Moral Injury and Spiritual Emergency

Moral Injury and Spiritual Emergency 

by Emma Bragdon, PhD

Joshua Mantz, (above), fresh out of West Point Academy, was a second lieutenant in the army deployed in 2006 to a dangerous zone in Baghdad, Iraq, at age 23.  Within months he was shot by a sniper, almost bled to death, and flatlined for 15 minutes (giving him a Near-Death Experience).  When close associates were killed during his watch, and he almost lost his life—he experienced survivor guilt and moral injury. He recovered his physical health sufficiently to return to his platoon after 4 months of recuperation.  He wrote in 2017 that human connection and community saved him from the darkness of moral injury.  Now he is a PhD candidate studying Philosophy, Religion and Consciousness, convinced that spiritual growth is the most powerful path to healing, and fully overcoming moral injury.  He avidly studies ancient philosophy from the far East and meditates daily.

Moral Injury Defined

Moral Injury often creates profound inner conflict that can destabilize the most healthy among us.

Psychiatrist Jonathon Shay created the term and defined moral injury.  It has three components- Moral injury is present when:

1. there has been a betrayal of what is morally right,
2. by someone who holds legitimate authority and
3. in a high-stakes situation.

Example: an enlisted person is asked to kill people in a war-time situation they don’t believe in. Given the number of veterans today who suicide because of moral injury—it is important to sort out how to help them heal with appropriate support so they avoid hurting themselves.  In 2021, 6,392 Veterans died by suicide (ref).  That’s more than 16, daily.  Joshua (above) found his way…others have not found the help they need.

Of course, moral injury can occur in many other environments, including a family, i.e., any environment where there is a hierarchy and those with less power feel forced into behaviors in conflict with their heart of hearts.

Moral Injury demands one or more of 4 responses:

1. a recommitment to one’s core/ foundational beliefs or
2. a choice to give up core beliefs, or
3. replace them—or
4. an attempt to repress the inner conflict.

The 4th option can lead most quickly to addiction and/or suicide.  However, the inner conflict and profound reevaluation catalyzed by the first three responses can also engender great difficulties in relationships, bringing on severe emotional distress that often leads to isolation and despair.  Appropriate support is needed by anyone who faces moral injury.  This may involve psychoeducation, group support, intensive workshops, pastoral counseling, or psychotherapy of various kinds, including psychedelic-assisted psychotherapy. I believe there will be different approaches needed for diverse cohorts.

Choosing the Best Language for Support

 Any individual’s core beliefs are likely to indicate the kind of support most appropriate for them, a process to relieve them of moral injury:

1. Those identified with morals/ethics articulated by a religion or spiritual tradition may find moral injury to be a religious or spiritual issue. For instance, “Thou shalt not kill” (unless you are clearly protecting yourself, your family, or your country) is firmly embedded in the primary texts of many religions. Support through the resources of their church/mosque/ temple/chaplain might be most helpful.
2. Those who follow a more secular, individualistic path may perceive their moral injury as a profound challenge to their innermost heart, or conscience. They may not use the term “spiritual” or “religious” to describe their pain…in fact they may shy away from or even be averse to these qualifiers.  Psych-education may be where they find effective healing.
3. Those that see all psychological distress as belonging to the zone of healthcare providers will likely seek support from these professionals. Psychiatrists and psychologists categorizing those with moral injury will likely simply relate it to “post-traumatic stress disorder”, a type of mental illness that may involve a complicated set of emotions, e.g. deep depression, anxiety, self-blame, guilt and shame, that can lead to sleep disturbance, alcohol and drug dependence, upsets in relationships, and suicidal ideation.
4. There are also individuals, like Joshua, who are being pushed into a higher level of consciousness through their inner conflicts. Rebecca Nicholson, PhD, writes “They are trying to make sense of a whole new reality that others around them do not see, all the while being open/subject to new information and non-ordinary phenomenon, also not experienced by others.” (personal correspondence)  Psych-education about ‘spiritual emergency’ and obtaining group or individual support from coaches educating in supporting those in spiritual emergency will likely be the most effective support for them.  Meditation practices can be stabilizing.

Spiritual Emergency Defined

Spiritual Emergency (SEY) is a period of disorientation that demands a person re-evaluate their life, especially their purpose and what gives them a sense of meaning, Those in SEY are having/ or have had spiritually-transformative experiences, (e.g. psychic opening, Near Death Experience) which can change their notion of who they are and what the world is about, and what they most value.    SEY can happen as a result of meditation and spiritual exercises, or stress, loss of physical health, loss of a job, even life transitions, e.g. from teenage into adulthood.  All of the stressors are possible in military recruits deployed to fight, and were true of Joshua Mantz (above).

Joshua’s story is truly a spiritual emergency: he currently embraces spiritual awakening as his path and wants to encourage others, like him, to do the same, as it brings peace.

Is moral injury a spiritual emergency for all people in the military who may have both moral and physical injury?  It may be that “existential crisis” is a better term for most people traumatized by moral injury. Dr. Shay, who originated the term moral injury, argues that PTSD is not an illness but the persistence of adaptive behaviors needed to survive in a stressful environment.

Invitation to You

Do you believe moral injury is a mental illness, a religious problem, an existential crisis, or a stepping stone to the process of ongoing spiritual growth, aka “spiritual emergence”?  Please describe your reasoning  You can use the comment box below to send us your answer and discuss with others.  At IMHU we are reflecting on how to be of support to veterans, police, 1^st responders, EMTs and the like who personally experience or want to support those with moral injury.  Your reflections will be helpful as we build connections between moral injury and SEY as a community.  We may contact our followers to convene a focus group on this topic later in the Spring, 2024.