Military Sexual Trauma and Moral Injury: Understanding the Difference
Military sexual trauma (MST) comprises a range of harmful experiences, including rape, sexual coercion, attempts at forcible sexual contact, and sexual harassment (Conrad et al., 2014). Estimates vary across studies, and the definitions that the Veterans Administration (VA) has used over the years have changed, as well as the Department of Defense’s reporting requirements.
Prevalence of Military Sexual Trauma (MST)
Conservative estimates state that 20% of women veterans have experienced military sexual trauma, but that does not fully account for the 80-90% of assaults that go unreported (Conrad et al., 2014). In the moral injury study for women veterans I am co-leading, 80% of participants interviewed so far experienced some form of sexual trauma. One participant, who works to help other veteran women said that pretty much everyone she knows is a sexual assault survivor.
Understanding Moral Injury
MST is so prevalent among women who served that it is common for people to equate moral injury in women to MST. They are not synonymous terms. Moral injury refers to the psychological injury that occurs when a traumatic event clashes with a person’s deeply held moral values (Nash et al., 2013). Moral injury research is still in its early stages, and there is no agreed-upon list of potentially moral injurious events (MIEs).
Identifying Potentially Moral Injurious Events
Currier et al. (2015) identified 20 MIEs in six categories: acts of betrayal, acts of disproportionate violence inflicted on others, incidents involving death or harm to civilians, violence within military ranks, inability to prevent death or suffering, and ethical dilemmas/moral conflicts. Nash et al. (2013) developed a scale that included nine items — six of which involved perceived transgressions by self or others and three items related to betrayal by others. Currier et al.’s (2015) scale included the item, “I was sexually assaulted,” but the instrument by Nash et al. (2013) stuck to more general categories.
Beyond Military Sexual Trauma
The point is that while many women experience moral injury as a result of a sexual assault, MST is not the only event that causes psychological harm. In our research, morally injurious events included gender harassment, hostile work environments, hazing, extreme disrespect, and sanctuary trauma.
Understanding Sanctuary Trauma
Sanctuary trauma is a new term related to moral injury. It has not been taken under research yet. Even in moral injury circles, it is a relatively unknown term. In society, health care providers, chaplains, and others are considered to be in positions of trust. They have special education and have been vetted. People tend to think of these professionals as a special class of people that can be trusted. Chaplains are often thought of as “people of God.” When one of these special people violates a client’s sense of moral rightness, the effects can be devastating.
Learn More About Moral Injury
You can learn more about this in our book: Moral Injury Research, Discussions, and Support Methods, Volume 1. You can purchase it on Amazon for $20 or read for free with Kindle Unlimited.
Dr. Daniel Roberts is an author, consultant, and teacher who conducts world-class education and research in military chaplaincy. He has over 15 years of experience in providing emotional and spiritual support to the men and women in the armed forces. Daniel also provides training and mentorship to thousands of military chaplains through conferences, classroom instruction, and one-on-one coaching. His students include chaplains from the US Army, Air Force, and Canadian Armed Forces (CAF). Dr. Roberts also helped the CAF develop military doctrine for the deployment of chaplains as religious advisers.
References
Conrad, P. L., Young, C., Hogan, L., Armstrong, M. (2014). Encountering women veterans with military sexual trauma. Perspectives in Psychiatric Care, 50(4), 280-286.
Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2013). Initial Psychometric Evaluation of the Moral Injury Questionnaire-Military Version. Clinical Psychology & Psychotherapy, 22(1), 54–63.
Nash, William P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646-652.
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