Soul Wounds: The Impact of Moral Injury in First Responders and Implications for Counseling
First responders (e.g., law enforcement, firefighters, paramedics, and emergency dispatchers) operate in conditions where responsibility to act, empathy, and moral influence converge with human tragedy. More than 80% of first responders have endorsed experiencing traumatic events. First responders are disproportionately subjected to events and experiences that may conflict with their deeply rooted moral values. These events increase their risk of facing stress-related issues outside of those experiences, as outlined in established fear-based stress disorders. As such, first responders are at an increased risk of depression, substance abuse, posttraumatic stress disorder (PTSD), and suicide. This paper addresses the complex diagnostic distinctions between PTSD and moral injury (MI). An event leading to posttraumatic stress disorder does not necessarily mean a moral injury has occurred; however, moral injury is always traumatic. MI has been defined as “a response to trauma when a person or group’s core moral foundations cannot identify, justify, process, and integrate the trauma experience into a meaningful system that sustains relationships and human flourishing.” Commonly accepted characteristics of MI include shame, guilt, spiritual or existential crisis, and loss of trust in oneself or others. When MI goes untreated, secondary diagnostic characteristics can include anxiety, depression, anger, reexperiencing, self-harm, and social issues. This paper discusses the importance of moral repair, personal renewal, and self-forgiveness in one’s journey of healing and restoring one’s moral identity. Culturally competent clinicians must listen attentively, devoid of judgment or individual agenda, and be proficient at recognizing and treating a moral injury.
Keywords: moral injury, posttraumatic stress disorder, trauma, first responder, counseling
CMHC 699 – Capstone
Mindi Barta
3:00pm – 4:00pm L203