Moral Injury is different than PTSD. With PTSD, the primary concern is physical safety. With moral injury, it is relational safety and trust.
Post-traumatic stress disorder and moral injury have important differences: PTSD is the result of a life-threatening experience that leads to chronic hypervigilance and fear; it is difficult to ever feel safe. Moral injury involves loss of trust; it is not a disorder but a reasonable response to having one’s ethical compass thrown off track.
There are many different ways that can lead to moral injury. For example a soldier in the line of duty may accept the necessity of shooting an enemy combatant. But when, in attempting to identify the assailant, he finds a picture of the dead man’s children, a sense of the value of service may itself be shattered. Shooting a civilian, especially a woman or child can lead to moral injury. An officer giving a bad order in combat can give the officer moral injury and also those to whom he gave the order. These are just a very few of the causes of moral injury.
Moral Injury leads to guilt and shame that continues to increase if untreated.
Moral injury is not currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Scientific consensus has yet to reach its parameters.
The fact that moral injury is not listed in the DSM or considered PTSD is great news for those suffering from it. You can seek help and never be given a label after treatment. The Vietnam War and the Afghanistan War were totally different than any other war we were in. The enemy did not wear a uniform.
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Therapists, counselors, social workers, and clergy are often the front lines of addressing moral injury; however, the larger community can also take part. Veterans suffering moral injury may seek help from another veteran. I also suggest that they first seek a member of the clergy first.
Consider that moral injury affects, and is affected by the moral codes across a community. In the case of veterans, moral injury stems in part from feelings of isolation from civilian society. Moral injury, then is a burden carried by very few, until the “outsider’ becomes aware of, and interested in sharing it. Listening and witnessing or moral injury outside the confines of a clinical setting can be a way to break the silence that so often surrounds moral injury.
Isolation, drugs or alcohol are never the answer to healing. Most important suicide is not the answer and hurts family and friends...
Again, moral injury is not a label for a person and does not label a person as does PTSD. It can treated by a member of the clergy who is under the seal and will never share anything with others.