Adequately theorizing the role of morality in moral distress is crucial for understanding what
‘moral injury’ entails. When questions about the complex nature of morality go unaddressed, unsubstantiated assumptions about trauma’s moral dimensions and its implications are easily incorporated, leading to the risk of complex issues being approached reductively. In the current concept, the general idea is that moral injury is the result of an act that violates a soldier’s beliefs about right and wrong (e.g. Litz et al. 2009, Drescher et al. 2011, Nash et al. 2013, Vargas et al. 2013, Currier et al. 2015). The concept speaks of violations of one’s ‘deeply held moral belief and expectations’ (Litz et al. 2009), and a resultant ‘loss of trust in previously deeply held beliefs about one’s own or others’ ability to keep our shared moral covenant’
(Nash and Litz 2013, p. 368, see also Farnsworth et al. 2014, Litz et al. 2015, Frankfurt and Frazier 2016). A person’s moral beliefs are thus understood as a coherent system of values that may be violated by intruding acts. Yet, no consideration is given to the possibility of values being in conflict with one another (see also Molendijk et al. 2018). This implicit approach to moral beliefs as a harmonious unity gives rise to questions when considered from the perspectives of philosophical and social scientific studies. An important insight drawn from these disciplines is that an individual embodies multiple and potentially competing moral beliefs and assumptions (e.g. Williams 1973, Baarda and Verweij 2006, Zigon 2008, Hitlin and Vaisey 2013, McConnell 2014, Tessman 2014). In this section, I will discuss this issue and its implications in more detail.
A person’s moral beliefs and expectations are essentially both personal and social (Bandura 1991, Haidt and Joseph 2004). While specific moral beliefs and expectations may differ in people, they do not develop in a social vacuum. Individuals develop them through the socialization process of becoming members of a community. The community provides assumptions and meanings through which they understand their experience and make moral judgments about what is acceptable and unacceptable conduct, creating a moral compass that guides their actions (cf. Bandura 1991, Haidt and Joseph 2004, Zigon 2008, Hitlin and Vaisey 2013). Childhood constitutes an important period of moral socialization, yet the process of internalizing moral beliefs and expectations never stops. Interacting with others – including parents, friends, communities and social institutions – an individual continuously elaborates and alters acquired values and norms, and adopts new ones (cf. Van Gennep 1909, Bandura 1991, Eriksen 2001, Zigon 2008).
So, whereas some moral concerns may be found world-wide (Haidt and Joseph 2004, Cassaniti and Hickman 2014), morality is ‘thick’, meaning that values and norms are shaped by their specific sociohistorical context (Walzer 1994). An individual’s moral beliefs are developed with reference to the different groups of which he is a member, such as religious groups, generational distinctions and organizations. Accordingly, morality can both serve as a glue binding groups together and be a source of conflict between groups (Zigon 2007, 2008, Hitlin and Vaisey 2013). Moreover, conflict may arise within the individual. A person lives and acts on a daily basis, within a range of social levels (e.g. group, organization, nation) and a
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Part I Setting the Stage Chapter 2 Toward a Broader Theoretical Approach to Moral Distress
range of social contexts (e.g. different ethnic cultures, professional cultures) (see e.g. Eriksen 2001, Hanna 2004, Baarda and Verweij 2006). As a result, rather than owning an orderly and harmonious system of values, a person embodies multiple moral commitments, which at times make conflicting demands, creating tensions that need to be managed (Hanna 2004, Baarda and Verweij 2006, Laidlaw 2014, McConnell 2014, Tessman 2014).
Managing moral tensions is not a rational endeavor, like solving brainteasers. Only in laboratory experiments with hypothetical situations could one come close to a situation where people approach moral issues as abstract puzzles. In practice, people’s judgments are not merely governed by formal reasoning, which rationally weighs all relevant values one against one the other, but also by deeply felt emotions. Anger, disgust, shame and compassion, to name but a few, inform moral perceptions and decisions (see e.g. Haidt 2001, Skoe et al. 2002, Harris 2003, De Graaff et al. 2014). Furthermore, the specific social context plays an important role. Experiments by Milgram (1974) and Zimbardo (2008) provide perhaps the most notorious reminders of this. Their experiments showed that when people are placed in situations with particular group dynamics, social pressures and power relations, they may more readily engage in behavior they would otherwise consider immoral.4 Of course, these experiments were radical and extreme, and in some respects their direct applicability to real-life situations may be questionable (e.g. Banuazizi and Movahedi 1975). Nevertheless, by creating these extreme circumstances, the experiments made apparent what is often not so obvious: people’s moral standards and behaviors are to an important extent shaped by context and the social roles people assume in this context (e.g. Bandura 1991, Hanna 2004).
This means that the same people may adopt different moral standards in different contexts.
In the case of soldiers, the values and norms they follow on deployment may not be the same as those they abide by in civilian settings.
Morality, in short, comprises rational and emotional dimensions of social life, and as such is multilayered and fragmented. At the same time, people are generally unaware of this.
Moral beliefs can be best understood as embodied dispositions which people usually enact without thinking out beforehand (Zigon 2008). This is not to suggest that moral decisions are based on nothing, but rather that they are not primarily the result of reflection. Accordingly, people are generally unaware of having multiple, potentially competing moral beliefs.
They live their lives without constantly experiencing conflict by which they maintain, as Ewing (1990) called it, an ‘illusion of wholeness’. They tend to think of themselves in terms of completeness, coherence and consistency, not in terms of fragmented, shifting selves (Ewing 1990, Zigon 2008).
In line with this, people’s explanations of their behavior are often judgments made in hindsight. These are often, at least partially, post-hoc rationalizations rather than completely accurate reflections of what occurred at the moment (Haidt 2001, Tessman 2014). Usually, people only come up with reasoned arguments when they become aware of an inconsistency in their moral judgment, either because the inconsistency generates discomfort (Haidt
4 In the Milgram experiment, participants were ordered to administer what seemed to be agonizing dangerous electric shocks to whom they thought were other voluntary participants; many did (Milgram 1974). In Zimbardo’s Stanford experiment, participants were placed in a situation with strongly asymmetric power relations; some participants were made prisoners, others were made guards. Many ‘guards’ resorted to disrespectful and even sadistic behavior toward the
‘prisoners’ (Zimbardo 2008).
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Chapter 2 Toward a Broader Theoretical Approach to Moral DistressPart I Setting the Stage
2001, Tsang 2002) or because anticipated criticism by others raises the need for justification (Billig 1996, Haidt 2001). In any case, both ad-hoc and post-hoc interpretations are ways in which people eventually come to understand the situation in which they were involved and the role they played in this situation. Organizing and structuring memories into meaningful narratives enables people to make sense of their experiences. As such, the stories that people construct of their experiences become personal truths of what they have seen and done (cf.
Kleinman 1988, Good 1994, Haidt 2001, Molendijk et al. 2016).
To turn back to the issue of competing moral commitments, these are most obvious in moral dilemmas. To begin with, let me give an example that soldiers joked about in an ethics course I observed. They sketched a scenario in which a soldier’s girlfriend asks for his opinion of her trendy flower-printed jeans. As her boyfriend, the soldier does not want to hurt her, but as his mother’s son, he does not want to lie. Hence, he is confronted by a dilemma.
While this example was meant as a joke, it well illustrates that everyone embodies multiple moral commitments and that everyone encounters numerous moral dilemmas every day, often without being aware of it. Moreover, it demonstrates that a moral conflict does not necessarily engender disturbance or distress.
That said, a soldier’s world constitutes pre-eminent conditions for moral conflicts that do engender serious distress. Soldiers may have to use and witness violence in dangerous circumstances. While they are instruments of the state who must adhere to political norms and legal rules, they also remain moral agents with personal values (Baarda and Verweij 2006). Even when they agree with all they are ordered to do, they remain members of a society which makes violence taboo (cf. Grossman 1995). Given that soldiers hold multiple moral commitments in the context of war and violence, it is not hard to imagine that they may experience distressing moral conflicts. In extreme cases, they may face tragic dilemmas which force them to choose between two evils, leaving them inevitably with ‘dirty hands’, no matter their choice (e.g. Walzer 1973, Baarda and Verweij 2006, Parrish 2007, Blattberg 2015).
What is the psychological impact of tragic dilemmas and other morally critical situations?
The literature on this topic provides no clear answers. Philosophers have predominantly discussed the topic in normative debates on ethics, and the specific psychological impact of these acts has therefore not been their main concern (Walzer 1973, Williams 1973, Marcus 1980, Wijze 2005, 2012, Tessman 2014). However, when desiring to understand moral distress, it seems that precisely this is necessary: to examine in depth how people experience and are affected by tragic dilemmas and other moral quandaries. The concept of moral injury does attend to the psychological experience of moral quandaries, but the problem is that this concept tends to approach a person’s moral beliefs as a harmonious unity. Instead, drawing on the abovementioned insights, this study considers that a person’s moral beliefs constitute a complex total of multiple, potentially competing values. As the following chapters will make clear, morally distressing experiences are often more complicated than clear-cut transgressions, and, accordingly, moral distress is more complicated than unequivocal feelings of guilt and shame.
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Part I Setting the Stage Chapter 2 Toward a Broader Theoretical Approach to Moral Distress