Foundations of Moral Injury

Instructor: David L. Fisher, Ph.D.

Note: All readings are available for free by clicking on the links in this syllabus EXCEPT for Dr. Meagher’s book, as the full book is used. Please purchase a copy of his book by clicking this link or finding it at your favorite bookseller.

Goals and Objectives

This class explores the question, “What is moral injury?”  The examination of this topic is interdisciplinary as there are many conceptual models of moral injury.  Peter Marin (1981), speaking of the Vietnam war veterans’ experience expressed it thusly: “the unacknowledged source of much of the vets’ pain and anger: profound moral distress, arising from the realization that one has committed acts with real and terrible consequences, (1981, p. 68).  However, the concept of moral injury is not just a contemporary mode of thinking about the consequences of war or other traumatic events in human affairs.  Homer (trans. 1996) said:

Now you are burnt out husks, your spirits haggard, sere,

Always brooding over your wanderings long and hard,

Your hearts never lifting any joy—you’ve suffered far too much (10:502).

Here we have two descriptions of moral injury separated by 2,600 years from two different modalities of thinking.  In contemporary terms, it has often been applied to combat veterans, though this seems to be a delimitation of researchers and practitioners, not theory.

As noted in the opening paragraph, moral injury is an interdisciplinary epistemology.  As such, the course readings cross different milieu, disciplines, and genres while staying grounded in the traditions of depth psychology.  In order to ‘see through’ language to get to the lived experience of moral injury, we will start by challenging Descartes’ ontology that is taken for granted by our language, expressed as, if you will, a Cartesian, dualistic split: mind-body, experience-behavior, inner-outer, truth-fantasy: in the spirit of C. G. Jung we pivot to ‘psychic reality is reality.’  Our examination gives primacy to the lived experience outside of medicalizing labels, for example: “I’m feeling blue today” conveys a completely different phenomenological experience than “today I have an adjustment disorder with mixed anxiety and depressed mood.”

As the title suggests, this course is designed to lay the foundation of thought concerning moral injury: it is not focused on specific populations of people, nor is it a practicum.  Rather, it provides the philosophical, theological, and psychological basis of morality and explores what happens to the human psyche when those moral tenets are violated in some way.  That said, this course does insinuate the language of morality into the psychological discourse, particularly when it comes to violence and war.

Methodology, Objectives, and Evaluation

The course is composed of required reading, recommended reading, lecture, and small group discussion.  The Socratic method will be used to guide discussions and challenge all participants’ understanding of the material.  The student/practitioner is expected to have read required readings before each session; a complete understanding of each reading is not required, nor expected, but the student/practitioner should arrive with questions or thoughts stimulated by the readings.  These questions and thoughts can take the form of requests for clarity, amplification, or challenge. 

Recommended readings expand the epistemological grounding of the topic.  Depending upon the interests of the student/practitioner these provide a ready-made reference for further learning focused on their interests.  While not required, some allusion to recommended reading content will inform certain lecture components.

We will meet four times in three-hour sessions.  The sessions are held every two weeks to give participants the chance to prepare for the session and complete the readings.

All readings, with the exception of one book, will be available as PDFs for download by registered attendees.  There is also a list of books with links to Amazon on the Moral Injury Institute website if you choose to purchase the full book(s).  Full disclosure, these are affiliate links that provide a small commission to the Institute to help fund ongoing operations and keep the price of classes low.

Objectives

  • Ability to articulate a cogent description of moral injury.
  • A grounding in the philosophical, theological, and psychological literature of moral injury.
  • A facility to see through conventional medicalized terms and thinking concerning the human condition particularly when it involves psychic trauma.
  • Be able to synthesize a definition of moral injury through the lenses of philosophy, theology, and psychology.
  • The ability to apply concepts of moral injury to case studies.
  • Differentiate between medical and moral injury languages as they apply to the human condition.

Evaluation

  • Course attendance: miss no more than one three-hour block, or three hours over the course. 
  • Class participation: students are expected to participate in class to the best of their ability and comfort.  It is understood that some students are more comfortable speaking in a group than others.  The rubric is not one of domination of discourse, but thoughtful participation that demonstrates a facility of the readings and lecture content.
  • A written, two-page evaluation of a case study applying the discourse of moral injury.  No formal style need be followed (such as APA, Chicago, or MLA) but the student/practitioner should indicate through citation, footnote, or other device that they are quoting or paraphrasing others’ writing or thinking.  The paper should be double spaced, use a 12 point font, and have one inch margins all around.  A specific font is not required, but should be easily readable (no specialty fonts). This paper will be graded on a pass/fail basis.  The evaluation rubric is delineated below:
    • Pass: demonstrates knowledge of the language and writings of moral injury; cites at least four readings/references; demonstrates practical application to a case study.
    • Fail: fails to turn in paper within 7 days of the last class; demonstrates no or a misapplication of the language or writings of moral injury; fails to cite the work of others (plagiarizes); fails to demonstrate connection between moral injury and case study.
  • Students/practitioners must achieve a pass on the final paper, meet attendance requirements, and participate in class in order to receive credit for class leading to the Certificate in Moral Injury (this is class one of three).

Course Outline

Session One

Robert Johnson says, “feeling is the ability to value…to feel is the sublime art of having a value structure and a sense of meaning—where one belongs,” (1989, p. 32).  In this session, we will explore Western philosophical and theological understanding of what it means to be a moral human in this world.  Note that the theological readings for this session are not meant to endorse any religion or creed, but rather to show how deeply rooted the idea of morality is in Western theologies and culture.

Required Reading:

Total required reading commitment: 105 pages.

Questions to guide your thinking:

  • What is morality?
  • Why do we need rules on what defines a morally just war?
  • How do we know moral injury when we see it?

Session Two

A Vietnam combat officer asks, “Can you imagine sipping tea in a man’s living room while you pay him for killing his child” (Schroeder & Dawe, 2007, p. 157)?  This session is about how moral injury has been expressed throughout the ages, particularly in the arts of poetry and theater. We will pay attention to how philosophy, theology, and poetry align to tell the same stories about morality, particularly regarding war and its combatants.

Required Reading:

Total required reading commitment: 107 pages.

Questions to guide your thinking:

  • Is peace the opposite of war?
  • In what ways have you gone to war?
  • What do warrior poets reveal about war and its aftermath?

Session Three

“Here, Bullet, here is where I complete the word you bring hissing through the air” (Turner, 2005). This fragment of a poem exemplifies the existential angst of the warrior post combat.  This session we make a turn towards the warrior and poet (or in many cases, the warrior poet).  We continue to explore Heidegger’s thinking on poetry and how it applies to the phenomenology of war.

Required Reading:

Total required reading commitment: 91 pages.

Questions to guide your thinking:

  • Do poets have something to say about the aftermath of war?
  • Can you have morality derived from just theology or philosophy, or is morality a mix of various ways of thinking?
  • Why might governments not want to talk too much about the reality of war and its effect on those who fight them?

Session Four

In our final session, “the supposed gloriousness of battle and death is juxtaposed with the reality of those fighting and dying. This highlights, as James Hillman (2004) would put it, a terrible love of war.  There is Eros, a chance at transcendent glory and eroticism all mixed with the brutal reality of the violence and horror on the field of battle.  Psychologically, in the aftermath of combat, the warrior often needs to come to terms with this paradox of eroticism and brutality, of Ares and Aphrodite” (Fisher, 2018).

Total required reading commitment: 92 pages.

Questions to guide your thinking:

  • Does PTSD accurately describe what happens to some veterans?
  • Is moral injury confined just to people who have gone to war?
  • What does it take to heal from moral injury?

Required Readings

Alexander, D. W. (2018). Gregory is my friend. War and moral injury: A reader (R. Meagher & D. Pryer, Eds.), 197-207. Eugene, OR: Cascade Books.

Barks, C. (1993). Becoming Milton. The rag and bone shop of the heart, 81-82. In R. Bly, J. Hillman & M. Meade (Eds.). New York, NY: Harper Perennial.

Benton, W. (1941). Summary of the distance between the bomber and the objective. Retrieved from https://www.poetryfoundation.org/poetrymagazine/browse?contentId=23051

Catholic Church. (2000). Catechism of the Catholic church (2nd ed.). United States Conference of Catholic Bishops: Washington, DC.

Heidegger, M. (2013/1971). The thinker as poet. Poetry, language, thought, 1-14. In A. Hofstadter (Trans.). : New York NY: Harper Perennial Modern Thought

Heidegger, M. (2013/1971). What are poets for? Poetry, language, thought, 87-141. In A. Hofstadter (Trans.). New York NY: Harper Perennial Modern Thought.

Hernandez, M. (1993). War. The rag and bone shop of the heart, 68. In R. Bly, J. Hillman & M. Meade (Eds.). New York, NY: Harper Perennial.

Hess, H. (1971/1919). Thou shalt not kill. If the war goes on, 123-127. In R. Manheim (Trans.). New York, NY: Farrar, Strauss and Giroux.

James, W. (2011). The moral equivalent of war. Worcestershire, UK: Read Books. (Original work published 1910).

Johnson, R. (1989). Chastity. He [revised edition]: Understanding masculine psychology, 31-42. New York, NY: Harper Perennial.

King, N. (1942). Ode to the full moon during an alert.” Retrieved from http://www.warpoetry.co.uk/2nd_WW.html.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 696–706

Meagher, R. E. (2014). Killing from the inside out: Moral injury and just war. Eugene, OR: Cascade Books

Marin, P. (1981, November). Living in moral pain. Psychology Today, 68–80.

Mason, S. (1986). After the reading of the names. Johnny’s song, 132-33. New York, NY: Simon & Schuster.

Neumann, E. (1990). The new ethic. Depth psychology and a new ethic, 76-100. Boston, MA: Shambahala Press.

Pryer, D. (2018). What we don’t talk about when we talk about war. War and moral injury: A reader (R. Meagher & D. Pryer, Eds.), 60-73. Eugene, OR: Cascade Books.

Radnoti, M. (1993). Postcard. The rag and bone shop of the heart, 73. In R. Bly, J. Hillman & M. Meade (Eds.). New York, NY: Harper Perennial.

Rios, M. (2018). The glue is still drying. War and moral injury: A reader (R. Meagher & D. Pryer, Eds.), 83-94. Eugene, OR: Cascade Books

Rosenberg, I. (1998). The immortals. In D. Roberts (Ed.), Out in the dark: Poetry of the first world war (p. 146). Bishops Close, Hurst, West Sussex, UK: Saxon Books. (Original work published 1917)

Sgarzi, J. A. (2009). Healing a warrior world. Spring, 81, 243–263.

Shay (2002). Odysseus in America: Combat trauma and the trials of homecoming. Scribner: New York, NY.

Shay (2014). Moral injury. Psychoanalytic psychology, 31(2), 182-91.

Tick, E. (2018). Military service, moral injury, and spiritual wounding. War and moral injury: A reader (R. Meagher & D. Pryer, Eds.), 307-16. Eugene, OR: Cascade Books.

Turner, B. (2005). Here bullet. Retrieved from http://www.poetryinternationalweb.net/pi/site/poem/item/14245/auto/0/0/Brian-Turner/HERE-BULLET

Vernede, R. E. (1998). A listening post. In D. Roberts (Ed.), Out in the dark: Poetry of the first world war (p. 107). Bishops Close, Hurst, West Sussex, UK: Saxon Books. (Original work published 1917)

Recommended Readings

Aquinas, T. (1948). Summa theologica (Fathers of the English Dominican Province, Trans.). Benzinger Bros.: New York, NY. (Original work published 1485)

Augustine, Saint, Bishop of Hippo. (2009). The city of god (M. Dods, G. W. Glenluce, & J. J. Smith, Trans.). Hendrickson Publishers: Peabody, MA. (Original work published 426)

Crane, S. (1979/1885). The red badge of courage: an episode of the American civil war. In H. Binder (Ed.). New York, NY: Avon.

Fisher, D. (2018). Dulce et decorum est: Moral injury in the poetry of combat veterans (Doctoral dissertation).  Retrieved from https://www.worldcat.org/title/dulce-et-decorum-est-moral-injury-in-the-poetry-of-combat-veterans/oclc/1097193120. Carpinteria, CA: Pacifica Graduate Institute.

Hedges, C. (2003). War is a force that gives us meaning. New York, NY: Anchor Books:

Hillman, J. (2004). A terrible love of war. Penguin Books: New York, NY.

Homer. (1996). The odyssey. In R. Fagles, (Trans. ). New York, NY: Penguin Books.

Puetz, T. (2014). Secret choices. Page, AZ: Dragon Tale Books.

Remarque, E. M. (2013/1930). The road back: A novel. New York, NY: Random House.

Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. New York, NY: Scribner.

Shay, J. (2002). Odysseus in America: Combat trauma and the trials of homecoming. New York, NY:Scribner.

Tick, E. (2005). War and the soul: Healing our nation’s veterans from post-traumatic stress disorder. Wheaton, IL: Quest Books Theosophical Publishing House.

Tick, E. (2014). Warrior’s return: Restoring the soul after war. Boulder, CO: Sounds True.

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