The Maltese Association of Psychiatry (MAP) urges giving priority to the safeguarding of the health of the nation by putting a stop to moral injury.

But what exactly is moral injury? The term has been circulating in the scientific literature since the mid-1990s in relation to psychological distress. Initially described by trauma expert and psychiatrist Jonathan Shay in war veterans, moral injury results when a person is harmed when people of trust fail to do the right thing.

The experience of that person is a sense of betrayal, humiliation, frustration, anger and shame. In these situations, the stakes are usually high. Moral injury also impairs the capacity to trust. It elevates the presence of worry, irritability, feeling on edge, despair, hopelessness, interpersonal violence and, less often, suicidal behaviours within people.

Published scientific research shows that the presence of toxic leadership, maleficent organisations and psychological distress can lead to moral injury within the people of a nation.

A continued state of corruption can lead to a state of fragility within a nation

Moral injury is further defined as an injury to an individual’s moral conscience and values resulting from an act of perceived moral transgression (Haleigh et al., 2019) resulting in moral dis-orientation. Litz and colleagues (2009) described potentially morally injurious events as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations”.

While moral injury has been mainly described in military personnel, it is not confined to this group. An example of moral trauma is found in people who become law enforcement officers with the intention of helping make society and their communities safer but who find themselves working in a corrupt organisation.

The concept of moral injury emphasises the psychological, social, cultural and spiritual aspects of one’s overall mental well-being, as well as that of a nation.

Governmental or institutional corruption can also constitute moral injury. Corruption, as defined by the UN Convention on Corruption (2004), represents a threat to the stability and security of societies, undermining the institution of democracy, ethical values and justice.

A continued state of corruption can lead to a state of fragility within a nation, to conflict and a vicious cycle of institutional anarchy and violence. It reduces quality of life. Addressing corruption should be in the interest of every government to ensure social peace and avoid internal conflict. The uprisings in North Africa are a powerful reminder that failure to curb corruption can directly affect the legitimacy and stability of political regimes.

The prevention of moral injury requires leadership and cohesion.

We endorse the media statement issued by the Richmond Foundation on Sunday and are concerned with the level of instability that resulted from the recent news-worthy reports of criminality, corruption and deceit in our island over the past two weeks.

We urge politicians to put an end to the current state of affairs that can lead to moral injury.

MAP remains concerned that, without an imminent state of stability, fragility of the self will ensue with damaged attachment (relationship) patterns, anxiety and anger.

This is what occurs when one loses the stability felt through having a solid base, thus losing one’s own personal peace of mind. We are concerned that long-term effects of this state, with the feeling of disillusionment and hopelessness, lead to depression and, in rarer cases, post-traumatic stress disorder.

We are also concerned for the overall mental and emotional well-being of our nation and appeal to the persons in power to re-establish normality and stability without further delay. Do it for the health of the nation.

If you feel upset or feel the need to talk to someone, contact your family doctor, call Appoġġ on 179 or the Richmond Foundation on 1770, or chat online at

Nigel Camilleri is president of the Maltese Association of Psychiatry.

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