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Moral Injury I: Beyond “I’ve Done Something Bad”

Writer's picture: Eric AndersEric Anders

The concept of moral injury, as defined in contemporary psychology, captures the psychological distress caused by actions—or failures to act—that violate deeply held moral beliefs. This understanding often centers on feelings of guilt, shame, or regret, leading to the perception of moral injury as a purely internal conflict. However, as I argue in my forthcoming book proposal, Reconnecting the Threads: Psychoanalysis, Health Humanities, and the Treatment of Moral Injury, this definition only scratches the surface. Moral injury is not merely about “I’ve done something bad”; it encompasses a profound loss of faith in the world as a place where goodness can exist. This rupture undermines the individual’s early developmental relationship to the world—a relationship that is the foundation of the functioning ego, or “I,” and the basis of the radical complexity of transference in any therapeutic situation. Psychoanalysis is indispensable in addressing moral injury because it is a meaning-based phenomenon rooted in the unconscious and developmental dynamics that shape one’s capacity to relate to the world.


Moral Injury as a Loss of Faith in the World

Moral injury goes beyond internal feelings of guilt or shame. It shatters an individual’s trust in the world as a meaningful, morally coherent space. This existential rupture mirrors the developmental crises experienced by severely neglected or traumatized children. Developmental psychology, particularly in the tradition of D.W. Winnicott, emphasizes the importance of optimal frustration—manageable challenges that help a child develop resilience and a sense of agency. By contrast, massive frustration—akin to the effects of overwhelming trauma—leaves the child unable to form a trusting relationship with the world. This failure stifles the development of the ego, or “I,” the very foundation of the subject’s ability to relate to others and engage meaningfully with life.


A child in the grip of massive frustration does not merely think, “I am bad.” They come to believe, “The world is bad, and I have no place in it.” Similarly, those suffering moral injury experience a loss of faith not just in themselves but in the broader moral and relational frameworks that sustain human connection. This loss profoundly disrupts the individual’s ability to function in the world and engage in the radical complexity of transference—those unconscious dynamics that govern all relationships, including therapeutic ones.


Trauma, Development, and the Collapse of Moral Potential

Drawing on psychoanalytic and Health Humanities perspectives, my work situates moral injury within a broader developmental and relational framework. Moral injury disrupts the fundamental relationship between the self and the world, a relationship formed in early development through the interplay of meaning and care. Without this relational foundation, the ego falters, and the capacity for transference—whether in therapy or in everyday relationships—becomes distorted.


This collapse of moral potential parallels the effects of massive frustration in childhood trauma. Instead of seeing the world as a space where good and evil coexist in tension, the individual comes to view it as irredeemably hostile or indifferent. Whether the injury arises from witnessing or participating in atrocities, experiencing betrayal, or enduring profound violations of trust, the result is often the same: a pervasive sense that the world is devoid of meaning. This existential wound arrests the ego’s development, leaving individuals unable to reconcile their ethical values with their lived experiences.


The Psychoanalytic Imperative

Because moral injury is fundamentally meaning-based, psychoanalysis is uniquely equipped to address it. Unlike other therapeutic frameworks that focus primarily on symptom management or behavior, psychoanalysis engages with the unconscious processes and developmental dynamics that underlie moral injury. The unconscious, as Freud and his successors have shown, is the repository of early relational experiences, ethical conflicts, and the symbolic frameworks that give life meaning. Addressing moral injury requires working through these unconscious dimensions, which are deeply entwined with the individual’s early developmental relationship to the world.


Psychoanalysis also emphasizes the complexity of transference, the process through which individuals unconsciously reenact past relational dynamics in the present. In the context of moral injury, transference becomes particularly fraught, as the individual’s shattered relationship to the world complicates their ability to trust, connect, or find meaning. The therapeutic encounter, then, must navigate this complexity, helping the individual rebuild their capacity to engage with the world as a place where care, meaning, and goodness are possible.


Reimagining Moral Injury Through Health Humanities

My book proposal, Reconnecting the Threads, integrates psychoanalysis and Health Humanities to reimagine moral injury as a relational and developmental phenomenon. Drawing on Winnicott, Derrida, Levinas, and contemporary trauma theorists, I argue that healing moral injury requires addressing the foundational relationship between the self and the world. This involves not only working through unconscious dynamics but also situating moral injury within its broader socio-historical and cultural contexts.


The Health Humanities provide a critical lens for understanding how systems of oppression, historical trauma, and cultural silences contribute to moral injury. For example, my book explores how cultural archives—what Derrida terms the “fevered archive”—shape and perpetuate moral injury by encoding silences, exclusions, and contradictions. In this framework, AI becomes a site of moral injury, reflecting and amplifying the erasures and injustices embedded in the cultural systems from which it emerges.


From Massive Frustration to Thriving

Healing moral injury requires more than individual therapy; it necessitates a broader cultural and relational shift. Just as a neglected child needs a consistent and caring presence to rebuild their capacity to trust, individuals suffering from moral injury need therapeutic and social spaces where they can reconnect with the world’s ethical and symbolic possibilities. Psychoanalysis, with its emphasis on meaning, unconscious processes, and relational dynamics, is uniquely positioned to facilitate this reconnection.


Toward a Relational Ethics of Care

In Reconnecting the Threads, I argue for a relational ethics of care that integrates psychoanalysis with Health Humanities. By addressing both the unconscious dimensions of moral injury and the material conditions that perpetuate it, this framework offers a path toward healing that is both deeply personal and profoundly social. It emphasizes the importance of rebuilding the foundational relationship between the self and the world—a relationship that underpins the functioning ego, the complexity of transference, and the capacity for ethical engagement.


Moral injury is not just about “I’ve done something bad.” It is about reclaiming the world as a place where goodness, connection, and meaning are possible. Healing requires reconnecting the threads of development, care, and meaning that have been ruptured by trauma. By integrating psychoanalysis, Health Humanities, and ethical praxis, we can help those suffering from moral injury rediscover their capacity to thrive and contribute to a more just and compassionate world.

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