Moral injury
Although I have often written about the reality of moral injury I have not used that term. The term may be first being coined by the journalist David Wood to talk about how it occurs and manifests itself in the context of combat. (Check out interview with him by Terry Gross). Today, one can google the term moral injury and find an article by Shira Maguen, PhD and Bret Litz, PhD entitled “Moral Injury in the Context of War” on the ptsd.va.gov website. As doctors Maguen and Litz explain, “Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.”
Moral injury may have to do with the action of doing something or the action of not doing something. Every time we make a decision to do something or to not do something which violates, at some core level, the very essence of our humanity, some part of us dies. Some might refer to this as a soul death. We all experience soul death. Robert Jay Lifton in his book, The Nazi Doctors, eloquently describes how health care providers – doctors, psychologists, nurses and others – convinced themselves or allowed themselves to be convinced that they could violate their professional and personal ethics for the good of the state and not lose a part of themselves. Doctors – not physicians who are healers – convinced themselves that agreeing to sign the death certificates for those who died in the gas chambers was no different than agreeing to amputate a limb to save a person. Killing individuals to save the state became their rationalization.
I recall when I was five and I used racism to get out of trouble with my mother. I blamed a verboten behavior on my little black friend knowing, at some level, that my mother would believe me before she would believe a black child. This behavior of mine took a part of my soul which became a wound, I wound which I continue to carry to this day. The fact that I have confessed this “sin” on numerous occasions including more than once as a member of a racial justice committee lessens the intensity of the wound but does not erase it.
My experience of moral injury does not compare to what we demand of those we send into combat, whether that be as part of “troops on the ground operation,” piloting a bomb carrying and dropping a drone, exposing oneself to constant physical danger, or witnessing the death of friends and acquaintances. In combat situations the frustration and anger at those responsible directly and indirectly for the death of one’s friends and others in one’s platoon, company or other people with whom one is serving may lead to a terrorist like act against a group of so-called innocent civilians.
Every day, individuals I know who work for corporations are asked to do something which violates some part of their core beliefs or values – to put tasks or profit before the welfare of others – to participate in charging obscene prices for a medication which costs pennies to manufacture- to allow a deceptive practice to occur such as practiced by VW.
Every time one of us by commission or omission does something which negates the values which affirm our common, sacred humanity some part of our soul is injured.
Soul injuries or moral injuries cause part of the brain to quit functioning, other parts of the body to tense up and eventually quit functioning which then affects the overall well-integrated system which is our body and which, in turn, injures the family, the community and, yes, the nation.
The 12-step recovery program, some parts of some of some religious customs or practices, and some practices adopted by other healing professionals are designed to heal moral injuries (healing is not curing). Confessing first to self (perhaps in writing if the part of the brain which handles speech has been shut down), then to another, atoning, asking for and accepting forgiveness all air in the healing process. Patronizing statements such as “You did not have a choice. You were just doing your duty. You are not responsible for the orders of others.” do not help to heal. To heal we must know that others know and can still love us without diminishing the grievous nature of our deed.
Moral injury is a physical injury which may be invisible if not looking with the eye of courage and compassion. Yet, it surely is physical just as stump from a severed limb.
We need to teach our children, our health care professionals, our teachers and our parents that moral injuries must be treated – not punished – but treated as the deep wounds that they are. Until we do we will continue to be separated and when separated from each other we are more likely to suffer more moral injuries.
Written September 25, 2016
Although I have often written about the reality of moral injury I have not used that term. The term may be first being coined by the journalist David Wood to talk about how it occurs and manifests itself in the context of combat. (Check out interview with him by Terry Gross). Today, one can google the term moral injury and find an article by Shira Maguen, PhD and Bret Litz, PhD entitled “Moral Injury in the Context of War” on the ptsd.va.gov website. As doctors Maguen and Litz explain, “Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.”
Moral injury may have to do with the action of doing something or the action of not doing something. Every time we make a decision to do something or to not do something which violates, at some core level, the very essence of our humanity, some part of us dies. Some might refer to this as a soul death. We all experience soul death. Robert Jay Lifton in his book, The Nazi Doctors, eloquently describes how health care providers – doctors, psychologists, nurses and others – convinced themselves or allowed themselves to be convinced that they could violate their professional and personal ethics for the good of the state and not lose a part of themselves. Doctors – not physicians who are healers – convinced themselves that agreeing to sign the death certificates for those who died in the gas chambers was no different than agreeing to amputate a limb to save a person. Killing individuals to save the state became their rationalization.
I recall when I was five and I used racism to get out of trouble with my mother. I blamed a verboten behavior on my little black friend knowing, at some level, that my mother would believe me before she would believe a black child. This behavior of mine took a part of my soul which became a wound, I wound which I continue to carry to this day. The fact that I have confessed this “sin” on numerous occasions including more than once as a member of a racial justice committee lessens the intensity of the wound but does not erase it.
My experience of moral injury does not compare to what we demand of those we send into combat, whether that be as part of “troops on the ground operation,” piloting a bomb carrying and dropping a drone, exposing oneself to constant physical danger, or witnessing the death of friends and acquaintances. In combat situations the frustration and anger at those responsible directly and indirectly for the death of one’s friends and others in one’s platoon, company or other people with whom one is serving may lead to a terrorist like act against a group of so-called innocent civilians.
Every day, individuals I know who work for corporations are asked to do something which violates some part of their core beliefs or values – to put tasks or profit before the welfare of others – to participate in charging obscene prices for a medication which costs pennies to manufacture- to allow a deceptive practice to occur such as practiced by VW.
Every time one of us by commission or omission does something which negates the values which affirm our common, sacred humanity some part of our soul is injured.
Soul injuries or moral injuries cause part of the brain to quit functioning, other parts of the body to tense up and eventually quit functioning which then affects the overall well-integrated system which is our body and which, in turn, injures the family, the community and, yes, the nation.
The 12-step recovery program, some parts of some of some religious customs or practices, and some practices adopted by other healing professionals are designed to heal moral injuries (healing is not curing). Confessing first to self (perhaps in writing if the part of the brain which handles speech has been shut down), then to another, atoning, asking for and accepting forgiveness all air in the healing process. Patronizing statements such as “You did not have a choice. You were just doing your duty. You are not responsible for the orders of others.” do not help to heal. To heal we must know that others know and can still love us without diminishing the grievous nature of our deed.
Moral injury is a physical injury which may be invisible if not looking with the eye of courage and compassion. Yet, it surely is physical just as stump from a severed limb.
We need to teach our children, our health care professionals, our teachers and our parents that moral injuries must be treated – not punished – but treated as the deep wounds that they are. Until we do we will continue to be separated and when separated from each other we are more likely to suffer more moral injuries.
Written September 25, 2016
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