Moral Injury and PTSD

The theme of the recently concluded 2013 UCIPC Lake Arrowhead conference was “Moral Injury”—a term introduced by Jonathan Shay to refer to the many ways warfare produces not only  “post traumatic stress” reactions, but also profound injuries to the soldier’s sense of personal moral continuity.  Moral injury differs from the traditional fear-based models of war-zone exposure (PTSD), focusing attention on guilt- or shame-based injuries to the self.

The first link connects to a 2012 article in PTSD Research Quarterly, which summarizes the distinction between PTSD and Moral Injury, reviewing several efforts to operationalize the construct in the treatment of returning soldiers:

“Military personnel serving in war are confronted with ethical and moral challenges, most of which are navigated successfully because of effective rules of engagement, training, leadership, and the purposefulness and coherence that arise in cohesive units during and after various challenges. However, even in optimal operational contexts, some combat and operational experiences can inevitably transgress deeply held beliefs that undergird a service member’s humanity. Transgressions can arise from individual acts of commission or omission, the behavior of others, or by bearing witness to intense human suffering or the grotesque aftermath of battle. An act of serious transgression that leads to serious inner conflict because the experience is at odds with core ethical and moral beliefs is called moral injury.” (Read Entire Article Here)

The second link connects to a recent blog post on Moral Injury, which contains an interesting video interview with Jonathan Shay, who discusses the importance of moral injury for understanding the nature of war trauma.

“I really don’t like the term ‘PTSD,’” Department of Veterans Affairs psychiatrist Dr. Jonathan Shay told PBS’ “Religion & Ethics Newsweekly” in 2010. “He says the diagnostic definition of “post-traumatic stress disorder” is a fine description of certain instinctual survival skills that persist into everyday life after a person has been in mortal danger — but the definition doesn’t address the entirety of a person’s injury after the trauma of war. ”I view the persistence into civilian life after battle,” he says, “… as the simple or primary injury.” (Read Entire Article Here)