When They Pour Salt in the Wound: Moral Injury Becomes an Official Condition According to the APA
- Scotti Quam
- Apr 29
- 4 min read
In September 2025, Harvard University in partnership with the American Psychological Association (APA) released that Moral Injury will now be officially recognized as a condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
If you’re not a social science junkie like me, perhaps this sounds like a decent advancement, or you’re wondering WTH moral injury even is? or you’re asking yourself, that’s nice, but why should I care?
Let me ask you this: do you hate being told to worry about and pay attention to your mental health? Are you tired of being reminded of the mental health stigma in the fire service? Do you feel like the medical field just keeps coming up with new ways to tell you there’s something wrong with you?
Because this time, I would argue, THEY ARE.
The Intent Behind The Label: Moral Injury (Disorder)
What even is Moral Injury?
Moral Injury (MI) according to the FireFighter Behavioral Health Alliance (FFBHA) “refers to experiences/situations that go against an individual’s internal moral compass such as lack of fairness or the inability to do what is right and just.”
If you have been following Slow Living Solutions’ primary drivers of burnout, moral injury is synonymous with the driver unmet expectations/expectation violation which encompasses not just moral injury, but what you thought the job was versus what it is in reality.
Why is the DSM label of Moral Injury as a condition significant?
Much like my last email on Burnout vs. PTSD, the acknowledgement of a psychological phenomena with a clinical label is the gateway to the availability of a clinical treatment plan. Extensive research is conducted to confirm patterns in patient symptoms to arrive at a clinical label. This has included research specifically done with groups of firefighters on moral injury.
Slow Living Solutions does not contest the research, definition, or existence of moral injury. Nor do we deny that moral injury has mental health impacts.
However…
The devil is in the details.
What’s the fallout?
1) There’s an implied clinical problem.
In PTSD, there is an actual “short circuiting” that the brain does in an effort to protect itself. A clinical intervention is not without justification. But moral violations, both personal morals and social morays, are learned beliefs that don’t impede brain functionality.
2) When we label something a ‘mental condition’ that you have, what’s being implied is “there’s something wrong with you,” (hence where the mental health stigma comes from in the first place).
Moral Injury is the result of our own meaning making—we are creatures who logic, reason, and rationalize our experience of time through storytelling. Story connects emotions of the sensory limbic brain to the logic and reason of the prefrontal cortex to process what has happened. Mental conditions arise from either avoiding our own narratives altogether, or not externally processing them with safe social connections. Moral Injury isn’t something that you ‘have’ it’s something you [temporarily] experience.
3) Clinical problems are assumed to have clinical solutions.
What we know time and again is that negative mental health outcomes (suicide, chronic illness, etc.) are drastically decreased when individuals grappling with negative experiences have positive and healthy support systems. A clinical solution encourages that social connection for managing the experience must be bought and administered in isolation (and in the fire service, on the down-low).
4) Labeling moral injury as a mental condition negates the collective experience of the traumatic incident.
Sure the argument can and has been made that they symptoms of moral injury mirror PTSD, but if you look closer, moral injury is much more part and parcel with grief. We feel both independently, but more often than not, they are experienced collectively. The tribal nature of community provides the social connection that protects against mental illness.
The concept of “the brotherhood” in the fire service originates from the construct that the fire service takes care of its own because of the nature of a collective experience. Conversations around the kitchen table are what protect morale injury narratives from growing and perpetuating. Labeling moral injury a ‘condition’ implies “handle it yourself. Don’t trust the group.”
What’s the ‘real’ solution then? |
We need to quit the ‘labeling BS’ that commodifies every facet of the human experience:
The lynchpin to all of this is TRUST. Trust = Character + Competence. We have to trust our own agency over our emotions to trust others interpersonally and organizationally. Can therapy help us to do this? Sure. But the fire service could also solve this problem by fostering solutions that regenerate social infrastructure and treat mental health as an outcome, not an action. |
Sources: Firefighter Behavioral Health Alliance. (2023, February 9). Moral injury white paper [White paper]. https://www.ffbha.org/wp-content/uploads/2023/02/Moral-Injury-White-Paper-2-9-23.pdf VanderWeele TJ, Wortham JS, Carey LB, Case BW, Cowden RG, Duffee C, Jackson-Meyer K, Lu F, Mattson SA, Padgett RN, Peteet JR, Rutledge J, Symons X and Koenig HG (2025) Moral trauma, moral distress, moral injury, and moral injury disorder: definitions and assessments. Front. Psychol. 16:1422441. doi: 10.3389/fpsyg.2025.1422441 |
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