How to deal with PTSD and moral injury?
David J. Morris is a Marine veteran who wrote the book on PTSD: The Evil Hours: A Biography of PTSD. A fellow at the Black Mountain Institute, he’ll be part of an urgent panel this month, “The Grief of War: PTSD and Moral Injury in Today’s Veterans,” sponsored by BMI. (Disclosure: It will be moderated by Desert Companion’s Heidi Kyser.) We asked him a few relevant questions.
PTSD has been in the news; moral injury less so. What is it?
Moral injury is a newer idea related to PTSD that was developed by Jonathan Shay, a retired psychiatrist at the VA Boston. Moral injury speaks to the idea that soldiers may, over the course of their service, end up violating deeply held personal ideas of right and wrong. As Garett Reppenhagen, an army sniper in Iraq, explained in a recent article for Salon, “... I felt guilt and shame over committing atrocities against an occupied country. We went over there and brutalized and oppressed, and that is part of my psychological and moral injuries. If I can’t talk about it at the VA, then the VA can’t help me.”
Interestingly, the concept of moral injury, while technically new, harkens back to PTSD’s roots in the Vietnam War. One of the original ideas behind what became PTSD was the idea of what was termed moral pollution by some Vietnam vets. Sadly, when PTSD was recognized by psychiatry in 1980, clinicians immediately began to de-emphasize (its) moral and political aspects, focusing instead on the biological and behavioral aspects of the disorder.
Why has it received so much less attention than PTSD?
Because the VA and psychiatry have done everything in their power to de-emphasize both politics and morality. Psychiatrists don’t know how to talk about moral issues, and so they pretend they don’t exist. For example, moral injury isn’t even mentioned in the DSM, the bible of psychiatry. Researchers today are all laboring under this giant fantasy that a miracle drug is on the horizon that will “cure” PTSD once and for all.
What do you see as the consequences of society failing to address these issues?
The worst-case scenario is a repeat of the dark realities of the Vietnam era — a lost generation. Certainly we’re seeing aspects of this with the current suicide epidemic, which a 2016 VA study pegged at 20 a day. At UNLV, we just lost a vet by suicide over the holiday break.
7p, February 15, free, Rogers Literature & Law building, UNLV