When the Tear Is Moral: Rethinking Moral Injury Beyond the Standard Model

A torn photograph. On one side, a man sits alone, eyes downcast, his face marked by something deeper than sadness. On the other, a woman holds a child close, both of them quiet, burdened. A jagged rip separates them—not just physically, but emotionally, morally.

This image captures something essential about moral injury—and how we may be misunderstanding it.

What Is Moral Injury, Really?

Traditionally, moral injury has been defined as what happens when someone commits, witnesses, or fails to prevent an act that violates their deeply held moral beliefs. It’s often framed in psychological terms: a traumatic event causes internal dissonance—between one’s actions and one’s values—and this leads to guilt, shame, anger, or despair.

This could be referred to as the “standard model” and informes much of the current clinical literature, especially in veteran and healthcare contexts. I've referenced it myself in previous blog posts. And it has value. Many clients I work with can point to a specific moment—a decision under pressure, an act committed or allowed—that changed how they saw themselves forever.

But this model doesn’t tell the whole story.

A Broader, Deeper Wound

Over years of working with military veterans, and others, in morally exposed roles, I’ve met many people whose injuries weren’t caused by one event, but by a slow erosion—a gradual wear on their moral sense from working in systems where they were asked, again and again, to look away, keep quiet, or compromise. Not just once, but repeatedly.

What links both groups—those harmed by a single traumatic moment and those worn down by years of moral compromise, is the relational nature of their pain.

The injuries they carry aren’t just about “what happened.” They’re about who it happened with. Who it happened in front of. About who failed to act, or who demanded their silence. About how they see themselves now, in the eyes of those they love—or avoid.

Not Just Beliefs, but Relationships

A recent article by Acampora et al., 'Critique of the Standard Model of Moral Injury', makes a compelling case: the standard model is too narrow. It treats moral injury as a violation of internal beliefs. But morality, they argue, isn’t just what we believe. It’s how we live in relation to others, to our communities, and to ourselves.

From this view, moral injury is not just an internal error to be corrected with cognitive restructuring. It is a rupture in moral relationship. A wound not just in thought, but in trust, meaning, and belonging.

Why This Matters for Practice

This shift, from beliefs to relationships, has serious implications for how we understand, prevent, and treat moral injury.

It explains why emotional regulation, as important as this is, alone often isn’t enough. Clients may still feel stuck even after processing, or reframing, trauma because the relational tear remains unaddressed.

It validates the moral dimension of the pain, not just as a symptom, but as a signal that something important has been lost or betrayed.

It expands our scope as clinicians and systems to consider how institutions, teams, and cultures contribute to the erosion—or repair—of moral connection.

Healing the Tear

Moral injury isn’t always visible. It doesn’t always come with flashbacks or panic. Sometimes it shows up as silence. Detachment. A man who can no longer sit at the dinner table with his family. A nurse who can’t look herself in the mirror after too many shifts where dignity was sidelined.

Healing requires more than soothing distress. It requires moral repair: the rebuilding of fractured trust, the reweaving of relationship, the restoration of dignity.

In this light, the tear in the photograph is not just an aesthetic choice. It’s a metaphor—for the space between people, the fracture between self and values, and the human cost of unresolved moral pain.

And like any tear, it can’t be erased, but it can be acknowledged, and it can repaired. It can be stitched into the story. And in time, it might even become a place of strength. Implications for Practice and Systems

If we understand moral injury not only as a psychological response to a belief violation, but as a relational rupture embedded in social and institutional contexts, our clinical and organisational responses must shift accordingly.

Therapeutic approaches should incorporate relational and meaning-based interventions, not just cognitive or emotional processing (again these are helpful, but may not be the whole intervention). This includes work on shame, trust, forgiveness, self-concept, and perhaps most importantly - social reconnection.

Assessment frameworks need to expand beyond event-based inventories to include relational, systemic, and cumulative moral stressors.

Prevention strategies should focus on ethical cultures, psychologically safe environments, and mechanisms for moral accountability and support.

Leadership and organisational responsibility are key. Many moral injuries occur not in isolation, but within systems that tolerate or normalise ethical compromise. Addressing moral injury at scale means recognising the systemic conditions that give rise to it.

In short, reducing moral injury to individual belief violations risks obscuring the social, cultural, and institutional factors that often play a central role in its development and maintenance.

A relational, context-sensitive model offers a more accurate, compassionate, and clinically useful way to understand and respond to moral injury—one that aligns with both the lived experiences of those affected and the realities of the environments in which they operate.

Christian Hughes is a Psychotherapist and Consultant specialising trauma, moral injury, and ethical strain. His work draws on over 15 years of experience in trauma, identity, and moral complexity. To explore working together, visit www.christiankhughes.com or get in touch at hello@christiankhughes.com.