MORAL INJURY ARTICLE

By Craig LaSeur, MA, LAC, LCDC

Since Vietnam, PTSD has progressively become understood and effectively treated. Often standing with PTSD or on its own lies a condition that is often not understood or remains invisible: Moral Injury.

Due to the acute nature of PTSD, significant attention is given to assessing, treating and education. If the PTSD is treated and moral injury is not, there can remain a condition that fosters instability, loss of joy, loss of trust, disconnection from healthy / supportive relationships, negative self-image, loss of faith, and impulsivity. Further, PTSD and Moral Injury share some common symptoms that can make assessing the conditions difficult.

PTSD occurs when an individual experiences or witnesses a traumatic event. The impact of the event(s) can be felt immediately, develop slowly overtime or remain dormant only to become operative later.

Some of the common symptoms are (there are more that will be identified below under shared symptoms):
   • Flashbacks
   • Memory loss
   • Fear
   • Startle response

Moral Injury is a condition of shame, self-defeating thinking/behaviors, anger, and demoralization occurring when an individual observes or participates in events that transgress their personal belief system about moral/ethical conduct. This can include the act of killing, violent behavior, betrayal of trust from leadership, witnessing depraved actions or failing to stop immoral/unethical acts. Moral Injury is a form of loss, a disconnection and distancing that can cause significant difficulty in a person’s life.

Here are the common traits of Moral Injury:
   • Grief
   • Sorrow
   • Shame
   • Alienation
   • Regret

There are symptoms that are shared by both conditions. Given the prevalence of information, education and treatment of PTSD, these symptoms have the tendency to be associated with PTSD solely thus overlooking the possibility of Moral Injury.

These include:
   • Anger
   • Depression
   • Anxiety
   • Nightmares
   • Insomnia
   • Self-medication with drugs and/or alcohol

The above definitions and symptoms are simplified nor are meant to be an exhaustive narrative on the subject. As with most conditions, the symptoms and manifestations can vary from person to person. It is a basic starting point to begin considering the role Moral Injury can play in a person’s wellbeing.

Healing from Moral Injury can take many different forms. At The Hero Program, we approach this healing in three different ways. 

   • Education: One component of the curriculum is an overview of Moral Injury, what causes it, the effects, and the process of healing. This is often the first exposure of the concept of Moral Injury for a veteran.

   • Individual Sessions: The case managers/therapists and veterans will discuss Moral Injury in order to assess if it is something the veteran needs and wants to address. The work to treat Moral Injury occurs in a group setting, requiring vulnerability and intensive work. The therapist and veteran will determine if the veteran is ready and capable of taking on the process of healing.

   • Moral Injury Group: For veterans who are committed to staying at the Hero Program 60 days, the Moral Injury Group is available to them. This is a three-week group that meets daily, Monday-Friday. Recovery occurs in the context of relationships thus the group is an essential component of recovery.

Recovery from Moral Injury can be a liberating experience. It means the end of isolation, connecting with healthy relationships, finding meaning, experiencing faith and joy. There is help for Moral Injury at the Hero Program and in many other institutions so if you think you suffer from Moral Injury, please reach out.