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Running Head: Moral Judgment and Moral Injury 1 RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 1 © 2019, American Psychological Association. This paper is not the copy of record and may not exactly replicate the final, authoritative version of the article. Please do not copy or cite without authors' permission. The final article will be available, upon publication, via its DOI: 10.1037/tra0000518 Moral Decision Making, Religious Strain, and the Experience of Moral Injury Steven L. Lancaster* and Maggie Miller Bethel University, St Paul, MN *Corresponding Author: Department of Psychology Bethel University 3900 Bethel Drive St Paul, MN 55112 Office: 651-638-6895 Fax: 651-638-6001 Email: [email protected] RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 2 Abstract Objective: Moral injury is the lasting psychological, spiritual, and behavioral effects of having perpetrated acts that transgress moral boundaries. Contemporary models of moral injury in military veterans examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined appraisals of one’s acts and religious strain as potential mediators of the link between transgressive acts and symptoms of moral injury. Further, given the inherent importance of moral cognitions in the appraisal process, we tested whether the acts to appraisals link was moderated by altruism in military veterans. Method: An online survey, distributed using crowdsourcing software, was completed by military veterans. The survey included measures of transgressive acts, appraisals of these acts, religious strain, altruism, and self- and other-directed symptoms of moral injury. Mediation and moderated serial mediation were used to test the hypotheses. Results: Our results indicated appraisals and religious strain significantly mediated the acts to symptoms pathway for both self- and other-directed aspects of moral injury. This pathway was significantly moderated by altruism such that a stronger link exists between acts and appraisals at higher levels of altruism. Conclusion: Overall, these findings suggest that religious functioning and moral decision making are important aspects of the experience of moral injury and are worthy of future study. Keywords: moral injury, transgressive act, military, religion, altruism Clinical Impact Statement: The present study is the first to demonstrate the role of altruism in the experience of moral injury in military veterans. This study suggests that the conceptualization and treatment of moral injury should be extended to examine the impact of moral decision making in the post-transgression appraisal process. Moral Decision Making, Religious Strain, and the Experience of Moral Injury RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 3 Military combat deployments involve exposure to environments in which there is a high probability for encountering ambiguous situations wherein one might be forced, or choose, to act against their own conscience (Frankfurt & Frazier, 2016; Nash & Litz, 2013). These conscience- violating acts, known as transgressive acts, and their negative psychological consequences, known as moral injury, have become a major emphasis of research in both the psychology and chaplaincy literatures (Farnsworth, Drescher, Evans, & Walser, 2017; Frankfurt & Frazier, 2016; Litz et al., 2009). The most widely accepted definition of moral injury is provided by Litz and colleagues, which states that moral injury is the “lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (2009, p. 697). More recently, transgressive acts have been defined as “experiences that involve the violation – or transgression – of accepted boundaries of behavior” (Frankfurt & Frazier, 2016, p. 319). While widely recognized as a problem affecting members of the military (Bryan et al. 2015; Frankfurt & Frazier, 2016; Lancaster & Erbes, 2017; Litz et al., 2009), the nature of the relationship between transgressive acts, appraisals of these events (that is, one's thoughts, beliefs, and attitudes), and the experience of moral injury is not well understood. Further, there is a clear theoretical and empirical need for additional work on potential mediators between these acts and other aspects of the moral injury experience (Frankfurt & Frazier, 2016; Harris et al., 2011; Hodgson & Carey, 2017; Lancaster & Erbes, 2017). Recent research in the field of moral injury has placed a focus on the role appraisals play within an individual's interpretation of transgressive acts (Farnsworth, Drescher, Nieussma, Walser, & Currier, 2017; Frankfurt & Frazier, 2016; Lancaster & Erbes, 2017). Cognitive models, dating to the work of Beck (1970) and others, emphasize the role of appraisals in how RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 4 people process and experience life events. This general cognitive model has been widely expanded and has been useful in explaining a number of trauma-related reactions including PTSD (Ehlers & Clark, 2000). Authors such as Farnsworth et al. (2017) and others have suggested that the appraisal is a key factor in understanding why some military members experience moral injury symptoms and others do not (Frankfurt & Frazier, 2016; Lancaster & Erbes, 2017). A recent model of moral injury by Farnsworth and colleagues (2017, p. 392) emphasized the role of moral pain, which includes “...the occurrence of moral thoughts pertaining to culpability or judgment, or dissonance between the two.” They further argue these moral cognitions “take the form of evaluative cognitions and moral judgments” that go beyond the exaggerated or distorted cognitions seen in other disorders (p. 393). Thus, empirical and theoretical work supports the role of appraisals in the experience of moral injury and highlights how these cognitions differ from those associated with other forms of psychological distress. Given the importance of moral appraisals cognitive models of moral injury, it is important to understand the transgressive act to moral appraisal process. The development of moral injury symptoms assumes the person has an intact moral system; otherwise an individual would not recognize an act as a moral violation (Litz et al., 2009). Models of moral decision making often emphasize that moral decisions are made intuitively, using automatic emotional responses, and then reflection and reasoning occur later (Greene, Morelli, Lowenberg, Nystrom, & Cohen, 2008; Haidt, 2001). At the same time, other models emphasize the role of past learning, including early childhood experiences, and current environmental conditions on moral decision making (Narvaez, 2019). The environmental context could be especially influential for moral decisions made during stressful situations, such as combat, as these actions may be re- evaluated once the person is out of the stress environment. Post-deployment changes in RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 5 environment may also play an important role in the appraisal process as competing demands, values, or beliefs may lead to ongoing conflict or tensions that need to be worked out in one’s “moral imagination” (Lacewing, 2015). Thus, this reflection process can be influenced by various persuasive or cognitive arguments and may lead to changed perspectives on the morality of one’s actions (Colby & Damon, 1992; Lacewing, 2015; Paxton, Ungar, & Greene, 2012). Especially given the important role of character development in the military (Callina et al., 2017), members of the military may be better equipped to use reflection in making moral judgments (Narvaez, 2010). One specific trait that may a play a role in the appraisal process is altruism, which has been associated with how people respond to situations in which the right or correct behavior is not immediately clear (Kurzban, DeScioli, & Fein, 2012; Sarlo, Lotto, Rumiati, & Palomba, 2014). Kurzban et al. (2012) found that an individual is more likely to utilize trait altruism when the situation includes people conceptualized as kin. Given the familial-like bonds that can form during military service, the role of altruism may be a key predictor of how military veterans interpret their acts and the acts of their “family.” In response to limitations with earlier measures, Starcke, Polzer, Wolf, and Brand (2011) developed an assessment that measures one’s altruism by testing one’s responses to everyday moral situations. This measure utilizes more common events, such as “what would you do if you found a wallet?”, to assess more general levels of moral thinking. Based on the literature noted above, we predicted that trait altruism would moderate the appraisal process, such that those higher in altruism would show a stronger connection between acts and appraisals of these acts, as those higher in altruism are more likely to deem their past acts as morally wrong. RUNNING HEAD: MORAL JUDGMENT AND MORAL INJURY 6 Religion is a primary way in which many individuals make moral decisions and evaluate novel moral dilemmas (Graham & Haidt, 2010), and most major religions emphasize a moral self-commitment in which individuals should take responsibility for their behavior (Narvaez, 2010). Further, as about three out of every four members of the military indicate that religion plays an impactful role within their life (Koenig et al., 2017), it is important to examine how the role of religion
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