1
|
Hodgson TJ, Carey LB, Koenig HG. Moral Injury, Betrayal and Retribution: Australian Veterans and the Role of Chaplains. JOURNAL OF RELIGION AND HEALTH 2022; 61:993-1021. [PMID: 35175506 DOI: 10.1007/s10943-022-01507-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 05/11/2023]
Abstract
This paper presents additional qualitative results from Phase 1 of a larger study examining potentially morally injurious events/experiences (PMIE) and/or moral injury (MI) among Australian veterans (Hodgson et al. in J Relig Health 60(5):3061-3089, 2021). It makes specific reference to (1) betrayal and (2) retribution experienced or perpetrated by Australian military veterans during military conflicts and peacekeeping missions. During two veteran seminars conducted in Adelaide, South Australia, a total of 50 veterans were recruited, 10 of whom were willing to be interviewed and audio-recorded about their deployment experiences. Narrative data analysis of veteran transcripts indicated that all participants had engaged in or were exposed to a PMIE/MI of one kind or another, and all had experienced betrayal and/or witnessed or perpetrated retribution. Given the ethical, moral and spiritual issues involved, the role of chaplains in addressing moral injury for the benefit of veterans through the use of 'Pastoral Narrative Disclosure' (PND) is suggested-with a specific focus upon 'restoration' and 'ritual'. Additional research is recommended with regard to acts of betrayal and retribution among veterans, as well as the further development of PND to address PMIE/MI.
Collapse
Affiliation(s)
- Timothy J Hodgson
- School of Historical and Philosophical Inquiry, University of Queensland, St. Lucia Campus, Brisbane, QLD, Australia.
| | - Lindsay B Carey
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Centre for Spirituality, Theology and Health, Duke University, Durham, NC, USA
| | - Harold G Koenig
- Centre for Spirituality, Theology and Health, Duke University, Durham, NC, USA
- Duke University Medical Centre, Duke University, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jidda, Saudi Arabia
| |
Collapse
|
2
|
Jones KA, Freijah I, Carey L, Carleton RN, Devenish-Meares P, Dell L, Rodrigues S, Madden K, Johnson L, Hosseiny F, Phelps AJ. Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review. JOURNAL OF RELIGION AND HEALTH 2022; 61:1051-1094. [PMID: 35290554 PMCID: PMC8922078 DOI: 10.1007/s10943-022-01534-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
The aim of this research was to describe the evidence examining the approaches taken by mental health providers (MHPs) and chaplains to address symptoms related to moral injury (MI) or exposure to potentially morally injurious events (PMIEs). This research also considers the implications for a holistic approach to address symptoms related to MI that combines mental health and chaplaincy work. A scoping review of literature was conducted using Medline, PsycINFO, Embase, Central Register of Controlled Trials, Proquest, Philosphers Index, CINAHL, SocINDEX, Academic Search Complete, Web of Science and Scopus databases using search terms related to MI and chaplaincy approaches or psychological approaches to MI. The search identified 35 eligible studies: 26 quantitative studies and nine qualitative studies. Most quantitative studies (n = 33) were conducted in military samples. The studies examined interventions delivered by chaplains (n = 5), MHPs (n = 23) and combined approaches (n = 7). Most studies used symptoms of post-traumatic stress disorder (PTSD) and/or depression as primary outcomes. Various approaches to addressing MI have been reported in the literature, including MHP, chaplaincy and combined approaches, however, there is currently limited evidence to support the effectiveness of any approach. There is a need for high quality empirical studies assessing the effectiveness of interventions designed to address MI-related symptoms. Outcome measures should include the breadth of psychosocial and spiritual impacts of MI if we are to establish the benefits of MHP and chaplaincy approaches and the potential incremental value of combining both approaches into a holistic model of care.
Collapse
Affiliation(s)
- Kimberley A Jones
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Isabella Freijah
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Lindsay Carey
- Department of Public Health, La Trobe University, Melbourne, Australia
| | | | - Peter Devenish-Meares
- Graduate School of Business, Queensland University of Technology, Brisbane, Australia
| | - Lisa Dell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Sara Rodrigues
- Canadian Centre of Excellence on Post-Traumatic Stress Disorder (PTSD) and Related Mental Health Conditions, Ottawa, Canada
| | - Kelsey Madden
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Lucinda Johnson
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Fardous Hosseiny
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Andrea J Phelps
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, 3053, Australia.
| |
Collapse
|
3
|
Fleming WH. Complex Moral Injury: Shattered Moral Assumptions. JOURNAL OF RELIGION AND HEALTH 2022; 61:1022-1050. [PMID: 35274226 DOI: 10.1007/s10943-022-01542-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
An infographic model of moral injury (MI) is introduced in this conceptual paper that distinguishes the development of a worldview discrepancy-induced genus of MI, called complex moral injury (C-MI), from a standard expression of moral injury (S-MI), clearly delineated as perpetration-focused and a violation of moral belief in the contemporary view. It builds upon a previous essay that examined the potential of paradoxical circumstance (e.g., clashes of value, competing moral expectations, and moral paradox) to inflict MI among military personnel during wartime (Fleming in J Relig Health 60(5):3012-3033, 2021). Accordingly, it heeds Litz et al.'s recommendation to expand the research of MI beyond the effects of perpetration and investigate the impact of morally injurious events that shake one's core moral beliefs about the world and self (Litz et al. in Clin Psychol Rev 29(8):695-706, 2009). A review of definitional, scale, and qualitative studies shows evidence of a nuanced and complex form of MI that presents as moral disorientation and is a response to a disruption and subsequent failure of foundational moral beliefs to adequately appraise ethical problems and inform moral identity. Interrelations between MI, assumptive world, and meaning theories suggest the mechanism of C-MI and potential therapies. Case studies from a Veterans Administration hospital in the United States and a walk through the diagram will help illustrate the model. Clinical implications of a definition that includes morally injurious events that shatter fundamental moral assumptions are discussed. The role of chaplains in facilitating acceptance and meaning-making processes is recommended for C-MI recovery. Acknowledging the model's need for empirical support, a plausible scale is discussed for future research.
Collapse
Affiliation(s)
- Wesley H Fleming
- Clinical Chaplain, Syracuse VAMC, 800 Irving Ave, Syracuse, NY, 13210, USA.
| |
Collapse
|
4
|
Hodgson TJ, Carey LB, Koenig HG. Moral Injury, Australian Veterans and the Role of Chaplains: An Exploratory Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:3061-3089. [PMID: 34553273 DOI: 10.1007/s10943-021-01417-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 05/11/2023]
Abstract
Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury (MI). This qualitative study formed 'Phase 1' of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidence identified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested-namely 'Pastoral Narrative Disclosure.' It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility.
Collapse
Affiliation(s)
- Timothy J Hodgson
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, Australia
| | - Lindsay B Carey
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, Melbourne, 3086, Australia.
| | - Harold G Koenig
- Departments of Psychiatry and Medicine, Duke University Health System , Duke University, Durham, NC, USA
- Division of Psychiatry, Department of Medicine , King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|