Psychologist Michael Valdovinos explains that moral injury, a 'unique kind of stress', is now formally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Moral injury occurs when individuals are forced to act or witness actions that contradict their deeply held convictions, leading to psychological harm.
Valdovinos, a former US military psychologist, notes that moral injury can result from a single catastrophic event, such as harming an enemy combatant in an unjust conflict, or from a gradual build-up of moral distress, as reported by workers in slaughterhouses or prisons. Symptoms often mimic depression, including sadness and feelings of being a bad person.
In his new book, Moral Injury: When Good Conscience Suffers in a World of Hurt, Valdovinos highlights that the Covid-19 pandemic overwhelmed medics who felt they had betrayed their oath to do no harm. He also shares his own crisis of conscience while deployed in Afghanistan, where he struggled with his role overseeing interrogation and detention operations under the Geneva Convention.
Valdovinos argues that moral injury is not unique to war. 'Anytime people repeatedly participate in or witness actions that violate their moral framework and they feel unable to change it, you create the conditions for moral injury,' he says. He suggests that the current political climate in the US is causing more citizens to experience moral distress.
The DSM now includes moral injury under 'moral problems', allowing it to be formally documented. However, Valdovinos emphasises that standardised assessment and diagnostic pathways are still being developed. He believes that connection with others is key to recovery.
