In our modern world of continual change and warp-speed technological development, there are few conditions as widespread as moral injury.  Perhaps at this time, more than ever, the effects of moral injury are being felt, but they are rarely seen for what they are. It’s only been in the last 300 years we’ve even had some concept of what moral injury is.  This owes to Bishop Joseph Butler, who in early 18th century England, who spoke in his sermons about wounds that have a moral aspect to them. He considered them to have components of “contempt” and “injustice.” This concept of moral injury has recently gained prominence because of the serial and long-lasting wars our country has been involved in, during which service men and women are typically deployed for extended periods of time for multiple deployments.  Their struggles and experiences have increased our awareness of PTSD and suicide, but little time and attention has been paid to moral injury and how these often are related to the above conditions.

How It All Starts

For the sake of identification purposes, let’s say I work in a factory, and my boss tells me I have to work in back-breaking conditions without adequate breaks and opportunity for self-care.  Suppose I get paid low wages and see my boss living a lavish lifestyle, and add to that he treats me and the other factory workers shabbily. If this factory produces bombs that are dropped on children in a foreign country and I find out about it, this can create a great deal of distress in me.  I might get very upset and feel awfully about what I do. I could feel a great deal of shame about this, as well as get angry at my boss to the point of rage that he’s profiting off the killing and destruction in this foriegn country. This is the essential crux of moral injury: doing things that violate my values, watching others carry these out, or authorizing immoral acts of others.  The effects of moral injury can manifest in a myriad number of ways, but the fundamental experience is usually very similar: shame.  

What Keeps It Going

What keeps moral injury going is when the shame leads to depression or shows up as a part of PTSD, which can go hand in hand with moral injury.  If I’ve seen something horrific, I can also have feelings of guilt and shame at not being able to stop it, or not trying to stop it. The shame cuts to the core of a person’s identity, whereas guilt is usually less in degree and corresponds to violating one’s values.  Negative thoughts related to guilt often cover up deep-seated shame in many individuals.

How Shame Expresses Itself

One of the many ways shame expresses itself if by way of anger.  For some people, especially men, anger can be one of the only acceptable emotions.  This can be especially true for men who are combat military. So it is no surprise that shame can masquerade as anger when it is triggered.  If this goes into rage, it can be another variation on a theme. If the shame isn’t discharged by anger, then taking it a notch up to rage might seem like a natural progression.  The problem is, this may only serve to further ingrain the shame. If a person winds up raging when they would otherwise feel shame, they might wind up feeling more shame in retrospect for the way they acted during their rage episode.  If the remorse they feel over this rage episode gets turned inward, it can take up residence as self-hatred, which in some cases can be expressed as suicidal behavior in the worst-case scenario. The shame can also contribute to addictive behaviors, as a way to squelch or numb out the unpleasant feelings.  These can also lead to anger and rage episodes, such as in cases of someone who is an ‘angry drunk.’ Self-pity can be a natural result of addictive behaviors, and could potentially be another manifestation of shame. One of the other more unusual expressions of shame can be laughter, particularly if it’s of a derisive nature.  This is, in some respects, a reactive expression of shame where the person can’t tolerate this feeling and projects it on to someone else, who may be the apparent object of derision. There can be much feeling of discomfort associated with shame, and if laughter can potentially discharge some of this discomfort, then that would help explain this phenomenon.  

The Connection Between Alienation Indices and Moral Injury

Another angle on the situation can also be glimpsed by examining the seldom referred to Voter Alienation Index, measured by the Harris Polling Company for over 50 years now.  One of its key statistics from the 2016 poll showed that 70% of Americans believed that those who run the country (elected officials) are out to take advantage of people like them, and 82% of them believed that the people running the country don’t care about what happens to them.  These percentages have been going up for years and are correlated to suicide rates that have been gong up almost every year for the last 20 years. I mention this poll because it is related to moral injury from the standpoint of how witnessing those in authority acting more in their own self-interest instead of the public’s self-interest can be one experience of moral injury, from that of the victim.  We’re exposed to it on an ongoing basis from watching news reports of public corruption, self-dealing, and lack of responsiveness to constituent input. All this contributes in some way to a particular experience of moral injury. Add to that evidence that the national depression rate has been climbing for over 80 years now, as Dr. Jean Twenge of San Diego State University and others found in a clinical psychology review 2009 study of MMPI (Minnesota Multiphasic Personality Inventory) questions going back to 1938, and you can see the potential impact of moral injury going on through the decades.  From a time when we, as a country, were a champion of freedom and liberation, to the postmodern era on into the technological era when everything moves so fast, it’s hard to slow down even to catch one’s breath. The undercurrent of moral injury has been flowing across the decades and may now be creating a swell in what we suffer from in terms of our psychological distress individually and collectively.  

The Way Out of Moral Injury

As Brene Brown has made abundantly clear in her TED talks from 10 years ago, talking about shame helps to reduce it, and calling attention to it and moral injury is a start to help to undo both of them.  It deserves to be as valid and recognizable condition as depression, PTSD, anxiety, and other mental illnesses. Otherwise it remains in the shadows as an unseen antagonist to other mainstay conditions and illnesses.  Processing and working through the emotions and events that have caused moral injury, either the ‘death by a thousand cuts’ or the truly horrible and egregious ones we’ve experienced is so essential as well. By doing this we can more capably work to align ourselves with the kind of values that help us to live as part of a community and society that will serve and uplift each individual not in spite of society and culture, but because that is the primary purpose of them in the first place.