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Treatment for Moral Injury

PTSD word cloud

I’ve heard about PTSD — But What is Moral Injury?

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I’ve heard about PTSD — But What is Moral Injury?
-By Don M. McNulty

As a Bio-technician in the Crime and Trauma Scene Industry, I suffered from PTSD like many first responders and those in the medical field. I thought if I studied everything I could to understand my condition, I would affect a better recovery and help me manage it. Unfortunately, I believe one never heals from PTSD, but we learn to manage it into remission.

While attending a Chaplaincy Conference here in Missouri, we had a quick session on Moral Injury. I had never encountered that term in my research, so it got my attention. However, as I spoke with others who have continued to suffer for years from PTSD, they had never heard of the term. Knowing those who continue to suffer from PTSD made me wonder how I learned to place mine into remission, and they hadn’t been able to get to any higher level of healing. Until now, I concluded that most of those I spoke to were active in combat, where I’d never been.

So today, with this writing, I’m presenting perhaps another avenue for victims of this disorder to seek more information to reach a healing place.

PTSD word cloud

What is Moral Injury?

“Moral injury can occur when someone engages in, fails to prevent, or witnesses acts that conflict with their values or beliefs. Examples of events that may lead to moral injury include:

  • Having to make decisions that affect the survival of others or where all options will lead to a negative outcome
  • Doing something that goes against your beliefs (referred to as an act of commission)
  • Failing to do something in line with your beliefs (referred to as an act of omission)
  • Witnessing or learning about such an act
  • Experiencing betrayal by trusted others.”

The National Center for PTSD provides the above definition of Moral Injury.

Moral injury and PTSD are very different but have similarities, often causing confusion between the two disorders. PTSD is a mental health condition caused by exposure to a traumatic event. This event can be anything from combat to sexual assault. On the other hand, moral injury results from one violating their moral code, which could be as simple as lying to someone you love or as serious as committing a war crime or violating a religious-based moral code.

Moral injury can be incredibly damaging, leading to guilt, shame, and self-loathing. These feelings can be perplexing and hard to cope with, often leading to substance abuse and suicide. PTSD, while also incredibly damaging, is more focused on the symptoms caused by the traumatic event itself. These symptoms can include flashbacks, nightmares, and intrusive thoughts.

People with these disorders may avoid discussing or taking part in activities that remind them of the traumatic event, such as Group Therapy. People with Moral Injury may also feel like they can’t talk about it because they feel intense shame. Both victims feel no one will understand what they’re going through.

The symptoms of moral injury and post-traumatic stress disorder can be relieved with different treatments. For those suffering from PTSD, treatment should focus on relieving the physical effects caused by traumatic events, like therapy or medication. For people who have experienced a more profound hurt, such as an act of morality offense, this may take longer because they need to come to terms first before moving forward into talking about what happened, which is an often-difficult process.

Understanding the differences between moral injury and PTSD is vital to get the right help for yourself or someone you love.
If you think you may suffer from moral injury rather than PTSD, please seek help immediately and have that discussion with a qualified professional.

Why have I not heard of Moral Injury?

Moral Injury is a term that has been gaining traction in recent years to describe the unique damage caused by war and other traumatic experiences, as stated above. Jonathan Shay, a doctor who has worked extensively with veterans, coined the term in his book “Odysseus in America: Combat Trauma and the Trials of Homecoming.”

PTSD is a well-known and well-studied condition caused by exposure to traumatic events. Intrusive thoughts, flashbacks, nightmares, and hypervigilance characterize PTSD. However, there are many symptoms, and no two people experience PTSD in precisely the same way.
We treat PTSD and moral injuries in different ways. Treatment for moral injury should focus on helping the person come to terms with what they have done. Therapy can be a long and challenging process, but it is necessary to move on.

The significant difference between PTSD and Moral Injury

PTSD is a registered mental health condition we treat with therapy and medication. It results from seeing a traumatic event outside of ourselves.

Currently, the Medical Psychiatric Community does not consider Moral Injury a mental health condition. Moral injury results from someone committing an act that violates their inner morality. However, there is growing evidence we should treat Moral Injury as its own category of trauma.

If you or someone you know is struggling with Moral Injury, you can take steps to get help. You can find resources at the websites for Veterans Affairs in the U.S. and Canada if they were part of the military, and others can find help with The National Center of PTSD.

Both PTSD and Moral Injury involve therapies like cognitive-behavioral therapy or exposure therapy. However, treating Moral Injury also often involves soul-searching, reflection on the event, and its impact on your life.

Have you known people suffering who won’t get help?

Both disorders frequently will cause their victims not to seek the help they need. They mistakenly believe if they try harder, they can learn to manage its effects, which rarely works.

Knowing this is an emotional and psychological problem they are experiencing, they also erroneously believe there is a stigma from society attached, and it would follow them throughout the rest of their lives. They are so focused on the pain that everything else is black.

I liken it to a person who slams a hammer down on their finger; all that matters now is the pain. I could place a dancing bear before them, and they would not realize it. Why? Because their entire focus is on the pain they are feeling, and nothing else matters.

I’ll close with a YouTube video showing a person’s awareness when focused on a task. You can find it at the following link.

https://youtu.be/KB_lTKZm1Ts

Crime Scene Cleaners, LLC endeavors to bring you relevant information to help you deal with the stresses of life and work. We serve the States of Missouri and Kansas, if there is anything we can help anyone in your community please contact us at 1-800-808-7642 or www.crimescenecleanerskc.com