Resources

Below are curated lists of resources on Moral Injury in the military and Moral Injury in healthcare professions. We will be adding to this collection continually, including some videos and links to online resources, so please do check back for more or join our mailing list to be notified of major updates.

Jump to:

• Resources on Military Moral Injury
  • Religious and Theological Resources
• Resources on Moral Injury in Healthcare Professions
• Resources on Moral Injury in Veterinary Professions

Videos of previous webinars are also available on our Moral Injury Webinar Series page.

Resources on Military Moral Injury

Video

Books

Robert Emmet Meagher and Douglas Pryer, War and Moral Injury: A Reader

A great primer for understanding Moral Injury, this anthology contains sections and chapters from veterans, war poets, researchers, clinicians and chaplains. Through these varied means of description and expression, it is able to illuminate several different facets of Moral Injury.

Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character

Credited with bringing the term ‘Moral Injury’ into modern discourse in this book, US VA Psychiatrist Jonathan Shay reaches back to Homer’s Iliad to draw parallels between the tragic elements of war understood by the Greeks and the disfiguring of character that many US veterans of the Vietnam war experienced.

Jonathan Shay, Odysseus in America: Combat Trauma and the Trials of Homecoming

In his second (and perhaps most poignant) volume, Shay returns to Homer and the language of Ulysses’ return in the Odyssey to highlight the profound difficulties that veterans face in adjusting to life in the civilian world. 

Peter Lee, Reaper Force: Inside Britain’s Drone Wars

An in-depth look at the experiences of drone operators in the UK military during the conflicts in Iraq and Afghanistan. It largely lifts up the accounts of the numerous ethically challenging situations they regularly faced, the complexities of agency within those situations and the significant moral toll it takes on them.

Nancy Sherman, Afterwar: Healing the Moral Wounds of Our Soldiers

A philosophical engagement with the narratives of several returning US veterans of the wars in Iraq and Afghanistan that reflects on their accounts of grief, shame, guilt and moral trauma through ancient Greek philosophers and the work of Immanuel Kant, Friedrick Nietzche and several others. 

Robert Emmett Meagher, Killing from the Inside Out: Moral Injury and Just War

This work contains an extended and developed argument that the Just War Tradition, particularly as appropriated in the context of Christian theology, is a primary cause of Moral Injury as it undermines critical conversation about military endeavour, national values and the true costs of conflict. It is developed in a US context, but features a discussion of and commentary upon the Just War Tradition from ancient Greece to medieval Christianity and into the modern context.

Brad Kelle, Ed., Moral Injury: A Guidebook for Understanding and Engagement

A collection of essays that highlights clinical perspectives on Moral Injury, ancient and modern portrayals of Moral Injury, as well as scholars that engage Moral Injury from varying religious perspectives (mostly Christian). It brings together the work of many of the more prominent voices in the interdisciplinary field of Moral Injury research.

Scholarly articles

Brett Litz et al., “Moral injury and moral repair in war veterans: A preliminary model and intervention strategy" Clinical Psychological Review 29(8) (2009) pp. 695-706

This landmark 2009 article brought a significant clinical and inter-disciplinary focus on Moral Injury as a concept, differentiating it from PTSD, articulating its rootedness in moral emotions, and arguing for a broader definition than Shay’s – acknowledging that one could experience Moral Injury due to a transgression of moral values by oneself – in addition to suffering the betrayal of ‘what’s right’ by authorities.

Jonathan Shay, “Moral injury” Psychoanalytic Psychology 31(2) (2014) pp. 182-191

In a 2014 re-examination of the concept of Moral Injury, Shay discusses the connections he makes to Homer’s poetry and the treatment of veterans in brief and also poses more practical ways that can help veterans examine their own experiences. He offers some practical ways to differentiate PTSD from Moral Injury and slightly revises his schema in light of the attention to perpetrator trauma in Litz et al.'s 2009 study.

Jacob Farnsworth et al., "A functional approach to understanding and treating military-related moral injury" Journal of Contextual Behavioral Science 6(4) (2017) pp. 391-397

This article seeks to define more precisely some key terms beyond the Shay and Litz definitions of Moral Injury. It notes the distinctions between morally injurious events, moral pain, moral injury and moral healing. These distinctions allow for a more nuanced understanding of the scale and scope of severity in Moral Injury.

June Price Tangney at al., "Moral emotions and moral behavior" Annual Review of Psychology 58 (2007) pp. 345-272

An extended discussion of the moral emotions of shame and guilt, distinguishing between shame as an egocentric and isolating emotion and guilt as a prosocial one that may drive positive behavioural change, as well as problems with this conception. It discusses the other-directed moral emotions as well, through the lens of other-directed empathy as a possible inhibitor of harmful behaviour.

Craig Bryan et al., “Moral injury, posttraumatic stress disorder and suicidal behavior among National Guard personnel” Psychological Trauma: Theory, Research, Practice and Policy 10(1) (2018) pp. 36-45

The report of a study that suggested that Moral Injury, particularly in those veterans who were also suffering from PTSD, conferred an increased risk for suicidal behaviour, particularly noting that those in the study that experienced Moral Injury had an increased risk for attempted suicide. 

Amy Cameron et al., “Moral injury as a unique predictor of suicidal ideation in a veteran sample with a substance abuse disorder” Psychological Trauma:  Theory, Research, Practice and Policy 13(8) (2021) pp. 856-860 

Surveying a group of veterans with depressive symptoms, PTSD and substance abuse issues, this study found that the best predictor of suicidal ideation within the group was exposure to morally injurious events.

Religious and Theological Resources

Videos

Books

Rita Nakashima Brock and Gabriella Lettini, Soul Repair: Recovering from Moral Injury after War

An accounting of the importance of understanding Moral Injury not as a medical “problem” but as a wound of the soul – something that has to be addressed in a more complicated understanding of what it means to be human, both as individuals and collective society. This work pioneered religious research into Moral Injury and was the argument that opened the investigation of Moral Injury by theologians and religious scholars.

Joseph McDonald, Ed., Exploring Moral Injury in Sacred Texts

A collection of essays that engage religious scriptures from Christianity, Judaism, Islam, Buddhism and US Civil Religion through the lens of Moral Injury in order to examine how these texts contribute to the moral identity of those who are guided by them and to identify sources of moral recovery within their pages. This is one of the few collections that engages non-Christian religious traditions in the exploration of religious resonances and Moral Injury.

Larry Kent Graham, Moral Injury: Restoring Wounded Souls

A thoughtful guide that connects core principles of pastoral and spiritual care with the particular needs of those who have experienced Moral Injury through the exploration of religious resources, rituals and practices. A landmark text that is concerned with framing and directly addressing moral trauma in pastoral counselling.

Nancy Ramsay and Carrie Doehring, Eds., Military Moral Injury and Spiritual Care

A collection of essays illuminating spiritual resonances with Moral Injury, with particular attention to practices and rituals that may aid in helping individuals and communities recover from Moral Injury through focus on their own experiences of injury, moral emotions and rituals that may connect to hope. This volume includes an examination of Christian, Jewish and Islamic perspectives and practices.

Dayne Nix, Moral Injury and a First World War Chaplain: The Life of G. A. Studdart Kennedy

An examination of the ways in which the morally injurious experiences of a British Army chaplain in the first world war deeply affected his life and impacted on the way he understood his own faith. Nix explores the ways in which Kennedy drew upon his faith after the war to express himself in poetry, critique ineffectual practices of the post-war Anglican church and re-orient his life. 

Brad Kelle, The Bible and Moral Injury: Reading Scripture Alongside War’s Unseen Wounds

An exploration of Moral Injury within the Christian canon through the narratives of biblical figures such as Saul and Judas, as well as an accounting of the power of ritual in the ancient Israelite tradition in forming moral identity and mediating the experience of war after conflict. It concludes with a candid discussion of the question – does reading biblical warfare texts morally injure the reader?

Brian Powers, Full Darkness: Original Sin, Moral Injury and Wartime Violence

A theological examination of the power of an Augustinian concept of original sin - with attention to its emphasis on external forces that condition human willing – to illuminate the conditions in wartime that precipitate moral injury. 

Zachary Moon, Warriors Between Worlds: Moral Injury and Identities in Crisis

Written from the perspective of a US military chaplain and practical theologian, this work articulates the concept of ‘moral orienting systems’ in order to describe the ways in which we experience moral stress, incorporate new belief systems and experience moral emotions – all while noting that Moral Injury is not a measure of a defective moral compass, but one that is functioning properly in response to extreme stress.

Joseph Wiinikka-Lydon, Moral Injury and the Promise of Virtue

An argument that the language of virtue ethics – particularly through the work of Iris Murdoch – provides a valuable vocabulary with which to address Moral Injury, particularly locating our capacities to understand ourselves as capable of goodness as a critical aspect of both experiencing and recovering from Moral Injury.

Michael Yandell, War and Negative Relation: A Theoethical Reflection on Moral Injury

A theological argument from a US Army veteran of the Iraq war and systematic theologian that Moral Injury is a ‘negative revelation’ – the disclosure of the value of goodness, justice and meaning through their absence, and that the value of life can be paradoxically glimpsed through the dehumanisation of wartime violence.  

Scholarly articles

Alan Fontana and Robert Rosenheck, “The role of loss of meaning in the pursuit of treatment for posttraumatic stress disorder” Journal of Traumatic Stress 18(2) (2005) pp. 133-136

A study of US veterans of the war in Vietnam that found that those who experienced significant loss of meaning and sought help from the VA were more likely to seek help from clergy as well.  The authors argue that pastoral counsellors should be incorporated into care teams in order to help people work through existential issues. 

Joseph Currier et al., “Military veterans’ preferences for incorporating spirituality in psychotherapy or counseling” Professional Psychology: Research and Practice 49(1) (2018) pp. 39-47

A study that found that US veterans generally preferred the integration of religion and spirituality into their care. However, the study also finds that the issue is complex, suggesting that a veteran's background with religious traditions and baseline worldview matters in their preference for engagement with spiritual care.

Joseph Currier et al., “Moral injury and spiritual struggles in military veterans: A latent profile analysis” Journal of Traumatic Stress 32(3) (2019) pp. 393-404

A study that suggests that Moral Injury may be classified along ‘psychological’ and ‘spiritual’ categories, with the former essentially devoid of significant existential issues or lack of meaning, and the latter including those issues.  The authors argue that this delineation is vital in addressing appropriate care to veterans.

Moral Injury in Healthcare Professions

Books

Eldo E. Frezza, The Moral Distress Syndrome Affecting Physicians: How Current Healthcare is Putting Doctors and Patients at Risk

An exploration of ‘moral distress syndrome,’ a cognate to Moral Injury in the healthcare setting; Frezza argues for the caregivers’ own other-directed empathy as a key to both identifying Moral Injury in themselves and others, and as a cornerstone of recognising the societal elements of healthcare Moral Injury.

Cynda Hylton Rushton, Moral Resilience: Transforming Moral Suffering in Healthcare

A work that understands moral suffering by drawing close parallels with Buddhist understandings of suffering as an unavoidable part of caregiving. It offers ideas around sustainable moral practices and aligned values and language as ways to bring stability to the moral core of healthcare workers.

Press articles

Mariam Alexander, “NHS Staff are suffering from ‘moral injury’, a distress usually associated with war zones” The Guardian, 21 April 2021

While this is an editorial piece in the Guardian, its author is a psychiatrist who notes the way that, during the COVID-19 pandemic, the language of the healthcare setting became increasingly militarised, and NHS workers also began to show clear signs of Moral Injury – in the sense of systemic betrayal, not having the resources to make proper moral decisions and facing high-stakes situations day after day.

Journal articles

Lorna French et al., “’If I die, they do not care’:  U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19” Psychological Trauma: Theory, Research, Practice, and Policy 14(3) (2022) pp. 516-521

A study of NHS workers that found that many of the cases of what is commonly referred to as ‘burnout’ contained a moral component and identified betrayal-based Moral Injury in this setting. Its authors argue for attention to these wounds as Moral Injury in order to facilitate healing or risk a long-term lack of trust and fractured relationship with the organisation.

Moral Injury in Veterinary Professions

Articles

Victoria Williamson et al., “Veterinary professionals’ experiences of moral injury: A qualitative study” Vet Record (2022) 

A study that links existing notions of Moral Injury, notably that of Litz et al. (2009), to the experiences of veterinary practitioners in the UK. It finds that they may be vulnerable to moral injury through a set of potentially morally injurious events unique to the veterinary profession – notably the culling of livestock and the elective euthanising of healthy animals at the request of owners.

Susan C. Kahler, “Moral stress the top trigger in veterinarians’ compassion fatigue” Journal of the American Veterinary Medical Association 246 (2015) pp.16-18

An article featuring an interview with Dr Elizabeth Strand, Director of the Veterinary Social Work Program at the University of Tennessee. She notes the high levels of moral stress that veterinarians face, most prominently in handling ethical dilemmas involving the euthanasia of animals. She notes that US veterinarians have significantly higher rates of suicidal ideation and depression than the rest of the American populace.

James W. Yeates and David C. J. Main, “Veterinary opinions on refusing euthanasia: Justifications and philosophical frameworks” Veterinary Record 168 (2011) p. 263 

An article exploring the frameworks that seem to govern veterinary opinions on euthanising animals and the criteria they use to decide not to euthanise an animal. In terms of Moral Injury, this article details a lot of the ethical dilemmas that are most troubling and potentially morally injurious in the long term for veterinary professionals. 

Victoria Williamson et al., “Experiences and impact of moral injury in U.K. veterinary professional wellbeing” European Journal of Psychotraumatology 13 (2022)

A quantitative study finding that 89% of veterinary professionals responding to an anonymous online questionnaire reported exposure to potentially morally injurious events.  It noted that nearly 70% of respondents experienced ‘betrayal’ types of Moral Injury when moral violations by colleagues impacted them significantly.