It might be Moral Injury (and not PTSD)

This talk is divided into three parts—

1️⃣ PTSD & Moral Injury are different (2:04)

2️⃣ What Moral Injury looks like (30:34)

3️⃣ Healing Moral Injury (1:04:25)

Part 1 | PTSD & Moral Injury are different

In part 1 (which begins 2:04) at we discuss the main differences between PTSD and Moral Injury, noting that they’re both “invisible wounds,” yet they are unique.

Whereas PTSD is primarily and soul hurt (read: emotions), Moral Injury is a primarily a spirit hurt (read: conscience.

It’s important to note the differences…

… because any part of us can be injured. And, the part that is injured is the part that needs to be healed.

By the way, most injuries— especially in the “invisible” areas of the soul and the spirit— don’t reach the level of being diagnosable.

However, we must still seek to heal the hurt at the level we have it.

We conclude this section by defining PTSD as well as Moral Injury.

And, you’ll see Danny’s story from his time in Vietnam, highlighting the differences between the two (24:50).

Part 2 | What Moral Injury looks like

In part 2 (begins at 30:34) we dive deeper into Moral injury.

Moral Injury is a response to internal “threats”— not external threats (or perceptions), like PTSD.

Moral Injury CAN occur from the “bads we commit” AND the “goods we omit,” but life is far more nuanced that just “doing the right thing and avoiding the wrong thing.”

So, in this section, we highlight nine different ways Moral Injury occurs.

Note: these examples are not meant to provide an exhaustive list— but simply to show examples.

Here are the nine we discuss.

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1️⃣ You do the right thing but it’s an ethical “wrong” in another environment (38:05).

Example: J.T., firing his weapon, to “take out” an insurgent

2️⃣ You neglect doing something “good” or something you feel you should have done (39:32).

Re: Danny’s experience in Vietnam.

3️⃣ You do something good but a bad outcome happens (40:46).

The airplane he was piloting crashed. He survived but over a dozen others did not.

4️⃣ You don't do something wrong at all— but you don’t recognize the signs of something bad about to occur (42:37).

Example: Chris got a promotion. He celebrated with his fire team, but got a call about 2 hours later.

5️⃣ You survived something, yet someone else was injured or killed (43:56).

Example: Jonathan’s training officer delivered a warrant on one of Jonathan’s regular off days.

Example: Father Ed… and survivor’s guilt

6️⃣ You’re the victim— something happens to you, yet you still feel guilt & shame (46:47).

Example: She was the victim of military sexual trauma (repeated rape).

7️⃣ You try to help but you don’t succeed (48:37).

Example: The fireman went the “wrong way” in the house fire. They discovered there was someone in the opposite side of the house, after the fact.

Example: The tank accident

8️⃣ You think you could have helped, but you were ordered to stand down (51:21).

Example: Rachel had orders to wait until law enforcement cleared the scene of the shooting, while two victims awaited her.

9️⃣ You see something that defies all moral & ethical sensibility (54:03).

Example: Jackson received a call, and went to help the victim at her neighbor’s front porch.

(Again, this not an exhaustive list of the ways Moral Injury can occur— it’s a list of ways that is HAS occurred.)

Notice that the common denominator in each of these is NOT “fight or flight” (like PTSD). It’s “guilt and/or shame.”

In other words, it’s a spiritual/conscience hurt— not a soul/emotional hurt.

Here, we play another example that shows Moral Injury— when a veteran doesn’t get diagnosed for PTSD— that shows the distinctions (58:08).

And, another veteran talks about wishing he could “scrub his brain” (1:03:27).

To clarify, any part of us affects all the other parts.

Part 3 | Healing Moral Injury

In part 3 (begins at 1:04:25) we talk about the path forward for Moral Injury.

The biggest issue with Moral Injury is the guilt and shame factor— each which causes people to want to hide and “stay in the dark.”

When writing a recent book, Overcoming Warrior Family Trauma, we found the following stats related to suicide (1:05:40).

My thought— after talking to many professionals— is that Moral Injury drives the suicide rate. In part, it seems that the symptoms of Moral Injury “grow” over time (whereas PTSD lessons). And, people are more likely to take their own lives later in life rather than earlier.

The solution is to walk into the light (1:13:52). Oddly enough, practitioners from across various fields and strains of faith agree…

… forgiveness is required.

And that forgiveness must come from another person.

When we walk in the light, healing happens, cleansing occurs, and we find community, connection, and common ground.