Invisible Injury

Soldiers enter the military with the intention of serving their country and with the feeling that they are good and would never harm anyone under any circumstances. However, these thought and sense of right and wrong are sometimes altered due to the social influence, power of the situation and stressors that are facing.

The definition of trauma as indicated by John Wilson in “The Traumatizing Unconscious of Traumatization” is the ability of the therapist to differentiate between the usual and unusual and drawing the line between the normal and the abnormal through the individual’s ability to cope with his past, present and future life experiences.

In the comic, “ Invisible Injury”, a traumatized former marine who has been depending on alcohol for many years has attended therapy lately in which he reveals to his Psychiatrist, Jonathan Shay about his traumatic experience in the Vietnam War. Through “Narrative Exposure therapy”, the former marine started by expressing his feeling towards other soldiers and ordering them to kill prisoners, he described it saying, “I carried them into sin”. It describes his feeling of guilty which is one of the symptoms of “Moral Injury”.

Moral injury is the ability of differentiating between the right and wrong in the individual’s attitude and behavior. In response to the marine’s thoughts and feelings about being guilty, Shay has been able to have “Empathy attunement” towards his client’s situation. For example, he mentioned in the comic that Shay said, “My patient took that as an order to kill them”. Having empathy towards the client is due to the traumatized experience he said when the authorized figure gave the marine order to kill the soldiers and consequently had had to transfer the order to soldiers under his supervision.

Further, Shay has emphasized on respecting the client’s sense of still realizing what is right and what is wrong in regards of feeling guilty. Respecting your client will guarantee more elaboration form the client and will encourage him more to open up on other experiences, he is reluctant to say. In this sense, the clients is going through “ Trauma Specific Transference Transmission” (TSTT); he is narrating all the vents that caused him the trauma as it is decoded by the therapist, which has previously been in the state of “Trauma Specific Transference” (TST).

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Based on the transmission of events that happened during the therapy, Shay believes in the role of “Shrinking the moral horizon” concept plays in the sufferer’s life. He described it as a big tent that includes people who you are in contact with at work, family, friends and those who are affected by your behavior directly or indirectly.

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For instance, in the comic, the soldier started to take away people from his tent day after day due to the behaviors he has taken on. Those behaviors include blaming people for responsibility on assisting him in taking certain actions that not only affect his life, but others too. He feels accountable for destroying others’ lives as well, to end up alone and surrounded by war all the time. One of the most powerful stories the client is telling is having to shoot all dogs during his service in Iraq. It is strong in the significance of dogs for the soldiers, in which they make him feel happy. Being given the order of killing dogs is somehow killing his own source of happiness and depriving him from the ultimate creature that he used to live with all his childhood. The soldier betrayed his sense of moral aspect in order to obey the rules of the authority.

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Brett Litz, clinical psychologist was able to divide moral injury as the client is exposed to, into three biggies: Self-harm, self-handicapping and demoralization, in which they affect the traumatized client’s life. Through the given “biggies”, the individual is destroying himself unconsciously and sometimes it can be called consciously in an attempt to forget the harm he caused to himself and others.

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The drawback is that not all symptoms of moral injury are included in the diagnosis of Post Traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). The factor that caused many soldiers in the past to pretend they have some of the symptoms of PTSD, to be diagnosed and treated of PTSD. It is important to mention the empathic capacity of the therapist to be able to emphasize and absorb the client’s thoughts and feelings during the therapy. As Litz mentioned that the core of therapy is to help the client get rid of their “uniquely toxic wounds” and integrate with their sense of self, instead of escaping from the world and living in chaos and in isolation. 

Difference in diagnosis between PTSD and Moral Injury:

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The video shows attempts of coping with Moral Injury, after war:

Link for the video:


Self- Care Plan

It seems that the results of the self care assessment, really reflects my underestimation for having a plan that keeps my life happy. Unfortunately, I don’t tend to give my body and mind, the needed amount of rest to be fueled with energy in order to accomplish all the tasks I have. On contrast, I am the kind of person who would do anything assigned to her and even things for others, only because of my feeling of commitment towards others and work. Hence, the self-care plan has given me a great opportunity to reorganize my life again in somehow a mandatory way as part of the course “ being committed to the plan”, which will encourage and motivate me to work on myself and hopefully it will start to be a habit after following it for the first month.


There is a strong link between the results of the self-care assessment and the way I function in different life aspects; workplace, emotionally, relationships, physically and spiritually.

These are my results:

Workplace or professional Self- Care      28/40

Physical Self- Care                                       17/28

Psychological Self- Care                             17/48

Emotional Self-Care                                    25/32

Spiritual Self- Care                                      25/32

Relationship Self-Care                                22/32

Overall Balance                                              7/8

 Starting with my worst results is unfortunately the “Psychological Self- Care”:

I need to indulge more in social and cultural activities that address topics, not related to my field of study or interests. This will indeed widen my horizon, in addition to a stress relieving technique, as I believe it would be able to stop my mind a bit from processing information for an exam to study, for instance or a paper to write. I also want to join a “Yoga” squad in which I can try meditation techniques, as I have never tried them before but have always heard about its great effect on getting rid of all life stressors. Both activities are doable as for attending lectures or talks that are not related to my field, would be accessible through any lectures in university. Also, for the “Yoga” classes, I have started today to join a fitness group and they have a yoga class that I will ask to join starting next Monday.

I also want to focus more on my relationships with my colleagues at work or university, which is related to the “ Workplace or professional self-care”:


johnny-carson-comedian-quote-never-continue-in-a-job-you-dont-enjoy.jpgOne of my first priorities that I hope would be able to achieve is having a supervisor or a psychologist that I always go and talk to without even having a huge problem. It is more of a way getting all what stress me out of my way than being in a therapy because of psychological problem or disorder, disturbing me. Honestly, I have thought of taking this step into action many million times before, but what stops me every time is that I am shy of going and talking to someone who might underestimate my problems or what bothers me compared to other clients’ problems. In addition to, not be used to ask help from others. I have always been raised as a strong woman who is sued to accomplish all the tasks on her own, which makes my proud of the way I am brought up, but sometimes I need to feel not that strong so that I can break that wall and go ask for help when I am tired.

 For the “Physical Self- Care”, I have taken this test, few hours before getting back to sports.

The test has actually played a major part in encouraging me to play sports again and be more energetic. Today is my first day as a healthy woman, eating healthy and practicing sports that I aim to be a habit “life style” on the long run. Accordingly, I will start to eat healthy and regular meals starting form tomorrow in order to maintain the body shape I want to reach. I will also consider taking my dog, “Ziza” for a walk as a way of walking or even jogging and for the dog to feel happy, same as I will.


However, my problem with neglecting my well being for the sake of finishing my tasks and being committed to whether my professors, parents or even friends who need my help, is huge problem that will need a lot of time to work on fixing. I am the type of person who likes to listen to people’s problems and try to help them even though this would have a negative impact on myself, maybe it is out of commitment, being shy to leave them without help or because I love them and do not want to see them sad, while am idle, doing nothing to help them with because at that moment I will feel so guilty that I didn’t offer them help when I could. Indeed, I will never try to change this side in my personality; however, I will plan to arrange some” quality time” for myself to sit and relax without answering phones or looking at mails. Despite this, I am sure I will tell those who I care for, beforehand that I will not answer any phones from 7 pm -8pm, for instance they can call me anytime. 😀

Concerning the “Spiritual and Emotional; Self-Care”, I believe they are somehow related to each other.

Being spiritually good will reflect on having empathy towards people, wanting to help people and make the happy. I think on the spiritual aspect, I am like the “yoyo” game. It depends on my psychological status and problems. If I am sad and have many problems I would more likely pray or read the Bible. However, I always remind myself of thanking God on even arriving university safe with all the accidents we see on our way, but I usually do not do so, and only ask for God’s intervention when I am in trouble. Recently I have started to practice praying in the car in the morning while going to university, as a way of making it a regular habit to pray every morning. I have came up with this idea because I see my mother praying every morning before going to work, which returns to my thought about the bond between emotional self care and spiritual self care. I regard my mother as my role model because I love her that I would like to imitate as if I am a child imitating her mother’s behaviors. For my family I have a strong emotional bond that does not need much work to be done on improving, thanks God: D

However, sometimes I have problems in communicating with my brother who is almost two years younger than me. We used to be closer when were younger but due to many recent problems there is a gap that we tend to ignore or pretend that we don’t see in order not to face the reality and talk about the factors that have led us to this point. In other words we are avoiding the stressors that might cause disturbance. I will try to go out with my brother more and be closer to him. I want our old bond when we were young to return.

Lastly the “Relationship Self- Care”, this has caused many problems as I used to take my partner for granted as he understands my problems and stressors I ma passing through, and work on other things.

Recently, when I grew older, I learnt that nothing is taken for granted and that if you do not work hard for what you want, you won’t be able to reach it. That is what I am currently working on for almost one year. I am working on dividing time for people in my life. Time for my close friends, school friends, friends from university, family and my “significant other”. For instance, I can go to the cinema or have coffee with my partner even if I have many work to do, this would make him feel how important he is to me. The same case is for my family, today I went with mother to many places because he want my help, even though this had me late on many things that I need to accomplish for university and my personal life. This has took me years and many difficult times that I have passed through in order to understand the importance of prioritising my relationships and giving each person in my life the “quality time” I will enjoy myself and he/she will enjoy as well without annoying others for prioritising work over family, for instance.


Jean-Martin Charcot neurologist and psychologist

Pitching into the concept of trauma requires the focus on one of the greatest pioneers among trauma psychologists. Jean-Martin Charcot was born in the ninetieth century, in Paris, for a carriage builder father. When he turned 19, it was the time he graduated form secondary school, to later achieve his goal and enter the medical school of the University of Paris.

That was the school he accomplished his internship in which he surprisingly worked as a professor in. Along with teaching students, Charcot was a famous neurologist and the director of the Salpêtrière Hospital. He was married to Madame Durvis, in 1862 and had two children, Jeanne and Jean-Baptiste.

Charcot had three main contributions to modern neurology and psychiatry. He first diagnosed the hysterical disorders (psychoneuroses), and presented a study of its etiology and that proved by the time that hysteria was caused to female patients mainly on the form of physiological disturbances, such as anesthesias and paralysis. He was also able to determine the relationship between behavioral symptoms and the physiological disturbances of the nervous system; thus detecting the roots of the abnormal behavior symptoms. In order to learn more about hysteria, Charcot finally invested more time in studying the “hypnosis” (mesmerism) technique that he believed was a great way in diagnosing hysteria in therapy.

Through the patient being hypnotized, they fall asleep, in order to be able to recall and integrate with their traumatic incidents that they were escaping in their walking state, through narrative psychology (to link their past with their present). In integrating past traumatic incidents with PTSD patient’s new life, Charcot believed that once the “forgotten” traumatic event is integrated under hypnosis; it would be easier for patients to integrate all dissociative memories in their walking state later.

Charcot was not interested in the history of the trauma or how the patients formed it; he was more interested in the physical appearance of it in the form of hysteria on the patients. He was more inclined to use the biopsychological approach than the biopsychosociological one, that emphasized more on emphasizing wit patients and genealogy in trauma psychology, linking all threads of their traumatic incident together as trying to fix the damaged branches of a family tree.

It is impressive to note that Charcot had taught many of our leading psychologists, such as Sigmund Freud, Pierre Janet and Alfred Binet. However, the teacher’s students came into disagreement with their tutor, as they believed that hysteria was the result of a psychological, not neurological dysfunction. In addition to that Freud thought hysteria was related to a repressed sexual interest that is one of the symptomology of showing it is hysteria on females.

However, he came to agreement that patients had suffered form hysteria as a form of emotional consequence to the traumatic incident they experience, whether it is a fall from a scaffold or a railway crash. The main cause from being traumatized is due to the way they had shaped the incident in their minds, not the physical consequences of the event on them. Charoct contributed to modern neurology in diagnosing what is known today with the “Charcot Foot”. It is mainly caused to diabetic patients who have weakening in the bones that is due to damage in the foot nerves.

Charcot died in Morvan, France in the year 1892 at the age of 65 years.

Interesting Facts about Charcot:

  • A song “Let Yourself Go” from The Alan Parsons Project’s Freudiana is dedicated to Doctor Charcot.
  • A 2012 French historical drama film, Augustine, is about a love affair between Charcot and a patient.

Watch this conversation on hysteria causes: Charcot and his student, Freud.

A Discussion between Sigmund Freud and Jean-Martin Charcot on a patient with hysteria