Where do moral injuries come from? A relational conception of moral practice and experience.

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. The authors 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 re-establishing the moral conditions that support life affirmation.