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Moral Injury and the Lived Experience of Political Violence

Published online by Cambridge University Press:  10 March 2022

Daniel Rothenberg*
Affiliation:
Arizona State University, Tempe, Arizona, United States (daniel.rothenberg@asu.edu)
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Abstract

Moral injury names how the lived experience of armed conflict can damage an individual's ethical foundations, often with serious consequences. While the term has gained increasing acceptance for the clinical treatment of veterans and as a means of better understanding the impact of war, it is generally applied to individualized trauma. As part of the roundtable, “Moral Injury, Trauma, and War,” this essay argues that moral injury is also a useful means of addressing political violence at a societal level. It explores the term's value within international human rights discourse and practice, particularly in efforts to document and analyze the systematic commission of atrocities to achieve accountability and reconciliation. The essay presents field research among Iraqi human rights investigators as a means of reflecting on the value of rediscovering agency in the aftermath of societal trauma. In this way, moral injury provides guidance on the essential ethical qualities of the lived experience of violent repression, an issue central to a more complete understanding of international affairs.

Type
Roundtable: Moral Injury, Trauma, and War
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Carnegie Council for Ethics in International Affairs

Moral injury is one of the most significant ideas of the last several decades for assessing and addressing the impact of war. The concept references a type of psychological harm associated with how the lived experience of armed conflict damages an individual's ethical foundations, often with serious consequences. The term was coined in the 1990s by Jonathan Shay, based on his clinical work with combat veterans, many of whom experienced profound, even debilitating, responses to what they had done and witnessed in war.

The potential for moral injury to clarify the impact of political violence lies in its focus on how traumatic experiences can affect an individual's ethical grounding, their sense of connection to the good. Shay describes moral injury as “a betrayal of ‘what's right,’”Footnote 1 and journalist David Wood conceives of it as a “bruise on the soul.”Footnote 2 Just as physical injuries have complex, long-term consequences, moral injuries produce “harm,” often experienced as guilt, shame, fear, and self-anger. And, like many forms of physical incapacity and suffering, moral injury cannot necessarily be cured, but requires a process of adjustment to a new status—learning to live with trauma.

The powerful ethical and emotional impact of war has long been recognized. Many cultures have terms to address war's spiritual damage, and some create rituals to assist those impacted by the lived experience of conflict in reintegrating into society. In many ways, moral injury's value lies in its ability to focus contemporary Western discourse on aspects of trauma that are inadequately covered by accepted terms, particularly post-traumatic stress disorder (PTSD). Moral injury focuses on the domain of ethics to name the complex, deeply rooted ways that violence transforms an individual's sense of self, purpose, identity, and spirit.

Because it is a relatively new concept, the broader implications of moral injury are still being explored. This is especially true with regard to the term's value for critically confronting the outcomes of war and political violence at a social, rather than individual, level. That is, even as moral injury is increasingly accepted as an important idea for understanding war's psychological impact on soldiers and civilians, its use for engaging societal trauma is still developing. While the lived experience of conflict is subjective, war is always a complex social practice involving, implicating, and transforming institutions and societies. Can a society experience moral injury? And, if so, what might be the explanatory value and usefulness of applying the term to the collective experience of war and other forms of political violence?

One way to address these questions is to explore links between moral injury and international human rights discourse and practice, particularly efforts to document and analyze the meaning and impact of state terror, authoritarian rule, and the systematic commission of atrocities. Like moral injury, specific human rights violations, such as torture, extrajudicial killing, or rape, are experienced by individuals and impact victims in distinct ways, often creating long-term physical and psychological harm. Yet, while the clinical use of moral injury focuses on the individual impact of trauma, human rights research engages the social and political significance of violence.

This essay explores the value of moral injury for understanding the lived experience of intense systematic political violence. By taking the lessons learned from using the concept of moral injury to address veterans’ trauma and applying them to human rights work, we can see how a more expansive use of the term may assist our understanding of individual and societal healing in ways that highlight the significance of ethics for addressing key global challenges.

Moral Injury as a Concept

The concept of moral injury was developed in response to the significant, sometimes devastating, psychological impact of the lived experience of war.Footnote 3 The term names a harm that was previously inadequately recognized, linking the clinical and popular understanding of trauma with an acceptance of ethics as an essential element of an individual's sense of self. While the concept engages classic philosophical questions, moral injury is a practical, goal-oriented term. As Shay explains, “Moral injury is something we can do something about.”Footnote 4 In this way, the term's value and efficacy is based on the idea that identifying the ethical harm that causes suffering is necessary for assisting individuals in confronting their pain.

Specifically, moral injury arose out of the clinical limitations of PTSD in addressing the experiences of veterans. PTSD was recognized as a formal psychiatric diagnosis in 1980, and since then it has become a significant element of trauma therapy. Its widespread use has contributed to growing sensitivity and interest among clinicians and within the broader culture in identifying and treating the complex, long-term impact of traumatic experiences. However, clinicians serving veterans recognized that PTSD's focus on trauma resulting from actual or threatened physical harm did not adequately describe the experiences of those whose suffering was bound to violations of their core values.Footnote 5 Clinicians discovered notable differences in how these distinct forms of trauma manifested themselves in patients, with PTSD presenting as “fear, horror, helplessness,” and moral injury being associated with “guilt, shame, anger,” and a profound loss of trust.Footnote 6 As such, treating moral injury required a distinct therapeutic approach tailored to the needs of those confronting harm to their ethical foundations.

The link between agency, experience, and trauma is key to how moral injury functions. That is, individuals experience moral injury because of how what they have done, failed to do, or witnessed challenges the solidity of their sense of self as ethical actors. This represents a significant difference from other forms of trauma, such as PTSD, which are associated with psychologically impactful experiences—whether combat, accidents, or violent crime—that do not necessarily involve a link between a suffering individual's action or inaction and their foundational moral beliefs.

While anyone volunteering to participate in the military is aware of, at least abstractly, the potential ravages of war, moral injury often arises out of a clash between the reality of the lived experience of conflict and the core ideas that support a coherent sense of self and purpose. In this way, the analytic value of moral injury lies in how it reveals the impact of one of the essential challenges of armed conflict, which is the way it upends accepted ethical standards and norms. As Nancy Sherman explains, “War justifies—more importantly, demands—what, in peacetime, would be unjustifiable, the destruction of the lives and happiness of others.”Footnote 7 Because the context of war is distinct, those living through armed conflict commonly face multiple complex moral dilemmas arising from a clash between their values and expectations and a practice that, by its very nature, involves destruction, damage, and the purposeful infliction of harm on others.

Within the discourse of moral injury, there is a difference between trauma arising from acts committed by the affected individual and trauma resulting from “a betrayal of what's right” by those in authority. The first case relates to the moral impact of something one has done and the second to the ethical harm of being part of an institution or social environment in which those in power commit and/or condone acts experienced as ethically damaging, thereby implicating the individual. To date, the discourse of moral injury recognizes these two situations but does not address the implications of this difference for understanding the full scope of the ethical impact of political violence. This is particularly true as regards the potential value of the term for naming collective experiences, whether based on membership in an organization or common exposure to the devastation of war and large-scale repression.

Furthermore, although moral injury is generally used to reference the individual psychological harm of armed conflict, war is fundamentally collective. So, while individual combatants’ ethical suffering varies widely, one of the key values of the concept of moral injury is found in its explanatory capacity for naming what is experienced by groups of soldiers, or even a generation. In this way, the harm of moral injury can never be understood solely on an individual level since ethical claims are, by their very nature, collective and socially grounded. So, while the debilitating consequences of suffering moral injury are, like all forms of pain, radically subjective, the substance and resonance of the core values that are damaged are linked to a broader social order.

Human Rights, Testimony, and Trauma

From the 1980s to the present, international human rights discourse and practice has relied extensively on documenting the lived experience of those who have suffered violations, whether as direct or indirect victims. In fact, much of what we know about violations around the world is based on information gathered through field research and first-person interviews with victims and others.Footnote 8 This approach to understanding the nature of violations is often necessary because of efforts by states and other empowered actors to deny, obfuscate, or hide evidence of widespread abuse. In this way, human rights work often involves difficult and even dangerous efforts at truth telling through the rigorous documentation of violations based, to a large degree, on victim and witness testimony.

First-person narratives reveal the immediacy of the lived experience of human rights violations. While they are not the only significant source of information about systematic repression and require corroboration, they connect claims about political violence with a sense of the intimacy and meaning of suffering. Testimonies highlight the importance of human rights work for protecting people from atrocities, while ensuring that claims about legal violations are grounded in an acknowledgment of their profound personal and psychological impact. Furthermore, the process of presenting testimonies about violations that have long been denied or suppressed often serves to strengthen community identity and assist individuals and groups address the many ways in which political violence produces long-term harm.

While human rights research relies heavily on individual experience, it tends to use these accounts to focus attention on issues of accountability and the systematic use of violence as a strategy of repression. In this way, human rights work can also provide a lens for understanding political violence both as a violation of international law and as a breach of foundational norms essential to the proper functioning of society. Like war, systematic violations of human rights create social contexts that challenge and violate basic values, making profound ethical demands on individuals, communities, and societies. And like war, there are specific types of ethical injuries that emerge from these violations, as I will argue below.

Systematic human rights violations traumatize entire societies, which helps explain why they are committed. Perpetrators of politically motivated extrajudicial killing, torture, and rape do not seek only to harm the direct victims of these crimes but also to instill terror in broad populations. They do this as a mode of control and an expression of power and dominance—a willingness to deploy violence and breach ethical norms by engaging in brutal repression. As such, efforts to document and analyze human rights violations are formal processes of gathering evidence of atrocities as well as inquiries into acts and policies designed to inflict physical harm and create moral injury. Applying the innovative focus of the term's insights on how political violence creates trauma can substantially deepen the value and contributions of human rights work.

Among the most compelling examples of human rights research are truth commissions and other large-scale research projects that document and analyze violations as part of broader societal reflections on the devastating social impact and long-lasting legacies of systematic political violence. These efforts are premised on the idea that uncovering the truth of violations is essential to social healing and to the possibility of establishing a more peaceful and respectful social order. Such efforts are generally “victim centered,” privileging the lived experiences of those who have suffered violations. This approach builds on the idea that speaking one's truth is a powerful expression of agency, especially within social contexts defined by severe repression and systematic silencing. In this way, highlighting the voices of victims enables a deeper understanding of past violations while assisting a society in confronting its history and, ideally, seeking reconciliation.

Because of its commitment to the lived experience of victims and others, human rights work has long acknowledged the profound psychological impact of violations. With this has come an openness to engaging critical approaches to trauma. In some cases, these efforts involve linking field research with the work of psychologists and other experts to assist victims with processing their experiences. In other cases, the findings of human rights projects are used to direct resources and programs to affected individuals and communities. In this way, human rights projects, especially large-scale efforts such as truth commissions, document and analyze political violence through victims’ lived experience in a manner that confronts trauma and supports processes of individual, communal, and societal healing.

Interestingly, human rights work, including efforts to assess the social impact of authoritarian rule and civil war, generally does not specify the way political violence produces ethical harm. While human rights discourse is premised on a conception of fundamental rights as foundational moral and legal claims, its conception of trauma has not embraced the key insights of moral injury. This is likely a reflection of the fact that moral injury is a new term that has largely been developed in a clinical setting with a focus on combatants rather than civilians. The analytic lens of moral injury may well provide a useful way of linking a victim-centered approach to addressing violations with a more nuanced way of understanding the psychological harm suffered by those who have experienced political violence. That is, the language of moral harm may well deepen human rights practice in a manner similar to how it has improved clinical efforts to address veterans’ suffering. Key to this process is openly engaging how ethics operates as a connecting thread between individual lived experience and collective suffering.

Case Study: Iraqi Human Rights Researchers

When states commit human rights violations in a systematic manner, societies are transformed, not only politically but ethically as well. In these situations, populations are forced to endure life within a context of routine state-sanctioned killing, torture, rape, and other crimes. Alongside institutionalized impunity comes an ideology of denial, as the truth of these crimes is hidden. Those living under regimes of this type must adapt to a social environment whose ethical foundations are overturned, as the state becomes predatory, an instrument of terror. Populations are forced to survive in contexts that make constant demands upon them to deny the reality of state crimes, avoiding criticism of—and even supporting—agents of repression, both overtly through required acts and tacitly through inaction and silence.

This environment profoundly challenges people's moral sensibilities and places them in a situation analogous to that of a soldier operating in a context where those in authority enact ethically damaging policies. Life under state terror forces members of society to be complicit in systematic repression or, at least, to accept its practice. Living within social contexts of severe repression impacts the ethical framework of individuals, families, communities, and entire societies. This leaves a legacy of trauma that, while it is experienced differently by distinct individuals, represents a type of broad societal harm. Because governing systems that rely on human rights violations systematically deny the occurrence of these unjust practices, human rights research projects that gather information on the lived experience of victims provide an especially useful means of revealing the truth of what has been denied and directly confronting the social impact of repression.

To illustrate this, it is useful to review a study of the experiences of Iraqi human rights field researchers, who worked on a large-scale documentation project that gathered thousands of first-person accounts of human rights violations and related abuses committed in Iraq, both under the regime of Saddam Hussein and following the U.S.-led invasion.Footnote 9 After the project was completed, a team of Iraqi and American social scientists, physicians, and psychologists used qualitative and quantitative measures to better understand the experiences of a group of Iraqi researchers who had worked on the project.Footnote 10 The study looked at the psychological impact on the researchers resulting from their work documenting the suffering of fellow Iraqis.Footnote 11

Local human rights researchers, like this group of Iraqis, commonly share the experience of having been victims of political violence while working professionally to document and analyze atrocities suffered by others. In addition, as members of societies profoundly impacted by violence, they often personally know both victims and victimizers. In fact, over half of the interviewers in the study were direct victims of human rights violations, and nearly six in ten had family members who were victims.

As one member of the Iraqi team explained:Footnote 12 “Once I interviewed a man in Kirkuk . . . . He was arrested by the Mukhabarat and very severely and systematically tortured, including with electricity. He mentioned his cellmates and how they had been tortured too. After I conducted the interview and wrapped up the papers, I told him that one of his cellmates was my father. When he heard that he stood up and held me and started crying. I couldn't control my emotions. I started crying with him. We spent a long time together. I went back home and told my mother the story. I burst into tears again.”Footnote 13 Another Iraqi interviewer explained how he had worked on the testimony of a family killed by a U.S. airstrike while he was recovering from a car bomb that exploded nearby. “I had some shrapnel in my hand, but I am alright now,” he said. This overlay of multiple experiences highlights the complex psychological impact of political violence on local populations and the special challenges faced by local human rights researchers.

The study revealed that the experience of conducting interviews with other Iraqis affected the researchers emotionally and psychologically: “I became angry and was upset easily, even at home with my husband”; “I lost the desire to eat. I was very anxious and worried about everything”; “I used to be startled by nightmares, remembering victims’ stories such as rape and torture. It was as if I was being tortured myself.” In addition, they reported that the work caused them to reflect intensely on the anger and outrage they felt at living in a society—during and after the Saddam era—in which cruelty and violence were commonplace: a world fundamentally lacking in values, characterized by the routine denial and obfuscation of violations as well as near complete impunity for the perpetrators.

However, the study also found that the Iraqi researchers were deeply satisfied by their work. Many expressed a sense of accomplishment, a feeling that their participation in a large-scale human rights research project focused on Iraqi society provided them with a means of acting positively in the face of so much suffering. As one team member explained: “I am so proud that I have done these interviews.” Many of the researchers viewed their work documenting the suffering of others as assisting themselves in both confronting their pain and feeling more connected to their fellow Iraqis: “I was kidnapped before, and I have gone through a lot of bad things. However, the interviews helped me shoulder some of my own miseries. When I talked to people and listened to their own horrible ordeals, I kind of settled down with my own”; “I became more emotional after these interviews. And I started feeling others’ problems and emotions around me.”

The concept of moral injury as applied to human rights research may provide an answer to why the Iraqi interviewers found their work documenting atrocities to be so profoundly enriching. The Iraqi interviewers had long internalized the psychological impact of daily life in which systematic political violence was a constant. Like those they interviewed, they commonly suffered feelings of shame and anger from what they witnessed and experienced, coupled with an inability to confront a social order overdetermined by brutality and cruelty.

However, by working intimately with other Iraqis, most of whom had never told their stories to anyone, the investigators offered members of their own society a rare opportunity to speak and to be heard. As the Iraqi interviewers explained, the human rights documentation they conducted was a form of ethical action that connected the harm they experienced, in its pain and isolation, with the lives of others. This process served as a means of rediscovering their agency, of confronting the silencing of terror by recognizing the suffering of others. This finding supports the idea that truth telling is a form of individual and societal reparation, and that providing victims with an opportunity to tell their stories is an essential mechanism of empowerment.

While these insights may not inform moral injury's clinical use for treating individual trauma, they suggest that this relatively new term may help us understand aspects of the value of victim-centered human rights work that deserve more attention. That is, a key reason why societies should engage victims and provide opportunities for people to voice their stories is that doing so provides a connecting thread between the harm suffered by individuals and the moral damage to the larger social order. The impact of systematic political violence on a society cannot be fully understood without a reflection on its ethical dimensions, on how the lived experience of repression and cruelty harms foundational ideas and norms.

Engaging the Moral Injury of Political Violence

In much the same way that moral injury has deepened our understanding of the clinical and social impact of war on soldiers and others, the term may help guide our engagement with what it means to live within societal contexts of systematic and violent repression. Through the lens of moral injury, the psychological impact of participating in war presents similarities to the effects of surviving other experiences of sustained political violence, especially as these harm one's ethical sense of self as well as the solidity of one's individual and communal identity. Those living under brutal authoritarian rule or widespread political violence confront multiple challenges to their sense of what is right. Direct and indirect victims of severe repression commonly suffer various forms of trauma and are forced to confront a world of constant risk in which their core moral beliefs are routinely challenged.

At the same time, the discourse and practice of international human rights, particularly its focus on the essential role of truth telling and the need for a victim-centered approach, provides a useful conceptual bridge between the use of moral injury to address combatants’ experiences and a broader process of deepening the global inquiry into the meaning and impact of systematic political violence. This is because those who have suffered moral injury have been forced to live in a world of profound ethical illegitimacy, whether as combatants, civilians, victims, witnesses, or survivors.

Through its focus on the essential ethical qualities of violent repression and conflict, moral injury provides guidance on the value of openly engaging with the nature of brutality and seeking to uncover and recognize particular forms of harm and suffering by restoring a sense of purpose following the chaos and uncertainty of individual and societal trauma. The concept suggests ways in which the value of testimony and truth telling serve to reaffirm identity, enable healing, and support one of the core goals of engaging with violations, which is to make good on the promise of “never again.” In this way, moral injury provides insight into the lived experience of political violence, highlighting the central role of ethics for addressing key challenges within international affairs.

Footnotes

*

Development of this essay was supported by National Endowment for the Humanities award number AV-26061518.

References

1 Shay, Jonathan, “Moral Injury,” Psychoanalytic Psychology 31, no. 2 (2014), pp. 182–91CrossRefGoogle Scholar, at p. 182.

2 David Wood, “The Grunts: Damned If They Kill, Damned If They Don't,” Huffington Post, March 18, 2014, projects.huffingtonpost.com/projects/moral-injury/the-grunts.

3 “The consequences of violating one's conscience . . . can be devastating. Responses include overwhelming depression, guilt, and self-medication through alcohol or drugs. Moral injury can lead veterans to feelings of worthlessness, remorse, and despair; they may feel as if they lost their souls in combat and are no longer who they were. Connecting emotionally to others becomes impossible for those trapped inside the walls of such feelings. When the consequences become overwhelming, the only relief may seem to be to leave this life behind.” Brock, Rita Nakashima and Lettini, Gabriella, Soul Repair: Recovering from Moral Injury after War (Boston: Beacon Press, 2013), pp. xvxviGoogle Scholar.

4 Shay, “Moral Injury,” p. 183.

5 As Volunteers of America explains: “Post-traumatic stress disorder is fear-based. Moral injury is based in moral judgment.” “Frequently Asked Questions about Moral Injury,” Volunteers of America, www.voa.org/moralinjury-faq.

6 See table in Shay, “Moral Injury,” p. 185, which is based on BLitz, rett T., Stein, Nathan, Delaney, Eileen, Lebowitz, Leslie, Nash, William P., Silva, Caroline, and Maguen, Shira, “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy,” Clinical Psychology Review 29, no. 8 (December 2009), pp. 695706CrossRefGoogle ScholarPubMed.

7 Nancy Sherman, Afterwar: Healing the Moral Wounds of Our Soldiers (New York: Oxford University Press, 2015), p. xiv.

8 Rothenberg, Daniel, “Field-Based Methods of Research on Human Rights Violations,” Annual Review of Law and Social Science 15 (October 2019), pp. 183203CrossRefGoogle Scholar.

9 The larger research project was designed and managed by the author and focused on violations committed by the regime of Saddam Hussein and the Ba‘ath Party from 1968 to 2003 and by government forces, foreign militaries, militias, and others from 2003, following the U.S.-led invasion of the country, to 2008 when the field research ended. The project trained teams of Iraqis to conduct human rights research throughout the country, documenting massacres, extrajudicial executions, torture, rape and sexual violence, disappearances, and other atrocities.

10 The Iraqi researchers in the study included women and men from diverse backgrounds (Arab Sunni, Arab Shi‘a, Kurds, Christians, etc.), who worked on the project from 5 months to 2½ years and collectively gathered over two thousand first-person testimonies from around the country.

11 The study used the Professional Quality of Life Measure (ProQOL) to assess compassion satisfaction and secondary traumatic stress. The ProQOL is one of the most widely used tools for assessing the positive and negative psychological impact of those who provide professional assistance helping others who have experienced suffering and trauma. See the ProQOL website at proqol.org/.

12 All quotations from the Iraqi researchers are taken from the study conducted by the author and others based on their experiences gathering and analyzing testimonies of fellow Iraqis.

13 The Mukhabarat under Saddam Hussein was the primary state intelligence organization. It was involved in constant surveillance of Iraqis and had offices throughout the country, including many detention centers where torture was systematically committed.

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