10/10/2014 03:39 pm ET Updated Dec 10, 2014

Surviving Dangerous Work Through 'Soul Space'

What if, every day that you are at work, you face serious injury or death? Such work has many challenges, but often unexamined are the spiritual crises that dangerous work entails. It doesn't just threaten the body; it also threatens the soul. For people who do this work, religious communities can help with emotional and spiritual survival, if they attend to understanding what such work entails.

"I could have died," survivors often anxiously say. Life threatening experiences, as ethicist Mary Pellauer notes, are a "fundamental spiritual crisis" because they "contain the whole dimension of the existential quality of death."

In addition, dangerous work often involves profound moral dilemmas, choices that have to be made in the midst of emergency and threat. Choices that have to be made when there are no "good" choices.

This is often the case in war. For example, when a soldier looks down her gun sights at something she can barely see, she may have to shoot before having any certainty. If she shoots and then discovers she killed an unarmed civilian, she's violated the rules of the moral conduct of war. If he hesitates and a spray of machine gun fire kills his best friend, he's failed to do his duty and it cost his friend his life. That sense of having failed under dangerous conditions can lead to profound grief, to feeling ashamed, to being angry at oneself or others, and to losing one's moral foundations. It is called moral injury, and it can be even more intense for those who believe the war they have been sent to fight is immoral or unjust and who feel betrayed by leaders.

Moral injury, as Rita and Gabriella Lettini note in Soul Repair: Recovering from Moral Injury After War is a common effect of war because the dangerous extremities of combat often make clear moral choices impossible or force a choice before the outcome is known. Many veterans manage to recover while others, far too many others, are so afflicted that they eventually take their own lives, sometimes months or years later as their moral anguish deepens.

Why do some recover while others continue to struggle? We believe that a key factor is spiritual resiliency or what we call "soul space," an ability to hold a breathing space, a consciousness inside that what one does as a professional soldier is not all of who one is. The psychoanalyst Donald Winnicott called it "play space" in children, and it is crucial to adult mental health. It is an awareness of self and other as different that helps us understand that we are not just the job we do, that our personal lives are our own, that deep in us is a deep place of knowing who we are and that, maybe, we can be loved again. Soul space is a kind of transcendence that some call conscience, or empathetic self-awareness, or, even, God. It grounds us in the knowledge that what we must sometimes do is not the sum total of who we are, that it does not define us completely.

Another important place that soul space is crucial is sex work, and we learned this in the early 1990s working on our book Casting Stones: Prostitution and Liberation in Asia and the United States.

Sex work can range from a self-employed individual who manages her own choices to conditions of exploitation and control by a pimp or madam, and even to outright slavery. In 1996, the average age of entry into sex work was age 14; it is now 12.

Sex work often has few "good moral choices," but sex workers do exercise a moral compass. They engage in sex work to survive as runaways, to feed their children or to help their families, or to fulfill what they perceive are the requirements of being loved, though there are many other reasons as well.

It is crucial to listen respectfully to those in the sex industry. One thing we heard in our interviews with sex workers in five Asian countries and many U.S. cities is that the work carries enormous emotional and physical risk, as well as a risk to a coherent sense of self, especially for those who have been sexually, emotionally, or physically abused as children. Those who survived or were surviving the sex industry had soul space. They were able to hold to a coherent sense of self outside the work and maintain personal relationships. They performed their dangerous work without romantic pretensions as business and could talk to us about it once they understood we respected them. They even took some pride in being tough and doing their jobs well, but separated their work from what they did at home or with their intimate partner.

Without soul space, dangerous work can lead to the loss of a will to live. Moral injury after war is most devastating, according to VA psychiatrist Larry Dewey for those who kill, not as professional soldiers, but because they are elated at killing, are in a state of berserk rage, want vengeance, or kill those on their own side. They became the killing they were doing. He calls this "breaking the Geneva Conventions of the soul."

According to VA clinician Shira Maguen et. al. veterans who have killed in war are two to three times more likely to commit suicide that other veterans, who already have a suicide rate three times the general population. Veterans with moral injury often develop substance abuse disorders and are unable to establish intimacy and trust because their memories and feelings of sorrow, guilt, anger, and shame isolate them from others.

For those in dangerous work, risky self-medicating through drugs and alcohol is a way to silence inner pain. Those in sex work frequently use drugs or alcohol. And the young and vulnerable, especially, often fuse to their abusers through trauma bonds and are unable to hold a self-other distinction, making them susceptible to resigning themselves to abuse and violence because they believe they cause them. Without a soul space, they will confuse intimate relationships with bonds formed by violence. They lose the ability to form intimate relationships based on trust and healthy love. Instead of "breaking the Geneva Conventions of the soul," they "lose the conventions of intimacy."

Learning from those who do dangerous work -- even dangerous work as different as serving in combat or doing sex work -- is vital to better understanding how to cultivate and protect the soul space of those who face terrible choices and grave threats to body and spirit. Knowing that, when we are trapped in terrible extremities of experience, we are not just helpless victims, but agents of our own souls can be life-saving knowledge when danger dominates our lives.

Americans believe our society is becoming increasingly dangerous, with gun violence, militarization of police forces, devastations from the sudden, violent effects of climate change, and perceived threats from global disease pandemics or terrorism. A recent Centers for Disease Control report shows an alarming trend of increased suicide.

The spiritual crisis of moral injury comes from having to make moral choices in the midst of existential dilemmas. Dangerous work is traumatizing, and those who have done it can teach us much about how people do or do not survive it spiritually. Such knowledge matters to them, and to all of us.

It is becoming clearer that cultivating "soul space" outside oppressive systems is a way to survive and an important mode of spiritual resistance for individuals and societies.