Moral Injury

 

Moral injury, a concept implying that one’s behavior goes against one’s morals, both individually and collectively. Behavior in one setting. like murder, is considered evil, but in the context of war, taking a life, is understood in a different way, and yet, it brings up the possibility of profound guilt, which, in my mind, is almost identical to moral injury. The idea that one can feel good about a behavior in the moment, but upon reflection, can have crippling regret, is the power of the human psyche to re-evaluate one’s actions with superego ideals, leading to despair, with the challenge of subsequent forgiveness. Suicides are high in our post Iraq and Afghanistan veterans, and so it is possible, but not proven, that this high rate of self-destruction, is due, at least in part, to a particular crisis in moral injury. Perhaps the behaviors of our returning soldiers, in retrospect, is too painful for words, too outside the concept of forgiveness. So, the question is whether the term “moral injury” furthers our understanding of these veterans, or whether it is redundant, given our established diagnosis of PTSD. I think “moral injury” focuses on guilt, whereas PTSD focuses on hyperarousal. Both are key components to the disabling psychological trauma which many of these veterans experience. “Moral injury” adds on to the multifaceted way in which those who have gone through an experience, so outside of mundane human activity, are left with a mind filled with confusion and anxiety. Understanding this suffering, perhaps by crystallizing a part of it under the term “moral injury” is one step further to helping those who suffer alone, join a community of empathic souls.

Lost Years Stimulated By Turning 50

Tea, turned 50 in December, but she is still fixated on this number. “I finally figured it out,” she tells me with great enthusiasm. “Yes,” I say, nodding that she has built up suspense. “Well, as you know, my son died twenty years ago and for me, the world just stopped. I was in a grief period, of course I still am, but I was really in another world for so many years, that turning 50 does not seem real to me. Everyone looks at me with a sense of recognition about how hard it is to turn 50, but I know that I am experiencing something that they do not connect to. I feel the loss of so many years where all I could think about was my son. That distortion, if you will, made me lose the normal tracking of time, such that I cannot latch on to my age. Sure, I have the other issues of aging, both body and brain, but that is not what is getting to me.” Tea relates this to me, as if she has solved a challenging puzzle. She is enthusiastic and not sad about her disclosure. “You know, it makes me sad to hear you talk about your son and particularly sad to hear how you feel you have so many lost years because of it. I am a bit perplexed as to why you don’t sound sad as you talk about it. At the same time, I can understand that you had an itch, which was the mystery of the meaning of turning 50, and now you have scratched it.” I say, knowing that we have discussed on numerous occasions how talking about her son is sad for both of us, but that does not mean we should not talk about him. “Yes, I do feel like I scratched an itch. That nails it. Before, I just felt so uneasy about my age, but it did not make sense to me, because normally I am not sensitive in that way. Now, it makes sense to me, so I feel better.” Tea, has done self-analysis, in a way in which she is communicating to me that the tools from our work together have helped her dig into her mind and test out hypotheses, until she lands on a concept that feels satisfying to her. “It must be so hard to ‘lose’ so many years, and have the people in your world not appreciate your feelings. I mean, I can connect with what you are saying, but it still must feel lonely.” I say, highlighting an old discussion about how Tea feels so alone in her grief. ”Maybe you lost many years, but now that you have turned 50, you will be starting to appreciate time in a different way.” I say, highlighting that maybe this self-discovery will yield a deeper presence for her. “I can only  hope,” Tea says, now looking sad, but appreciative of our discussion.

The Yoga Intervention

http://www.traumacenter.org/about/..\clients\MagInside.Su09.p12-13.pdf

This article, by a well-respected expert, asserts that yoga heals the mind by working with the body. That makes sense to me.

Grief and Dread: Thinking About 9/11

“Grief and dread,” are the words echoed in the memories of 9/11. The paradigm of trauma, the events of September 11th, exemplify the characteristics which often lead to PTSD. This was a sudden and unexpected tragic event. If there were terrorism on the tenth anniversary, yesterday, this would not have been unexpected, but it could have been a tragedy. The grief is the loss, but the dread, is how out of control our lives can be, despite routines that we do day in and day out. It was World War I that made psychiatrists sensitive to this issue of trauma; this issue of the particular pain of sudden and unexpected harm. It is psychologically easier to have a diagnosis of cancer, giving fair warning, if you will, to the person about their upcoming demise. Trauma, however, feels so unfair. There is no way to prepare; there is no way to slowly change your mindset from contentment to helplessness. It happens way too fast. Time is an important dimension when it comes to receiving bad news. The mind seems to need some preparation, such that without that, there is an uncomfortable jolt to the mental apparatus. Consequently, the unexpected nature of these events like 9/11, make them etched in our collective minds, such that we will always be able to swap stories about what this terrorism meant to us on that day. We are forced to remember that our old paradigms can change in a moment. Once we “learn” that, we never forget. Trauma and memory often go together. The association between the event and the shock, causes a deeper imprinting in the hippocampus, the area of the brain responsible for memory. This long-lasting memory also causes the dread; the dread of knowing there are a lot more experiences in life that we simply cannot prepare for. This brings us back to the moment; the moment is all we have. We all know this, but sudden, unexpected, tragic events bring us back to this truism. We have to plan for the future, but we certainly cannot count on it.