I’m Michele — a therapist, clinical ethicist, writer, and academic researcher working at the leading edge of one of the most important, but little-known areas of trauma and healing today. It’s called moral injury and its cousin moral distress (the field generally is also referred to as moral trauma). And it’s different than depression, anxiety, feelings of burnout or defeat, even posttraumatic stress disorder (PTSD).

In brief, moral injury happens when our core moral foundations or expectations are violated in high stakes situations. These violations can happen from actions a person took themselves (such as harming another person, whether it was intentional, unintentional, or unavoidable); actions a person witnessed, including betrayal (like abuse, violence, infidelity, discrimination, or being wrongly accused); actions a person was forced to do against their will or better judgment (like abandoning or neglecting someone; also lying, cheating, or falsifying information because a higher-up commanded or pressured you too); and actions that a person couldn’t take to prevent a bad situation from happening (like natural disasters, accidents, suicide, and medical injury or illness). Violations like these recast the way we see ourselves, others, and the world, and they cause changes in behavior that signal a loss of trust, connection, self-worth, and meaning.

Moral distress happens when institutional or systemic barriers prevent us from acting with integrity, particularly when it comes to fundamental moral principles and ethical responsibilities. It also happens when others don’t grasp a moral imperative that is clear to us, or from repeatedly not having our values respected, either individually or collectively.

All these painful experiences are commonly called “soul wounds,” because they cut to our core or essence — to the very things that define us.