Framework 06, Litz, Shay and colleagues
Moral injury
The harm that comes from doing, failing to prevent, or witnessing something that breaks your own code.
Jonathan Shay, a psychiatrist working with Vietnam veterans, wrote about the damage done when a person's sense of what is right is betrayed. Brett Litz and colleagues later set out a working definition of moral injury: the lasting harm that can follow perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs.
They described it as distinct from post traumatic stress. Where PTSD is often organised around fear and threat, moral injury tends to show up as guilt, shame, self condemnation, and a loss of trust in yourself or others.
Why it matters
It was first described in veterans, and it is now discussed for first responders, medical staff, and others. It also speaks to many men outside those jobs who believe they failed someone who died. The replayed decision. The thing you should have noticed.
Guilt that reassurance does not touch may be a different kind of injury, and it has its own literature.
What it is not
It is not a diagnosis, and this practice does not treat it. If this describes something you are carrying, a clinician who knows the moral injury literature is the right person to talk to, and you can ask for one by name.
Where it shows up here