Moral Injury as a Soul Wound: A Cry to Faith Communities
“What sometimes happens in war [trauma] may more accurately be called a moral injury — a deep soul wound that pierces a person’s identity, sense of morality and relationship to society.”
Counseling professionals, health care providers and chaplains are using with more frequency the phrase moral injury. While originating with combat veterans, it can be equally applied to survivors of rape, abuse and trauma. Beyond a traumatic event, moral injury is a soul wound or a spiritual crisis. And precisely for that reason, clinicians confess to few interventions for recovery causing them to call upon faith communities to respond to this sacred wound.
Attending a recent conference considering best practices for caring for veterans and their families, Chaplain Major Kerry Wentworth defined moral injury as damage done to our “core values, conscience or moral compass.” Moral injury strikes at the heart of a person’s identity. For example: “participating in giving orders in combat that result in injury or death, failing to provide medical aid to someone whose been wounded or following orders that are illegal or immoral, etc.” Psychologists, Litz et al. (2009) deepen this description defining moral injury as “the inability to contextualize or justify personal actions or the actions of others alongside the unsuccessful accommodation of these experiences into pre-existing moral schemas” (p. 705). Veteran Affairs psychiatrist Jonathan Shay who likely coined the term summarizes saying “moral injury is a betrayal of what is right leading to lifelong injury” (1994, 20).
Moral injury is distinguished over and against Post Traumatic Stress Disorder (PTSD). Again, in Shay’s words: “PTSD is more like the wound of war, while moral injury is more like an infection in the wound.” Extending the analogy he warns that an infection is more dangerous than the original wound “because its not often detected and not easily treated (2010).” Nuancing it more some say that PTSD is fear based while moral injury is guilt and shame based (Antal and Winnings, 2015). Deepening the spiritual connection, Diane Silver calls moral injury “a deep soul wound that pierces a person’s identity, sense of morality and relationship to society” (2011, 6). As such its not just about how an event impacts the psyche, but how a society, family or faith community sees and supports the person impacted. Therefore, healing happens not only on a therapist’s couch or even in a military chaplain’s office, but within a safe faith community.
Underlining the role of community, Georgetown University ethics professor Nancy Sherman heard stories of moral injury when she interviewed veterans of Iraq, Afghanistan, Vietnam and World War II for her book, The Untold War. “Regret,” she writes, “doesn’t begin to capture what the soldiers I talked with feel. It doesn’t capture the despair or depth of the feeling — the awful weight of self-indictment and the need to make moral repair in order to be allowed back into the community in which he feels he has somehow jeopardized his standing (https://psmag.com/beyond-ptsd-soldiers-have-injured-souls-69ec55cbe65#.lmcttmidz).
Seeing moral injury as a soul wound is significant. Not only because it calls faith communities to reflect and respond, but because it shifts the problem from a medical model with a mental health diagnosis to a spiritual crisis. And since medical professionals admit they can’t adequately address moral injury, they’re reaching out to religious leaders to reflect on moral repair. Chaplain Major Kerry Wentworth concluded his presentation, Finding Faith After Moral Injuries with a plea: “We have few interventions. I’m looking to those of you here today to offer some answers.”
Some in the audience suggested doing service, random acts of kindness, self-compassion and forgiveness as pathways toward healing. But what’s been shown to be most effective in treating moral injury is group therapy. Veterans and service members communicating with others who have experienced similar injuries tend to have more agency to give voice to their struggle. The San Diego Naval Medical Center uses this therapy technique in its moral injury/moral repair program, which is the first of its kind. In the program, participants become safe with one another before sharing their stories. Group members are then encouraged to provide support to one another by refraining from judging their peers or excusing them. The goal, according to program psychiatrists, is for the participants to accept that wrong was done, but to also understand it and learn how to deal with it (http://www.goodtherapy.org/blog/psychpedia/moral-injury).
Small groups with trained leaders who cultivate safety and practice deep listening to sufferer’s stories seems like a good place to begin for faith communities. To writer Margaret Wheatley’s point: “All we need to do is listen. Not judge, not recommend, not fix. Just listen, bearing witness, keeping our hearts open (http://www.margaretwheatley.com/articles/speakingoursuffering.html). Perhaps, the practice of cultivating safety and becoming good listeners makes it possible for people to heal themselves. The following story suggests that:
During the Truth and Reconciliation Commission hearings in South Africa, many of those who testified to the atrocities they had endured under apartheid spoke of being healed by their own testimony because they knew the nation was listening. A young man who had been blinded when a policeman shot him in the face at close range said: "I feel what has brought my eyesight back is to come here and tell the story. I feel what has been making me sick all the time is the fact that I couldn't tell my story. But now it feels like I've got my sight back by coming here and telling you the story” (ibid).
Coming from a Christian perspective, I believe in a God who listens and invites us to bear witness to one another. Perhaps that’s what can best be offered by churches in such circumstances: cultivating safety, listening deeply and bearing witness to moral injury. Reflecting more broadly, moral injury isn’t only about the wounds of war, but rape, trauma and all forms of abuse. When persons tell their stories and are silenced, shunned or stigmatized we reinjure rather than repair. Cultivating sanctuary to share our stories without judgement, advice, moral platitudes or feeling the need to tell our own might bring efficacious repair. Summarizing in the words of Parker Palmer, “The soul doesn’t want to be fixed. In fact it flees and hides when pursued by a fixer. The soul wants only to be welcomed, heard and attended to by people who are willing to offer simple hospitality (1999,14). Sanctuary is critical. Listening is key. No doubt the Spirit of God will bring all else that needs to be at the Table.
Antal, C. & Winings, K. (2015). Moral injury, soul repair and creating a space for grace. Journal for Religious Education, 110 (4). 382-394.
Brock, R & Lettini, (2012). Soul repair, recovering from moral injury after war. Boston, MA: Beacon.
Litz,et al. (2009). Moral injury and moral repair in war veterans. A preliminary intervention strategy. Clinical Psychology Review, 29, (8). 695-706.
Palmer, Parker (1999). The courage to teach guide for reflection and renewal. San Francisco, CA:Jossey-Bass.
Silver, D. (9.1.11). Beyond PTSD soldiers have injured souls. Pacific Standard.
Thompson, M. (9.2.11). “Could PTSD really be post traumatic soul disorder?” Time Magazine.
Wheatley, M. (2002). Speaking our suffering. http://www.margaretwheatley.com/articles/speakingoursuffering.html
Wentworth, K. (11.3.16). Finding faith after moral injuries. Perspectives for Clergy. Caring for veterans and their families.