The American Psychiatric Association is considering a new medical diagnosis: moral injury disorder, a profound wound that alters one’s worldview, one’s sense of right and wrong, of good and evil.
“Sadly, such a wound often leads to significant social impairment and long-term mental health challenges,” explains Dr. Jennifer Wortham, an award winning activist and public health scholar at Harvard University, who is working with the American Psychiatric Association to integrate this diagnosis. Acknowledging moral injuries and creating a dedicated diagnosis code, she adds, will both advance empirical research and bring to light the need to provide tools for clinical staff treating survivors. In an attempt to raise awareness and further research, Dr. Wortham is initiating the World Congress on Moral Injury, Trauma, Spirituality and Healing, to be held at Harvard on March 11.
The new diagnosis will likely stand on its own ground, separately from post-traumatic stress disorder, conveying that though these conditions are associated and share some common features, they are still distinct.
The concept of moral injury has existed for years, some would say for as long as humans have acknowledged morality. In modern times, it has been covered extensively in the military context, as therapists and researchers attempt to contextualize and assist war veterans, many of whom experienced acts that transgressed their deeply held moral beliefs – either as victims, perpetrators or witnesses. In recent years, there has been a growing body of research on moral injury experienced by the general population and front-line workers exposed to challenging ethical dilemma, such as during the global Covid-19 pandemic.
Heartbreakingly, moral injuries are still happening every day, all over the world. Hamas’ brutality and use of sexual violence as a weapon of war on October 7 shocked the world and traumatized an entire nation, though appallingly it was not acknowledged by women’s rights organizations for weeks. The failure to acknowledge these events was experienced as a profound betrayal; a core symptom of moral injury. Unfortunately, this lack of acknowledgment, of accountability, characterizes many moral injurious situations. On March 4, the United Nations acknowledged the sexual violence committed by Hamas on October 7, with reasonable grounds to believe such violence may be continuing against hostages.
“The use of sexual violence as a weapon of war can never be tolerated,” Dr. Wortham says. “The world is now suffering collectively from moral injury. People are being forced to take sides, where standing up against one type of atrocity is made to seem as if you’re endorsing the other type – and that’s not the case. We need to end all atrocities if we are ever to evolve as a human race. Sexual violence and abuse, these are one of the greatest violations of dignity any human can experience.”
And she would know. Dr. Wortham, who spearheaded the global campaign that resulted in the United Nation’s declaration of a World Day for the Prevention of, and Healing from Child Sexual Exploitation, Abuse and Violence, has also led a very personal journey. Her two brothers survived sexual abuse by their parish priest. “Following the reporting of my brothers’ abuse to church officials, our lives were never the same. My family was shunned by our faith community, and the betrayal, shame, and stigma we all experienced haunts us to this day,” says Wortham. “My personal healing process was to work with the church to try and fix the problem, and the first step is acknowledging it.”
Stories like hers are not rare. The UN estimates that 120 million females under 20 have experienced sexual violence, whereas 3-17% of boys under 18 have been subjected to sexual violence.
How can one heal from such a devastating injury? There is no evidence-based answer, and treatment strategies are still being researched. “I believe true healing must take a holistic approach to address the wounds of the mind, the heart, the body and the soul,” Wortham says. “For me, spirituality and my belief in God have been an anchor. But acknowledgment, forgiveness, and eventually reconciliation and letting go can be practiced by everyone. There is hope.”
There are different paths to healing. The first step starts with acknowledging the injury and asking for help. Both Israeli and Palestinian civilians have suffered greatly in this war, apart from losing their own lives or loved ones, losing their homes, their sense of security and their trust in leadership. These all lead to moral injuries. The world should courageously recognize all moral injuries perpetrated before and after October 7, bring the hostages back home and start a global healing process.
