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.”
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.
Reconciliation: A Son’s Story