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MORAL INJURY: Violation of Meaning

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MORAL INJURY: Violation of Meaning

Moral injury arises when individuals face betrayals of their core values, often due to institutional pressures or impossible choices, leading to profound psychological and spiritual harm. Unlike PTSD, which stems from fear of external danger, moral injury involves internal shame and guilt over perceived wrongdoing, as illustrated by extreme examples like Sophie's Choice or everyday dilemmas in healthcare and social work. This injury manifests as self-destructive behaviors, withdrawal, and a shattered sense of meaning, where individuals feel unworthy of help or forgiveness. Healing requires a process of honest storytelling, where the injured party confronts their actions in a supportive community, and symbolic restitution, such as acts of repentance or confession, to restore a sense of moral balance. Without such acknowledgment, moral injury can lead to chronic despair, addiction, and isolation. The key is to transform the "lead" of guilt into "gold" through shared understanding and meaningful reparation.

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Welcome to this Jungian life. Three good friends and Jungian analysts, Lisa Martiano, Debra Stewart and Joseph Lee invite you to join them for an intimate and honest conversation that brings a psychological perspective to important issues of the day. I'm Lisa Martiano and I'm a Jungian analyst in Philadelphia. I'm Joseph Lee and I'm a Jungian analyst in Virginia Beach, Virginia. I'm Debra Stewart, a Jungian analyst and Cape Cod. Today we are going to talk about moral injury, the definition of which is social, psychological and spiritual harm from feeling that there has been a betrayal of one's core values, fairness, loyalty, justice. In other words, moral injury wounds, one's conscience. And this can take place interpersonally and it can also take place as a result of having to obey orders. From an official supervisor or boss, military superior. And it results in a loss of trust, a sense of ongoing guilt, distress and unresolved conflict. And it also attacks the person's self-concept as a good or as a decent person. And I think moral injury takes place in a number of areas, certainly the military, but also the field of medicine and other caretaking responsibilities, teaching, politics. When institutional values go against what a person's personal code of conduct and conscience is. For me, when I was resting into this and trying to think about what does it look like? The image that came up for me is that older movie, Sophie's Choice, which was I believe based upon a book. And in the movie, and it's been a heck of a long time, I've seen it, but "Meryl Streep" plays a Polish woman who is in an abusive relationship and she's abusing alcohol and she's just kind of a mess. And it's sort of like, well, why? What's going on with her and what you discover by the end of the film is that as she was escaping Poland, a Nazi, accosted her and she had two sons. And he said, "Pick which son lives? Otherwise, I'll kill them both." And she deburred and no, no, no, I couldn't possibly do that, but he was insistent. And so she picked. And that's the reference to the title. So the sense that she was forced to make this awful decision that wounded her psychically such that she would never function again. So that's a perfect illustration and such a point in one of how moral injury can result in PTSD, despair, suicidality, addiction, depression, anxiety that can't be alleviated because the inner conflict seems to be beyond some kind of resolution or reconciliation. I mean, it's obviously also an extreme example. And I think that probably all of us can relate to moments where we were either someone or the situation demanded that we compromise a core principle and we had this kind of mini-so-vistroice moment. I mean, I know I've certainly had those. I remember when I was working in a community mental health organization in another state, being asked told that I had to terminate with some clients. And how heart-wrenching that was. And I did my best to sort of find other sources or possibilities, options, resources for them. And I felt like such a betrayal of certainly what I thought mental health care would be, but also of them, of asking them, implicitly asking them to open up and be vulnerable and then sending them on their way prematurely. And I left that mental health organization. And I had taken these clients on in my own self-defense here without knowing that I was going to be asked to terminate them. So prematurely. And in the fence of the mental health organization, the county cut our funding by 80%. And so we were asked to do a job without the resources, namely time, to do that job. And the pretense was that it somehow was all okay and we could make it work. And that was not true. And there were some sort of stories that I've heard from friends and clients who work in the medical field. And particularly during this COVID pandemic, the institutions often pressing them to speedily resolve what's happening, let's say, in an emergency room. And I was thinking at such a pace that the doctors feel that their behavior is irresponsible. And yet the institution and oftentimes the profiteering dynamic around it puts a risk for losing their job and other kinds of conflicts. And so they're often feeling trapped. When somebody says you must meet and discharge a client within 15 minutes. And when that's not possible to be shamed or even threatened in as much as your job is at risk because you don't produce a metric that the algorithm has defined. And the incredible painful conflict that some but not all that some physicians carry, which really is hard for them to true find a way through that. Especially because people in the medical field go into the medical field at all levels because they are invested in healing. And so what a horrible contradiction to be told just rush through it. Your next patient is coming every 15 minutes. Well, and it really contributes to burnout. I think this I think yes, moral injury contributes to burnout. You know, in Vietnam, I started my career working with Vietnam vets. And one of the things that I learned is one of the roles in Vietnam that had the highest rates of PTSD. There were several roles. The people that were in those roles tended to develop PTSD at higher rates. And one of them was medic. And it's because you were given the responsibility of caring for the wounded. You know, you were given some training. You were given, you know, a field medical kit. But there really was very little you could do. And it was that contrast of being the person that was responsible for healing. But you had very little capability to do it. And I think that that it's the same thing, right? It's like you should be able to do something, but actually it's this horrible position to be put in. Because you there's really very little you can do. I think another layer to that in a way may be that the truth about inadequate resources and inadequate support is not spoken. And the individual lines of carrying it. Yes, exactly. That the real problem is with the system, the institutions that give these medics, for example, kits that are inadequate to cope with battle injury. But there's a level of pretense as if this is okay or you're not supposed to say that or you're being disloyal. Which is a value that the military in particular instills pretty heavily. And so there are several layers to this kind of moral injury. Another environment that comes to mind relative to our profession as social workers. This friends who had spent many years doing child protective services. And as local and state governments continue to remove funding to sit and review dangerous situations and to be able to identify, let's say, you know, 50 children that are at risk and have to decide where the intervention is going to happen. and where it won't. And where it won't happen means that the child is being left in that situation and the constantly shifting criteria around what is bad enough to warrant an intervention because we can only afford to take on or to address X number of clients a week a month a year, also inadequate staff. So there are many situations where social workers, I think this is very common with social workers. Where social workers are put in situations where adequate response is decisively interfered with by the decision to underfund. And then I'm leaning into a bit of a political position right now, but often the underfunding is is a ploy to generate metrics that demonstrate that the program cannot function and then justifies its termination. So make something not work to justify eliminating it and abandoning the entire issue in the culture. And social workers who are caught in systems where they are knowing that this is happening and feeling that they are helpless to actually respond and yet their livelihood in their own kind of safety and ability to keep their families afloat. They're income and other things. Leave some in a situation where they're trapped. You know Joseph, what that made me think of is that it seems like all of these situations that we've lifted up involve a case where we have been asked to shoulder an archetypal burden and we are merely human. So we're being asked to make life or death decisions or decisions about, you know, which child gets left in some terrible situation. We're being expected to know these things that we can't possibly know. We're being expected to care for others in this kind of archetypal fashion and yet we're just human. It seems to me that the same thing comes up if we have a loved one on life support, for example, and we need to make a decision whether or not to remove life support. I mean that some people can do that and find peace with it. But for many people it's very, very difficult and it and it haunts them. And the thing that's unique about moral injury is that it is a unique issue about core beliefs. Unlike PTSD where someone might be physically at risk, putting in a life-threatening situation and the startle reflex and various other parts of the body and the brain are involved, moral injury has something to do with the fundamental values and beliefs that somebody has integrated and being in a situation where they feel that they cannot be aligned with those values. It creates a kind of storm inside of the soul. I think it most frequently shows up as shame and sorrow and regret and a feeling that the only response is to withdraw, to alienate oneself from family, from culture. It's very much, it reminds me of that, that archetypal moment in the story of Genesis where Adam and Eve have a shift of consciousness and they suddenly decide that they are shameful and their first impulse is to hide. And so a great deal of work done as you had said, Lisa with military is even getting them into treatment because the impulse to hide can prevent them from seeking help and often they don't feel they deserve help. There is a feeling that often they should suffer. You bring up such an important point, Joseph, here about the difference between moral injury and being injured, which also of course happens a lot with military and other people in emotionally fraught situations that have to do with care. That there's such a difference between having been injured and having flashbacks and being hyper-vigilant and fearful of ongoing attack versus in moral injury, the sense that the person himself or herself is the one who committed the wrong. Yeah and when I was doing the work with that, one of the ways to treat PTSD is through exposure therapy of one kind or another where you help the person gently kind of adjust to the traumatic memory. You survive to the event, you can survive the memory and so you decrease these PTSD symptoms of intrusion and avoidance. However, exposure therapy does not work in cases where the symptoms are the result of the person having committed an atrocity or having been the perpetrator. Whether it was an atrocity or you know it's I have this memory of shooting this the at Kong and you know it the exposure doesn't work there you know it works with I saw my buddy you know get blown up on a you know this truck went over a land mine that that can help but I have this horrible memory of shooting this be at Kong and seeing this guy ride or whatever did not it didn't it made it worse. There is a psychiatrist an author named Jonathan Shea who wrote a book about Vietnam vets called Achilles in Vietnam and what he says about recovery of healing from moral injury is that it requires purification through community process that other people have to share that Vietnam vets for example experience horror trauma anguish and that has to be heard that person has to be allowed to voice it and it has to be received and I think that goes to my point earlier about systemic change and institutional responsibility that this does not belong to an individual alone because as you were saying Lisa it's archetypal it's much bigger it has to be shared and that is something that I think is still pretty insufficient because it's very hard for us to truly fully recognize the impossible situations that many people are in I'm thinking especially of healthcare workers during COVID they could not possibly treat all the people that were in their care there were too many. I once worked with a woman who was a veterinarian and she really provided an education for me because she was really suffering and she alerted me to something I did not realize before is that veterinarians have very high rates of depression and even suicidality and I was you know grasping to try to understand this and she helped me and it's exactly moral injury because obviously most veterinarians go into the field because they love animals but what you do as a veterinarian and what you more so what you witness as a veterinarian is a lot of a lot of cruelty toward animals you see a lot of a lot of people you know not treating their animals well and you sort of have to just step aside and kind of just let that happen you see people being very casual about their animals are just putting them down because they're moving say and it just eviscerates people it just kind of hollows them out. I'd like to offer just a list of the manifestations of moral injury so that perhaps people might be able to identify it a little bit more easily so people who are profoundly caught in this web often demonstrate self harm in one way or another who are self-care people can come to this decision that they don't even deserve to shower substance abuse to avoid the pain to numb recklessness often because they feel that their lives don't matter self defeating behavior because they don't believe that they deserve success hopelessness often because they feel whatever they have been caught in whatever the actions were have no resolution there is no forgiveness there is no restoration so of loathing there is often an interference with their natural capacity to have empathy that as they begin to regard or perhaps even already are preoccupied with the thought, it's so excruciating to imagine the experience of the other that empathy has to be cordoned off and locked away so that people don't feel that they're going to be destroyed. There's a preoccupation with their internal distress which prevents them off and from attending to the outer world, of course there is remorse and a lot of self-condemning interjects which then leads us to a question, you know, what does one do? What do we do with that? What did Sophie and Sophie's choice? What did she need that she could not find or could not get in that moment? You know, I think the underlying thing about moral injury, it's a violation of meaning. It disrupts our ability to find meaning. I think that that list is really helpful, Joseph, and at the core of all of those things are to just restore that sense that we sort of live a meaningful life in a meaningful world. And so that is the task, how do we restore that? So one of the steps that's often taken in this situation is to help the person create a profoundly honest autobiography about these experiences. This is something that we see in 12 step programs where people are asked to do a fearless, moral inventory, then to confess to often their sponsor what they had done and what had happened to be able to have someone here in a profoundly accepting and non-judgmental way, the reality that they are confronting. It's often a first step and that the biographies often need to involve highly specific information. Let me see this in therapy all the time, whether or not it's moral injury or something else, where people will toss out a problem, but they'll generalize it in a way that makes it almost impossible to actually lay hands on it. Now in one way that could just be an opening salvo, they're just brushing against something that's really painful and that's just the first pass around the topic. But sometimes without help, people will continue to keep the injury in a kind of fog and a kind of haze. And often the analyst needs to help them lay hold of the story and to be able to tolerate it and verbalize it. That's not a whole transformative process, but it is the beginning. And if we think about it alchemically, that the pre-my materia, the lead that could become something different like gold, has to be identified, brought forward, made visible, and put into the alchemical container, ostensibly the healing relationship with a therapist or an analyst, and that until the pre-my materia and till the substance that is to be transformed is identified, then the work is kind of stymied. Yeah, I think that's a great point and I've certainly seen exactly what you're talking about. I also think that finding a way to, I want to say something like repent might be important. You know, I remember this one supervisor that I had gave me such good advice. She had worked with someone who had accidentally done something really awful as a young person. This person had a difficult life for decades and been to therapist after therapist. And therapist after therapist had said, "Oh, you were young, you didn't know, you need to forgive yourself." But it didn't do anything. And then this woman who was my supervisor said, "You know, you did something terrible, you need to, what are you going to do to make up for that?" And so the patient herself devised kind of a program of repentance that, you know, I don't know what it would involve, but I would make up, you know, something like maybe doing some volunteer work or making a sizable financial contribution or something. I mean, it really needs to be meaningful to the person. So when I have someone in my practice who's done something for which they feel great remorse, I follow that lead. I say, "Okay, what are you going to do to sort of set the scales right?" You know, and that is one of the wonderful things about Catholicism is it provides a way to come back into the community after having sinned that a sense of belonging gets restored. And it's understood that God forgives you if you just do the things that the priest describes for you to do. And sometimes we need that. We need a way, we need to feel like we can earn our way back if there's been a betrayal. And some of that really is symbolic. So that really brings in how healing a symbolic restitution can be because I know in the process of confession and a church often children go in in particular, you know, and they didn't come in when their mom called them and they didn't do this and that. And the symbolic restitution remorse is to say the prayers. You can't make up for having caused serious injury or death, but you can make a symbolic restitution. And that step in AA of a fearless and searching moral inventory does that also. And I'm thinking one word we haven't used yet here is honesty of that that supervisor, Lisa said, yes, this did happen and you were responsible for it, even though that was not the person's intention that yes, this did happen. And that begins to move it from the archetypal realm into the realm of ego consciousness hence humanity. And it's a tool towards to face it rather than letting it remain in that kind of haze. We have to bring it down to earth into our lived reality. And being radically honest around something so painful and so remorseful, it feels like a crucifixion understandably. It is excruciatingly painful and to go through that and at the other side to be able to feel that you are not destroyed by speaking your truth. You know, I'm thinking another part of this and I just if I really appreciate that you brought up that it can be in sort of a fog because I think in the movie, Sophie's choice and my God, I haven't seen that movie in like a really long time. She has a secret. You know Sophie has a secret. There's the sense she's so charming and so personable but there's something really dark and what is it? What is it? And that kind of drives the film and she doesn't speak about this. It's a secret. And I remember working with one Vietnam that who hinted that he had done terrible, terrible things and he said he would never tell me or anyone else. And you know, this is in the the terminus of the therapy environment. You know, and I was I was unsure of whether it would serve him to tell me. I wondered if he needed to keep it locked away. But but it was a sense that it was something so terrible that it would sort of destroy him to share it. But at the same time, living with such a secret really kept him outside of humanity. And some secrets are poisonous. I think there is that fairy tale where the king has a secret that he cannot bear and the kingdom is suffering and he's suffering. And he's given this suggestion that he should go to a tree at the edge of a river and whisper his secret into the hole in the tree, which is then descends through the roots and is carried away by the river. And that's one part of the ability to let go and to have some hope of restoration. I also want to go back here to the communal aspect of this, the institutional aspect. I think that's something that we lose sometimes when we're dealing with individuals. But that too has an archetypal component, the Irish myth of Cuculean, who was their most famous heroic, capable handsome warrior who would go into battle and be so caught up that he would slay anybody in his path. And when he came back from battle, you know, he was still in this altered state. And according to the tale, when he came back, he would be met by naked women, you know, embodying the feminine in its nakedness and evoking kind of an eros as a counter agent to the embattled warrior that he had been. And they would be carrying vats of cold water. So he would sit in the first and it would burst apart because he was so hot. And the second would boil over. And then finally, the water would just get hot. But it requires others for people with this kind of trauma and moral injury to cool down, to cool off. Yeah, other people have to help us hold it. Yes, they have to, there have to be others who hear and who help and who approach like the women approached, who Kulein, they went out to meet him. And also they don't catch on fire. So this is one of this can also seem very, ego-distonic to analysis, that the analysis will have the unfire with anguish about something they may have done. And they may want the analyst to enter into the anguish with them. In one sense, it's not unlike Job, where he wants his friends to sit in the ashes with him and feels that that was somehow help things. But actually the analyst needs to bring the cool water, needs to not be reactive, to not be crushed with anguish, but to bring something that is different. Water comes to fire, and sometimes by the way the analyst can bring fire to water and try to really rally something for that matter. But to bring the attitude that is Kulein ensuing. I want to talk about a couple of other instances, sort of extreme versions of this. I know that in past decades, there have been certain African warlords who have conscripted young men. And one of the things that the African warlord would have the adolescent do, the first thing, is to shoot his parents. You know, sort of, I'm holding a gun to your head if you don't shoot your parents, I'll kill you. And once a young person has done that to his parents, then he's kind of owned by the warlord. It's a way of wounding the psyche to such an extent that kind of future loyalty is guaranteed. Because once you've done that, you sort of can't turn back. And a similar vein would be what happened during the cultural revolution in China, where many, many children and young people reported their parents. And sometimes those parents are grandparents or whatever were killed or executed on the basis of the child's report. So it's sort of the system that uses our tendency, our susceptibility, our vulnerability to manipulate us. So moral injury certainly reeks havoc with the concept of loyalty and attachment. It turns attachment toxic that you annihilate your parents, you know, verbally or actually, and you're then toxically attached to the warlord. It goes back to what you said before, Lisa, about how moral injury is an attack on meaning. It really is a horrible wounding of soul. So taking just a pivot back to what do we do in the midst of this? One technique is to imagine the individuals who we have harmed for its pearls called this the empty chair work, to imagine the person before us and to be able to save the things that we could not or did not say at the time. And also to imagine a response from that image. And that's a way of acknowledging the loss's impact, implications, the meaning to be able to bring forward what is in the person but hasn't had an environment to safely come forward. And that can be the beginning process to foster balance. It can help the individual accept the part of themselves that acted this way, but also to understand that that was only a part of them and that a regrettable action or even being swept into a complex that then compels a terrible behavior is not one's destiny, that it is a terrible, devastating moment or even a period of months or years in one's life, let's say if one is sent to war for a certain number of months or years. But that is not the totality of what it means to be human and who that person is. You know, I want to come at that from a slightly different way, Joseph, I think that's a lovely point and I want to just bring in a personal example and just talk about that for a second. As I've mentioned before on the podcast, I for a couple of years from 1994 to 1996, I worked for a refugee organization in the form Yugoslavia in Bosnia and Croatia. And there were many things about that experience that felt like moral injury and some were big, like, you know, I was there when garage to fell and the people in garage to were massacred and my organization collected, you know, soap and toothpaste and gave it to their widows. And I mean, you know, yes, it's lovely that we provided them with soap and toothpaste and what else were we going to do? But, you know, the sort of the moral injury of kind of being in close proximity to that and sort of just watching the world do nothing. I mean, by the way, there's a film called Quovadas Aida, which is about the fall of Srebrenica. And and, you know, this is this is very much in this same ill care because you see, I believe it was the Dutch UN peacekeepers there just roll over and let this massacre happen. You appreciated that they were in a difficult situation. I mean, they didn't they didn't there was no teeth to their presence there. And I think again, that, you know, that's moral injury. But in any case, so there was that and there was just the, you know, the sort of, I mean, you do that for a while and you get cynical because I could also see that, you know, we got a really sizable grant at one point and it was, it was so clearly political. It was lining up with President Clinton was getting a lot of criticism for how the administration was handling things in the Balkans and it's like, and then it's like, whoa, out of nowhere, we get this big grant that we didn't, you know, it was like, it wasn't even possible to spend it wisely kind of and it was just so clear that we were being kind of used politically because then the administration said, oh, you get an X amount of, you know, millions of dollars and blah, blah, blah, it just felt compromising. It felt it felt like here, I went there and I thought I was going to save people and you know, life isn't like that, you know, there's all these kinds of compromises and when I was there, I visited a friend of mine who teaches that a women's university in Calcutta. So I traveled to India and I was visiting her in Calcutta and I remember saying to her, I said, you know, I envy you because what you do is morally clean because she's this university professor and she laughed and she said, Lisa, the women that come to my college are sent there by their parents so that they will be more eligible marriage partners and many of them will wind up in these, you know, really kind of terrible marriages. They're, you know, it just, it raises their value on the marriage market. That's why I'm teaching. I mean, I still remember that all these all these decades later because I thought, yeah, you know, it's just there's a sort of cost of doing business and it's impossible to be kind of morally pure no matter what we do. There's some, there's some, there's something dirty about really just about anything that we could do and somehow we have to come to terms with that. But Joseph, to take it back to you're talking about sort of, so how do we heal from this or what do we do about it? I mean I think I think in In my case, it led to a kind of clarification of values. I mean, yes, I had to come to terms with the fact that nothing can be kind of morally pure and perfect. I had to sort of let go of that idealistic view of the world. But it also made me think, well, what really does matter to me? What's most important? How can I use my talents in the world in such a way that has kind of maximum integrity? And that did lead me not that long after to go into social work school and pursuing becoming an analyst. So there was a, that was part of that process. And Lisa, I think your examples also bring up that we can't lead morally pure lives. There is shadow. And how do we judge what the cost of doing business is? It's not going to be all or nothing. The purity idea is always affected by shadow. And when the shadow is really very, very dark, it makes it all the more difficult, but it is still part of the same reality of how do we come to terms with shadow and to acknowledge that it is there. And there are the justifications, you know, whether it's the person who can't forgive him or herself or the rationalizations of, this is just the best we can do and it's better than nothing or the gaslighting and dishonesty or the avoidance versus we have to face shadow that is even that dark. Something that's moving through our whole conversation is the idea of the internalized moral authority. What's the word called that the super ego, although Jung has suggested that the self has its own kind of morality. So the role of imagination is important in the healing process. We talked about imagining the person that we have injured and entering into an imaginal dialogue. To a step that is important, I think, is imagining one's inner moral authority, speaking to the one who is confronting us internally and saying we failed or that we have sinned mightily and coming into a dialogue. One of the things that Jung recognized and we have all seen his analysts in our practice miraculously is so long as the inner figure remains invisible. It has a much more global power and the ego can often be tempest tossed. When we can bring the inner figure into view that we can see it as a discrete object, implicitly there is distance between me and the inner image. And that distance between I and other can give us enough breathing room to begin to think about what has happened and how I am narrating that to myself, which returns a certain amount of power to the ego. So imagining our internal moral authority, sketching it, doing a painting of it, talking to the moral authority over and over again, even arguing, also asking how this inner figure came to these conclusions. There is something on the other side of this issue of moral injury is that sometimes we have internalized an internal moral authority that violates our natural sense of self and identity and that we wind up feeling morally injured when we are acting in ways that are reasonable and even life affirming. For instance, a young kid discovers their gay and for people that have been raised in very particular kind of religious environments, they have an internal moral authority that is ferociously against their expressing it. And if the young person eventually enters into an experimental phase and they begin to become sexual and enter into relationships, the moral authority can become so violent that they can exhibit similar symptoms, drinking too much, self-harming, hiding, berating themselves, very similarly. So the internal moral authority sometimes is aligned with values that on a conscious level one could agree with, but sometimes the inner moral authority is profoundly antithetical to life. And that puts us in a very complicated situation, but we often need help and support to challenge the subrigo. That brings up for me Joseph with the examples you just provided. And examples of teachers and health care providers during the pandemic that one of the other things that is sometimes important to do is to leave, to actually take the very difficult action of standing for one's own values, whether it's about sexual identity or the values that I have for health care, or the values that I simply have for my own well-being and survival. And to take the risk of standing alone, of I'm going to claim who I am, I'm not going to work here anymore, even though I don't know where my next paycheck may be coming from. Where else I can get a job of having to confront that kind of abyss between the known world and what else is out there? As an example, we're hearing through news reporting that occasionally a Russian soldier in Ukraine will abandon their equipment and walk off either to surrender to the Ukrainian forces or even just walk off into the forest and just abandon the whole campaign, the war campaign. I think those stories are hinting at this choice, this moral injury that people feel particularly they recognize if family members, they're Russian but they have family members living in Ukraine and they're tasked by a government to conduct this tremendous death-dealing war. And some people have decided apparently to just walk away and I can imagine there are very frightening repercussions to doing that. And yet there's a part of me that implodes them for having the integrity and strength to set down these weapons and make a different decision. Yeah, I think it's inevitable in life that we will be placed in a position where we have to make a decision like that. I'm thinking about the scene from the Mahabharata that we reference frequently in the podcast where Arjuna is on the battlefield with Krishna and he looks across at his enemies and their members of his extended family and he says, "I can't do this." But Krishna convinces him that it's his destiny to do it, that this is the work of the gods and that he needs to be brave and play his role. And regardless of what we think about the outcome of that, I'm lifting it up today because I think it raises this truth that we all face minor moments like that throughout our lives, that it's inevitable that we have to make these difficult moral choices of one kind or another. And that these are important moments for us psychologically because they really are moments when we have the opportunity perhaps to stand for something to, and that might be a real moment of individuation as well. We must choose. Yeah. Which is the core of being human. You know, nature is full of all kinds of marvelous creatures, but Arun doesn't get to choose what kind of a nest it's going to build. It has an instinctive wisdom and it builds the same nest as all other wrens do. All Hyenas run and forage in the similar way they can't decide they're going to take up cooking, but human beings are granted this tremendous capacity to choose and to generate options. And I don't want to come across as naive. Some of those options could be frighteningly costful, but we still have choices. I want to swing back to something that I think you may have mentioned around remorse, which can be very difficult in the consulting room, that we don't want to relieve somebody of their remorse, that they actually need to feel remorseful as part of the recovery process. But we do want to examine the way that they're talking to themselves about it, so that it leaves room to be more than just their remorse, that we can move through the world and carry a burden of guilt, because we have a moral center when we wish we had not done something. But I think the goal is for that to live in part of our inner landscape that is contained a kind of island, so to speak, in us, which we may still visit frequently, that the rest of the inner kingdom needs to flourish, needs to have other interests, may need to find a partner and create a family and continue with one's education, etc. And that we are tasked with holding our lives as a sacred trust, and that we have a responsibility to life, to contribute beyond our mistakes. I think that was really beautifully said, Joseph, and there's not much more to say after that, so perhaps we can transition to a dream. Did you know your dreams reveal the wisdom of your guiding self? Dreams connect us to the secret world within and remind us that we're never alone. We're always accompanied by our inner companion who offers healing, balance, insight, and guidance as we make key decisions. At 28, Charles felt lost and isolated. He had a dream that touched him deeply. As he worked with the dream in dream school, he understood that it was showing him how he was profoundly connected to life. This powerful insight led him to make real progress with his goals. During dream schools 12-month transformational program, you'll learn to harness the power of your unconscious wisdom, decode the language of metaphor and symbol, discover mythological motives that shape your life, reveal unknown facets of your personality, unlock the door to inner wisdom, to enroll just go to interpretmydream.net and sign up today to gain immediate access to the first three dream school modules. Your best life awaits you at dream school and we can't wait to see you there. Today's dream comes from a 60-year-old woman who is a special needs teacher who's about to retire and she's also a counselor. And here's the dream. I'm standing near a well. I have to go down into it. When I'm in the well, I am me, but I am also a slightly younger, stronger man. The cylindrical walls of the well are grim and dark. There is a cylindrical metal structure and on the outside of this are two dead babies, toddlers, and a slightly older one who is not quite dead but needs resuscitating. The water has been appoluted as a result of the bodies. I shout, rock it up. This is so the babies can be pulled up. I wake up and feel dark. As I think about the dream, it occurs to me that rock it up could have been rock it up. However, in the dream, although I didn't see the structure move up, I imagined it going up at great speed. For context, she says, "I'm about to retire from teaching due to voice problems. I have to apply for early retirement, but my pension will be small. I will continue to work as a counselor for a limited number of clients. I live in the UK. For a long long time, I have wanted to live in a more rural setting and have a garden of my own once more. I love the sea and live close by at the moment. Dilemma. I live alone having divorced almost 20 years ago. My children live in work, 250 miles away. I have no other family in this country. Since the dream, the last member by marriage of my family died in a particular unsettling experience as it was not peaceful. I have not been teaching for four months now. The path is unknown and I feel on the cusp. The last years have been very difficult and I have had too much responsibility, too much to do. I am tired." She notes that her feelings in the dream were "pollution, darkness, need to urgently act and not look or think too much." Then she also notes that she has experienced shifts and started training in sandplay therapy. She says, "I suddenly found myself three weeks after the dream, creating a hole and putting a figure at the bottom on the blue. It had a door in it which, if opened, connected to a river." That was a sand tray experience. I'm imagining. Also just to add to that, sand trays are especially constructed for this work and the bottom is usually painted blue to represent water often. I am struck by the contradiction, the opposites in the stream right away that our dreamer starts out standing by a well and going down into it. Welles, of course, are life-giving sources of water. They were meeting places in ancient times because everyone had to go to the well. There are many fairy tales that have to do with going down a well, most famously the mother, Holly one. Yet in this well, instead of something that is life-giving, she finds toddlers and babies who are either dead or need to be resuscitated. So the images of the babies are kind of contaminant when they are in that environment. So if I step away from the gruesomeness of it and don't get overly caught in that, which means maintaining a symbolic attitude and we're not thinking about this literally, that some kind of infant dynamic in the psyche had been hidden in the unconscious, cast into the well, to get away from the ego, to get away from the conscious life. But as we know, when we disavow aspects of ourselves, they continue to exert an influence from the unconscious. And I think the idea of the contaminant or the poison that comes from a thing that was cast away is tremendously poignant. So then it begs the question of what might the two infants represent in terms of her own psychology that she had not been able to accept at some time in the past. But now seems to have the courage and through the presence of the animus, her inner masculine companion, she's able to find the strength to retrieve something that was cast away. Eventually the well will become pure again, although that does not happen immediately. The water would have to be removed or constantly flushed out before the aquifer allows it to return to a state where it could be useful again and not dangerous. Yeah, that's all really, really great. If I think I'm really just building on that to say that this is possibly a trauma dream and that there may be some perhaps early trauma, maybe perhaps quite early, these are babies and toddlers, where something's been kind of cast into the darkness that hasn't been dealt with and it has been kind of working on poisoning the well all these years. And now it needs to be surfaced and there's some urgency to it. It needs to be brought up into the light of consciousness and related to possibly. That's just one hypothesis and we couldn't know that for sure without consulting with the jamer. One thing that comes to mind for me is that babies often represent the most foundational primal needs, any for comfort and food and safety and mirroring and companionship and all of the things that we know and imagine that a baby, an infant would need. Many of us are not lucky enough to be born in a home, where our infant needs are met adequately and we can often reach a certain age where crying out for the unmet need is beginning to interfere with our lives. If we have the benefit of an analyst, we might be encouraged to go down, confront, visualize, and to consciously negotiate with it. But many of us, as a survival technique, simply dispose of the need. I don't need that. I just don't need it. Now, when I think about her comments that she's worked so hard for so many years and she has so little at the end of all that, it creates an image of cross-strips just my fantasy that work may have been a way to avoiding these unmet needs, or perhaps meeting the needs through proxies. For instance, sometimes we work or overwork as we feel that our clients are now our family, or that our colleagues have become family, that we're serving something internally, beyond just serving, for instance, the children she served as a special needs teacher. And now that she's preparing to retire, the way that she had tried to manage the unmet needs is leaving, which returns her now to a state where she is alone with herself, so to speak. And now the infantile needs are clamoring and in pain and crying out, and beautifully in the dream need recicitation. One of the areas that can help us relative to this idea of moral injury or being forced to participate in something which is so violating to our inner-value system is to begin dream work, that it's not uncommon for people who are in a state of agony in their conscious life to have dreams where there is a beautiful and peaceful figure that they interact with and they have a moment of grace. I can think of one client who was in a state of great suffering, and they had what they thought initially was a kind of toss away dream where there was an enormous tree. And the tree, its trunk, descended all the way down into a kind of underground grotto, and the canopy of the tree extended hundreds of feet upward. It wasn't an explicitly dynamic image, but when we really stayed with it and we stayed with it for weeks, what emerged was a feeling that there is something below the surface of my trauma that can nurture me, can nurture my soul that I am this tree. And as that image began to develop some sense of relief, some sense that there was in this person a life that was not spoiled by this misfortune, I think that's very important. It's the kind of the restoration and some sense of the ego self-axis that was brought about by the dream. I mean, I think that that's one thing that happens in moral injury is it cuts us off sometimes from the self, and that can speak to us again through dreams. And it's also the appearance of the transcendent function that there's something that comes in that transcends this horrible, horrible pain and suffering. There's a sense of being a companion and being gifted that there is more to the person. There are these other qualities, these other experiences, these other sources of life within. Because often with something like moral injury, we get subsumed by it as if this is who I am. And I think the dreams point, as we mentioned before, to the destiny that there is something more, there is something ahead, there's a future. Dreams are experiences, and there is this too. That we are more than our outer life. There's a source within that is essentially healing. There is a source within that takes us inexorably along the route toward individuation. That is what the psyche wants. It's natural gradient according to Jung. And signs of it are often present in dreams. I have another dream story that was so important that this is a very, very long time ago when I was really doing social work, but I still had some Jungian context that I would bring into it. And I was working with a middle-aged woman who had been abused as a child, violently abused, and had confessed that she had been very violent to her own children in term, this kind of echo of the pattern, kind of repeating in the next generation. And she was at a stage now where she was calm and self-reflective and in agony that she had permitted this to happen and felt that there was no way out. Her children had abandoned her later in life, feeling that they needed to escape her and escape the childhood. And so as we were working in active imagination around this, and I was not sure in any way how this could be resolved, in the midst of this internal cry for help, the image of a perfect, white egg just manifested in her internal hand. I have to say that as an onlooker, I didn't find that particularly remarkable. I was like, "Oh, is this going to help?" But she began to weep. And she held the egg. And after a while she opened her eyes and she said, "I couldn't imagine something so perfect and pristine and white that could be left inside of me." And that was at least the beginning of feeling there was an image of goodness inside of her, which I think people that knew her in her adult life would have thought. But she could not feel that. But some grace inside of her gave her the image that only she could have understood as new menace to the degree that it was. It's beautiful. And it gives me a teary feeling, which takes me to a herf feeling in my, how I, as I imagine it, of being so moved. And how important tears are here, that when we have access to our tears, something has been humanized, something softens, something is in the alchemist phrase, "insoluteo dissolving." And often in myth and fairy tale, that is when the angel appears. And dreams can help us get there. I'm also thinking about some of this in the context of trauma and grief. Because what the dream says is that there are two dead babies, toddlers, and a slightly older one, who's not quite dead, but needs resuscitating. And I would like to hold the possibility that bringing them into the light of day and facing what needs to be faced, bringing it into consciousness, may also be possibilities. Babies are often the future. They are potential of, you know, what will my, my little child be, you know? There's a song about that, the case, the ra, but what's been lost, what needs to be let go of, what needs to be mourned, and what can live the slightly older one, who can be resuscitated at this stage in life where she is tired. She's the only one living in the UK, her children are far away. She would like a garden, she likes to live never see. There's a feeling tone here in the dream and in her, the context she provided, of having to face and adjust to the losses and what lies ahead for her. There's a future. Her new life as she retires from her work as a special ed teacher. I'm also very interested in the vocal problem. I've plagued her here at the end of her career, and, again, pure speculation on my part. But I found myself thinking about, at least when I was a kid, somebody might suddenly show up in third grade with a patch over one of their eyes. And as used to be a technique, that you would often patch the good eye so that the lazy eye, quote, unquote, is forced to be roused, is forced to kind of come on board. And after a time the patch is removed and the vision is improved. So I'm imagining being a teacher and a counselor, which is a career that is in many ways dependent upon our ability to communicate vocally. But that good eye so to speak is being shut down, hopefully temporarily or impaired, is being patched so to speak. And then I can imagine other qualities like listening, watching, sensing, mental reflection could then have a greater opportunity to surface, because the primary mode of engagement has been impaired. And there might be gold in that shift to be able to bear that with a kind of quiet acceptance and goodwill and see if there is just as a centri-experience revealed that there is underneath the river, there is a larger wellspring under all of this suffering and contamination that is in reach and might require a kind of quietness in order to find. You've been listening to this Jungian Life. From our website, this JungianLife.com, you can follow us on Twitter, like us on Facebook, help us produce future episodes by funding us through Patreon and submit your dreams for possible interpretation on another episode. We'd like to thank our listener who shared a dream for today's show and hope you'll let us know what topics you'd enjoy hearing more about. Until next time, keep living this Jungian Life. you

Podcast Summary

Key Points:

  1. Moral injury is defined as social, psychological, and spiritual harm resulting from a betrayal of core values like fairness, loyalty, and justice, often occurring in military, medical, teaching, or political contexts.
  2. It differs from PTSD by focusing on internal conflict over one's own actions or complicity, leading to shame, guilt, and self-condemnation rather than fear of external threats.
  3. Manifestations include self-harm, substance abuse, recklessness, hopelessness, loss of empathy, and withdrawal, as seen in examples like Sophie's Choice or overwhelmed healthcare workers.
  4. Healing requires community acknowledgment, honest autobiography, and symbolic restitution (e.g., confession, reparative actions) to restore meaning and reintegrate the individual.

Summary:

Moral injury arises when individuals face betrayals of their core values, often due to institutional pressures or impossible choices, leading to profound psychological and spiritual harm. Unlike PTSD, which stems from fear of external danger, moral injury involves internal shame and guilt over perceived wrongdoing, as illustrated by extreme examples like Sophie's Choice or everyday dilemmas in healthcare and social work. This injury manifests as self-destructive behaviors, withdrawal, and a shattered sense of meaning, where individuals feel unworthy of help or forgiveness.

Healing requires a process of honest storytelling, where the injured party confronts their actions in a supportive community, and symbolic restitution, such as acts of repentance or confession, to restore a sense of moral balance. Without such acknowledgment, moral injury can lead to chronic despair, addiction, and isolation. The key is to transform the "lead" of guilt into "gold" through shared understanding and meaningful reparation.

FAQs

Moral injury is the social, psychological, and spiritual harm from feeling that there has been a betrayal of one's core values, such as fairness, loyalty, or justice. It wounds one's conscience and can result from interpersonal actions or obeying orders.

Moral injury can occur in the military, medicine, teaching, social work, and other caretaking roles. It happens when institutional values conflict with a person's personal code of conduct and conscience.

PTSD often involves physical threat and symptoms like hypervigilance, while moral injury stems from a violation of core values and beliefs. In moral injury, the person feels they committed a wrong, leading to shame and withdrawal.

Symptoms include self-harm, substance abuse, recklessness, hopelessness, self-loathing, loss of empathy, and preoccupation with internal distress. It can also lead to depression, anxiety, and suicidality.

They often feel shame and a sense of not deserving help, leading to withdrawal and hiding. This impulse to hide can prevent them from reaching out for treatment.

Healing often involves creating an honest autobiography of the experience and confessing it in a non-judgmental setting. This helps bring the injury into conscious awareness and begin transformation.

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