Moral injury: understanding Swedish veterans who are assessed but not diagnosed with PTSD
This article is based on an interview study of 24 Swedish veterans who experienced deteriorating mental health and increased suffering without meeting the criteria for a PTSD diagnosis. With no clinical answers as to the cause of their deteriorating mental health, they have been thrown into a veteran’s health limbo. The analysis was based on an inductive logic. A key finding of the analysis was a kind of deep-seated permanent moral conflict that could be conceptualized as moral injury. Such an injury can give rise to intense guilt, shame, anxiety, anger, dejection, bitterness, identity issues and more. The results section of the article details five different yet for the sample representative cases of moral injury and their implications. The notion of moral injury is linked to Mead’s division of the self into an I and me, where me is the socially constructed part of the self that is charged with the morality of a group. Thus, a moral me played a key role in the development of moral injury. The conceptual apparatus illustrates a new way of understanding experiences that can create suffering and negatively impact a veteran’s mental health. Future research is encouraged that examines this topic, national designs for addressing moral injury, screening for moral injury, and methods for healing included.
Abstract: People are the most important Australian Defence capability. The resilience, dedication and professionalism of the Defence and veteran community underpin our national security. We want Australians to be attracted to serving our nation in our Australian Defence Force, and confident that they and their families will be respected and well supported by their leaders, their mates and the broader Defence organisation. In addition, they should be safe in the knowledge that whatever may befall them during their service, they will be properly looked after, and their service acknowledged, respected and commemorated by a grateful nation. As such, it is our nation’s duty to empower and support their mental health and wellbeing. This means providing for our people and their families to serve well, live well and age well, no matter where they are on their Defence and veteran journey. This strategy adopts a preventive and holistic approach. In addition to early intervention and comprehensive care, it prioritises wellbeing from the day they sign up, until well after they’ve hung up their uniform for the last time. By embracing a life course approach, we honour the service and acknowledge the sacrifices made by the Defence and veteran community This strategy unites the Department of Defence and the Department of Veterans’ Affairs in their resolve to foster a culture of proactive wellbeing and mental health care. It leverages combined expertise and resources to ensure our Defence and veteran community receive the support they need during and after service. This strategy is complemented by action plans that describe the initiatives, programs and services that will achieve our goals and outcomes. This strategy will fortify Australia’s Defence capability by building a positive culture, with leadership that empowers self-agency and supports the wellbeing of Defence’s integrated workforce. Our approach will help Defence achieve the outcomes of the National Defence Strategy 2024 while improving recruitment and retention of personnel in the Australian Defence Force. We acknowledge the work of the Royal Commission into Defence and Veteran Suicide. The insights and reports of the Royal Commission, as well as other reports including the Productivity Commission’s: A Better Way to Support Veterans inform our wellbeing and suicide prevention initiatives, programs and services. This includes the co-design of a new agency focused on veteran wellbeing. I am proud to share with you the first joint Defence and Veteran Mental Health and Wellbeing Strategy. It provides a shared vision, goals and outcomes for meaningful change to empower every member of our Defence and veteran community to lead healthy and fulfilling lives. The journey ahead requires concentrated effort and unwavering dedication in order to build a more resilient and healthier Defence and veteran community. I sincerely thank all those who have provided input. You have helped shape the vision, goals, outcomes and priorities in this strategy in an effort to improve the mental health and wellbeing outcomes for those in the Defence and veteran community.