Moral injury is not a danger- or fear-based response to an event. Moral Injury is tied to a sense of betrayal, a breaking of social trust, and transgression of one’s values.
“Out of suffering have emerged the strongest souls;
the most massive characters are seared with scars.”
-Khalil Gibran
Is it possible to take a painful and negative event from our past, and 're-purpose' it to become an empowering feature of our story, of our identity?
The process of re-organizing neural circuits to integrate a negative past event into a more complex and mature perspective is tied to cognitive flexibility. This flexibility is a major aspect of the healing process for moral injury.
What is Moral Injury?
I offered an overview of moral injury in the last article, but here’s a quick recap...
As Jonathan Shay defines it,
"moral injury occurs when there’s a betrayal of ‘what’s right’, either by a person in authority or oneself, and in a high stakes situation."
Litz and colleagues divide moral injury into three types:
- bearing witness to,
- perpetrating, or
- failing to prevent
events that transgress deeply held moral beliefs and expectations.
As we see from studies by pioneering researchers such as Ruth Lanius, Moral Injury is an emerging frontier in neuroscience and psychology to help us understand...
- humans as a socially cooperative species
- the importance of social trust and what happens when those bonds are broken
- the importance of cognitive and psychological flexibility.
What's beautiful about the exploration of moral injury is that it helps us find ways to bring negative events into a new light. In doing so, it exposes resilient and powerful aspects of the human response to stress. The processes used to navigate moral injury shed light on how to help help all of us be more empowered and find new ways to contribute to the greater whole.
As we talk about moral injury, it’s also helpful to explore the idea of morality
What is morality?
Jonathan Haidt, a professor of moral and political psychology at NYU describes morality as
“interlocking sets of values, virtues, norms, practices, identities, and evolved psychological mechanisms that work together to suppress or regulate selfishness and make cooperative social life possible."
Haidt’s work also examines ‘moral emotions’, which he describes as:
“those emotions that are linked to the interests or welfare either of society as a whole or at least of persons other than the judge or the agent.”
The realm of moral injury opens us to explore ourselves as a socially cooperative system.
It can bring us clarity as to what really matters to us. I believe that is why researchers use the words ‘haunt and consume’ when they talk about events that are related to moral injury: these are events that puncture the fabric of one’s deeply held ideas of what is right and good.
The cognitive challenges of moral injury
When a traumatic or morally injurious event happens, what I often see is that a person stuck in a loop of replaying that event in their mind over and over again.
We see this in psychoanalytic theories about trauma as well: when something traumatic happens, there is an incompleteness to the scene.. the situation did not resolve in a desired way. Because of the incompleteness of the situation, some defense mechanisms occur, including:
- complete avoidance or even a phobia of anything that could trigger an association with the past event;
- suppression of the thoughts or emotions related to the event - this can include distraction, numbing, addictions;
- repetition compulsion - which is a reenactment of the scene to gain mastery over it. This can including talking to people in a certain way, or being attracted to certain events or relationships that allow the person to go through the scene again, but this time get it 'right'. I call this ‘attract to reenact’
The tricky part with these mechanisms, especially repetition compulsion, is that because this is coming from an unconscious place, the person often more or less repeats the event, or reacts in a similar way - and therefore never gets a resolution in a way they desire.
This creates an unsolvable puzzle for the brain… it keeps trying to resolve a situation that has occurred in the past, which is impossible to do. It will keep attempting to do this either in the person's inner dialogue or in leading them to reenact the scene in other ways. With those neural circuits firing over and over again, it can create a hyper-coherence or rigidity to the brain activity, and the person stays stuck in an unresolved scene.
If they have felt betrayed by someone else, an institution, or felt that they let someone down, their attention will amplify anything that resembles this betrayal. This then influences our selective attention. As mathematician, neuroscience and cognitive psychology researcher Stanislas Dehaene describes:
"our brain ruthlessly discards the irrelevant information and isolates a single conscious object, based on its salience or its relevance to our current goals. This stimulus then becomes amplified and able to orient our behavior." - from Consciousness and the Brain
If a person's goal is to avoid, suppress or reenact the unresolved past event, their attention will guide them to notice and amplify stimulus that will lead them to continue avoiding, suppressing or attracting-to-reenact this event.
How do we get out of this?
Some of the processes currently being explored in the realm of moral injury include:
- Cognitive Processing Therapy
- Prolonged Exposure
- Narrative Exposure
- Adaptive Disclosure
- Acceptance and Commitment Therapy
I won’t go into all the details of these here (see below to get links for all of these), but there are some overall patterns and themes to these processes...
Bringing the unconscious to the conscious workspace.
Some of these processes guide people to consciously bring up and access the painful emotions associated with their moral injury. By doing this, they help a person activate the circuits that cause them distress, but do so in a safe setting that allows them to simultaneously access their more mature circuits that have new, more mature perspectives for putting the past situation into perspective. Before a person can do that, however, they must actually feel and consciously access the thoughts and emotions so that they can navigate them in new ways.
As Stanislas Dehaene puts it:
"[...] any information that reaches the conscious workspace immediately becomes capable of regulating, in an extremely deep and extensive manner, all our thoughts. [...] As a result, whatever we become aware of becomes available to drive our decision and our intentional actions, giving rise to the feeling that they are "under control".
Forgiveness
Forgiveness is a process that expands one’s perception of an event to include higher and wider perspectives. This allows for new neural circuitry to activate.
Two key ways this happens are through expanding one’s awareness to include:
- a longer time horizon than just that specific moment in time. Through this expansion, a person is able to see other events that may have led up to that incident
- other interconnected nodes and systems so that the event is not only about that specific person, but it recognizes other players that have interacted before that moment and it examines the role that all those interactions may have had on the actions of that person (whether it is oneself or another person)
This process of expanding awareness engages something called cognitive or explanatory flexibility. Activating the neural circuits involved in that process allows someone to get ‘unstuck’ from the self-referential and repetitive rumination about the event.
Finding the utility of the painful events and emotions
By acknowledging that someone feels shame, guilt or rage at something they saw or participated in that they felt was 'not right' there's utility to that. That type of emotional pain is what can get someone seek forgiveness. These emotions can be an energy that fuels someone to become part of a movement to help others not go through what they have witnessed or experienced.
Feeling moral pain can allow someone to clarify their values as to what someone truly believes is right and good in the world. ACT in particular is a process that helps people re-engage those values and connect with how they can integrate those values into their actions here and now. By doing this, we give that painful event or emotion a new purpose, a utility that can move someone in new action, and in service to others. Being able to adapt what has happened and integrate it into new ways is an aspect of psychological and regulatory flexibility.
The Association for Contextual Behavioral Science explains that,
"psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values."
Moral Injury as an Emerging Frontier for Neuroscience, Psychology and Systems Thinking
Moral Injury is a concept that highlights the importance of our nature as an interconnected system and the mechanisms we have in place to promote social cooperation and regulate selfishness. It addresses deeply held beliefs about what is good and right, and the pain that occurs when those values are betrayed by someone else or by oneself. In exploring this realm, we have the opportunity to nuance our understanding of human suffering and distress.
Because we all are connected to (or are) someone who has been a part of a war or collective trauma, we are all connected to by an experience of moral injury in some shape or form. This is a field that is worth our efforts to explore.
I go in depth into this in today’s podcast episode, including how:
- forgiveness and flexibility help us activate highly sophisticated and evolved neural mechanisms
- the mechanism of morality improves energy efficiency and resilience of a system
- brain activations are different in trauma compared with moral injury
- the human species is an interconnected network of nodes that requires social signaling for trust and cooperation
Related articles:
Moral Injury Part 1: Residues from the Past
Moral Injury Part 2: Psychic Trauma Annihilation Anxieties
Resources:
Acceptance & Commitment Therapy (ACT): Association for Contextual Behavioral Science
Dehaene, Stanislas (2014). Consciousness and the Brain: deciphering how the brain codes our thoughts
Jameton A. Nursing practice: the ethical issues. Englewood Cliffs, NJ: Prentice Hall, 1984
Ransley and Spy (2004). Forgiveness and the Healing Process
Shay, J. (2014). "Moral Injury", Psychoanalytic Psychology
Shay, J. (2010). Achilles in Vietnam: Combat Trauma and the Undoing of Character. Simon & Schuster
What is Moral Injury - National Center for PTSD, Veterans Affairs:
