Logotherapy and Existential Analysis for Moral Injury

Logotherapy and Existential Analysis for the Management of Moral Injury

New Book by Edward and Maria Marshall (2021)

Logotherapy and Existential Analysis for Moral Injury

The COVID-19 pandemic brought Moral Injury (MI) to the forefront of clinical attention and research. This multi-dimensional syndrome has been first described in the military context and is now understood to affect people in other occupations such as health care, business, education, law enforcement, the legal profession, disaster relief, international aid, social justice, as well as other areas of social and occupational functioning. Moral injury occurs when deeply held beliefs, ethical and moral principles have been trespassed. The violation of universal values and personal principles can be committed by oneself or by others. Witnessing potentially morally injurious events gives rise to guilt, shame, remorse, anger, disgust, feelings of betrayal, spiritual struggles and disorientation, loss of meaning, and despair. The secondary symptoms of moral injury may include anxiety, depression, and post traumatic stress. The symptoms of moral injury can vary in intensity and can present from mild to severe, seriously impairing functioning. Moral injury is not considered a mental illness but a syndrome that warrants clinical attention.


Employing a phenomenological hermeneutic method of systematically reviewing pertinent texts, the present study explores the lived experience of moral injury in relation to assessment and treatment methods currently available. Conceptually, research indicates that self care, moral resilience, and social support are linked with factors such as resiliency, post-traumatic growth, and self-transcendence. These factors are correlated with meaning, a key factor in wellness following existential frustration and distress. Thus, a holistic body, mind and spirit approach to the assessment and response to moral injury is warranted.


Viktor E. Frankl’s Logotherapy and Existential Analysis (LTEA) is an evidence-based meaning-centered approach to psychotherapy and counselling that has been successfully applied in the treatment of conditions involving existential issues. The present research examines the contribution of LTEA to the conceptual understanding of moral injury and to its related symptomatology. It details the application of LTEA principles and structured meaning-centered interventions in responding to moral injury. The applications are illustrated with examples that help to position this method into a holistic framework promoting re-connection, renewal, and health.

Culture and Personality

There is a role for education to help individuals develop their personality throughout life. Beyond the influences from the somatic and psychological dimensions, the person has the capacity to reflect and decide how to respond to life. The freedom of will of the human spirit also influences culture, since culture is amenable to develop over time. Personality relates to the individual whereas culture relates to the community. Within the community individuals exercise their freedom with responsibility. Their lives and response to life have consequences on other members of the community.

There has been an emphasis on the discoveries of determining factors in society. To have a complete picture of what humans are capable these factors need to be complemented with acknowledging the human capacity to decide a meaningful response to the environment. To bring awareness of the human capacity to freely respond to reality in spite of conditioning factors according to reasonable judgment is one of the roles of education and psychotherapy.

For example, we may reach conclusions through statistical research about the influence of the economy on mental health and how an economic crisis situation can precipitate a mental health deterioration on predisposed individuals. The person can feel excluded from the community or develop low self-esteem because it becomes impossible to keep up with expectations of society. On the other hand each individual can develop the capacity not to be completely determined by such external factors. This is the time to look outwards to what can be done to improve the situation which may benefit the community as a whole.

The person needs to take the initiative beyond expectations in their particular circumstances to the benefit of the community even though the community is not expecting much from the person. Leaders in position of power have it easier to exercise this capacity of outreaching to the community since this is what is expected from them, but individuals suffering from lack of employment, failure, marginalization, the effects of immigration, minorities, chronically ill, disabled, etc., are not expected to contribute much to the community, and their input is perceived at times bothersome and unwelcome. These are the individuals who require to mobilize the resources of the human spirit the most in order to reaffirm their dignity, uniqueness and humanity. In essence, to become leaders, or agents of change in their own right.

The first step to strengthen the capacities of the human spirit is an invisible change that happens inside the person to perceive the world not as a threat but as a place to explore and improve. From the time the person starts to think about how to reach out to others rather than focusing only on personal problems there starts to be a benefit for the community. This internal spiritual change, may translate into action, to alleviate the suffering of those around the person.

According to personality theories, there are certain types of personality which may have it easier to develop this outward way of thinking. This doesn’t mean that this change is not possible or available to any individual.

Breaking the barrier from changes in interior life to visible action can also have its difficulties, since there would be a reaction from other members of the community, not necessarily encouraging or welcoming. There may be reluctance that the change comes from the so called marginalized, since the majority of the community have excluded those individuals in the first place. It is then when the individual needs to put to the test the defiant power of the human spirit fighting for what is right. This is a psychological fight rather that a physical one. The individual needs to adapt and be flexible to aim at what is possible within their means to promote peace, compassion, and love, to those afflicted by suffering. Encouraging peer support, community building, friendship and love are possible targets in most situations.

Personal and community development are about learning how to respond to life situations meaningfully. Personality and culture are developing in the right direction when there is a process put in place involving the search for meaning. Most of the times to find the right answer to the world problems requires a search for the best option, since it is very difficult to get it right at the first attempt, with subsequent initiatives required, to respond adequately to the same or unprecedented problems.