Sarah Denne

Our paper makes three contributions to moral injury (MI) research. First, we observe that while researchers have repeatedly acknowledged limitations with prevailing definitions of moral injury and offered alternatives, the underlying core conceptual model—which characterizes moral injury as intrapsychic damage to belief structures—has remained largely unchanged. We argue that this is a significant impediment to research progress. Second, through conceptual analysis of the most influential etiological accounts, we identify numerous implicit and untested assumptions about morality that burden the standard model. We propose that adopting a minimalist, social-functionalist conception of morality, toward which the literature is already drifting, could reduce this conceptual burden. We further hypothesize that the literature retains these assumptions because they appear logically necessary to sustain the causal link between belief violation and MI outcomes. Third, we observe that current leading treatments already target relational repair, reconditioning, and rehabilitation, which suggests that moral injury may be better understood as a form of relational disruption rather than belief violation. We acknowledge that developing this alternative would need to be pursued by the clinical research community itself. While our findings and analysis require additional development and testing to have actionable application in clinical contexts, we believe our conceptual analysis serves as sufficient justification for reconsideration of the prevailing conceptual paradigm.

Many critics have called Clarice Lispector a mystic. Lispector, however, was not a religious figure, but rather a 20th-century Brazilian writer who was influenced by both her Jewish background and her Catholic Brazilian context. There are various forms of Jewish and Christian mysticism that reject transcendent union with God and, by referencing them, I elucidate the complexity of Lispector’s mystical fiction. By looking at challenges to mystical union in these traditions, I aim to show the ethical complexity of this concept and how that complexity is deepened through Lispector’s writing as she problematises blurred boundaries between self and Other.

The predominant account of the etiology of moral injuries among Veterans and military personnel in the clinical psychological and psychiatric literature construes morality as inherent in belief structures. This supports the conceptualization of moral injuries as intrapsychic phenomena resulting from exposure to high-stakes events in which fixed beliefs are contravened in ways that result in psychological harms, including maladaptive beliefs and distress. We identify several problems with this formulation and offer suggestions for modification, including greater focus on: 1) experiences rather than events in identifying circumstances in which moral injuries occur, and 2) degradation of relevant relationships rather than conflicts with and among moral contents. These shifts in framing could have epidemiological salience, facilitating more robust case characterization and enabling a variety of approaches to reestablishing the moral conditions that support life affirmation.

This article seeks to describe in general terms what has become the standard way of conceptualizing moral injury in the clinical psychological and psychiatric literature, which is the key source for applications of the concept in other domains. What we call “the standard model” draws on certain assumptions about beliefs, mental states, and emotions as well as an implicit theory of causation about how various forms of harm arise from certain experiences or “events” that violate persons’ moral beliefs and systems. Our analysis makes these assumptions more explicit and subjects them to critical scrutiny. In so doing, we survey the current literature and identify basic features of how moral injuries are defined, how they are thought to occur, and the forms of treatment or repair that appear to be indicated. We caution that it matters how moral experience is characterized and argue that an alternative understanding of what is the moral in moral injury is important for overcoming critical challenges to the standard model. Moreover, recently evolving approaches to moral repair could be more consistent with an alternative model. Our concluding suggestion is that a more robust account of the nature of moral experience and its relations to self-identity and social experience more generally could advance understanding of the etiology of moral injury and promote rehabilitation.