By Pete Kilner, Ph.D.
version: 1-10-2018
original posted: 11-1-2016
original posted: 11-1-2016
Currently, the academic literature on moral injury recognizes two causes of moral injury. I think that it’s largely overlooking a third cause, one that involves religious belief and the mystery of evil.
I think the evidence shows that combat-related moral injury is caused not only (1) by feeling betrayed by an authority figure and (2) by doing (or failing to prevent) actions that violate your own moral beliefs, but also (3) by encountering large-scale, senseless violence and suffering.
Comparing Three Causes of Moral Injury
Level of violation
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Personal
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Organizational
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Divine
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The perceived violator of moral goodness
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Soldier him/her-self
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Leader who wielded authority over the soldier (e.g., section leader, commander, POTUS)
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Whoever is responsible for the world, aka, God.
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Victim’s response
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“I did something terrible. I’m a bad person.”
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“I was screwed by ‘higher.’ I trusted them literally with my life but was used and abused. I risked my life and took others’ lives, and my buddies died, for someone who didn’t care.”
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“No real God would allow this situation to take place. This is irrational, horrifying, unfair, more than I can handle. This world sucks.”
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Likely symptoms
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Guilt, shame, self-harm, risky behavior.
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Anger at the organization, cynicism, loss of faith in human institutions, inability to trust.
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Anger at God, loss of faithin God, doubt goodness of world, demoralization.
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substance abuse, suicidality
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- One catalyst of moral injury is feeling deeply betrayed by a legitimate authority. This thesis was initially put forth in the 1990's by Dr. Jonathan Shay, a Veterans' Administration psychiatrist who had worked with Vietnam War veterans for decades. Shay argues that moral injury is caused by three elements:
- A betrayal of what’s right
- By someone who holds legitimate authority (e.g., in the military--a leader)
- In a high-stakes situation
2. Over the past seven years, a second catalyst of moral injury has been discussed--where the injury is caused by the soldier’s own actions that violated his/her deeply held moral values. This view was first published in peer-reviewed journals by Litz, Nash, Maguen, and others in 2009. See https://www.ptsd.va.gov/professional/co-occurring/moral_injury_at_war.asp
In the decade previous, I'd written about this form of moral injury--calling it PTSD or PITS--in non-peer-reviewed media:
"Military Leaders’ Obligation to Justify Killing in War" (JSCOPE 2000, Military Review 2002)In the decade previous, I'd written about this form of moral injury--calling it PTSD or PITS--in non-peer-reviewed media:
Instances of senseless, unfair evil that have been described to me include: good people dying horrible deaths and bad people escaping death, due to “luck”; the carnage after a VBIED, including innocent children grievously wounded or blown literally into pieces; encountering the victims of sectarian cleansing, tortured to death by power drills to their heads or other inhumane methods.
A framework that accounts for all three catalysts of moral injury would be:
- A betrayal of what’s right
- By "someone" you previously trusted, which may be:
- yourself--your own moral judgment/courage; and/or
- a legitimate authority in your chain of command (from NCO to President); and/or
- God
- In a high-stakes situation such as war
A definition of moral injury, then, might be…
Moral injury is the psychological, social, and/or spiritual harm that results from experiencing a violation of a deeply held moral belief, perpetrated by a trusted authority, in a high-stakes situation such as war.
Moral injury is the psychological, social, and/or spiritual harm that results from experiencing a violation of a deeply held moral belief, perpetrated by a trusted authority, in a high-stakes situation such as war.
The “trusted authority” who betrays and loses that trust can be:
- the soldier, when he/she does something that violates their own moral code.
- a leader (or entire chain of command), when he/she disregards the humanity of the soldier.
- God, or the soldier's sense of the divine, when the soldier encounters senseless, unfair suffering.
Moral injury can be acute (resulting from a particular incident) or cumulative (resulting over timer from a series of incidents).
Army Chaplain (COL) Timothy Mallard has made a similar point, arguing that while "warriors often do experience moral injury as currently defined [definitions 1 and 2, above], they also often suffer something else"—what he calls 'spiritual injury'. He concludes, "Moral injury and spiritual injury are sibling twins of the same mother, yet they are undoubtedly distinct; like all twins, they must be treated as individuals."
Perhaps that is the case, or perhaps all moral injury is spiritual injury. Moral and spiritual injury may be the same phenomenon, looked at through different lenses. After all, if God is the foundation of morality, then even definitions 1 and 2 implicate God.
I recommend Mallard's entire article, The (Twin) Wounds of War," available at https://providencemag.com/2017/02/twin-wounds-war-spiritual-injury-moral-injury/
Also, if you're interested in how leadership can prevent or reduce moral injury, I invite you to read "Military leaders' role in mitigating moral injury" posted here on Veterans Day 2016: http://soldier-ethicist.blogspot.com/2016/11/the-military-leaders-role-in-mitigating.html
5 comments:
Pete,
Divine moral injury . . . this is an interesting concept, but I'm not sure what to make of it. If I believe that God is the source of morality, to feel divine moral injury must, I assume, shake even my basic understanding of the concept of morality in the first instance. If God causes moral injury, what's the point of morality in the first place? Is there even such a concept? Is that what you mean by demoralization, i.e., the undoing of a sense of morality in an individual? I think that moves the injured toward sociopathy, where there are no moral governors on behavior.
Divine moral injury would seem like the most difficult type to address. At some level, a person can understand the moral failing of those in authority, and even his own moral failing, as a function of their humanity. I'm not sure how a person of faith overcomes moral injury that he believes is God's responsibility.
It seems to me that people of faith must try to prepare themselves in order to mitigate this sort of effect. Theologians in some faiths have been tackling this question -- i.e., how can a just God let this happen? -- for many centuries and I am sure there is ample literature that one might consider as "mitigation-in-advance" of such an occurrence. I would think that chaplains have a great responsibility to help prevent divine moral injury. Unfortunately, we in the military are afraid to talk about religion outside of the chapel's four walls. With the right preparation, commanders and chaplains can do this without coming across as proselytizing (which they must avoid). But we can't take this sort of moral injury on if we're afraid to talk about religion and God.
Anyway, this was a layman's stream-of-consciousness reaction to your blog post. It was not a well-considered theological argument, so take it or what it's worth and don't judge me!
Regards,
Pete Haas
Pete: Excellent comments!
This category of moral injury effects only those who believe in a good and powerful God. The soldiers who have witnessed the horrors of war cannot reconcile the evil of the world with the the goodness of God, and since they can see the evil, they begin to doubt God. When a person of faith doubts God's existence, they enter an existential crisis. What's the meaning of life? Why be good? Does anything really matter?
These crises aren't limited to soldiers in war. Parents who lose children, victims of particularly sadistic crimes, etc, also ask themselves these questions.
A theodicy is an argument that reconciles the existence of an all-powerful loving God with the reality of a world in which hateful, unfair acts sometimes occur.
Pete
If you look at James Fowler's work, you'll see that an existential crisis is an integral element of maturing faith. Yet our culture sees it as a "bad" thing. It is instead an opportunity to deepen one's understanding/search for God, one that casts aside immature notions of God as a cosmic puppet-master for something infinitely richer. Spiritual care providers have a responsibility to shepherd people through this transitional phase. We can assist the soldier in identifying embedded theologies that are no longer applicable to his/her life. We can support them as they identify life-giving theologies.
I wonder if we shouldn't just say there are several kinds of moral injury that result in moral emotions such as shame, guilt, self-condemnation, grief, and despair. "By someone in authority" might exclude some forms that do not involve actually doing something to violate core moral foundations, but involves being immersed in work that makes one feel terrible in a more vague way. It might be useful to turn to more collectivist-group oriented societies for understanding some forms that don't have an individual willing agent but infect the collective. Given unit cohesion and the subordination of individual identities in the military, I think there may be forms of moral injury that are hard to squeeze into the "an agent did it" box. I am thinking of the kind of work that mortuary units do, which involves immersion of death already inflicted. There may be grief or anger at enemies involved, but there is also the visceral kind of disgust that is probably hard-wired into the human brain as a survival mechanism. Deep cultural/religious taboos proscribe contamination by human carnage, and the taboos carry a lot of implicit moral freight--even accidental exposure places a person outside acceptable society (hence the aversion to morticians, executioners, and others who process dead flesh, even leather tanners in some societies). I think these morally inflected taboos especially devastate mortuary units. See Synder, J. (2014). ’Blood, Guts, and Gore Galore’: Bodies, Moral Pollution, and Combat Trauma. Symbolic Interaction. September. DOI: 10.1002/SYMB.116. Jess Goodell describes this kind of moral injury in Shade it Black. She notes after 8 months in Iraq, her entire unit was haunted by ghosts.
A worthy topic. I am a Veteran and contributor to some study on Moral Injury.
The context (or rather, the change in context) is elemental to moral injury.
I liked your quote “Do you think of your subordinates primarily as soldiers who happen to have personal lives on the side, or as people just like you who happen currently to be soldiers?”. Understanding this fact - that soldering is a temporary state - will help understand and overcome moral injury.
Soldiers are trained to act and react in ways that will preserve their lives and the lives of others, and it is not just OK, it is expected and encouraged. The problem occurs when the soldier departs the situation where his/her (deadly) lifesaving actions are the right thing to do, and their actions are judged by a different set of standards. We, the civilian community to which the soldier returns, has a significant role in healing the moral injury of our veterans.
JP
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