Understanding Moral Injury: The Hidden Wound in Healthcare and Beyond

31 July

When we think about psychological distress, terms like burnout, stress, and PTSD often come to mind. But there’s a less talked about—and equally impactful—experience called moral injury that’s gaining recognition, especially among healthcare workers, first responders, and military personnel.

What is Moral Injury?

Moral injury happens when someone feels deeply betrayed by actions—or inactions—that violate their core moral or ethical beliefs. It’s not about fear or trauma in the traditional sense but about feeling guilt, shame, or spiritual distress because you’ve witnessed, caused, or been powerless to stop harm that contradicts your values.

For example, during the COVID-19 pandemic, many nurses and doctors had to make heartbreaking decisions about who could receive life-saving care, or witness patients dying alone without family. These experiences can leave lasting moral wounds.

How is Moral Injury Different from Burnout or PTSD?

Burnout results mainly from chronic workplace stress leading to exhaustion and detachment.
PTSD stems from fear-based traumatic events and hyperarousal symptoms.
Moral injury centres on a violation of your moral code—leading to feelings like guilt, shame, or loss of meaning.

It can deeply affect your sense of identity and purpose, often leading to depression, anxiety, or even suicidal thoughts if left unaddressed.

Why Does Moral Injury Matter?

Moral injury impacts mental health and job performance, increasing risk for depression, anxiety, and burnout. Recognising it is vital to get the right support and prevent long-term harm.

What Helps?

Emerging research highlights therapies like Acceptance and Commitment Therapy (ACT) and narrative approaches that focus on reconnecting with personal values and meaning. Peer support, spiritual care, and workplaces that acknowledge moral injury without stigma are also crucial.

How Can I Support You

If you’re experiencing feelings of moral distress, guilt, or shame connected to your work or life experiences, know you don’t have to face it alone. As a midlife burnout and trauma-informed psychologist, I offer compassionate therapy and support tailored to your unique journey.

Feel free to reach out to explore how therapy or a supportive community might help you heal and reclaim your wellbeing.

Further Reading & Resources

Bryan, C. J., et al. (2018). Acceptance and Commitment Therapy for moral injury and trauma-related psychopathology in military personnel: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 86(3), 248–260. https://doi.org/10.1037/ccp0000279

Wilson, A., Smith, K., & Thompson, R. (2023). Moral injury and mental health outcomes in frontline workers: A systematic review. International Journal of Environmental Research and Public Health, 20(7), 4782.

Moral Injury Australia: https://www.moralinjuryaustralia.org

Compassion Fatigue Awareness Project: https://compassionfatigue.org

Shannon A Swales

Meet Shannon Swales, a Psychologist

Your guide through burnout recovery and beyond

I’m Shannon Swales—a Clinical Psychologist, writer, speaker and someone who knows burnout not just professionally, but personally. My work is grounded in both clinical expertise and lived experience, offering a compassionate space for those feeling depleted, overwhelmed, or unsure how to keep going.

My own turning point came after career-halting burnout and mental health challenges of my own. I began writing about it through my blog, A Different Kind of GAP Year, which later became my memoir, Nothing Left to Give: A Psychologist’s Path Back From Burnout. That story has shaped everything I do.

Today, I guide others through burnout and recovery via 1:1 therapy, the Midlife Reclaimed podcast, and a supportive community space for midlife women. I also deliver workshops, contribute to podcasts and publications, and speak on topics like psychological flexibility, emotional fatigue, and the deep work of reconnection.

My therapy practice is offered online across Australia and centres around personalised, evidence-based support. I bring warmth, curiosity, and deep respect to every session—because I believe healing is possible, and that your story deserves to be met with care.

If you’re ready to reclaim your energy, your clarity, and your connection to self, I’d be honoured to walk alongside you.

https://www.shannonaswales.com