What is Moral Injury?

     Donald Trump, before his election bragged that he wouldn't loose a single follower if he pulled out a gun in Times Square and shot someone. Rodrigo Duterte, president of the Phillipines, repeatedly brags about having murdered several suspected drug dealers, and encourages his people to do the same. Trump and Duterte have a lot of supporters at home and abroad. 
     How do you feel when you hear about such things?

     "The sorrow, grief, and rage you feel is a measure of your humanity and your evolutionary maturity. As your heart breaks open there will be room for the world to heal."       Joanna Macy

      “… 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.”
        Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.

     "Moral injury is 
     • the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress their own moral and ethical values or codes of conduct
     • disruption in an individual’s confidence and expectations about one’s own or others’ motivation or capacity to behave in a just and ethical manner
     • the inability to contextualize or justify personal actions or the actions of others and the unsuccessful accommodation of these … experiences into pre-existing moral schemas
     • a deep soul wound that pierces a person’s identity, sense of morality and relationship to society."
       The Moral Injury Project - Syracuse University http://moralinjuryproject.syr.edu/about-moral-injury/

     See also: "Ignoring 'Soft Skills' & Moral Injury": http://healthyhealers.blogspot.ca/2016/03/ignoring-soft-skills-moral-injury.html

Alexia Foundation http://www.alexiafoundation.org/stories/tradition-womens-rights-and-circumcision-in-guinea-bissau-africabr

Ignoring "Soft Skills" & Moral Injury

     "Soft skills" like communication, deep listening, bed-side manner, empathy, professionalism, mindfulness etc are considered a joke in the hidden curriculum and are basically ignored by students & faculty alike in university education: http://healthyhealers.blogspot.ca/search?q=soft
     When students or graduate health-care professionals are caught committing unprofessional acts, everyone is shocked. The dust settles, and "soft skills" continue to be ignored.

     Interesting lessons from the military:
     “If military practice tells soldiers that their emotions of love and grief – which are inseparable from their humanity – do not matter, then the civilian society that has sent them to fight on their behalf should not be shocked by their ‘inhumanity’ when they try to return to civilian life.”

     “… 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.” 
       Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.

     Parents spend less & less quality time with their children; schools are forbidden to teach kids basic manners or morals; CEOs, clergy & politicians are progressively losing respect & credibility. These are fundamental violations of ‘what’s right’ ! 
     Meanwhile rappers, reality stars & dysfunctional sports & movie stars are default role models. Young adults are explicitly exposed to & socialized by the lowest of cultural norms. See: http://healthyhealers.blogspot.ca/2013/01/larger-homes-more-exotic-trips-fancier.html This openly invites people to contravene basic, innate, implicit human codes of conduct, causing moral injury to everyone, victims & perps alike.

     When do we start taking "soft skills" seriously enough to teach them explicitly?

     "Moral Injury": http://healthyhealers.blogspot.ca/2017/01/what-is-moral-injury.html

      "Worldview - Maturity Level - Impacts": http://jglovas.wix.com/awarenessnow#!Worldview-Maturity-Effects/c17jj/56e5715b0cf27db4b02a4011

 

Lessons from Combat Trauma

     Shay, an experienced psychiatrist, writes (in italics) about his experiences treating many Vietnam vets with PTSD. 
     I suspect that a surprising proportion of us, though never having physically been in an actual war, have nevertheless accumulated, not the same, but similar trauma over a perfectly imperfect lifetime. And have probably never received any timely counseling.

     “The child’s inner sense of safety in the world emerges from the trustworthiness, reliability, and simple competence of the family.”
     Children who grow up feeling unwanted, know no safety - have definitely been traumatized: http://www.johnlovas.com/2013/11/attachment-to-people-memories-concepts.html

     “… 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.”
     Children expect unconditional love, but none of us receive it. The greater the gulf between what we ardently need and what we feel we receive, the greater the sense of betrayal - the 'moral injury': http://healthyhealers.blogspot.ca/2013/07/the-inner-child-unconditional-love-and.html

     “Another veteran in our program wrote: ‘In my wildest thoughts I never expected or wanted to return home alive, and emotionally never have.’ 
     The sense of being already dead may contribute to the berserker’s complete loss of fear … It may also be the prototype of the loss of all emotion that defines for combat post-traumatic stress disorder the prolonged states of numbness – the inability to feel love or happiness or to believe that anything matters.” 
     How does a child appear when the expected source of unconditional love repeatedly says wildly hurtful things to the child? S/he may not reveal any change in expression. But there's inner amazement & profound confusion - 'Is this a Martian pretending to be my mother?' Also internally, there are earthquakes & aftershocks, with new layers of concrete hastily lathered around the heart.

     “What I want to emphasize here is the rapid transformation of grief into rage. For many of the (Vietnam) veterans in our treatment program for combat post-traumatic stress disorder, replacement of grief by rage has lasted for years and become an entrenched way of being. Much therapeutic effort aims at reawakening the experience of grief, which we regard as a process of healing, painful as it is.” 
     “I believe that the emergence of rage out of intense grief is a biological universal and that long-term obstruction of grief and failure to communalize grief can lock a person into chronic rage.” 
     I suspect many 'angry young men', as well as women, express their grief through rage.

     “There is growing consensus among people who treat PTSD that any trauma, be it loss of family in a natural disaster, rape, exposure to the dead and mutilated in an industrial catastrophe, or combat itself, will have longer-lasting and more serious consequences if there has been no opportunity to talk about the traumatic event, to express to other people emotions about the traumatic event, to express to other people emotions about the event and those involved in it, or to experience the presence of socially connected other who will not let one go through it alone. This is what is meant by communalizing the trauma.”
     It may not be until the late teens, when children of dysfunctional parents move away from home, and finally have the courage & safe opportunity to explore, and perhaps vent their grief.

       Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.