I’m sure you’ve heard the arguments about moral hazard over the last few years—the idea that by helping others we put them in danger of becoming lazy and less responsible. Lately I’ve seen increasing discussion of something called “moral injury.” Researchers studying post-traumatic stress disorder in soldiers tell us guilt and shame, not fear, may be a primary factor. It turns out that we humans probably can’t do damage to each other without damaging ourselves.
This shouldn’t be a new concept, although I suppose it has been described in spiritual and not medical terms more often. The old language of sin and redemption has become stuck in religious circles and lost meaning in secular society, but the underlying truth remains, and we forget it at our peril. Perhaps we can use mental health research to open up new ways of speaking and thinking about the consequences of our actions.
I’ve been wondering this week if our society has been increasingly engaged in collective moral injury. When some of us speak harshly of the poor, blaming them for their difficulties and refusing assistance, it might cause a sense of self-righteousness—but is it really possible to do that without some part of us being hurt? When we see others being marginalized and threatened and do not speak up firmly, out of concern for our employment or social acceptance, or because of compassion fatigue, what does that do to our bodies? When we fight back by labeling the complicit with polarizing and ugly names like “repugs”, as if these others are incapable of morality and humanity, do we strengthen our own righteousness at unknown cost? What do such words or silences do, deep in our brains, hearts, bowels, bones and arteries?
I wonder if some of the better health and longer life in countries who attend more deeply to human needs and dignities is related not just to the provision of services but to the effects of kindness on the health of the kind. Are we sicker and more unhappy not just because we can’t all get medical care but because we are actively hurting ourselves by failing to make it available to others?
Moral hazard is not an imaginary thing, although it doesn’t always work quite the way we’d expect. Raising the individual cost of healthcare, at the point of service, does result in less use of unnecessary care-seeking—but it also reduces needed care. Can we help those who need it without enabling them to stop putting in their own effort? I think so, but I doubt pushing the personal responsibility mantra will do it. A better message: each of us is needed and has a valued contribution to make, not to ourselves but to each other. A person receiving food stamps could be assisted and encouraged also in finding a way to help her community. She needs to hear “we can’t do this without you.” In healthcare, we could find ways to remind each other that taking care of our own health and reducing unnecessary use of healthcare resources is a way to free up those resources so everyone can get enough. When we quit smoking, eating unhealthy foods, or being sedentary, we are not just helping ourselves.
I am trying to remember these days, with variable success, that we will never achieve substantial change without engaging the hearts of those we see as opponents. It is so tempting to be groupish and point fingers, to say “well, at least we are not like those folks.” Maybe understanding our words could become moral injury boomerangs will help us stop. Let’s leave room and openness in our exhortations, so that persons of all political identities feel welcome to join us. Let’s ask ourselves whether it is better to feel righteous or better to see good things happen.
Surrounded by injustice, how can we keep ourselves healthy and limit or repair moral injury? The old religious practices of confession and penance are in decline, even within churches. Recovery groups use the model of making amends and find that tremendously healing. Perhaps we can find new ways and words to do the same thing in our larger society, ways of acknowledging where we have caused suffering or allowed it to happen without bearing witness, followed by some positive act towards justice. Our moral injuries are severe— frequent tending is required. What can we do, however small, today?