Embittered in the Soul: Cultural Shaping of Moral Injury Among Akan Women

Background and Purpose:

 “Moral injury” (MI) refers to lasting psychological, social and spiritual harm caused by the individuals’ or others’ actions in high stakes situations that transgress deeply held moral beliefs and expectations (Shay, 1994). MI may result in guilt, shame, rage, depression (Kopacz, Simons, & Chitaphong, 2015); loss of meaning (Currier, et al, 2015); and a collapse of trust in one's own or others' capacity to behave ethically (Drescher et al., 2011). Although moral injury is assumed to be a widespread human experience, almost no research has been conducted within non-Western cultural contexts. Yet social workers provide services to individuals from diverse cultural contexts, nationally and internationally.  As part of a 10-year ethnographic study of Akan women in Ghana, we asked: 1) Do Ghanaian participants identify “moral injury” (as described in the Western literature)? 2) To what extent are morally injurious events and experiences shaped within Akan (Ghana) ontology, gender roles, and customary law.

 Methods:

This study was conducted in the Brong-Ahafo region of Ghana.Participants were widowed women (23), religious professionals (19) providing services to widows, and a secular social worker (1). Researchers conducted 14 individual interviews, and 2 focus group interviews. The researcher first described theWestern concept of “moral injury” and then asked the extent to which this experience was consistent with participants’ own experiences.All 30-90-minute interviews were audiotaped and transcribed verbatim. Emic codes were induced through repeated readings of each transcript (Schwandt, 2014) by two independent coders. Disagreements were resolved through discussion. Peer de-briefing and member checking further enhanced the credibility of our interpretations (Lincoln & Guba, 1985).

Results:

Ghanaian participants described events and experiences consistent with moral injury as described in the Western literature. For example, they described sexual exploitation of widows. In response to morally injurious events they reported loss of trust, spiritual crises, intense anger and bitterness, and generalized emotional pain.

Moral injury was also culturally nuanced. In describing “moral injury,” some participants used a Twi term, roughly translated as “to kill the soul.” The Akan’s perceive the human being as comprised of three elements: the soul, the spirit and the body. The soul is the radiance of God in the human being. The spirit is the person’s personality and character. Soul killing involves destroying the divine presence in the person, and the disintegration of the soul/spirit/body trinity. They also described moral injury in the context of Akan gender roles including the stigmatization of widowed women. Participants also described morally injurious events within the Akan customary legal system that leaves widows vulnerable to in-laws who may drive them off of the property they needed to survive.

 Conclusions and Implications:

Our research with Akan women illustrates both that the experience of moral injury occurs in diverse cultural contexts, and that it is culturally nuanced.Such understanding is foundational to providing services to social work clients in diverse national and international contexts.