Although they have some overlapping challenges, Post-Traumatic Stress (PTS) and Moral Injury are not the same thing. A service member or veteran may have PTS, Moral Injury, or both. The mental state of someone with PTS is that of someone who feels unsafe - that the world is not safe, and that others can be trusted. PTS has a strong biological component - patients are often chronically activated, flooded with anxiety or flashes of sudden rage, which is often how warriors express anxiety.
When people are struggling with unaddressed PTS, they exist in a state of what I call “chronic threat response” that is paired with a biological alteration that Special Forces Col Jim Lynch calls “dysfunctional sympathetic tone” – as described in this article in THRIVE GLOBAL - A New Model for Trauma Care: The Fusion of Biological and Psychological Approaches
. Moral injury has some overlapping symptoms with Post Traumatic Stress, but the clinical picture is not the same.
A person with moral injury feels somehow tainted, stained, or contaminated. The clinical picture of someone who has been morally injured is that of a cancerous form of shame that metastacizes over time if the moral injury is not addressed. To be clear, the presence of shame does not mean that someone has done something they should be ashamed of, as explained in another blog in this series, “What is Moral Injury?”
In short, just as PTS can be seen as an injury that can occur after exposure to a trauma, moral injury can happen to us in the same way. Further, shame can be socially transmitted from one person to another, and from one group of people to another group.
But the impact is not the same. Understanding key differences become important when it comes to creating a recovery plan that is on target. The treatment for PTS and moral injury is not the same, because the roots and the personal impact of each are not the same.
In my book, WARRIOR: How to Support Those Who Protect Us
, I describe the treatment approach I’ve used to address moral injuries, with consistently good outcomes. It is not the same as the treatment approach I’ve found most helpful for Post-Traumatic Stress (which is described in the THRIVE GLOBAL article referenced earlier in this blog).
Getting a handle on what moral injury is, and training healers in how to address moral injury, is going to be critical to advancing the care of military service members and veterans.
Want to Learn More? Here is a link to where you can pick up a copy of my book WARRIOR