A Contextual Model of Moral Injury: Redefining Trauma in Frontline Professions through Ethics and Context

An honourable dirty job

Our study focused on ‘frontline work’, a sociological term referring to roles at the literal or metaphorical frontline (Eikenaar, 2023). We specifically examined the military and police as contexts where workers often confront human suffering and make decisions with high impact. This overlaps with other sociological and organisational concepts, such as ‘high-risk occupations’ and ‘extreme work’, which refer to physical risks, emergencies or disruptions, both in the task itself and in the work context (Garavan et al., 2024; Hällgren et al., 2018), as well as ‘dirty work’, which denotes labour that is physically, morally or emotionally tainted (Hughes et al., 2017). Building on these frameworks, the term ‘high-impact profession’ emerged as an overarching category to capture the significant, yet complex, effects these professions can have on workers.

One might expect the ‘high impact’ of soldiering and policing to arise from a fundamental tension between the necessity of violence and the notion of doing good. However, this is not necessarily the case. Despite common slogans like ‘serving the country’, police officers and soldiers are often not focused on abstract ideology. Their primary motivations include an affinity for sports, camaraderie and a stable salary (Eikenaar, 2023; Gibson and Abell, 2004). Also, they are generally not troubled by the use of force, although they do need it to occur in a framework that offers justification. Police officers stress ‘wanting to do something for society’, while soldiers emphasise that ‘I do stand behind what I do’ whereas society has ‘the luxury of judging war from a safe distance because we take up that nasty job for them’ (Eikenaar, 2023; Molendijk, 2024; White et al., 2010).

So, the moral complexity of frontline work does not necessarily lie in the exposure to violence as such, but rather in workers’ complex relation to violence and human suffering. First, unlike any other profession, their position towards violence is complex: they are potential witnesses, victims and perpetrators of violence and suffering, all at the same time (Hannah and Sowden, 2013). Second, they face violence in dual roles: as obedient instruments, executing state-mandated directives and policies, and willing agents, consciously serving as conduits of state authority (Molendijk, 2024). Third, their use of violence carries a morally ambivalent status: soldiers and police members are not mere lawless aggressors but wield force as agents of an organisation that is granted the monopoly on violence by the state, in the name of society, yet in the name of freedom, peace and safety.

Taint management

Owing to the moral complexity of their roles, soldiers and police officers are particularly vulnerable to experiencing moral conflict, while the stigma surrounding violence can further compound moral turmoil. Clearly, they work in high-impact professions. Some cope by stressing that their work is actually morally virtuous, while others strengthen an us/them divide between themselves and society. Recall, for instance, the soldiers judging civilians for judging them ‘from a safe distance’. They bond with peers while condemning those who criticise their actions. At the organisational and political leadership levels, similar defence mechanisms are used. Organisations often maintain a low profile or rebrand their actions as humanitarian, while in both cases maintaining a culture of silence regarding incidents towards ‘the outside world’ (see also Ashforth and Kreiner, 2014). Simultaneously, within the organisation, a strict division of tasks may be imposed, limiting professionals’ direct encounters with the source of their ‘dirty work’, such as human suffering, thereby allowing them to maintain emotional distance (see also Eikenaar, 2024).

These coping mechanisms can be considered forms of ‘taint management’. Take this officer’s remark: ‘The rules give you a lot of grip. They protect you. And they are binding.’ Another insightful statement: ‘I wanted to keep a distance, I didn’t want to bond too much with the people [because] that makes you weaker’. In our research, we were told many such statements, showing that these coping strategies are partly inevitable for moral-psychological protection.

That said, such coping can also lead to problematic emotional detachment, and it may perpetuate a cycle of silence and misunderstanding. As one veteran phrased it: ‘I wanted to help people, and then you find out the world is rotten. . . . I was maybe naïve [and then] I became numb. . . . But nobody understands – or well, nobody gives a shit.’ Another related: ‘Going forward strewing teddy bears, long live the rainbow, the bees, the butterflies, you know . . . That’s how people here would like to see it. But that’s not how it is.’ As a result, while frontline workers’ coping strategies may offer short-term relief, they can have counterproductive long-term effects, increasing the risk of creating more morally injurious situations and fostering disillusionment and isolation.

Betrayal, double binds and ambiguity

Shay (1994), who coined the term moral injury, has always emphasised the important aspect of betrayal. In line with Shay’s work, our research led us to consider leadership and decision-making – and thus moral betrayal by leaders and decision-makers – not only as an indirect, circumstantial factor in moral injury but also as a direct cause of moral injury, namely in high-stakes situations.

To reiterate, frontline professions like policing and soldiering are essentially high-stakes occupations, and thus high-impact professions. Members of these professions operate as instruments of the state in dangerous contexts, putting them in a state of great vulnerability and requiring them to relinquish a great deal of control over their safety to the leadership (Shay, 1994). Moreover, doing such ‘dirty work’ means being socialised into a specific occupational culture with an associated moral constellation, where values such as service, loyalty and a willingness to sacrifice are central (Eikenaar, 2024; Gilhuis et al., 2024; Shay, 1994). Consequently, members are in a position of great dependence and necessary trust in their organisation and government, embodied by organisational and political leadership. Dependence is the reliance on a person or institution for one’s well-being, safety and integrity (Smith and Freyd, 2014). Trust is the expectation that this other will be benevolent, or at least do no harm, while, by definition, it also entails uncertainty regarding the other’s ability and willingness to do so. Dependence and trust therefore occur in a relationship of inequality and reinforce one’s state of vulnerability. Betrayal, then, is the willing violation of this relationship and, moreover, the violation of deeply held moral values: it is a betrayal of ‘what’s right’ (Shay, 1994).

A leader is the representative and guardian of their members’ well-being, safety and integrity, and as such is entrusted with a critical responsibility. Therefore, experiences of betrayal by leaders can be not just painful but profoundly morally injurious (Molendijk, 2019; Shay, 1994). For instance, the Afghanistan veterans we interviewed recounted feeling that their leaders prioritised the mission’s political and societal image at home over soldiers’ safety, delaying critical support decisions like providing fire support to soldiers in dangerous situations. This perceived lack of support in life-or-death situations prompted some soldiers to say: ‘Our biggest enemies are not outside the gate, but above us – that’s who our biggest enemies are’. In turn, these veterans’ superiors were often frustrated by pressure from their own higher-ups. For instance, as one former colonel recounted, when he initiated a particularly risky operation, a general was sent out from the Netherlands to tell him: ‘If things go wrong, you’re accountable [. . .] so that they could say, we sent someone’.

Importantly, experiences of betrayal can result not only from evidently unethical leadership, but also from more nuanced leadership transgressions that may not be immediately apparent. The complex relationship between frontline work and violence – marked by a complex position, dual roles and a morally ambivalent status – can place not just frontline workers themselves but also their leaders in tragic dilemmas. Leaders may find themselves trapped between competing interests and values, for example, in a complex web of ambitious political goals (e.g. a peace mission in a war zone), while simultaneously facing significant constraints on their abilities due to societal sensitivities (e.g. restricted rules of engagement, limited troops and lightly armed troops) and budgetary cuts (leading to staff shortages and inadequate training) (Molendijk, 2019). Thus, leaders may become caught in dual pressures and double-bind messages.

Ambiguity management

Unable to resolve tensions, leaders often resort to compromises. This can involve ‘strategic ambiguity’ in their decision-making and communication: the deliberate use of vague or ambiguous language to achieve a sense of agreement among stakeholders while allowing for multiple interpretations (Kalkman and Molendijk, 2021). While such compromises and ambiguity may smooth over disagreements between actors, they often do not truly solve the problems. That is, compromises may not mean that actual synthesis is achieved – that conflicting views and interests are truly reconciled – but rather, that conflicting views and interests are handed down or left to the lower levels to deal with (Molendijk, 2019).

The Srebrenica genocide in Bosnia is a tragic example of leadership feeling caught and thus unwillingly inflicting moral injuries on others. In 1995, the United Nations troops were deployed to protect the Safe Area of Srebrenica, but their mandate was intentionally (strategically) vague. They were mandated ‘to deter attacks’ against the Safe Area of Srebrenica, but no explicit authorisation was given to ‘defend’ Srebrenica (Rapporteur Report, 2015). At the Dutch political level, the decision was made to deploy only a few hundred peacekeepers armed with light weaponry – which Dutchbat soldiers dubbed ‘water pistols’. Consequently, the declaration of Srebrenica as a demilitarised Safe Area was not just violated during Srebrenica’s attack in July 1995, but daily from the outset. Military commanders in Srebrenica found themselves forced to keep their troops motivated while prohibiting them from intervening in violent incidents to avoid escalation, effectively trapping both themselves and their soldiers. For instance, one soldier recalled witnessing a Bosnian soldier being killed from an observation post and wanting to act, only to be told by his commander, ‘no, we’re not allowed to do that’. He felt powerless and humiliated, as the perpetrator ‘just waved at us with his gun’. The UN officials who had been responsible for the diplomatic drafting of Safe Areas later referred to it as ‘a fake solution’ primarily intended ‘pour la galerie’, and ‘not linked to operational realities on the ground’ (Rapporteur Report, 2015: 13–14).

So, while members of frontline professions clearly face moral challenges when their personal values unequivocally conflict with organisational or political directives, ambiguity can likewise lead to moral injury. Such ambiguity breeds disorientation and internal conflict among members, especially in high-stakes situations where these challenges acquire particular moral significance. In response to this moral disorientation and conflict, they may resort to different coping strategies. On the one hand, they may redefine their duty in clear-cut terms, while on the other hand, they may latch on to personally felt moral beliefs (Kalkman and Molendijk, 2021). Yet, in conditions of ambiguity, no response can completely protect them from the risk of developing moral injury. In the first case, they must actively distance themselves from moral challenges beyond their duty, which in retrospect may cause stress; in the second case, they will embrace these challenges and follow felt moral obligations, but they will face competing values while doing so.

A bureaucratic family

The police, and especially the military, exemplify what sociologist Goffman termed ‘total institutions’ (Goffman, 1961). They demand complete commitment from their members, blurring the lines between work, home and personal time, while also deindividualising members to create a uniform collective. While research has extensively (and justifiably) criticised these processes (e.g. Bikos, 2024), an exclusive focus on their negative potential risks overlooking their benefits. Terms like ‘brothers in arms’ (military) and ‘blue family’ (police), often used by members themselves, should not be hastily dismissed as mere indoctrination. Rather, they reflect a genuine and necessary sense of belonging, camaraderie and shared purpose. For many, these institutions provide identity and meaningful connections, which provide stability and vital support in high-impact conditions (Wakefield et al., 2024).

Then again, precisely because of these dynamics, these institutions also earn the label of ‘total’ or even ‘greedy institutions’ (Coser, 1974). Furthermore, they are not just families but also bureaucracies, whose bureaucratic nature imposes strict regulations, hierarchy and procedures on soldiers and police members, who are ‘assets’ and ‘resources’ rather than brothers and sisters (Chappell and Lanza-Kaduce, 2010; Eikenaar, 2023; Gilhuis et al., 2024). While this family–bureaucracy duality inevitably arises from the nature of military and police work, our research revealed it as particularly morally risky. Quite literally implying an institutional ‘two-facedness’, it can create morally damaging situations and, more significantly, contribute directly to moral injury by causing profound experiences of betrayal. As outlined in the previous section, the complex relationship between frontline work and violence – a complex position, with dual roles and a morally ambivalent status – makes professionals inherently reliant on and trusting of their leaders and institution. The family-like dynamics in such institutions deepens this trust, but also amplifies the risk of perceived betrayal when the bureaucratic nature of the system manifests itself, as discussed below.

Hot ‘n cold management

Members thus must manoeuvre through an institution that is ‘hot and cold’. As with most things, this is a matter of degree. Minor grievances are typically laughed off, providing fodder for running gags. For instance, a common joke among soldiers (and a recurring meme on military social media channels) is that, while they are trained as ‘brothers in arms’ handling highly dangerous weapons systems, they are prohibited from having a sandwich toaster in their rooms due to fire safety regulations – meaning they cannot make a toastie after a long day of dangerous work. While soldiers generally understand and accept that such paradoxes are inherent in their profession, grievances become more serious when higher stakes are involved, and the two faces of their institution truly begin to feel like two-facedness.

The following example illustrates the complexity of this. Nowadays, when scandals involving moral transgressions appear in the media, organisational and political leadership often responds with measures such as stricter protocols, zero tolerance for mistakes, ethics training, codes of conduct and integrity committees. While these adjustments appear highly morally responsible and indeed tweak some aspects of the work, they typically leave the overall nature of the job and its tasks unchanged (cf. Dekker, 2013). What this means is that, as one respondent put it:

So, you go through all the ethics training, and the codes of conduct and so on, . . . and then you’re still in the same situations, like dealing with aggressive, confused people, . . . but now you feel extra responsible [and] then they turn around and have integrity committees judging whether you did it right.

Thus, these interventions aimed at preventing future moral transgressions produce a paradoxical outcome: the moral burden of high-impact professions is shifted entirely onto the frontline workers, whose jobs become increasingly complicated, thereby increasing the risk of both self-directed moral injury (feeling guilt or shame due to a heightened sense of responsibility) and other-directed moral injury (feeling betrayed by the organisation and/or government that put them in these situations).

The most damaging scenarios are often Kafkaesque, especially following distressing incidents. No matter how well intentioned leaders may be, personnel are essentially viewed as assets in bureaucratic systems – either useful or expendable. For example, bureaucratic logic often leads to treating members who seek recognition for work-related illness as suspects, requiring them to prove their condition while fostering a tendency to remove sick individuals deemed ‘useless’ (Gilhuis et al., 2024). Meanwhile, colleagues may express concern, only to be told, ‘we’re not supposed to ask how you’re doing’ because bureaucratic rules dictate that giving the person rest means prohibiting all contact with the affected individual. As the institution increasingly manifests as a bureaucracy, members may realise that when sick, ‘all of a sudden, you don’t exist anymore’, and that ‘this “beautiful family” drops you like a hot potato’ (Gilhuis et al., 2024).

In response to such experiences, professionals may react in different ways: they may accept the harsh reality of being reduced to an obsolete asset and isolate themselves in disillusionment, or they may acquiesce and seek a new purpose and identity. Alternatively, they may fight back, demanding recognition and reparations for their service and the trauma-related problems caused by an incident and its aftermath. In bureaucratic systems, seeking recognition often requires filing formal claims or even pursuing lawsuits. A Srebrenica veteran explained his motive for filing a claim as follows: ‘Doesn’t somebody have to pay for the mistakes back then? The only way you have is to demand compensation.’ Consequently, many police and military members involved in incidents find themselves embroiled in legal battles against their organisation or government while primarily seeking recognition and justice (Gilhuis et al., 2024). This creates a frustrating ongoing cycle where they fight harder and harder for recognition and justice, only to encounter more bureaucratic red tape, which reinforces their sense of misrecognition and leaves them stuck in a ‘solidified fighting mode’ (Gilhuis et al., 2024).

The following section will explore the meaning of recognition and misrecognition in greater detail as it expands its focus to society at large.

Discomfort and misrecognition

As stated, frontline workers are not a rabble of bandits, but use force on behalf of an organisation, acting as instruments of the state, which has granted them the monopoly on violence. Their work occurs in the name of society, with soldiers and police members themselves being members of that same society. Accordingly, they engage in activities that are outsourced by society, as such endorsed and even admired, yet simultaneously laden with stigma (Hughes, 1962).

This ambivalence is integral to the sociological concept of ‘dirty work’ (Hughes et al., 2017), a term already referenced several times. While workers themselves may not always view their job as such, society often regards it as a necessary evil. ‘Dirty work’ includes professions stigmatised in different ways: physically (e.g. bin men), socially (e.g. maids) or morally (e.g. paparazzi). Physically and socially, ‘dirty work’ is typically seen as more necessary than evil, whereas morally ‘dirty work’ is often perceived as more evil than necessary (Ashforth and Kreiner, 2014). Military and police work carries physical, social and moral taints, while also being physically, socially and morally respected at the same time (Eikenaar, 2024).

Members of high-impact professions frequently express feelings of misrecognition, particularly those who have been injured in their work. While the concepts of recognition and misrecognition may appear straightforward – where misrecognition is associated with negative perceptions and recognition with praise – far more nuanced meanings emerged in our research. When professionals expressed feelings of misrecognition, they were not simply seeking sympathy. Nor did they mean that they lacked praise – many, in fact, vehemently dismissed ‘hoorays and cheers’ as ‘bullshit’. Rather, they contend that the public often fails to understand or acknowledge that ‘I’m a human being too’. These accounts resonate with Honneth’s (1997) concept of recognition as revolving around a moral relationship with others, which may be respected or damaged.

Recognition management

Many of the military and police personnel we spoke to noted they are ‘cautious about sharing experiences with people who don’t really understand’. On the one hand, they fear judgement. On the other, they find it equally problematic to reject all responsibility for their actions. As one respondent reflected on their inability to prevent a fatality: ‘You can tell me a thousand times, “there was nothing you could do”, but I was there. We couldn’t do anything – we didn’t do anything.’

While many factors contribute to this discomfort, a common thread is that caricatures such as hero, victim or perpetrator distort the complex experiences of professionals and, in doing so, commit an injustice to these experiences. In fact, recalling respondents’ laments about society’s failure to recognise that ‘I’m a human being’, these caricatures contribute to dehumanisation. Heroic narratives romanticise complex, morally fraught decisions as noble sacrifices, focusing on honour while concealing the grim realities of human suffering. Similarly, victim narratives reduce professionals to passive figures, stripping them of agency and rendering them as helpless patients suffering from illness. Whether through condemnation, glorification or pity, the complexities, tragedies and contradictions of frontline work are erased. This reduces the many-sided realities of this high-impact labour into simplistic, black-and-white stories, forcing professionals into one-dimensional roles, which obscure difficult questions of morality, responsibility and justice.

As discussed in the previous section, those who have experienced betrayal, neglect or misunderstanding may acquiesce to this reality, isolate themselves and/or become entangled in legal battles with their organisations and government. What they typically seek is recognition and justice, but instead, they often encounter the opposite, deepening their distrust and anger towards not only their employers but also the broader political system, and society as a whole.

Thus, our findings show that misrecognition can deepen moral injuries, and inflict new ones, while recognition can facilitate moral healing. Moreover, they indicate the importance of distinguishing between different types of recognition. In particular, a distinction between affirmative recognition and transformative recognition proves helpful (Gilhuis, 2025). ‘Affirmative recognition’ occurs when individuals feel acknowledged but remain trapped in guilt, shame or anger. ‘Transformative recognition’, on the other hand, enables individuals to move beyond binary roles of perpetrator or victim, helping them heal their relationship with themselves and society (Gilhuis, 2025).