Moral Injury Can Cause PTSD

Most people who are familiar with PTSD (Post Traumatic Stress Disorder) tend to associate it with war veterans. However, war veterans are not the only ones with this disorder. PTSD is a mental health condition that’s triggered by a terrifying event. This event can be either experiencing it or witnessing it such as sexual assault, traffic collisions, or other threats on a person’s life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response.

Another term you may not be familiar with is “moral injury.” This occurs when one perpetuates, inflicts, or fails to prevent violence on others, or witness acts that transgress one’s deeply held moral beliefs. These may be either acts of omission and/or commission that lead to internal conflicts, shame, guilt and failure to forgive oneself.

Let me give you an example from a woman that I will call Kit. Kit’s roommate and best friend, Jane, developed cancer. Kit was an outgoing and highly social woman who enjoyed her job in the restaurant field as a server and bartender. She was a single mom, had many friends, and was a kind and giving person. When Jane became ill, Kit made the choice to be her primary caretaker in their home. She thought she could handle the responsibilities, with assistance from the hospice, and make Jane comfortable until the time came for her to die. It was her intention to provide quality, compassionate care for Jane. Her goal was for Jane to live as long as possible, and as well as possible.

Toward the end of Jane’s life she became restless and agitated. Kit administered a ‘comfort pack’ that hospice had provided to make Jane more comfortable. The comfort pack consists of medications to be used only when needed to relieve symptoms that arise in terminally ill patients. Jane was given two of these packs and her morphine drip was increased. Whereas Jane had been alert prior to the administration of the comfort packs, she became over sedated and could no longer speak. She died shortly afterward. Kit believed that she had mishandled these medications and caused her friend to die. She thought “It was not my role to administer the packs. We should’ve waited for more assistance. I didn’t understand what I was getting in to. I wish I had more education on what to expect.” Kit thought she had prevented Jane from communicating all that she may have wanted to say before she died. Instead of assisting Jane to live as long as possible, and as well as possible, she thought she had prevented Jane from her last words and had hastened her death. This was a moral injury.

Although she was a willing caretaker, she was unprepared for the reality of the dying process and she was not prepared for the emotional consequences to herself. Kit developed PTSD symptoms including depression and anxiety. She withdrew socially and rarely left the house. She was unable to work in situations that required social contact. She had intrusive memories of the process and could no longer tolerate the sight or description of blood; could not tolerate the sounds of labored breathing or slurping noises. She developed an aversion to certain smells and tastes.

I would like to say that Kit is now healthy and happy, but in spite of gains, remnants of this trauma persist. She still struggles with shame, guilt and failure to forgive herself as well as other PTSD symptoms. It is important to Kit that people understand that PTSD is not confined to war veterans. It can happen to anyone. If you are suffering from similar symptoms, get help from a mental health professional.

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Gardening Is Good for the Body and Soul

I’m not much of a gardener. For the most part, I plant Hostas and hope for the best. I work in an office and sit all day. I’m either engaged with people, or sitting at the computer. When I’m home, I’m most often reading or on my IPad. It can’t be good for my body or spirit. But when I’m in the garden, I notice a lift in my mood and outlook. It turns out there are quite a few psychological and medical benefits of gardening.

Gardening can ease stress and improve your mood. A study in the Netherlands found that gardening lowers the levels of the stress hormone cortisol, in comparison with a control group of people who read indoors for relaxation. A different study in Norway found that gardening helps improve depression. People who spent six hours a week growing flowers and vegetables had a measurable improvement in their depression symptoms. Their mood continued to improve for three months after the gardening program ended.

There are benefits to getting your hands dirty and being in the sun. Christopher Lowry, PhD at the University of Colorado at Boulder says that Mycobacterium, a harmless bacterium commonly found in soil, increases the release and metabolism of serotonin in the brain. This is similar to what antidepressant medications do. And the lack of certain bacteria in our environment throws our immune system out of whack which can lead to inflammation and illness. Gardening can also keep you limber and get your blood moving. Regular gardening cuts stroke and heart attack risk by up to 30% for people over 60. Exposure to the sun will increase vitamin D and reduce the risks of heart disease, osteoporosis and various cancers.

It keeps your mind sharp. The physical activity with gardening can lower the risk of developing dementia. Two studies followed people in their 60s and 70s for up to 16 years, found that those who gardened regularly had a 36% to 47% lower risk of dementia than non-gardeners. As we age, we lose dexterity and strength in our hands. Gardening keeps the hand muscles agile.

Just walking in nature may be therapeutic. Or, simply looking at nature. A study compared two groups of patients recovering after surgery. One group looked out their windows at green trees, and the other looked out their window to a brick wall. The patients who had a view of trees healed significantly faster, needed less pain medication, and had fewer complications.

A garden, as simple or as complex as it can be, provides a sense of pride and accomplishment. So get out there and reap the benefits of nature.

Altruism

Altruism is the opposite of selfishness. It is the practice of concern for the welfare of others. Not everyone is capable of altruism. Some people lack empathy toward others, and would only offer assistance if it benefitted them. Others will help people in distress even when helping could easily be avoided. Even toddlers can be observed to have a desire to help others. Animals have been seen to exhibit compassionate behavior at their own expense. Examples of altruistic behaviors are helping, sharing, cooperation, philanthropy, and community service such as volunteerism.

Research shows that people are more likely to help if they see a person in need and they feel personal responsibility for reducing their distress. Studies also have shown that the number of bystanders witnessing suffering affects the likelihood of helping. Too many bystanders may decrease individual feelings of responsibility. You may think someone else will respond.

There are benefits to looking out for others. Volunteering has a positive effect on happiness and current and future health and well-being. It improves mental and physical health and longevity. Interestingly, it works in the other direction. Happy people are also kinder.

Perhaps you are concerned about injustices, poverty, the environment, or any other social issue. You may think “I’m just one person, how can I make a difference?” It is said that your individual efforts may not change the world, but it could change the world of one person. You don’t have to do it alone. And in fact, studies have shown that feeling over-taxed and overwhelmed by the needs of others can have a negative effect on health and happiness.

I am a member of Rotary International. Last year, our local Rotary Club had a membership of fifty-one people. At a recent meeting, I asked our committee chairs to estimate how many people their efforts benefitted. Our club recognized 24 high school students who were nominated by their teachers as having made considerable improvements. We hosted an outing for 85 senior citizens. Approximately 300 people benefitted from our international service program, this year focusing on needs in Chili. Between 150-200 people have benefitted from a free furniture program. Our club distributed 350 dictionaries to 3rd grade children. Approximately 400 people were involved in an educational “roundtable discussion” focused on water. Additionally, 45 high school students received financial scholarships. We hosted a foreign exchange student from Spain, and sent out a student to Finland. We began a new project to fund GED’s and citizenship fees for people who need them. The Galena Rotary Club counted 1892 people served by fifty-one members last year. That is an amazing figure, particularly in this small rural town. We have changed the world for individuals, our community, and the world.

If you begin to feel apathetic, overwhelmed, depressed or burned out in your attempts to make a difference, I recommend that you join clubs or groups with other like-minded people. Each and every one of us, doing small things together, really can change the world.

Domestic Violence: Pit Bulls and Cobras

I read with interest a news story that took place in Sycamore, IL, the place of my birth. Sycamore is a small rural town with a population of 17,519. It is a lovely place that was named after the Sycamore tree. Crime is 56% lower than the national average and has actually decreased. So you can imagine my surprise to learn of a homicide this month.

On June 9th Lidia Juarez was killed by her estranged husband by gunshot while in her car. Upon returning from lunch, she was found in the parking lot of her employer located in Sycamore. She worked in the social services field as a caseworker for the IL Department of Human Services.

She had filed an order of protection which her husband, Antonio Juarez, violated on March 10. He was also wanted on another warrant, issued March 24, for failing to appear in court for a domestic battery charge. He was found about an hour from where she was killed. He was shot and killed by police after he opened fire on the officers in Lyons, IL.

What causes domestic abuse? No one knows precisely what causes it, and there is no one reason. It is unpredictable. The victim can’t predict when the batterer will strike.

So what kind of a person commits domestic violence? Neil Jacobson and John Gottman did a study on men who commit domestic violence and found two profiles of men who engage in this behavior: pit bulls and cobras. This finding comes from studying physiological arousal during aggression. 20% of batterers can be described as cobras. They exhibited a decrease in heart rate as they became verbally aggressive. They looked, sounded and acted aggressively, yet internally they were calm. “Like the cobra who becomes still and focused just before striking its victim, these men were calming themselves internally and focusing their attention, while striking swiftly at their wives with vicious verbal aggression.” Cobras were more likely to use or threaten to use a knife or gun than the pit bulls. The Jacobson and Gottman study found that 9 percent had either stabbed or shot their partners. In general, cobras were more severely violent than the other batterers. They tend to be more antisocial, have criminal traits, and are highly sadistic in their aggression.

Pit bulls, on the other hand, had increased heart rates as they became verbally aggressive. They exhibited anger as a slow burn, gradually increasing it but never giving up. Pit bulls were much more insecure. They were fearful of being abandoned and perceived betrayal in their partners every move. They lock onto their partners much like a pit bull who refuses to give up a bone. They apply constant scrutiny and attempts at isolation.

Cobras were not particularly clingy, jealous or emotionally dependent. They may push their partners away, unless they need something and someone to give it to them. Their intense and severe violence will elicit fear and prohibit their partners from leaving.

It is a myth that victims stay in abusive relationships. It is much easier to enter an abusive relationship than leave it. The point at which victims begin to plan their escape is when they change from fearful and sad to disgusted and contemptuous toward their mate. This, with increased awareness of dangerousness, allows them to gather their courage and leave. The attempt to escape is a heroic journey. The risk of severe assault and homicide increases when the victim tries to leave. There is insufficient information to determine if Antonio Juarez was a pit bull or a cobra. There are aspects of both in his behavior. But Lidia had the courage to leave him and seek help. Sadly, the judicial system could not protect her.

This tragedy raises awareness of the dangers surrounding domestic violence. If you need help, contact the National Domestic Violence Hotline at 800-799-SAFE (7233). For additional information, go to www.thehotline.org.

Sticks and Stones May Break My Bones, But Can Words Also Break Me?

The Sticks and Stones children’s rhyme encourages victims of bullying to ignore the words, to refrain from retaliation, and to remain calm. This is sound advice for the most part. But it also implies that words are harmless. But the wrong words, at the wrong time, to a vulnerable person can cause unspeakable harm.

For example, this week I read about a 17-year-old girl, Michelle Carter. She is facing a manslaughter charge for encouraging her boyfriend, Conrad Roy, aged 18, to kill himself. She used text messages and phone calls to tell him to follow through with his suicide plan. Roy was sitting in his vehicle as the truck filled with carbon monoxide. He became nervous and got out. Michelle told him to ‘get back in’ and ‘it’s time to do it today’. He did in fact get back in the vehicle and die. This is a tragic story on several different levels.

Conrad had a difficult life. It was alleged that Conrad had become depressed after his parents’ divorce. He was physically and verbally abused by family members, and had done research on suicide methods. Michelle also had mental health struggles and was taking medications. I assume that they were for a psychiatric condition. It was implied that the medications could have impaired her judgment. Neither of these adolescents was in stable mental health.

Studies show that the rational part of a human’s brain isn’t fully developed until he or she is about 25 years old. That’s true for both Conrad and Michelle, who was one year younger than Conrad. As much as people would like to villainize Michelle for what appears to be a deliberate act, it is important to realize that they both have poor reasoning skills.

When people voice suicidal thoughts and intentions, it is believed that their pain, along with their mental illness may impair judgment, and an intervention to stop a suicide is ethically warranted. The suicidal person has lost the ability to carefully weigh the benefits and burdens of continued life. Therefore, health care providers intervene to provide life-sustaining treatments. Conrad lacked the wisdom of an adult or professional while struggling with life and death issues. He was not able to make a rational, autonomous decision to end his life. He sought support and advise from someone who was too young to be in that role.

Some believe Michelle did it to play the role of grieving girlfriend and to get attention. Perhaps, but she may have also believed she was being helpful. She also said ‘You’re finally going to be happy in heaven. No more pain. No more bad thoughts and worries. You’ll be free. It’s okay to be scared and it’s normal. I mean, you’re about to die.’ She knew of his depression and may have wanted to help him find happiness through death. Many people support assisted death as a viable option for people who experience chronic pain. But assisted death, where legal, is performed by physicians for qualified terminally ill people who are going to die anyway. These people request and obtain medication to hasten their deaths. The decision is voluntary and cannot be coerced. Michelle’s irresponsible words can be seen as coercing Conrad’s death. Therefore, she faces a manslaughter charge.

Vulnerable people who lack access to appropriate care and support, may be greatly harmed by words. Conrad could have been helped, rather than harmed, if he had talked to the right person.

If you are approached by someone for support when they are contemplating suicide, help them get appropriate care. Explore the reasons for the request and discuss various ways of addressing their suffering. In the case of an adolescent, inform their family and get professional help. It is our ethical duty to intervene for life, not death. You can reach the National Suicide Prevention Lifeline at 800-273-8255.

Blind Spots

I’m impressed with advances in safety features on new cars. The days of looking over your shoulder before changing lanes are over. Side view mirrors don’t see everything. Technology can provide alerts when cars are in your blind spot or alongside you. A flashing light or a vibrating steering wheel will tell you not to proceed. If only we had such a device to detect our personality blind spots and issue a warning to proceed carefully.

Humans have a tremendous capacity for self-deception. Examples of this can be found among addictions – “I can stop anytime I want to”; or persons with anorexia nervosa – they truly perceive themselves as fat; or narcissists – they lack empathy and the ability to be self-critical.

As it turns out, we are not good judges of ourselves. We have some amount of blindness to our own traits.

Humans are capable of unthinkable acts. And yet, many consider themselves to be acting within the realm of normal behavior. Let me give you two examples. First, you may or may not remember Ariel Castro. In October of 2013 he was sentenced to life in prison plus 1,000 years for kidnaping and physically, sexually and emotionally abusing three women over an eleven-year period. In spite of evidence of extreme abuse, he took no accountability for his actions. He said he was “a normal guy.” He is clearly and without a doubt, out of the range of normal. His behavior is abnormal.

And then there’s a Brazilian soccer player who had his mistress murdered and fed to dogs. After serving 6.5 years, he claims he is “starting over.” 32-year-old Bruno Fernandes de Souza said: “What happened, happened. I made a mistake, a serious one, but mistakes happen in life. I’m not a bad guy. People tried to bury my dream because of one mistake, but I asked God for forgiveness, so I’m carrying on with my career, dude.” I get the sense that he truly believes he is not a bad guy. But make no mistake, he is a bad guy. He is a sociopath.

So how does this kind of self-deception work? It works through denial, justification and minimization. People who commit harm have justified their actions to themselves in some way. They minimize or disregard the pain they create for others, thereby reducing their feelings of guilt. Rather than taking responsibility for harming others, they blame others. For example, “She deserved it.” Or, “Other people have done worse, what’s so wrong with it?” Or, in Fernandes de Souza’s case “Why can’t you get over it? I did.”

What can we do? Check our own blind spots through self-reflection. In what way are our beliefs at odds with our actions? Ask other’s for feedback on what they see as our blind spots.

And hold others accountable for their actions. Don’t let them deny, minimize or justify their hurtful actions. If we normalize bad behavior, we unleash more of it in the world. We want to inspire the best in ourselves, not the worse.

Quirks, Flaws and Fatal Flaws

There’s one in every crowd. They are the difficult people who have no idea that they are annoying. They may be unaware that others want to avoid them, or make excuses to get away from them. No one is perfect, but some people are less perfect than others. Let’s sort out quirks, flaws and fatal flaws.

My brother, who is a really great guy, has a quirk. He has been going to Subway Restaurant and ordering the same exact sandwich for eleven years. Since 2006 he has ordered a 6″ ham and turkey sandwich on wheat bread with pepper jack cheese, lettuce, tomato, pickle, onion, jalapeno, light mayonnaise, mustard, oil, vinegar, seasoned with salt, pepper and oregano. Being quirky is “weird” in an endearing way. My brother is just weird enough to be interesting and intriguing but not weird enough to repel. We all have quirks. You can ask him what mine are.

Flaws on the other hand are deficiencies in a person that are perceived as negative. Examples of a flaw may be frequently interrupting someone, chronic tardiness, or having a hot temper. Some people are flawed with personality disorders. A personality disorder is a “deeply ingrained and maladaptive pattern of behavior of a specified kind, typically manifest by the time one reaches adolescence and causing long-term difficulties in personal relationships or functioning in society.” Many people with personality disorders seek and benefit from treatment.

According to Stuart C. Yudofsky, MD, fatal flaws come from people who are unwilling to acknowledge their personality problems or are unable to change their damaging behaviors. These people may have other attractive qualities and may be in our lives. They may even hold positions of power and influence.

Yudofsky addresses personality disorders in his book Fatal Flaws. He says fatal flaws are brain-based dysfunctions of thinking and impulse that lead to persistent patterns of personality and behavior that betray trust and destroy relationships. His book examines eight personality disorders that often lead to violated trust, broken commitments, dangerous behaviors, and destructive relationships. These disorders are histrionic, narcissistic, antisocial, obsessive-compulsive, paranoid, borderline, schizotypal, and addictive personality disorders. These traits can leave a trail of wreckage. Some of these flaws, like narcissism and antisocial types, will never respond to treatment. They don’t perceive themselves as having flaws.

He states that what makes a flaw “fatal” is if one or more of the following is true (taken from Yudofsky’s book):

1. The person with the flaw does not perceive that he or she has a problem.

2. The person with the flaw does not want to change.

3. The nature of the flaw is such that it is not amenable to correction.

4. The nature of the flaw is such that there is the probability of future physical harm occurring to you, to your child, or to others.

5. The nature of the flaw is such that there is the probability of violations of the law by the individual with the flaw.

6. The nature of the flaw is such that there is the probability that the person with the flaw will involve you in the breaking of the law.

It is important to understand the difference between quirks, flaws and fatal flaws. If you notice someone has a quirk, enjoy it. If you notice someone’s flaws, be forgiving. If there is a threat of serious injury from someone with a fatal flaw, protect yourself.

 

Can You Be Addicted to Sex?

You’ve probably heard the saying “too much of a good thing can kill you.” In many cases, too much of certain behaviors can lead to an addiction. My favorite definition of addiction is a compulsive use of a substance, or behavior, in spite of negative consequences. There are four different stages of addiction; use, misuse, abuse, and dependency.

Most people are well aware of addiction to substances, but don’t know about process addictions. Process addictions are addictions to activities or processes such as gambling, spending, and sex as opposed to drugs or alcohol. They are also known as behavioral addictions. They are defined as a compulsion to engage in behaviors despite the negative impact on one’s life.

Let’s use the example of sex. Healthy sexual expression varies widely. Addiction does not identify certain behaviors as normal and others as abnormal. But it creates a label for problematic behavior gone wild. Some clinicians disagree about whether sex addiction should be considered an addiction. They prefer to call it OCSB, Out of Control Sexual Behavior. Whatever you call it, it comes with risk.

I recently read an article entitled Your Belief in Porn Addiction Makes Things Worse by David J. Ley, PhD. This article addresses the use of porn. He refers to the work of Joshua Grubbs which demonstrates that identifying oneself as a porn addict, creates emotional distress such as depression, anxiety, anger and stress. Moral or religious prohibition against porn can create distress, regardless of the frequency or extent of its use. The author goes so far as to say that porn addiction treatment does more harm than good. He states that “people who believe themselves to be porn addicts need to understand how and why porn use is not an addiction, and how viewing themselves as a porn addict may affect their self-image and emotional health.”

I hear his point that labeling oneself as a porn addict, will likely make you feel bad about yourself. But let’s be clear. It’s not only the label, but the actions associated with porn addition that will make you feel bad about yourself. This is true whether you view porn with religious or moral prohibitions or not.

For example, the Society for the Advancement of Sexual Health lists potential negative outcomes. Sexual addiction and compulsive sexual thoughts and behaviors (such as porn) lead to increasingly serious consequences, both in the mind of the addict and in his or her life. Research shows that 70 to 75 percent of sexual addicts report having had suicidal thoughts related to their sexual behavior patterns. Often, sex addicts suffer from broken and distant relationships. Forty percent of sex addicts report severe marital and other relationship problems. Health consequences of sex addiction may include HIV infection, genital herpes, HPV, syphilis, gonorrhea, and other sexually transmitted diseases (STDs). Sex addicts have a highly increased risk of contracting a STD and of passing it along to unknowing spouses or loved ones. Some sex addicts go to jail, lose their jobs, get sued, or have other financial and legal consequences because of their compulsive sexual behavior. Financial difficulties from the purchase of porn, use of prostitutes, and travel for the purpose of a sexual hookup and related activities can tax the addict’s financial resources and those of his or her family, as do the expenses of legal representation in divorce cases.

Therefore, I respectfully disagree with Dr. Ley’s position that treatment for porn addiction does more harm than good. It seems to me that he confuses the use of porn, with the abuse and dependency of viewing porn. He is minimizing the potential negative consequences of Out of Control Sexual Behavior.  If you wonder if your behavior (whether it is eating, spending, gambling, or some other behavior) is out of control, ask yourself if it is compulsive and if there are negative consequences. Has your use of this behavior crossed over into abuse or dependency? If so, treatment is warranted.

Empathy

As a psychotherapist, I am often asked how I can listen to people’s problems all day long? Isn’t it exhausting, or even worse, annoying? They might assume that I have limitless stores of empathy. While it is true that empathy, warmth, and genuineness in psychotherapy are critical for a good therapeutic relationship, it doesn’t stop there. An effective therapist utilizes tools and interventions to improve the client’s situation.

Can you have too much empathy? Ideally, therapists have a combination of empathy, sympathy and compassion. If I were to become as distraught as my client who suffers, therapy would not be effective. It is the therapist’s job to take action to prevent this pain in the future, rather than crying with them.

It is important to distinguish empathy, sympathy, and compassion. Empathy is feeling and sharing someone’s emotions. It is from the heart. It says “I feel your pain.” Sympathy is not feeling the other’s pain, but is having an intellectual understanding of it. It is from the head. Although overstated, it is like saying “it sucks to be you” but also includes a wish to see the other better off or happier. And compassion is the end goal of empathy. It is not simply feeling their pain, and understanding their pain, but acting to alleviate their pain. Compassion asks, “how can I help you?”

Are we born with empathy? Many researchers believe that one can learn to be empathic. Parents who encourage their children to imagine the perspectives of others, and teaching the child to reflect on their own feelings, and expressing warmth toward the child will develop empathy in the child. When I see a baby that responds to another baby, who is crying, with compassion, I know that their parent, or caretaker, has done a good job of nurturing the child.

We can also lose the capacity for empathy. Empathy can be disrupted from such things as a brain injury or stroke, particularly if it occurs on the right side of the brain.

We are more empathic toward people who are more similar to us. And it is more likely to occur between individuals whom we see more frequently. It is more difficult to empathize when there are differences between people including status, culture, religion, language, skin color, gender, and age.

Psychologist Simon Baron-Cohen describes an empathy scale from 0 (having no empathy at all) to 6 (an unstoppable state of empathy for others). Those with zero empathy are psychopaths, sociopaths, or antisocial personality types. Those at a level of 6 will cry with others who are crying. This leads to burnout, and can be a burden to others. Others will then feel the need to attend to your pain.

Baron-Cohen developed a 60-item questionnaire, called the Empathy Quotient (EQ) designed to measure empathy in adults. I took the test and scored 49 out of 80. Higher scores indicate greater levels of empathy. That makes me just a bit higher than average. The truth for me is that at the end of the day as a psychotherapist, my clients take their problem with them. I leave the office to carry on with my own business, attending to my own problems.

Obedience to Authority: How Far Should You Take It?

Most people have seen the videotape of a passenger being forcibly removed from a United Airlines flight. Apparently, the flight was over-booked and four United crew members were needed for another flight the next day. United requested four passengers to give up their seats. Three of the four went quietly, but Dr. Dao, a 69 year old Kentucky physician, refused. Three security officers pulled him out of his seat. Dr. Dao suffered a concussion, broken nose and damaged sinuses and lost two front teeth when he was dragged off a flight. His family was “horrified, shocked and sickened” by the incident. His daughter said “What happened to my dad should never have happened to any human being, regardless of the circumstances.”

There is public outcry about this man’s treatment. United Airlines personnel were acting in accordance with the airline’s policy. They were following protocol. In the aftermath of this incident, United has apologized, refunded the other passenger’s fees, and changed their policy. Although they were following the chain of command, didn’t they have a higher moral principle at stake here? Should they have taken the moral high ground and refused to engage in this violence?

Many of us would like to think that we would’ve tried to intervene to stop the violence. It’s easy to blame the airline, the security officers, perhaps even the other passengers for sitting idly by. In my fantasies, I’d like to think that I would offer myself as a shield and encourage others to do the same. But the truth is, I am not a courageous person. If given a choice of fight, flight or freeze, my history tells me that I would freeze.

There are rules after all, and we are expected to play by the rules, right? Dr. Dao did not follow orders. There may be times when we are called to make a choice between obeying authority and respecting the dignity and safety of another human being. Sometimes our conscious speaks to us. We may know right from wrong, but don’t always act accordingly.

It turns out that humans are hardwired to obey authority. From childhood we are taught to obey authorities like our parents, teachers, religious leaders, and our bosses. We lack training in disobedience toward unjust authority.

There are two psychological studies that address obedience to authority figures, the Milgram and Zimbardo experiments. These studies show that on average, people will obey authority figures despite moral objections, and will become authoritative and cruel in position of power. We are wired to follow leaders and side with in-groups (and against out-groups as we perceive them) at the expense of moral principles.

Stanley Milgram did a study at Yale in 1961 in which an authority figure tells a person to shock a person in the other room when that person gets the wrong answer on a test. As a Jewish American, he wanted to know why the average German would enact cruel orders of the NAZI party, without question. He found that all participants obeyed the authority figure despite moral objections. None of the participants checked on the victim to see if they were OK, and no one requested that the experiment be stopped.

Phillip Zimbardo, conducted the Stanford Prison Experiment, during the 1970s to understand the psychological effects of becoming a prisoner or a prison guard. People were randomly assigned the status of prisoner or guard. The study found that the guard became authoritative and abusive, and the prisoners tended to obey the guards, even though they knew it was just an experiment. Repeated studies show similar results all over the world. It is believed that people are naturally primed to obey authority, likely due to group dynamics. Obedience involves a hierarchy of power or status. Conformity happens through social group pressure.

Adolf Eichmann helped organize the Holocaust, in which six million Jewish people were killed. He was executed in 1962. He expressed surprise that Jewish people hated him, stating that he had just followed orders, and that obeying orders is a good thing. He wrote “The orders were, for me, the highest thing in my life and I had to obey them without question.” He did not appear to be a monster – he had a normal family life, was declared sane and was described as very average. His behavior was the product of social expectations.

The United incident happened quickly. What would you do? We don’t always have time to thoughtfully consider our options. Next time you “just follow orders,” take a deep breath, quiet your fears, and make a principled decision.