Note: This article contains mention of violence, including violence against children.
Recently, the mother of an eight-year-old girl told us the following story. Her daughter had come home from school distraught because she had joined other girls in “being mean” to a classmate. She hadn’t said anything herself, but she’d stood with the bullies and giggled while they ridiculed the classmate. Earlier, the girl had been on the receiving end of the bullies’ taunts, herself; now she was flirting with the power they held.
Afterward she was filled with a remorse so strong that she was sick for the remainder of the day—nauseated, anxious, and ashamed. It was as if her whole body was telling her that her choice had gone against something intrinsic to her character.
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The mother was concerned about her daughter’s behavior, but we assured her that this was not something to worry about: Her child’s moral compass was intact, and beautifully sensitive to right and wrong. Sure, she had experimented with a darker aspect of human social interaction—and her role in it—but her own position had become crystal clear. What she needed now was simply assistance from skilled adults to help her find the language and actions to navigate her social world in a way that helped her stay in integrity with her values.
It is remarkable that children are born ready to develop a moral framework. Even babies show empathy and prefer fair, kind actors over unjust, mean ones. This makes sense. Humans are social creatures. We have evolved capacities over thousands of years to help us live with others. Our bodies contain genes, neurotransmitters, and nerves that drive us to care for, empathize with, and respect the people around us. Decades of research show that when we act in harmony with these inclinations, we have better mental and physical health and even longevity. At a community level, societies that encourage prosocial actions thrive and are more resilient.
But when our moral map is violated, we suffer.
Psychologists are increasingly recognizing a condition called moral injury—a psychological harm caused by experiencing serious moral transgressions. It occurs when there’s a deep or chronic conflict between what we believe is right versus what we’re being asked to do, witness, accept, condone, or remain silent about. Any involved party—whether perpetrator, target, accomplice, or bystander—can experience moral injury, whether immediately or eventually.
Initially, feelings of guilt, shame, or shock arise, but if left unaddressed, these can metastasize into chronic anxiety or depression and even existential challenges like feelings of meaninglessness, a loss of trust in others and in institutions, a spiritual crisis, or an erosion of the sense of one’s goodness. When we experience moral injury, it’s as if our understanding of how the world is organized—and our place in it—shatters, leaving us unanchored and despairing.
Moral injury is distinct from other psychiatric concerns. It’s different from post-traumatic stress disorder (PTSD) in that it centers around the moral emotions like guilt, remorse, empathic alarm, or moral outrage, whereas trauma, on the other hand, is centered on fear and helplessness. Moral injury is also different from moral distress, which is more mild or temporary, and it is not the same as being simply offended, triggered, or insulted. Moral injury is a deep wound resulting from chronic or severe exposure. Individuals vary in their susceptibility to moral injury; two people might experience the same event differently.
The concept is not new. Ancient Greek writings refer to “moral defilement,” acts that run counter to the virtues that promote personal excellence and social harmony. Contemporary world religions all address violations to moral behavior, such as Christianity’s concepts of sin and forgiveness, Judaism’s atonement, Islam’s concept of tawba or repentance, and Hinduism’s karma and concept of right action.
But it first appeared in the psychological literature when psychiatrists found that some veterans of wars in Vietnam, Iraq, and Afghanistan suffered from “moral anguish,” from their leaders’ transgressions or their inability to help innocent women and children. Without intervention, they tended toward either revenge or self-destruction, and recovery focused on knitting their “moral existence” back together. More recent studies have looked at moral injury among health care workers during the COVID-19 pandemic, first responders, and even journalists covering humanitarian crises.
Could someone who holds harmful views claim moral injury? This has not been documented to our knowledge. It would be hard to justify, given that moral frameworks across cultures and eras have emphasized compassion, fairness, respect for others, loyalty, responsibility, courage, and integrity. Developmental science has documented the progression of care and justice across childhood.
As we grow into adulthood, we increasingly try to make life choices—to the extent possible—that are congruent with our values: the work we do, where we live, the people we choose. Some areas of life are easier to align than others. But at some point we inevitably hit patches that elude our control altogether.
Today, the daily news brings innumerable events that spark moral outrage or empathic alarm. Civilians are kidnapped by masked men and taken to detention facilities because of policies the majority of Americans oppose. Military personnel are invading and patrolling neighborhoods. Gun violence is the leading cause of death of U.S. children, but leaders say school shootings are “a fact of life.” Government workers are pressured to act against their professional training. Corporate leaders are making large donations or concessions to curry political favor. Free speech is under attack, political opponents are indicted, and civil liberties are denied. Universities are threatened, evidence-based medical care is rebuffed, and grift is rampant. A prominent political advisor parrots the Nazi propaganda of Joseph Goebbels.
If we are not directly involved in these events, we are witnesses to them. How, then, do we live? How do we navigate the distress these injustices cause before it escalates to personal psychological harm—and the destructive thoughts and actions that can result from that harm?
The research is clear: We need to pay attention to our feelings, not only because we care about others but also for the sake of our own well-being. If we let moral injury fester without acknowledging and working with it, we can become injured from the inside, twisting into someone we don’t like and don’t want to become. When the emotions of moral distress are not acknowledged or addressed, they can grow into cynicism, apathy, polarization, or extremism. Left unattended, they either work their way inside a person to distort character and cause depression, despair, and disengagement, or they’re expressed outward in a cruel, destructive rage. Either way, when caring becomes too painful, the result is a rising tide of anguish, anger, and helplessness.
But what can an individual do against forces bigger than themselves?
Several responses are suggested, from the sparse psychological research to date as well as from writers, activists, artists, and other people who have worked with moral injury. We share some approaches here with the hope that you will pause to consider what feels right for you. Every person is different, and your energy, vulnerabilities, and risks will vary. There is no one magic solution.
Individual-level practices to sustain integrity
Consider your framing. For example, some hold a compassionate view that people are more than the worst thing they’ve done and are often acting under severe constraints. Others take the sting off with humor.
Call upon a spiritual practice. Many approaches include forms of prayer—for oneself and for victims. The Buddhist practice of metta (loving-kindness) extends concern even to those who have caused harm.
Preserve your dignity. In his book Man’s Search For Meaning, the psychiatrist Viktor Frankl shares insights from his time as a prisoner in Nazi concentration camps. Moral integrity is not just an abstract principle, he writes, but something tested under conditions of radical deprivation, cruelty, and loss of control. Integrity lay in how one bears unavoidable suffering—with despair or dignity. He describes three keys:
- Freedom of attitude: In the camps, he writes, guards could control prisoners’ bodies but not their inner choices. “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way….It is this spiritual freedom—which cannot be taken away—that makes life meaningful and purposeful.”
- Small moral acts: Sharing a crust of bread and comforting a companion were kindnesses that preserved prisoners’ agency and affirmed their and others’ humanity.
- Purpose beyond survival: Prisoners who anchored themselves to a meaning and purpose beyond their circumstances survived better. Frankl pinned his hopes to his beloved wife and to his scientific writings.
Rest and reset. Step away, take breaks, and sleep. Energy needs to be replenished in order to get up and go again. You don’t know how long it will take to manifest the hoped-for change; it may be beyond your lifetime. But we plant the tree in whose shade we may never sit.
Savor moral beauty. The psychologist Rick Hanson explains the human brain’s negativity bias as “Teflon for the good and Velcro for the bad.” To counter this bias, take an extra minute to deliberately appreciate moments of courage, integrity, and kindness you see around you. Let them register in your body and mind to amplify a more positive ratio.
Practice self-forgiveness. We are each limited by the contexts in which we live. Chances are, you’ve done the best you could under difficult circumstances. Give yourself grace.
Interpersonal-level strategies
Support others’ moral actions. If you are a parent or work with children, know that children are inherently empathic and prosocial, and want to be “good.” But they are in need of guidance as to how to organize and express those tendencies, especially in difficult or ambiguous situations. Name and talk about strategies in developmentally appropriate language.
Find like-minded people. Burdens are lighter when shared, and others can offer concrete strategies as well as social support.
Know that any contribution is additive. While you can’t solve an entire systemic problem, your contribution to any piece of the problem contributes to change.
Look for inspiration and leadership. Draw on inspiration from historical figures. Look for people with expertise or access to levers of change. Training in legal rights, noncompliance, paths to systemic change, etc., can be helpful. Listen to analysts that give you direction. Emulate successful strategies.
Seek therapies with spiritual or moral framings to help make personal meaning of what’s happening.
Offer direct assistance. After the Annunciation mass shooting in Minneapolis, one hospital staff member crawled into a CT-scanner with a frightened child to hold their hand so they wouldn’t be alone. Citizens sent food to the hospital for the medical staff who were too rushed to eat. These acts have an immediate impact.
Focus locally, on your immediate circles—your community, your children, even your garden.
System-level strategies
Pick your lane(s). Focus on actions that are reasonable for you to take. You may call or write your representatives or you can join an organization to get out the vote. You may put your body in harm’s way to protect immigrants leaving court, or you may feed or pray for those who do. You don’t have to do it all or fix everything—your piece, done with care, makes a difference.
Support nonviolent resistance, such as “soft secession” strategies, economic boycotts, or “Moral Mondays.”
Join peaceful protests.
Provide care to frontline activists.
Find a place to offer your expertise.
These are just a few of myriad ways to prevent and soothe moral injuries. At the very least, it may be enough just to recognize the phenomenon and understand that it’s a dynamic potentially at play, whether you take action or not.
These ideas are summed up in the poem “Do It Anyway” by Kent Keith, famously affixed to Mother Theresa’s wall in her orphanages in Calcutta. Part of it reads:
The good you do today, will often be forgotten. Do good anyway. Give the best you have, and it will never be enough. Give your best anyway.
In the final analysis, it is between you and God. It was never between you and them anyway
The authors’ views are their own and not those of the Yale School of Medicine.
