Transcript Learn@Lunch with Professor Tom Frame

Moral injury and the inner wounds of our time | 14 March 2018

 

Welcoming remarks from Professor Michael Frater, UNSW Canberra Rector

Good afternoon, everybody. My name's Professor Michael Frater, I'm the Rector of UNSW Canberra and it's my great pleasure to be here today to thank you for joining us for this lunch, bite-size lecture series with UNSW Australia's leading academics. Before we get started, I want to take this moment to acknowledge the Cadigal people, the Eora nation, the traditional custodians of this land and pay my respects to their elders, past and present.

Some quick housekeeping, can you please be aware that today's session will be recorded and available for podcasting by the UNSW alumni website. Also, would you please switch your mobile phones to silent mode. Today's speaker is Professor Tom Frame and Tom would introduce himself by saying that he started his career as a naval officer then left the navy to become an Anglican minister and then came back to the navy as the Anglican bishop to the Australian defence force.

I would introduce Tom by saying that Tom is one of the archetypal products of the 50 year relationship between UNSW and the Australian defence force. He graduated from UNSW on the Kensington campus under the sponsorship of the Royal Australian Navy, and then during his career with navy, he came back and did a PhD with us in Canberra. Tom, as a historian, has throughout his career used his discipline to get insight into a whole range of areas, and he's not afraid of taking on controversy. His PhD, indeed, was on the collision between HMAS Melbourne and the Voyager, and there was no short of controversy there.

One of his recent projects is looking at moral injury, which is something which is very important to veterans of military operations and through that, very important to us as a society, but it's not without its challenges, and Tom's skills as a historian are actually very important here in helping us to better understand it. So please join with me in welcoming Tom Frame.

 

2.30 Presentation by Professor Tom Frame, UNSW Canberra

Well, good afternoon everyone, and it's good to see some ... I was going to say old faces, but that might seem to be disparaging, but people I haven't seen for some time. I'm grateful to the rector for his welcome. We in Canberra feel ourselves much blessed to have Michael, because he's engaged with the work that we do. He's not one of those academic administrators for whom building number one where administration occurs is the limit, if you like, of his horizons. He's engaged with our work, he's a contributor to the things that we do and for the first time in my life, I've got a boss that's younger than me. And that's good for the soul, is it not? I think so.

Now, I'm much encouraged by the invitation from the UNSW alumni team to speak at this event, and can I say I'm honoured by your presence here today. I'm actually the first person in my extended family to attend university, at all, and I didn't realise how profound or enduring would be my association with UNSW when I enrolled in an arts degree of February of 1981, because the university has become one of the three institutions that has most shaped my life's journey. I remain deeply grateful to the navy that it gave me no choice about the university I would attend for either my undergraduate studies or my post graduate work. I am proud to be a UNSW graduate and part of the alumni community, a community that boasts so many eminent scholars, inspiring leaders, and gifted professionals.

I'm not sure what might've drawn you to this talk on the concept of moral injury, but let me start with a universal human experience and take things from there. Now, we've all sustained physical injuries that have affected our ability to function and we actually take these kind of injuries for granted. They happen, they're a part of life. We engage in behaviour knowing that we might get hurt and we realise that from time to time, someone else's actions might result in us being hurt. Now, some injuries might lead to permanent disability, some injuries produce temporary inability, some injuries cause pain, but have no lasting effect.

Now, I suspect you're with me thus far, but let me go now, if I can, a little bit further and ask, but can we be morally injured? Can we be morally injured? Well, the notion of moral injury was first proposed by the American psychologist Jonathan Shay after years of working with veterans of the Vietnam War in the United States. Shay thought that moral injury was present when, and let me quote from him, "There has been a betrayal of what is morally correct by someone who holds legitimate authority and in a high stakes situation." That was the first ever definition of moral injury and it was only proposed a bit over a decade ago.

Brett Litz, another American psychologist, thought he could improve on Shay's definition and he expanded it to include, "Now adaptive beliefs about the self in the world." He said, "In response to perpetrating bearing witness to, failing to prevent or learning about acts that transgressed deeply held moral beliefs and expectations." So there was a building of this later definition on the briefer one from Jonathan Shay. Fundamentally what we're seeing is that moral injury is portrayed as an unseen wound to the inner self.

Now, this wound is hard to describe, after all, it can't be seen, but it's consequences it what thought are manifest in conduct. If you are morally injured, you will behave in a different way. It's also been argued that collective moral injury is a possibility when a whole nation is injured by the moral failings of its leaders. Failings that damage and debilitate the common life of the body politic. Now, I won't say more this afternoon about this form of moral injury other than to note its existence has been inserted, and indeed, you saw earlier a picture of Richard Nixon, and it was argued that Nixon's behaviour, if you like, inflicted upon the entire American nation, an injury that took some time for it to recover from.

Conversely, when I was at a conference last year on the future of war in Washington D.C., the question was put by a speaker, "What was America's worst military defeat in the last 50 years?" People thought and people thought before they could throw out their answers, he said, "It's Abu Ghraib." Abu Ghraib was America's greatest defeat in the last 50 years, it was a defeat in as much as it deprived America of any capacity to take the high moral ground that perhaps might've been the basis for any military action that it may have contemplated and, indeed, I would say it still continues to suffer from the erosion of moral authority as a result of the injury inflicted upon the entire United States army, perhaps its other services as well, by virtue of what happened at Abu Ghraib.

So take those two definitions for a moment, and can I say for me, they actually prompt a whole series of questions. Questions like, "Well, what's actually injured in moral injury? Is it an affliction of the psyche or the conscious or the reason? Is it damage to that part of the brain responsible for moral thought or does it disturb a person's essential being more broadly? Is moral injury different from an ethical injury or synonymous with it? Is the injury self-inflicted, inflicted by others, or the unavoidable outcome of particular circumstances?"

We might ask, "Are certain groups more susceptible to moral injury than others, depending upon their age, their gender, their ethnicity or their culture?" We might ask, "Does a strong religious faith or a well-developed moral code offer protection, protection against incurring a moral injury? Is moral injury inflicted instantaneously from a particular experience or is it sustained gradually from reflection on a series of events? Is moral injury a permanent one? Does it cause, perhaps for some, short-term debilitation, but for others, ruin their lives? And if you are morally injured, do you realise that's happened to you?" And how could this realisation, "I'm not the person morally that I thought it was," then compound in subsequent behaviours?

And if we accept the possibility of moral injury that it might actually be out there, there may be an infinite number of ways for a person to be morally injured, depending upon their personality and the circumstances in which they find themselves. Now, the thing I'd say first up is the whole notion of moral injury isn't actually new. The term is, the definitions are, but we need to only look to Homer's Iliad, to other classical texts to understand that people who do things and have done things that human beings have said on one account ought not to see do here or perpetrate, then people are going to be damaged and when they come back from a damaging experience, and often people think of armed conflict when they come back to civilised society, they need to be ready to return.

One of the great tragedies I think of the Vietnam War of which there were many, when I was the bishop to the defence force it was even true one of my own chaplains, he'd been killing Viet Kong in the jungles of Vietnam and two days later was let loose in the streets of Adelaide. Anyone here from Adelaide? Oh, I can speak freely then. The contrast between the jungles of south Vietnam and Adelaide on a Monday night, well, you have to make your own fun in the latter situation, can I put it to you? Friends, play me a great many questions can be posed of the conceptual dimensions of moral injury before we even start to address its practical dimensions.

Now although research into the experience has just begun to gain momentum in the United States and it's really barely started in Australia, the term moral injury has nonetheless gained current in the popular press and in the scholarly journals, both here and abroad. So, an uninformed reader could be excused for thinking that the existence of moral injury was undisputed, that everyone thinks it exits, that it's meaning is uncontested and that the underpinning research is highly textured. It's actually none of those things, but such is the rapidity in which the term has been taken up and the prevalence of its use, that's what you might be led to conclude.

Now, despite moral injury being applied to a number of unseen or non-visible wounds sustained primarily in the context of armed conflict, such as those sustained by soldiers, police, aid workers, and diplomats, many of the definitions, and I start and I would end with Shay and Litz are vague or unclear. They are suggestive more than specific, they're short on detail and definitely they're lacking empirical substantiation.

Most definitions fail to identify even that part of a person affected by moral injury or explain why an experience is morally injurious. Now going back to our shared experience, physical injuries can be observed and addressed because they're consistent in form and comparable in character. In contrast, moral injuries, if they exist, cannot be seen, they're hard to describe, and they affect people differently. I would say from, if you like, my tentative conclusions about moral injury that it's heavily dependent on a person's experiences of the world and its operation, their personal values and virtues, and the way they interpret what they see and hear.

If I can give you my own example, if you like of a moral injurious experience, in the 1980s I was on a ship in the South China Sea, we came across, perhaps, 20 bodies that had been dismembered by sharks in the South China Sea. We picked up the remains, we took them to the nearest port, and the port authority said, "Why did you bring that rubbish in here? What do you want us to do with it? Take them back where you got them from." It was not good fishing body parts out of the sea. It was, actually, can I put it to you from me, worse to hear that reaction to take these unmourned people back from whence they came and attempt to give their passing and indeed their lives, some meaning.

It doesn't take me much to close my eyes and recall how morally outraged I felt at that time and tried not to think that this is the world in which I live where human remains are referred to as "garbage" and can be disposed of in plastic bags as if they had no more significance. Well, regrettably though, to date inquiries into the incidents prevalence and severity of moral injury, I've focused on the military community. Although researchers agree, it's not restricted to uniform personnel. And indeed you could validate what could be said about military people from the experience of civilians, and I hope that would occur, because at least in theory, individuals employed in most professions could sustain a moral injury.

For instance, people working in the medical profession could be morally injured by the requirement to make unpalatable decisions about the quality of patient care when hospital resources are limited. In other words, you might have to find yourself in a situation where you'll decide who might live and die. I had a recent conversation with a veterinarian who said that he thought he was something like morally injured by request to destroy perfectly healthy dogs, because greyhound racing had been banned. Police could be morally injured by political direction to focus on trivial crimes attracting media attention, when really serious crimes are left ignored. Why are we looking at this, which is rubbish, which is inconsequential, because the politicians, because the headlines want us to look at that. It's wrong that we're focused on that rather than that could be the police response. Perhaps in legal profession, morally injured by plea bargaining or by perceived inequities and sentencing guidelines.

Now all professions, all professions, try to avoid the possibility of their members suffering something resembling a moral injury by the imposition of codes of conduct. Now this may or may not be an effective preventative measure. Very often, I think they exist for risk mitigation to serve the interest of insurance companies. But codes of conduct, they don't hurt, but do they actually help? Now, clearly any and every human occupation is associated with moral questions and ethical dilemmas that often oblige the individual to make painful choices between the lesser of two evils, but hear that phrase again, the lesser of two evils. In the end, it's a fallen world, I can only do things that I regard as being repugnant to me, but I have to choose one. Such situations force people to act in a way that is morally deleterious, but does it actually injure them?

That's an important question. Well, let me take another tact on this matter, as well. We might also imagine that the experience of moral injury affectively varies with host nation popular culture. Now, in as much as morals embody and reflect culture, the causes and the consequences of moral injury we would perhaps say, would be shaped by the general and the specific cultures refracted through national identity and institutional belonging that shape individual moral selves and prepare them to negotiate moral dilemmas. I joined the navy as a 16 year old. Very, very quickly, they took away my individuality, except for a name tag that said T. R. Frame, everything else was the same as everybody else. I was told the navy might have previously been them, now it's us or we, I belonged, there was a new code of conduct, this is how we would act, this is what was expected of us.

To be part of this organisation, you acquire its identity; get a sense of your destiny and that requires conduct of a particular kind. That's a micro culture, but it can also be true of whole nations and it might shock you, probably doesn't, but it might. Is anyone here from America? There is one person, I'll speak guardedly. Our personnel find in the middle east when they're working with the Americans, they're working with people who might speak English, but they're not like them. The conduct of operations is quite different and before we do think highly of ourselves, the Canadians actually have a different approach than we do, to say approach operations and some things in the grey area of what's acceptable between law and ethnics. So whole nations, it seems to me, not just micro cultures, but whole nations can shake people up to have a certain view of moral values and how they're held and how they're exercised.

I mean, some cultures, for example, appear to place a much lesser value on human life or give little emphasis to social equity. If you're an outsider coming to inside those particular communities, you could find the differences are devastating. And certainly those that I have worked with closely who went to Somalia in the 1990s, either as civilians or uniform people or to Rwanda, found that the attitude towards life was very difficult for them to bear. Human life did not have the value that they thought you ought to have ascribed to it, yet they are visitors to that country. They are there to help, not to hinder, and to work with the people rebuilding a kind of society. The trouble was, the kind of society they wanted to build was one that looked more like Australia than Rwanda or Somalia and there's a lot of dissonance when people find, but there's parts of this country that we just find repugnant, but it's not your country, but being there and experiencing it first hand is very hard for some people.

I also think it true that the character of moral injury can change with the passage of time and the seasons of life. As social norms and cultural conventions change rapidly in western societies, shifts in historic attitudes will bear directly, can I suggest to you, on the likelihood and the severity of moral injury. Now, we look back on slavery and imperialism with horror, although neither was seen as egregious by everyone at different points in human history. Because the moral self develops and matures with the ebb and flow of life, whatever constitutes an offence against the beliefs that undergird the moral self, whether it's denial, betrayal or contravention of those beliefs, they will reflect shifts in social attitudes and personal options.

What am I getting at? I might in old age abhor behaviour that I applauded in my youth. There's one of the Psalms that I like, Plasm 25, where the Psalm says, "Lord, forgive us for the sins, the deeds, the actions, we committed when we were young." In other words, we thought that was once alright, but when we live a bit more of life and our values change, we look back and think, "No, please. I'd rather not be reminded of that." It could be, and I have seen it with veterans of the Vietnam war, that the things that they did between 1965 and 1972 are things that they look back on now with completely different eyes and not just because after 1975, north Vietnam prevailed. The only war up until that time we've seen not to have won, people argued that we haven't won one since, in the sense of all our objectives having been achieved, but with the passage of time, all men can reflect upon what the youth within them did and it can haunt them.

Now with all of this supposition surrounding the notion of moral injury, I gathered together a small project team UNSW Canberra to consider unseen wounds in the context initially of oversea service rendered by Australia defence force members. Now, at the defence academy campus, and you may not know, but UNSW has been the provider of academic education for service officers for 50 years, this is our 51st year. It's a strong and enduring partnership. Our main student cohort is actually uniformed ADF members. People in a former life like me. We got this project team together, I went to see the assistant minister for defence and the vice chief of defence force, talked to them about what we were doing and they welcomed us to begin a commission project that would do four things.

The first thing was to provide a detailed description of moral injury and its differentiating from the better known post-traumatic stress disorder, PTSD. Now after months of deliberation and debate, and if you have six academics, you get seven different opinions, we defined moral injury as, "The result of harm or damage, which leaves a wound that reduces the functioning or impairs the performance of the moral self, which causes an injury, which is that part of a person where moral reasoning and moral decision making takes place."

We wanted to talk about the moral self as a component of who we are and it's that part that is wounded, injured, and consequently, behaves in a different way post the injury. We concluded that exposure to or participation in actions that violate an individual's own moral code caused moral injury. Why is that? Well, because they destabilise the moral norms an individual uses to make sense of themselves and the world. So moral injury can be sustained through acts of commission and omission and the extent to which these moral norms are ignored, denied or betrayed, determine the severity of the injury. Along with the strengths of the beliefs and their nature. In other words, if these moral beliefs are held very, very strongly and someone's very conscious of them, then the wound, in fact, could be far more severe.

We concluded that a person could simultaneously incur a moral injury and suffer post-traumatic stress disorder though a single event or experience, but the important thing is that trauma, the T in PTSD, needs to be present in a diagnosis of PTSD. It's not required in the case of moral injury. Something may not be traumatic, but it might be morally injurious, particularly if the injury is incurred through reflection over time.

So for a person to be morally injured, their moral values, their moral reasoning, their moral compass must be affected in some way. And so the involvement of morality, however understood, makes more moral injury different from PTSD and other occupation related mental health conditions and psychological disorders. So that was the first thing we began to do, have a go at defining it. The second thing, task, given to us by the vice chief was to identify the moral values and virtues that are most likely to be injured.

Now here it was difficult, because defence legal were concerned about us interviewing anybody because if they told us about a morally injurious experience, it might of had a legal dimension and they therefore, might have indicted themselves, potentially in an activity for which the defence force discipline act might've had an interest. In other words, "We're not sure you should talk to those blokes, 'cause they might tell you that they did something wrong." "Yeah, okay. So how are we going to get at this subject?" "Yeah, that's a good question," to which we said, "What's the good answer?" And we're still waiting.

But from the anecdotal evidence we have, we believe that what is, if you like, more injurious, so willingness to trust, a readiness to show loyalty, adherence to conviction, and confidence in judgement  has been the individual moral values and virtues more effected by moral injury. So this notion of people being betrayed and betrayal being critical to moral injury, we actually think there's something in that. Now, it could be a betrayal of one self, a betrayal of one's country, or a betrayal by someone who's actually giving authoritative direction. But betrayals in it there.

The third task was to outline the specifically Australian characteristics of moral injury from a historical and contemporary perspective. What is interesting was to go back to letters and diaries of the Anglo-Boer war of 1899, 1902, and actually find and write about material that had never perhaps been noticed by others before of Australian soldiers saying, "We don't like the idea of rounding up Boer women and children and putting them in concentration camps and burning their farms." And there was some that had the strength of character to say, "I didn't come all the way to do this." Or, "This is not what we do," or "Somehow we're different," or "I just think this is wrong."

It was right back then, 1899-1902, a conflict very much like the ones were engaged in now where the civilian population is not neatly divided between combatants and non-combatants and people with uniforms and people with not, the issue is that people think that somehow in those three years, the Boer war, some moral norms were violate and this, if you like, injured those who observed it. Now the evidence suggests that since 1990 and when we talk about modern warfare, most of us now talk about 1990, which marks the Iraqi invasion of Kuwait. Australian uniform personnel have been less concerned with the decision making behind deployments and we believe more concerned with what people have done when they got there.

Now, while the political factors associated with a deployment are not unimportant, Australians seem to be as a general tendency more closely attentive to the conduct of missions, including strategy and tactics. It's a bit like, "Well, I don't know about politics, but I know about operations and some of these things don't pass the pub test." There is also evidence to suggest sensitivity among Australian personnel to the generally brutalising effects of armed conflict and consciousness of the deleterious effect of such conflict on personal well-being and behaviour. If you send people to Iraq or Afghanistan or places where there's been implosion of civil values, like Somalia or Rwanda, guess what? They come back busted. Not everyone, but a good many.

Now although most researchers agree that moral values are shaped by culture in each nation has its own distinctive cultural traits, it is not yet possible to determine any specifically Australian characteristics of moral injury beyond very general observations. In other words, we don't know if Australian moral injury is totally consonant with that of Americans, Canadians, the Dutch or the British. I think the tragic part is that British research into this is almost non-existent. Now, whether that's a British cultural trait, you just get on and do it, but certainly we've been working with our partners at Kings College London, who have the contract with the British army and their work on this is about three years behind us. We're probably five years behind the Americans, but certainly the British have not attended to this to the degree to which I believe they should, because certainly they've had no shortage of legal and moral conundrums to affect their people.

The fourth task was to review the existing literature, and simply what I would say about that is that when you look at concepts like guilt, shame, remorse, forgiveness, absolution, they normally belong to philosophers and theologians. At the moment, this particular field is 95% tried by psychologists. That's fine, that's great, but I'm always concerned when one discipline grabs something, takes its boundaries, picks them up and throws them over whatever the matter of inquiry is and that might have the effect of excluding others. There is no reliability, no consistency in what Litz and Shay for instance, think they're meaning when they talk, for instance, about guilt and shame.

Now, there may be words that psychology could use as presenting symptoms or in generalisations, but what the words mean, where they came from and perhaps connecting the words with the experience, I think we still need philosophers and theologians to say, "Well, guilt's like this and shame's like this," and remorse and forgiveness and absolution, these are what these words tend to mean, 'cause it's interesting that you give people a word and they say, "Yeah, that's what I feel." Words can be suggestive, words can create experiences and sensations where previously they might not have existed.

Certainly, we are also concerned that there has been a conflation of PTSD and moral injury. In other words, it's not much different or one's a subset of the other. We believe that future research into moral injury should concentrate on the moral character of the events, which are thought to cause injury and focus specifically on how moral injury impairs individual performance. Such research would assist in managing moral health and negotiating the moral complexity of assigned tasks. One of the things that I've put to defence is before they deploy someone overseas or even to the New South Wales police service, is this person psychically fit? Have a fitness test. We all accept that, but what about moral fitness? Is someone able to negotiate the moral complexities of a situation in which they're gonna be surround. Oh, and by the way, they're just about to turn 19.

Now, we therefore concluded that moral injury can be experienced in five different ways. The first way is a form of disturbance, producing a crisis in moral beliefs and prompting confusion about the world's moral reliability. "The things I once believed, the things which once ordered my life, I'm not sure about them anymore. And I thought there was a certain moral logic inherence in the way the world worked, I'm not so sure." There's a wonderful line at the end of the movie, The Mission, with Jeremy Irons and Robert DeNiro. Who's seen the movie? Help me here. And it ends up, it's a kind of, it's in 17th century South America and this native community have kind of been decimated, it's the Portuguese and the Spaniards and the Jesuits to try to help and basically the two forces get together and the local Indian population are kind of wiped out.

The cardinal who sent the tribe to intervene, says to the belligerent parties, "By what moral logic could you justify any of this?" One of them replies, one of the representatives in the nation says, "The world is thus. We are in the world. The world is thus," and the cardinal replies, "No, thus have we made it. Thus have we made it." And so for many people, and it may even be police, on a daily basis go out to places where moral order has perhaps been completely eroded or we send people to places where there's genocide, mass deportation, and ethnic cleansing, to then get them to come back and say, "Yes, the world is morally reliable, but not there and not there and not there and not somewhere else, and not in that neighbourhood." People could begin to think that, "Well, morality is nothing more than a cultural construct and you make the best of it where you are and the circumstance in which you are living."

I've met enough people now who are not conscious, that are moral code is discernible and practicable in life, because they simply think there's no moral logic necessarily to their own life or the world in which they live. It's also the case that people will reflect upon what they have done, sometimes not in the heat of the moment, but in the cool of the day, and think, "I can't believe I did that," and that could become more acute with time to be disturbed by things.

One of the difference of course between the military and the police is when the police kill someone, generally speaking, the coroner or someone else will say, "Yes, that was justified." Doesn't happen to a military person. They'll kill someone and at some point in the future, they will make up their mind whether it was justified or not, and sometimes they don't.

We also thought that moral injury is a form of alienation that occurs when an individual believes they are responsible and culpable either in whole or in part, for an act they regard as morally impermissible in which they cannot assimilate, integrate, or accommodate into their pre-existing systems of meaning. Short hand, "I can't believe I did that." Or, "That wasn't me." If you've ever watched the movie, you might think I sit around all day watching movies, I don't, Rector, I actually sit at my desk and do work, but the judgement  of Nuremberg, starring Alec Baldwin, was a kind of made for TV type movie, there's a number of wonderful dialogues. I mean, most of it's fairly predictable, but there's some wonderful dialogues and particularly one with Albert Speer. Now, most of it's imagined, but where Speer says, "I kind of did that and I did this and it was a movement and this was alright and that made this alright and something else alright. In the end, I couldn't recognise the person I had become, but now I can."

Now, Speer wasn't hanged, but some of the other defendants in that movie are heard to say things like, "When I did something small or when I was, if you like, unable to assimilate to either something I did or happened around me, then I just took that this was the new reality and was kind of lost in the way that had ebbed and flowed." So it's alienation. Alienation from, perhaps, one's own self. People are broken, people are at war with themselves.

Moral injury, I think, can also be portrayed as a violation of an individual's moral conscience following an act of perceived moral transgression that produces profound emotional shame or anguish. I meet people all the time that cannot get over something they did 40 years ago. They could be a person of religious sentiment and the promise is if one is contrite, if one seeks forgiveness, that absolution can come and that whatever the thing is, it can be as far as the Easters, from the west with you, but no, there are some people that want to suffer. They hang on to their guilt, they're addicted to a certain kind of sadness. Reminds me of a recent song, 'cause if you think I just listen to movies, I hear the radio as well. It's Gotye, for what it's worth.

The interesting thing is that some people just cannot get over what they have done and it debilitates them in lots of different ways. They cannot accept that their actions were justified, they cannot accept that they can ever be forgotten, and self-recrimination, remorse, can mark the rest of a person's life. Guilt and shame are heavy burdens for the person who carries them. The fourth way that moral injury could be understood, think is in the form of damage, impairing a person's moral health and well-being and its functioning. Witnessing something that deduces our ability to think and act morally. I no longer know what is right. I no longer know what is wrong, so I become a bystander, even in my own life, 'cause I'm not sure that I can make those judgements anymore. Such a person might reject the existence of moral values on a universal scale. Moral injury then is essentially a damaged moral self. I withdraw, if you like, from the game. If I see something that's morally complicated, I'll run the other way.

We also thought that moral injury is associated with the disorientation of a person's moral compass, when their world view is shattered after observing or participating in actions they deem to be immoral. We see here slightly different form the previous form, but discontinuities between the idealised moral self and the realised moral self. That observing cruelty and callousness, "Well, it's just then part of life and there's nothing I can do about it." The extent of the disorientation, of course, depends on the strength of the moral convictions that were previously held and the duration of exposure to an immoral act.

This disorientation might lead the person in the end to rationalise immoral acts and to normalise criminal acts. There's that great line in Apocalypse Now, isn't there? The movie with Marlon Brando. Because it's based on Conrad's Heart of Darkness and there's kind of Willard's going up the river and in the movie, the guy that's going up to kill Marlon Brando, who's kind of gone crazy. He's a half colonel who's just gone totally kind of totally native, as he's reading the indictment why he has to assassinate Kurtz who's gone up river and the line is, "Charging anyone with murder in this place is like handing out speeding tickets at the Indy 500." And charging a soldier with abusive language in the context of using napalm and mines, that's disorientating.

Now, each of these approaches suggests that moral injury is sustained by participation and/or observation of actions that the observer deems to be immoral. The interpretation of the event then appears to be crucial to whether a person sustains a wound in the nature of the injury that results. The interpretive process of course is highly subjective. Influence as it is by diverse personal beliefs, convictions and values. There's two people could observe the same thing, one could be injured by it, the other one can be almost unaffected by it. That's what makes moral injury something difficult for us to get our hands around.

Our inquires lead us to believe that the three main consequences associated with moral injury can be quickly stated. The first is it does have a bearing on person wholeness and well-being, that the morally injured do not function with the same moral agility or consistency as those who have been unwounded, and thirdly, that the morally injured have wounds that affect their personal and their professional interactions. I once said when I was teaching police ethics in Melbourne, I said, "Roger, Rogerson didn't get up one morning and decided to become Australia's most notorious ex-policeman. It happened through time. It happened through time, and it also infected his private life as well as his professional behaviour." For instance, injuries that might've depleted a person's trust in other people, depleted their confidence in institutional leadership, disrupted their confidence in moral opinions, that person perhaps is no longer living, they're just existing, and it could be an animalistic existence, at that.

These affected interactions have a bearing on the public duties of all who are morally injured. Their attitude to the profession of which they're members and their regard for the state. Now, there may be other causes and consequences of moral injury too, but we feel that we've gained a sense of the origins of moral injury that we've observed its main features and discerned its major outcomes. We look forward to doing some field work if we're able to test our hypotheses and would welcome comparisons in contrast between military personnel and the members of other professions, whose work is similarly complex and controversial.

The fruits of our work so far are a book, Moral Injury, Unseen Wounds in the Age of Barbarism, and Moral Injury Towards an International Perspective with our colleagues in the PLUS alliance at Arizona State University and at Kings College London. Now, there's a couple of these that are freebies, so if you don't morally injure each other and want to grab them, they're on the stage down there below. Please take them away so I don't need to carry them in the plane. Let me pause at this point and take your questions, comments, and criticisms. Thank you.

44.20 Q & A Session

Michael Frater:                Right, do people have some questions for Tom? All right. Start in the middle there, then we'll work our way down this side.

Jeremy King R.:                Hello, Tom. Jeremy King Ross, good to see you after two years. My question, I think you've answered it in the third slide, isn't moral injury just little more than a violation of one's conscious? The in-authenticity of human beings, when they're not acting as they authentically believe or behave, so they're out of phase. My second question is, do I have a right as a former member of parliament, so I should've raised my hand when you said, to be morally outraged at perhaps Barnaby Joyce's behaviour, or is that an individual choice, that we should not be concerned about someone else's as long as we are mastering our own first?

Tom Frame:                       Thanks, Jeremy. On the matter of the first, as I've said, one form of moral injury is a violation. You went on to say if someone's perceived or their view of the moral nature of whatever it is they're doing and what confronts them, and I would agree, the only thing that I would add is that sometimes people think what they did was alright, and it isn't. In other words. There are some things which people ought to feel guilty and ought to feel ashamed, because they have a view of their own behaviour or they have a view of what is right in a particular circumstance, and the rest of us would say, because morality is actually fed, if you like, by consensus, that this person actually ought to have been morally injured by what they do.

                                            Certainly, there are some things that if people do them and they're not morally affected, they might be injured, but not morally effected, we would wonder about them. Killing another human being in whatever the circumstances, if they're not morally affected by that, then we've got a homicidal maniac. We've got a person that you don't want on the defence force. If they're not affected by killing people or when they are no longer affected by killing people, 'cause they're on their ninth deployment to Afghanistan, they may not be the person to send. They have lost the ability to discriminate.

                                            On the second matter, I suppose that's a tricky one. Like anything, we will always, generally speaking, be the best judges of our own ... of the mitigation of our own actions. I do think it's the case that you do what you do and you do what I do, but you don't live in my shoes. You don't see things as I see them. You don't know the treatment that was inflicted upon me that led me to do that. I think like all of these things, and because I said that moral injury had to do with reflection, is that if we don't in a society and we're not led by politicians in having discussions about what's acceptable behaviour, what we regard as proper moral standards for people in a profession, then it'll just be a race to the bottom; and therefore, I certainly wouldn't load it on politicians to make the judgements about what is, if you like, a moral standard in a certain place. I don't think the legal profession wants to be put in a position where it has to do that, but it arise from community discussion and if it doesn't happen in families around the dinner table where people talk about these kinds of things, then I think we have the fundamental building block missing.

Speaker 4:                         Super fascinating. I have so many questions.

Tom Frame:                       Just one.

Speaker 4:                         Just one. I noticed that all the conversation so far has been about people being put in positions where they're taking actions that are against their moral code, if you will, to put it simplistically, but what about when someone is subject to an action that is against their morals? Is there moral injury then? How does that fit into the framework?

Tom Frame:                      Yes, and yes. Yes, they are morally injured, so if I'm the victim of morally egregious behaviour and then it's likely I'm morally injured. I was adopted at birth, my Scottish father was a violent alcoholic, and my dad's view of taking out his frustrations with the world was, "Why argue with yourself when you've got a boy you can pour your grief out on?" And so when I grew up, somehow I always thought it was my fault or that I'd done something to contribute to my father's explosive temper and abusive behaviour.

                                            It took me till I was nearly 34 to have that conversation with myself and convince myself that the moral character of his behaviour was his and that I wasn't morally complicit, but it did mean that, and it's still probably true, that I live with a tyrant.

Speaker 4:                        Do you think it leads to the same outcomes when you lose your moral compass in the result of ...

Tom Frame:                       I would think so. Yeah, if all you ever see is morally egregious behaviour, then that then becomes the standard. Where are you going to get the inspiration to act other? I remember being in northern Ireland when the troubles was still on and the whole rising generation of young Irish people who didn't know anything else but that, and so when a solider walked through a beer garden in a pub, fully laden as though he were in Afghanistan, but he's in Belfast, that seemed to me to be ... and I was chilled seeing it, because we don't see that in this country, but for them, that was just part of the way in which life ran, because armed conflict was an everyday experience.

                                            I think you raised two dimensions of something. If I had more time, I would've addressed, but you're absolutely right, and particularly if people have been the victims of torture and things like that, then it's quite likely that they then would engage in torture, because that was an acceptable form of conduct for those they might've regarded as being people whose example they were prepared to follow. Thank you.

Speaker 5:                         I've often heard young people say, "Dad never talks about the war," where the father has been a solider in a military conflict somewhere. Is that a common outcome of moral injury, where the person that's injured becomes a bystander and doesn't talk about it, doesn't ... and in situations, I think you mentioned that they become observers and they don't buy into decision making. Is that a common outcome?

Tom Frame:                      Thank you for the question. It's certainly something that I've observed, is that people don't want to talk about a morally injurious experience if guilt and shame are involved, because that's an element of self-realization of perhaps a component of who they are, of which they are not proud. Certainly, even if the great war, which we are still fixated on in Australia, it's the minority of people that talked about it, the minority of people that marched, not the majority.

                                           Years ago when I was doing some work on the submarine AE2, which we lost in the Sea of Marmara in Turkey, there were whole swathes of medals that no one had ever claimed. I was amazed by that. I think there were nine sets out of 31 sets medals for AE2. They never bothered to even claim them. What's that kind of telling you? My grandfather's medals are in the home guard. No one ever got around to getting those, so it may be that what we're seeing with that is far more common than we would think, that certainly people think ... And on the great war, the adverse of the medals, is the great war for civilization to which a novelists have said, "Well, that's what it took to save civilization, to actually act in a totally uncivilised way," what could be said about the moral character of the war?”

                                           But I would draw a distinct between the two great wars and everything's that followed, because in the two great wars, it was war that weighs on a national scale, where the entire population was caught up. Everyone had a relative that went or came back, and it was part of a whole lot more conversation. The moment the Australian defence force consist of, I don't know, 0.01% of the population, and therefore, it's a small minority experience. Our people are out at the moment probably killing people overseas in the name of the Australian government in which we know nothing, and we don't really talk about it. Therefore, the level of general conversation about these things, I think, are deteriorated, because it doesn't effect that many people other than the direct family members of those who have deployed.

                                           We won't have mass wars like, will be quite beyond this when it happens, but we're not likely to have wars like the first and second war on industrial scale, because technology doesn't make it necessary. Therefore, we'll have very small numbers of people going and doing things. To quote Jack Nicolson in A Few Good Men, "The people like you at parties don't want to talk about," 'cause who would want to talk about it? It isn't pleasant, and it isn't whatever, and I have to say those that I've met who've killed people actually say least about it. It's grubby work. They rationalise it only by being good professionals.

                                            It was professionally competent operation, but don't tell us they think that it's a morally upright act when they hear people talk about valour and ability in war, I think most of them find that utterly elusive.

Michael Frater:                We'll just take one last question.

Speaker 6:                         Thank you. Just continuing the film theme, Eye in the Sky starring Helen Mirren from 2015-

Tom Frame:                       I think actually Alan Rickman too.

Speaker 6:                         That's right. He's passed away. But in that film, it examined not so much the tour of duty, but rather the drone operator whose remote from the place where he wants of fire the missile and there's a child in the way, but given that Australia has just approved the purchase of two billion dollars of U.S. reaper drones, could you perhaps comment on how the ADF might examine its rules of engagement and the worlds like collateral damage, given that there could be situations for remote targeting and those men that have to go back to their wives and children after they've offed someone.

Tom Frame:                      Yeah. I'm at three things. The first one is, that we need to realise that when we, Australia, commit to a multi-national operation, we largely retain the ability to say what we will and won't do and there's been a number of instances within the last couple of decades where an operation has been ordered, an Australian national commander has held up the red card and said, "Well, that's not acceptable to us and we won't participate." So, we don't lose the ability to be who we are because our people have Australian flags by virtue of being part of a multi-national coalition. I think that's an important thing, so we will distinguish ourselves from others.

                                                On the matter of remote warfare, American drone operators seem to be highly affected by moral injury because people thought, "Well, it's just an arcade game." That's what it looks like, and I think it's the fact that there isn't a tactile experience to go with it, the unreality of it and therefore, the, I think not having smell and sound, it's just sight, actually makes it more and more difficult for those people to get a sense of the gravity of what they've done, other than in a way that implicates them if things don't go right.

                                                Drone operators are now being treated as a different category of people, a different kind of moral injury than others. Do we know much about it? Not really, but we've just been engaged by six brigade Australian army to produce a course, and it'll be in our master’s programme, but not enrollable ... What's the word? You can't enrol if you're not a member of a certain community, called Moral Leadership in Complex Operations, and we're going to look at that in that course.

                                                So once we've run it a couple years, we'll probably open it to the public, but in the first instance, it'll just be uniform people, because it'll have some classified materials as part of it and interrogations the other big episode in that as well. So, these things are being taken seriously, had we made the progress we ought? No, because technology will always be out there and you'll see the ethics is wildly chasing it, trying to kind of a put a critique around it, so that when people are morally injured, at least we knew it was likely and perhaps we put in place some abatement strategies, but what you're pointing to is that these things are not going to go away, they will become more complicate, and therefore, more controversial.

Michael Frater:                 Thanks very much, Tom. I think many of you coming today might've wondered what a historian would have to say about something like moral injury and why don't we have a psychologist speaking instead? Certainly when I first heard from Tom about this research project, that was one of the things that went through my head, but I think what Tom's shown us is that historians actually have lots of useful things to say, not just about the past, but about the present and the future by applying big techniques of analysis. So, please join with me in thanking Tom for his time.