Toward a dual process model of moral injury and traumatic illness

The 3T model of military veteran radicalization and extremism: exploring risk factors and protective strategies

In the aftermath of several wars within the last century, seminal research forewarned against the rising tide of radicalization and violent extremism (VE) among military veterans. Building on the pioneering work, the current study explores risk and protective factors related to military veteran extremism. Utilizing the retrospective thick description approach, the study utilized both primary (e.g., interviews) and open-source (e.g., court transcripts) data to examine and contextualize the VE trajectory across the military lifecycle (premilitary, military, postmilitary), as informed by people from various social networks (e.g., family, civilian/premilitary). The select sample comprised 30 VE veterans and 30 VE civilians who committed/planned a VE act between 2003 and 2019, and a comparison group of 10 non-VE veterans (i.e., veterans who resisted radicalization and VE). Directed content analyses results yielded a conceptual model reflecting three general risk factors (Transmission of Prejudice, Trauma and Adversity, and Transition) common among civilian and veterans alike. In addition, behavioral and cognitive strategies related to three general protective strategies (Resistance against Transmission of Prejudice, Addressing Trauma and Overcoming Adversity, Navigating Transitions) were found to steer veterans away from radicalization and VE across the military lifecycle. Implications for future research are discussed.

Moral trauma, moral distress, moral injury, and moral injury disorder: definitions and assessments

We propose new definitions for moral injury and moral distress, encompassing many prior definitions, but broadening moral injury to more general classes of victims, in addition to perpetrators and witnesses, and broadening moral distress to include settings not involving institutional constraints. We relate these notions of moral distress and moral injury to each other, and locate them on a "moral trauma spectrum" that includes considerations of both persistence and severity. Instances in which moral distress is particularly severe and persistent, and extends beyond cultural and religious norms, might be considered to constitute "moral injury disorder." We propose a general assessment to evaluate various aspects of this proposed moral trauma spectrum, and one that can be used both within and outside of military contexts, and for perpetrators, witnesses, victims, or more generally.

What is veteran suicide prevention really about? Questions from the community to researchers

Military veterans are one of the most researched groups in healthcare in the United States. This population has extremely high rates of suicide attempts and completions. Despite increasing research focus, millions of dollars in funding, and being designated as a high clinical priority, rates of suicidal behavior continue to rise among veterans. Veterans are extremely concerned about this trend and critical of some suicide prevention projects. This study engaged 20 veterans who are connected to individuals within the military community who have attempted or completed suicide. Through semi-structured interviews, participants expressed a profound sense of disconnection from existing policies, treatments, and strategies aimed at preventing veteran suicide. During the course of the interviews, participants posed their own questions: Why is the public really concerned about veteran suicide? Why won't the public recognize its part in the veteran suicide epidemic? Why won't the medical industry listen and collaborate with us? This study underscores the critical need for all stakeholders involved in veteran suicide prevention to reflect on these concerns and to incorporate veterans' insights into future prevention strategies, creating a more responsive and effective approach.

Moral injury: understanding Swedish veterans who are assessed but not diagnosed with PTSD

This article is based on an interview study of 24 Swedish veterans who experienced deteriorating mental health and increased suffering without meeting the criteria for a PTSD diagnosis. With no clinical answers as to the cause of their deteriorating mental health, they have been thrown into a veteran's health limbo. The analysis was based on an inductive logic. A key finding of the analysis was a kind of deep-seated permanent moral conflict that could be conceptualized as moral injury. Such an injury can give rise to intense guilt, shame, anxiety, anger, dejection, bitterness, identity issues and more. The results section of the article details five different yet for the sample representative cases of moral injury and their implications. The notion of moral injury is linked to Mead's division of the self into an I and me, where me is the socially constructed part of the self that is charged with the morality of a group. Thus, a moral me played a key role in the development of moral injury. The conceptual apparatus illustrates a new way of understanding experiences that can create suffering and negatively impact a veteran's mental health. Future research is encouraged that examines this topic, national designs for addressing moral injury, screening for moral injury, and methods for healing included.

Moral injury symptoms and related problems among service members and Veterans: A network analysis

LAY SUMMARY

Both moral injury (MI) and posttraumatic stress disorder (PTSD) can result from adverse experiences (potentially morally injurious events [PMIEs] for the former and Criterion A events for the latter) and may lead to similar symptoms. Thus, debate is ongoing as to whether MI and PTSD are distinct. Depressive symptoms can also follow these events and may also overlap with symptoms of MI and PTSD. This study investigated how distinct MI is from PTSD and depression by examining networks composed of MI-related outcomes (trust violation, shame, functioning), PTSD symptom clusters, and depression for participants who reported experiencing a PMIE and those who did not. This study is the first of its kind to use MI outcomes with PTSD and depression in a network analysis. The results suggest that MI, PTSD, and depression are distinct but related phenomena, with more connections between these phenomena present particularly among those who experienced a PMIE. Moreover, the negative alterations in cognition and mood cluster of PTSD and MI-related functioning appears to explain some of the co-occurrence among constructs.

Caught between is and ought: The Moral Dissonance Model

Considerable academic effort has been invested in explaining the causes of, and processes behind moral injury. These efforts are mostly focused on assessment and treatment within a clinical setting. Collective and social factors contributing to moral injury are often overlooked in current literature. This perspective article considers the role of contextual factors associated with moral injury and proposes a framework that describes their relation to individual aspects. The resulting Moral Dissonance Model (MDM) draws on existing theories and frameworks. The MDM explains how dissonance can occur when the actual behavior-the response to a morally challenging situation-contradicts with morally desirable behavior. Individual and collective factors, which change over time, contribute to the experience of dissonance. The inability to sufficiently solve dissonance can lead to moral injury, but not as a matter of course. The MDM can help to understand the underlying processes of moral distress. It raises awareness of the influence of public debate and controversy, and the resulting changing societal attitudes over time. Its implications and future use are discussed.