Beyond PTSD to “moral injury”

Can I prove Dr. Jonathan Shay is right? Yes, because he proved it to me before this generation went to war. I contacted him back in 2000 after reading his book, Achilles in Vietnam.

After reading about a hundred clinical books on PTSD so that I could understand what made my husband so different from the rest of the veterans in my family and hearing my Dad say "shell shock" it was obvious to me that there was something missing in all of the books. The humanity in the inhumanity of war. In Shay's words, the "moral injury" of the people sent. Shay's book not only helped me to save my marriage, it helped me to save others.

Beyond PTSD to “moral injury”
Filed by KOSU News in Public Insight Network.
February 20, 2013

“I really don’t like the term ‘PTSD,’” Department of Veterans Affairs psychiatrist Dr. Jonathan Shay told PBS’ “Religion and 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.”

Shay has his own name for the thing the clinical definition of PTSD leaves out. He calls it “moral injury” — and the term is catching on with both the VA and the Department of Defense.

We’re turning our attention to this idea of moral injury and the limits of the PTSD diagnosis to explore what happens to a person who has experienced combat.

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 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, Shay explains, is the primary injury, the “uncomplicated injury.” Moral injury is the infection; it’s the hemorrhaging.
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I knew my husband was a good man but he started to believe he was evil because of all the things flooding his mind. While I understood the clinical aspects of PTSD, what I was living with was missing from thousands of pages in the 80's. I began to believe I was right about the spiritual aspect of PTSD when I discovered Point Man International Ministries was addressing it since 1984 but I was not aware of them until the 90's when I got online.

Shay's book reenforced the need to heal the soul/spirit first since that was where PTSD began.

It is not a matter of forgetting war but more a matter of making peace with it and all that came with it but first they had to know themselves. What was their original intent? Was it to defend this country? Was it to help the others already fighting the battles? Was it to save lives? All of this is forgotten when they see so much horror and evil during war. They forget that had the enemy surrendered, they would have been very happy to stop fighting. They didn't want to kill anyone but in war, that is what they have to do because other people are trying to kill them. The "moral injury" hits them harder than anyone else other than police officers, because they do not just witness the horror, they participate in it. That is the nature of war. It isn't pretty.

When I work with veterans, I walk them back so they can see the whole event as well as what they were feeling at the time and then help them make peace with it so they see themselves for who they really are inside and most of the time, they were the "givers" ready to help anyone in need. They see that while they endured some evil things, they did not become evil because of them. I help them discover that God was in fact there all along as long as within all the mayhem of war, someone cared about the suffering, reached out to help, cried, mourned for the loss of humanity.

If you ever want to understand what PTSD is, read Shay's book and know that this generation is just as human as all the generations that came before them. When it comes to their suffering, we know better than we did when Vietnam veterans came home but unfortunately, the lessons learned have been forgotten.