The Chaplain’s Compass

This scoping review considered the role of chaplains with regard to 'moral injury'. Moral injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the 'soul' that are far more difficult to heal-if at all. As part of a larger research program exploring moral injury, a scoping review of literature and other resources was implemented utilising Arksey and O'Malley's scoping method (Int J Soc Res Methodol 8(1):19-32, 2005) to focus upon moral injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term 'moral injury' in relation to spiritual/religious issues (n=482), the results revealed 60 resources that specifically noted moral injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or moral injury. The World Health Organization International Classification of Diseases: Australian Modification of Health Interventions to the International Statistical Classification of Diseases and related Health problems (10th revision, vol 3-WHO ICD-10-AM, Geneva, 2002), was utilised as a coding framework to classify and identify distinct chaplaincy roles and interventions with regard to assisting people with moral injury. Several recommendations are made concerning moral injury and chaplaincy, most particularly the need for greater research to be conducted.

Invisible Moral Wounds of the COVID-19 Pandemic: Are We Experiencing Moral Injury?

This article explores the developing definition of moral injury within the current key literature. Building on the previous literature regarding 'Moral Injury, Spiritual Care and the role of Chaplains' (Carey et al. in JORH 55(4):1218-1245, 2016b. doi: 10.1007/s10943-016-0231-x ), this article notes the complexity that has developed due to definitional variations regarding moral injury-particularly with respect to the concepts of 'betrayal' and 'spirituality'. Given the increasing recognition of moral injury and noting the relevance and importance of utilizing a bio-psycho-social-spiritual model, this article argues that betrayal and spirituality should be core components for understanding, defining and addressing moral injury. It also supports the role of chaplains being involved in the holistic care and rehabilitation of those affected by moral injury.

IntroductionThe concept of moral injury has drawn attention to the role of military chaplains (MCs) in supporting veterans. While international research has explored military chaplaincy interventions, collaboration with mental health professionals, and institutional influences, longitudinal, process-oriented insights into military chaplaincy practice remain scarce, particularly in the Dutch context, which combines secularization, pluralized worldviews, and a unique institutional position of MCs.MethodsThis study employs a qualitative longitudinal design, analyzing the practice of 6 Dutch MCs in their counseling work with post-active veterans over a period of 3–12 months. Data consists of detailed conversation reports from each dyad and quarterly group reflections with participating MCs. Analysis included cross-sectional and longitudinal approaches, identifying both patterns in how MCs address moral injury in one-on-one meetings with veterans and how these meetings unfold over time.ResultsThree interrelated dimensions characterize Dutch MCs' practice: presence – encompassing the physical setting and relational quality of encounters; their institutional position which we characterize as an embedded independent position within the military and healthcare systems; and moral reflection – referring to attuned pathways of how MCs address moral struggles. Longitudinal analysis revealed four typologies of contact development: (1) clear request and alignment, (2) emerging focus, (3) development through the relationship, and (4) minimal responsiveness with story-sharing focus. Breakthrough moments were observed primarily in types 1–3 and required sustained engagement.DiscussionThe study emphasizes the moral significance of relational presence and the embedded independent position of MCs in addressing moral injury. Dutch MCs create a ‘moral space' allowing veterans to explore moral concerns, re-establish self-trust, and recognize broader sociopolitical dimensions of moral injury. These findings highlight the importance of attuned, politicized, and confidential care in addressing moral injury, with implications for professional development, interdisciplinary collaboration, and the quality of veteran care.

An infographic model of moral injury (MI) is introduced in this conceptual paper that distinguishes the development of a worldview discrepancy-induced genus of MI, called complex moral injury (C-MI), from a standard expression of moral injury (S-MI), clearly delineated as perpetration-focused and a violation of moral belief in the contemporary view. It builds upon a previous essay that examined the potential of paradoxical circumstance (e.g., clashes of value, competing moral expectations, and moral paradox) to inflict MI among military personnel during wartime (Flemingin J Relig Health 60(5):3012-3033, 2021). Accordingly, it heeds Litz et al.'s recommendation to expand the research of MI beyond the effects of perpetration and investigate the impact of morally injurious events that shake one's core moral beliefs about the world and self(Litz et al. in Clin Psychol Rev 29(8):695-706, 2009). A review of definitional, scale, and qualitative studies shows evidence of a nuanced and complex form of MI that presents as moral disorientation and is a response to a disruption and subsequent failure of foundational moral beliefs to adequately appraise ethical problems and inform moral identity. Interrelations between MI, assumptive world, and meaning theories suggest the mechanism of C-MI and potential therapies. Case studies from a Veterans Administration hospital in the United States and a walk through the diagram will help illustrate the model. Clinical implications of a definition that includes morally injurious events that shatter fundamental moral assumptions are discussed. The role of chaplains in facilitating acceptance and meaning-making processes is recommended for C-MI recovery. Acknowledging the model's need for empirical support, a plausible scale is discussed for future research.

In their work, police officers are routinely exposed to potentially traumatic events, some of which may also be morally distressing. Moral injury refers to the multidimensional impact of exposure to such potentially morally injurious events (PMIEs). Mainly originating from a military context, there is little empirical research on moral injury in policing. The aim of this study was to gain insight into what PMIEs and moral injury in police officers entail. We used a generic qualitative research approach inspired by grounded theory. Semistructured interviews were conducted with 13 treatment-seeking, trauma-exposed police officers at a Dutch national center for psychotrauma. Participants were 11 men and two women with a diagnosis of profession-related posttraumatic stress disorder, who reported being troubled by exposure to a morally transgressive event. Findings were categorized into three categories in terms of PMIEs and moral injury: (1) no high stakes PMIEs, (2) high stakes PMIEs but no moral injury, and (3) high stakes PMIEs and moral injury. Within the third category, three main themes and associated subthemes emerged: (1) a sense of responsibility in death, (2) the illusion of control, and (3) a duty to remember. This study is the first to explore high stakes PMIEs and moral injury in trauma-exposed, help-seeking police officers. Findings show that moral injury seems a relevant clinical concept in policing. PMIEs may change their fundamental self-perception and lead to deep feelings of guilt and shame. Directions for future research include examining police officers' treatment needs and perspectives on "moral recovery." (PsycInfo Database Record (c) 2025 APA, all rights reserved).

“Basically, I look at it like combat”: Reflections on moral injury by parents involved with child protection services

This paper presents additional qualitative results from Phase 1 of a larger study examining potentially morally injurious events/experiences (PMIE) and/or moral injury (MI) among Australian veterans(Hodgson et al. in J Relig Health 60(5):3061-3089, 2021). It makes specific reference to (1) betrayal and (2) retribution experienced or perpetrated by Australian military veterans during military conflicts and peacekeeping missions. During two veteran seminars conducted in Adelaide, South Australia, a total of 50 veterans were recruited, 10 of whom were willing to be interviewed and audio-recorded about their deployment experiences. Narrative data analysis of veteran transcripts indicated that all participants had engaged in or were exposed to a PMIE/MI of one kind or another, and all had experienced betrayal and/or witnessed or perpetrated retribution. Given the ethical, moral and spiritual issues involved, the role of chaplains in addressing moral injury for the benefit of veterans through the use of 'Pastoral Narrative Disclosure' (PND) is suggested-with a specific focus upon 'restoration' and 'ritual'. Additional research is recommended with regard to acts of betrayal and retribution among veterans, as well as the further development of PND to address PMIE/MI.

Moral injury, a persistent distress arising from experiences that shatter one's sense of goodness in oneself, others, or higher powers, is consistently linked to trauma yet remains underexplored among childhood sexual abuse (CSA) survivors. Additionally, while positive and negative religious coping often serve as protective and risk factors for adverse mental health outcomes, respectively, no research to these authors' knowledge has examined their relationship to moral injury. The present study investigated how CSA severity, moral injury, and religious coping influence depressive symptoms among survivors of CSA. Adult CSA survivors (N = 376) were recruited via Prolific (56.91% female; Mage = 38.60) and completed validated measures of CSA, moral injury, religious coping, and depressive symptoms. Structural equation modeling was utilized to test the hypothesis that religious coping and moral injury would serially mediate the relationship between CSA severity and depressive symptoms. CSA severity predicted increased positive religious coping and negative religious coping, negative religious coping predicted increased moral injury, and positive religious coping predicted decreased moral injury. Moral injury, in turn, significantly predicted depressive symptoms. The indirect paths through negative religious coping were significant, but the pathways through positive religious coping were not. To our knowledge, this study provides the first empirical evidence of relationships among CSA, religious coping, moral injury, and depressive symptoms. These findings extend moral injury assessment beyond military and healthcare contexts and highlight the need for interventions that address moral and spiritual distress among CSA survivors.

The dominating emphasis of psychological research into moral injury has focused on clinical assessment, diagnosis, and treatment. This article focuses on the particular case of the role of the leader/leadership in moral injury in a military context. To address this objective, a systematic scoping literature review was conducted with the aim of investigating the scope of existing research to identify gaps and encourage future research and interventions. Thematic analysis was used to structure the data in an explorative inductive manner and an attempt was made to integrate the themes identified to gain a more holistic understanding of the subject matter. The results show that a significant portion of the literature views leadership failure or leader betrayal as a potentially morally injurious event (PMIE), a primary cause (predictor) of moral injury. However, a significant number also view leadership as a key factor in the prevention and mitigation of moral injury. Consequently, the lack of empirical evidence focusing on the role of leadership in moral injury must be regarded as problematic and should be given greater emphasis to advance understanding and guide the development of effective, evidence-based interventions.

The literature on moral injury (MI) is currently undermined by the lack of clear boundaries regarding the construct and a dearth of research on the processes by which potentially morally injurious events lead to MI. The heuristic continuum model of moral stressors proposes ways of distinguishing between moral frustrations, moral distress, and MI. In this commentary, we highlight five testable principles that can be derived from the heuristic model and evaluated using well-established constructs. Specifically, we describe meaningful distinctions between guilt and shame and address how these moral emotions can be used to distinguish between moral distress and MI. We also describe the potential role of event-related rumination, shame proneness, and cognitive flexibility in the development of MI following exposure to potentially morally injurious events. We believe that these principles offer critical next steps for the advancement of the MI field and illustrate how MI research can be generalized beyond the military context.

Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury(MI). This qualitative study formed 'Phase 1' of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidenceidentified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested-namely 'Pastoral Narrative Disclosure.' It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility.

BackgroundMilitary medics, who are both professional soldiers and qualified nurses, can face situations where their training and moral ethos conflict in the performance of duty. Their role has intrinsic duality. They are both a soldier, thus a member of a military organisation as well as well as a healer, a nurse with a corresponding duty of care. Both roles have ethical, legal and professional responsibilities, codes of conduct and moral codes. Both also are roles which have strong cultural images and distinct expectations from individuals and those around them. This can lead to moral dilemmas, moral injury and long-term psychological illness. In the 2024 Royal Commission into Defence and Veteran Suicide in Australia, moral injury was cited as a relatively new, but not widely acknowledged, risk factor that may lead to suicide. In the context of defence, moral injury can be described as being experienced by a person who participates in, or witnesses, actions that go against their moral code or moral beliefs.Research designThe research presented is a component of a larger study into the role duality of the Australian Army medic in warzones. It focuses on interviews from twelve currently serving army medics who have deployed overseas in recent conflicts with the research question: How does the intrinsic duality of the role of the medic impact the individual performing this specialised role.Ethical considerationsThis research has ethics approval from both the Australian Defence Human Research Ethics Committee #778-15 and the Human Research Ethics Committee #2015/024. Participants have given formal consent for their reflections to be used in publications.ConclusionFor this research the psychological impact of these ethical conflicts on Australian Army Medics who have served in this dual role has been investigated, with specific focus on moral injury.

Research on moral injury has thus far paid little attention to social factors and cultural elements. This study addresses this gap by examining the effects of one particular cultural artefact on moral injury that is typical of armed forces, (military) decorations, including awards and medals. Through a preregistered experiment involving two scenarios—omission of helping behavior and commission of mortar fire—resulting in civilian deaths, we manipulated the factors self-attribution versus attribution of blame to others/the system and the presence or absence of a decoration. Moreover, we conducted seven qualitative interviews. Contrary to our expectations, none of the experimental conditions within the scenarios yielded significant differences. However, the scenarios themselves differed significantly from each other, indicating that wrongful inaction may have a stronger effect on moral injury than wrongful action. The subsequent qualitative interviews (N = 7) revealed nuanced insights, suggesting that the effects of decorations on moral injury may vary. Cases were discerned in which military decorations demonstrated the potential to either alleviate or exacerbate moral injury. This dynamic depended on factors such as an individual’s assessment of the justifiability of the act for which they received the decoration, and the perceived authenticity of the decoration’s bestowal – whether it was experienced as a genuine acknowledgment or merely a superficial gesture. These findings indicate a possibly complex interplay of cultural artifacts and moral injury within military contexts.

Aim: Moral injury (MI), originally studied in military contexts, refers to emotional distress resulting from actions that conflict with one's core values. MI outcomes may help explain how potentially morally injurious events (PMIEs) contribute to mental health issues, yet empirical evidence remains limited. This longitudinal study examined whether MI outcomes mediate the relationship between PMIE exposure during combat and posttraumatic stress symptom (PTSS) clusters following discharge. Method: We followed 374 male combat veterans over a five-year period. Pre-enlistment psychological characteristics were conducted 12 months prior to enlistment (T1). PMIE exposure was measured during the final month of military service (T2) using the Moral Injury Events Scale (MIES), capturing experiences throughout active duty. MI outcomes were assessed six months post-discharge (T3) using the Expressions of Moral Injury Scale–Military Version–Short Form (EMIS-M-SF). Finally, PTSS clusters were evaluated one year after discharge (T4) using the PTSD Checklist for DSM-5 (PCL-5). Results: A total of 48.7% of participants reported exposure to PMIEs, while 8% met criteria for probable PTSD. Path analysis demonstrated a direct effect of PMIE-betrayal (T2) on arousal and reactivity as well as negative alterations in cognition and mood symptom clusters (T4). Results also showed indirect associations between exposure to all PMIE dimensions (T2) and PTSS clusters (T4) via MI outcomes (T3). Conclusions: Findings underscore the role of MI outcomes in the development of specific PTSS clusters following PMIE exposure. Integrating MI-informed interventions may enhance treatment for veterans transitioning to civilian life.