“A Stain on the Soul”: Why Moral Injury Requires A Different Treatment Plan Than PTSD
with Bessel van der Kolk, MD; Judith Herman, MD; Rachel Yehuda, PhD; Ruth Lanius, MD, PhD; Matt Gray, PhD; Wyatt Evans, PhD; Bill Nash, MD; Megan Schmidt, PsyD; Ruth Buczynski, PhD
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My takeaways are that a big difference between moral injury and ptsd is that moral injury can carry an intense sense of shame and guilt justifiable by past actions or transgressions, whereas a common symptom of guilt and shame from ptsd is often hindsight bias or unfounded. A helpful route to healing from moral injury is to help clients regain and connect with their moral values.
How is ADD related to moral injury? Some feel such guilt and shame for not being able to accomplish what they want that they cannot move forward.
the importance of not discounting legitimate feelings of guilt and shame, but accepting them as a path to affirming or discovering core values and building new actions based on those values as a kind of amends making.
Caution of retraumatizing with too much repetition, rather engaging community in shared responsibility and commitment.
Allowing guilt in Moral Injury and not speed up the process or glossing over in CBT
It is so complicated and complex to tease apart trauma from the moral injury when they are so intertwined. but necessary.
So many health practitioners in hospitals during early covid felt their hands were tied in limits to what they were aloud to do to help their patients, or what they were required to do that they knew would cause greater harm, and had to just watch their patients die. Such moral injury.
I will be more aware of my clients’ traumas and if they are suffering from PTSD or moral injury. I will take time to assess if it is one or the other.I will also take into account the treatment options for both. Thank you for this valuable information!
Thank you for highlighting the scope of individuals who suffer from moral injury outside the context of military combat. Even still, the examples provided were of more intense situations which included death or a real threat to survival, which are ideal examples for the purpose of this training. That said, I want to also acknowledge that moral injury could be sustained by an individual who lashes out on a loved one while triggered. The trigger may have had nothing to do with those on the receiving end of the lashing. The individual is then left with feelings of shame from losing control upon being triggered PLUS intense remorse for the pain inflicted on their loved ones. This can be extremely devastating to one’s sense of self and strain their most-valued relationships. Let’s say the individuals family members are harsh and unforgiving- this can cause the wounds of the moral injury to deepen and intensify. For someone who is already struggling with their history of trauma, such experiences of interpersonal conflict can create a perceived lack of safety in one’s closest relationships, thereby exacerbating symptoms such as feelings of disconnection and unworthiness. I’m curious to hear from other practitioners what protocols or best- practices should be considered when working with a client who is suffering from interpersonal conflicts and internalized shame that occur after they’ve lashed out on loved ones while in a triggered state? Thank you!
What an incredible session, I learned so much that I can use right away with a client who I now know is dealing with moral injury. I will start doing the values exploration and then discuss some behavioral activation to help her realign with what was important to her before the injury occurred. I think just being able to name this as moral injury will be extremely helpful
One moral injury that was missed is women who have abortions or nurses who assist in abortions.
I found this program on moral injury very helpful and am reviewing my clients who may be “stuck” even after processing PTSD. I am looking forward to adding some of the strategies mentioned–especially the reconnection to their core values and making amends– to help my clients move forward to more vitality and peace in their lives. Thank you for the presentation.
Important to know which trauma interventions may be contraindicated for clients who experience moral injury.
I found this presentation and discussion very helpful. I have found that using some traditional Buddhist practices in these cases can also be very effective. Something as simple as acknowledging and expressing remorse about a transgresion we have committed can be very healing, and helps to releive that ‘stain on the soul’. Coupled with atonement and self-forgiveness practices.
It was good to see some mention of this in the last minute of the program.
I appreciate and share your valuing of deep Buddhist practices. Thank you!
It’s crucial to understand, I’ve found, that “making amends” is essential to healing. It goes deeper though, when the person who has been traumatized by committing acts deeply offensive to their deepest values –discovers they not only can offer something of themselves of value to others, but that in doing so, they are fulfilling a destiny: a wounded healer archetype comes to mind….The Injury gives rise to the Gift. Comment about the father discovering he can reclaim and offer nurture, intimacy, hugs, connection with his kids for himself, but that he is making amends for neglecting them, out of his guilt and alienation. Last note: our prisons with successful rehab programming, involve the wounded healers, discovering they are Good At Heart, and that the world needs their love and contributions. Blessings
I forgot to add that our political world also shows examples of people who did reprehensible, corrupt acts, and, often in prison, reclaim their humanity, and reenter the world with strong moral convictions, and actions, forever tempered by their past deeds.
I love the attachment concept woven into the interventions – rupture followed by repair suggestions when seeking reparations – it also touches on the Wounded Healer motif where the place of our wound can be the place of our healing and service to the world. thanks for such an inspiring talk
I have not heard of moral injury before and would like to learn more. It made me think of clients who have recovered from substance abuse and the effects it had on their family’s and coping with that information as a sober person. I would also like to learn more about ACT.
I appreciated the discussion on how someone who has committed an act that has left them with moral injury can’t reframe that act – they engaged in the act, it was a reprehensible act, they feel terrible guilt and they will not be able to “explain it away.” But they can reclaim their moral selves and make amends.
This session made me realize people who are addicted are often suffering from moral injury — ex. they’ve stolen money from someone they loved, they’ve cheated sexually on their spouse; getting high took priority over caring for their children… helping them navigate those difficult feelings while acknowledging culpability may help heal their hearts.
This was a wonderful workshop and I feel excited in applying the concepts I learned today. The information was tremendously valuable and can only improve my care for my clients. It opened my mind to understanding the different approaches I should take between PTSD and moral injury. Thank you so much to all the presenters. Elisabeth.