Telos of Moral Injury

We are pain and what cures pain,
both.
We are the sweet cold
water and the jar that pours.
I want to hold you close like a lute,
so that we can cry out
with loving.

Would you rather throw stones at a mirror?
I am your mirror and here are the stones.

~Rumi

Goals and Objectives

Therapeuō means not only to heal or cure, thus; the descendant term therapy, it also means to render service to the gods.  For it is the gods, from a mythic and archetypal perspective, that will drive us mad and show us the cure.  Phaedrus tells us “he who, having no touch of the Muses’ madness in his soul, comes to the door and thinks that he will get into the temple by the help of art-he, I say, and his poetry are not admitted” (Plato, trans. 1871). Thus, for Phaedrus, one cannot be cured until one has become mad, in fact, one cannot enter the temple of healing if one has not been touched by madness. It is, as Plato tells us, a divine madness that leads to the cure (Plato, 360).  In a more contemporary context Hillman tells us “myths do not tell us how, they simply give us the invisible background which starts us imagining, questioning, going deeper” (1975, p. 158).

The above mytho-historical understanding of madness and therapy stands in stark contrast to Heidegger’s essay The Question Concerning Technology. Roger Brooke notes that “the medicalization of psychological life is the most pressing aspect of something that is more general and insidious in the field of (clinical) psychology. It is, as Heidegger described in his essay, The question concerning technology, our compulsion to set upon everything in our world with appropriating agendas.”  Further, “it is widely taken for granted that we are here to help patients fix their problems, get rid of their symptoms, become more functional and happier, think more rationally, be more congruent and in touch with their feelings, make better object choices, enjoy sex more, be more individuated, get over their trauma, and work through their grief.”  In short, rather than simply be a witness to someone’s suffering there is a propensity to try and “fix” someone.

In this class we will set aside medicalized modes of diagnoses found in the Diagnostic & Statistical manual and its concomitant treatment modalities such as cognitive behavioral therapy (CBT) and prolonged exposure (PE).  Instead, we will focus on what does it mean to be mad from a mythic perspective.  Why might we go mad from moral injury?  What can be done about it?  Finally, we will examine the telos of this madness initiated by a moral injury, particularly in the context of combat veterans.  Finally, we will explore other traumas that can inflict a moral injury and what the telos of that injury might be.

To do this, we will start with the ancient Greeks and the gods of their mythology.  The stories of these gods and goddesses are told primarily in epic poems.  This should be a not so subtle clue that poetry will play a significant role in our discussions.  As such, poetry should be read more than once, on separate occasions to let the words sink in and make the images manifest.  From these images, meanings become conscious.

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, except as noted in the section below, 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

  • Articulate both the individual and cultural telos of moral injury.
  • Explain the existential gaps in the medicalization of human suffering.
  • A facility to see through conventional medicalized terms and thinking concerning the human condition particularly when it involves psychic trauma.
  • The ability to apply concepts of moral injury to case studies.
  • Gain an appreciation for poetry that highlights moral injury.
  • Articulate and practice the art of witnessing without intervention.

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, six to eight 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 three of three).

Books that need to be purchased:

Hillman, J. (1992/1975). Re-visioning psychology. New York, NY: HarperPerennial.

Johnson, R. (1993). Owning your own shadow: Understanding the dark side of the psyche. New York, NY: HarperOne.

Plutarch. (1936). On Isis and Osiris. In F. C. Babbit (Trans.). Cambridge, MA: Harvard University Press. (Original work published 120)

Szaz, T. (2010/1974). The myth of mental illness: Foundations of a theory of personal conduct. New York, NY: HarperPerennial.

Course Outline

Session 1

“Mental illness is a myth whose function is to disguise and thus render more palatable the bitter ill of moral conflicts in human relations,” (Szaz, p. 156).  Here we examine the very foundations of our medicalized approach to treating mental illness.  This is not a trivial pivot for it calls into question the whole medical model of treating suffering.

Required Reading:

Total reading commitment: 184

Session 2

Phaedrus tells us “he who, having no touch of the Muses’ madness in his soul, comes to the door and thinks that he will get into the temple by the help of art-he, I say, and his poetry are not admitted.”  Thus, for Phaedrus, one cannot be cured until one has become mad, in fact, one cannot enter the temple of healing if one has not been touched by madness. It is, as Plato tells us, a divine madness that leads to the cure (Plato, 360).  In a more contemporary context Hillman tells us “myths do not tell us how, they simply give us the invisible background which starts us imagining, questioning, going deeper” (1975, p. 158).

Required reading:

Total reading commitment: 101

Session 3

“The characteristics of the Warrior in his fullness amount to a total way of life, what the samurai called a do. These characteristics constitute the Warrior Dharma, Ma’at, or Tao, a spiritual or psychological path through life.” (Moore & Gillette).

Required reading:

Total reading commitment: 142

Session 4

If Remembering was situated in Greek goddesses, Re-membering is situated in an Egyptian goddess.  Isis and Osiris’ myth addresses the possibility of forgiveness or redemption from moral injury.  Why Isis and not a Greek god or goddess?  Christine Downing explains that “forgiveness was not a big deal virtue among the Greeks” (Downing, 2018).  Mercy [Compassion] may have some applicability, but she does not forgive nor redeem, moreover compassion for one’s suffering is not the same as redemption from the underlying act, nor is forgiveness.  However, there is redemption available in a reading of the myth of Isis and Osiris.

Required reading:

Total reading commitment: 132

Required Readings

Campbell, J. (2013). Goddesses: Mysteries of the feminine divine (S. Rossi, Ed.). Novato, CA: New World Library.

Frantz, G. (2011). Violence and redemption. Psychological Perspectives, 54:379-381.

Heidegger, M. (2008). The question concerning technology. Basic writings, pp. 307-342. New York, NY: HarperPerennial.

Hesiod. (1972). Theogeny ( R. Lattimore, Trans.). Ann Arbor, MI: The University of Michigan Press. (Original work published 1959)

Hillman, J. (2010) The suffering of salt. Uniform edition of the writings of James Hillman volume 5, pp. 54-81. Putnam, CT: Spring Publications. 

Hillman, J. (1991) A blue fire (T. Moore, Ed.). New York, NY: PerennialHarper (Original work published 1989).

Johnson, R. (1993). Owning your own shadow: Understanding the dark side of the psyche. New York, NY: HarperOne.

Jung, C. G. (1983). The spirit Mercurius (R. F. C. Hull, Trans.). In H. Read et al. (Series Eds.), The collected works of C. G. Jung (Vol. 13, 1st. Paperwork ed., pp. 191–237). Princeton, NJ: Princeton University Press. (Original work published 1942)

Jung, C. G. (1959). The psychological aspects of the Kore (R. F. C. Hull, Trans.). In H. Read et al. (Series Eds.), The collected works of C. G. Jung (Vol. 9i, 2nd ed., pp. 182–206). Princeton, NJ: Princeton University Press. (Original work published 1951).

Lawrence, D. H. (1992). Healing. In R. Bly, J. Hillman, & M. Meade (Eds.), The rag and bone shop of the heart: A poetry anthology (p. 113). New York, NY: HarperCollins Publishers.

Moore, T. & Gillette, D. King, warrior, magician, lover: The archetypes of the mature masculine. New York, NY: HarperCollins.

Pausanias. (1918). Lebadeia & The Oracle of Trophonius. Description of Greece. In W. H. S. Jones and H. A. Omerod (Trans.). London, UK: Loeb Classical Library, William Heinemann Ltd.

Plato. (1871). Phaedrus. In B. Jowett (Trans.). Retrieved from http://classics.mit.edu/Plato/phaedrus.html

Plutarch. (1936). On Isis and Osiris. In F. C. Babbit (Trans.). Cambridge, MA: Harvard University Press. (Original work published 120)

Rilke, R. M.  (1992). Sonnets to Orpheus VIII. In R. Bly, J. Hillman, & M. Meade (Eds.), The rag and bone shop of the heart: A poetry anthology (p. 113). New York, NY: HarperCollins Publishers.

Sanford, J. A. (1995). Fate, love, and ecstasy: Wisdom from the lesser known goddesses of the Greeks. Wilmette, IL: Chiron Publications.

Szaz, T. (2010). The myth of mental illness: Foundations of a theory of personal conduct (original work published 1974). New York, NY: HarperPerennial

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)

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

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.

Heidegger, M. (2013/1971). Poetry, language, thought. In A. Hofstadter (Trans.). : New York NY: Harper Perennial Modern Thought

Hess, H. (1971/1919). If the war goes on. In R. Manheim (Trans.). New York, NY: Farrar, Strauss and Giroux.

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.

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.

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

Meagher, R. & Pryer, D. (2018). War and moral injury: A reader. Eugene, OR: Cascade 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.