Decolonizing moral injury studies and treatment approaches: An Africentric perspective

Abstract

This article draws from an Africentric perspective to engage the ways in which the notion of moral injury is approached within psychology. The paper argues for the need to interrogate dominant Eurocentric approaches to moral injury and calls for more openness towards non-Western belief systems. The paper attempts to show how rituals that are perceived in the African context to be healing and transformative continue to be absent in the mainstream psychology literature and theorization. For this reason, there is a call for the centring of Indigenous healing rituals if the discipline is to make a positive and inclusive contribution in the scholarship of moral injury. The article is significant given its potential to contribute to the body of knowledge on the importance of centering African perspectives when engaging the notion of moral injury.

Keywords

Africentric paradigm Eurocentric paradigm moral injury rituals of cleansing and repossession treatment of moral injury

In contrast to Europe and North America, where literature on moral injury has proliferated, research and writings on moral injury and its aftermath in continental Africa are still in their infancy. Yet, the literature on moral injury and related areas in Africa is enough to encourage a comparative review of the differential understandings and treatment approaches devoted to combatting the aftermath of moral injury in the two traditions. Before embarking on this, however, it appears beneficial to first explore the genealogy of the term moral injury. In this regard, a close review of the available Western literature suggests that the term moral injury was introduced by psychiatrist Jonathan Shay in his 1994 book, Achilles in Vietnam. However, since the publication of Shay’s book, some more notable and pertinent definitions of moral injury have emerged in Western literature. The most popular and cross-referenced among them was proposed by Litz et al. (2009). They defined potentially morally injurious events as those that entail “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (p. 697). They further remarked that moral injury might include symptoms of posttraumatic stress disorder (PTSD), self-harming (e.g., nonsuicidal self-injury and suicidal behaviours), self-handicapping behaviors, and demoralization (e.g., hopelessness).

This article aims to highlight the differential emphasis in Western and African approaches to the understanding and treatment of moral injury. To achieve this aim, a review of Western literature on the meaning, scope, sources, and pathways to recovery of moral injury will first be undertaken to serve as a comparative background to the examination of the African discussion of the same phenomenon to follow. As a way of showing the differential approach to treatment of moral injury other than that in the West, some samples of generic rituals (Granjo, 2007) of cleansing and repossession in the treatment of moral injury of child soldiers in Africa will be presented. In order to show that in continental Africa, the problem of moral injury is not a phenomenon that manifests only among the veterans of war, an attempt will be made to present a case illustration of how moral injury can manifest in the adult civilian population in Africa. This will be followed by a brief description of a generic sample of rituals of cleansing and repossession in the treatment of moral injury of a Liberian civilian couple as an illustrative example. The article will conclude with drawing some pertinent social–cultural and other related implications of the entire discussion.

Theoretical anchor

The present article is grounded on two Africentric theoretical perspectives. The first is the asset-based perspective and the second, the theory of decoloniality. Some brief clarifications of each are given below.

The asset-based perspective

The asset-based perspective is an offshoot of the Africentric paradigm proposed by Onwumere and Egbulonu (2014), who emphasized that Africans would be better served if they are able to draw from their cultural heritage for values, rituals, cultures, and traditions that are most useful in the modern world. Applied to the context of the present article, the asset-based perspective proposes that when searching for a treatment approach for confronting the menace of moral injury among African victims, it is necessary to remember that Africans are usually guided in their lives by their belief systems. And that Africans in continental Africa are heirs to a rich heritage of Indigenous healing traditions that must be rediscovered and made use of in promoting the psychocultural restoration of contemporary Africans beleaguered by the crisis of the moral and cultural wounds of war. According to this perspective, every generation, contemporary Africans included, is endowed with a cultural asset for health promotion (like those to be highlighted in this article under the theme of rituals of cleansing and repossession in Indigenous Africa) passed on to them from the previous generations of Africans. Following this perspective, some enduring generic cultural practices (Granjo, 2007) indigenous to several communities in Africa can be resorted to as seasoned and relevant additions to emerging Western approaches to treatment of moral injury.

The theory of decoloniality

In the context of this article, the theory of decoloniality (Mpofu, 2014) speaks to the overrepresentation in mainstream psychological literature of Western perspectives of understanding and treatment of moral injury while criticizing the continued exclusion of the African perspective of the same phenomenon in Western psychological discussions. The theory traces the background of this anomaly to the side effects of colonialism in Africa, namely, coloniality, which is another word for neocolonialism. The continued exclusion of African perspectives in the literature on moral injury in mainstream psychology is exacerbated, according to this theory, by the crisis of coloniality in contemporary Africa; a crisis through which Africans lost belief in themselves and in their culture and tradition, including their psychological independence as a people (Achebe, 1973; A. Nwoye, in press). The theory teaches that the African identity crisis that emanated from the phenomenon of coloniality coalesced into the generic African burden of colonial mentality through which Africans began to see themselves as members of an inferior race. Against this background, many Africanists (Achebe, 1973, 1989–1990; Biko, 1978; Mpofu, 2014; A. Nwoye, 2015, 2017; Segalo & Cakata, 2017) call for the reorientation of African consciousness and the assertion of the counter discourse of decoloniality through which Africans could be empowered to recover initiative and agency and regain belief in themselves and in their cultural heritage and put away the years of denigration and self-abasement arising from colonialism. Following this theory, according to Segalo and Cakata (2017), for Africans to respond effectively to the realities of their present environment, the manner in which reality is perceived has to change drastically to allow for multiple voices. Thus, through the cognitive armamentarium of decoloniality, continental Africans are motivated to learn to reassert their perspectives in the modern African world (Achebe, 1958, 1973, 1989–1990; A. Nwoye, 2015; Segalo & Cakata, 2017), and to find anchor in themselves and in their rich cultural heritage of Indigenous healing in facing the challenges of the contemporary African environment.

Influenced by the theory of decoloniality, this article aims to review the available studies authored by scholars in Africa focused on the theme of the African approach to treatment of moral injury; with the major purpose of determining what such scholars suggest as pathways to recovery for the African victims of moral injury and to highlight how the African approach to the understanding and treatment of moral injury differs from the Eurocentric (individuocentric) tradition in responding to the same phenomenon. To successfully engage in this, an attempt will first be made to review and understand the existing Western literature on the phenomenon of moral injury. In doing this, the review will be organized around the following three themes: (a) conceptualization of moral injury, (b) sources and consequences of moral injury, and (c) treatment approaches to moral injury.

Review of Western literature on conceptualization of moral injury

A careful review of Western literature on the conceptualization of moral injury reveals that although notable research and writings for understanding the phenomenon of moral injury have proliferated (Bayer et al., 2007; Drescher et al., 2011; Farnsworth et al., 2017; Gray et al., 2012; Griffin et al., 2019; Koenig et al., 2019; Koenig et al., 2018; Litz et al., 2015; Litz et al., 2009; Lynd & Lynd, 2017; MacNair, 2002; Maguen & Burkman, 2013; Maguen & Litz, 2012; Maguen et al., 2010; Maguen et al., 2011; Molendijk et al., 2018; Nash, 2007; Neria & Pickover, 2019; Smith et al., 2013; Southwick et al., 2006; Sreenivasan et al., 2014, etc.), there is a persistent lack of agreement among Western scholars on the best way to conceptualize the problem of moral injury. A sustained critical review of such a literature would suggest that the greater consensus of the literature has tended to settle around the definition by Litz et al. (2009), which proposes that the phenomenon of moral injury entails the notion of “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” (p. 697). However, further review suggests that Maguen and Litz (2012), while not rejecting the above definition outright, considered it incomplete and introduced the idea that the transgressions that act as precipitants to moral injury “can arise from individual acts of commission or omission, the behavior of others, or by bearing witness to intense human suffering or the grotesque aftermath of battle” (p. 1).

The above observation concurs with the succinct remark by Griffin et al. (2019), who suggest that the growing Western literature on moral injury must include variable definitions of potentially morally injurious events. Hence, judged from the African perspective, which was conspicuously omitted in such studies, one of the limitations in the Western conceptualization of moral injury is the failure to sufficiently emphasize that in many contexts, like we have in Africa, people—particularly child soldiers—can suffer from moral injury not because of the transgressions they deliberately and voluntarily took upon themselves, but from being forced to commit some harrowing, unspeakable, and horrific acts against their parents, relatives, or friends that violate their deepest sense of moral decency and ancestral code of conduct.

The above observation draws attention to the limitation of the Western approach to understanding moral injury when seen from the decolonial perspective; an idea also reflected in the second section of the literature review, below.

Review of Western literature on sources and consequences of moral injury

The result of an integrated review of the Western literature on moral injury by Griffin et al. (2019) established that, taken together, the major causes of moral injury include the crisis of: direct involvement in heavy levels of violence (killing, maiming, collateral killing), witnessing the after-effects of killing, the experience of failing to conform to schematic beliefs about warfare and roles for service members (as, e.g., in Operation Iraq Freedom), and bearing witness to intense human suffering. In terms of consequences of moral injury, the same authors outlined the following as emanating from many writings that came out of the United States: profound despair; self-harm and suicide; inability to trust self/others; depression; poor self-care; inability to enjoy life; detachment; isolation; emotional numbing; feelings of being condemned; negative changes in ethical attitudes (e.g., intense anger, blaming others, etc.); disillusionment with the government, military, authority, and civilians (for getting people involved in a war of blame or an unjust war); reexperiencing of moral injury events; and avoidance.

These findings, when read against the context of the African perspective, suggest that a major limitation of Western studies on sources and consequences of moral injury is their lack of emphasis on the problem of violation of Indigenous cultural mores (a crisis in the African sample) that arises from the experience of moral injury. Here, the notion of violation of Indigenous cultural mores is used to refer to the offences and experiences of the individual that happen during wartime and that run against the acceptable cultural mores and traditions of the community in which the individual is a part. Such cultural offences and violations include the harrowing experiences of having to engage in sex by coercion with one’s mother, cannibalism, and killing of one’s friends and relatives. Engagement in such unspeakable experiences leads to a sense of desecration and assault, invasion or violation of the cultural foundations of the community in which the individual hails from. In many African societies, performance of some generic rituals by the offender concerned is needed for the return of communal order and making peace with one’s ancestors due to involvement in such offences (Granjo, 2007).

Review of Western literature on treatment of moral injury

A critical review of the Western approaches to treatment of moral injury suggests that although a number of Western models for treatment of moral injury have been proposed (Farnsworth et al., 2017; Gray et al., 2012; Litz et al., 2015; Litz et al., 2009; Maguen & Burkman, 2013; Smith et al., 2013; Southwick et al., 2006; Sreenivasan et al., 2014), those that deserve specific mention are Adaptive Disclosure (Litz et al., 2015), the Cognitive Behaviour Therapy (CBT) derived models, and the recent model called Acceptance and Commitment Therapy (ACT; Farnsworth et al., 2017). A close study of these models shows that none of these has distinguished itself as an intervention of choice with proven consistent positive outcomes among the majority of its practitioners.

Some examples of the variable nature of the treatment approaches on offer in Western literatures include Adaptive Disclosure (Maguen & Litz, 2012), which consists of eight 90-minute sessions, each of which includes imaginal exposure to a core haunting combat experience and uncovering beliefs and meanings in this emotionally evocative context. In adaptive disclosure, patients also engage in experiential exercises that entail either a charged imagined conversation with the deceased or a compassionate and forgiving moral authority. So far no outcome studies are available to explore the success rate of this treatment approach (Griffin et al., 2019).

Another model of care for clients with moral injury described by Litz et al. (2009) was essentially a modified form of CBT that encompasses an aspect of the Gestalt therapy technique of the empty chair or chair-work. Like Adaptive Disclosure, the CBT-based model is made up of eight steps, with some of the steps encompassing substeps. The same limitation of lack of effect studies also bedevils the CBT-based model.

Moving away from these examples is the treatment approach to moral injury reported by Ramay (2018), who sees moral injury as an experience of profound loss and grief with individual and systemic consequences. Her treatment protocol emphasizes the value of ritual as a resource for healing, both for veterans and their families affected by moral injury and for faith communities who may come to recognize their own complicity in moral injury. Ramay (2018) also briefly considers the possibilities of public rituals for bearing witness to communal aspects of responsibility in moral injury; an aspect that resembles the approach to generic rituals in the treatment of moral injury in the African context. Thus, an interesting part of Ramay’s (2018) contribution in the context of the present article is her recognition of the role of public rituals in the treatment of moral injury.

Overall, the above review of Western literature on moral injury supports the view credited to Griffin et al. (2019) that among the limitations of the growing Western literature on moral injury are: the absence of a gold-standard measure of moral injury as an outcome, scant study of moral injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect.

Limited applicability of Western approaches to treatment of moral injury

Under this heading, the point to highlight is that some considerable progress has been made in the United States towards the development of suitable intervention approaches for the treatment of moral injury. Yet available Western models of intervention (with the exception of Ramay, 2018) share some common limitations as far as their potential for application in the African context is concerned. One such limitation is their consistent emphasis on the individuocentric/intra-psychic perspective and the implied notion that the process of repairing a moral injury is a psychology clinic-based affair. This emphasis on the subjective element and the notion of moral injury as consisting mainly of the moral wounds of war still takes centre stage in many proposed intervention strategies in the United States. Such intervention approaches (e.g., Maguen & Litz, 2012) tend to focus largely on how such processes could be exploited by the individual client for their own psychological betterment. Little or no attention is given to the notion of moral injury as entailing the social–cultural wounds of war, and how to redress the associated cultural violation brought about by the horrendous and unspeakable experiences of war including acts of omission or commission, of the returnee solider(s). In particular, most of the discussions on treatment of moral injury highlighted in Western literature tend to focus on the problem of the veteran, rather than the civilian victim of such injuries. Yet civilians (refugees) with moral injuries abound in Africa.

This article is offered as part of an attempt to respond to some of these omissions and for closing some of the gaps in Western approaches to the understanding and treatment of moral injury. In doing this, a review of literature on sources of moral injury in continental Africa now follows.

Review of literature on sources and dimensions of moral injury in contemporary Africa

Under this heading, a review of related literature (Baro, 2006; Honwana, 2006; Hynd, 2020; Jal & Davies, 2009; Keitetsi, 2004; Mackenzie, 2012; Mackey, 2013; McDonnell & Akallo, 2007; Mutua, 2001; Schultheis, 2008; Singer, 2006) highlights the devastating sources of moral injury among African child soldiers, particularly those children (aged 8–15) conscripted as soldiers in civil wars in Liberia, Sierra Leone, Zimbabwe, Mozambique, and Angola. Here, however, two sources of data can be distinguished. The first emanates from child soldiers’ memoirs (Jal & Davies, 2009; Keitetsi, 2004; McDonnell & Akallo, 2007), which follow the framework of victim, savage, saviour, and campaigner, aimed at presenting child soldiers as victims before being rescued to help others suffering their fate (Coundouriotis, 2010; Hynd, 2020; Mackey, 2013; Mutua, 2001; Schultheis, 2008). The second (represented by the article by Baro, 2006) are those authored from the human rights perspective. Critics such as Hynd (2020), Mackey (2013), Mutua (2001), and Schultheis (2008) challenge the objectivity and accuracy of the first group of sources; suggesting that their forensic truth value is seriously in doubt as, often, the child soldier narrators appear to have been assisted with their writing by interested journalists and social activists. The implication is that the truth value of the content and dimensions of moral injury among child soldiers in Africa has therefore been compromised.

Given such a limitation, the present article zooms in on Daniela Baro’s (2006) important article titled “Children Witnessing Atrocities Against Parents or Caregivers: A Human Rights Perspective” as a more reliable source. Another reliable source with relevant data is Peter W. Singer’s (2006) book entitled Children at War. Singer’s book is an essential resource in the context of this article as it provides, like Baro, an in-depth and extensive outline of the causes and experiences of moral injury of child soldiers in Africa. However, due to space limitations, the illustrative data for the purposes of the rest of this discussion will be drawn from Baro’s (2006) article, which drew much of its accounts from data provided by Human Rights Watch (HRW) on atrocities inflicted on child soldiers in Africa that served as key precipitants to their crises of moral injury. Such morally injurious experiences in the African child soldiers, according to Baro (2006), include the following:

Forcing children to commit or witness crimes against their parents

According to Baro (2006), specific instances of this heartless practice were outlined in the report by Human Rights Watch, which showed that “child combatants in Liberia and Sierra Leone were forced to kill companions as an initiation process to enter the group.” The report noted that

boys from both factions have told us that there were initiation procedures when they joined . . . they were actually forced to witness the execution of family members or their friends. If they screamed or cried, they were killed. Boys have told us of being lined up to watch executions and being forced to applaud. (as cited in Baro, 2006, p. 193; see also Singer, 2006)

Forcing children to engage in horrendous acts against their conscience and cultural mores

Similar acts like those highlighted above have also been reported as practised by Uganda’s Lord’s Resistance Army (LRA) and the Uniao Nacional para a Independencia Total de Angola (UNITA) in Angola. According to Baro (2006), “children abducted by the LRA were made to carry out raids, loot and burn houses and kill civilians and other child soldiers” (p. 193). In one instance, Baro (2006; see also Singer, 2006) reports:

One boy tried to escape but he was caught. His hands were tied and then they made us, the other new captives, to kill him with a stick. I felt sick. I knew this boy before; we were from the same village. I refused to do it and they told me they would shoot me. They pointed a gun at me, so I had to do it. . . . I see him in my dreams and he is saying I killed him for nothing, and I am crying. (p. 193)

According to the same article by Baro (2006), African children have often been forced to watch or commit cannibalism, to undo family ties and bond with the armed group: “Examples from the DRC include a child associated to an ethnic-based armed group being forced to mutilate his mother’s breast for a ritual ceremony where body organs were eaten by the group” (p. 193).

In Sierra Leone,

B saw his father and brother beaten to death and their internal organs removed and given to his mother to prepare as a meal. The mother obeyed or else she would also have been killed. When the meal was ready, the rebels asked B and his mother to join them in eating the meal. (as cited in Baro, 2006, p. 194; similar stories are found in Singer, 2006)

Forcing children to break taboos and cultural norms into which they have been socialized

Baro’s report further showed that forcing children to break cultural norms was among the regular atrocities committed during the war years in some African countries. They manifest in such forms as forcing child soldiers not only to watch but also to actually rape their mothers, or to hold them while they are being raped. According to Baro (2006; see also Singer, 2006): “in Sierra Leone, men have been forced to rape members of their own family under threat of being mutilated by having their hands or arms cut off” (p. 196). Similarly, in Sierra Leone, rebels forced children into incestuous practices, one of the biggest taboos in any society: “They witnessed sons forced at gun point to rape their own mothers” (p. 196). Similar atrocities as above were reported not only in Sierra Leone, but also in Liberia, Northern Uganda, Angola, and Mozambique (Honwana, 2006; Singer, 2006).

Grounds for use of African Indigenous rituals in the treatment of moral injury

This article contends that because the atrocities inflicted on the victims, such as those cited above, include not only the moral but also the social wounds of war, and implicate the violation of the cultural memory and conscience of the victims, the processes of cure must include efforts at getting the community involved in this venture. This means that, at least in the African context where these atrocities are taking place, full psychological integration cannot take place unless endogenously generated rituals (Granjo, 2007) of integration available in the community of which the returnee solider is a part are drawn upon to effect this healing. Through such generic rituals, opportunity for connecting the returnees to their communities is promoted, and serve as avenues for redressing the cultural damages brought about by their war experiences.

Concurring, Green and Honwana (1999) argued that anthropological research done in Mozambique and Angola shows that war-related psychological trauma such as moral injury, particularly of the type experienced by African child soldiers, is directly linked to the power and anger of the spirits of the dead. The problem of performing proper burials in times of war does not allow for these spirits to be placed in their proper positions in the world of the ancestors, so they are considered to be bitter and potentially harmful to their killers and to passersby (Granjo, 2007; Igreja, 2003, Igreja et al., 2008; Jahn & Wilhelm-Solomon, 2015). Given this local exegesis, Granjo (2007) and Honwana (2006) suggest that healing and reintegration efforts need to be drawn from local views and systems. This perspective is consistent with the asset-based theory earlier reviewed in this article.

Green and Honwana (1999) further argue that social pollution may arise for being in contact with death and bloodshed as individuals who have been in a war, who killed or were around killings, are believed to be potential contaminators of the social body (Green & Honwana, 1999; Igreja, 2003, Igreja et al., 2008). For this reason, in the African context, the notion of moral injury is understood to embrace not only the phenomenon of subjective reaction to the moral wounds of war, but also to the crisis and torments of the social–cultural wounds of war. According to this African paradigm of mental health, it is through cultural and spiritual understanding and through undergoing ritual cleansing processes that affected people can find meaning and repair the cultural violation in their lives after traumatic experiences. Consistent with this understanding, the asset-based perspective and the theory of decoloniality outlined at the beginning of this article suggest that cleansing and purification rituals in Africa are needed for the community reintegration of people who present with the problem of moral injury.

Beyond the biopsychosocial approach to treatment of moral injury

The above indications suggest that although there might be instances of special needs when the application of Western individuocentric/biopsychosoical approaches to treatment of moral injury may apply in the African context, treatment of moral injury in continental Africa tends to rely more on the summoning and administration of Indigenous rituals of cleansing and repossession to those affected. Such rituals for war veterans do vary from place to place in Africa (see Granjo, 2007), but Honwana’s (2002, 2006) research shows that there are different but regular types of cleansing rituals for war veterans in Southern Africa; with some addressed to those who have participated in the war but did not kill; while others are specifically directed to those who killed other people. The latter is said to be more complex and requires the expertise of a traditional healer (Granjo, 2007). It is believed that if appropriate healing procedures are not followed the spirits of the dead can drive the killer insane (Igreja, 2003).

Granjo (2007) presented a full account of the philosophy, content, and structure of typical African rituals of cleansing but due to space limitations that account will not be reproduced here. The reader interested in learning more on such a theme should consult Granjo’s (2007) comprehensive article on that important subject.

For the purposes of the present article, some illustrative case examples of rituals of cleansing in the treatment of moral injury for African child soldiers along the lines highlighted above are provided in what follows.

Case examples of rituals of cleansing in the treatment of moral injury for African soldiers

According to Green and Honwana (1999), traditional healing for war-affected children in Angola and Mozambique seems to consist principally of purification or cleansing rituals, attended by family members and the broader community, during which a child is purged and purified of the “contamination” of war and death, as well as sin, guilt, and avenging spirits of those killed by a child soldier. Supporting the above observation, Granjo (2007) powerfully observes that:

Unlike in most wars involving Western countries, when veterans from Mozambican civil war began to return home, the first concern of communities was to make them confront their traumatic experiences and guilt. This was done through cleansing rituals, which were and are based on the local exegesis about misfortune. They allow, simultaneously, the confinement of past war actions as an exceptional situation and expurgate the individual veteran from being in danger and being considered a danger to the community. It allows him to be proclaimed a new man, entitled to a fresh start inside the community. In addition, to its importance for the individual reintegration of veterans, the generalized performance of such rituals also played and plays an important role in allowing the community members to accept previous enemies/veterans as “people like the others.” (p. 382)

Given below are samples of field reports that present the different ways in which such ritual cleansing ceremonies can be conducted in a typical African community for a returnee child soldier.

Case A: Rituals of cleansing for returnee child soldier X

As reported by Green and Honwana (1999):

On the day of [the returnee child soldier’s] arrival his relatives took him to the ndumba (the house of the spirits). There he was presented to the ancestral spirits of the family. The boy’s grandfather addressed the spirits informing them that his grandchild had returned and thanked the spirits for their protection as his grandson was able to return alive . . . A few days later a spirit medium was invited by the family to help them perform the cleansing rituals for the boy. The practitioner took the boy to the bush, and there a small hut covered with dry grass was built. The boy, dressed with the dirty clothes he brought from the RENAMO camp, entered the hut and undressed himself. Then fire was set to the hut, and an adult relative helped out the boy. The hut, the clothes and everything else that the boy brought from the camp had to be burned. A chicken was sacrificed for the spirits of the dead and the blood spread around the ritual place. After that the boy had to inhale the smoke of some herbal remedies, and bath [sic] himself with water treated with medicine. (p. 94)

Commenting on the above, Green and Honwana (1999) remarked that “this healing ritual brings together a series of symbolic meanings aimed at cutting the child’s link with the past (the war)” (p. 95). In their view, while modern psychotherapeutic practices emphasize verbal exteriorization of the affliction, here, through symbolic meanings, the past is locked away (Granjo, 2007). That way, non-discursive bodily practices are drawn upon in addressing the social wounds of war (Igreja, 2003). This is seen in the burning of the hut and the clothes and the cleansing of the body. To talk about and recall the past is not necessarily seen as a prelude to healing or diminishing pain. Indeed, it is often believed to open the space for malevolent forces to intervene. Igreja (2003) provides some direction on what one can call an outcome study for this practice.

Case B: Rituals of cleansing for returnee child soldier Y

In Green and Honwana’s (1999) report under this theme:

When the child or young man returns home, he is made to wait on the outskirts of the village. The oldest woman from the village throws maize flour at the boy and anoints his entire body with a chicken. He is only able to enter the village after this ritual is complete. After the ritual, he is allowed to greet his family in the village. Once the greeting is over, he must kill a chicken, which is subsequently cooked and served to the family. For the first eight days after the homecoming, he is not allowed to sleep in his own bed, only on a rush mat on the floor. During this time, he is taken to the river and water is poured on his head and he is given manioc to eat. As he leaves the site of the ritual, he must not look behind him. (p. 95)

As interpreted by Green and Honwana (1999), this case from Uige in Angola emphasizes the factor of the candidate for ritual cleansing having no interaction with family and friends before ritual cleansing. The child is kept out of the village until the ritual is performed, and cannot greet people or sleep in his bed until the ritual proceedings are over. As mentioned earlier, although children may be asked about war experiences as part of treatment, this is not a fundamental condition for healing arising from ritual cleansing in Africa. The ceremony aims at symbolically cleansing the polluted child and putting the war experience behind him, or to “forget” it (note the symbolism of being forbidden to look back in the example from Uige).

Food taboos and other kinds of ritual restrictions are applied. In the Uige case, for example, fish and fowl must be avoided by the cleansed person for 1–2 months, after which the person must be reintroduced to the food by the traditional healer who officiated at the ceremony.

Granjo (2007) presents an equivalent confirmatory (outcome) study for the type of case just described.

Case C: Rituals of cleansing for returnee child soldier Z

In their description of the category-C ritual, Green and Honwana (1999, p. 96) reported of the Okupiolissa ritual from Huila in Angola, Southern Africa, which clearly shows the active participation of the community in some cleansing rituals in Africa. This case also stresses the idea of cleansing from “impurities,” as given below:

The community and family members are usually excited and pleased at the homecoming. Women prepare themselves for a greeting ceremony. . . . Some of the flour used to paint the women’s foreheads is thrown at the child and a respected older woman of the village throws a gourd filled with ashes at the child’s feet. At the same time, clean water is thrown over him as a means of purification . . . the women of the village dance around the child, gesturing with hands and arms to ward away undesirable spirits or influences. . . . they each touch him with both hands from head to foot to cleanse him of impurities. The dance is known as: Ululando-w-w-w. When the ritual is complete, the child is taken to his village and the villagers celebrate his return. A party is held in his home with only traditional beverages. . . . The child must be formally presented to the chiefs by his parents . . . the child sits beside the chiefs, drinking and talking to them, and this act marks his change of status in the village. (p. 96)

Again, for Green and Honwana (1999),

these cleansing and purification rituals involving child soldiers have the appearance of what anthropologists call rites of transition. That is, the child undergoes a symbolic change of status from someone who has existed in a realm of sanctioned norm-violation or norm-suspension (i.e., killing, war) to someone who must now live in a realm of peaceful behavioral and social norms, and conform to these. (p. 96)

The two authors’ work cited above should be seen as a kind of outcome study for this cultural practice. This view follows from their observation that manifest symptoms associated with PTSD and related stress disorders reportedly disappear shortly after these ceremonies, after which the family, Indigenous healers, and local chiefs direct attention toward helping to establish an enduring, trusting relationship between the traumatized child and family members, and with adults of good character.

These endogenously generated intervention rituals are also intended to “re-establish spiritual harmony, notably that between the child and its ancestor spirits” (Green & Honwana, 1999, p. 96). These rituals take a generic format since all are oriented “to work to promote healing and reconciliation between the soldier and his village, between the Homecomer and the home” (Granjo, 2007, p. 383).

Granjo (2007) and Igreja (2003) provide a kind of confirmatory (outcome) study perspectives on the efficacy of these rituals.

Cleansing rituals for civilian victims of moral injury in Africa

The above illustrative samples of rituals of cleansing in Africa, of course, only apply to treatment of moral injury when former soldiers are involved. What happens in the context of providing healing to civilian victims of moral injury will be highlighted next. This is important as it appears that one of the differences between the emphases in the Western literature on moral injury and in the African context is the fact that in the West, particularly in the United States, much attention is given to addressing the moral injury of war veterans at the expense of discussing the moral injury needs of members of the civilian population.

Problem of moral injury in the civilian population in Africa: A case illustration

From the point of view of the African example, one typical case of the problem of moral injury in civilian clients concerns the peculiar problems of a husband and a wife from the formerly war-torn Liberia. This couple, although they had survived the Liberian war as refugees, came for psychological consultation with the narrative of being overwhelmed with some symptoms of moral injury arising from their personal memories of the atrocities of the war. The critical problem they came with arose from their inability to blend together after they (the husband and the wife) returned home at the end of the war to discover each other alive.

The case involved a husband whose wife was mercilessly raped “in his own eyes,” by the rebel soldiers after he was first roughly manhandled, and his hands and legs chained to the spare tire of the jeep (vehicle) they came in. The most painful aspect of their ordeal was that, following the rape, the wife became pregnant, with every effort to abort the baby being unsuccessful. The result was a son who, by the time of the repatriation and consultation, was 4 years of age. The husband’s major psychological complaints included persistent flashbacks, emotional agitation, insomnia, and impotence. According to him, these symptoms arise immediately when he recollects the wife’s rape ordeal with the soldiers, the memory of which is still very fresh in his mind, and now worsened by the presence of the “child of the rape,” who returned home with his wife. They reported that this problem was brought about by the fact that, immediately after the rape, the two spouses were taken to different destinations; with both of them ending up in different refugee countries, unable to trace the whereabouts of each other until the end of the war, when they returned to find each other home. The wife complained of severe emotional guilt (since she had thought of giving away the child for adoption, but never did). According to her, she rejected the adoption option owing to fear of what the husband might say should he come to know that the rape by the soldiers resulted in a pregnancy that gave rise to the birth of a baby boy that was put up for adoption. She also complained of continuing chronic confusion, flashbacks, insomnia, and depression. The affected child was aware of not being fully “received” or “accepted” by the father.

The couple sought therapy (in the manner of a Western therapeutic model) to find out what they could do to come to terms with these issues. In responding to this case, the present author drew insight and inspiration from the Africentric paradigm of healing that recommends the use of rituals of cleansing and repossession and other performative experiences in a case such as this precipitated by the problem of moral injury arising from the negative experiences of war.

Rituals of cleansing in the treatment of moral injury of a Liberian civilian couple

To assist them, the author recommended the application of rituals of leave-taking/repossession and other performative experiences available in traditional Africa, for effecting formal breaking of bonds in special circumstances, and for mending bodies contaminated by unplanned pollutional contact. Some detailed background concepts to this process have been elaborated elsewhere (A. Nwoye, 2005). But the kinds of cleansing and repossession rituals recommended were those designed to concretize the notion of formal breaking of ties between the presenting client and her previous rapists (the rebel soldiers).

In concrete terms, the rituals applied included those of cleansing the raped woman through organizing for her the taking of a ritual-bath to be done (very early in the morning, i.e., at the breaking of dawn) in a flowing public stream of the community in which the woman client belonged, and to be accompanied by one respected elder woman of her husband’s lineage who would serve as observer-witness and who would reclothe her with a ritual dress of emergence from the previous status of contamination arising from the war-rape experience.

In some communities in Africa, the new dress may be white in colour but in some other places, a dress of other colours may be used instead: in this particular case, a white dress was recommended due to its symbolic value as a colour of purity, innocence, and a new beginning. By getting into such new clothing after a ritual cleansing bath, the husband and the wife would come to feel that a transformation has taken place in the life and status of the woman, making her ready and fit for being repossessed by the husband in a state that reconnects to her prerape and her contamination days. To thicken this transformation, the woman client would be instructed by the accompanying elder woman to make a declaration to the effect that her “link with the rebel soldiers of her past is hereby broken; and that they should depart from her forever.”

In a culture such as that in Africa, that believes that nommo or words have a way of effecting what they declare, there is enormous faith from the people that the above declaration has the effect expected. In other words, this ritual proclamation of official breaking of bonds between the woman client and her previous violators, undertaken in the presence of the community (in the person of the elder woman who represents the community in this process) is understood by the select members of the community, including the woman’s husband, waiting at the home of the couple for the two women’s return from the stream, as fulfilling its declaration: that the bond is broken.

The entire performative processes (ritual bathing and reclothing) and the declaration of leave-taking add up to a kind of full repossession ritual that helps to reshape the psychology of the couple in relation to themselves.

Although there is no specific outcome study based on this case, the articles by Igreja (2003) and Igreja et al. (2008) provide a kind of co- or cross-validational perspective on the efficacy of these rituals.

Ritual of renaming the child

For the child of the rape to become transformed and integrated to the family fold, a ritual of renaming (this process usually presided over by an elder male of the lineage in which the couple belong) was recommended and undertaken. This ceremony of renaming the child included throwing a ritual feast for the community; who, in witnessing the renaming ceremony, and in partaking in the ritual feast, came to believe in the ritual transformation of the child too, seeing him with new eyes, that is to say, as changed from his initial status of liminality and nonrecognition (Taylor, 1994), to a state of reintegration into the membership of his family and community.

The above observations draw strength from the view emphasized in Indigenous Africa that there is a connection between ritual and health, matter and spirit, and existence and consciousness (Nyamnjoh, 2017).

The performative experiences highlighted reflect the opportunity created by the culture to enable the community to witness, nourish, and celebrate the liminal changes and transitional moments that often become necessary in the lives and tragedies of people challenged by some critical circumstances that leave them with no options for escape.

Again, although no specific outcome study currently exists for this case, the article by C. Nwoye (2014) presents an insightful report that showed that words are believed to effect or constitute or produce what they declare in African naming rituals.

Theoretical interpretation

The above descriptions corroborate the point emphasized in the asset-based perspective that served as part of the theoretical underpinning for this study. The asset-based perspective proposes that Africans are heirs to a rich cultural heritage that could be drawn upon for purposes of health promotion and recovery in contemporary Africa. Similarly, the above descriptions have come with samples of Indigenous healing traditions which the theory of decoloniality had hypothesized would be discovered when pertinent reviews of research and writings such as those undertaken in this study are engaged with.

From another perspective, it is also necessary to mention that the notion of the mystical power of language in human life that is made reference to in the rituals described above finds anchor in the view propagated by J. L. Austin, drawing on Wittgenstein, that language does more than just help to describe the social world: it also helps to constitute it, to produce it. In this regard, according to Austin, and in line with the African perspective, one of the significant aspects of language games was their “performative” (or illocutionary) function: language is used for promising, expressing affection and loyalty, co-ordinating action, causing offence and smoothing ruffled feathers, and in our own context, for “breaking bonds” and giving names to children.

These indications mean that, through the performative experiences valorized in the culture, the raped spouse was able to transition from contamination to healing; with all around, including the husband, believing in the concrete transformation of her old self into a new self; with the couple thereby reestablishing and repossessing their initial unity and bonding, in the presence of a witnessing community who recognize that they (the couple) have been able to transcend the old disruptions of their wartime period through the rituals performed (Granjo, 2007).

For the child of the rape, the rituals and performative experiences that were made available acted as a mark of his transformation “in the eyes of the community” from an illegitimate status; or from “a child of the fields,” to a child of incorporation (van Gennep, 1909/1960), a true family’s child (Granjo, 2007). In this way, the rituals highlighted above, as assumed in the African perspective, not only point to or reflect new realities, they help to create them. With the performance of such rituals, the old meanings of the couple-clients’ situation lose their hold and are replaced by new meanings of who they are to one another; promoting their permanent repossession of one another (Igreja, 2003). And these changes are assumed to have taken place just because the culture has prescribed that once such rituals and performative experiences are undertaken, their effect follows (C. Nwoye, 2014).

These indications mean that, at least in the African context, the experiences of ritual and therapy are cathartic; and this, not in the old sense of emotional release, but in the sense of moving people to a place they had not been before (e.g., the child of rape regaining integration into the culture) or where they had been, but were accidentally dislocated by the action and assault of others (as in the case of the raped wife).

Thus leave-taking, cleansing, and repossession rituals in Africa provide opportunities through which some kinds of words and prescribed ritual actions make identity reconstruction and renegotiation possible (Granjo, 2007; Green & Honwana, 1999; Igreja, 2003; A. Nwoye, 2005).

Implications and concluding comment

A number of lessons from this article can be highlighted. One is the social value of this article, which is that rituals of cleansing and repossession of returnee soldiers in Africa must precede any plans for their socioeconomic integration. This is important as often many well-intentioned NGOs from Europe and North America (Betancourt, 2008; Boothby, 2006; Wessells, 2005, 2006), who don’t seem to know the basic cultural priorities in the lives of these children at this time, come quickly and impose proposals for the education and socioeconomic betterment of these returnee child soldiers; seeing their formal education immediately after the war as paramount in their need for social reintegration. What must be remembered is that while such NGO initiatives are praiseworthy and have their place, they must be planned to come at an appropriate time and never before the rituals of cleansing and repossession of these war-affected children have been conducted.

Second, this article shows that the use of rituals in mental health promotion appears to be one aspect of psychological practice in Africa with some exceptions (Prince, 2015; Ramay, 2018) that uniquely distinguishes it from the traditional Western approach to psychological intervention in the treatment of clients with moral injury. And it is possible to speculate that the reason for this is because Western psychotherapy places enormous emphasis on the use of words and reliance on reason as the chief armamentaria for the promotion of therapeutic change. In Africa, in contrast, both verbal and ritual (including nondiscursive bodily) practices are drawn upon to effect healing in the distressed.

Third, although in Western literature there is little or low-key mention of the problem of moral injury among the civilian population (Griffin et al., 2019), in Africa this is the rule rather than the exception.

Fourth, and finally, the Indigenous psychological treatment approaches highlighted in this article emphasize the important contributions of culture and the community in the treatment of moral injury in the African context. And it is most heartening to note that in the West, presently, judging from Ramay’s (2018) account, there seems to be a gradual shifting of emphasis towards affirming the important roles of rituals and the community in the treatment of moral injury.

Footnotes

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Augustine Nwoye

Author biography

Augustine Nwoye is a professor of psychology and Fulbright scholar in the discipline of psychology at the University of KwaZulu-Natal, South Africa. He is one of the foremost promoters of the notion of African psychology as a postcolonial discipline and has made original and important contributions to the definition and study of African psychology in universities in Africa. Among his recent articles are: “What is African Psychology the Psychology of?” in Theory & Psychology (2015) and From Psychological Humanities to African Psychology: A Review of Sources and Traditions (Oxford University Press, 2020).

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