What actually is moral injury?

Increasingly, one hears about "moral injury" being experienced by soldiers, first responders, journalists, police officers, Indigenous people, and doctors and nurses (the latest example I happened to hear). But what exactly is moral injury? Is it a real thing, or just a trendy buzzword?

Well, yes, it's a real thing, but yes, to some extent, it's also a trendy buzzword, used a little too freely to make a dramatic point.

Moral injury has traditionally been used to describe the experiences of soldiers (and civilians) in wartime situations. It can be defined as damage to an individual's moral conscience, ethical codes or values, as a result of an act of perceived moral transgression (either on the part of the individual or of others around them). It causes profound feelings of guilt or shame, resulting in lasting emotional, psychological, social or spiritual distress, similar but different to post-traumatic stress disorder (PTSD).

Most commonly, it is mentioned in the context of war, where it might affect, for example, a soldier who has to kill civilians (either where there is no alternative, or accidentally), or who gives an order that results in the death of a fellow service member, or who follows orders that are either illegal or immoral, etc. 

More recently, though, it has become increasingly applied to the healthcare profession, particularly since the COVID-19 pandemic. Even before COVID, moral injury was being attributed to healthcare workers, as spending cuts ate into doctors' and nurses' ability to do their job to the best of their ability. Since then, though, things have only got worse, and standards of care have often fallen well below what workers would consider to be acceptable, resulting, it is argued, in moral injury every bit as real as that experienced by solders in battle.

Nurses and doctors in this situation may live with social withdrawal, substance abuse, and even suicidal ideation and self-destructive acts. Depression and other mental health problems are widely experienced in today's healthcare circles.

That said, moral injury is a rather woolly, poorly-defined concept, and it is easy to use it as a buzzword or a handy catch-phrase in a political context. Often, a more appropriate word may be "burnout", which is usually taken to mean a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. This too can cause physical symptoms like headaches, intestinal issues, fatigue and changes to appetite and sleep patterns, but it is not on the same scale as moral injury.