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: In March 2023, the governor of the Commonwealth of Massachusetts appointed the first secretary of the Executive Office of Veterans Services (EOVS) to oversee state-level veteran benefits and programs. EOVS replaced the Massachusetts Department of Veterans’ Services and, since its inception, has worked with the governor to improve veteran care and housing. In 2024, the governor signed An Act Honoring, Empowering, and Recognizing Our Servicemembers and Veterans, which seeks to update and expand health and wellness benefits for veterans. To support new initiatives, EOVS partnered with the authors on a comprehensive analysis of the well-being of veterans in Massachusetts. In this analysis, the largest of its kind since 2017, the authors identified unmet veteran needs and evaluated how well EOVS programs are serving veterans. The findings and recommendations presented in this report will provide valuable guidance for EOVS to ensure that its programs are aligned with what Massachusetts veterans need most. The authors also offer a draft strategic framework for EOVS to consider as it works toward strengthening strategic planning efforts in the years ahead.