On May 3, four days after a remembrance at Manzanar happened on the 75th anniversary of the internment camps, I met a Japanese American woman in Los Angeles who sought my input about moral injury for a documentary related to the internment. She began by explaining that some African American and Hispanic people in California had raised Japanese babies during World War II. At first, I was puzzled by this information and how it related to moral injury. I was unprepared for the answer or the magnitude of moral injury she suspected was there.
She explained that she was worried about very elderly Japanese women who, with only minutes to decide and no idea of what lay ahead, had to choose which child to give away and which to take into internment. When the internment order was issued by Franklin Roosevelt, Japanese mothers who worked in fields with Black and Hispanic farm workers saw police arrive suddenly, surround the fields, and take the Japanese workers away to be imprisoned without due process—62% were U.S. citizens, and it only took being 1/16 Japanese to be taken captive.
The mothers were allowed to bring one child and, if they had it, one suitcase. Thinking perhaps that a very young child would not remember them and fearing what lay ahead, many mothers suddenly gave their infants and toddlers up to the workers around them. The woman who was worried about the mothers asked me, “What kind of moral injury might they be still carrying, and what kind of shock might they experience if their abandoned children wanted to meet them? How had they dealt with their suffering all these years?”
Profound questions about moral injury haunt this story. The end of the story of Japanese internment was not genocide, but that terrible instant of choice between children is depicted in the film “Sophie’s Choice.” The Japanese mothers faced a similar harrowing and unbearable decision. Sophie finally killed herself. How might the surviving mothers respond to their story being made public or to meeting the surviving children they gave away?
Moral injury is a profound suffering that accompanies the loss of a moral compass and meaning system because a person or group is involved in events and acts that cause grievous harm. Some of the most devastating forms identified in combat veterans are having to kill or being ordered to do illegal things such as torture. However, even victims of violence can experience it because of what they had to do to survive, because of being unable to save loved ones, or because of feeling forever tainted or disgusting from being defiled by evil. The guilt, shame, remorse, despair, and self-condemnation of moral injury can linger in a person for a lifetime, unspoken, and affect those who love them. A community can carry it and bequeath it to generations who are born after the original trauma.
Moral injury has no formal diagnosis or treatment protocol. I believe it is a normal human response to morally devastating experiences—not a mental health disorder but a spiritual suffering that comes from having been given a value system that shapes one’s moral conscience and having violated that system. For too long, it has been confused with post-traumatic stress disorder (PTSD). The diagnosis of PTSD is based in fear symptoms resulting from experiences of terror, which can interfere with life functions.
Moral injury is different. Therapy can be crucial, especially if it occurs with PTSD and brain injury, but therapy is triage for individuals. Moral injury is suffering that can’t be healed by therapeutic intervention alone because it requires the reconstruction of a moral identity and meaning system through regular, prolonged processing of the whole person, mind, body, psyche, and soul. Conscience is a function of empathy and how we relate to the world. The suffering involved is also how we relate to the world, and the recovery of empathy is crucial to the journey to recovery: through naming what is agonizing to remember; confessing and processing it with a benevolent listener; long, hard reflection; making amends; reknitting trust and relationships; finding self-compassion; and knowing your life is of value to others.
When an entire community has experienced moral injury, it must process its suffering or it can over-determine its identify and erupt as mistrust, toxic relationships, and suspicion of outsiders. Communities that fail to address moral injury can also inflict it by losing themselves in a victim identity and being unable to see their own power and responsibility or the harm they cause.
Akin to a low-grade fever, moral injury saps the energy for human flourishing, and it can erupt as a full-fledged life-threat when ordinary activities and life tasks fail to repress its invisible suffering. It can also surface late in a long life when mental capacities to control emotions and traumatic memories weaken. When and how it emerges in a life or a community is dependent upon how social and cultural meaning systems and taboos are enacted and how moral failures and trauma are processed.
After World War II, Japanese Americans quietly carried their humiliation and trauma from the camps while they rebuilt their stolen lives. Most who were interned only began to speak of it when their children learned of the history and asked about it. The interned had sought with silence and hard work to prove they were patriotic Americans in the face of racist hatred that labeled them foreign enemies. Younger generations began in the 1960s to press for redress and reparations. They were later supported by the Japanese American Citizens’ League (JACL), a civil rights organization founded in 1929. When Congress issued a formal apology for the internment in 1988, the admission of officially inflicted injustice, harm, and suffering was far more significant to the survivors than the paltry $20,000 compensation. When hatred of Muslims erupted after 9/11, the JACL was one of the first civil rights groups to speak against Islamophobia and stand in solidarity with Muslims. It has also opposed indefinite detention and began supporting marriage equality in 1994.
Moral injury recovery is a collective responsibility. When we individualize moral injury as a personal failure, we lose the nature of moral conscience as social, as what enables ethical relationships. We are shaped into moral persons through the people who love and train us so well that we behave morally without thinking much about it. Morality goes deep into our body-feeling-behaving system, and it is usually automatic because it “feels right.” Moral questions engage our thinking when we do not know what to do. When an automatic action is provoked by fear, suspicion, or a need to survive, it can override the slower moral reasoning process. Then, we are at risk for moral injury. Or we may find, as those Japanese mothers did, that we have no good option, there is no time to mull a choice, and whatever we do causes harm.
Long-term recovery for moral injury requires multiple modalities, especially adequate deep sleep, and whole-person activities that involve creativity and body-engagement through the arts, natural beauty and spiritual practices, and trustworthy people who will listen to the story of trauma multiple times. Healing also requires a community that holds and restores meaning. While recovery is not a return to life before trauma, healing comes with a renewed sense of curiosity and hope, with capacities for vulnerability and love, with a desire to be of value to others, with the expansion of empathy and concern for former enemies, and with spiritual resilience in the face of further suffering.
In September, in Princeton, NJ, a collaboration of three organizations is hosting an intensive seminar for people who want to integrate moral injury recovery into their work. It offers a chance to understand, participate in, and learn recovery modalities such as the arts, spiritual practices, rituals, story-telling, and community formation. While it is focused on veterans and the formerly incarcerated, the healing modalities are things ordinary communities can learn and benefit from. The goal is to implement collective moral injury recovery beyond clinical models —while remaining in partnership with clinicians. While I will be among those faculty, I look forward most to learning from the other faculty and everyone in attendance, and, perhaps, finding an answer to the suffering that might still haunt those elderly Japanese mothers.