Moral Injury

As with so many of our blog posts, this one is prompted by a recent book, Say Nothing: A True Story of Murder and Memory in Northern Ireland by Patrick Radden Keefe.

This highly-regarded book is about the troubles (and more) in Northern Ireland.  The detailed descriptions of the violent struggles and political battles between the IRA and the British authorities are as horrifying as they are riveting.  Amazingly, Boston College created an archive of oral histories containing interviews with many of the participants given with the understanding that the interviews would not be made public until after those interviewed had died.  Keefe was able to take advantage of some of these interviews to paint a detailed and sometimes excruciating picture of the bombings, the torture, the “disappeareds,” the hunger strikes, and all the rest.

What caught our attention at Ethics Unwrapped was the book’s reference to the notion of moral injury.  One definition of “moral injury” is a betrayal of what’s right by a person in legitimate authority in a high stakes situation.” (Shay).  In Say Nothing, author Keefe speaks of moral injury in connection with the interview with Brendan Hughes, a former soldier in the IRA who laments having killed people and having sent members of the IRA out to their deaths in the struggle against the British authorities.  At the time, these actions seemed justified.  They seemed to be “worth it” in the battle for an independent and united Ireland.  However, when IRA leaders later negotiated with the Brits and settled for much less than total victory, those sacrifices suddenly seemed unnecessary and perhaps wasted.  Hughes felt as if he had killed and caused others to be killed for no good reason. It was devastating for him. These emotions seem to be classic manifestations of moral injury.  Moral injury can be very serious, leading to “serious distress, depression, and suicidality.” (Syracuse University).  Its impact can be comparable to that of PTSD.

Moral injury is most commonly associated with those who have served in the military.  Perhaps they served on the U.S. side in Vietnam and later wondered what they had actually fought for, given the many lies they learned that their government had told to justify the war.  Perhaps they served in Iraq or Afghanistan and later obsessed about the seemingly endless nature of those conflicts.  Had they killed civilians, tortured prisoners, bombed cities and the like, for reasons that seem inadequate now?

Do only those who have seen war-like conditions experience moral injury?  It has been suggested (Talbot & Dean) that physicians who suffer from “burn out” are actually manifesting a form of moral injury that arises from continually being unable to provide high-quality care and healing in a broken health care system.  Police officers, journalists, and first responders have also been thought vulnerable to moral injury when their ideals clash with what they are actually asked to do.

And we agree with Dr. Michael D. Matthews that “[w]orkers in corporations, who believe in the intrinsic value of the products or services the corporation sells, may experience moral trauma when they come to understand that the corporation puts profits above health and safety concerns of customers or even the employees themselves.” If much of your career has involved hiding debt for Enron, creating fake customer accounts for Wells Fargo, manipulating LIBOR for Deutsche Bank, creating software to cheat emissions detection devices for Volkswagen, or saddling minorities with sub-prime mortgages for Countrywide Financial, you might well feel moral injury.

The engineers at Morton Thiokol whose initial opposition to the disastrous January 1986 launch of the Space Shuttle Challenger was overcome by their superiors and officials at NASA suffered from that decision most of the rest of their lives.  Bob Ebeling suffered deep depression and was saddled with guilt.  Boisjoly was disabled by severe headaches, depression, and insomnia; he even sued Thiokol and NASA for his depression and the PTSD-like symptoms which are often caused by moral injury.  Engineer Allan McDonald suffered feelings of loss, grief, and “gnawing anguish.”

Some, like the Morton Thiokol engineers, likely feel moral injury almost immediately after their actions.  For others, it may take longer.  But over time, the rationalizations they used at the time (e.g.: “It’s not my fault, my boss ordered me to do it.” “Hey, everyone was cheating.” “They were so stupid, they deserved to be screwed.”) wear thin and the enormity of their wrongdoing and its painful clash with their desired self-image, causes the pain of moral injury to bloom.

When we think of financial frauds and other forms of corporate wrongdoing, we must consider not only the harm to the victims, but also the damage to the self-concepts of the employees who are recruited to the task.  Only then can a full accounting of the damage of unethical business activity be had.

Perhaps we at Ethics Unwrapped should create a video on moral injury.

 

Sources:

Howard Berkes, “Remembering Roger Boisjoly: He Tried to Stop Shuttle Challenger Launch,” NPR, Feb. 6, 2012, at https://www.npr.org/sections/thetwo-way/2012/02/06/146490064/remembering-roger-boisjoly-he-tried-to-stop-shuttle-challenger-launch.

Howard Berkes, “30 Years After Explosion, Challenger Engineer Still Blames Himself,” NPR, Jan. 28, 2016, at https://www.npr.org/sections/thetwo-way/2016/01/28/464744781/30-years-after-disaster-challenger-engineer-still-blames-himself.

Philip M. Boffey, “Engineer Who Opposed Launching Challenger Sues Thiokol for $1 Billion,” New York Times, Jan. 29, 1987, at https://www.nytimes.com/1987/01/29/us/engineer-who-opposed-launching-challenger-sues-thiokol-for-1-billion.html.

H. Patricia Hynes, “The Iraq War and Moral Injury,” Truthout, March 20, 2013, at https://truthout.org/articles/the-iraq-war-and-moral-injury/.

Patrick Radden Keefe, Say Nothing: A True Story of Murder and Memory in Northern Ireland (2019).

Giulia Lamiani et al., “When Healthcare Professionals Cannot Do the Right Thing: A Systematic Review of Moral Distress and Its Correlates,” Journal of Health Psychology 22:51-67 (2017).

Brett T. Litz et al., “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy,” Clinical Psychology Review, 29: 695.-706 (2009).

Michael Matthews, “Stress Among UAV operators: Posttraumatic Stress Disorder, Existential Crisis, or Moral Injury? Ethics and Armed Forces: Controversies in Military Ethics and Security Policy (2014).

Michael Matthews, “Moral Injury: Toxic Leadership, Maleficent Organizations, and Psychological Distress,” Psychology Today, March 10, 2018, at https://www.psychologytoday.com/us/blog/head-strong/201803/moral-injury.

Thomas Ricks, “What is Moral Injury, and How Does It Affect Journalists Covering Bad Stuff?” Foreign Policy, Sept. 7, 2017, at https://foreignpolicy.com/2017/09/07/what-is-moral-injury-and-how-does-it-affect-journalists-covering-bad-stuff/.

Jonathan Shay, “Moral Injury,” Psychoanalytic Psychology, 21(2): 182-191.

Simon Talbot & Wendy Dean, “Physicians Aren’t ‘Burning Out.’  They’re Suffering from Moral Injury,” Boston Globe, July 26, 2018, at https://www.bostonglobe.com/ideas/2018/08/04/physicians-aren-burning-out-they-suffering-moral-injury/xGsJTQBHBzHdM2CvrWLa0M/story.html.

Syracuse University, “The Moral Injury Project,” at http://moralinjuryproject.syr.edu/.

Brooke McQuerrey Tuttle et al., “Police Moral Injury, Compassion Fatigue, and Compassion Satisfaction: A Brief Report,” Salus Journal, April 29, 2019, at http://www.salusjournal.com/wp-content/uploads/sites/29/2019/04/Tuttle_Salus_Journal_Volume_7_Number_1_2019_pp_42-57.pdf.

Victoria Williamson et al., “Occupational Moral Injury and Mental Health: Systemic Review and Meta-Analysis,” The British Journal of Psychiatry, 212(6): 339-426 (2018).

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