A War Within: Making Sense of Moral Injury and Suicide with Ex-Serving Members of the Australian Defence Force

Abstract

<p>Australian Defence Force (ADF) members can be exposed to events that violate their moral beliefs and values. Such violations are termed moral injury. Moral injury creates deep, unresolved feelings of betrayal, guilt, and shame and can heighten the risk of suicide. Current research investigating moral injury in military populations is predominantly from the United States. In Australia, while suicide rates are higher among ex-serving ADF members, research into moral injury remains limited. A concept analysis was undertaken to examine key contributing factors and consequences related to moral injury. The findings highlighted that current definitions do not adequately address the complexity of the experience of moral injury. Therefore, this study explores the lived experience of ex-serving ADF members to understand first-hand how moral injury relates to their experience of suicide behaviour (thoughts, plans and attempts) by answering the research question: ‘How do ex-serving Australian Defence Force members experience moral injury, and how does this relate to their suicide behaviour?’</p> <p>In-depth narrative interviews theoretically underpinned by social constructionism and pragmatism were conducted. Data were analysed using thematic analysis guided by Braun and Clarke (2013). Eleven ex-serving ADF members participated. Analysis of the narratives revealed an overarching theme ‘shifting sands of relationships’ – which constituted three sub-themes that, when combined represent the experience and complexity of moral injury: 1) ‘Moral injury as conflicted expectations’; 2) ‘Moral injury as a mask’; and 3) ‘Walking forwards with moral injury’. Relationships and betrayal were found to be essential components to moral injury. Understanding moral injury as being relationally bound adds new knowledge to current literature by exploring the multidimensionality of relationships and the ontological impact on personhood that is often left unexplored. Whilst betrayal (interpersonal, intrapersonal and systems) exacerbates the symptoms and effects of moral injury and reduces the ability to find new meaning and purpose in life after the morally injurious events.</p> <p>The findings of this study provide insight into the perceptions, experiences, and impacts of moral injury in a post-ADF service context. Importantly, the findings provide greater insight into the shifting relationships with oneself and others and highlights the impact of these relationships on the mental health and wellbeing of ex-serving ADF members. Recommendations include using this information to better inform the support services engaging with individuals exposed to or experiencing moral injury following their time in the defence forces. These include government agencies, clinical and therapeutic supports, families and ADF communities to further explore their roles and capabilities in the lives of those living with the moral trauma of military experiences.</p>