Moral Injury

Apparently this is a thing. It was identified by an activist on behalf of US Army vets. He said it was: betrayal of 'what's right' in a high-stakes situation by someone who holds power. Puts the blame squarely on management. I heard about it during this YT video.

One day someone will do a study of the sad career of this concept, and psychologists and their kind will hang their heads in shame.

A more recent definition is “the inability to contextualize or justify personal actions or the actions of others and the unsuccessful accommodation of these . . . experiences into pre-existing moral schemas”. This polysyllabic neo-gibberish appears to put the blame squarely on the injured person, since it is their “failure to contextualise other people’s actions into pre-existing moral schemas” - in other words, management didn’t do anything wrong, you just don’t understand why what they did was right.

Any idea that can be so easily turned on its head has something wrong with it. The mistake (which I have just recognised after many abandoned words) is to go in search of what’s wrong and try to explain or rectify it. Because it won’t affect the underlying insight.

Which is that some people can be severely shaken and lose faith in the institutions within which they are working, when they see some ghastly event happen as a result of yet one more incomprehensibly dumb management decision.

They can also lose faith and respect for themselves for going along with that decision, for fear of a Court Martial, the sack, a poor performance review, and otherwise having their career screwed. The relevant phrase comes from a Sunday Times journalist after Rupert Murdoch bought it: it is an unpleasant experience to discover that the size of one’s soul is just less than the size of one’s mortgage.

Even civilian life can inflict sufficient insults, disappointments, refusals, rejections, broken promises, incomprehensible bureaucratic decisions, below-inflation pay rises, increased prices for decreased quality and quantity, zero-hours contracts, redundancies, offshoring, increased taxes for policies no-one agrees with, long waiting lists, cancelled operations, unavailable GPs, LTN schemes appearing out of thin air… to reduce even the strongest to despair and self-doubt.

The concern is that this will affect the functioning of our society and economy. Trust feels like something nice and warm that we should have in our leaders and institutions. But we don’t, because that’s not how it works.

We just need to know that the law or institutional practice says that if we competently follow our leader’s instructions, we are absolved of any liability, if anything goes wrong as a result. Which is why we should always get everything in writing. The deal is that we will not question their dumb and self-serving decisions, and they will protect us from the consequences of following those dumb and self-serving decisions.

It’s when that deal is broken that all hell breaks loose amongst the ranks. Management that goes looking for low-level scapegoats is tarred and feathered in the press, should the story get that far. And management finds out that “staff goodwill” is a real thing, especially when it vanishes.

Most of what is covered by “moral injury” (front-line warfare and NHS treatment of whistleblowers excepted) is what used to be considered a “welcome the real world” moment, in which one’s delusions and were rudely broken, and one’s un-informed expectations were properly informed. It was regarded as a moment in which one added additional adult maturity to one’s character. People who could not handle the disappointment or shock were regarded as a little short of moral fortitude. Back in the day, women who couldn’t handle the shock were offered a move to (name some gentler place off the serious career track here). Men just sucked it up.

“Moral injury” suggests that our delusions and unrealistic expectations are in fact precious possessions, and their loss in the face of reality is to be regarded as a blow to the integrity of our character from which we may never recover. The truth is no longer learning, but injury.

We are supposed to be shocked as our delusions are dispersed, and then build the character needed to carry on doing good work despite being in a world we now know is far-from-perfect. Being cynical is not good enough, and nor is running away in shock.

It may be that the only way to do good work is to do the same job somewhere else. Nothing wrong with that: there’s no obligation to stay in a dysfunctional institution run by a**holes. Apply for a job elsewhere, and speak so well of the place you’re leaving that everyone wonders why you are leaving. Except they will know, and appreciate your willingness to play the game.

(Edited 24/7) It may be you are not cut out for nursing / surgery / sales / customer service / (enter some other activity here). That’s how it used to be said. Nothing wrong with that. Find another occupation, preferably that you don’t have high-flown illusions about. Yes, sometimes management or the enemy do something so egregious that not to react to it would be inhuman, and to regard it as an opportunity for growth would be obscene. Then we could talk about “injury”. But that happens to very few people outside a war zone, or the NHS.

Sleep Hygiene Is Not For Regular People

There needs to be a name for a piece of advice, given as part of a programme, that almost everyone would not be able to follow, and so, when they complain that the programme “doesn’t work”, the guru can say “Did you do the thing I put in there that I know almost nobody every does?” and you say “No, because almost nobody can” and the guru says “Well, that’s the most important part of the programme”.

In the self-improvement / recovery business, that thing is usually “sleep hygiene”. This says we should go to bed and wake up at the same time every day, and get at least five full circadian cycles of sleep, waking up from shallow sleep. Everyone’s circadian cycle is different in length, and the default number is 90 minutes.

Now think this through. You have to go to work. Starts at (say) 09:00, but it’s best to get there around 08:30 so you get a seat in the open-plan office. Say it’s an hour’s commute. So that’s 07:30. An hour for dressing, breakfast, showering and the like, 06:30 wake-up time. Seven and a half hours’ sleep plus dozing-off time, means getting into bed at 22:30 the previous evening. That means you’re winding down - no exciting TV or we-need-to-talk conversations - around 22:00. You left work at 17:30, were on the gym floor at 18:00, exercised and showered and on your way home at 19:15, arriving home at 20:15, leaving you 105 minutes to deal with life at home. Maybe you caught a movie at 18:30, which stopped at 20:30, so you were home at 21:30-ish, and straight into your wind-down routine. Weekends? You’re up at 06:30 while the rest of the world doesn’t even get started until about 10:00.

What you didn’t do was go to the theatre at 19:30, because that’s letting you out at 21:15 or so, adds fifteen minutes to the commute, so you’re home at 22:30, and oops! Nope.

Sleep hygiene is often incorporated into self-improvement and recovery programmes. Not because sleeping consistently is good for you (though it is), but because of all the things you stop doing in order to sleep consistently. No more late nights. No more parties. No theatre, ballet, concerts, gigs, or Above and Beyond all-dayer’s. No drinks after work. No chasing after potential partners of your preference. No weekend city breaks (what is the point of going to any major European city if you’re not going to party?).

It’s a terrific way for people who want to minimise their contact with the rest of the human race to do just that. I’d love to join you, but pumpkin time comes early for me.

Usually those same recovery programmes will suggest that one spend more time with friends, family and “like-minded people”. Rub that tummy while patting the head of your sleep hygiene.

Also, try sleep hygiene when you have young children. Or you have to deal with your partner’s snoring / restless leg / need to start sharing when you get to bed.

Nah. Sleep hygiene for regular people with actual lives is, well, aspirational.

We’re not supposed to practice sleep hygiene, anymore than we’re supposed to abstain from alcohol and sex. Abstaining from any of those is for people like me who would be far worse off if we indulged. Sleep hygiene, like sobriety, is either a productivity hack (for e.g. athletes) or for messed-up people who need to avoid screwing-up. It’s not for regular people.

Real people are supposed to get tipsy and laid from time to time, and they are supposed to be short of sleep now and again.

What they are not supposed to be is permanently sleep-deprived, running on six or less hours of sleep a day. That has all sorts of horrible effects on our short-term functioning. But sleep hygiene does not, take it from me, have all sorts of beneficial effects on short-term functioning: one does not feel better, one just doesn’t feel worse.

So given the unrealistic demands it makes, why is it included in self-improvement or recovery advice?

So the gurus can blame you for not following the programme when you tell them it isn’t working.

Relationships as Identity (or Not)

If there’s one thing everyone in the psychology business agrees on, it’s that people really benefit from being in relationships. We are happier, feel more connected, feel that our lives have more purpose and direction, we are healthier, less stressed and more relaxed.

(That is not a factual statement, and isn’t meant to be. It is aspirational, a statement about what the consequences of relationships should be. A relationship that doesn’t have some of those consequences is “un-healthy” or “toxic”, “abusive”, “exploitative”, and other words meaning“bad”.)

Writing this, it struck me that the Big-Name philosophers don’t write much about relationships. They focus on the individual (morality) and the institutions that govern individuals (politics). They might have talked about one’s “relations with other people”, but that was about how well one dealt with, got along with, and otherwise had-to-with others. One could be arrogant in one’s relations, or too meek, or well-judged, or many other qualities.

The current idea is a tangle of different things: it refers to a kind of informal implicit contract: I expect this and that from you, and you expect this and that from me; it refers to how we behave with others; it can also refer to the possibilities for the future, and the lost opportunities in the past; the history of how and when we met, treated each other, and felt about it at the time and afterwards; it is the current condition of our dealings and feelings; it may also have institutional or social significance, such as being part of the feudal hierarchy of an organisation, or “significant others”, or “sworn enemies”. “Relationships” make up a large chunk of our biographies, and hence in some sense, our so-far realised selves.

This idea emerges with the development of a line in psychology that defines an individual’s identity as much or more by their relationships, than their personal qualities and abilities - and this makes sense, as after all, many of our personal qualities refer to our behaviour around other people. However it often turns into the implicit claim that people with very few relationships are not fully people, but rather just a collection of ingredients waiting to be made into a person by mixing and baking them in the heat of “relationships”. (There is no doubt that children do not develop into functioning adults unless they have parents, teachers, and peers, but after reaching adulthood that ends. Adults without much interpersonal contact may become eccentric - or do other people avoid them because they are already slightly eccentric?)

If there is a definition of an “ordinary person”, it is one for whom their relationships form the principal part of their biography and identity.

One may be “un-ordinary” in many ways, perhaps by having a goal or skill to which one is dedicated, and which one’s relationships either enable, or are subordinate. Athletes, performing artists, research mathematicians, entrepreneurs, politicians, and similar, are good examples. They may also have partners, children and an extended family life, but they fit around the central purpose (especially in providing excuses for getting out of unwanted purpose-related engagements). That’s where their identity comes from. If those people use therapists at all, they will use therapists who specialise in whichever type of un-ordinary they are.

Faced with a generalist, ideological psycho-therapist used to dealing with ordinary people, the un-ordinary person should apologise for being an introvert. This is a Magic Word that therapists must respect. They will usually adapt their “go out and meet more people, and join a local club or association” advice accordingly.

It Is About The Nail

A lot of work goes into theories of how the patient / client came to have their problem. The answer is invariably something that happened in the past, and therefore cannot be changed.(1) It’s the same with a viral infection: does it really matter where or from whom you got it? What matters is whether there’s an available affordable antidote or if you have to sweat it out.

Here’s a simpler approach.

You’re doing something DoublePlusUnGood. The next time you get an urge to do it - don’t. Even if it means you have to stand under a cold shower, run a mile, or bang your head against the wall. You’re allowed to do anything (except self-harm) you need to do to stop yourself doing it. You can give the bathroom a thorough clean, or finally sand down and varnish those shelves. Whatever it takes.

Start by removing yourself from as many of the temptations as you can. Alcoholics stop going into pubs, bars and off-licenses, and stay away from the booze shelves in the supermarket. If you only ever see Eddie and Frank to have a drink, stop seeing Eddie and Frank. Nobody said this was easy. Other people with other addictions can take relevant pre-emptive avoiding action.

You’re going to think about doing whatever it is. That’s okay. This isn’t about the chaos inside your head - yet - it’s about what you do.

Just don’t do it.

Rinse, repeat, until it becomes easier.

It’s AA in disguise, of course. What the Floundering Fathers recognised was that giving up drinking (or enter your vice here) for ever was too much to contemplate. Not having the next drink is way, way, easier. So is focusing on what you need to do today, and not worrying about tomorrow or yesterday.

That’s the advice that the addict / screw-up needs to get them started. Happiness and all those other good things will follow as a consequence, once the noise in their heads has quietened down, and they have some confidence that they can get through a bad patch without giving way to the wrong temptation.

However, addicts have Meetings. Meetings don’t always work for everyone, and nobody knows how they work for the people they work for. There’s just something about being in a group of people being honest about whatever is The Problem. You’re not alone. It can be done, because others are doing it.

Meetings are for things one wants to stop doing.

The idea doesn’t work for things that one wants to start doing. Underearners Anonymous is the closest to that, and I’ve been to those meetings. It helped me, but I’m not sure it helped many of the other people. The reference book is pretty good though.

I think psycho-therapy can be useful in helping the client understand what may be getting in the way of doing the things they need to do to achieve the things they want to achieve. In the end, it comes down to a programme of practical action, and that’s either the Steps or it’s some kind of self-improvement (take a class, go to the gym, say “hi” to one girl a day, whatever). It’s not the essentially reflective and exploratory process of psycho-therapy.

Because, in the end, it is about the nail.



(1) However, knowing what that historical something is will help you see its consequences as put there by someone else and so that can be removed or ignored in the future.

The Unavoidability of Ideology in Psycho-Therapy

Doctors and surgeons deal with stuff that is obviously wrong with the body in front of them. We can know what is wrong with something, without knowing what is right for it. The absence of wrong things does not mean anything is especially right about it. Between “Yuck” and “Wow” is a large range of “okay I guess”.

Doctors and surgeons are trained to identify what is or might be wrong with the body in front of them. They do not have as clear an idea of what a “good” body might function and look like, never mind how a “healthy person” might live. They might point out that the idea assumes that there is only one way, or at most a very narrow range of ways, that counts as “healthy”, while all the evidence suggests that there are many ways people can live perfectly well.

The equivalent for a psycho-therapist would be to identify the various insults, abuses, mis-uses, missed good times and learning opportunities, that the client endured on their way into adulthood. Just how badly were they brought up? Was it all the parents, or was the young client a puzzling tearaway or otherwise hard to deal with? What limiting beliefs has the client got as a result? And so on.

Having discovered those injuries, the therapist should explain what the client can do to change the way they think, how they live, who they spend time with, and so on, if the client wants to stop feeling the angers, resentments and other negative emotions, and become a more normal person. There may be limits to the changes the client can make or is prepared to make, and the therapist must respect those.

The question is where the idea of the “normal person” comes from.

One answer is that it comes from psycho-therapeutic practice. Therapists hear patients complaining that their lives would be better if only they had this and that and the other thing, and conclude that this and that and the other thing are essential requirements for human happiness. With this in mind, plus memories of the course on “positive psychology” at university, they start to concoct a list… I mean, construct a model of what a “good life” looks like. This model then guides the way they talk to, hear, and advise their clients.

The therapist should explain what is involved in this “good life” and ask the client if there is anything they particularly want, or that clashes with their other goals. The weakness of this approach is that there is a fair amount of slop in the interpretation of the specifics of the “good life”. It’s at this point that the therapist can, perhaps unwittingly, perhaps with the firm conviction of their correctness, foist their own ideologies on their clients.

This open-ness to ideology is not a bug of psycho-therapy. It’s a feature. The therapist has to use their own experience and understanding, some of which will come from their ideological leanings, to interpret the ideas in the model. It’s unavoidable.

Most of the clients want to find love, connection, cut out the substance abuse, stop self-harming, get along well with others, and stop being so damn sensitive all the time. They want to “go along to get along”, to fit into a social / political / moral way of life, “to be good members of society” - but as they see what it is to be a “good member of society”. It’s important that the client and the therapist do not have any points of serious disagreement about what that is.

Therapists and psychologists are inclined to be ideological. The majority of therapists are women, as are the majority of therapeutic clients. The subject has developed to deal with women’s problems in a way that makes sense to women. There are male therapists and psychologists, but they have to get through the market- and ideologically-slanted university courses and professional training, and so have to adopt the relevant protective ideological plumage.

Therapists openly offering Muslim therapy, Christian therapy, feminist therapy, and other overtly religious or political approaches to therapy are not doing anything wrong. They are providing a specific product to a specific market - if you’re not in that market, you won’t take that product. One possible exception would be when a therapist with a strong social justice / feminist outlook is assigned to a client by the Courts.

As With The Body, So With The Mind

As medicine is to the body, so psychology is supposed to be to the mind or soul.

Doctors and surgeons are in the business of fixing stuff that is obviously and identifiably wrong or broken: broken bones, lumps in the brain, wounds from accidents or fights, really bad cases of food poisoning, malaria, the pox, chlamydia (the STD of preference for straight people), cleft palate… something that can be identified and treated in some way.

At the other end of the spectrum are the physical trainers and dieticians working with (say) a movie star or a Olympic team, or cosmetic surgeons. The aim is to improve something that is already okay and provides a foundation for that improvement.

It’s the in-between that’s awkward. People who aren’t actually sick, but who keep getting colds and infections. People who aren’t actually obese, but who can’t sustain much physical effort. People who have poor diets or can’t get enough exercise. There’s nothing broken and they aren’t suffering from the effects of a virus or bacteria, but they aren’t exactly shining examples of the potential of the human body either. Doctors can’t help because there’s nothing much wrong, and the trainers can’t help because there’s not enough right either.

As with the body, so with the mind.

Psychiatrists are in the business of fixing stuff that is obviously so wrong that the patient is experiencing distress and impaired functioning in their everyday life over an expended period, usually at least six months and often more than a year. That’s a general condition for a psychiatric disorder in the DSM-5. Look at the symptom lists and you will realise that to get a DSM-grade diagnosis, you’re in a bad way. There are symptoms which on their own would have people backing away from the patient slowly and politely and blocking their calls - and DSM diagoses usually require three of more of these. Psychiatrists are also doctors, can prescribe, and insurance companies will often stump up on their signature. Their medical training leads them to want to deal with conditions where there is obviously and identifiably something wrong.

At the other end are of the spectrum are life coaches, dating coaches, PR coaches, dieticians, beauticians, and physical trainers, who work with the (usually) well-off and high(er) functioning middle- and upper-classes. The aim is to improve something that is already working reasonably well.

It’s the in-between that’s awkward. The people who aren’t quite distressed, but don’t feel happy either. They are holding down a job suitable for their abilities, paying the bills, eating reasonably, not getting blitzed every night, and otherwise taking care of everyday maintenance… but they might not be having much fun either. They aren’t scared of talking to people, but it’s not their favourite thing to do. They don’t think they are awful, but there’s a nagging voice in residence somewhere in their head. Or maybe they are just oblivious and wonder why they only ever meet people once. They may get hugs, but not from the person they really want to be hugged by - just someone who will do.

These people are the market for psycho-therapy. They need to be working or have access to money because they will need to pay the therapist themselves - the insurance companies only pay for psychiatrists - and maybe they could get some therapy on the NHS. If they could get to see a GP, and the GP didn’t just write for some low-grade prescription anti-depressants.

What are psycho-therapists supposed to do with these people? Find something wrong and try to fix it? Give the patient what amounts to a self-improvement programme of exercise, dietary change, sleep routines, removing negative thinking and all that jazz? If the patient comes in with a specific problem, the chances are that what they need is a specific solution, and specific is self-improvement.

At first they seemed to follow Freud’s example, and sit quiet while the client talked, or not. The few techniques they used were close to, if not outright, hacks, from so-called “active listening” to suggesting people wrote with their other hand, as it let one’s creativity flow more easily. Some would head for childhood, to find fault there (and be rude about the client’s parents in the process), and some would look for patterns of behaviour that needed changing. Some would interact with the client and some would stay quiet. And some use the “models” from so-called “positive psychology”.

Psychology as Pre-Science

The first time I read Gaston Bachelard’s The Making of the Scientific Mind, I didn’t really understand what I was reading. Same the second time. I mean, I understood the words, but I didn’t get the message. I was expecting to read a story about the change between pre-scientific to scientific ways of thinking. Since Bachelard’s subject is chemistry and life sciences, that transition isn’t as stark as it is in physics.

The book is full of extensive quotes from authors, now unknown as scientists, but famous at the time for writing about phenomena in the real world. Bachelard’s point is that they do so in a shallow way, often using analogies with familiar objects and their properties - the number of things claimed to be analogous to sponges is quite remarkable. These old-style “explanations” read fluently, and no doubt at the time, plausibly. Now, of course, it reads as grammatical gibberish.

It feels like reading a lot of contemporary psychology.

Those seventeenth-century authors made experiments as well. Hundreds of them, but all of them by today’s standards slightly mad, or trivial, having nothing to do with the fundamentals of the relevant science. We’re talking about experiments to prove which combination of coloured tights generates more static electricity. As if that might be significant in itself, rather than, as we would see it, a consequence of more fundamental laws of chemistry and the properties of the dyes and materials.

That feels a lot like contemporary psychology.

People have been making remarks about human behaviour and emotions since before Plato thought that laughter was a way of showing oneself superior to the person one was laughing at. Hume’s famous book is called A Treatise on Human Nature - it’s an extended rant about how devious and rotten people are, interspersed with some more conventional philosophising about the various aspects of the psyche (Reason, Passions, Understanding, and so on). Some of what Hume and others said was perspicacious, some more relevant to their times than ours, and some of it just wrong.

Psychology has many birthdates, and the publication of William James’ two-volume book on Psychology is as good as any other. It’s an odd book, with chapters on how the sense organs work, and a much more famous one exhorting us to the formation of habits as a way to simplify our lives. Descriptive anatomy right alongside old-school moralising. Psychologists have never gave up the combination. Even the ones who look as though they are doing “real science” by investigating the way the brain works, cannot resist the temptation to write pop-science pot-boilers about how their work proves we have no free will or that consciousness is an illusion.

In the next few posts, I’m going to wander around this subject.