In my previous post a few days ago, I mention a range of emerging research in moral injury. I think this field may be quite important for expanding the field of reflection in theological ethics, but I’ll be getting to that a bit later. I wanted to dwell for a moment on a phenomena that I’ve observed in the literature which points at a hazard in interdisciplinary research that is well worth our attention, particularly for scholars who are working across humanities / science / social-science boundaries like I often am.

In working with the category of moral injury, and also more broadly around trauma studies, I’ve noted a desire by activists (with whom I have much common cause) to make the condition as broadly applicable as possible. You can see this in the claims that all persons living in our societies experience moral injury and trauma as a result of our enclosure and oppression in neoliberal societies. This is a difficult challenge for humanists interfacing with trauma studies, particularly if your scholarly reflection doesn’t touch down on personal experience with the condition you’re probing and appropriating for wider reflection. And indeed, I’ve seen this work out in much broader engagement with scientific concepts, around ecological concepts, biological theories of evolution, cognition in other-than-human animals and plants.

There is something about these concepts which can be uniquely compelling – they draw us in and provide a catalyst for thinking and reflecting on a context where we want to sharpen the focus of our audiences. In some ways, it might be said that they can serve as generative metaphors, opening up new kinds of expansive or transitive thought. But the conceptual origins of generative metaphors can be various – a concept can be porous, open ended or expansive from the start. Some concepts arise from material conditions which are quite specific and can be defined forensically. Of course, some of these forensic definitions can themselves carry a level of construction and fiction, to be fair. This all relates to the different possible characteristics of a source domain, and the ways that we interface with those different characteristics. I’ve noticed a particular appetite in writing about forms of crisis and mental distress (perhaps arising from the intellectual structures of psychoanalysis) to work expansively with categories of distress and situate them in all of our everyday lives. I’ve also noticed sharply negative reactions from those persons who experience these conditions in the sharp form as a form of oppression. This can be seen in the push-back against more expansive understandings of autism and neurodivergence, shown in the expression of fears that mainstreaming concepts will lead to an erosion of social and biomedical support for those who have meaningful high support needs. In a similar way, I’ve seen fears that appropriation of concepts of trauma may lead to an erosion of understanding trauma as an exceptional situation. Do we all experience trauma? I don’t really think so, actually. We all experience hardship, perhaps even some levels of suffering, but to use the word “trauma” to define these situations which already have other terms (which perhaps we have become desensitised to) does indeed risk, I think, a diversion of attention. Speaking about forms of trauma which are disabling can suddenly provide difficult when the background context of conversation assumes that everyone is experiencing and attempting to surmount these matters.

There’s a risk that reacting negatively to these forms of generalisation and appropriation of the metaphors of trauma can work in service to forms of positivism. In a desire to bring a rejoinder, we can reach for tools which offer specificity, e.g. DSM diagnostic pathways, and other features of contemporary experimental psychological research. But is this the right kind of specificity? And is reaching in this way, e.g. as a valorous gatekeeper, the right way to do this? I don’t think so. There are forms of specification which can draw us deeper into personalising our accounts of suffering and oppression, though these are hard to do as they require levels of disclosure and communication. There are also ways of doing this work which adds further texture to our accounts of the everyday. It may also be important for us to work with more highly specified theodicies – avoiding lazy characterisations of evil which use broad brushstrokes or work in overly encompassing ways. That’s not to say that we shouldn’t use the category of evil, but that we need to really unpack what we mean and how that applies. It’s also possible that, looking to the broader interdisciplinary working category, that some attention to forms of source domain for our metaphors may reveal that there are concepts which commend and even advertise themseves as supportive of broader appropriation, which might serve the cause of justice by being more widely deployed. Similarly, it’s equally possible that we may need to proceed more sensitively and carefully in our use of concepts. This is especially difficult, I think, for scholars who are personally experiencing oppression or suffering for the first time as this initial experience can carry such sharpness (given the lack of background to provide a sense of bas relief) that we can lose the ability to determine whether our appropriations are inappropriate. For this, I think, we need to rely on more experienced hands – and perhaps not just human ones.

 

If we approach something like moral injury or complex PTSD less in terms of a forensically defined diagnostic pathway, and more as a metaphor which can be more freely appropriated, we can sometimes lose the ability to define thresholds of experience, that is, when a person experiences the phenomenon without the persistent experience of bodily harm or a certain level of oppression which proves disabling

About 20 years ago, psychologists working with returning war veterans noticed that many solidiers carried the symptoms of PTSD, but lacked the kinds of specific acute episodes of embodied trauma and injury that serve as catalysts for this condition. The triggering event which they uncovered was that those soldiers had experienced a situation in which they were instructed to violate their own moral code, to prosecute torture, to engage in what they knew to be immoral, or at best morally ambiguous killing of civilians, and so forth. As Willie Jennings suggests,

The idea of moral injury powerfully articulated in the writings of psychotherapist Jonathan Shay has emerged in recent years as a crucial hermeneutic for understanding the tortured memory work of war veterans, trying to come to terms with having transgressed their moral beliefs. How does one negotiate life after transgressing, not simply a moral principle, but the coherence of a moral universe? Moral injury occurs when the fabric that holds moral agency and the self together are torn asunder. (From War Bodies: Remembering Bodies in a Time of War, in Arel and Rambo (eds.), Post-Traumatic Public Theology, p. 23-24)

This has been written up and developed into clinical diagnostic categories and pathways for treatment in subsequent research (see for example Litz et al, 2009). It has also been the case that researchers have begun to find applicability for this concept in other “battlefields,” identifying instances of moral injury as in teaching professions, where teachers are given orders to practice substandard, or even harmful forms of pedagogy, and in the health services, when doctors and nurses are told they must triage or mitigate care in ways that they know will cause harm to individuals who are suffering. This hit quite close to home when I discovered that my own colleagues have studied instances of moral injury as it has occurred in British Universities as a result of neo-liberal pressures to raise revenue and keep xenophobic government ministers happy.

I have experienced this kind of situation where you find yourself “under orders” which generate levels of uncomfortable, what might even be considered oppressive levels of cognitive dissonance. And it’s worth noting that these forms of hierarchy can be quite covert, not looking on the outside like the command and control structures that we might expect, veering towards more subtly coercive forms of control. In some of these cases, many of us in contemporary Universities have felt a burden to express care in the context of professional practice and found that it is forbidden, even pathologised and shamed. From converstions with peers, this experience is not ubiquitous, but is nonetheless widely experienced among practitioners in education, health care, social work and military service. This is likely why professionals are leaving those fields in record numbers.

Though this phenomenon is experienced widely, it does not always pass the threshold of psychological burden into the experience of trauma. There are some persons who experience the kind of cognitive dissonance I am describing here who can set it to one side and carry on, feeling forms of discomfort which do not rise to embodied experiences of trauma. But there are also impacts that can be particularly sharp for some people, reaching levels which are disabling.

This phenomenon was observed much earler as well by a research team led by the philosopher and anthropologist Gregory Bateson. In what they called the “double bind” phenomena, Bateson and his collaborators observed that people may experience trama when they are subjected to conflicting orders, particularly when the mismatch between them is not presented as straight-forward disagreement but may be a sort of control without obvious coercion (outlined in Steps Towards an Ecology of Mind, pp. 271-278). It’s important to note that Bateson’s work was in relation to attempts to define and understand schizophrenia, wihch in the 1950-60s when he was conducting this research, had a much wider field of concern – encompassing a wide range of what might now be considered mental health disorders or other forms of neurodivergence. Contemporary experimental psychology can work towards diagnostic criteria that are almost incomprehensibly nuanced, with sub-genres of sub-genres seemingly distinguished on the basis of arbitrary traits. In contrast, research before the DSM could sometimes be almost incomprehensibly comprehensive. Bateson goes so far as to suggest that this research into the underlying epistemological “tangles” which represent the “double bind” is “transcontextual,” pertaining to a “genus of syndromes which are not conventionally regarded as pathological” (272). That is, something very much resembling moral injury lies at the heart of schizophrenia, what he calls elsewhere “the mental description of schizophrenia” (Bateson, 1977, Afterword).

The reason that I highlight this wider context from earlier research is that I’m particularly mindful of the ways that in the 1960s, the diagnostic category of schizophrenia included autism, which was then considered a form of male juvenile schizophrenia. While I’d sharply disagree (and most experimental psychologists would likely as well) with Bateson’s underlying conclusions about habits, behaviour and rigidity, there are many ways that we can redefine his premises whilst holding on to their descriptive power. What I’m getting at here, which I’ve already hinted at above, is my sense that Bateson’s team had grasped an insight which more recent moral injury research is only just starting to return to, that the “double bind” can be uniquely oppressive for neurodivergent persons, particularly with forms of autistic cognition that are sometimes described as monotropic, more pathologically as “rigid” in the DSM, or more recently (and astutely) as being oriented around cognitive inertia and flow states.

There are some caveats I need to apply here briefly before explaining why I think autistic cognition might tie into a higher level of vulnerability towards moral injury trauma. It is important to note that the tendency towards ritual and routine (which has been ruthlessly pathologised by psychiatry), e.g. rule generation and rule following, can be seen as a secondary condition, an attempt to create order in chaos and soothing for persons experiencing trauma. Are untraumatised autistic individuals as likely to pursue rules with rigidity? In a similar way, as I’ve noted elsewhere, the experience of being constantly misunderstood (e.g. the double empathy problem) can lead to a person being more methodical as a necessity in pursing communication with different others. So we can see ways that rigidity and rule-orientations are a necessary form of trying to maintain relationship and connection with others in a world which is semiotically and sensorially traumatising in complex ways and where other forms of thought and communication are persistently privileged.

But with those caveats established, I do nonetheless think that there are ways that autistic cognition, at least in my own experience, does revolve around being value oriented in sometimes more persistent ways. This has been noted in research which attributes higher than average orientations towards justice and lower-than average rates of crime among autistic individuals. And there are anecdotal versions of this, which have been relentlessly pathologised in contemporary television and film with characters “sticking to their guns” to unusual levels. The point is that this basic orientation may render us more succeptible to the forms of trauma which are latent in moral injury. It’s interesting to me to note that Bateson and his team seems to have picked this up quite early in their research, which hasn’t really been returned to in psychology of moral injury.

 

Works Mentioned:

Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 1994)

Brett T. Litz, Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva, and Shira Maguen (2009) “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy,” Clinical Psychology Review, vol. 29, no. 8, 695–706.

Matthew R Broome, Jamila Rodrigues, Rosa Ritunnano and Clara Humpston, “Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice” in Clinical Ethics (2023): doi: 10.1177/14777509231208361.