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done to us, the betrayals of those we trust, or involve integrity, conscience, and moral iden�-
the painful reali�es we witness. Consider this ty.
change to our story:
Before the storm, Maria’s neighbor had promi- Defining Moral Injury
sed to come with his boat and evacuate her and Moral injury is described as the enduring dis-
the children before the worst of the flooding. tress that arises when one’s deepest moral be-
But as the hours dragged on, he never showed liefs and values are violated. Drawing on a ran-
up. Though Maria and her children were even- ge of research and theore�cal perspec�ves,
tually rescued, she was haunted by a profound scholars have iden�fied four primary forms of
sense of betrayal. In therapy, her primary focus moral harm (Shay, 1994; Litz et al., 2009). While
was not on hypervigilance, flashbacks, or avoi- not mutually exclusive, these categories offer a
dance—although she would come to address helpful framework for tracing the different ent-
these issues later. Instead, her complaints cen- ry points into moral suffering.
tered on the betrayal of her neighbor: “Why Acts of commission refer to having done some-
didn’t he come for us?” “We could have died.” thing that violates one’s conscience—perhaps
“Did he decide we weren’t worth the risk or harming another person, breaking a vow, or
something?” “We trusted him.” “How could he ac�ng in a way that contradicts one’s most che-
just leave us there?” In the first weeks of thera- rished values.
py, it wasn’t fear that consumed Maria, but the Acts of omission arise when someone fails to
weight of moral harm that manifested as hurt, act in a moment of responsibility, watching
betrayal, disillusionment, and anger. The prima- harm occur without stepping in, and later car-
ry wound she ini�ally carried was not about her rying the unbearable ques�on: “Why didn’t I
and her children almost perishing in the flood. do something?”
It was about a broken moral trust—a moral in- Betrayal experiences are wounds that occur
jury rooted in betrayal by someone she had when a trusted person, leader, group, or ins�-
counted on in her hour of greatest need. tu�on violates, abandons, or exploits the trust
that has been placed in them. Such experiences
The second part of Maria’s story illustrates how fracture the very founda�on of trust, o�en lea-
not all harm is rooted in fear. Although she later ving individuals disoriented and uncertain
confronted symptoms like hypervigilance and about whom—or even whether—they can
flashbacks, her ini�al anguish was centered on trust again.
betrayal. The wound that consumed her was Witnessing experiences capture the anguish of
not the danger of nearly drowning or losing her seeing atroci�es, injus�ces, or abuse unfold
children, but the collapse of trust when her and being unable to stop it. This leaves the wit-
neighbor—someone she depended on—failed ness haunted by what was seen or experi-
to keep his word, which put her and her child- enced, as well as the accompanying powerless-
ren at risk. Her primary suffering arose from a ness of what could not be stopped or undone.
moral viola�on, not from nearly drowning. T Each of these destabilizes what philosopher
his example underscores a crucial point: while Charles Taylor (1989) describes as a person’s
some clients’ wounds flow from fear, others are moral horizon—the invisible map of rightness,
born of moral harm—viola�ons of trust, cons- meaning, and trust in self, others, or God, that
cience, and core convic�ons of right and wrong. orients daily life. When this horizon is ruptured,
To truly understand these deeper wounds, we people no longer experience themselves or the
must look at them not only psychologically but world in quite the same way. What was once
also philosophically, spiritually, and theological- taken for granted—trust in leaders, the belief
ly. These perspec�ves help bring ques�ons of that one would act bravely, or the assump�on
meaning, conscience, sin, grace, and human di- that jus�ce will prevail— collapses, leaving the
gnity into sharper focus, allowing us to under- person disoriented, alienated, and struggling to
stand moral harm more clearly. Only then can find foo�ng in a world that no longer feels mo-
we begin to determine the most effec�ve ways rally coherent.
to care for individuals whose deepest struggles
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