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).
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.
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.
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.
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:
The video shows attempts of coping with Moral Injury, after war:
Link for the video: https://www.youtube.com/watch?v=2oJwa87cQ_g