Moral Injury Report

About the Study

The primary aim of our research is to measure moral injury caused by clergy sexual abuse and its concealment in the U.S. Catholic Church. This pilot study creates a new instrument to measure moral injury in survivors of clergy sexual abuse, current and former church employees, as well as Catholic college students. While moral injury can occur in a variety of settings, abuse by a priest (someone ordained in persona Christi, "in the person of Jesus Christ") compounds the betrayal as a violation of sacred trust by someone representing what is holy, the church, or God. This results in psychological distress, spiritual anguish, moral confusion, social isolation, and other dimensions of moral injury—not just for survivors, but those impacted by this betrayal, and others who feel implicated by their association with beliefs, practices, and institutions that contributed to this abuse of power.

Executive Summary

Moral injury results from a betrayal of trust, disrupting one's beliefs and moral compass. It comprises persistent psychological and emotional distress, moral confusion, spiritual anguish, social alienation, and distrust for institutions. Moral injury overlaps with and extends beyond post-traumatic stress disorder, which inadequately spans the psychological, emotional, moral, spiritual, behavioral, and relational dimensions of human personhood.

While the majority of research on moral injury has focused on soldiers' experience in combat, it has recently been explored in various professions ranging from healthcare to education to law enforcement. At present there are only a few, limited instruments to measure moral injury among civilians. To our knowledge, our instrument is the first to measure moral injury caused by clergy sexual abuse and its concealment.

In particular, this pilot study aims to measure moral injury as it relates to the moral conscience, which means "to know together." For this reason, our instrument explores moral injury on three levels—intrapersonally, interpersonally, and transpersonally—intent on examining the impact of clergy sexual abuse and its concealment by officials in the Catholic Church on relationships and our collective sense of what we "know together." Denying people the truth of what has happened deadens the moral conscience and undercuts the moral resources to respond to survivors and all those impacted with compassion and solidarity.

Our research shows that clergy sexual abuse caused moral injury to survivors and that moral injury can be detected among other individuals, including those who work for the church at the diocesan or parish level as well as university students. We measured moral injury by addressing the following dimensions of the moral life: moral identity (the sense of one’s inherent goodness or the experience of shame); moral perception and reasoning (the ability to make sound moral judgments or the experience of moral confusion/disorientation); moral agency (the capacity to exercise free will or the experience of constraint/ futility); moral relationships with others (feeling safe and being able to trust others or the experience of betrayal, stigmatization, or isolation); and relationship to God and institutions like the church (feeling connected and finding institutions credible or experiencing abandonment, punishment, and loss of confidence in the authority or credibility of the church).

We developed a survey that was distributed to adult survivors of clergy sexual abuse, current employees of Catholic dioceses and parishes, and students at a Jesuit university. Informed by extensive research into moral injury and clergy sexual abuse, this novel questionnaire assessed participants' religious identification and beliefs, awareness and impact of clergy sexual abuse in the Catholic Church, and experiences of moral injury in relation to the clergy abuse crisis.

A total of 389 participants responded to at least one of the items assessing moral injury. Analysis of the 59 moral injury items can be categorized in three areas: damage in trust towards authority/community (church, God, authority figures, organized community; 28 items), agency and perceived human goodness (10 items), and perceived lack of personal goodness or personal failure (16 items). Correlations between moral injury and symptoms of posttraumatic stress, depression, and anxiety indicate that moral injury is related to, yet distinct from, these mental health concepts. Our findings provide evidence that we developed a valid measure of moral injury in the context of clergy sexual abuse.

Additional analyses compared the degrees of moral injury endorsed by the three main groups of participants (i.e., survivors, employees, and students). An examination of total moral injury scores for the three groups indicated that on average, survivors experienced the highest levels of moral injury, followed by students; employees endorsed the lowest levels of moral injury despite the fact that they reported greater exposure to abuse as compared to students. In the domain of damage in trust toward authority/community, survivors reported greater moral injury relative to students and employees. For the domain of agency and perceived human goodness, employees endorsed less moral injury compared to students and survivors. For perceived lack of personal goodness/personal failure, the pattern of results mirrored that of the results for total moral injury (survivors > students > employees).

These results indicate that while moral injury was generally higher among those who are directly connected to clergy sexual abuse via their personal experiences of abuse, the impact of this crisis extends further, causing moral injury among those with varying degrees of affiliation with the Catholic Church. Moreover, the variability in findings between total moral injury and the three components of moral injury suggests the importance of nuanced conceptualization and measurement of this construct.

In addition to the quantitative data collected by our research team, we designed an interview script based on our preliminary research on moral injury. Dr. Ashley Theuring interviewed 15 self-identified survivors of clergy sexual abuse, raising questions focusing on the moral lives of the participant, asking them to talk about their sense of identity and agency, their moral reasoning, and their relationships with the church, others, and God. This group of survivors consisted of five women and ten men who experienced clergy abuse from ages 6-16 years old (on average, the abuse started at age 10.8 years old and lasted 3.06 years). Six of the participants identified as Catholic, five identified as spiritual, and four identified as non-religious/non-spiritual. After the interviews were conducted, transcribed, and anonymized, the research team coded the qualitative material for significant themes.

Major themes from our data include:

1. Most if not all the survivors expressed wrestling with shame. We also found that shame was often linked to guilt, stigmatization, and isolation. Often survivors kept their abuse a secret, worried about the im- pact it would have on loved ones, in particular.
2. A majority of survivors reported that when they shared their experience of abuse with a church em- ployee, they endured a negative response that ranged from blame, flat-out rejection, or silence. Some survivors were traumatized by the response they received from church officials.
3. A significant factor in the healing process is participation in community with other survivors.
4. As is common for childhood trauma, survivors denied their abuse or lost memory of it for decades. During this time, they often employed avoidance tactics to survive or cope. Survivors recounted the
   initial abuse and its resurfacing as traumatic.
5. Participants shared that clergy sexual abuse damaged their relationship with God and in many cases,
   severed their relationship with the church. For many survivors, enduring clergy sexual abuse and its concealment by church officials irrevocably damaged their sense of the church’s moral authority or credibility.

There may be a significant experience of moral injury during the period of avoidance or memory loss, but we were not able to directly measure it in this study because all the survivors we interviewed were in the process of addressing and healing their abuse. Participants described the period of time between their abuse and reporting it in terms of moral confusion ("a mess"), lacking moral agency (for many, enduring despair and futility), and a strong sense of shame (expressed as unworthiness, invisibility, destructive behaviors, and suicidality) in addition to poor mental health and in some cases, PTSD.

Key Findings

Through both quantitative and qualitative research, we measured moral injury across a number of dimensions of the moral life: identity, perception and reasoning, agency, and relationships with others, God, and the church. Moral injury often produces shame and moral confusion, futility and despair, distrust for and isolation from others, severs one's relationship with God and makes one feel less safe or able to rely on institutions.

Our instrument to measure moral injury included 59 items, which we can reduce down to three main features of moral injury: damage in trust towards authority/community (church, God, authority figures, organized community); agency of self and others' perceived human goodness; perceived lack of personal goodness/personal failure.

Correlations between scores for exposure to abuse, experiences of potentially morally injurious events (PMIEs), and moral injury generally indicated that individuals who reported greater levels of exposure to abuse and experiences of PMIEs also endorsed greater moral injury. Moreover, correlations between moral injury and symptoms of posttraumatic stress, depression, and anxiety indicate that moral injury is related to, yet distinct from, these mental health concepts. Together, these findings provide evidence that we developed a valid measure of moral injury in the context of clergy sexual abuse.

When we compared the total moral injury scores for the three groups we surveyed (survivors, church employees, and college students, on average survivors experienced the highest levels of moral injury, followed by students; employees endorsed the lowest levels of moral injury. Our data indicate that while moral injury was generally higher among those who are directly connected to clergy sexual abuse via their personal experiences of abuse, the impact of this crisis extends further, causing moral injury among those with varying degrees of affiliation with the Catholic Church. Moreover, the variability in findings between total moral injury and the three components of moral injury suggests the importance of nuanced conceptualization and measurement of this construct.

Our interviews with survivors of clergy sexual abuse underscored the importance of relationships with others in the formation of the moral self. Not only do other people shape one’s moral identity (beliefs, values, practices) but other people also contribute to and/or constrain one’s moral agency. When survivors experience stigma, silence, and isolation, they are not able to recover a positive moral identity or heal from their abuse. When others reject, minimize, or misinterpret a survivor’s story, it undermines one’s moral value (i.e., sense of being worthy or belonging). Etymologically, conscience means "to know together," highlighting the need to be attentive and responsive to moral injury intrapersonally and interpersonally, since moral identity, reasoning, and agency are constructed in relationships with others. When abuse remains a secret, it prevents us from being aware of reality and what justice requires.

Funding Information

This study was funded by a generous grant from Fordham University as part of Taking Responsibility: Jesuit Educational Institutions Confront the Causes and Legacy of Sexual Abuse. Co-sponsored by Fordham's Department of Theology and Francis and Ann Curran Center for American Catholic Studies, Taking Responsibility advances research regarding the protection of children, youth, and vulnerable persons in Jesuit institutions of education. Key goals for the grant include:

• support for rigorous, focused investigations into aspects of clerical sexual abuse as they have manifested at Jesuit institutions;
• the production of resources aimed at assisting Jesuit administrators, faculty, staff, students, and others to examine
• the causes, history, and consequences of sexual abuse, as well as ethical considerations about our responsibility in the present day;
• the facilitation of ongoing conversation, including through regular online and offline meetings for consultation and study and a major conference in Spring 2022; and
• the development of a partner network of Jesuit educational institutions through which this work can continue.

Read more information about Taking Responsibility and projects at other Jesuit institutions.

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About the Authors

Dr. Marcus Mescher
Associate Professor, Theology Department

Dr. Kandi Stinson
Professor and Director, Sociology Program

Dr. Anne Fuller
Assistant Professor, School of Psychology

Dr. Ashley Theuring
Assistant Professor, Theology Department