The research is still evolving – but we’re discovering more about the overlapping similarities and key differences between moral injury and PTSD.
And as leading researchers like Bill Nash, MD uncover more insights, they’re finding that conventional trauma interventions may not be fully effective in treating this form of trauma.
In the video below, Bill shares an example of a moral injury and how trauma symptoms can persist if we don’t account for it in treatment.
Please have a look.
Here’s an example, and this breaks my heart to even think about it. But I was consulted by psychologist a year or two ago to consult with a family they were working with; a couple who had had their infant daughter attacked by the family dog. The dog chomped down on the baby’s head, and brain damage and still not clear how severe the disability will be for the baby. This happened at home with dad in the next room fixing a meal or something, and the first thing he heard was this scream and growl. And he went out there and pulled the dog’s jaws off of his child.
So, I am consulted and I sit and speak with this couple, and guess what? Their individual responses to this traumatic experience were very different. Because he was home. He failed. She didn’t fail, he failed. And it doesn’t matter that there may be nothing he could have done to prevent that from happening, he will always, until his death, will feel responsible for that, because that’s how we’re wired. Social institutions are not capable of moral emotion. That’s why we have to feel them for our institutions. Because corporations don’t feel shame or guilt. They don’t feel anger, so we have to feel that for them.
So to me, helping this person begins with setting aside whatever kind of theoretical understanding you might have of that. And just as a human, if that had happened to me, oh my God. Nothing else matters until you can sit with that. Right? That’s crazy. But the clinicians were… they were actually criticizing him for not doing his homework and not seeming to recover and improve as fast as his wife was. That’s adding insult to injury, literally. Literally. And we do it all the time. It’s heartbreaking.
In Mastering the Treatment of Trauma, we dive deeper into how you can distinguish moral injury from PTSD. You’ll also hear strategies to help you treat it (and what interventions might be contraindicated).
You’ll get the latest insights from Bessel van der Kolk, MD; Judith Herman, MD; Rachel Yehuda, PhD; Ruth Lanius, MD, PhD; Matt Gray, PhD; Wyatt Evans, PhD; and more top experts.
Take a look here.
Now I’d like to hear from you. When have you encountered moral injury in your work with trauma? What strategies helped you to recognize it? I’d love to hear about it in the comments below.