Moral Injury: A New Description of What Ails You?

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Naomi Osaka withdraws from the French Open with mental health issues. Simone Biles withdraws from the Olympic all-around gymnastics competition because of mental health struggles. The pressure on top athletes is enormous. We are becoming familiar with their issues as more and more athletes come forward to articulate their problems. But what about you? What about someone who gets up in the morning and reads the daily newspaper and/or watches the news in the evening? How are you feeling? 

Feeling in the dumps? What could be the reasons? Winter blues? Add COVID and lack of social interaction. Worried about climate change? Arctic melting? For Americans: Are the Republicans set to sweep mid-terms in 2022? No accountability for higher-ups in the January 6 assault on the Capitol? Supreme Court catastrophic? Bye-bye Roe vs. Wade? Potential U.S. civil war? Global politics? Russian troops ready to cross Ukraine border? Chinese pressure Hong Kong and Taiwan? Illiberal democracies flourishing? For the French: “Pissed off” with the man, Emmanuel Macron, who is pissed off with you? Aren’t the Brits incensed with partying BoJo? The list could go on and on. I have no magic cure for all that ails you (or me). But I do have a description of a new phenomenon which may explain some of your symptoms. 
We learned what post-traumatic stress disorder (PTSD) is for returning Vietnam War vets. It is now considered a familiar disease for soldiers after combat. While it was certainly prevalent throughout history - shell shock and combat fatigue in W.W.II - it became officially recognized in 1980 when it was included in the American Psychological Association’s statistical manual for mental health practitioners.
Similar to but different from PTSD are potentially morally injurious events (PMIEs). They are described as “the psychic fallout of ‘morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress [one’s own] deeply held moral beliefs and expectations.’” Whereas PTSDs sufferers are overwhelmed with fear, PMIE sufferers are overwhelmed with shame or guilt. 
PSTD and PMIE are usually connected to combat veterans. But they are different. While the military has recognized PTSD, only recently has the United States military established a program for treating veterans with PMIE. The San Diego Naval Medical Center has an eight-week moral injury/moral repair program.
But the diagnosis of PMIE has not been solely limited to soldiers. Moral distress among health care workers was described by the bioethicist Andrew Jameton in 1984. It has also been described in terms such as burnout or compassion fatigue. 
But what about you (and me) who are not athletes, soldiers or health care workers? A center dealing with moral injury asks potential patients the following question: “Have you ever had people get hurt or die because of something you did (or failed to do)?” Failed to do? What have you done or failed to do on the list of the above? 
For example: While there are limitations about what one individual can do to effect climate change, there are numerous small things that could make a difference. Worried about growing illiberalism in the U.S.? What have you done to make sure Trump and the Republicans don’t take over the country and establish an autocracy? Moral injury does not have to be limited to an event. It can also deal with a larger series of events. 
PMIE focuses on the sufferer’s “perpetrating, failing to prevent, or bearing witness to acts that transgress [one’s own] deeply held moral beliefs and expectations.” It assumes that the patient has “deeply held moral beliefs and expectations.” A soldier can say that failing to prevent a massacre of civilians is against her moral beliefs. And a vegan could say that eating meat or watching a cow being slaughtered is against her moral beliefs. 
How to certify that an individual or a collective has been injured morally? The answer is subjective. While I might consider myself a moral refugee from a country or a global citizen pilgrim against all forms of nationalism, someone else may not consider an event or series of events to be morally harmful. 
But the fact that there is a label such as potentially morally injurious events opens up a new category of mental health issues. If mental health is as important as physical health, then moral injury should be considered similar to other injuries. 
Naomi Osaka and Simone Biles’ revelations have been universally accepted. Among athletes, mental health issues are being recognized like physical injuries. Moral injury is a mental health issue; I’m sure there are plenty of sufferers out there. I am also sure that an eight-week moral injury repair program would not be long enough to cure what ails me.
    

 

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  • Psychic wounds are serious and life destroying. It behooves the general population to consider it a moral imperative to prevent/alleviate to whatever degree possible. People like Edward Snowden, Julian Assange and Chelsea Manning should not be punished unceasingly for doing acts of justice. They could be released for time served if considered otherwise than innocent. The crimes they exposed vindicates the method. Unjustified wars and prisons like Guantanamo are irreparable scars on the face of humanity. Whether individuals or groups are in mental or physical pain from trauma, it must be addressed.

  • I agree with Laurie.

    To hearken back to the cold war era, it was clearer who was in public life and who was not; with a populace you identified with or not. Apparently we need a former president who is, in his job description on twitter, a 'Personality' before his other ... accomplishments.

    I apoligize if I sound flippant Mr. Warner because I am new to this country outre-mer (U.S., Florida) but, I have not done anything to 'unseat' any republicans if it were in my power, because these birds of a different feather did welcome me rather with open arms, and by working with them rather than against them in my small role as member-at-large at a new charity set up in the Clubhouse International model, I can learn about their need to govern, and the rewards for my labor aren't wages or influence but just... the feeling that I am needed. In my home country of Canada I was never allowed to feel that I was needed, even essential. I was not encouraged to grow into an adult with adult responsibilities. I learned rather that society was ungovernable and that the family unit was the largest club to which I could apply as member.

    This may sour your regular readership and I apologize for this very personal account. I have to say though, that in Florida, you do get what your taxes pay for. I do not have the same global perspective here that I enjoyed in Geneva for twenty-two years. I do not have social connections, a listed phone number or family who are a part of my daily life. I do have an authentic American experience that can dip into and out of its own history, my colleagues are in New York, in Chicago; Arizona or California.

    Just incidentally while not a top athlete (or even one who can touch bottom!) I do model various fads along with my two brothers who will one day hopefully hold a torch for others who were not born with our nordic features or strong bone structure. I can see both the frailty of life in the concerns of the aging population all around me; also the boundless energy of youth which can be recaptured by the Freedom 55 set who are just as healthy as the Swiss. There are no basements nor bomb shelters here to hide from these supermen and women!

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