Narrative Clinical Review. This page provides the verified citation, abstract, and full-text PDF for the journal article.

Clinical boundary: Moral injury is not a formal psychiatric diagnosis and should not replace assessment for PTSD, depression, burnout, substance use, or acute risk. Individual care cannot substitute for correcting unsafe or unethical organizational conditions.

Publication Details

Author: Christian Jonathan Haverkampf
Journal: The Journal of Psychiatry Psychotherapy and Communication
Publication date: 2023-09-30
Volume, issue, pages: 12(3), 81–90
Article type: Narrative Clinical Review

Recommended citation: Haverkampf, C. J. (2023). Moral Injury in Healthcare and the Helping Professions: Shame, Betrayal, and Psychotherapeutic Repair. The Journal of Psychiatry Psychotherapy and Communication, 12(3), 81–90.

Abstract

Moral injury offers language for suffering that follows perpetrating, failing to prevent, witnessing, or being betrayed around events that violate deeply held moral expectations. In healthcare and helping professions, such events may arise where responsibility for vulnerable people meets scarcity, unsafe systems, hierarchical power, discriminatory policy, or repeated institutional silence. Moral injury is not a formal psychiatric diagnosis and should not become a replacement label for burnout, moral distress, post-traumatic stress disorder (PTSD), depression, or ordinary regret. This narrative clinical review considers evidence available through 30 August 2023. It examines shame, guilt, anger, betrayal, grief, loss of trust, and spiritual or existential conflict while keeping realistic responsibility and systemic constraint in view. Assessment should clarify the event, role, available choices, power, consequences, appraisals, symptoms, and current safety without presuming either innocence or culpability. Direct treatment evidence for healthcare workers remains sparse; most psychotherapeutic models and trials come from military populations. Clinicians can nevertheless draw cautiously on trauma-informed guilt work, cognitive therapy, compassionate witnessing, values-guided action, peer support, and chosen spiritual care. Psychotherapy cannot repair an organization that continues the violation. Credible care therefore links individual treatment with acknowledgment, ethics, safer staffing and policy, accountable review, and material opportunities for restitution and prevention.

Keywords

moral injury; moral distress; healthcare workers; burnout; shame; organizational repair

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