Atkey Sarah K, Martin Krystle, Fergus Karen D, Goldberg Joel O
Department of Psychology, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada.
Department of Psychology, Faculty of Social Sciences and Humanities, University of Ontario Institute of Technology, Oshawa, ON L1G 0C5, Canada.
Int J Environ Res Public Health. 2025 Mar 3;22(3):372. doi: 10.3390/ijerph22030372.
Few studies have examined how committing criminal acts of violence impacts the lives of perpetrators who were mentally ill at the time of offence and in which the act itself reflects behaviour that is uncharacteristic of the individual. Theoretical accounts and clinical reports describe a phenomenon termed moral injury, which profiles the deleterious emotional effects that can arise from actions that transgress moral beliefs and expectations. Shame, guilt, spiritual/existential conflict, and loss of trust are considered to be core symptoms of moral injury with growing empirical studies which examine moral injury in military and public safety worker samples. The extent to which these kinds of moral injury phenomena might be evident among mentally ill perpetrators was explored using a qualitative-methods approach in a sample of 19 adult participants hospitalized in a Canadian forensic programme inpatient service. The sample consisted of 13 male and 6 female patients, with a mean age of 36.2 years ( = 10.8), and the majority diagnosed with schizophrenia or schizoaffective disorder. A qualitative interview was conducted where participants were asked to describe feelings about the index offence, the effect it has had on their well-being, and how they have coped with having committed the offence. Using a reflexive thematic analysis process, 5 themes and 23 subthemes were generated that relate to the various resultant impacts. The five themes which emerged were (1) Living with the Emotional Aftermath; (2) Trying to Make Sense and Coming to Terms; (3) My Eyes Have Opened; (4) Facing the Music; and (5) Moving On. The findings are discussed in terms of their implications for understanding forensic inpatients who may be attempting to come to terms with violence they committed while mentally ill and for informing moral injury intervention strategies which might be adapted for forensic mental health services and public health recidivism prevention programmes.
很少有研究考察实施暴力犯罪行为如何影响犯罪时患有精神疾病且其行为本身有别于个人特征的犯罪者的生活。理论阐述和临床报告描述了一种被称为道德伤害的现象，它剖析了违背道德信念和期望的行为可能产生的有害情绪影响。随着越来越多针对军事人员和公共安全工作者样本进行道德伤害研究的实证研究出现，羞耻、内疚、精神/存在冲突以及信任丧失被视为道德伤害的核心症状。本研究采用定性研究方法，以加拿大一个法医项目住院服务中收治的19名成年参与者为样本，探讨这类道德伤害现象在患有精神疾病的犯罪者中可能显现的程度。样本包括13名男性和6名女性患者，平均年龄36.2岁（标准差 = 10.8），大多数被诊断患有精神分裂症或分裂情感性障碍。研究进行了一次定性访谈，要求参与者描述对索引犯罪的感受、该犯罪对其幸福感的影响以及他们如何应对所犯下的罪行。通过反思性主题分析过程，生成了5个主题和23个子主题，它们与各种由此产生的影响相关。出现的五个主题分别是：(1) 承受情感后果；(2) 试图理解并接受现实；(3) 我已醒悟；(4) 承担后果；(5) 继续前行。本研究结果从其对理解可能正在试图接受自己在精神疾病状态下实施的暴力行为的法医住院患者的意义，以及为可能适用于法医精神卫生服务和公共卫生累犯预防项目的道德伤害干预策略提供信息的角度进行了讨论。
