PTSD vs. Moral Injury?


Because of the overwhelming response to my “moral injury” posting yesterday, it is included again today by popular demand.  I have also added must read comments from followers, Dan and Elaina, who offer excellent points supporting the use of “injury” as an alternative to “disorder.”

Steve Sparks
Author
Reconciliation: A Son’s Story

Following is a quote from…

The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan

JONATHAN SHAY Smith School of Social Work, Northampton, Massachusetts, USA
79:286–298, 2009

“Moral injury, something that I have studied my whole career in

psychiatry, is what happens when there is a high-stakes violation of ‘‘what’s
right’’ by someone holding legitimate authority in a high-stakes situation.
The ‘‘what’s right’’ is in the realm of culture. Legitimation and authority are in
the social structure. And the stakes here, such as the love that this marine has
for that marine he went through boot camp with, and went out to the Fleet
with, and shared the same fighting hole with in Iraq—this love is in the
mind, the social system, and the culture. When moral injury happens, it’s also massively physiological. You know that from your own experience, that when there’s a high-stakes
violation of what’s right by someone with legitimate authority, it’s a kick in
the stomach. There is a profound physiological reaction, as well as being
psychologically momentous. Moral injury, as I have defined it here, is coded
by the body as physical attack and will create full-fledged post-traumatic
syndromes with intrusions and everything else.”

http://www.index.va.gov/search/va/va_search.jsp?SQ=&TT=1&QT=moral+injury&searchbtn=Search

Moral injury is described in the above link from the Department of Veterans Affairs. More recently, in a news report from the Washington Post, http://www.washingtonpost.com/world/national-security/new-name-for-ptsd-could-mean-less-stigma/2012/05/05/gIQAlV8M4T_story.html, discusses the merits of changing PTSD to reflect “injury” vs. “disorder.” More research and debate on the issue of changing how we frame PTSD is critical. All too often PTSD discourages treatment, soldiers tend to see it as a stigma and keep it a secret, and will not take appropriate proactive steps to start the healing journey. I write in my book, Reconciliation: A Son’s Story, how keeping my own diagnosis was a secret for 40 years until it was safe to finally bring it to the surface. I am convinced that my career success and completing college would have been hampered by bringing attention to a mental health diagnosis from the US Navy back in 1965. This is very high-stakes business! What does an individual do? Well, we take the least path of resistance, which can be very painful indeed.

Steve Sparks
Author
Reconciliation: A Son’s StoryDan and Elaina* ~ PTSD-is-Normal.com said…

Thank you, Steve, for posting this. I hadn’t heard the term “Moral Injury” before, but this is exactly where I am in my trauma therapy… dealing with the moral issues that my Complex PTSD has caused in my life. I will read the va.gov articles on this subject; thanks for the link.

As for the idea of removing the word “disorder” from PTSD, and replacing it with “injury,” I fervently hope this becomes a reality! The stigma of PTSD is a double whammy, and very much undeserved. In many ways I have been re traumatized because of my “labels.” As the late Tim Fields, author of BULLY IN SIGHT and founder of http://www.bullyonline.org said: “PTSD is a psychological injury, not a mental illness.”

I suspect, though, that all or most “mental illnesses” are in fact psychological injuries, rather than something inherently wrong that one was born with. My 50-year-old brother has been labelled schizophrenic since he was a teenager, and he does in fact live much of his life in a fantasy-land of delusions. However, the extreme traumas in our childhood home that caused my Complex PTSD, could very well account for my brother’s schizophrenia, in my opinion. He was only 3, and I was 12, when the worst of our family traumas happened. Because he was so much younger than I, I believe his mind and personality were much more vulnerable to severe and permanent damage.

Too many adults seem to think that it doesn’t matter what they say or do around a very young child, because he or she won’t remember it when they are older. But those early years are like wet cement. My brother was perfectly fine until the traumas happened.

~Elaina 

May 8, 2012 10:39 PM

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