Healing From the Iceberg of Moral Injuries During the Mideast Peace Plan Ceasefire
Key Takeaways
- The Mideast conflict ceasefire has led to moral injuries and distress among Israelis, Palestinians, and Americans, impacting mental health professionals.
- Addressing moral injuries in psychiatric practice is crucial, with recent inclusion in diagnostic manuals highlighting its clinical importance.
Explore the complexities of moral injuries in the Mideast conflict and their impact on mental health during a historic ceasefire.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
The last column discussed some mental health considerations in the Mideast conflict ceasefire. Given the moral distress and injuries that many have experienced about the Mideast conflict, as well as our related internal country’s political polarization conflicts and changed priorities, let’s now consider them during this historic ceasefire. Without the attention the fighting demands, we may be able to more readily assess the complexity of moral struggles in ourselves, in Israel, and in Gaza. Like an environmental iceberg, this moral iceberg has much of risk below the surface, including a mixed historical relationship of the peoples, intergenerational transmission of trauma for both peoples, and whether any forgiveness can be provided to either side. One example of the power of forgiveness was when Netanyahu apologized to Qatar for Israel’s lethal strike on Qatar, laying the groundwork for this ceasefire.
Moral Injuries in the United States
One of the founding principles of our democracy has been the ability to speak out and peacefully protest when citizens feel their freedom is being compromised by our leaders.1 Over the last 2 years, that has been expressed in protests about the war in the Mideast, both pro and con. For those in health and mental health care dedicated morally and ethically to life and doing no harm, the deaths and injuries of innocents, especially children, has caused related moral distress and injuries. Locally, my hometown newspaper, the Milwaukee Journal Sentinel, had a front page article Saturday that covers the diverse moral concerns on “Milwaukee Jewish, Palestinian leaders express relief, uncertainty over Gaza ceasefire.”2
Moral Injuries in Israelis
Israel is also a form of democracy. Since the invasion by Hamas on 10/7/23 and the taking of hostages, there have been ongoing protests about prioritizing the return of hostages or the defeat of Hamas, or both. In this ceasefire, all living hostages have been returned in exchange for over 2000 prisoners, but some protest remains for the remaining bodies of those deceased, as proper burial and honoring the dead is a major Jewish value. There has even been a moral and religious struggle in Israel about who should fight in such wars.
Moral Injuries in Palestinians
One can argue about what moral values Hamas tend to have, whether they are more like freedom fighters or freedom repressors, but already in the very shaky ceasefire with Israel, they have turned inward to eliminate any rivals, with the similar collateral harms of their use of Gaza human shields during Israel’s bombardments. Arguably, that seems to indicate a different moral value of life and martyrdom.3 Palestinians in general seem to be conveying the value of having a safe home where basic needs can be met and the opportunity to move up the pyramid of Maslow’s hierarchy of psychological needs.
Healing Moral Injuries
As review of the war decisions and operations are reviewed over time, it is likely that we will also find more examples of positive moral strength and courage. Additionally, because morality can be so individually variable, some will have few moral injuries where more might be expected. We know that lack of moral struggle is common in those with sociopathic tendencies and if present in leaders, can lead to very destructive policies. Or, when narcissism is malignant, the moral concerns are basically for the self.
Just this month, moral injury got listed in our psychiatric diagnostic manual under “Other Conditions That May Be a Focus of Clinical Attention.” That connects with our growing expertise in religion and spirituality as it pertains to psychiatry. This addition should stimulate us to pay more attention to its relevance in our patients, ourselves, and our communities. On Yom Kippur Day in my synagogue, our educator and I led a large group discussion on moral injuries during Biblical times on up to what the attendees were experiencing right now. What is not helpful is ignoring these injuries and just trying to “tough it out” with increased resilience.
Clinically, morally, and ethically, we must avoid using political priorities to refuse to refer patients to those with whom we disagree politically, religiously, and spiritually. Treatment can include a focus on moral injuries if it is bringing significant psychological distress, but clinicians, too, need to not cross boundaries, nor inject our own political beliefs into the treatment.
When moral injuries are also present along with trauma, treatment is even more challenging. Like appreciating the hidden dangers of icebergs, therapists will have to expect the need to go below the surface of the moral injuries to understand their personal, collective, and historical meanings.
Fortunately, psychiatry at its best has the knowledge and expertise to help free bodies, minds, and spirit constrained by mental disorders and moral injuries, a process that parallels the quest for freedom in democracies.
Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.
References
1. Snyder T. On Tyranny: Twenty Lessons from the Twentieth Century. Crown; 2017.
2. Carson S. Milwaukee Jewish, Palestinian leaders express relief, uncertainty over Gaza ceasefire. Milwaukee Journal Sentinel. October 17, 2025. Accessed October 20, 2025.
3. Barenboim D, Said E. Parallels and Paradoxes: Explorations in Music and Society. Penguin Random House; 2004.
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