Is a Moral Injury the same thing as PTSD?
The term moral injury was coined in the 1990s by psychiatrist Jonathon Shay who observed the presence of it in Vietnam military veterans. It refers to the trauma of behaving or witnessing experiences that go against a person’s values/moral beliefs. This experience tends to deeply violate an individual’s core values. Essentially, it’s the internal response to an ethical dilemma a person has to decide on.
What is moral injury?
Moral injury is a prolonged experience that has emotional, psychological, social, behavioral, and spiritual impacts on an individual. It often leads people to question their identities, beliefs, confidence, and expectations of themselves and others.
Examples of moral injury:
Doctors must decide on which patients they can and cannot see.
Veterinarians must decide to put animals down when no one is available to adopt them.
Social workers must decide on what they can and cannot do for their clients.
Military soldiers are assigned to protect and defend themselves which can be through violence towards other people.
Front-line workers making critical life or death decisions for their patients.
An individual freezing or underperforming during a traumatic event.
During the pandemic, and even now, our healthcare system had many workers experiencing moral injury. Healthcare workers who were providing care for people who were suffering from COVID-19 felt it intensely. The number of hospital beds that were available were limited and the knowledge needed to treat the disease was also limited. They were risking their lives working in such environments while being unsure if they were able to save others. This is an example of those who have experienced moral injury.
What does moral injury look like?
Feelings of Guilt → individual’s experience guilt of the situation and can isolate themselves with information about the situation.
Experiencing Depression → individual’s feeling overwhelmed by their choices which prevents them from living healthy lives.
Feelings of Betrayal → individual’s having a hard time forgiving themselves for their choices/behaviors.
Feelings of Shame → individual’s feeling like they are a bad person because of what they did.
Thoughts of Suicidal Ideation → individual’s may feel like they don’t deserve to live.
How is moral injury different that PTSD?
PTSD and moral injury are similar but there are differences. Post traumatic stress disorder can be found in the Diagnostic Statistical Manual-5 (DSM-5), which means that it’s a formal diagnosis. Moral injury is not a formal diagnosis. According to the US Department of Veterans Affairs, PTSD differs from moral injury because it is a fear-based experience. Moral injury includes fear but it’s based in estrangement from an individual’s character and core beliefs.
What can I do to help someone going through moral injury?
Reach out to them and ask them if they’d like to talk about their experience. Social support is a way to process experiences of moral injury.
Find a trauma-informed therapist who can provide a safe space for them to heal and process what they’re going through.
Suggest Meditation and Mindfulness practices. (https://insighttimer.com is a great resource for this)