Moral injury has been defined by Drs. Brett Litz and Bill Nash as “[t]he lasting psychological, biological, spiritual, and social impact of perpetrating, failing to prevent, or bearing witness to acts that can transgress deeply held moral beliefs and expectations.” It is a phenomenon strongly identified with military experience, but goes beyond that.
Moral injury (also called “moral harm”) can arise in four different ways, two of them involving the sufferer’s own actions and two involving others’ actions.
First, moral injury can arise from people’s own actions, when they do something that is inconsistent with their moral code. In the heat of battle, a U.S. soldier in Iraq faced a boy who appeared to be only about 12 years old, holding a big gun and spraying bullets in a firefight. The soldier shot and killed the boy. It was a “righteous kill,” but a deed that haunted the soldier’s psyche for a long time.
Second, moral injury can arise from one’s own inactions–their failure to do something that their moral code would normally require them to do. Healthcare workers at the height of the COVID-19 pandemic often found themselves unable to provide the level of medical care that they felt that they should provide and customarily did provide. They were haunted by the deaths of the patients they couldn’t save.
Third, moral injury can arise when people bear witness to the immoral actions and inactions of third parties. You might be a medic in wartime. You never pick up a rifle or injure an enemy soldier, yet you might find yourself obsessed by horrible acts done by other members of your army.
Fourth, moral injury can arise when one is betrayed by another party. According to some, there are three requirements: (1) betrayal of what’s right, (2) by a person in a position of authority, (3) in a high-stakes situation. Many front-line health workers felt betrayed when their superiors did not provide them with the staffing and PPE needed to provide reasonable levels of care during the height of the COVID-19 crisis, and many U.S. soldiers who killed in Iraq felt betrayed when they learned that the “weapons of mass destruction” used to justify starting the war never existed.
Although it is reasonable to argue that the moral trauma that arises in the business world cannot be fairly compared to that inflicted in a shooting war, Dr. Michael D. Matthews has suggested that “[w]orkers in corporations, who believe in the intrinsic value of the products or services the corporations 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.” This led us to suggest in an earlier blog post: “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 cheat devices for Volkswagen, or saddling minorities with sub-prime mortgages for Countrywide Financial, you might well feel moral injury.”
The fact that business activity can inflict moral injury was called to mind when we read Walt Bogdanich and Michael Forsythe’s book When McKinsey Comes to Town: The Hidden Influence of the World’s Most Powerful Consulting Firm. Bogdanich and Forsythe are not kind to McKinsey. Indeed, they often criticize McKinsey for being “bad guy-adjacent”—for having clients who have done bad things though there is no clear proof that McKinsey was involved in those bad things. Sometimes, as with Enron and the Houston Astros, the problem seems to be that former McKinsey consultants have acted unethically. And the authors do not claim that McKinsey is not generally good at what it purports to do—advance client interests.
What the authors do claim, and support with quite a bit of evidence, is that McKinsey very often works for bad clients and helps them do bad things.
The bad clients, in the authors’ minds, include authoritarian states (China, Russia, Saudi Arabia, etc.), opioid sellers, tobacco companies, fossil fuel companies, and ICE.
The bad things include fanning the opioid epidemic, selling more tobacco and thereby causing more cancer, introducing America’s teens to vaping, helping dictators tamp down dissent, increasing greenhouse gas emissions, making already bad conditions worse for ICE detainees, spreading the gospel of financial securitization that led to the 2007-2008 economic meltdown that nearly sank the world economy, volunteering to give pro bono advice to governments and then leveraging its connections into tens of millions of dollars of (often no-bid) contracts with those same governments, and increasing income and wealth inequality by constantly advising clients to pursue plans that take money from the pockets of workers and put it into the pockets of executives and shareholders.
Worse, McKinsey repeatedly finds itself in conflict-of-interest situations where it advises competitors in the same industry or, worse yet, has big contracts with regulated firms and with the firms’ regulators at the same time. And these conflicts are not disclosed, at least not until McKinsey is caught in the act by the New York Times or someone else.
Worst of all is the hypocrisy. While Goldman Sachs is pretty upfront about letting everyone know that it is a shark that you’re getting into the pool with, McKinsey has long stressed its values, giving idealistic young college graduates what they think will be the opportunity to do good while doing well (McKinsey’s salaries are generous). And those opportunities do exist, certainly.
But too often in recent years, those idealistic young McKinsey consultants have learned that they are taking pay from an entity that is often not on the side of the angels. The book recounts several recent instances when McKinsey employees were disappointed, angry, and felt betrayed in the wake of disclosures that:
- McKinsey was advising ICE to spend less on food, medical care, and supervision of detainees (p. 76, 83-84, 88-89)
- McKinsey had contributed significantly to the opioid crisis by advising Purdue Pharma and other firms as to how to “turbocharge” sales, including by targeting “high abuse-risk patients” (p. 148)
- McKinsey was, and has traditionally, derived much of its income from serving fossil fuel companies that contribute mightily to climate change. (p. 159, 167)
- McKinsey had numerous contracts with Saudi Arabia’s regime that murdered journalist Jamal Khashoggi (p. 254-2550
The aforementioned examples of moral injury arose from betrayal or bearing witness to the actions of others in their firm. But some moral injuries at McKinsey have come from the sufferer’s own actions, performed at the behest of the firm:
- One former consultant came to McKinsey hoping to improve the world, but later said: “[i]nstead of being a force for good, I found myself a party to the most damaging forces affecting the world: the resurgence of authoritarianism and the continued creep of markets into all parts of life.” (p. 25)
- Another former consultant joined McKinsey because it promised him the opportunity to make the world a better place. But he felt he had to leave the firm when he was assigned to help a client fire 1500 employees “not because it was struggling, but because they wanted to make more money…..I could not come into work every day knowing that everything I had worked my entire life for—all of it was being used to make other people’s lives worse.” (p. 28)
- Another consultant created a cottage industry within McKinsey that involved corporate executives hiring McKinsey to advise them that they were underpaid and to suggest ways that money might be found elsewhere (perhaps by laying off low-level workers) to raise those salaries. This, of course, put McKinsey in great demand by the executives of competing companies who would hire McKinsey and could, in all honesty, tell them that they were underpaid in comparison to executives at the firm that McKinsey had already advised. You can see where this is going. Later in life, the consultant said that he felt “guilty” about the impact of his work on economic inequality. (p. 50).
- An employee of Allstate insurance began experiencing severe headaches and other signs of moral injury when he began to implement a McKinsey-created plan to screw policyholders in order to increase profits and executive salaries. (p. 202)
At the end of the day, despite all its faults, McKinsey does some good work in the world, and some good. Perhaps much of the harm caused by McKinsey’s clients following McKinsey’s advice is the inevitable result of business activity in a rough-and-tumble free enterprise economy. Perhaps it’s not. The only point we make here is that in judging its own actions in how it selects or rejects clients and how it advises them to act, McKinsey should always consider the harm that it does, and remember that that harm includes the moral injury that it inflicts upon its own employees and others.
Walt Bogdanich & Michael Forsythe, “How McKinsey Got Into the Business of Addiction,” New York Times, Sept. 29, 2022, at https://www.nytimes.com/2022/09/29/business/mckinsey-tobacco-juul-opioids.html.
Walt Bogdanich & Michael Forsythe, When McKinsey Comes to Town: The Hidden Influence of the World’s Most Powerful Consulting Firm (2022).
Anto Cartolovni et al., “Moral Injury in Healthcare Professionals: A Scoping Review and Discussion,” Nursing Ethics, 28(5): 590-602 (2021).
Kelly Denton-Borhauf, And Then Your Soul is Gone: Moral Injury and U.S. War-Culture (2021).
Brandon J. Griffin et al., “Moral Injury: An Integrative Review,” Journal of Traumatic Stress, 32: 350-362 (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).
Michael Matthews, “Moral Injury: Toxic Leadership, Maleficent Organizations, and Psychological Distress,” Psychology Today, March 10, 2018.
William Nash & Brett Litz, “Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Families,” Clinical Child Family Psychological Review 16(4): 365-375 (2013).
Jonathan Shay, “Moral Injury,” Psychoanalytic Psychology, 21(2): 182-191 (1994).
Edward Tick, War and the Soul: Healing Our Nation’s Veterans from Post-traumatic Stress 2005).
David Wood, What Have We Done: The Moral Injury of Our Longest Wars (2016).
Related Ethics Unwrapped Blog Posts:
Covid 19’s Moral Harm: https://ethicsunwrapped.utexas.edu/covid19-moral-harm
Moral Injury Blog Post: https://ethicsunwrapped.utexas.edu/moral-injury