Moral injury

We find a place for what we lose. Although we know that after such a loss the acute stage of mourning will subside, we also know that we will remain inconsolable and will never find a substitute. No matter what may fill the gap, even if it be filled completely, it nevertheless remains something else.

Sigmund Freud, letter to his friend Binswanger upon the death of his son

We took a long (well, six miles anyway) walk along the Intracoastal Waterway yesterday, just to get out of the house. Last week, our mayor closed down the hiking and biking trails in our town – of which there are 135 miles that we used every single day before this whole bullshit coronavirus panic. Since we have a trail that runs behind our property and is usually heavily populated, we were shocked by the total absence of traffic after the mayor’s order. It became almost a form of entertainment to see what kinds of people defied it (spoiler: most of them were not young). But the governor issued a blanket safer-at-home mandate that exempted exercise and superseded the mayor’s order, so people are back to getting their Vitamin D and keeping their mental health intact again. I never realized how important this aspect of living was until this past week, both to individuals and to the health of an entire community. People who stay at home all the time quite seriously go insane.

On our way back home, we ran into a neighbor that we have not seen in a long time. He is a retired Army chaplain, and has been commuting back and forth between Florida and some Midwestern state that I forget. We got to chatting with him (he and his wife seem to share our opinions on the nonsensical nature of the lockdown) and learned that in his golden years he has decided to get a PhD in theology. He has been traveling to fulfill the requirements of that.

This was obviously very interesting to us, as we have two generations of theologians in the family. He’s about to defend his dissertation via teleconference, which I suggested is probably better than doing it in person. My own defense for my Master’s turned into an epic bitch-fest among the professors gathered, so I think distance can only improve this ritual. Of course, this might not be the case for everyone. You know I lobbed some bombs.

So I asked him what his dissertation was on, and he explained that it was on the problem of “moral injury” of veterans returning from war. This is something an Army chaplain has a lot of real-world experience with. I had never heard this term, despite spending entirely too many years reading philosophy, so I was intrigued.

Moral injury:

Moral injury refers to an injury to an individual’s moral conscience and values resulting from an act of perceived moral transgression, which produces profound emotional guilt and shame, and in some cases also a sense of betrayal, anger and profound “moral disorientation.”

The concept of moral injury emphasizes the psychological, social, cultural, and spiritual aspects of trauma. Distinct from psychopathology, moral injury is a normal human response to an abnormal traumatic event. According to the U.S. Department of Veterans Affairs, the concept is used in literature with regard to the mental health of military veterans who have witnessed or perpetrated an act in combat that transgressed their deeply held moral beliefs and expectations.

I highly recommend following that link and reading about the evolution of this concept, not just in the military but in medicine. It occurred to me that there is probably some cohort in epidemiology now that are looking at tens of millions of people losing their jobs over pneumonia and experiencing some form of moral injury. As this is a contributor to long-term mental illness, that’s not a subtle detail to overlook in a specific industry, especially one that demands high-stakes decision-making all the time.

I found this entire conversation about moral injury very interesting, as my father was drafted to Vietnam and even to this day – fifty years later – struggles with PTSD and what I now understand to call moral injury. Acute trauma really does physically re-wire your brain through some unknown mechanism. It brings about a different, higher level of consciousness akin to taking drugs. There’s a sense of otherness that follows you around for the rest of your life like a dog.

I also feel like many of the problems that exist with children these days are a form of moral injury. They are being raised in a social environment that often demands fealty to abusive, increasingly absurd worldviews – the teacher who demands you shame a classmate for thoughtcrimes, social media mobs, etc. – that have broken their sense of moral order and burden them with negative emotions like guilt that they are not generally capable of working through independently because they lack experience and context.

It made me think a lot about how situations that could potentially involve moral injury tend to be disproportionately leveled on younger generations. A society that wonders why high-schoolers could ever want to mow down their classmates has no problem sending teenagers and young adults to wars on the other side of the world. Even in your early 20s, your brain is still physically developing on a large scale. Of course combat ruins that natural process. But so does the loss of functional institutions, solidarity within communities, and all of the other things that on a daily basis would be guiding young people toward a life well-lived. A society that pushes thousands of small acts of cruelty creates a lot of moral injury on a cumulative basis.

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