With thanks to Neal Conan, host talk of the nation:
"whether you call it battle fatigue or shell shock or PTSD, we've come to accept that the trauma of combat can leave profound psychological scars. But how do you describe the damage from actions that violate one's values, but don't involve trauma, injury from horrific scenes that betray core moral beliefs?
Some mental health experts have adopted a relatively new term: moral injury. It's not accepted as a psychiatric diagnosis, there's no real treatment, but more and more veterans believe it finally puts a name to their condition and an explanation to their symptoms." Dr. Jonathan shay is a doctor and clinical psychiatrist. He worked with the va for many years and with various military leaders. He has a BA from Harvard, and an M.D. And a Ph.D. from the University of Pennsylvania.
Shay writes that his "current most precise (and narrow) definition of moral injury has three parts. Moral injury is present 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." factor (2) is an instance of shay's concept of "leadership malpractice"
He writes "that person who’s betraying “what’s right” could be a superior — or that person could be you. Maybe it’s that you killed somebody or were ordered to kill. Or maybe it was something tragic that you could have stopped, but didn’t. Guilt and shame are at the center of moral injury. And, as Dr. Shay describes it, so is a shrinking of what he calls “the moral and social horizon.” when a person’s moral horizon shrinks, he says, so do a person’s ideals and attachments and ambitions.
There are no clean lines separating PTSD from moral injury (which is not a diagnosis) — there is no venn diagram, as with ptsd and traumatic brain injury – but dr. Shay explains a fundamental difference by using a shrapnel wound as an analogy.
“whether it breaks the bone or not,” he says, “that wound is the uncomplicated — or primary — injury. That doesn’t kill the soldier; what kills him are the complications — infection or hemorrhage.”
Post-traumatic stress disorder, dr. Shay explains, is the primary injury, the “uncomplicated injury.” moral injury is the infection; it’s the hemorrhaging.
PTSD in service members is often tied to being the target of an attack — or being close in relationship or proximity to that target.
Moral injury, Dr. Shay says, can happen when “there is a betrayal of what’s right by someone who holds legitimate authority in a high-stakes situation.”
Vets-help and Dr shay have begun conversation as to how we can work together.
From The New York Times -The Rev. Rita Nakashima Brock focuses on helping people whose actions in war have shaken their deeply held moral beliefs. By SAMUEL G. FREEDMAN Published: January 11, 2013.