thinking about moral injury
I saw a tweet the other day that felt like a flash lighting up a lot of experiences I’d only seen the outlines of in the dark. It said “I was complaining to my friend about how awful things feel and how hard it all is at the minute, and he said 'it's a period of deep moral injury for anyone with a thinking mind and a working heart,' and if that doesn't just hit the nail on the head I don't know what does.” (https://twitter.com/MarieGardiner/status/1778390958796624043) I don’t remember when I first heard the term “moral injury” and I’ve not done a proper scholarly lit review on it, but ever since learning the term it’s preoccupied me off and on. I wrote a short essay a while back borrowing the idea as I understand it to talk about the awfulness of online teaching (https://academeblog.org/2021/05/11/faculty-moral-distress-about-pandemic-teaching/).
My interest in the concept grows in part out of my being generally compelled by awfulness and violence, and by something I struggled with in my book, which was trying to give a full spectrum account of the harms involved in workplace injury. Part of my argument in the book was that workers compensation laws talk about injury in reductive ways tied to a reductive sense of what workers are. I wanted to counterpose to that a more robust, holistic sense of people’s humanity. That was far more a matter of being guided by gut level unease and an impulse to tell stories, both very strongly felt, than it was anything I felt like I could really explain at any kind of general level. Working on that felt a bit like shining a light down a hole and seeing it was deeper than I thought, getting a bigger light and seeing the hole was even deeper than that, getting an even bigger light and seeing it was even deeper still, getting... you get the idea. That’s not to say I became interest in moral injury because of my book, it’s to say my interest comes from the same place. The concept of moral injury is important at least in because it helps make articulable awful shit that is real in people’s lives yet which is not immediately intuitive or easy to explain without that concept.
The way I understand the concept is that people have values which it is genuinely injurious, actively traumatizing, to violate, and are pushed into circumstances where they end up violating those values - often circumstances where there every option is morally injurious in that way. There are likely nuances I’m missing since, as I said, I’ve not done a robust literature review. What I have read is mostly stuff by and about healthcare workers. Healthcare workers care a lot about what they do, which is important because what they do is high stakes in terms of human consequences, and yet healthcare institutions often set those workers up to fail, so that they can’t provide healthcare at a level/in a way that lives up to their values, to their prioritizing care. And that genuinely injures them. It’s my understanding this can be a contributor to PTSD.
I mentioned I wrote a piece on this regarding teaching. I took pains there to say that in my own case I hesitate to claim moral injury as I don’t want to claim to be on the level of healthcare workers in terms of either stakes or the harm done. I said instead ‘moral distress’ but this is a continuum. (Seeing the genocide in Gaza unfold has been morally distressing as well for sure. Feels bad to put that in a parenthetical remark, but nothing I can think to say feels adequate either.)
I had the thought today that moral distress has likely been widespread in working class life. Marx talked about there being a moral element of the price of labor power. Another moral element of life in capitalist society is people’s investment in use value production, specific use values I mean. Capitalism is one way that societies organize the processes of interacting with non-human nature and with the products of that interaction, which is to say, societies are in part production processes, understanding those terms expansively. In all class societies some kinds of production are socially validated more than others and that validation/invalidation is a matter of conflict. In capitalism that validation is massively subordinated to accumulation, to turning money into more money, which means some values are suppressed/neglected/downgraded/disrespected/treated as matters of indifference: to a significant degree there’s a powerful nihilism to capitalism, since the main social organizing principle is making more money. (That’s not to say that all substantive values are good, far from it.)
These patterns play out in specific ways like what I mentioned regarding healthcare workers. Let me try it this way. In the fall of 2000, right after graduating from college, I moved to Scotland on a temporary work visa and while there I got a job at a bookstore. They put me and a coworker in the library of a branch campus of a college there where we sold textbooks off of a card table. It was far from glamorous and it paid minimum wage but I was in love with the place and with books and I was young and punk en0ugh that I thought minimum wage was okay enough. Early on the owner of the bookstore drove my coworker and I out to this library and I chattered excitedly about how delighted I was to be in Scotland AND in a bookstore and he said, dead eyed, that to him it was just selling things for money - “it might as well be tins of beans,” he said, it was all the same to him. That same reduction is everywhere in capitalism. A lot of what people most love, want, need to live, let alone thrive, is only available as something bought for money and sold by people who (or sold for the benefit of the owner who employ those people and who) are only interested in that very important stuff because it’s a vehicle for making more money. Sure, you want your loved ones to stay alive, but to the hospital system as a profit-making entity, and oftentimes for the people paid to run those systems, the healthcare your loved ones buy - might as well be tins of beans, all the same to the boss.
That said, the people doing and making those needed things are often far less indifferent to the end result. I briefly organized hospital janitors in an organizing campaign with the union AFSCME and the janitors cared a great deal about doing a good job. Many of them had really serious problems at work - terrible pay, abusive supervisors, inhuman schedules - but several of them spoke really passionately about how they were upset that the hospital didn’t stock adequate cleaning supplies so that for the last day or three of the month it was really hard to clean the rooms adequately. They’d have to clean toilets with the glass cleaner used to wipe off the windows sometimes. One of them said to me ‘that place is full of sick people, I don’t want someone to get sicker cuz the room is dirty, I hate that thought. I try so hard but if there’s no supplies there’s only so much I can do.’ Related, I distinctly remember my dad, a now retired electrician, being upset for a while when I was a kid because the contractor he was working for was having houses in a subdivision have the wiring in the basement that was visible be covered in an expensive piping, but none of the rest of the wiring was so covered. People looking at the houses would see that visible cover and understandably assume all the wiring in the whole house was like that. I asked him about it years later and he remembered it with great disgust, saying the contractor saving probably six hundred bucks per house, dishonestly. My mom was a teacher for a while and had lots of similar stories of school administrators cutting corners on the kids with teachers having to make do, and many of us teaching in higher ed have related stories.
The way I’d say all this is that what I’ve said here is a matter of workers understanding at some level that at least some of the times the things we do and make are very important parts of what other people need to have good lives, and with some kinds of goods and services, like healthcare and medicine, to live at all. That recognition of this genuine importance to other people is importantly pro-social, pro-other-people’s-well-being: it’s a solidaristic orientation. (Of course not everything that every worker does or makes is important like that, and sometimes the importance isn’t always immediately visible: I briefly worked in a factory literally sorting the contents of big boxes of trash, picking out the profitably recyclable elements of shredded cell phones. I didn’t care at all about that. Later they sent me to the loading dock where I helped ship cell phones. Those phones might matter a great deal in some people’s lives, and they might not. I’d never know. And certainly a great deal of what gets made is actively antisocial and harmful.) That solidaristic orientation is subordinated to the need to make a profit - might as well be tins of beans, just something to sell. A significant part of the management does is impose that indifference, discipline workers into it: do just good enough of a job, no less but no more. For some workers in some settings, that means doing worse than their values, like with healthcare workers as I mentioned. When that happens, those workers can suffer moral distress, and in some cases, real injury as I said.
I think in instances of bodily injury there can be accompanying moral injuries as well to the bystanders. The janitors I helped organize - one was in his 70s and hassled by management a lot. He had a heart attack at work. When he came back, management road him harder and he started having chest pains. The other janitors stood up for him, which was great, and at the same time their experience was one of seeing this old man who they worked with and cared about treated badly and having limited ability to respond, until they were able to collectively pus back. The life of that social process which is in one respect an important instance of solidarity lived in action was in another respect a process involving moments of being forced to witness abuse - potentially fatal abuse; one of the janitors told me she was afraid this man was going to die at work - that these people were at least momentarily unable to stop. When I got hurt at work at 18 when some lumber fell on me and broke my hand the production line stopped for a few minutes. Then it started again and I remember several co-workers’ faces, including my uncle who I worked with and commuted to work with.
Part of what I’m working my way toward is that at least certain versions of felt solidarity involve real distress at what is done to other people.
There’s a poem I dearly love by Bertolt Brecht called “To Those Who Follow in Our Wake.” (It’s here, the German version comes first, I dunno why. https://harpers.org/2008/01/brecht-to-those-who-follow-in-our-wake/) It starts off declaring “Truly I live in dark times!” and talks about the discomfort involved in having good feelings and positive experiences in such times:
“He who laughs / Has not yet received / The terrible news. / What times are these, in which / A conversation about trees is almost a crime / For in doing so we maintain our silence about so much wrongdoing!”
Later the poem expresses a desire to stop wanting various things:
“I would happily be wise. / The old books teach us what wisdom is: / To retreat from the strife of the world / To live out the brief time that is your lot / Without fear / To make your way without violence /
To repay evil with good — / The wise do not seek to satisfy their desires, / But to forget them. / But I cannot heed this”
I read this as in part implying that to ‘wisely’ abandon effort to satisfy desires as part of living apart from the world’s strife involves giving up the concern that makes the news terrible: that, this kind of ‘wisdom’ makes laughter amid horror less troubling because trouble less perceived. These ‘wise’ are not louder about wrongdoing but more comfortable in their silence.
I’d like to eventually try someday, after I’ve done more of the proper lit review on moral injury, to write an essay to the effect that labor historians should consider moral injury and moral distress as a category or object of historical analysis. I’ll say, I have no idea how to do this with the specific sorts of archival materials I’ve worked with in my admittedly limited archival forays. (I’m a good historian, I think I’m allowed to say that now, but whatever my particular strengths are they’re not especially in the archival research part of the set of activities involved in historical scholarship.) I think it could be done with other sources and with non-archivally focused methods and in investigations of the present of the sort that many qualitative social scientists do - interviews and observation and ethnography and all that, none of which I know anything about. For now all I can say, but which I can say with confident conviction, is that I’m sure moral injury or moral distress can inferred to be a really significant part of working class life.
It’s an important part of the life of lower and middle management too. As I’ve mentioned on here before at least once (https://buttondown.email/nateholdren/archive/connecting-a-few-more-dots-more-notes-on-social/), I’m currently flailing around trying to write an academic article related to part of my book, the chapter on industrial physicians. Industrial medicine developed as a distinct subfield in the early 20th century, the industrial physicians forming their own professional organization in 1916. Part of what made them distinct is that they were employed in the medical departments of large business corporations, especially manufacturers. In the book I focus on their role in designing and enacting programs of employee surveillance perpetrated via medical techniques, for the sake of preventing the employment of disabled people whose impairments made them especially expensive to injure under workers compensation laws. I called the doctors ‘discrimination technicians.’ In the thing I’m currently writing I continue to think about the technician part, with a focus on how they filled out paperwork for their bosses that reported on the medical ‘care’ they ‘provided’ to injured production workers and the medical examinations they conducted for the purposes of discrimination against disabled people. That paperwork was, like all paperwork, dull and bloodless yet it was specifically dull, bloodless depiction of the literally bloody life of production and the metaphorically bloody discrimination they helped perpetrate. In terms of how I read that bit of this Brecht poem, they helped their bosses in senior management be ‘wise’, to never hear the terrible news and so to laugh easily.
As I said, witnessing injuries in the workplace can be distressing, can be at least somewhat morally injurious, and part of what I’m trying to get at with this Brecht bit is that I suspect that this moral distress is inflected differently for people in supervisory or lower management roles, as they’re torn between their understandable distress and the values and priorities that are tied to their positions low but not at the bottom of the food chain. To be blunt, climbing the ladder warps people morally over time, I think - a career on the management track will tend to ghoulify, because fucking people over fucks you up. Of course, so does getting fucked over. (“Ordinary people do fucked up things when fucked up things become ordinary,” in the words of another poet. https://www.youtube.com/watch?v=IAQb0xUErKI)
None of this is only a matter of harms in the workplace. I saw someone say that my essay on what I called broken sociality (archived here https://buttondown.email/nateholdren/archive/the-hits-dont-start-volume-2-me-in-peste/, last I checked the link on the Peste page wasn’t working, unfortunately) was about moral injury and I wished I’d said that. I think that’s definitely a factor. I focused on work in that essay but not exclusively - capitalism is a whole kind of society and way of life subordinated to making money, it’s not only workplaces. I talked a bit in this post - https://buttondown.email/nateholdren/archive/explaining-the-explanations-or-neither-their/ - about liberals having resources that help them morally disregard other people.
I didn’t think of that as about moral injury at the time but I was in a twitter conversation tonight with a twitter friend (hi Martha!!) and occasional co-author (I mean just once - SO FAR! - but that one time - ahem, Time - was to me quite the occasion: https://time.com/6223311/our-third-covid-winter-is-coming-america-isnt-ready/) and that friend said that some people are likely crumbling inside right now due to the conflict in their values that they must be experiencing due to staying silent on the genocide in Gaza. (Speculating, I think that silence is a mix of careerism, a vague desire not to offend people they look up to, and a degree of political confusion. My wife has also suggested to me that middle class people are socialized into deference to authority in various ways. I feel like I can feel elements of this in my own life tied to my formal education but it’s uneven and often comes out in the form of disappointment and bewilderment as I basically overestimate people who I experience at a gut level as people I’m almost but not quite peer with - I think I expect them to do and act in line with what are to my mind the obvious right and smart things to do and which they should understand even better than me since they are, my gut feelings assert with strong clenches, my betters.)
This point about people internally crumbling really struck me and sparked some more thoughts on moral injury. I’ve tended to think of the concept exclusively as a matter of distress on the part of people I sympathize or empathize with, and I think it’s powerful for that. But it’s also a concept that gets at the distress underlying some decisions I’m not exactly open-minded about, like getting on the management track and the kinds of actions that tend to flow from those choices, and I think it’s a factor in some people’s silences on the Gaza genocide.
It’s obvious that not all people hurt are paragons of virtue. Suffering is not morally purifying. Again, ordinary people do fucked up things when fucked up things are ordinary. The harms of moral injury can lead to responses that let people down in really serious ways because those harms can lead people to neglect or simply be unable to meet important responsibilities they have. I also think, and this is what really started to click in my head tonight in response to what Martha said, that some people sort of morally insulate or armor themselves (I feel like ‘character armor’ is a psychoanalysis term but I don’t remember what it means and can’t be bothered to look it up - I mean, I could, but I won’t read whatever the google search turns up, not tonight, it’s late and I’m tired and lazy - I mostly know it because it’s referenced in a Jawbox song: https://www.youtube.com/watch?v=l_7GrWO3uj4) in order to avoid moral discomfort. Basically they react anti-solidaristically to the discomfort of perceiving others’ suffering and the discomfort of being pulled between their response to that perception and the more convenient and acceptable feelings and related actions that their superiors expect - can’t climb the ladder if you act too demonstrative in the wrong ways with the people below you. Pity’s probly fine, being virtuous condescension (https://writingtothink.wixsite.com/mysite-2/post/talmbout-condescension) but no feelings, words, actions that imply much upwardly directed criticisms. I don’t mean to say this is only or primarily a matter of naked self-aware cynicism, though that absolutely does exist sometimes. I mean instead that it’s more often, I suspect, a matter of not fully conscious - enacted by the selfish survival focused lizard part of the brain - ducking of the distress. There’s a nontrival relationship here, I think, to political resignation as well. Throwing up one’s hands at the possibility of anything different is followed by feeling helpless but still distressed, but makes it possible to just tune out. After all, if nothing can be done about it, why pay attention to it? Be wise! Retreat from the strife of the world! And there are resources to facilitate that, and people get paid a lot of money to generate them (https://buttondown.email/nateholdren/archive/no-such-thing-as-long-covid-well-fu-uh-uck-you-pal/)
I really need to get off here, this is too long and I’m tired and have dishes to wash but one more thought I want to try to dig out of the ground: I think people contribute to their own processes of becoming ghouls in response to elements of moral distress, trying to avoid moral injury of the sorts I mentioned earlier. (In my industry, higher ed, I think this - and the related realities of burnout due to bad and worsening conditions plus stagnant pay in a context of rising prices and scarier futures for people’s retirement and their kids - are significant factors in faculty quitting faculty jobs to become management. Some of the ideology of the industry leads to that being mistaken for something other than what it actually is, which is straightforwardly driving people out of faculty jobs because who would actively choose to stay in this kind of job long term under the industry standard conditions?) In doing that avoiding people in effect inflict a different set of injuries on themselves. In the terms of the tweet I started with, if it’s a problem having a heart and mind during life in a hellscape, some people set about learning to turn off their heart and mind. To an important extent we all do this in capitalism - no one could live if they truly felt all the system-generated suffering of others to an appropriate degree; this is briefly but powerfully discussed via the term ‘social coldness’ in the Werner Bonefeld book my friend Rob Hunter and I reviewed together (https://spectrejournal.com/on-economic-compulsion/) - but there’s a difference between doing so where you are and doing so tied to climbing the ladder. The latter (ugh, sorry) involves becoming a feedback loop of suffering to a much more significant degree and deliberately trying to avoid even merely symbolic opposition to the political sources of that suffering, let alone more serious opposition.
This really will be the last thought here, Brecht again:
“You, who shall resurface following the flood / In which we have perished, / Contemplate — / When you speak of our weaknesses, / Also the dark time / That you have escaped.”
Those weaknesses are directly related the weight, the distress, of our own and others’ suffering:
“Even the hatred of squalor / Distorts one’s features. / Even anger against injustice / Makes the voice grow hoarse. We / Who wished to lay the foundation for gentleness / Could not ourselves be gentle.”
Living with that distress, carrying that weight, is part of the best course of action in these dark times - the self-callousing ghouls who ‘wisely’ keep quiet in their retreat from the strife of the world, letting themselves laugh easily, are making deep moral mistakes that make themselves far worse - self-ghoulifying, self-dehumanizing - but even so, the weight and distress is something we want to go away eventually, via the eventual end of the world of social murder, oppression, war.
Alright, well, that was too long, but in my defense I didn't have time to make it short. Keep on trucking my friends, enemies, and frenemies. Over and out.