By Ashley E. Schumacher, MS, LAPC

I have been wondering whether we may be missing how many people have experienced moral injury because we tend to look for it as a distinct psychological construct rather than considering it as something that can affect the whole person.

Moral injury is often understood as occurring when something we experience, witness, participate in, or inherit violates something deeply held within us about what is good, right, or just. But the human person does not experience life in separate compartments. What happens to our conscience can affect our emotions. What happens relationally can affect how we perceive ourselves and others. What happens to our sense of vocation can affect our freedom, our choices, and our sense of meaning.

From the perspective of the Catholic Christian Meta-Model of the Person, this matters because the person is an integrated unity. An injury that touches something fundamental about goodness, dignity, truth, relationship, or responsibility may be experienced through many dimensions of personhood: conscience, sensory-perceptual experience, emotion, cognition, reason, relationship, vocation, virtue, volition and freedom, and personal unity.

This raises an important possibility: perhaps moral injury does not always look like moral injury.

A person may not say, “I have experienced a violation of my moral expectations.” They may say, “I don't trust myself anymore.” “I can't trust anyone.” “I feel like I have lost myself.” “My body reacts before I know why.” “I know what I should do, but I cannot make myself do it.” “I don't know what my life is for anymore.” “I can't reconcile what happened with what I believe about God.” These experiences may be understood through different psychological or spiritual categories, yet they may sometimes reflect different dimensions of a deeper moral wound.

This also makes me wonder whether we sometimes locate moral injury too late.

Moral development does not begin with words. It begins in relationship. Caregivers are among the first people through whom a child encounters the world. Through repeated experiences of being comforted or left alone, protected or frightened, welcomed or rejected, responded to or ignored, a child begins to develop expectations about self, others, relationship, trust, and what can be expected from the world. These relationships also participate in the earliest formation of conscience and moral reasoning.

A preverbal child does not need to understand the words betrayal, neglect, injustice, or wrong in order for something deeply disordered to be experienced within a relationship. The body and senses can register an experience before the child has the cognitive or linguistic capacity to explain it.

This does not mean that a young child experiences moral injury in exactly the same way an adult does. It raises a different question: Can the moral dimension of an experience be encountered before it can be consciously understood as moral?

If so, some moral injuries may have an embodied, sensory-perceptual, and relational beginning that precedes explicit moral reasoning. And if that occurs while conscience, moral reasoning, and expectations about relationship are still developing, the injury may reach into the very processes through which the person is learning what it means to be a person in relationship with others.

This is one reason I think attachment injuries deserve to be explored more fully in relationship to moral injury.

The same may help us understand what happens when moral injuries occur later in life. A betrayal in an intimate relationship, school, the workplace, military service, a religious community, or another institution is not necessarily caused by an earlier attachment injury. But it may land upon an already formed relational and moral landscape.

A later betrayal can therefore touch something much older and deeply tender.

The injuries remain distinct, but they can become superimposed upon one another. Experiences across different relationships and systems may converge and mutually reinforce the way a person has learned to see themselves, others, God, and the world.

There may also be another layer of injury that occurs much later: the moment a person finally has the language to recognize what happened.

Someone may spend years knowing that something felt wrong without having a framework for understanding why. Then, through therapy, education, or another encounter, they may realize, What happened to me was not simply painful. Something morally significant was violated.

That recognition can be deeply healing. But it can also be painful.

The person may grieve what they did not receive, become angry about what should have been different, or begin to question relationships, beliefs, institutions, or assumptions about themselves that had been built around the earlier experience. I would not say that naming an experience as moral injury necessarily creates a second moral injury. But it may create a second encounter with the injury—a new layer of moral pain or disorientation that comes from consciously recognizing the significance of something that was previously experienced without the words to name it.

This has implications for therapy.

If moral injury can begin before it can be articulated, and if it can reverberate across the whole person, therapy cannot always begin with a coherent narrative. Sometimes the work begins by gently noticing what is happening in the present: in the body, in perception, in emotion, in relationship, in conscience, in one's sense of freedom or agency, or in the expectations a person brings into the therapeutic relationship.

The clinician does not need to decide what these experiences mean or impose the label of moral injury. Rather, the clinician can understand that the client may be communicating through more than language and remain present to what is happening at the sensory-perceptual, embodied, emotional, cognitive, rational, relational, and spiritual levels of experience.

A therapeutic relationship can become a place where these experiences are encountered without being forced into a narrative before the person is ready. The client's dignity can be respected, their perceptions taken seriously, their boundaries honored, and ruptures in relationship noticed and repaired.

If we understand moral injury as something that can affect the integrated human person, we may begin to recognize it not only when someone can name a moral violation, but also in the many ways a person may experience a rupture in conscience, perception, relationship, freedom, vocation, virtue, or personal unity.

Perhaps the question is not only, “Has this person experienced moral injury?”

Perhaps we also need to ask:

“Where has this person's capacity to encounter what is good, beautiful, true, just, relational, dignified, and meaningful been wounded—and how is that wound being experienced across the whole person?”