Moral Injury: What on earth is that?

Moral Injury: What on earth is that?

Reflecting on the nature of some workplaces, and the dilemmas many face on a daily basis, I am drawn to the idea which has been actively explored since the end of the Vietnam war. Moral injury is not only experienced by war veterans but by anyone in a high risk, life or death situation.

Psychiatrist, Jonathan Shay, is understood as the person who coined the phrase. After working for over twenty years with war veterans returning from the Vietnam war and noticing consistent patterns and symptoms of war trauma, he used the poem, Iliad and the Odyssey, by Homer, considered one of the greatest poets in history, as a lens in which to understand what was happening to these war returnees. You may recall, Iliad and the Odyssey, are two poems depicting particular aspects of the final stages of the ten year Trojan War which to this day remains uncertain whether the war existed or was purely mythical.?

Shay, using Greek mythology in an attempt to understand the experiences of soldiers in the Vietnam war and the wording of his publication, Achilles in Vietnam: Combat Trauma and the Undoing of Character. is deeply telling.?

He records the soldiers' experiences, not so much in combat with the enemy, but the shortage of food, water and ammunition and the lack of care for soldiers on the ground. The most galling encounter of all was, “the shortage of competence.” There were simply a plethora of things that went wrong which disadvantaged the soldiers and made fighting incredibly difficult.?

As I reflect on moral injury over the next few weeks I am laying a foundation in this initial article to understand Shay’s thinking. It is prudent to share his observations leading to his coining the phrase ‘moral injury.’ Listen to his commentary as he reflects on the encounters of combat soldiers.??

Is betrayal of “what’s right” essential to combat trauma, or is betrayal simply one of the many terrible things that happened in war? Aren’t terror, shock, horror, and grief at the death of friends trauma enough? No one conclusively can answer these questions today. However, I shall argue what I’ve come to strongly believe through my work with Vietnam veterans: that moral injury is an essential part of any combat trauma that leads to lifelong psychological injury. Veterans can usually recover from horror, fear, and grief once they return to civilian life, so long as “what’s right” has not also been violated ... we now turn our attention to the soldiers’ reaction to betrayal of “what’s right.” These are unchanged across three millennia.

Reading through Shay's description it is clear, despite the involvement of war, there was something deeply affecting the soldiers at a deep and unseen level. Away from the brutality of the battlefields we too, if we see/witness something happening in front of our eyes which is not right something profoundly happens to us. A violation of our values occurs and it sets off a chain reaction, an inner earthquake disrupting our interior landscape requiring a response from us. This is not only an ideological concept. No. Moral injury gets our attention because it causes us pain. The? difficulty, of course, is this inner turbulence is different for all of us given our socialisation, and subsequent later life experiences. What then is moral injury?

Moral injury, as defined by The Moral Injury Project at Syracuse University, ‘is? the damage? done? to? one’s? conscience? or? moral? compass? when? that? person? perpetrates,? witnesses,? or? fails? to? prevent? acts? that? transgress one’s? own? moral? beliefs, values,? or? ethical? codes? of? conduct.’? Other definitions expand our understanding of moral injury. For example, Kent Drescher, and others, in an unpublished paper An examination of Moral Injury among Veterans of Combat, contend that moral injury is:?

the disruption in an individual's confidence and expectations about their own or others motivation or capacity to behave in a just and ethical manner brought about by bearing witness to perceived immoral acts, failure to stop such actions, or perpetuation of immoral acts, in particular actions that are inhumane, cruel, depraved, or violent,bringing about pain and suffering of others or their death.

Definitions of moral injury abound but you get the picture. Moral injury has its basis in attempting to understand the experiences of the returning soldiers from the Vietnam War but it would come as no surprise to many that these are common experiences of many war returnees from the numerous wars we have had since being on the planet. You may also understand that moral injury not only occurs as a result of scenes witnessed on the battlefields but in our places of work we attend for a significant part of each day and our lives. The life and times of the? front-line workers of the NHS during the pandemic are a case in point.

Moreover, it should also come as no surprise that when one experiences moral injury, and the inner turmoil it causes, it does not simply disappear into the ether, as if by magic. No, it needs to be dealt with.?

Since it is only a recently acknowledged effective treatment it is still in its infancy. However, using Cognitive Behavioural Therapy, CBT, a talking therapy, which can help us solve personal problems by changing how we think, feel, and thus positively influencing behaviour, has proved to be quite effective.?

A first aid approach for gaining relief, if you may be experiencing moral injury, is to talk with someone whom you trust and will not judge you as you talk about what is bothering you.?

As can be seen, moral injury can have significant repercussions on our well-being. This is something we shall explore over the next few articles.?

Peace.??