Is co-construction an answer to moral injury?
The panel discussion at the 2023 Hero’s Journey Symposium in Washington, CD considered perspectives of psychologists, researchers, and veterans on the creation of “better pathways from wounds to wellness.” The panel reviewed the history and trajectory of moral injury as a construct of mental health. The construct was initially used with combat veterans, but has more recently been considered as a meaningful way to view troubling experiences of others, including frontline health care workers during the COVID-19 pandemic. Although moral injury has been discussed as a syndrome, it does not have status as a formalized mental health diagnosis—and there remains a division of opinion as to whether it should. That question was one of several considered by the moral injury panel, which also looked at activism among veterans, and media portrayal of mental health issues as part of the communication environment in which public perceptions of moral injury are taking shape.
The Hero’s Journey Symposium series was initiated by Mary Lowe Mayhugh, a retired US Army Colonel who lost her son John to suicide ( https://johnpmayhugh.org/about-us. ). Among other goals, the Foundation seeks to change the national narrative about “brain health” to a more holistic model, with more sensitivity to the stigma that is associated with currently prevalent models of counseling, treatment, and recovery.
The 2023 panel on moral injury was facilitated by Kathleen Koch, a former CNN news correspondent who has subsequently created the LeadersLink Foundation to help elected officials learn from responses to disasters such as hurricanes, earthquakes, and floods (http://www.kathleenkoch.com/about.aspx).
Panelists were chosen to reflect direct perspectives of moral injury by veterans, as well as members of the clinical and academic communities who have been working with the syndrome.
Representing the veterans’ perspective was Timothy (“Tito”) Torres, an Army special forces officer who founded and serves as Executive Director of the Moral Compass Federation (https://www.moralcompassfederation.org/).
The US Department of Veterans Affairs (VA) was represented by Dr. Melissa Smigelsky, Ph.D, and Dr. Jason Nieuwsma, Ph.D, both with the VA Integrative Mental Health program of the Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC). The goal of the VA MIRECC organizations is to advance practice through public dissemination of VA-funded research ( https://www.mirecc.va.gov/).
The academic perspective was represented by Barton D. Buechner, PhD, a Senior Adjunct Faculty member with the Military Psychology MA Program Adler University ( https://www.adler.edu/program/psychology-specialization-in-military-psychology-online/) and a founding member of the CMM Institute for Personal and Social Evolution.
The make-up of this panel offered an inter-disciplinary approach to understanding and addressing moral injury along with some diversity of opinion as to the best courses of action for addressing moral injury; especially when considered in the context of current programs designed to treat Posttraumatic Stress Disorder (PTSD) as a codified form of mental illness.
Despite the diversity, some areas of “yes-and” agreement did emerge:
- Moral injury should not be turned into another medical-model mental disorder.
- The root causes of moral injury can include different forms of betrayal by others in authority and while it can be experienced as a source of personal shame and guilt, it is more commonly a source for anger.
- Co-construction of a new reality (with caring others) was mentioned frequently by all panelists as a more productive way of helping those experiencing moral injury.
- There are already some promising therapeutic methods (Acceptance and Commitment Therapy and Adaptive Disclosure) that are considered particularly well suited to addressing the underlying causes of moral injury as well as productive responses. (CMM has not directly been applied to these therapies, but all have a component of social constructionist thought as their guiding premise).
- Veterans and the general public have not yet become fully aware of the definition and significance of moral injury. We all need to become more attuned to it, as it may hold a key to the evolution of a more just and equitable social infrastructure (possibly refreshing outdated institutions, practices, and mental models).
Segments of the 2023 Hero’s Journey Symposium—including this panel—will be shared on Howard University Public Broadcast Programing during the year. We will report on this and provide links in future editions of the CMMI Newsletter.