The invisible (yet real) wounds of character: towards an enactivist approach to moral injury

This paper interrogates philosophically the notion of moral injury, a syndrome that has ethics built into its definition: moral injury is not only a trauma associated with psychological suffering and cognitive disruption; it is also a process of moral degradation and loss of ethical competency. I argue that the enactivist approach to cognition, especially the “patternist” and interactionist version informed by phenomenology and virtue ethics that Shaun Gallagher advocates may be helpful to correctly construe moral injury in terms of moral character deterioration and disruption of practical wisdom. Standard approaches to moral injury in psychiatry and clinical psychology are unable to account for the distinctively normative features of character deterioration because of their rationalist, reductionist, and internalist assumptions. On the contrary, enactivism offers an integrative understanding of mental life as a process of participatory sense-making and value construction that encompasses multiple, emergent levels beyond the naturalistic dimension of biopsychological processes to include, importantly the pre-reflective/embodied dimension (habitual moral dispositions, such as virtues), the phenomenological/existential dimension (conscious experience and moral sense-making), and the intersubjective/relational dimension (relating to socio-cultural and symbolic norms, involving groups and institutions). By incorporating all these factors, the integrative perspective advocated by enactivism is better positioned to describe the inherently ethical dimension of human experience and account for the double-nature of moral injury, a syndrome that, by its own definition, requires both a descriptive (clinical) and a normative (value-laden) account. For these reasons, enactivism promotes a more comprehensive and efficacious approach to diagnosis, therapy, prevention, and social intervention.