Moral injury is a hot button phrase that has been used to describe many war-related trauma symptoms that don’t necessarily fit under the PTSD umbrella. Moral injury was first introduced by Jonathan Shay, a psychiatrist who drew on instances from history and literature to help shape the undefinable difference war Veterans display when they return. He described moral injury as when:
“(1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation.”
Recently, moral injury has resurfaced as a distinct, yet, collaborative issue that one can face when presented with an experience that questions “who am I?” Like PTSD, moral injury can lead to symptoms of trauma, but Maguen & Litz(2012) separate this trauma as an internal struggle. The ongoing theme that arises is the idea of betrayal, either to oneself, one’s codes, or others. With Veterans, the betrayal can come from their peers, a commanding officer, or be in conflict with the moral code they had established.
This is not a new concept, the idea that different betrayals can have great impact can be found all across our history. In Dante’s Inferno, the 9th circle of hell (Betrayal) is broken into sub-levels depending on the severity: Family, Political, Guests(Game of Thrones?), and Master, or God. When applied to modern life, we might notice that betrayals of our very foundation, or our moral code, can have the greatest impact. How we see ourselves as a person is defined by our congruence with our own ideals. If you believe that to be a ‘good man’ you must never harm an innocent, and then you are forced to kill a young woman or child to save yourself, you may suffer from moral injury. It isn’t because the act can’t be justified, but the fact that you no longer believe you fit your own definition. When our real self meets our ideal, the results can be devastating. Are you who you believe yourself to be? The answer may surprise you…or haunt you.
Treating moral injury may have significant positive effects, especially when paired with the treatment of underlying traumas. It also has far reaching implications. In today’s society, we are often faced with situations which go against the ideal we might have for ourselves. Even those principles are created based on what we view as important within our own society and culture. Shame and guilt tie into many of our own anxieties, but it’s a socially constructed view which we can address. As more stories arise of these instances we have a responsibility to look at the underlying cause of our own symptoms.
By: Courtney Kidd, LMSW
SJS Staff Writer
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