Many combat veterans face difficulties coping with their personal lives, relationships, and families when they leave the service and return to civilian life. Most studies examining the effects of combat on veterans focus on posttraumatic stress disorder (PTSD) as well as a collection of related consequences. Interest in the term moral injury of military veterans as a related mental health construct has grown. Researchers have investigated the effects of spiritual wellness of combat veterans. However, there is a paucity of counseling literature on the relationship between spiritual wellness and moral injury when combat veterans return to civilian life. Investigating the relationship between spiritual wellness and moral injury as based in existential theory could offer insights to improve quality of life of veterans, families, and society. This study examined the connection between spiritual wellness and moral injury among combat veterans using a quantitative survey with a cross-sectional, correlational analysis and incorporating demographic variables. Results showed that the relationship of spiritual wellness on moral injury is statistically significant. Participants with low spiritual well-being were likely to have an elevated level of moral injury. Those with strong levels of life meaning and purpose were less likely to experience moral injury. These findings can be used to help combat veterans heal from the wounds of war. Clinical interventions associated with life meaning and purpose could enable successful reintegration of combat veterans into society. Results could be used to identify and test specific treatment options. Outcomes could also be used to explore the relationship of combat veterans to other professions subject to moral injury and further explore the relationship of moral injury to PTSD.

Serving in the military is often a disruptive event in the lives of those who join, precipitating a reassessment of the service member’s ethical sensibilities or, tragically, resulting in lasting moral injury and trauma. The military experience compels them to navigate multiple identities, from citizen to warrior and back. Their religious identity, sometimes rooted in a civilian religious community, can be altered by military participation. Those who find faith during service often adopt one rooted in military culture. Still others find faith after leaving the service, providing a salve for the disruption of military experience. In many cases, religious cultural toolkits provide necessary meaning-making frameworks to make sense of war; however, these same frameworks can exacerbate trauma when moral expectations do not reflect reality, resulting in moral injury. Drawing on a series of inductive, in-depth qualitative interviews with forty-eight veterans and six military chaplains, this dissertation explores how varied religious resources and potentially traumatic events affect the lives of post-9/11 veterans who once or currently identified as Christian. Adding to existing research on moral injury, it traces how military chaplains, ethics education, just war theory rhetoric, and formal religious practice supplied by the military alter the course of service members’ moral lives. As these resources aim and re-aim them at the military’s institutional strategic goals, service members come to inhabit the warrior identity. Amid this new identity and the realities of modern warfare, trauma is likely, and service members must navigate an interruption to their deeply held moral beliefs, narratives, and expectations. After service, lasting moral wounds, traumatic experiences, and a loss of identity can make reintegrating to the civilian sector challenging, thus precipitating or exacerbating trauma. These narrative trajectories reveal how veterans use Christian faith or other systems of meaning-making to understand war and their identities as service members and veterans. Drawing on post-traumatic theologies and feminist and womanist ethics, this dissertation argues that these stories uncover tainted theological frameworks and a military culture in need of redemption. / 2023-11-04T00:00:00Z

This research investigates the intricate interplay between the moral emotions of shame and guilt, within justice-involved populations, with a special focus on those deemed Not Criminally Responsible (NCR) due to Mental Disorder. Recognizing the pivotal role of offense-related shame and guilt in motivating behavior and influencing psychological functioning, we conducted an extensive investigation to underscore the significance of acknowledging moral injury (MI) and its symptoms within this context. By synthesizing two comprehensive studies, our objective was twofold: to shed light on the prevalence and effects of shame and guilt, and to introduce the concept of moral injury as a fundamental lens for understanding their impact. In the first study, we examined the influence of shame and guilt on motivating behavior and psychological well-being among offending populations. We found that shame consistently relates to adverse outcomes, including defensive behaviors, self-loathing, and externalizing behaviors such as blame-shifting. Contrary to our predictions, guilt was associated with constructive responses, such as self-forgiveness, empathic concern, and assuming responsibility for one's actions. However, both shame and guilt contributed to the risk of recidivism among certain offenders. This study illuminates the intricate dynamics between moral emotions, psychopathology, and recidivism, underscoring the need to acknowledge the differential influences of the moral emotions, shame, and guilt. In the second study, we developed and validated the Moral Injury Screener in the Offending Population NCR (MIO-NCR), a self-report measure that assesses MI in justice-involved individuals, particularly NCR individuals. Through rigorous psychometric analysis, the MIO-NCR demonstrated promising criterion and construct validity. Our findings emphasized the centrality of guilt and betrayal in MI experienced by NCR individuals, aligning with contemporary syndromal definitions. The MIO-NCR, an invaluable tool, enables promising identification of MI within the NCR population. By consolidating these studies, we found that shame and guilt manifest profoundly withinthe justice-involved population, underscoring the value of MI and its core symptoms. The current thesis not only reaffirms the importance of understanding moral emotions but also advances knowledge on MI within this unique context. Our research provides a framework for developing a comprehensive approach to intervention and rehabilitation that recognizes the intricate relations between moral emotions, psychopathology, and recidivism, ultimately fostering healthier outcomes for justice-involved individuals. / Thesis / Master of Science (MSc) / This study delves into moral injury experienced by individuals labelled non-criminally responsible (NCR) due to mental health issues within the criminal justice system. Moral injury captures the emotional turmoil, including guilt and shame, arising from engaging in morally conflicting actions or facing betrayal. Our research explores the influence of moral emotions like shame and guilt on those involved in criminal activities. We discovered shame often leads to negative behaviors and self-disapproval, while guilt promotes self-forgiveness and empathy. Both emotions impact the likelihood of reoffending. We also designed and validated a new tool, the Moral Injury Screener, to grasp moral distress in NCR individuals. This tool revealed that guilt and perceived betrayal are central to their moral struggles. Recognizing these feelings is vital for understanding and addressing moral injury within the criminal justice system.

The current study used a sample of service members and veterans to explore the association of combat exposure and perceptions of the family system using a moderated mediation model. Combat veterans over the age of 18 with a family of creation (N = 154) completed an online survey through which they were administered a background information questionnaire, the Combat Experiences subscale of the Deployment Risk and Resilience Inventory – 2, the Moral Injury Events Scale, the PTSD Checklist for DSM-5, the Patient Health Questionnaire, the Beck Anxiety Inventory, the McMaster Family Assessment Device, and the Dyadic Adjustment Scale – Revised. Results of six moderated mediation analyses revealed that exposure to potentially morally injurious events (pMIEs) moderated the relationship between (1) combat exposure and couple relationship satisfaction and (2) combat exposure and family functioning, both via PTSS, anxious symptoms, and depressive symptoms. To our knowledge, the empirical models presented in this paper are the first to model the role of pMIEs in SMV literature, and provide a foundation for other models to emerge moving forward. Implications and limitations are discussed.

Moral injury (MI) is a term that is increasingly being used to describe the psycho-spiritual consequences of events that deeply transgress an individual’s core human values. Stemming most predominantly from the literature on military mental health, MI is understood to be characterized by intense moral emotions such as guilt, shame and anger, as well as existential and spiritual conflict prompted by an event that has deeply disrupted an individual’s beliefs about themselves and the world. Emerging research has shown that exposure to such events as well as particular features of MI distress are associated with increased incidence and severity of mental health problems, such as PTSD and depression. To date, the majority of the research on MI has been conducted in the military context, most predominantly in the United States. Thus, the two studies included in this dissertation come together to evaluate the construct validity of MI by assessing whether a) the patterns of distress identified in military populations to date could also be observed in the Canadian military context, and b) the patterns of distress most pertinent to MI thus identified in the occupational stress literature could be observed in the general population in the context of the COVID-19 pandemic. In Study 1, treatment-seeking military members and Veterans (n = 18) completed a semi-structured interview about the impact of military experiences that deeply disrupted their core beliefs and values. A qualitative analysis was performed and yielded eight main themes: change in moral attitude, increased sensitivity and reactivity to moral situations, loss of trust, disruptions in identity, disruptions in spirituality, disruptions in interpersonal relatedness, rumination, and internalizing and externalizing emotions and behaviours. In addition to the participants who completed the interview, an additional 37 participants (n = 55) completed a structured diagnostic interview and self-report measures of exposure to potentially morally injurious events (PMIEs), combat exposure, guilt, anger, posttraumatic stress disorder (PTSD) and depression. Quantitative analyses revealed that PMIE exposure, but not combat exposure, was related to psychological distress, most notably to symptoms of PTSD. In Study 2, participants recruited from the general population (n = 355) completed an online survey assessing a) exposure to and appraisals of morally-laden COVID-19 stressors, b) mental health symptoms, and c) dispositional characteristics including trait emotions, anxiety sensitivity, sense of duty, and religiosity/spirituality. Path analysis revealed specific indirect associations between self-based moral appraisals and PTSD and depression through guilt, and between both self- and other-based moral appraisals and PTSD and depression through anger. Number of COVID-19 stressors had no influence on these associations. Sense of duty, reparative guilt, and anxiety sensitivity best predicted negative moral appraisals. Together, findings from these studies provide support for the MI construct and extend existing findings by showing that the associations among key features of MI and mental health can be observed in various contexts, and that patterns of distress theorized to comprise the MI construct likely extend to lower-level stressors outside the military context. Potential mechanisms regarding the etiology and maintenance of psychological distress in the context of MI were also identified (e.g., moral appraisals and cognitive features such as rumination), which require further investigation. A better understanding of MI across contexts is likely to help refine approaches to clinical case conceptualization and treatment for those at risk of mental health problems in the aftermath of morally distressing events.

Positive social support, realistic job demand, and appropriate levels of control over their responsibilities can mitigate empathy fatigue and burnout among nurses, increase quality care for patients, and lay the foundation for teams to embrace challenges during crises. The COVID-19 pandemic stretched nurses in all these areas, leading many nurses to contemplate changing fields. Failure to address and embrace the difficulties that nurses face during such crises can result in loss of nurses and impact the entire healthcare industry. The present study used one-to-one interviews to glean insider perspectives of changes in job demand, control, and support nurses experienced as they showed up to work in COVID-19 units. Results showed that the bridge to overcoming daily battles and stresses came primarily through supportive education and skill building, emotional support from peers, and venting after a challenging event. Keywords: social support, emotional support, informational support, moral injury, Demand-Control-Support Model

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The current study examined the nature and extent of endorsement of PMIEs, the nature and severity of MI symptoms related to endorsement of a PMIE, and the relations between extent of endorsement of PMIEs and MI symptoms. We hypothesized that (1) PMIEs perpetrated by others would be endorsed to a greater extent than PMIEs perpetrated by oneself; (2) medical professionals who endorsed a PMIE would report significantly greater severity on all MI symptoms compared to medical professionals who did not endorse a PMIE; (3) experiencing PMIEs (perpetrated by oneself and/or others) to a greater extent would predict higher levels of MI symptom severity, and MI symptom severity would specifically be most strongly predicted by PMIEs perpetrated by oneself. Hypotheses were examined using t-tests, Pearson's r correlations, and multiple multivariate regression analyses. First, the current study found that PMIEs perpetrated by others were endorsed to a greater extent than those perpetrated by themselves; second, greater exposure to PMIEs was associated with significantly greater severity of 10 of the 14 outcomes. Third, PMIEs perpetrated by oneself predicted more MI symptomatology than PMIEs perpetrated by others, indicating that while PMIEs perpetrated by others are more common, PMIEs perpetrated by oneself are more strongly associated with MI outcomes. This study highlights the widespread and harmful impact of PMIEs among medical professionals.

Made available in DSpace on 2016-04-26T14:58:01Z (GMT). No. of bitstreams: 1 Ana Perwin Fraiman.pdf: 3818282 bytes, checksum: 3631114114743b17184657c9f856881d (MD5) Previous issue date: 2010-04-15 / This thesis aims to reveal: the macro context, which is public and impersonal, and the micro level, which is private, highly personal and subjective, around time that has marked the withdrawal and retirement of those who are older from their jobs. The phenomena described here inscribe its history about what actually comprise and means retirement, in the midst of the current transformations in the labor market, at the same time it clarifies the subjective experiences lived by people close to retire. Presented within the transverse model of study and research, not only of related knowledge, interlacing the social sciences to other different areas, this thesis gathers a group of knowledge that, as a whole can better lead to understanding the paths taken to reach the precarious situation experienced by a large parcel of the population of all retired Brazilians and what other ways might be opened from that. This thesis focuses mainly on major areas of conflict and paradox, as well as search possibilities for dialogue between the old and new. Similarly, it demands to know how the human person has absorbed and metabolized the violence slaughtered on it by virtue of convulsive paradigmatic changes that occur. It refines its lenses, driving looks particularly to interpersonal relationships that are seen in the labor universe. It aims to inventory, interpret and narrate about the processes and mechanisms that people have adopted, and may also be able to use to create a new future: a future in where they have the freedom and autonomy to recreate and integrate the new reality that emerges. It is focusing on rituals that deny and others that dignify the value of the person, and seeks to understand what specifically happens in human relations within the organizational work space and within the institutions space that, often as a guillotine, prevent the person from continuing and use its vital forces, that allows it to signify their existential journey and recognize themselves in possession and enjoyment of full rights of citizenship / Esta tese pretende revelar: o contexto macro, que é público e impessoal, e o contexto micro, que é privado, altamente personalizado e subjetivo, em torno do tempo que tem marcado a retirada e o afastamento dos postos de trabalho daqueles que são mais velhos. Os fenômenos aqui descritos inscrevem a sua história sobre aquilo que, efetivamente compreende e significa a aposentadoria, em meio às transformações atuais no mercado de trabalho, ao mesmo tempo em que lança luzes às experiências subjetivas vividas pelas pessoas que estão próximas a aposentar-se. Apresentada dentro do modelo transversal de estudos e pesquisas, não apenas de saberes afins, entrelaçando as ciências sociais a outras diferentes áreas, este trabalho integra um grupo de saberes que, em seu conjunto é capaz de melhor conduzir à compreensão dos caminhos trilhados para se chegar à compreensão da situação de precariedade vivida por grande parcela da população de brasileiros e brasileiras aposentados nos tempos atuais e quais outros caminhos podem se abrir a partir disso. Esta tese se debruça, principalmente sobre algumas das principais áreas de conflito e paradoxo, bem como busca possibilidades de haver diálogo, entre o velho e o novo. Da mesma forma, procura conhecer como a pessoa humana tem absorvido e metabolizado as violências que sobre ela se abatem em virtude das convulsivas transformações paradigmáticas que ocorrem. Refina suas lentes, dirigindo os olhares em especial às relações interpessoais travadas no universo do trabalho. Procura inventariar, interpretar e narrar a respeito dos processos e mecanismos que as pessoas têm adotado e, poderão ainda vir a utilizar-se de, para criar um novo futuro: um futuro através do qual elas próprias tenham liberdade e autonomia para se recriar e para se integrar a nova realidade que se desenha. Focando rituais que negam o valor da pessoa e outros que a dignificam, busca compreender o que de específico acontece nas relações humanas no espaço organizacional de trabalho e no espaço das instituições que, muitas vezes, como uma guilhotina, impedem-na de prosseguir e empregar suas forças vitais, que lhe permitam significar sua jornada existencial e se reconhecer em posse e gozo de seus plenos direitos de cidadania

Bad Paper follows the lives of former military service members, who have received an other-than-honorable discharge, but also have service-connected post traumatic stress disorder (PTSD). Due to the "suck it up" culture of the military, many of these veterans would not report any psychological troubles in fear of being labeled "weak" and potentially affecting their promotions. With no outlet for their PTSD, drugs and alcohol became a way of "self-medicating," which led to their dismissal from the service. A dishonorable discharge, commonly called "bad paper," from the military disqualifies veterans from receiving help from the VA. The process to overturn this status is arduous and veterans must navigate the bureaucracy of the Veterans Affairs (VA) administration as well as the individual military branches with virtually no help from either.