A Review of Research on Moral Injury in Combat Veterans

The moral injury construct has been proposed to describe the suffering some veterans experience when they engage in acts during combat that violate their beliefs about their own goodness or the goodness of the world. These experiences are labeled transgressive acts to identify them as potentially traumatic experiences distinct from the fear-based traumas associated with posttraumatic stress disorder. The goal of this article was to review empirical and clinical data relevant to transgressive acts and moral injury, to identify gaps in the literature, and to encourage future research and interventions. We reviewed literature on 3 broad arms of the moral injury model proposed by Litz and colleagues (2009) Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., &; Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706. 10.1016/j.cpr.2009.07.003[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]: (a) the definition, prevalence, and potential correlates of transgressive acts (e.g., military training and leadership, combat exposure, and personality), (b) the relations between transgressive acts and the moral injury syndrome (e.g., self-handicapping, self-injury, demoralization), and (c) some of the proposed mechanisms of moral injury genesis (e.g., shame, guilt, social withdrawal, and self-condemnation). We conclude with recommendations for future research for veterans suffering with moral injury.     

Journals received

Many philosophers think that dispositions are necessarily intrinsic. However, there are no good positive arguments for this view. Furthermore, many properties (such as weight, visibility, and vulnerability) are dispositional but are not necessarily shared by perfect duplicates. So, some dispositions are extrinsic. I consider three main objections to the possibility of extrinsic dispositions: the Objection from Relationally Specified Properties, the Objection from Underlying Intrinsic Properties, and the Objection from Natural Properties. These objections ultimately fail.     

Highly Skilled Migrants’ Strong Ties with Their Home Country: Evidence from Filipinos in New Zealand and Australia

This paper provides empirical evidence of the “embedded connectedness” of highly skilled migrants with their home country through the Philippine case in New Zealand and Australia. This challenges the findings in other studies that show the weak connection between them and the home country which is generally explored more in terms of economic remittances. While the majority of the participants in the study are already citizens of the host country, they remain emotionally tied and culturally connected to the Philippines as evidenced by their information-seeking behaviour, feeling of nostalgia, sending of remittances, taking of dual citizenship, attendance in Philippine-related events and the country they perceived as home. One interesting finding in the study is that most of them have taken citizenship for pragmatic reasons, that is, for the benefits and security that it could bring them. It concludes by emphasising the relevance of capitalising on these strong diasporic ties to entice the skilled diaspora to return to their home country and/or be involved in development activities back home.     

Identity-Related Dysfunction: Integrating Clinical and Developmental Perspectives

Recent changes to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders highlight the importance of identity dysfunction within several psychiatric diagnoses. Despite a long-standing tradition of identity research and theory in the developmental literature, there is limited work establishing intersections between clinical and developmental conceptualizations of identity problems. The relative lack of integration between decades of clinical and developmental work is unfortunate, and likely limits progress in both areas. In this commentary, the authors argue for greater interdisciplinary collaboration and highlight contributions from developmental and clinical theories, which, if integrated, could enhance identity scholarship. The developmental psychopathology perspective is introduced as an ideal framework to promote these goals.     

Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes

Objective

To explore the interplay of maternal depressive symptoms on the infant limbic-hypothalamic-pituitary axis (LHPA) and neurological development.

Design

Pregnant women were monitored for depressive symptoms using the Beck Depression Inventory (BDI) at 28, 32, and 37 weeks of gestation and at delivery. A mixture growth curve analysis divided the women into three risk groups: low/stable, intermediate, and high/increasing depression based on BDI scores. The infant neuroendocrine system was examined using cord blood for adrenocorticotrophic hormone (ACTH) and cortisol measurements. Two-week-old infants were examined using Neonatal Intensive Care Unit Neurobehavioral Scale (NNNS).

Results

Infants born to women of the high/increasing depression group had significant ACTH elevation at birth. On NNNS examination, these infants were more hypotonic and habituated to auditory and visual stimuli.

Conclusion

When compared to non-depressed women, maternal depressive symptoms, even in the absence of major depressive disorder, appeared to facilitate a different developmental pathway for the infant LHPA and early neurological development.     

Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence

This study investigates the early manifestation of co-occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co-occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.     

Exploring the effects of ownership and choice on self-memory biases

Objects encoded in the context of temporary ownership by self enjoy a memorial advantage over objects owned by other people. This memory effect has been linked to self-referential encoding processes. The current inquiry explored the extent to which the effects of ownership are influenced by the degree of personal choice involved in assigning ownership. In three experiments pairs of participants chose objects to keep for ownership by self, and rejected objects that were given to the other participant to own. Recognition memory for the objects was then assessed. Experiment 1 showed that participants recognised more items encoded as "self-owned" than "other-owned", but only when they had been chosen by self. Experiment 2 replicated this pattern when participants' sense of choice was illusory. A source memory test in Experiment 3 showed that self-chosen items were most likely to be correctly attributed to ownership by self. These findings are discussed with reference to the link between owned objects and the self, and the routes through which self-referential operations can impact on cognition.     

The colour of gender stereotyping

Despite legislative attempts to eliminate gender stereotyping from society, the propensity to evaluate people on the basis of their sex remains a pernicious social problem. Noting the critical interplay between cultural and cognitive factors in the establishment of stereotypical beliefs, the current investigation explored the extent to which culturally transmitted colour-gender associations (i.e., pink is for girls, blue is for boys) set the stage for the automatic activation and expression of gender stereotypes. Across six experiments, the results demonstrated that (1) consumer choice for children's goods is dominated by gender-stereotyped colours (Experiment 1); (2) colour-based stereotypic associations guide young children's behaviour (Experiment 2); (3) colour-gender associations automatically activate associated stereotypes in adulthood (Experiments 3-5); and (4) colour-based stereotypic associations bias impressions of male and female targets (Experiment 6). These findings indicate that, despite prohibitions against stereotyping, seemingly innocuous societal practices may continue to promote this mode of thought.     

From Social Construction to Relational Construction: Practices from the Edge

In this paper, I talk about Ken Gergen??s influence in the communication discipline. Beginning with his ground-breaking publications in the 1970??s (Gergen 1973, 1978), we see him challenging the taken for granted separation of theory and practice, scholar and practitioner. One of Ken??s many contributions?Cregardless of disciplinary domain?Chas been the nurturing of forms of practice being developed by creative and innovative practitioners and young scholars alike. There are several key resources that are woven throughout Ken??s work that have continued to inspire and influence practitioners working in mental health, healthcare, organizations, schools, communities, and peace building endeavors. The most central of these resources include (1) centering relational processes which, in turn, generate the expansion of (2) collaborative, participatory practices that embrace alternative worldviews through a (3) a reflexive stance. Ken has challenged himself and all of us to stay on the edge because it is on the edge that new relational possibilities can be created. He has invited us to embrace the edge as the place of great comfort; comfort in knowing that there will always be possibilities for forging new ways of making meaning together.     

Differentiating Adolescent Self-Injury from Adolescent Depression: Possible Implications for Borderline Personality Development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.