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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Courtney, you write somewhat like I do, in that you leave me with a huge question….what is “the underlying cause of our own symptoms”? Is it unique to each of us as individuals? Or is there a common thread which we can work on healing together? It feels like a lonely struggle, and perhaps a loosing battle as you have left it at the end of your article…
Indeed, the Vietnam war awoke in Americas consciousness the very validity of what became known as PTSD. I agree that what often is missed in our understanding is that the Soldier not only make ofbroke moral code in the battlefield but that American citizens broke faith with the returning veterans reinforcing the shame and guilt of actions taken in combat. To top it off the veteran discovered that his actions, his motivations were betrayed by the government that sent him into battle. I was one of those who, as a young teenaged Marine, went to Vietnam to help the poor people who were oppressed by communism. I soon discovered that the average sufferred by our hands as much as by the so called enemy.
Upon my return the anger and rage of this betrayal ate at my gut till i wised up and forgave myself.
Absolutely Jon, the many forms of betrayal play a large role in the moral injury one might encounter. Betrayal of commanding officers, the military, and even the country were part of that injury that was more unique to the Vietnam era. I am glad to hear that you have been able to “forgive yourself” and reclaim some of what you had built. Thank you for your service.
only those with no moral code (antisocial personality) have never broken their own personal moral code.