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.