A Name For What This Is

The words available for what happened to you are all slightly wrong.

Disappointed is far too small. Upset sounds like a mood. Traumatized feels overstated, and also clinical in a way that does not match, because what you are carrying does not feel like a medical problem. It feels like something broke that was supposed to be structural.

People reach for hurt, and then hear how insufficient it sounds, and stop talking.

There is a better term. It came out of work with combat veterans, it has been applied to healthcare workers and to police, and in the last few years researchers have applied it directly to congregations and to the Catholic abuse crisis. It is called moral injury, and once you have it, a lot of what you have been experiencing organizes itself.

Where the term comes from

Jonathan Shay was a psychiatrist at a Department of Veterans Affairs clinic in Boston who spent years working with Vietnam veterans. He noticed something that the diagnosis of PTSD did not account for.

Some of the men he treated had been through terrible things and were carrying a wound that did not look like fear. It looked like the collapse of their belief that the world had a moral order in it. And when he traced what those men actually talked about, the event at the center was frequently not the worst combat they had seen. It was a commander who had betrayed them.

In 2002 he defined moral injury with three components. It is present when there has been a betrayal of what is morally right, by someone who holds legitimate authority, in a high-stakes situation.

Read that sentence again with your church in it.

A betrayal of what is morally right. By someone who held legitimate authority, which in a congregation is not merely organizational authority but spiritual authority, the kind people submit to voluntarily and at depth. In a high-stakes situation, which describes a place where people bring their marriages, their grief, their children, and their understanding of God.

The part that includes you

Shay's definition centers the person who was directly betrayed. In 2009, Brett Litz and colleagues at Boston University extended it, and their version is the one that explains why the whole congregation is affected.

They defined moral injury as perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.

Bearing witness to. Learning about.

That is the entire congregation. You do not need to have been the person it happened to. You do not need to have been in the room. Learning about it is in the definition, because what does the damage is not proximity to the event. It is the collision between what happened and what you believed was true about the world you were living in.

This is why the person who has never met the woman involved can still find themselves unable to walk into the building.

What it actually feels like

Researchers describe moral injury as producing a recognizable cluster. Persistent psychological and emotional distress. Moral confusion. Spiritual anguish. Social alienation. Distrust of institutions.

More specifically, the things people report:

• A shaken confidence in their own goodness and in other people's
• The sense that a reliable moral order does not exist after all
• Loss of a sense of meaning or purpose
• Self-condemnation, often for things they could not reasonably have prevented
• An expectation of being harmed or exploited again, which colors relationships that have nothing to do with church
• Difficulty trusting any future leader, including good ones

Shay described the end state of severe moral injury as the replacement of a person's capacity to trust with the settled expectancy of harm, exploitation, and humiliation.

If you have found yourself scanning every new leader for what is wrong with them, that sentence is describing something real, and it is not cynicism or a character flaw. It is an injury behaving the way injuries behave.

It has been studied here

This is not a metaphor someone stretched to fit.

A research team at Xavier University built an instrument specifically to measure moral injury caused by clergy sexual abuse and its concealment in the Catholic Church. They surveyed survivors, current and former church employees, and Catholic college students.

They found moral injury most acute among survivors, which is unsurprising. They also found it clearly present among students who felt betrayed by what leaders had done and hidden, and among employees who felt implicated by working for the institution.

One detail from that study is worth sitting with. The researchers reported difficulty recruiting church employees. Many declined because the subject hit too close to home, or because they worried about how participating would be perceived by their pastor, even though the survey was anonymous.

That is moral injury and institutional fear operating together, and it is probably happening in your church right now among people you see every week.

Why this is not a diagnosis, and why that helps

Moral injury is not classified as a mental illness. There is no entry for it in the diagnostic manuals. Researchers describe it as a wound, a crisis of conscience, an injury to the soul.

For a lot of people that is exactly the right fit, and it does something useful.

If you have resisted the idea that what you are experiencing is a psychological condition, you may have been resisting the wrong framing rather than the wrong idea. What happened to you was not primarily an emotional event that upset you. It was a moral event that violated something you had built a life on. Treating that as a mood disorder misses what it is.

This does not mean counseling is unhelpful. Moral injury frequently travels with depression and anxiety, both of which respond to treatment. It means the core of the thing is not a chemical problem or a thinking error, and being told to reframe your thoughts will feel beside the point, because it is.

What tends to help

The research on treating moral injury is younger than the research on describing it, so this is offered with appropriate humility. What appears consistently:

Naming it accurately. People report substantial relief simply from having the category. One writer who went through this in her own church described the moment she encountered the term as a relief, because she had spent months asking what was wrong with her and with everyone around her. Having a name for an injury changes it from evidence of weakness into a thing that happened.

Telling it to someone who does not flinch. Moral injury is sustained by isolation, and it isolates by design, because the content is often something people believe they should not say. Saying it to one person who can hear it without managing you is the most consistently useful thing available.

Working out what you still hold. Not rebuilding your whole framework at once. Just identifying what survived. Most people find that more survived than they expected, and that it is a smaller and sturdier set of things than what they had before.

Distinguishing the source from the substance. If something true was said from that pulpit, it did not stop being true because of who said it. That is easier to write than to feel, and it is usually a slow arrival rather than a decision.

Making room for moral repair. Where there is something you can actually do, doing it matters more than thinking about it. That might be an apology to a specific person, or supporting someone who was harmed, or working on your church's structures so it cannot happen the same way again. Moral injury responds to moral action better than to reassurance.

A note for people in leadership

Two things.

Your staff have this. The Xavier findings on employees who felt implicated by their own institution apply to youth workers, administrative staff, and worship leaders who are currently expected to keep the church running while carrying it. They are unlikely to tell you, and the reason they are unlikely to tell you is in the study.

And so do you, probably. If you were on the board, if you missed it, if you signed off on something, if you are now the one holding it together, the definition covers failing to prevent. Leaders in your position frequently attend to everyone else's injury for a year before noticing their own.

When this is more than a guide can hold

Moral injury often co-occurs with depression, anxiety, and post-traumatic symptoms, and those are treatable.

Worth taking to a licensed counselor:

• Sleep that will not return to normal
• Not being able to work or care for people who depend on you
• Drinking or using more than you want to be
• Intrusive images or thoughts that will not stop
• The self-condemnation becoming constant
• Any thought of harming yourself

Look for someone who works with trauma, and it is reasonable to ask whether they are familiar with moral injury specifically. Some are.

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Sources

• Shay, J. (2002), Odysseus in America, and Shay, J. (2014), "Moral Injury," Psychoanalytic Psychology 31(2).
• Litz, B. et al. (2009), "Moral Injury and Moral Repair in War Veterans," Clinical Psychology Review 29(8).
• Xavier University moral injury research project, on moral injury caused by clergy sexual abuse and its concealment: xavier.edu/moral-injury-report
• Carey, L. and Hodgson, T., on definitional consolidation across the moral injury literature.

This guide is educational and is not a substitute for counseling or medical care. If you are in crisis, contact a licensed professional or call or text 988 in the United States.