Moral Injury and US Army Social Work Officers

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Dexter R. Freeman
Samuel Odom


Moral injury, military social work officers, post-traumatic stress, spirituality, moral injurious events, deployment


Uniformed social work officers, serving as healthcare providers and soldiers, are frequently confronted with the complex and conflicting responsibilities to uphold loyalty, duty, respect, and commitment to their unit’s mission while also upholding their professional and personal values, principles, and duties as social work professionals and servants of humanity. As Army social work officers return home, many carry spiritual and emotional wounds as warriors and healthcare providers. This paper discusses the results of  a qualitative study that examined the occurrence of potential moral injurious events that social work officers experienced during their  deployment in support of Operation Iraqi Freedom from 2007- 2009.  The authors also examine the challenges that these healthcare professionals experienced, resulting in a potential existential crisis that was caused by the wounding of their soul.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5. American Psychiatric Association.

Antonelli, M. (2017). Moral injury. The American Journal of Psychoanalysis, 77: 406-416. doi: 10.1057/s11231-017-9107-4.

Barnes, H.A., Hurley, R.A., & Taber, K.H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. Journal of neuropsychiatry, 31(2)98-103. Doi: 10.1176/appi.neuropsych.19020036

Beard, M. T. (2015). Distinguishing PTSD from moral injury: Conceptual and experiential approaches [Unpublished manuscript].

Blinka, D, & Harris, H.W. (2016). Moral injury in warriors and veterans: The challenge to social work. Social Work & Christianity, 43(3), 7-27

Bollinger, A., Riggs, D., Blake, D., & Ruzek, J. (2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 255–270. doi: 10.1023/A:1007706727869.

Bremault-Phillips, S., Pike, A., Scarcella, F., & Cherwick, T. (2019). Spirituality and moral injury among military personnel: A mini-review. Frontiers in Psychiatry, 10, 1-9. Doi:10.3389/fpsyt.2019.00276

Brock, R. N. & Lettini, G. (2012). Soul repair: Recovering from moral injury after war. Beacon Press.

Bryan, C. J., Bryan, A. O., Anestis, M. D, Anestis, J. C., Green, B. A., Etienne, N, Morrow, C. E., & Ray-Sannerud, B. (2016) Measuring moral injury: Psychometric properties of the moral injury events scale in two military samples. Assessment, 23(5), 557-570. Doi:10:1177/1073191115590855

Bryant, A. N. (2007). Gender differences in spiritual struggle during the college years. Sex Roles, 56, 835-846. DOI:10.1007/s11199-007-9240-2.

Currier, J., Holland, J., Drescher, K., & Foy, D. (2015). Initial psychometric evaluation of the Moral Injury Questionnaire-Military version. Clinical Psychology & Psychotherapy, 22, 54-63. DOI: 10.1002/cpp.1866

Daley, J. G. (Ed.). (1999). Social work practice in the military. Haworth Press.

Davis, D. E., Worthington, E. I., Hook, J. N., & Hill, P. C. (2013). Research on religion/spirituality and forgiveness. Psychology of Religion and Spirituality, 5, 233-241.

Dekel, R., Solomon, Z., Elklit, A., & Ginzburg, K. (2004). World assumptions and combat-related posttraumatic stress disorder. The Journal of Social Psychology,144, 407–420.

Freeman, D. R. (2015). Archetypal identification: An alternative for spiritual well-being assessment. Journal of Religion & Spirituality in Social Work: Social Though, 34: 158-176.

Freeman, D.R. (2007). Spirituality and the calling of social work students. Social Work & Christianity, 34(3), 277-297.

Fontana, A., & Rosenheck, R. (1999). A model of war zone stressors and posttraumatic stress disorder. Journal of Traumatic Stress, 12, 111–127.

Gilbertson, A. (Fall 2008).The life and lonely death of Noah Pierce. VQR Online, 84(4). https://www.vqronline .org/vqr-portfolio/life-and-death-noah-pierce

Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Little Brown.

Harris, J.I., Erbes, C.R., Engdahl, B.E., Thuras, P., Murray-Swank, N., Grace, D., … & Le, T.V. (2011). The effectiveness of a trauma-focused spiritually integrated intervention for veterans exposed to trauma. Journal of Clinical Psychology, 67, 425-438. DOI: 10.1002/jclp.20777

Held, P., Klassen, B. J., Hall, J. M., Friese, T. R, Bertsch-Gout, M. M., Zalta, A. K., & Pollack, M. H. (2019). “I knew it was wrong the moment I got the order”: A narrative thematic analysis of moral injury in combat veterans. Psychological Trauma Theory, Research, and Policy, 11(4), 396-405.

Hodgson, T. J. & Carey, L. B. (2017). Moral injury and definitional clarity: Betrayal, spirituality and the role of chaplains. Journal of Religion & Health, 56, 1212-1228.

Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.

James, W. (1968). The self. In C. Gordon & K. J. Gergen, (Eds.). The self in social interaction (Vol. 1, pp. 41–49). Wiley & Sons.

Jung, C. G. (1990). The archetypes and the collective unconscious. Princeton University Press.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war Veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695-706.

MacNair, R. (2002). Perpetration-induced traumatic stress in combat veterans. Peace & Conflict, 5(1), 63–73.

Mental Health Advisory Team (MHAT-V). (2008) Operation Iraqi Freedom 06-08: Iraq: Operation Enduring Freedom 8: Afghanistan. Retrieved from http://www. armymedicine

Nasarov, A., Jetly, R., McNeely, H., Kiang, M., Lanius, R., & McKinnon, M. C. (2015). Role of morality in the experience of guilt and shame within the armed forces. Acta Psychiatrica Scandinavia, 1-16. DOI: 10.1111/acps.12406

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652. DOI: 10.7205/MILMED-D-13-00017

Padgett, D. K. (1998). Qualitative methods in social work research: Challenges and reward. Sage.

Pearson, C. (1991). Awakening the heroes within: Twelve archetypes to help us find ourselves and transform our world. HarperCollins.

Pearson, C., & Marr, H. (2003). A guide to interpreting the Pearson-Marr Archetypal
Indicator instrument. CAPT Publishing.

Platoni, K. (2018). The moral injuries of war. The American Institute of Stress Combat Stress, 9(3), 4-6.

Sayer, N. A., Noorbaloochi, S., Frazier, P., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving medical care. Psychiatric Services, 61, 589-597.

Shay, J. (2011). Casualties. Daedalus: The Journal of the American Academy of Arts and Sciences, 140(3), 179-188.

Sherman, W. T. (2015). Memoirs of General William T. Sherman. Publishing

Simmons, C. A., & DeCoster, V. (2007). Military social workers at war: Their experiences and their educational content that helped them. Journal of Social Work Education, 43(3), 497-512.

Simmons, C.A., & Rycraft, J.R. (2010). Ethical challenges of military social workers serving in a combat zone. Social Work, 55(1), 9-18.

Sokolik, J. (2015). Moral Injury and the military veteran: DePaul’s multi-faith veterans support project. DePaul Magazine: 1 (1).

Tanielian, T., Jaycox, T., Schell, T., Marshall, G., Burnam, M., Eibner, C., Karney, B.R., Meredith, L.S., Ringel, J. S., Vaiana, M.E., & The Invisible Wounds Study Team. (2008). Invisible wounds of war. RAND. Retrieved from

U.S. Department of Defense. (2013). U.S. casualty status. Retrieved from /news/ casualty.pdf

Van Hook, P. M. (2016). Spirituality as a potential resource for coping with trauma. Social Work & Christianity, 43(1), 7-25.

Wisco, B. E., Marx, B.P., May, C.L, Martini, B., Krystal, J.H., Southwick, S.M., Pietrzak. (2017). Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depress Anxiety, 34, 340-347.

Wood, D. (2014). The grunts: Damned if they kill, damned if they don’t. The Huffington Post.

Yan, G. W. (2016). The invisible wound: Moral injury and its impact on the health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 181, 451-458. DOI: 10.7205/MILMED-D-15-00103