What is Moral Injury?
Cost of Conscience, also known as Moral Injury, occurs when humans harm others, and the boundary between good and evil becomes blurred. For example, a soldier in combat harms and even kills presumed enemies, only to realize later that he killed innocent civilians. However, the circle of Moral Injury is not limited to battlefield and perpetrating harm; its sphere also includes failing to prevent, witnessing, and even learning from a distance about actions that violate our deeply held moral values, beliefs and expectations.
As a clinical psychologist, I am tempted to explain recent events in Pakistan from a widely known Posttraumatic Stress Disorder (PTSD) lens. However, the scope and scale of these events are so broad that the diagnostic frames of PTSD appear inadequate to explain the trauma, pain, anguish and distress one feels when others are harmed unduly. Moral Injury includes many dimensions of PTSD but goes beyond, and also includes guilt, shame, resentment, betrayal, moral distress, and moral indignation, which is experienced (or not) by those who witness, facilitate, or even learn about the innocent being harmed. In this respect, Moral Injury, in the context of recent events in Pakistan, also encompasses judges, journalists, human rights activists, leaders, families and even overseas Pakistanis. Thus, Moral Injury framework prompts us to think critically to understand what has transpired. My aim is to present a plausible way as how Moral Injuries have amputated the soul of Pakistan, taking a historical view and connecting it to present crisis.
I first describe the concept from the perpetrator’s perspective and then locate it within our wider socio-cultural stratosphere. I will explain the moral development and factors that might have arrested this development on a societal level. I will portray the plight of victims from diagnostic frames of PTSD and will end my thesis with a few recommendations as to where we can go from here.
Police and security personnel raided the homes of political leaders without justifiable causes, destroying furniture and appliances, looting valuables, dragging and beating women and children, threatening to, or actually video tapping them, for only being kin of political leaders.
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Could this beating and dehumanizing of the vulnerable be explained merely as fulfilling the duty? Perhaps. Police and law enforcing personnel—presumably, young adults with impressionable minds and fragile personality structures, hailing from lower middle-class families, might be more likely to be indoctrinated into a fixed mindset, downloaded by authorities that they have to obey orders. These orders, most likely, also include a message that we are dealing with criminal, evil, antisocial, anti-state and rogue elements who deserve this. Motivated and supported by peers and a sense of camaraderie might have lowered the inhibitions of police and law enforcement personnel to perpetrate heinous acts of exacting brutality onto the most vulnerable—children, women, and the elderly.
Indeed, professions and their training, by design, include tasks that carry the potential of harming others. The training regimen of the military and most law enforcement agencies includes standing, walking, running, speaking and shouting in specific routines designed to meet the needs and demands of the traditional battlefield. The repeated drills gradually override the effects of socialization (e.g., values learnt from parents, teachers, religion and culture) from the minds of young recruits. Furthermore, exacting harm onto others is perceived as an act of courage and provides a sense of control. For some, as these acts accumulate, come with them the accolades and a sense of omnipotence. A rogue sense of omnipotence can easily create sadistic tyrants. Annuals of history are full of such figures.
Moral injury entails complex dynamics of perpetrators and victims. In addition to obedience, there are other factors which need consideration. The Stanford Experiment provides compelling insights.
Standford Prison Experiment
Led by social psychologist Phil Zimbardo, the Stanford Experiment shows that a corrupt environment can turn good people into cruel, sadistic and evil. The experiment examined the psychological effects of authority and powerlessness in a prison-like environment. Students randomly assigned to prisoner and guard roles were scheduled to play these roles for two weeks. However, the experiment was terminated only on 6th day as prisoners were forced to endure cruel and dehumanizing abuse at the hands of guards, who were their peers. The experiment explained police brutality, domestic abuse and even genocide.
Decades later, Abu Ghraib prison provided a chilling real-life manifestation of this experiment whereby American soldiers, abusing their authority, dehumanized Iraqi prisoners. Now enshrined in the fundamental psychology curriculum, the Stanford Prison Experiment showed corrupt environments can turn good people into evil.
History is a cruel playbook of such records, which unfortunately repeat. In many ways, the recent catastrophic events in Pakistan are replaying the Stanford Prison Experiment. However, without a thorough evaluation, it is not prudent to assert that all good people turn into evil due to circumstances or lack the moral fibre to withstand evil. But what worries me is the behaviour of judges of the highest offices, prominent journalists, stalwart human rights activists, civil servants, and the international community, with a few exceptions –all have been quiet. Did the primordial fear engulf their courage, convictions and compassion? How do we explain the selective morality of the international community, which wages vociferous criticism of specific governments when females are punished for not observing Hijab or when a journalist is murdered cold-blooded but remains salient over blatant violations of human rights in another country, terming these violations as an “internal matter.”
Three Catastrophic Events
But then, the recent catastrophic events did not transpire in a vacuum. Pakistan, since its creation, has experienced such catastrophic events regularly. I have parsed in three broad categories from the standpoint of Moral Injury.
First, there is a seemingly unending spade of violence, including three wars with India and an ongoing war against terrorism, which took the lives of more than 80, 000 Pakistani citizens. This unending spree of violence has created many layers of Moral Injuries.
Second, political instability, closely related to violence, has not let Pakistan develop institutions that could shape its citizens into fair, morally upright and honest citizens.
Third, violence and lack of institutions have created conditions for a massive brain drain. Ministry of Overseas Pakistanis and Human Resources’s 2023 figures show nearly 10.8 million Pakistanis live abroad, forming the 6th largest diaspora in the world. It is a colossal tragedy that the country that helped produce doctors, engineers and entrepreneurs cannot benefit from them directly. Yes, remittances from overseas Pakistanis abroad help, but they are not a substitute for precious human resources. This created a vacuum only filled by undertrained professionals caught in a vicious cycle of exploitation and corruption and provided a breeding ground for Moral Injuries.
The net impact of these catastrophic events has been disastrous for a country where resources, rights and responsibilities are skewedly distributed, undertrained professionals are caught in a vicious cycle of corruption, and moral transgressions become part of societal norms.
Pakistan has not been able to nurture the moral development of young people. Religion, a powerful force that could have guided moral development, has been reduced, for the most part, to ritualistic practices and zealous protests. Some of these protests end up in public squares where minorities are lynched.
Moral development is in-built within us. Our religious, cultural, and social norms, developed over centuries, are supposed to guide and refine our moral development. Scientific evidence shows a main integrative centre in our brain for innate morality, with multiple connections extending into the brainstem, thalamus, and limbic system. Lesions and dysfunctions in these areas are associated with personality changes (for the worse) and criminal behaviour.
It is hard to imagine we have collective deficits (innate or acquired) in these regions, which drive us to act immorally. Still, the question is how and why good people act badly. Or do good people reconcile with immoral behaviour?
The notion of Cognitive Dissonance, spearheaded by Leon Festinger (1957) offers valuable insights. Festinger states that we experience a psychological conflict and feel stressed when two beliefs are inconsistent and contradictory (dissonant). In the context of recent events in Pakistan, hear out loud the beliefs of police personnel, “Exacting violence upon innocent people is wrong and I have to do my job, people.” Such dissonant beliefs might have caused some conflict or stress. To resolve the conflict and reduce the stress, he is either likely to incorporate new information or avoid circumstances likely to increase this conflict and stress. His beliefs will likely change to “Exacting violence upon innocent people is wrong. But these are not innocent people, and they deserve such a treatment Or complying with orders of my superiors is most important as I need to keep my job.”
It appears to me that when most Pakistanis experience Cognitive Dissonance, they are unable to do critical reasoning and change their contradictory (or dissonant) beliefs as fear of financial deprivation overrides any other considerations. However, what is deeply concerning in the context of recent events is that judges, journalists and human rights activists, who were known for their critical reasoning and were presumed to be the vanguards of the rule of law, human rights and democracy–with few exceptions–all seem to have conveniently changed their beliefs and have blindly yielded to authorities to avoid any stress.
Morality and moral development are complex processes. Religious and philosophical traditions have long debated and directed us towards paths of moral development. Lacking expertise in both domains, I will briefly discuss the psychological perspective. Lawrence Kohlberg was the first one in modern psychology to discuss moral development. Although his theory has been criticized for lacking female perspective and cross-cultural relevance, it continues to serve as a plausible springboard.
The moral development of most police and law enforcement personnel can be assumed at the “Morality of Obedience” stage. This stage is marked by, Do what you are told.” In other words, blind obedience. Limited critical reasoning, the absence of egalitarian norms and a lack of democratic institutions might have reinforced the morality of obedience.
What about the morality of those with higher education occupying high social positions? Kohlberg states that these so-called elites follow Instrumental Egoism or Exchange, which can be summarized as Let’s make a deal. Making a deal is a familiar modus operandi among Pakistani politicians.
Kohlberg’s theory has six stages. However, it appears that Pakistan, as a social unit, hit a solid stop at the second stage. I cannot find credible individual or collective signs of advanced stages of moral development, which include being kind, everyone is obligated to, and by the law, due processes and procedures are followed. Most importantly, rational and impartial people would ideally organize cooperation for the collective good.
We are a nation plagued by moral developmental arrest. Our police and other law and order enforcing personnel do what they are told. They assume that obedience is the right thing to do. Our leaders, political and others, believe and operate on a pragmatic morality of tit-for-tat reciprocity. This tit-for-tat reciprocity also encourages them to make a deal. A vicious cycle of blind obedience and tit-for-tat morality has rarely allowed us to develop an autonomous and impartial sense of morality. As a result, we find moral bankruptcy runs amok in our national institutions. The rank of 140 on the Corruption Perception Index, by Transparency International, out of 180 countries is hardly a surprise.
The impact of Moral Injury is broad. Besides police and security personnel’s firsthand involvement in harming others, how about their bosses who ordered them to raid homes, knowing that these actions were politically motivated, not on violations of law and order? How about justices who denied bail of women repeatedly and approved physical remand, which resulted in physical torture, knowing they are not culpable of any crimes they are accused of? What about journalists and media people who broadcast messages handed to them, knowing these are erroneous and could be misleading? As research on Moral Injury shows, these individuals sooner or later with grapple with moral anguish and moral despair. When greed of material gains will settle, existential pain, which is deeper and invisible than physical pain, will set in.
In this moral predicament, let’s not forget victims. What they experienced, in my view, has sown the seeds of individual and collective Post-traumatic Stress Disorder (PTSD).
Post-Traumatic Stress Disorder (PTSD)
PTSD is a form of anxiety that develops in some people following extreme traumatic events and experiences physically, emotionally, or even life-threatening. Cross-national research shows that nearly 3.9% of the individuals in the general population and 5.6% of those exposed to trauma develop PTSD. Examples include combat, crime, assault, accident, natural disaster, rape/sexual, domestic abuse, bullying, and harassment. The three catastrophic ongoing events in our national history include most of these examples triadically.
PTSD does not just happen in war or combat situations. It is not merely an American disease depicted in Hollywood movies. It is the body and mind’s adverse reaction to trauma. Indeed, not everyone exposed to trauma develops full-blown PTSD. However, video footage of recent events across and beyond Pakistan and subsequent crackdowns by security forces will likely result in many people experiencing PTSD. However, the symptoms may incubate for months or even years before an individual can discern that trauma has left them with a more than normal reaction. Shell-shocked, they are likely to relive moments and memories of the crackdown and avoid places and people associated with their trauma. Some will resort to silence; others may try to silence their pain through harmful substances. Some will withdraw from the everyday grind of life, yet others will feel startled by daily hassle and bustle. Some will have increased anger or sadness; some may fluctuate between them.
Where to Go from here?
1. Stop Ongoing Harm: We need to find all possible means to limit and possibly end the ongoing harm to the most vulnerable and take all possible measures to stop perpetrators so they cannot continue their actions. Furthermore, we must take measures to prevent further onset of events and processes that carry the potential for Moral Injury.
2. Provide Need-based Resources: Address the immediate effects of those impacted most. Assess their acute needs and connect them with available resources. Some will need therapeutic services to deal with symptoms of PTSD, while others may not show clinical range symptoms but still suffer from invisible signs of feeling ashamed, guilty, moral indignation, moral disappointment or a sense of moral betrayal. These individuals also need comprehensive and holistic support, including artistic, spiritual, nature and movement-based therapeutic intervention.
3. Inquiry Commission: It is crucial to make sense of specific, especially large-scale, events that resulted in multiple instances of moral injury. A multidisciplinary Inquiry Commission involving psychologists, sociologists, journalists, human rights activists, law enforcement professionals, ethicists, faith leaders and most importantly, all those directly and indirectly impacted by morally injurious actions needs to be formed with sufficient autonomy to investigate
4. Restorative Practices: Restorative Justice Practice and Forgiveness should be applied to all those involved in the circle of moral injury. Without minimizing, dismissing or downplaying the role of justice, the processes such as Restorative Justice and Forgiveness should be seriously explored and applied. While ideally desirable, forgiveness is an exceedingly challenging and tricky process. Restorative Justice practice allows perpetrators to take responsibility for their actions to help them understand the harm they deliberately and inadvertently have caused. The carefully curated process of Restorative Justice offers opportunities for victims to express their feelings within a safe milieu, hoping that doing so will reduce their distress. Restorative Justice practice, spearheaded by community leaders, can be a first step towards restoring trust in social institutions.
5. Training: Training military, police, and other law enforcement agencies need comprehensive training as to how their policies, processes, and practices can inflict moral injuries to their employees, as well as all those with whom they work. The training, informed by a multidisciplinary approach, should be experiential. It should include case studies, lived experiences, and specific and concrete direct and indirect impacts of moral injuries to develop an internalized sense to prevent, avoid and manage them.
We all have an inborn capacity to love, empathize and relate with others. However, when we deviate from our default and harm others without any personal reasons but due to authority, we experience Moral injury. The most common illustration of moral injury is of soldiers in combat, harming and even killing presumed enemies, only to realize later that they were innocent citizens. The circle of Moral Injury also includes failing to prevent, witnessing, and even learning from a distance about actions that violate our deeply held moral values, beliefs and expectations. To heal from Moral Injury, we must restore our enormous potential for forgiveness, empathy, compassion and kindness. Instead of perceiving these as abstract and Utopian notions, we must translate these positive attributes into concrete actions that could bring out the better angels of disposition.
Nothing about Moral Injury is so alien to fall outside the scope of our common and shared bonds of forgiveness, empathy, compassion and kindness.
Dr. Tayyab Rashid is a clinical psychologist and lives in Toronto, Ontario, Canada.