What Not to Say to Someone Dealing with Moral Injury

Moral values and the identities that sustain our relationships are the most important aspects of our lives: they constitute what is most sacred in us. Our sense that we are worth something and beloved by others lies at the heart of our relationships with them and the world. The violation of that worth—a moral injury—whether by our own actions or the actions of others, is thus an act of desecration. Healing hearts requires a holistic process of reconnection to one's self-worth and life-sustaining relationships.

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And yet, attending to someone with whom you have a relationship and who is struggling with moral injury is not always easy. People with moral injury are often distant, cold or aloof, reluctant to share, preoccupied, controlling, drinking or sleeping too much, burnt out, or otherwise not able to be present. Talking might be difficult, and little excites them. They may even be unaware of why they feel so horrible. These are all signs that their system may be shutting down to protect itself from emotional pain.

People with moral injury are often reluctant to share their experiences with families and friends out of concern that they may contaminate them with their own terrible memories. They may fear they will be judged and rejected, or worry their anger will overtake them. Their hesitations are not unwarranted. Stories of moral injury can be disturbing to hear, and any sign of repulsion or judgment from those they love risks derailing the healing process. Many people will not even tell a therapist about their moral injury for fear of being diagnosed, evaluated, or condemned.

While there is no one perfect way to respond to or support someone you care about who is struggling with moral injury, here are some helpful tips:

• Ask the person if they’ve heard of "moral injury." Often, when people are introduced to the term, they have an “ah-ha!—so that’s what’s called” moment. All this time, they’ve felt deep down that something is wrong, but until then they didn’t have a term for it. Having that term, and knowing that they’re not weird, weak, or disordered, can go a long way to giving your loved one new perspective, motivation, and relief.
• Don’t force your loved one to tell you “the awful truth.” Even if you consider yourself someone to be trusted, your loved one may not be ready to share their story—they may not even be ready to face it themselves. The story is theirs to share when they are ready. Instead, practice patience, and gently let them know that you’re there when they are ready.
• Don’t take on the role of therapist, even if you are one. Showing up, expressing love, listening, and holding back judgment (even if it’s hard) are all wonderful (and advisable) practices. Presuming that you can “fix” your loved one’s moral pain, or trying your hand at armchair therapy is not advisable. What can be helpful is gently encouraging them to seek appropriate professional help. Affinity groups can also be a helpful entry point for rebuilding trust, so that sharing becomes easier. For example, veterans who share military culture, law enforcement officers who share security or intelligence culture, doctors who hold in common the hippocratic oath, refugees from shared conflicts or regions, those who’ve had similar experiences can be a resource for someone to feel understood.
• Get consent if you do offer advice or strategies. It’s natural to want to help a person suffering with moral injury, but a know-it-all is not helpful. Stay clear of, “If I were you, I’d…” or, “What you should do is…” Be empathetic—put yourself in your loved one’s shoes—but don’t let your shoes walk all over theirs. Let your loved one ask you for your opinion before you offer it. If, at some point, you feel strongly that you have some wise words to offer, consider saying, “Can I make a suggestion?” Or, “Maybe you would find this helpful…” So often it’s all in the presentation.
• Don’t say, “Everything happens for a reason” or, “We’re only given what we can handle.” While you may believe this, others may not. And even if someone did believe it previously, moral injury has a way of calling into question deeply held beliefs and principles. It's best not to project your own onto others. This is especially true for people facing betrayal, loss of faith, or injustice. Be present. Be a steward by helping your loved one accept the situation with “benevolent honesty,” (DeMarco, 2021) a phrase I coined to describe a way to be gentle with ourselves as we absorb painful realities. Also, try helping them to find something meaningful about the situation that they can hold onto. Don’t try to play God.
• Stay clear of sayings like, “Don’t be negative. Just think happy thoughts.” While wallowing is not the most effective path for healing, let’s not forget that moral injury is a negative experience. Trying to shield a person’s suffering behind forced feelings of happiness isn’t going to make the pain go away. It’s just going to lodge it somewhere else. “Just be positive” and other happiness-based platitudes are often nothing more than a way to fill an awkward silence when we don’t know what to say. Instead of touting the “just be positive” line, how about just being honest. It really is okay—and often more helpful—to say to someone, “I wish I knew what to say to you. I can’t imagine what you’re going through. Please, let me know how I can help.” If you do want to focus on something positive, remind the person of their strengths and gifts, and encourage them to leverage those when the pain becomes especially heavy. Likewise, remind your friend or loved one of what they have done in the past when challenge or heartache has arisen and inspire them to do it again.
• Give yourself leeway. Being present to someone who has moral injury isn’t easy. You may not always get it right. You may unintentionally stick your foot in your mouth; it happens. You will also have your own set of emotions to deal with—some of which may be unpleasant ones, especially because it may feel like the relationship is out of balance, with you giving more than you are getting. Learning to stay within your “window of tolerance” (DeMarco, 2020a) can be helpful. Grounding and breathing exercises (DeMarco, 2020b) can work to this end. Leveraging other friends and community, or your own affinity groups, can also go a long way to ensuring that you get the support you need when you are supporting an important other.

No one can rise from the ashes of moral injury to build a new moral identity without relationships, without love. Morally injurious events may be experienced by one person, but moral injury affects everyone who loves that person, and healing requires a response that does not place the burden of healing solely on individuals. Being present with someone who is struggling with moral pain can be difficult. But knowing how to do this will make the process easier. It will also ensure that your relationship with this person will not only sustain but also likely strengthen and grow.

About

Dr. DeMarco is an award-winning writer, and a therapist, clinical ethicist, and trauma researcher specializing in moral injury and moral distress. She is the author of the Psychology Today blog “Soul Console: Healing from Moral Injury” and one of Medium’s Top Writers for Mental Health and Health, respectively. Her writing has appeared in national and international publications, including the New York Times, POLITICO, The Boston Globe, Psychology Today, and The War Horse, among others. She’s also been featured as a trauma, health, and spirituality expert for MindBodyGreen, Integrative Practitioner, Lifehacker, Bloomberg/WNBP Radio, Partners HealthCare, and the American Heart Association. Her new book Holding Onto Air: the Art and Science of Building a Resilient Spirit is now available.