forced to give up the tender, fragile lives that had grown inside of them. In an ideal world, no wars are fought. Healthcare decisions are clear-cut and easy. Mothers birth and raise their babies in supportive, loving communities. Pain and loss and heartache are minimal. But we know the world is far from ideal.

On the horizon of hope, buoyed up by idealism, I—along with healthcare workers, veterans, and other helpers—made life a life choice wrought with shrapnel to the soul. Torn between the knowledge of what’s right, duty, and feeling ill-equipped for the magnitude of the traumas we find ourselves in, we continue to do our best within very flawed and broken systems.

I find some comfort in Khalil Gibran’s words: “Your children are not your children. They are sons and daughters of life’s longing for itself.”4 But it isn’t lost on me (through the lenses of my children) that the real trauma we all endure is the chasm of personal separation. Life’s longing for itself winds us back around to interconnection. It points us back toward compassionate curiosity at another’s circumstances and an ability to listen hard—even if we don’t want to.

Any injury creates an invitation to delve deeper into the conditions which caused it, and moral injury is no exception. It’s excruciatingly hard work to challenge the systems that cause hurt, but at least we can try. We can begin by sharing our stories and the hard-earned wisdom that comes from weathering our conflict, pain, and heartache—however hard they may be.

Maybe the salve for moral injury rests in embracing our flawed humanity, and the cure is the process with which we increase our awareness of our own trauma footprint. Both require patience and humility, but they are what the world is waiting for.

(Moral injury, as it pertains to the adoptive community, is a growing area of interest. The topic was initially brought forth in 2016 by adoption expert Mirah Riben, in her Huffpost article: Adoption Related Trauma and Moral Injury.6 )


[1] Shay, J. Moral Injury. 2014. Psychoanalytic Psychology. American Psychological Association Vol. 31, No. 2, 182-191.

[2] Litz, B. T. et al. 2016. Adaptive Disclosure: A New Treatment for Military Trauma, Loss and Moral Injury. New York Guilford Press.

[3] Verrier, Nancy Newton. The Primal Wound: Understanding the Adopted Child. Gateway Press. 2003.

[4] Gibran, Khalil. The Prophet. Knopf Publishing. 1923

[5]Other helpful information available at the Shay Moral Injury Center:

[6]Riben, Mirah. Adoption-Related Trauma and Moral Injury. Huffington Post. 2016.

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