Moral Injury and the Press

This article on moral injury is generally pretty good. Reporters, but also NGO workers often slip through the cracks when speaking of moral injury (I know I bracketed them out of my dissertation), so it’s good to see another article that addresses this subset of professions.

For instance, this was one of the main points of my dissertation, that PTSD & Moral Injury are two different things and are often, but not always, co-morbid:

Moral injury and PTSD can occur together—this is not infrequent—but they are two separate phenomena.

Here’s where I start to diverge from Feinstein (and many others in the field), the psychiatrist the journalist writing the article quotes extensively. Many researchers continue to try and ‘medicalize’ deep soul issues. Take this exchange, for instance:

When we spoke recently, Feinstein described moral injury as “a wound on the soul, an affront to your moral compass based on your own behavior and the things you have failed to do.” In other words, rather than being triggered by external actions, moral injury comes from the feeling that one has failed to live up to one’s own ethical standards.

While I agree with his assertion that moral injury is an affront to “your moral compass” I don’t believe it has to have anything to do with your own behavior or “things you failed to do.” It can be as simple as seeing an adult hit a child…it has nothing to do with what you did or what you did not do: the simple act of witnessing something that is an affront to your own ethic and morality suffices to cause a moral injury, albeit a minor injury. Similarly Feinstein also makes the claim that

moral injury occurs “only when symptoms get to a point of impeding a person’s ability to function.”

As my example above demonstrates, an affront to one’s morality does not necessarily reflect on one’s ability to function. This need to medicalize also, in my opinion, drives this binary thinking: one either cannot function, or it is not a moral injury. Lived human experience belies this belief: how many of us have been the victims of all sorts of trauma and moral injury, yet still function in society; in the vernacular of social workers, we do our activities of daily living (ADLs) just fine. That does not mean that our psyches are not shaped or tortured by the traumas we have endured.

Overall though, any attention on moral injury is beneficial with one caveat: that soul gets medicalized out of the equation.

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