Institutional betrayal

Last updated

Institutional betrayal is a concept described by psychologist Jennifer Freyd, [1] referring to "wrongdoings perpetrated by an institution upon individuals dependent on that institution, including failure to prevent or respond supportively to wrongdoings by individuals (e.g. sexual assault) committed within the context of the institution". [2] It is an extension of betrayal trauma theory. When institutions such as universities cover up violations such as rape, sexual assault and child sexual abuse (as in the Penn State child sex abuse scandal), this institutional betrayal [3] undermines survivors' recovery. In a landmark study in 2013, Carly P. Smith and Freyd documented psychological harm caused by institutional betrayal. [4] A legal analysis concludes that this study is reliable under the Frye standard and the Daubert standard. [5]

Contents

The term is receiving increased attention based on recent White House statements about sexual assault on college campuses. [6] The term is also used by the Harvard University student group Our Harvard Can Do Better. Recent debate about how colleges respond to sexual assault by students has brought this issue renewed media attention. [7] [8] [9] Many students who have been sexually assaulted in college have taken to Instagram to provide anonymous accounts of their assault and the college's response. Although sharing accounts of trauma can be helpful in reducing a sense of aloneness, reinforcement via social media may cause an increase in reported PTSD symptoms linked to institutional betrayal. [10]

Institutional betrayal can occur within families, governments and the military, organizations, workplaces, religious institutions, or any organizational system in which people are dependent on systemic protection. [11] Individuals who have experienced extensive trauma appear to be both less satisfied with police responses in the face of an intimate partner violence incident and more distrustful of police. [12] Therefore, these individuals may experience feelings of institutional betrayal due to a perceived failure of the police to prevent further revictimization. Individuals who have been frequently retraumatized are also the ones most likely to utilize health care and mental health services. Institutional betrayal in the medical system is currently being investigated in the Canadian health care system. It is hypothesized that institutional betrayal in the medical system will explain symptoms of PTSD, depression and anxiety above and beyond the effects of general tendencies to trust others or the patient satisfaction with the care received. [13]

Institutional betrayal in academia

The experience of betrayal from academic institutions is one of the primary focuses of research on institutional betrayal due in part to political statements and student advocacy and outcry regarding college campus sexual assault around the United States. [6] [7] [8] [9] Along with universities and college campuses, institutional betrayal has been experienced by high school students as well. High school students were shown to express feelings of institutional betrayal correlated with gender-based harassment during school. [14] Additionally, students in high school and university settings have indicated feeling betrayed by their academic institutions due to mishandling cases of bullying due to sexual- or gender identity. [15] [16] Beyond issues of institutional betrayal due to omission or commission in systemic, intersectional factors, students have shown feelings of institutional betrayal in university policy. A poll which surveyed students during the 2020 Fall semester through 2021 Winter semester at University of Oregon showed that over half of all responding students indicated feelings of institutional betrayal due to the university's handling of the COVID-19 pandemic. [17]

Instructors and students have expressed feelings of betrayal incurred from university administration due to microaggressions and racial stress. [18] [19] Women in particular are at risk of experiencing institutional betrayal due in part to gender-based biases and microaggressions, as well as experience of campus sexual violence. [19] [20] Women of color are shown to more likely experience feelings of institutional betrayal regardless of whether they experienced campus sexual violence. [20]

Institutional betrayal in medicine

Institutional betrayal due to the medical industry is experienced by patients and providers. [21] [22] [23] Patients and doctors can feel betrayed due to systemic issues in medicine (e.g., difficulties due to access, insurance, overall cost, etc.), problems related to organizational response, such as during the COVID-19 pandemic, [21] or due to interpersonal issues between a patient and healthcare provider. Current studies being conducted in the Canadian healthcare system further broke down categories of institutional betrayal in two broad categories of "system level" and "doctor level" issues, identifying issues related to healthcare providers as not providing enough psychological support (e.g., not showing compassion, lack of communication, high emotional reactivity to patients) and inadequate medical care (e.g., failure to provide effective care due to lack of training or willingness, or providers not willing to consider alternative treatments or medicines). [24] [25]

In the United States, mental health care is often handled by primary care physicians (PCPs) rather than by psychiatrists or other prescribing physicians who are specialized in mental health. [26]

Government betrayal

A sense of being misled, betrayed, or otherwise having one's rights violated by a state entity, institutional betrayal as it pertains to a political or governmental agency's influence on stress and trauma in members of some or all of a population. Police brutality and overreach [27] are examples of institutional betrayal due to the nature of policing. Since police officers are intended to "serve and protect," brutality, violence, and oppression by the police creates a sense of mistrust and betrayal in government systems by victims and witnesses. [28] [29] In the summer of 2020, protests around the murder of George Floyd was a large-scale public outcry against police brutality which in part was due to a noted [29] sense of institutional betrayal.

Soldiers may experience a sense of institutional betrayal from government agencies. In the United States, veterans of the Iraq War and War in Afghanistan experience institutional betrayal due to a lack of government-managed resources following their return from deployment. [30] This may be due to perceived or factual issues with receiving benefits for medical or mental health care. [31] Similar concerns have been raised by veterans of other wars fought by the United States, with Vietnam and Gulf War veterans expressing concerns of being betrayed or "forgotten" by the United States government following the end of their respective conflicts. [32] [33]

Institutional betrayal and moral injury

Moral injury is a form of trauma that refers to the impact of perpetrating, witnessing, or being a victim of an act that goes against the subject's worldview or set of personal values. Moral injury can be suffered by anyone, [34] but is often associated with, and subsequently studied in populations of, soldiers or people who have participated in war. [35] [36] [37] In soldiers, moral injury can be associated with a feeling of betrayal by a governmental entity, wherein a governmental agency or governing body is seen as an enabler or enforcer of wrongdoing. [38] Aside from perpetration of wrongdoing on civilians or military personnel from another country, institutional betrayal through moral injury has been recently studied in cases of military sexual trauma. [39] [40]

Institutional courage

Institutional courage is a concept described by psychologist Jennifer Freyd as the antidote to institutional betrayal. Institutional courage refers to "rightdoings" by which institutions demonstrate accountability, transparency, and support of individuals who are harmed within the context of the institution.

Institutional cowardice

Institutional cowardice is a concept examined by forensic psychologist Laura S. Brown as being the primary force that supports and exacerbates institutional betrayal when a problem is recognized by an institution. [41] Institutional cowardice can be due to policy (e.g., a company not providing sick leave to workers dealing with mental health issues) or as a way for an individual to fall back on a supposed guideline or rule (e.g., someone refusing to offer concessions and stating that they are "just doing [their] job"). Freyd and Smith identified two dimensions of institutional betrayal [31] which rely on axes that range from isolated incidents to systemic issues, and from betrayal by omission and commission. An example of institutional betrayal that is systemic and an error of commission would be an employer expecting an employee to work overtime without paying them for overtime. Brown suggests that institutional cowardice is primarily an issue of omission rather than commission. [41] She uses examples such as consent forms that are provided to individuals after long-term fasting shortly before surgical procedures, or complaint forms "getting lost in the mail" to prevent an organization from recognizing an issue.

See also

Related Research Articles

Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence that includes child sexual abuse, groping, rape, drug facilitated sexual assault, and the torture of the person in a sexual manner.

Repressed memory is a controversial, and largely scientifically discredited, psychiatric phenomenon which involves an inability to recall autobiographical information, usually of a traumatic or stressful nature. The concept originated in psychoanalytic theory where repression is understood as a defense mechanism that excludes painful experiences and unacceptable impulses from consciousness. Repressed memory is presently considered largely unsupported by research. Sigmund Freud initially claimed the memories of historical childhood trauma could be repressed, while unconsciously influencing present behavior and emotional responding; he later revised this belief.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.

<span class="mw-page-title-main">Betrayal</span> Breaking or violation of a presumptive contract, trust, or confidence

Betrayal is the breaking or violation of a presumptive contract, trust, or confidence that produces moral and psychological conflict within a relationship amongst individuals, between organizations or between individuals and organizations. Often betrayal is the act of supporting a rival group, or it is a complete break from previously decided upon or presumed norms by one party from the others. Someone who betrays others is commonly called a traitor or betrayer. Betrayal is also a commonly used literary element, also used in other fiction like films and TV series, and is often associated with or used as a plot twist.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Recovered-memory therapy (RMT) is a catch-all term for a controversial and scientifically discredited form of psychotherapy that critics say utilizes one or more unproven therapeutic techniques to purportedly help patients recall previously forgotten memories. Proponents of recovered memory therapy claim, contrary to evidence, that traumatic memories can be buried in the subconscious and thereby affect current behavior, and that these memories can be recovered through the use of RMT techniques. RMT is not recommended by mainstream ethical and professional mental health associations.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).

Rape is a traumatic experience that affects the victim in a physical, psychological, and sociological way. Even though the effects and aftermath of rape differ among victims, individuals tend to suffer from similar issues found within these three categories. Long-term reactions may involve the development of coping mechanisms that will either benefit the victim, such as social support, or inhibit their recovery. Seeking support and professional resources may assist the victim in numerous ways.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

<span class="mw-page-title-main">Military sexual trauma</span> U.S. legal term for sexual assault or harassment during military service

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child, indecent exposure, child grooming, and child sexual exploitation, such as using a child to produce child pornography.

Jennifer Joy Freyd is an American researcher, author, educator, and speaker. Freyd is an extensively published scholar who is best known for her theories of betrayal trauma, DARVO, institutional betrayal, and institutional courage.

Vicarious trauma (VT) was a term invented by McCann and Pearlman that is used to describe how working with traumatized clients affects trauma therapists. Previously, the phenomenon was referred to as secondary traumatic stress coined by Dr. Charles Figley. The theory behind vicarious trauma is that the therapist has a profound world change and is permanently altered by the interaction of empathetic bonding with a client. This change is thought to have three conditional requirements: empathic engagement and exposure to graphic and traumatizing material, the therapist being exposed to human cruelty, and reenactment of trauma within the therapy process. This change can produce changes in a therapist's sense of spirituality, worldview, and self-identity.

A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

The ARC3 Survey is a campus climate survey developed to assess perpetration and victimization of sexual misconduct on college campuses in the United States. In addition to measuring rates of sexual assault on campus, the survey also gathers data on those who are engaging in sexual assault. It was developed by a group of sexual assault researchers and student affairs professionals in response to the White House Task Force to Protect Students from Sexual Assault. The survey is free for college campuses to use. The study has been used to assess both graduate and undergraduate students.

Betrayal trauma is defined as a trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival. The concept originally introduced by Jennifer Freyd in 1994, betrayal trauma theory (BTT), addresses situations when people or institutions on which a person relies for protection, resources, and survival violate the trust or well-being of that person. BTT emphasizes the importance of betrayal as a core antecedent of dissociation implicitly aimed at preserving the relationship with the caregiver. BTT suggests that an individual, being dependent on another for support, will have a higher need to dissociate traumatic experiences from conscious awareness in order to preserve the relationship.

In psychology, Trauma-informed feminist therapy is a model of trauma for both men and women that incorporates the client's sociopolitical context.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

Trauma- and violence-informed care (TVIC) describes a framework for working with and relating to people who have experienced negative consequences after exposure to dangerous experiences. There is no one single TVIC framework, or model, and some go by slightly different names, including Trauma Informed Care (TIC). They incorporate a number of perspectives, principles and skills. TVIC frameworks can be applied in many contexts including medicine, mental health, law, education, architecture, addiction, gender, culture, and interpersonal relationships. They can be applied by individuals and organizations.

References

  1. ↑ Platt, M; Barton, J.; Freyd, J.J. (2009). "A betrayal trauma perspective on domestic violence" (PDF). In Tark, E.; Buzawa, E.S. (eds.). Violence against Women in Families and Relationships. Westport, CT: Greenwood Press. pp. 185–207. ISBN   978-0-275-99847-9 . Retrieved October 23, 2021.
  2. ↑ Freyd, Jennifer. "Institutional Betrayal". Freyd Dynamics Lab, University of Oregon . Retrieved October 23, 2021.
  3. ↑ Baker, Katie J. M. (25 April 2014). "Rape Victims Don't Trust The Fixers Colleges Hire To Help Them". BuzzFeed News.
  4. ↑ Smith, Carly Parnitzke; Freyd, Jennifer J. (February 2013). "Dangerous Safe Havens: Institutional Betrayal Exacerbates Sexual Trauma". Journal of Traumatic Stress. 26 (1): 119–124. CiteSeerX   10.1.1.660.6567 . doi:10.1002/jts.21778. PMID   23417879.
  5. ↑ Wendy Murphy; Catherine S. Martin; Carly P. Smith. "Institutional betrayal trauma" (PDF). Archived from the original (PDF) on February 26, 2021.[ self-published source? ]
  6. 1 2 Steinhauer, Jennifer (29 April 2014). "Behind Focus on College Assaults, a Steady Drumbeat by Students". The New York Times.
  7. 1 2 "Scientists to AAU member university presidents". Freyd Dynamics Lab, University of Oregon . Retrieved October 23, 2021.
  8. 1 2 Kingkade, Tyler (26 November 2014). "Though Under Fire For Its Own Rape Response, UVA Advises Other Schools Nationwide". HuffPost.
  9. 1 2 Freyd, Jennifer J. (14 July 2014). "OPINION: Official campus statistics for sexual violence mislead". Al Jazeera.
  10. ↑ Hannan, Susan M.; MacDonald, Gillian (January 2023). "Exposure to an Anonymous Survivor Instagram Account is Linked to Institutional Betrayal Among Campus Sexual Misconduct Survivors". Journal of Interpersonal Violence. 38 (1–2): NP2207–NP2217. doi:10.1177/08862605221082738. PMID   35341366. S2CID   247757503.
  11. ↑ Freyd, Jennifer and Pamela Birrell (2013). Blind to Betrayal: Why we fool ourselves we aren't being fooled. John Wiley & Sons. ISBN   978-0-470-60440-3.[ page needed ]
  12. ↑ Tamaian, Andreea; Klest, Bridget (June 2014). Rate of revictimization exacerbates both dissatisfaction and distrust with the police in survivors of intimate partner violence (PDF). Canadian Psychological Association 75th Annual Convention. Vancouver, British Columbia: University of Regina, Regina SK. Archived from the original (PDF) on July 14, 2014.
  13. ↑ Tamaian, Andreea (August 2015). Institutional Betrayal in the Medical System: Development, Realiability, and Validity of a Self-Report Questionnaire (Thesis). hdl: 10294/6848 .
  14. ↑ Lind, Monika N.; Adams-Clark, Alexis A.; Freyd, Jennifer J. (19 August 2020). "Isn't high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms". PLOS ONE. 15 (8): e0237713. Bibcode:2020PLoSO..1537713L. doi: 10.1371/journal.pone.0237713 . PMC   7444512 . PMID   32813685.
  15. ↑ Pyke, Karen D. (9 January 2018). "Institutional Betrayal: Inequity, Discrimination, Bullying, and Retaliation in Academia". Sociological Perspectives. 61 (1): 5–13. doi: 10.1177/0731121417743816 . S2CID   149014370.
  16. ↑ Smidt, Alec M.; Rosenthal, Marina N.; Smith, Carly P.; Freyd, Jennifer J. (11 March 2019). "Out and in Harm's Way: Sexual Minority Students' Psychological and Physical Health after Institutional Betrayal and Sexual Assault". Journal of Child Sexual Abuse. 30 (1): 41–55. doi:10.1080/10538712.2019.1581867. PMID   30856062. S2CID   75138835.
  17. ↑ Schwartz, Natalie (21 October 2021). "Over half of students reported feeling 'institutional betrayal' at a university during the pandemic". Higher Ed Dive.
  18. ↑ Carroll, Doris (July 2017). "A faculty Woman of Color and micro-invalidations at a White research institution: A case of intersectionality and institutional betrayal". Administrative Issues Journal. 7 (1).
  19. 1 2 Gómez, Jennifer M. (January 2022). "Gender, Campus Sexual Violence, Cultural Betrayal, Institutional Betrayal, and Institutional Support in U.S. Ethnic Minority College Students: A Descriptive Study". Violence Against Women. 28 (1): 93–106. doi:10.1177/1077801221998757. PMC   8582003 . PMID   33851553.
  20. 1 2 Bedera, Nicole (July 2021). "Beyond Trigger Warnings: A Survivor-Centered Approach to Teaching on Sexual Violence and Avoiding Institutional Betrayal". Teaching Sociology. 49 (3): 267–277. doi:10.1177/0092055X211022471. S2CID   236248794.
  21. 1 2 Klest, Bridget; Smith, Carly P.; May, Collin; McCall-Hosenfeld, Jennifer; Tamaian, Andreea (August 2020). "COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected". Psychological Trauma: Theory, Research, Practice, and Policy. 12 (S1): S159–S161. doi:10.1037/tra0000855. PMID   32478553. S2CID   219169874.
  22. ↑ Gigler, Margaret E.; Lathan, Emma C.; Cardarelli, Oriana; Lewis, Chrystal L.; McCabe, Sean; Langhinrichsen-Rohling, Jennifer (7 September 2022). "Young adults' expectations for healthcare following institutional betrayal". Journal of Trauma & Dissociation: 1–16. doi:10.1080/15299732.2022.2120151. PMID   36073011. S2CID   252120464.
  23. ↑ Smith, Carly P.; Freyd, Jennifer J. (26 November 2017). "Insult, then Injury: Interpersonal and Institutional Betrayal Linked to Health and Dissociation". Journal of Aggression, Maltreatment & Trauma. 26 (10): 1117–1131. doi:10.1080/10926771.2017.1322654. S2CID   148585754.
  24. ↑ Tamaian, Andreea; Klest, Bridget; Mutschler, Christina (26 April 2016). "Patient dissatisfaction and institutional betrayal in the Canadian medical system: A qualitative study". Journal of Trauma & Dissociation. 18 (1): 38–57. doi:10.1080/15299732.2016.1181134. PMID   27116298. S2CID   46864349.
  25. ↑ Klest, Bridget; Tamaian, Andreea; Boughner, Emily (September 2019). "A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment". Psychological Trauma: Theory, Research, Practice, and Policy. 11 (6): 656–662. doi:10.1037/tra0000453. PMID   30896222. S2CID   84841965.
  26. ↑ Green, Bonnie L.; Kaltman, Stacey; Frank, Lori; Glennie, Melissa; Subramanian, Asha; Fritts-Wilson, Michelle; Neptune, Dominique; Chung, Joyce (March 2011). "Primary care providers' experiences with trauma patients: A qualitative study". Psychological Trauma: Theory, Research, Practice, and Policy. 3 (1): 37–41. doi:10.1037/a0020097.
  27. ↑ McAuliffe, Margarita Elena (2018). Officer Excessive Force: A Multicase Study of Institutional Betrayal (Thesis). ProQuest   2183395240.
  28. ↑ Timm, Allyson McKinney (29 May 2020). "George Floyd's Right to Life & America's Crisis of Racialized Police Violence". Justice Revival.
  29. 1 2 Hamby, Sherry (2 June 2020). "Why Do Some Protests Turn Violent? Institutional Betrayal". Medium.[ self-published source? ]
  30. ↑ Haen, Craig (February 2019). "What soldiers can teach therapists who work with trauma: A qualitative examination of contemporary American war writing". The Arts in Psychotherapy. 62: 85–93. doi:10.1016/j.aip.2018.12.005. S2CID   149956530.
  31. 1 2 Smith, Carly Parnitzke; Freyd, Jennifer J. (2014). "Institutional betrayal". American Psychologist. 69 (6): 575–587. CiteSeerX   10.1.1.660.9888 . doi:10.1037/a0037564. PMID   25197837.
  32. ↑ Bobek, Rebecca S. (2011). Betrayal Trauma in the Military: A Phenomenological Study Exploring Betrayal with Veterans Returning from Iraq and Afghanistan (Thesis). ProQuest   1024138486.
  33. ↑ Bloeser, Katharine; McCarron, Kelly K.; Merker, Vanessa L.; Hyde, Justeen; Bolton, Rendelle E.; Anastasides, Nicole; Petrakis, Beth Ann; Helmer, Drew A.; Santos, Susan; Litke, David; Pigeon, Wilfred R.; McAndrew, Lisa M. (September 2021). "'Because the country, it seems though, has turned their back on me': Experiences of institutional betrayal among veterans living with Gulf War Illness". Social Science & Medicine. 284: 114211. doi:10.1016/j.socscimed.2021.114211. PMID   34271400.
  34. ↑ "Moral Injury". Psychology Today. Retrieved 2022-10-17.
  35. ↑ Koenig, Harold G.; Youssef, Nagy A.; Pearce, Michelle (2019). "Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review". Frontiers in Psychiatry. 10: 443. doi: 10.3389/fpsyt.2019.00443 . PMC   6611155 . PMID   31316405.
  36. ↑ Frankfurt, Sheila; Frazier, Patricia (9 June 2016). "A Review of Research on Moral Injury in Combat Veterans". Military Psychology. 28 (5): 318–330. doi:10.1037/mil0000132. S2CID   147718485.
  37. ↑ Shay, Jonathan (April 2014). "Moral injury". Psychoanalytic Psychology. 31 (2): 182–191. doi:10.1037/a0036090. S2CID   201794514.
  38. ↑ Molendijk, Tine (April 2019). "The Role of Political Practices in Moral Injury: A Study of Afghanistan Veterans". Political Psychology. 40 (2): 261–275. doi: 10.1111/pops.12503 . hdl: 2066/205061 . S2CID   149708229.
  39. ↑ Houle, Stephanie A.; Vincent, Colin; Jetly, Rakesh; Ashbaugh, Andrea R. (November 2021). "Patterns of distress associated with exposure to potentially morally injurious events among Canadian Armed Forces service members and Veterans: A multi‐method analysis". Journal of Clinical Psychology. 77 (11): 2668–2693. doi:10.1002/jclp.23205. S2CID   235746222.
  40. ↑ Frankfurt, Sheila B.; DeBeer, Bryann B.; Morissette, Sandra B.; Kimbrel, Nathan A.; La Bash, Heidi; Meyer, Eric C. (2018). "Mechanisms of Moral Injury Following Military Sexual Trauma and Combat in Post-9/11 U.S. War Veterans". Frontiers in Psychiatry. 9: 520. doi: 10.3389/fpsyt.2018.00520 . PMC   6225808 . PMID   30450058.
  41. 1 2 Brown, Laura S. (11 August 2020). "Institutional Cowardice: A Powerful, Often Invisible Manifestation of Institutional Betrayal". Journal of Trauma & Dissociation. 22 (3): 241–248. doi:10.1080/15299732.2020.1801307. PMID   32780675. S2CID   221107495.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.