Overview

Why do some people who follow their conscience and do the morally right thing suffer from guilt, remorse, and anxiety? Normally, a person who follows her conscience will be free of negative emotions. Moral injury occurs when a person knows what is the morally right thing to do, but due to circumstances, she cannot carry out the morally right course of action. The violation of a person’s moral belief creates cognitive dissonance so that she cannot reconcile what she knows to be morally right with the wrongful action leading to self-doubt, guilt, and loss of esteem.

Prior to psychologists and psychiatrists understanding moral injury, individuals who experienced a violation of their deeply held moral values and beliefs, were diagnosed as exhibiting pathological behavior, namely, Post-traumatic Stress Disorder (PTSD). Recent advances in psychology now give us insight into their suffering. Developed by psychiatrist Jonathan Shay in the early 1990s, moral injury refers to a person in authority disregarding a subordinate’s judgment on the morally right course of action, thereby violating the subordinate’s trust and self-esteem. Moral injury, on Shay’s definition, assumes an institutional decision-making structure in which the individuals are embedded. Scholars broadened the definition to include a range of scenarios in which the person is: (1) obligated to carried out an immoral order; (2) sidelined (shunned) by others in the organization who then carry out the immoral action; (3) circumstances intervene (bad luck) and she fails to do what she knows to be the morally right thing; or (4) through weakness of will she cannot carry out the action she knows to be right.

Moral responsibility is linked with moral injury in so far as psychological and emotional distress occurs when a person perceives her moral belief to have been violated. When a person’s morality has been violated, he begins to doubt his ability to reason about his actions, to judge moral right and wrong. He continually reviews past events to find some assurance that he did the morally right thing. Doubt leads to scrupulosity. In Judeo-Christian casuistry, a scrupulous person is someone who cognitively doubts his ability to reason about the moral quality of his actions. He becomes mistrustful of his ability to judge his behavior, and engages in self-recriminations, feelings of guilt, revisiting mentally the events in question. Scrupulosity, in cases of moral injury, are not pathological (not forms of obsessive-compulsive disorder) but grounded in cognitive dissonance that can be resolved.