The importance of what they care about

Many forms of contemporary morality treat the individual as the fundamental unit of moral importance. Perhaps the most striking example of this moral vision of the individual is the contemporary global human rights regime, which treats the individual as, for all intents and purposes, sacrosanct. This essay attempts to explore one feature of this contemporary understanding of the moral status of the individual, namely the moral significance of a subject’s actual affective states, and in particular her cares and commitments. I argue that in virtue of the moral significance of actual individuals, we should take actual cares and values very seriously—even if those cares and values are not expressions of the person’s autonomy—as partially constituting that individual as a concrete subject who is the proper object of our moral attention. In particular, I argue that a person’s actual cares and values have non-derivative moral significance. Simply because someone cares about something, that care is morally significant. In virtue of this non-derivative moral significance of cares, we ought to adopt of a commitment to accommodate others’ cares and a commitment not to frustrate their cares.     

Military Moral Injury: An Evidence-Based and Intercultural Approach to Spiritual Care

How can spiritual care help veterans struggling with military moral injury? An evidence-based, intercultural approach to spiritual care is proposed. Evidence-based care uses research on military moral injury and religious and spiritual struggles to understand when religious and spiritual practices, beliefs, and values are helping or harming veterans. Intercultural spiritual care recognizes the complex, distinctive ways veterans’ values, beliefs, coping, and spiritual practices are shaped by interacting cultural systems, especially military training and cultures. Pastoral theologian Larry Graham’s (Sacred Spaces: The E-Journal of the American Association of Pastoral Counselors 5, 146–171, 2017) writing on moral injury and lamentation is used to develop two spiritual care strategies: sharing anguish and interrogating suffering. Spiritual care begins with lamenting the shared anguish of moral injury using intrinsically meaningful spiritual practices to help veterans compassionately accept the emotions arising from moral injury so intensely felt in their bodies. The second strategy is sharing the lament of interrogating suffering through exploring values, beliefs, and coping arising from moral injury. A literary case study of a young female veteran based on Cara Hoffman’s (2014) novel Be Safe, I Love You illustrates this evidence-based intercultural approach to spiritual care of military moral injury.

     

Moral Luck,Responsibility, and Systems of Tort Liability

Bernard Williams drew our attention to what might be wrong with denying the role of luck in our understanding of agency and responsibility. Susan Wolf and David Enoch, in separate works, have asked us to focus instead on what might be virtuous and valuable in embracing that role, and on how our institutions might assist us in that regard. They claim that the agent who ‘takes’ a responsibility that law or morality do not already assign to them may be displaying a special moral virtue or exercising a distinctive moral power. I raise some objections to Wolf’s and Enoch’s case for that claim, and query some of its purported institutional implications for tort law systems.

     

Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans

This paper evaluates the Impact of Killing (IOK) treatment—a psychological intervention designed to address moral injury and trauma associated with killing in war. Using qualitative data from interviews with 28 combat veterans, we examine IOK’s impact, how it differs from other trauma-focused treatments, and how it can be improved to better meet veterans’ needs. We found that many veterans processed their killing experiences for the first time in IOK, even though all had previously completed evidence-based treatments for posttraumatic stress disorder. Several described killing in war as the most distressing and transformative trauma of their lives, and all affirmed the value of an intervention focused directly and explicitly on moral injury and killing. IOK helped veterans to acknowledge their grief, shame, and distress; gently but critically examine their thoughts and beliefs about killing in war; and make strides toward acceptance, reconciliation, and forgiveness.     

No Blame No Gain? From a No Blame Culture to a Responsibility Culture in Medicine

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors.     

Using Internal Family Systems Theory in the Treatment of Combat Veterans with Post-Traumatic Stress Disorder and Their Families

As many as one-third of all combat veterans experience symptoms of post-traumatic stress disorder following their service to the military (United States Department of Veterans Affairs 2016). Despite government efforts to provide care for those suffering from PTSD symptoms, veterans still struggle to receive appropriate and effective treatments. Inadequate care often has devastating effects on the veteran and his or her family. Currently, veterans typically receive individual treatments such as cognitive behavioral therapy, exposure therapy, or eye movement desensitization and reprocessing. While the United States Department of Veterans Affairs provides individually focused evidenced based treatments, they do not currently endorse any particular model of family systems therapy for the treatment of PTSD in veterans or their families. The present article aims to demonstrate that Internal Family Systems (IFS), a systemic form of therapy, provides an effective treatment for combat veterans who suffer from PTSD. We propose that IFS’s collaborative approach, less-pathologizing stance, and simple language will resonate with military populations. We also argue that IFS provides a seamless transition between individual and family therapy allowing the therapist to address both the individual and relational effects of PTSD.     

Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

Recontextualising moral injury among military veterans: An integrative theoretical review

Moral injury was originally conceived as a socially-inflicted wound of betrayal experienced by military veterans (Shay, 1994). However, moral injury has since been redefined by psychological researchers as an individualised, predominantly perpetration-driven, and psychopathological phenomenon (e.g., Currier et al., 2015; Jinkerson, 2016). However, social scientific researchers (e.g., Hodgson & Carey, 2017; Molendijk, 2019; Wiinikka-Lydon, 2017) have contested mainstream psychology's medicalisation and decontextualisation of moral injury. This theoretical review integrates insights from across these discourses, and brings them into dialogue with ideas from moral psychology, evolutionary science, and community psychology. The aim of this cross-disciplinary review is to promote a more holistic understanding of moral injury that does justice to its individual and social dimensions. Drawing on these different theoretical strands, this paper proposes that moral injury can be best understood as a psychological wound to basic human needs for social belonging and cohesion. The implications of this integrative understanding of moral injury for applied psychologists and other societal actors are explored. While the relevance of moral injury to civilian populations such as health and social care professionals is clear (e.g., Dombo et al., 2013; French et al., 2021), this paper focuses on military veterans, whose experiences originally prompted the coinage of the term. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.     

Moral injury and the priesthood of all believers1

This article proceeds from the conviction that moral injury suffered by many combat veterans is a deeply spiritual matter requiring spiritual resources for healing. The tradition of the care of souls commends itself. It takes into account that the “soul” is an expression of the whole person in all its physical, spiritual, and social realities. Moral injury affects all those dimensions of personhood or soul. Since the Reformation the care of souls has been a vocation for the ministry of the whole people of God under the theology of the priesthood of all believers. A caring community is essential to healing for many dealing with moral injury. Indeed, the veterans themselves, in sharing their stories and their pain, become part of that ministry of the priesthood of all believers and may well find healing in the meaningfulness of their mutual ministry.     

青少年网络道德与其网络偏差行为的关系

青少年已经成为中国互联网的最大用户群体,他们在使用互联网中表现出的偏差行为与道德的关系值得关注。该研究使用问卷法探讨了496名青少年的网络道德特点与网络偏差行为表现以及二者之间的关系。结果发现:(1)青少年的网络道德表现较积极,网络道德认知、情感和意向之间存在显著正相关;(2)青少年的网络偏差行为不算严重,但男生的网络过激行为和网络色情行为显著多于女生,且网络过激行为随着年级升高而减少:其中网络攻击性、易怒、敌意和冲突水平都随着年级的增长而呈下降趋势;(4)青少年的网络道德认知和意向对网络偏差行为有反向预测作用,网络道德情感不能预测其网络偏差行为表现。网络道德越积极,表现出来的网络偏差行为越少。     

Locke's Theory of Demonstration and Demonstrative Morality

Locke famously claimed that morality was capable of demonstration. But he also refused to provide a system of demonstrative morality. This paper addresses the mismatch between Locke's stated views and his actual philosophical practice. While Locke's claims about demonstrative morality have received a lot of attention it is rare to see them discussed in the context of his general theory of demonstration and his specific discussions of particular demonstrations. This paper explores Locke's general remarks about demonstration as well as his claims about demonstration in natural philosophy, mathematics, and morality. Careful attention to these detailed discussions motivates a reevaluation of Locke's views on demonstrative knowledge of morality. Specifically, while Locke did believe that some demonstrative moral knowledge might be in‐principle available to us he also believed that facts about the difficulty of demonstration meant that this knowledge would in‐practice be largely unattainable.     

Empathy for Non-Kin,the Faraway,the Unfamiliar,and the Abstract––An Interdisciplinary Study on Mencian Moral Cultivation and a Response to Prinz

This article challenges the pessimistic view that empathy and other fellow feelings are biased and erratic motivation for morality. By discussing Mencius’ account on how to develop empathy from its biased and erratic beginnings, I argue that empathy can be extended to less common objects, such as non-kin, the faraway, the unfamiliar, and the abstract. The extension facilitated by empathy in turn enhances one’s moral cognition toward the sufferings of less common objects; the extension also helps to include less common objects into one’s circle of care. I respond to critics of empathy such as Prinz by highlighting the dynamic cultivational process of empathy that they overlook, and further point out that empathy can be cultivated so as to provide a remedy for the biases that no emotion is immune to. This article contributes to the ongoing discussion on moral cultivation in the Chinese philosophy community and the dispute over empathy’s role in morality in contemporary ethics.     

Beyond compassion: on Nietzsche’s moral therapy in <Emphasis Type="Italic">Dawn</Emphasis>

In this essay I seek to show that a philosophy of modesty informs core aspects of both Nietzsche’s critique of morality and what he intends to replace morality with, namely, an ethics of self-cultivation. To demonstrate this I focus on Dawn: Thoughts on the Prejudices of Morality, a largely neglected text in his corpus where Nietzsche carries out a quite wide-ranging critique of morality, including Mitleid. It is one of Nietzsche’s most experimental works and is best read, I claim, as an Epicurean-inspired critique of the present and an exercise in moral therapy. In the opening sections I draw attention to the wider social dimension of the text and its concern with a morality of compassion, which is rarely done in the literature. I then turn to highlighting Nietzsche’s “Epicurean moment,” followed by two sections on Nietzsche on the self in which I aim to bring to light his ethics of self-cultivation and show in what ways his revaluation makes central to ethics a modest egoism and care of self. In the conclusion to the essay I provide a contrast between Nietzsche and Kant and deal with reservations readers might have about his ethics. Overall, the essay seeks to make a contribution to an appreciation of Dawn as a work of moral therapy.     

Moral injury,coherence, and spiritual repair

In the PTSD literature, moral injury represents dissonance between a person’s beliefs about how they and the world should function, and the trauma event(s) they experienced. Given the association of moral injury with the assumptive world, it is not surprising the concept is closely intertwined with spiritual concerns. This paper reports on a spiritually integrated group intervention designed to help veterans with PTSD in the process of moral and spiritual repair. Qualitative findings are shared from interviews conducted with 18 participants who completed the intervention. Themes are centred around participants’ overall response to their experience in the group; where they are at regarding feelings such as guilt, shame, anger, trust, sense of betrayal, and desire for forgiveness; changes in religious/spiritual beliefs and practices and the experience of moral injury; and if they now find meaning in the trauma. The findings support the need for additional treatment options that address the moral and spiritual aspects of trauma.     

What is Enshrined in Morality? Understanding the Grounds for Nietzsche’s Critique

Abstract

It is a truism that Nietzsche is a critic of morality. But what does Nietzsche have against this institution of morality? I consider the prominent interpretation of Brian Leiter’s that Nietzsche takes morality to task for its bad effects in hampering the flourishing of great individuals and cultures. There are good reasons, I argue, to resist this reading as the best, and certainly as the exclusive, account of the grounds for Nietzsche’s criticism of morality. I go on to propose an alternative construal that sees Nietzsche as objecting to the expressive character of moral values themselves (an under-explored notion in anglophone ethics and social philosophy that I seek to elucidate in the paper). My project, in the first instance, is the exegetical one of understanding what is going on in Nietzsche’s texts when he criticizes morality. Nonetheless, there are important philosophical lessons to be learned here from Nietzsche’s work, if not necessarily about the actual failings of morality itself, then about the kinds of ethical and ideological objections that philosophers and cultural critics can sensibly raise. One of the central styles of critique that we see in Nietzsche’s work, exemplified especially in his criticism of morality, involves interpreting social and cultural phenomena, as one might interpret texts or works of art, with an eye toward extracting the meaning or significance they have in light of the ideals they enshrine, and then attacking them, on broadly ethical grounds, on account of this. It thereby creates the space for criticizing institutions not just for what pernicious effects they have, but for the intrinsically objectionable character of what they express.     

The Compatibility of Hegelian Recognition and Morality with the Ethics of Care

I draw connections between Hegel’s concepts of recognition and morality and demonstrate how they are compatible with an ethic of care. I explore Hegel’s Sittlichkeit and demonstrate the role that intersubjective recognition plays in the development and sustainment of ethical communities. I demonstrate how his emphasis on the community and interpersonal relationships play an important role in his moral theory. I then contrast Hegelian and Kantian views of morality and argue that Hegel’s account places greater emphasis on attending to the needs of others and showing genuine concern for their well-being. By highlighting the intersubjective nature of recognition between self-consciousnesses, and the interconnectedness of agents in an ethical community, I maintain Hegel’s morality is compatible with an ethic of care because it emerges out of intersubjective mutual recognition and its foundation is built upon responding to the needs of particular others and protecting the bonds of the community.     

道德情绪:探寻道德与创造力关系的新视角

先前有关道德与创造力的关系研究多关注道德的认知与行为差异对创造力产生的影响, 但研究结果却存在较大的分歧。为此, 研究从道德情绪的视角, 对二者的关系进行了系统地梳理, 发现道德情绪存在: 以情绪效价调节创造性认知; 激发道德动机, 中介人格与创造力的关系; 引发自我觉察, 促进顿悟与创造性成就的产生; 提升心理资本, 影响不同创造力特性的表达等, 多种影响个体创造力的路径。这表明, 与道德认知和行为相比, 道德情绪不仅能更加全面准确地体现出个体实际的道德活动、促进符合道德标准的创造力产生; 还为人们解释道德与创造力的关系提供了多样的路径与可能。未来需继续加深对道德情绪及其内在机制的理解、通过系统性地选取创造性任务, 明确道德情绪、道德与创造力之间的关系, 寻找道德培养与创造力激发的新模式。     

文化如何影响道德?文化间变异、文化内变异与多元文化的视角

道德判断与行为具有高度的文化敏感性, 来自不同文化背景、具有不同文化经历的个体, 对于同一道德现象的理解与建构存在显著差异。随着20世纪80年代文化心理学的复兴繁荣和全球化进程的不断深化, 文化视角的道德心理学在当代社会心理学语境中备受关注, 并已开展了初步的理论探索, 积累了大量的实证证据。基于文化心理学的视角, 本文将分别从文化间变异、文化内变异和多元文化三个方面梳理和评述不同文化因素(比如地域、生态、社会阶层等)如何影响个体的道德判断与行为, 期望推动未来研究进一步探索快速而剧烈的文化变迁背景下中国人的道德心理和价值体系已经发生了或正在发生着怎样的演变过程。     

Spitefulness and moral values

The relationship between spitefulness and an individual’s sense of morality or lack thereof has been neglected in studies of personality. It seems probable that individuals with higher levels of spitefulness exhibit fewer moral concerns relative to those with lower levels of spite. To examine associations between spitefulness and moral concerns, 436 community participants completed self-report measures concerning their spitefulness, basic personality dimensions, and moral concerns. Spitefulness was negatively associated with individualizing values (i.e., sensitivity to harm and fairness) such that spiteful individuals were less concerned about issues related to avoiding harm or injustice to others when making moral judgments. However, spitefulness was not simply associated with a general reduction in moral concerns as it was not significantly associated with binding values (i.e., concerns about ingroup loyalty, authority, and purity).     

Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support

Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1,090). The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief “it’s up to me to handle my own problems.” This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one’s own problems and thus had an indirect effect of reducing mental health visits. Both social support and PTSD affected veterans’ perceptions of needing to solve one’s own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians’ should explore veterans’ belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.