- Moral injury can occur in oppressive or dangerous circumstances such as intimate partner abuse.
- Moral harm occurs when self-protective behaviors compromise one's moral character.
- Moral injury is a sense of shame, guilt, and regret that needs attention in treatment, and differs from treating PTSD.
Moral injury can occur when our ability to maintain a good moral character has been compromised by the circumstances of an oppressive or dangerous condition, such as intimate partner abuse (IPA). In some cases, a survivor of IPA experiences a loss of agency over their life that can lead to behaviors, albeit self-protective, that conflict with their moral beliefs. It’s this moral harm that can contribute to the survivor feeling a deep psychological anguish of shame and guilt that makes up a moral injury. In trauma recovery from IPA, tender attention to the moral injury is critical to helping survivors fully heal.
Intimate Partner Abuse
One partner in an intimate relationship who uses psychological coercion to gain power and control over the other defines intimate partner abuse. Whether or not physical violence is present, psychological coercion can be accomplished with threats, intimidation, verbal and emotional abuse, gaslighting, imposed isolation from family and friends, restricting access to finances, and monitoring behaviors outside the home.
A controlling partner usually doesn’t disclose the full breath of their coercive intentions until after marriage and, even then, it unfolds insidiously over time. Eventually, the survivor goes from expecting love and collaboration from their partner to acquiescing to avoid being harmed. The psychological impact to the survivor of IPA is traumatic bringing on lower self-esteem, loss of emotional safety, and loss of trust in their perception and judgment. It can lead to developing Post Traumatic Stress Disorder (PTSD).
Survival Strategies and Moral Injury
Salzberger in a 2021 article, “The Moral Harms of Domestic Violence” distinguishes two types of moral harm that survivors of domestic violence suffer: moral damage and moral injury. Moral damage occurs “when the ability to develop or sustain good moral character has been compromised by an agent’s circumstances.” (Salzberger, 2021, p. 1).
Moral injury “refers to a kind of psychological anguish that follows from when an individual causes or becomes causally implicated in actions that we ordinarily would understand to be morally grievous offenses because of their circumstances.” (Salzberger, p. 2).
The survivor of intimate partner abuse uses strategies to minimize the harmful impact of abuse while at the same time, those same strategies can cause them moral damage. Examples of strategies that survivors utilize to protect themselves and end up compromising their moral character because of circumstances they have little or no control are as follows:
- Not speaking up and setting limits with their partner about matters of importance to them out of fear of retaliation and harm to themselves
- Becoming isolated by rejecting family and friends in order to go along with their partner who makes it extremely harmful to maintain contact.
- Acquiescing, from a partner’s threats, to demands that are placed on the survivor because of fear of one’s life; children’s wellbeing; safety of pets, etc..
- Going along with signing documents that hold fraudulent information such as tax returns and loans.
Eventually, for self-protection, the survivor behaves in ways that compromise their values and moral beliefs.
The Moral Injury of Survivors
In my recovery groups for women with controlling partners, too often I hear “How did I get here?” Often, this question is upon recognition of having lost one’s sense of self–who they are, and their wellbeing.
A female client in her trauma treatment for PTSD worked on a deep moral injury that taught me how important it is to bear witness. She felt she had compromised herself around moral beliefs believing her survival was at stake. She expressed a great deal of shame, guilt, regret, and grief from multiple losses that she endured. Once she worked through the shame and guilt of her moral injury, my client had access to her anger and could only then hold her perpetrator accountable for his abuse.
“The survivor’s shame and guilt may be exacerbated by the harsh judgment of others, but it is not fully assuaged by simple pronouncements absolving her from responsibility, because simple pronouncements, even favorable ones, represent a refusal to engage with the survivor in the lacerating moral complexities of the extreme situation. From those who bear witness, the survivor seeks not absolution but fairness, compassion, and the willingness to share the guilty knowledge of what happens to people in extremity." (Herman, 2015, p. 69)
“Traumas of a type and severity that cause Post Traumatic Stress Disorder (PTSD) are likely to cause moral injury, too. This does not mean treating PTSD alone will “treat” moral injury, nor vice versa. We favor the tenet that “treatment” of moral injury must be defined by the individual according to their beliefs and needs. Outlets for acknowledging and confronting moral injury include talk therapy, religious dialogue, art, writing, discussion & talking circles, spiritual gatherings, and more.” (From The Moral Injury Project, online).
As therapists, we need to make space for sharing and respond with compassion to the moral injuries of survivors of IPA and others who endure oppressive and/or dangerous circumstances.
Herman, J. 2015. Trauma and Recovery: The Aftermath of Violence–From Domestic Abuse to Political Terror. New York: Basic Books.
Salzberger, M. 2021. "The moral harms of domestic violence." Journal of Social Philosophy.
The Moral Injury Project, Jhttps://moralinjuryproject.syr.edu