How Can Theology and Research Illuminate Each Other in Understanding Moral Injury?

Introduction

The study of moral injury has emerged as one of the most significant developments in contemporary psychology, trauma studies, military ethics, healthcare, and helping professions. Originally explored among combat veterans, moral injury is increasingly recognized among clergy, healthcare workers, emergency managers, humanitarian workers, disaster responders, educators, caregivers, and others who regularly encounter situations that challenge deeply held moral convictions.

At the same time, moral injury raises questions that extend beyond the reach of psychology alone. People experiencing moral injury often struggle not merely with emotions but with meaning, identity, trust, responsibility, guilt, betrayal, forgiveness, and hope. They wrestle with questions that are fundamentally moral and spiritual in nature.

This reality creates an important opportunity. Theology and research need not compete in explaining moral injury. Instead, they can illuminate one another. Research helps us understand how moral injury develops and affects human functioning. Theology helps us understand why these wounds matter, how they shape the human soul, and what pathways toward repair may look like.

The most fruitful understanding of moral injury may emerge when empirical research and theological reflection are allowed to speak together.

What Research Teaches Us About Moral Injury

Modern moral injury research emerged largely through the work of psychiatrist Jonathan Shay and psychologist Brett Litz. While their definitions differ in emphasis, both recognized that some wounds arise not primarily from fear or threat but from violations of deeply held moral expectations.^1^

Shay described moral injury as resulting from betrayal by legitimate authority in high-stakes situations.^2^ Litz and colleagues expanded the concept to include actions taken, witnessed, or failed to prevent that transgress an individual’s moral beliefs and expectations.^3^

Research consistently identifies several recurring sources of moral injury:

• Betrayal by trusted leaders or institutions

• Participation in actions that violate personal values

• Witnessing preventable suffering

• Inability to protect vulnerable people

• Resource scarcity and impossible choices

• Repeated exposure to human suffering

• Feelings of responsibility for outcomes beyond one’s control

Researchers have documented associations between moral injury and:

• Shame

• Guilt

• Loss of trust

• Social withdrawal

• Spiritual struggle

• Depression

• Burnout

• Suicidal ideation

• Existential distress^4^

Importantly, moral injury differs from post-traumatic stress disorder (PTSD). PTSD is often rooted in fear-based responses to threat and danger. Moral injury is rooted in violations of conscience, meaning, trust, and moral identity.^5^

This distinction is particularly important for caregivers, clergy, and disaster responders. Many do not primarily suffer because they were afraid. They suffer because they were unable to prevent suffering, because institutions failed, because resources were insufficient, or because every available option carried consequences.

Research helps us identify these dynamics. Yet research also reveals that moral injury is ultimately a crisis of meaning.

This is where theology enters the conversation.

What Theology Brings to the Conversation

Theology begins with a recognition that human beings are not merely biological or psychological creatures. Human beings are moral, relational, and spiritual beings.

Consequently, injuries involving meaning, responsibility, guilt, betrayal, and trust are not merely psychological disruptions. They are wounds that touch the deepest dimensions of human identity.

Many theological traditions have long wrestled with experiences that closely resemble what contemporary researchers describe as moral injury.

Covenant and Betrayal

One of the most common themes in moral injury research is betrayal.

Scripture is filled with stories of betrayal:

• Joseph betrayed by his brothers

• David betrayed by trusted companions

• Jeremiah abandoned by his community

• Jesus betrayed by Judas and denied by Peter

Biblical faith recognizes that betrayal wounds more than relationships. Betrayal disrupts trust, identity, belonging, and meaning.

Research helps describe these injuries. Theology helps explain why they cut so deeply.

Guilt, Shame, and Moral Failure

Research consistently identifies guilt and shame as central features of moral injury.^6^

Theological traditions have spent centuries exploring these realities.

Christian theology distinguishes between guilt and shame in ways that remain remarkably relevant.

Guilt concerns actions.

Shame concerns identity.

People suffering moral injury frequently move from saying:

“I did something wrong”

to believing:

“I am something wrong.”

Theology provides language for addressing this collapse of identity through concepts such as grace, forgiveness, reconciliation, and belovedness.

Lament as Truth-Telling

One of the most significant contributions theology offers moral injury work may be the practice of lament.

Many injured people feel pressure to move quickly toward acceptance, resilience, recovery, or positivity.

The biblical tradition offers a different path.

The Psalms, Job, Lamentations, Jeremiah, and numerous prophetic texts demonstrate that faithful people often respond to suffering through protest, grief, confusion, and unanswered questions.

Lament is not a failure of faith.

Lament is faith refusing to abandon truth.

In this sense, lament may function as a form of moral and spiritual repair.

It creates space to acknowledge that something real has been lost, violated, broken, or betrayed.

Research increasingly recognizes the importance of narrative processing and meaning-making after trauma.^7^ Theology contributes an ancient language of lament that supports this process.

Theological Moral Injury

One of the emerging frontiers in moral injury work involves what might be called theological moral injury.

Many caregivers, clergy, responders, and survivors discover that catastrophe wounds more than emotional functioning.

It wounds theology.

Disaster responders often encounter suffering that exceeds available explanations.

Healthcare workers may witness deaths that seem senseless.

Pastors may pray fervently and still bury children.

Survivors may ask why God did not intervene.

Researchers frequently speak of “shattered assumptions.”^8^

Theologically, these experiences often involve shattered faith assumptions.

People may find themselves questioning:

• God’s goodness

• God’s power

• God’s presence

• Prayer

• Providence

• Meaning itself

These struggles are not signs of weak faith.

They are often evidence of profound encounters with suffering.

Research helps us understand the psychological dimensions of these disruptions.

Theology helps us understand the spiritual dimensions.

Together, they provide a more complete picture.

Meaning-Making and Faith After Explanations Collapse

Contemporary meaning-making research explores how individuals reconstruct purpose and coherence following overwhelming events.^9^

Researchers ask:

How do people rebuild meaning after suffering?

Theology asks a related but distinct question:

How does faith survive when meaning itself collapses?

These questions overlap but are not identical.

Research often focuses on cognitive reconstruction.

Theology often focuses on trust, hope, vocation, and relationship.

Both are necessary.

Many people never regain the explanatory certainty they once possessed.

Yet they may discover deeper forms of faith grounded not in answers but in presence.

Not in certainty but in trust.

Not in explanations but in companionship.

This insight is especially relevant for disaster spiritual care.

The goal is rarely to provide answers.

The goal is to remain present when answers fail.

A Shared Commitment to Human Flourishing

Theology and research ultimately share a common concern.

Both seek to understand what helps human beings remain human.

Researchers investigate resilience, recovery, meaning-making, and well-being.

Theology explores hope, reconciliation, compassion, vocation, and grace.

Neither discipline is sufficient by itself.

Research without theology can sometimes describe suffering without fully addressing questions of meaning.

Theology without research can become disconnected from the realities of lived experience.

Together, they offer a richer understanding of moral injury and more faithful approaches to healing.

Conclusion

The future of moral injury work does not belong exclusively to clinicians, researchers, theologians, or caregivers.

It belongs to all who seek to understand the moral, emotional, relational, and spiritual consequences of living in a wounded world.

Research provides critical insight into how moral injury develops and affects human functioning.

Theology provides language for questions that arise when suffering touches meaning, conscience, trust, identity, and faith.

The most important question is not whether theology or research possesses the better explanation.

The more important question is how theology and research can illuminate one another.

When they do, both become more capable of helping wounded people tell the truth about their suffering, reclaim their humanity, and discover pathways toward repair.

Notes

• Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 1994); Brett T. Litz et al., “Moral Injury and Moral Repair in War Veterans,” Clinical Psychology Review 29, no. 8 (2009): 695–706.

• Shay, Achilles in Vietnam, 20.

• Litz et al., “Moral Injury and Moral Repair in War Veterans,” 700.

• Rita Nakashima Brock and Gabriella Lettini, Soul Repair: Recovering from Moral Injury After War (Boston: Beacon Press, 2012), 14–18.

• Joseph Currier, Jason Holland, and Kent Drescher, “Residential Treatment for Combat-Related PTSD and Moral Injury,” Spirituality in Clinical Practice 2, no. 2 (2015): 122–133.

• Brett T. Litz and William E. Kelly, “Moral Injury and Moral Repair in the Context of War,” in Building Spiritual Strength, ed. Jamie Aten and Kent Drescher (Washington, DC: American Psychological Association, 2014).

• Crystal L. Park, “Making Sense of the Meaning Literature,” Psychological Bulletin 136, no. 2 (2010): 257–301.

• Ronnie Janoff-Bulman, Shattered Assumptions: Towards a New Psychology of Trauma (New York: Free Press, 1992).

• Park, “Making Sense of the Meaning Literature.”

Bibliography

Brock, Rita Nakashima, and Gabriella Lettini. Soul Repair: Recovering from Moral Injury After War. Boston: Beacon Press, 2012.

Currier, Joseph, Jason Holland, and Kent Drescher. “Residential Treatment for Combat-Related PTSD and Moral Injury.” Spirituality in Clinical Practice 2, no. 2 (2015): 122–133.

Janoff-Bulman, Ronnie. Shattered Assumptions: Towards a New Psychology of Trauma. New York: Free Press, 1992.

Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (2009): 695–706.

Litz, Brett T., and William E. Kelly. “Moral Injury and Moral Repair in the Context of War.” In Building Spiritual Strength: Integrating Spirituality into Mental Health Practice, edited by Jamie Aten and Kent Drescher. Washington, DC: American Psychological Association, 2014.

Park, Crystal L. “Making Sense of the Meaning Literature: An Integrative Review of Meaning Making and Its Effects on Adjustment to Stressful Life Events.” Psychological Bulletin 136, no. 2 (2010): 257–301.

Shay, Jonathan. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner, 1994.

Shay, Jonathan. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner, 2002.

Vander Weele, Tyler J. “On the Promotion of Human Flourishing.” Proceedings of the National Academy of Sciences 114, no. 31 (2017): 8148–8156.