ضربه اخلاقی اختلالی مقاوم به درمان و چشم‌انداز درمان‌های معنوی ‏خداسو برای ترمیم آن

نوع مقاله : تخصصی

نویسندگان

1 استاد، گروه روان‌شناسی، پژوهشگاه حوزه و دانشگاه، قم، ایران (نویسنده مسئول).‏

2 دانشجوی دکتری روان‌شناسی، پژوهشگاه حوزه و دانشگاه، قم، ایران. ‏

3 دانشجوی دکتری روان‌شناسی، دانشگاه آزاد بین المللی کیش، کیش، ایران.‏

4 کارشناسی ارشد روان‌شناسی، دانشکده علوم انسانی، دانشگاه آزاد واحد شهر قدس، تهران، ایران.‏

چکیده

ضربه اخلاقی، به عنوان یک چالش جدی در حوزه سلامت روانی است. این آسیب روان‌شناختی، زمانی بروز می‌کند که فرد با عملی متعارض با ارزش‌های اساسی خود مواجه می‌شود. مقاله حاضر با هدف بررسی عمیق این پدیده، پیامدهای روان‌شناختی آن را با استفاده از روش‌های مرور نظام‌مند و همچنین تحلیل منابع اسلامی، مورد واکاوی قرار می دهد. یافته‌های پژوهش حاکی از آن است که ضربه اخلاقی، ریشه در تعارض عمیق ارزش‌های بنیادین فرد دارد و با احساس گناه، هم‌سو و با مفهوم گناه کبیره در منابع اسلامی، هماهنگ است. این تعارض و تلاش برای پنهان‌سازی یا محافظت از آن، منجر به عذاب وجدان شدید و در نهایت، بروز اختلالات روان‌شناختی مقاوم به درمان می‌شود. بررسی‌ها نشان می‌دهد که رویکردهای درمانی معنوی، تا کنون، به عنوان روشی موثرتر در رهایی فرد از این آسیب شناخته شده‌اند. پیش‌بینی می‌شود که ضربه اخلاقی به زودی به عنوان یک اختلال روان‌شناختی اساسی شناخته شود. آسیب به ارزش‌های فرد، که اغلب توسط خود او ایجاد شده، به آسانی قابل جبران نیست به طوری که فقط الگوهای معنوی می‌توانند تسکین‌بخش باشند و فرد را از عذاب وجدان رها کنند. اگرچه الگوهای معنوی مبتنی بر منابع ذهنی و ساختگی که با معیارهای واقعی قابل سنجش نیستند نیز می‌توانند به پانسمان زخم اخلاقی منجر شوند؛ اما، تنها معنویت واقعی مبتنی بر منابع معتبر وحیانی و عقلانی، راهگشا است. در این راستا، الگوی درمان معنوی خداسو و الگوی شناختی-رفتاری انطباق‌یافته با مداخلات اسلامی (کوئنیگ، 2025)، به عنوان روش‌هایی مؤثر در مهار و مدیریت این آسیب پیشنهاد می‌شود.
 
 

کلیدواژه‌ها

عنوان مقاله [English]

Moral Injury as a Treatment-Resistant Disorder and the ‎Prospects of God-Centered Spiritual Therapies for Its Healing

نویسندگان [English]

  • Masoud Janbozorgi 1
  • Roghaye Shokoohi Fard 2
  • Mojgan Ahmadi 3
  • Fateme Madani 4
1 Professor, Department of Psychology, Research Institute for Hawzah and University, Qom, Iran (Corresponding Author)‎
2 Ph.D. Student in Psychology, Research Institute for Hawzah and University, Qom, Iran
3 Ph.D. Student in Psychology, Islamic Azad University, International Branch of Kish, Kish, Iran‎
4 M.A. in Psychology, Faculty of Humanities, Azad University, Shahr-e-Quds Branch, Tehran, Iran
چکیده [English]

Moral injury is a serious challenge in the field of mental health. This psychological harm arises when an individual encounters an act that contradicts their core values. The present article aims to deeply examine this phenomenon by exploring its psychological consequences through systematic review methods and analysis of Islamic sources. Findings indicate that moral injury originates from a profound conflict with an individual’s fundamental values. It is aligned with feelings of guilt and corresponds with the concept of major sin in Islamic sources. This conflict, along with efforts to conceal or protect it, leads to severe guilt and, eventually, to treatment-resistant psychological disorders. Research shows that spiritual therapeutic approaches have so far proven more effective in helping individuals recover from this type of trauma. It is anticipated that moral injury will soon be formally recognized as a fundamental psychological disorder. Damage to one’s values—often caused by the individual themselves—is not easily reparable, and only spiritual models can offer true relief from the torment of guilt. Although spiritual models based on mental constructs that are not measurable by real criteria may offer temporary relief, only genuine spirituality grounded in reliable revelatory and rational sources can provide true healing. In this regard, the God-centered spiritual therapy model and the adapted cognitive-behavioral therapy model with Islamic interventions (Koenig, 2025) are proposed as effective methods for managing and addressing this condition.

کلیدواژه‌ها [English]

  • Moral injury
  • spiritual therapy
  • God-centered spiritual treatment
  • Islamic psychology
  • spiritually/religiously integrated cognitive processing therapy

مراجع

* قرآن کریم
باقری شیخانگفشه، فرزین؛ فتحی آشتیانی، علی. (1402). بررسی ویژگی‌های روانسنجی
نسخه فارسی مقیاس علائم صدمه اخلاقی در یک واحد نظامی. طب نظامی، 25(4)، صص‌1960-1972. doi: 10.30491/jmm.2023.1006466.1
جان‌بزرگی، مسعود. (1398). درمان چند بعدی معنوی؛ یک رویکرد خداسو. قم: پژوهشگاه حوزه و دانشگاه.
جان بزرگی، مسعود. (۱۴۰۴)‌. درمان‌های شناختی رفتاری معنوی؛ موج چهارم. قم: پژوهشگاه حوزه و دانشگاه.
فراهانی، حجت‌اله؛ موثق، الهیاری؛ روشن چسلی، رسول و دهقانی آرانی. (2023).
فراترکیب و فراتحلیل درعمل همراه با کاربست R. روانشناسی بالینی و شخصیت، 21(2)،
صص 205-221.‎
Ames, D., Erickson, Z., Youssef, N. A., Arnold, I., Adamson, C. S., Sones, A. C., ... & Koenig, H. G. (2019). Moral injury, religiosity, and suicide risk in US veterans and active-duty military with PTSD symptoms. Military medicine, 184(3-4), pp. e271-e278.
Ames, D., Haynes, K., Adamson, S. F., Bruce, L. E., Chacko, B. K., Button, L., & Koenig, H. G. (2018). A structured chaplain intervention for Veterans with moral injury in the setting of PTSD. Durham, NC: Duke University Center for Spirituality, Theology and Health (Christian, Buddhist, Hindu, Jewish, and Muslim versions available.
Backholm, K., & Idås, T. (2015). Ethical dilemmas, work‐related guilt, and posttraumatic stress reactions of news journalists covering the terror attack in Norway in 2011. Journal of Traumatic Stress, 28(2), pp. 142-148.
Barnes, H. A., Hurley, R. A., & Taber, K. H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. The Journal of neuropsychiatry and clinical neurosciences, 31(2), pp. A4-103.
Battaglia, A. M., Protopopescu, A., Boyd, J. E., Lloyd, C., Jetly, R., O’Connor, C., ... & McKinnon, M. C. (2019). The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces. European journal of psych traumatology, 10(1), p. 1546084.
Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology, 20(3), p. 154.
Bryan, A. O., Theriault, J. L., & Bryan, C. J. (2015). Self-forgiveness, posttraumatic stress, and suicide attempts among military personnel and veterans. Traumatology, 21 (1), p. 40.
Bryan, C. J., Morrow, C. E., Etienne, N., & Ray‐Sannerud, B. (2013). Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and anxiety, 30(1), pp. 55-60.
Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis, J. C., Green, B. A., Etienne, N., ... & Ray-Sannerud, B. (2016). Measuring moral injury: Psychometric properties of the moral injury events scale in two military samples. Assessment, 23(5), pp. 557-570.
Bryan, C. J., Bryan, A. O., Roberge, E., Leifker, F. R., & Rozek, D. C. (2018). Moral injury, posttraumatic stress disorder, and suicidal behavior among National Guard personnel. Psychological trauma: theory, research, practice, and policy, 10(1), p. 36.
Carey, L. B., & Hodgson, T. J. (2018). Chaplaincy, spiritual care and moral injury: Considerations regarding screening and treatment. Frontiers in psychiatry, 9, p. 619.
Carey, L. B., Hodgson, T. J., Krikheli, L., Soh, R. Y., Armour, A. R., Singh, T. K., & Impiombato, C. G. (2016). Moral injury, spiritual care and the role of chaplains: An exploratory scoping review of literature and resources. Journal of religion and health, 55, pp. 1218-1245.
Christine E. Breazeale (2019). An Examination of Moral Injury, Acceptance, Meaning-Making, and Posttraumatic Growth Among Individuals with Symptoms of PTSD. Southern Illinois University at Carbondale.
Currier, J.M., Farnsworth, J.K., Drescher, K.D., McDermott, R.C., Sims, B.M., Albright, D.L. (2018). Development and evaluation of the Expressions of Moral Injury Scale—Military Version. Clinical Psychology & Psychotherapy, 25(3), pp. 474-488. doi: 10.1002/cpp.2407.
Currier, J. M., Holland, J. M., & Malott, J. (2015). Moral injury, meaning making, and mental health in returning veterans. Journal of clinical psychology, 71(3), pp. 229-240.
Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., & Litz, B. (2011). An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology, 17(1), pp. 8-13.
Evans, W. R., Stanley, M. A., Barrera, T. L., Exline, J. J., Pargament, K. I., & Teng, E. J. (2018). Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), p. 360.
Frankfurt, S., & Frazier, P. (2016). A review of research on moral injury in combat veterans. Military psychology, 28(5), pp. 318-330.
Greenberg, N., & Tracy, D. (2020). What healthcare leaders need to do to protect the psychological well-being of frontline staff in the COVID-19 pandemic. BMJ leader, 4(3).
Grimsley, C. W., & Grimsley, G. (2017). PTSD & moral injury: The journey to healing through forgiveness. Xulon Press.
Higgins, J. P. (2008). Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration and John Wiley & Sons Ltd.
Hodgson, T. J., & Carey, L. B. (2017). Moral injury and definitional clarity: Betrayal, spirituality and the role of chaplains. Journal of religion and health, 56(4), pp. 1212-1228.
Ioannidis, J. P. (2009). Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses. Cmaj, 181(8), pp. 488-493.
Jinkerson, J. D. (2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22 (2), pp. 122-130.
Koenig, H. G. (2025). Psychiatric problems in medical patients relevant to primary care physicians and mental health providers. The International Journal of Psychiatry in Medicine, 60(1), pp. 3-6.
Koenig, H. G. (2025). Spiritual/Religious-Based Cognitive Behavioral Therapies. In Janbozorgi M. (ed), Spiritual/Religious based Cognitive Behavioral Therapies: The Fourth Force. Publisher to be announced.
Koenig, H. G., & Al Zaben, F. (2021). Moral injury: An increasingly recognized and widespread syndrome. Journal of religion and health, 60(5), pp. 2989-3011.
Koenig, H. G., Youssef, N. A., & Pearce, M. (2019). Assessment of moral injury in veterans and active duty military personnel with PTSD: A review. Frontiers in psychiatry, 10, p. 443.
Koenig, H. G., Youssef, N. A., Ames, D., Teng, E. J., & Hill, T. D. (2020). Examining the overlap between moral injury and PTSD in US veterans and active-duty military. The Journal of nervous and mental disease, 208(1), pp. 7-12.
Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., ... & Pearce, M. (2018). The moral injury symptom scale-military version. Journal of religion and health, 57, pp. 249-265.
Kopacz, M. S., Connery, A. L., Bishop, T. M., Bryan, C. J., Drescher, K. D., Currier, J. M., & Pigeon, W. R. (2016). Moral injury: A new challenge for complementary and alternative medicine. Complementary Therapies in Medicine, 24, pp. 29-33.
Lennon, R. P., Parascando, J., Talbot, S. G., Zhou, S., Wasserman, E., Mantri, S., ... & Dean, W. (2023). Prevalence of moral injury, burnout, anxiety, and depression in healthcare workers 2 years in to the COVID-19 pandemic. The Journal of nervous and mental disease, 211(12), pp. 981-984.
Litz, B. T., Lebowitz, L., Gray, M. J., & Nash, W. P. (2017). Adaptive disclosure: A new treatment for military trauma, loss, and moral injury. Guilford Publications.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical psychology review, 29(8), pp. 695-706.
Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral injury and burnout in health care professionals during the COVID-19 pandemic. The Journal of Nervous and Mental Disease, 209(10), pp. 720-726.
McEwen, C., Alisic, E., & Jobson, L. (2021). Moral injury and mental health: A systematic review and meta-analysis. Traumatology, 27(3), p. 303.
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military medicine, 178(6), pp. 646-652.
Nash, W. P., Vasterling, J., Ewing-Cobbs, L., Horn, S., Gaskin, T., Golden, J., ... & Baker, D. G. (2010). Consensus recommendations for common data elements for operational stress research and surveillance: report of a federal interagency working group. Archives of physical medicine and rehabilitation, 91(11), pp. 1673-1683.
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military medicine, 178(6), pp. 646-652.
Nieuwsma, J. A., Brancu, M., Wortmann, J., Smigelsky, M. A., King, H. A., Visn 6 Mirecc Workgroup, & Meador, K. G. (2021). Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clinical Psychology & Psychotherapy, 28(1), pp. 239-250.
Nieuwsma, J. A., O’Brien, E. C., Xu, H., Smigelsky, M. A., VISN 6 MIRECC Workgroup, HERO Research Program, & Meador, K. G. (2022). Patterns of potential moral injury in post-9/11 combat veterans and COVID-19 healthcare workers. Journal of general internal medicine, 37(8), pp. 2033-2040.
Paul, L. A., Gros, D. F., Strachan, M., Worsham, G., Foa, E. B., & Acierno, R. (2014). Prolonged exposure for guilt and shame in a veteran of Operation Iraqi Freedom. American journal of psychotherapy, 68(3), pp. 277-286.
Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Religion and morality. Cognitive processing therapy for PTSD, pp. 285-287.
Ritov, G., & Barnetz, Z. (2014). The interrelationships between moral attitudes, posttraumatic stress disorder symptoms and mixed lateral preference in Israeli reserve combat troops. International journal of social psychiatry, 60(6), pp. 606-612.
Rozek, D. C., & Bryan, C. J. (2021). A cognitive-behavioral model of moral injury. In J. M. Currier, K. D. Drescher, & J. Nieuwsma (Eds.), Addressing moral injury in clinical practice (pp. 19-33). American Psychological Association.
https://doi.org/10.1037/0000204-002.
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Scribner
Volk, F., & Koenig, H. G. (2019). Moral injury and religiosity in active-duty US Military with PTSD symptoms. Military Behavioral Health, 7(1), pp. 64-72.
Wang, Z., Harold, K.G., Tong, Y., Wen, J., Sui, M., Liu, H., Zaben, F.A., Liu, G. (2021). Moral injury in Chinese health professionals during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy. 10.1037/ tra0001026.
Wang, Z.Z., Koenig, H.G., Tong, Y., Wen, J., Sui, M., Liu, H., Liu, G. (2020) Psychometric properties of the Moral Injury Symptoms Scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry. 20, p. 556. doi: 10.1186/s12888-020-02954-w.
Hines, S. E., Chin, K. H., Glick, D. R., & Wickwire, E. M. (2021). Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic. International journal of environmental research and public health, 18(2), p. 488. https://doi.org/10.3390/ijerph18020488.

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