Thoughts from the ICMI Annual Conference, 7-9 April in Durham, UK

Envisioning and Exploring Recovery from Moral Injury

A couple of weeks ago, I had the privilege of presenting and attending the International Centre for Moral Injury’s Annual Conference. This is the second year I’ve attended. In addition to enjoying the city of Durham and the University, I find so much meaning in learning from an international community of professionals, scholars, and genuinely wonderful people. The moral injury community is unlike any other professional community I’ve been part of. There isn’t a need to withhold research or information. Instead, there is a deep appreciation for others’ work and there is a spirit of mutual care and support! I think this is true because most if not all have had their lives affected by moral injury. The work we do is to heal others and to heal ourselves. Knowing this, it is easy to celebrate the moral agency of others and have deep gratitude for how they share their work so freely.

This year’s conference focused on approaches to repair. Even though the concept of moral injury has existed for over 30 years, it is still relatively unknown. While there is plenty of descriptive work that defines the problem of moral injury, greater attention is being given to how we recover and heal from it. The following are some of the takeaways I took from the conference.

In a data-driven world, moral injury and repair is driven by people’s narratives. I certainly appreciate empirical research and evidence-based methods of tending to people’s well being. I do think, however, the pendulum has swung to far in this direction. Presenters at the conference were utilizing data-driven tools, but common across all of them was the importance of narrative that identifies moral injury and what healing looks like. What this fundamentally signals is that moral injury and pathways to repair are fundamentally rooted in people’s narrative and must be the focus.

I was intrigued by the Church of England use of National Safeguarding and initiatives that emerge out of it on behalf of victims of sexual abuse. There is so much more I need to learn, but safeguarding is something that doesn’t exist within religious institutions in the United States. Safeguarding standards prioritize care and the narratives of survivors of sexual abuse. Co-production, where survivors are given a voice and actively participate in institutional repair with church leaders, and has led to the development of these standards. (Note: Text in italics is a correction - much thanks to Ioannis Athanasiou, Partnerships and Engagement Lead (National Safeguarding Team), Church of England for the clarification!)

I was fascinated by Eunil David Cho’s presentation on child moral injury and repair. Drawing from his work with children recruited as soldiers, he defines moral injury in children as undeveloped or arrested moral development, or the inability to decide what is moral or not. Moral repair is working to recover their moral agency, developing the ability to make moral judgments and decisions on their own. When I think of the influences on children and youth today that negatively impact their moral development, I wonder what role developing moral agency and critical thinking plays in those who work with children, youth, and young adults.

I was challenged by Brendan Geary’s presentation on moral injury in clergy sex offenders. Geary made it very clear that he was NOT excusing what they had done or minimizing the pain in survivors of such abuse. What his presentation did was highlight the problems with an institutional culture and its structures that set conditions where risk of transgression is increased rather than mitigated. I am challenged by the notion perpetration is not constrained to the individual alone and is instead comprised of multiple factors. How might this change how we view people, even those who do the most heinous things?

How professionals define “collective” in repair differs greatly. I noted that while there was a consensus about the importance of collective repair and healing done in community, the trajectory of repair differed. For those with a more clinical focus, collective repair is a mechanism to enact individual healing and resiliency. Presenters with a more social focus view collective repair as a movement that drives cultural, institutional change. For example, Kristine Chong’s presentation sparked my imagination on how community organizing and collectivist movements, and their techniques, can enact moral repair in mainstream settings. I’m being somewhat simplistic, but that distinction was palpable within the presentations. It’s worth noting, especially as we consider the wider influences on beliefs, values, and moral commitments that become points of contention, which brings me to my final point.

The movement to patholgize moral injury is a critical conversation and needs collective dialogue - now. Moral injury is currently not a formal diagnosis in psychiatric screen criteria such as the DSM. Thus, moral injury is not covered by insurance companies as part of psychiatric and psychological care and research is limited by a lack of consensus on a singular definition.

On the other hand, defining moral injury in this way leads to the belief that it is a syndrome caused by maladaptive thoughts and behaviors that require psychiatric or psychological intervention. Is moral injury always bad? There are others (and I fall into this group) that view moral injury as a phenomenon that while, devastating, is a sign one’s morality is at work. Thus, the individual’s beliefs and behaviors might not be the actual problem, and repair isn’t confined to clinical treatment of individuals only. The concern is that pathologizing moral injury, while increasing access to medical care and increasing research, may marginalize other disciplines and approaches outside of a medical model. Said another way, it marginalizes an important voice in the field of moral injury, one that asserts that “people aren’t the sole problem.”

I’ll close by saying that I am deeply appreciative of the International Centre for Moral Injury and their team. At a time when international collaboration and learning is becoming strained, I am deeply appreciative of the chance to learn and feel a sense of kinship from an international community doing important work!