What is moral injury?

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Moral injury (also known as soul injury), is a serious mental condition similar to PTSD that many Americans are suffering from right now under Trump’s increasingly threatening and authoritarian administration.   This condition is also very common among soldiers who are forced to commit acts that go against their conscience or violate their understanding of right from wrong.

According to Wikipedia, moral injury

refers to an injury to an individual’s moral conscience resulting from an act of perceived moral transgression which produces profound emotional shame. The concept of moral injury emphasizes the psychological, social, cultural, and spiritual aspects of trauma. Distinct from pathology, moral injury is a normal human response to an abnormal traumatic event.  The concept is currently used in literature about the mental health of military veterans who have witnessed or perpetrated an act in combat that transgressed their deeply held moral beliefs. Moral injury can also be experienced by those who have been transgressed against. For example, when one goes to war thinking that the purpose of the war is to eradicate weapons of mass destruction, but finds that not to be the case, the warrior can experience moral injury. Those who have seen and experienced death, mayhem, destruction, and violence have had their worldviews shattered – the sanctity of life, safety, love, health, peace, etc. – can suffer moral injury as well. This injury can also occur in the medical space – among physicians and other emergency or first responder care providers who engage in traumatic high impact work environments which can affect their mental health and well-being.

Moral injury or soul injury is quite common, and can affect entire populations.   It tends to separate people with a conscience and empathy from sociopaths, the latter of which are likely to be drawn to the very person or situation that is causing moral injury and PTSD to the normal population.

Since moral injury is closely related to PTSD, the symptoms are very similar.    Depression, sadness, and even suicidal ideation is common, especially if the victim sees no escape from the threatening situation or tyrannical leader/ government.

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It is under the spiritual perspective of moral injury that Lindsay Carey (Australia), John Swinton (UK) and Daniel Grossoehme (USA), provided a comprehensive holistic defintion of moral injury based on the systematic reviews of Jinkerson plus Hodgson and Carey. [30]

Moral injury is a trauma related syndrome caused by the lasting physical, psychological, social and spiritual impact of grievous moral transgressions or violations of an individual’s deeply held moral beliefs and/or ethical standards due to (i) the betrayal of what is right by trusted individuals who hold legitimate authority and/or (ii) by an individual perpetrating, failing to prevent, bearing witness to, or learning about inhumane acts which result in the pain, suffering or death of others and which fundamentally challenges the moral integrity of an individual, organisation or community.

The violation of deeply-held moral beliefs and ethical standards—irrespective of the actual context of trauma—can lead to considerable moral dissonance, which if unresolved, leads to the development of core and secondary symptoms that often occur concurrently.  The core symptoms commonly identifiable are: (a) shame, (b) guilt, (c) a loss of trust in self, others, and/or transcendental/ultimate beings, and (d) spiritual/existential conflict including an ontological loss of meaning in life.  These core symptomatic features, influence the development of secondary indicators such as (a) depression, (b) anxiety, (c) anger, (d) re-experiencing the moral conflict, (e) social problems (e.g., social alienation) and (f) relationship issues (e.g., collegial, spousal, family), and ultimately (g) self-harm (i.e., self-sabotage, substance abuse, suicidal ideation and death).

Moral injury can be treated with CBT and other psychotherapies, but not everyone has access to professional help.  Self care is of vital importance.  If the news is disturbing or upsetting to you, and is causing you PTSD-like symptoms, take breaks from it, or even ban it from your life altogether.   While it’s important to stay informed, if there’s a real emergency, you will find out about it.  Your mental health is more important than knowing every detail of what’s going on in the world or in the country.

Try to break the hypervigilance habit.  Many people feel more “in control” if they stay on top of current events, even following the slightest detail, but the reality is, outside of practical activities like voting, signing petitions, writing letters, or protesting, there isn’t much you can do to change things.   SItting around being depressed or worrying about what might happen in a week, or a few months, or a year can drive you crazy and make you miserable.   It will drain all the joy our of your life.  Keep in mind that even in the most undemocratic regimes, most people can still find moments of joy and love in the people and the world around them.  Anne Frank was such a person who remained hopeful even while interned in a concentration camp.   Obviously not everyone has the emotional makeup to remain that upbeat and brave, but her story has brought hope to millions.

Spend time with friends and family that you trust, obviously those who feel the same way as you do (things have become so polarized that you might have to avoid friends and family on the opposite side of the political spectrum, at least temporarily).   Be sure to spend time doing fun, nonpolitical things with your friends and family members, not just talking about politics and the news.   Of course there’s a place for that too.  If you want to feel like you’re making a difference, you can plan to attend protests as a group or have letter writing or phone call “parties.”

One way you can follow the news in a more lighthearted way is to watch the late night TV comedy shows, such as Saturday Night Live or Jimmy Kimmel, instead of cable or network news.     You will still get your news (in fact, these shows are often more accurate in reporting than actual news programs) but in a way that can make you laugh and see the lighter side of a very serious situation.    Gallows humor has its place, and can make an unpleasant or unbearable situation seem more tolerable.

Remember that if you are suffering from moral injury, there is nothing wrong with you.  In fact, it means you are functioning human being with a conscience, and you are merely reacting in a normal way to an abnormal situation.  Still, if the suffering becomes intolerable or you find it hard to function, it can’t hurt to seek counseling to learn coping skills.

Almost Sunrise is a documentary film about moral injury.  It focuses on returning soldiers, but should also be of interest to anyone suffering from this form of PTSD.    You can watch a short video and read an article about the film here:

Almost Sunrise / Moral Injury

According to their site, these are the most common symptoms of moral injury:

  • Overwhelming depression
  • Guilt or shame
  • Loss of meaning in life
  • Feelings of worthlessness, despair and remorse
  • Feeling like “I’ve lost a part of myself”
  • Feeling like “I do not know who I am anymore”
  • Feeling intense distrust
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My Seasonal Affective Disorder makes me want to hibernate until spring.

It’s baaaaack!  I hate this time of year.

Lucky Otters Haven

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Graph I made showing my mood pattern throughout the year. It’s this way every year.

I’ve been thinking a lot about my SAD.

SAD is triggered by the lack of light and shortening days for those affected with it. During the shorter days the brain produces more melatonin, a naturally occurring hormone that induces sleepiness in certain animals, like bears. It’s the reason why some mammals hibernate until the warmer, longer days of spring. Unfortunately, some humans retain this biological urge to hibernate, but because we must continue to live productive lives, our natural urge to sleep is ignored and seasonal depression is the result.

I seem to suffer from a weird form of SAD. The fall is much more depressing to me than winter. Most people with SAD feel terrible in late fall AND all winter. But for me, I start feeling depressed sometime in mid-August, when the…

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Jessica’s last words

I was so touched by this story I am reblogging it.

Her mission is our mission

On March 10, 2015,  my daughter Jessica took out a piece of paper and wrote out one last letter to me. She used a pink marker (her favorite color) as she jotted down her last thoughts. It was her last attempt to explain to me that life had gotten to much for her. That all the bullying and pain that she had endured from the previous year and a half had finally taken over her mind. Helpless and hopeless she ended the pain that she fought so hard to be free of. I know she didn’t do this to hurt me. She was ending her pain and what she thought was a life that couldn’t get better.img_8924-2

I carried a copy of that note in my purse for  3 years. I thought  about what the words meant to me and I decided to have her last thoughts      …

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Ask the Question. Ask the Direct Question.

I was heartbroken to hear of the suicide death of Anthony Bourdain.   I loved his shows about exotic cultures, food, and everyday life in faraway countries.  He always seemed so happy and had a life anyone would envy — traveling all over the world and writing about it for a living is my idea of heaven!  Many people would say the same thing about fashion designer Kate Spade, who also committed suicide earlier this week.

Depression and suicide doesn’t discriminate and can affect even those who seem to have great lives. We just don’t know what sort of inner demons Bourdain (and Kate Spade) struggled with.

If you struggle with depression or have suicidal thoughts or ideation, please reach out and talk to someone you trust. Don’t keep your depression a secret — it’s a medical illness, not something to be ashamed of.

Peace from Panic

(Trigger warning: this post discusses suicide. If you need help, call the National Suicide Prevention Lifeline at (800)273-8255 or text HOME to the Crisis Text Line in the U.S. at 741741)

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This morning I woke up to the tragic news about chef and travel host, Anthony Bourdain. Death by suicide.

Heartbreaking. And after the shock earlier this week, the suicide death of designer Kate Spade.

My husband and I love to watch Anthony Bourdain’s show on CNN, “Parts Unknown.” He was an amazing storyteller. He traveled to both popular and remote places around the world to get his stories. My favorite episodes were when he visited unknown villages, and I learned about another culture’s cuisine and way of life.

In his interesting, quirky, and cool way, Anthony would sit with locals and have in-depth conversations over a meal. People opened up to him. He had a special way of delving…

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Update about my son’s mental health ordeal.

This is just a quick update about my son, who started suffering severe panic attacks/dissociation episodes and a week later, from near-suicidal depression.

He is doing much better.   It turned out the medication the Emergency Room gave him to control the panic attacks (lorazepam — commercially known as Ativan) had an adverse effect on him and caused the depression.   Since he stopped taking them, he has not been depressed.

He’s been a lot less anxious too, but that may have been job-related.   He was transferred to a different location which is closer to his home, and is less stressful, and he has not had another attack.

He still plans to find a therapist, since he is an anxious person who has OCD and ADHD (attention deficit hyperactivity disorder, which my daughter also has).  Having these disorders together makes a person likely to suffer sudden panic attacks.

Thanks for everyone’s thoughts and prayers!  I do think that helped too.

Anxiety spiraling into major depression?

Last week I wrote about my son’s dissociation episodes and panic attacks.   He got some anti-anxiety medication there, but they put him to sleep so they haven’t been useful to him, and the panic has not gone away.  He’s been able to manage it a little better, using some mindfulness tricks, but has not been able to see a doctor yet (he will tomorrow).  His two trips to the emergency room just told him what he already knew and gave him a few pills for the panic.

Since last Monday, he says he has had 14 panic attacks.  Today he tweeted this:

the last 2 weeks ive been in a very dark place. im constantly afraid, never happy. ive lost all hope and happiness. i feel broken. I’m only able to focus on my faults. making choices triggers panic attacks. im so fucking scared of life itself. help me.

This rose alarm bells so I called him right away.  He sounded alright but sad/down.   I asked him if he was having suicidal thoughts.  He said no, but he thinks about death a lot (suicidal ideation).   He also said it feels like someone else has taken over his mind and this isn’t him.   He can’t think of a specific trigger that would have set off the panic attacks.  It seems to me the attacks were and are part of a depressive disorder, possibly major depression, which is what it sounds like.

I made him promise not to do anything crazy.  He said he wouldn’t.   He did say he appreciates me calling him so much (it used to annoy him) and staying on top of the situation.   I’m glad he tells me everything, but I’m still really scared.   I can’t be near him right now, and that makes it worse.

At least he’s opening up and being honest instead of keeping everything inside.   I think opening up and talking about it is a good first step.   He also said he’s been thinking about checking himself into the hospital for a week or a few days.  I think that is probably a good idea, even though he will lose pay.

I’m asking everyone to send your prayers his way (or positive thoughts, if you aren’t religious).     I hate seeing him like this.

Guest Post (by Anonymous): Thoughts About Suicide and Selfishness.

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The following is a guest post from another blogger who kindly asked me if I would post this.  She is hesitant to link to her blog here, since her blog tends to focus on much lighter content, but still wanted to share her thoughts about this dark subject that’s a real issue for so many people who feel like all hope has been lost, as well as the people who love and care for them.     This blogger is not suicidal, but has been in the past.  I think most of us have considered it as an option at some point in our lives.   We need to stop judging them for it!   It isn’t helpful.

Thoughts about Suicide and Selfishness.

By Anonymous.

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The word itself can be quite triggering to some people… It is taboo and disturbing. What better proof of that, than the fact that I didn’t find the courage to speak out loud in my own blog?

Suicide is something that makes people uncomfortable. One shouldn’t even think about it. It scares, especially if you’ve had depressive episodes in the past. Doesn’t thinking about taking your own life mean you might be thinking about actually doing it?

I don’t think so. I don’t think you have to be a professional, working on serious research to give it a thought or two. I know a lot of people think about it, but just don’t share their thoughts. I am willing to open that door today. But I don’t encourage you to keep reading if you are not comfortable with the subject.

I’d like to point out that I am no professional about the matter. I am not a doctor, or a psychiatrist. I’m just a woman, who went through severe depression at some point in her life, and who had to deal with the idea of ending her days. I’m just the close friend of a good man who did take that step while he was living “The Life.”  But I think my view is worth being shared all the same. The following are just opinions, that you might agree with, or not.

From my experience, most people seem to see suicide as a cowardly act. You’ll often hear the classic “He chose an irreversible solution to a temporary problem”. But when you talk to someone who has just lost a loved one to suicide, the first thought resembles more “How could he do this to me?”

As a society, we tend to blame people who commit suicide of robbing us from someone we cherish. How dare that person be so selfish, that they would choose to leave their family and friends mourning them behind?

When I look back those dark days when I struggled between staying one more day or putting an end to my misery, I see things quite differently. I remember how much I thought about all the people that love me. Going through depression doesn’t mean forgetting your surroundings. If anything, those people were the only reason I hesitated. Had I been truly alone, I would have jumped in a second.

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But I didn’t want my mother, my father and my brother to have to mourn me. Even if I seriously thought living without me would be a good thing in the long run. I knew no letter, no matter how long or how well penned would get them to understand I was right. No matter what I’d leave behind, they would end up suffering. And I could not stomach that.

I lived so they wouldn’t suffer. As simple as that. I ached and fought my demons, day by day, night by night, just so they wouldn’t have to wonder why I chose to rest, at last. Even to this day, I sometimes wish there were words that could explain the pain that rips my very soul when depression hits.

Mental distress is as painful if not worse than physical pain. People who haven’t felt it can’t imagine how real the hurt is. It is not “just” a matter of dark thoughts you can chase away or wait to see go away. And although some people can go through therapy or use medication to make the pain lessen, I believe some others will suffer all their lives.

In some countries, laws give the possibility to people suffering from chronic physical diseases that leave them with no quality of life to choose to end their life with doctors’ help. It is even considered an honorable way to leave this world. I agree that people shouldn’t be forced to live, when the suffering is too much to take. We put down our pets so they won’t have to go through unbearable pain, why should we force people to put up with agony?

I am not encouraging suicide. I think it is a terrible way to die. To hurt so much that you’d rather face mankind’s worst fear is horrible. But I don’t understand why we still tend to blame those who get to that point. No one would blame a cancer patient for losing their fight against that illness. Why do we do so, with mentally ill people?

“They should have asked for help!” you might think…. Which doesn’t make sense to me either. Would you blame your mom for dying from an undiagnosed heart failure?

Some people struggling with mental pain do seek help. But from my experience, a lot of doctors don’t measure the depth of the problem. They can’t see it on a scan, a physical exam, or on an X ray. It is not really their fault, but treatment is often lacking, even if people reach out for help.

I think my point here is just that maybe we should consider suicide a loss like that of any other disease. Families and friends shouldn’t have to deal with shame, and shouldn’t have to play the blaming game. The deceased should be able to rest in peace…

Just rest in peace.

Some days I feel like everything’s hopeless.

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Some days it seems like they are winning.    Now we even have State TV.    The reason we had regulations were to keep something like that from happening.    I feel like a character in Orwell’s 1984 and we are creeping closer to fascism every day.

Most days I feel hopeful.  I want to think that goodness will always trump evil.   I want to think most people have good hearts and can tell the difference between truth and lies.  I want to believe there is a way out of this darkness and justice will prevail.

Other days I’m not so sure.   They have so much power, so much money, and are taking over everything like a cancer.    Today is one of those days.   On days like this I feel like giving up.   I feel like nothing will change and will only grow worse.    I feel like I’ll never live to see my country as it used to be ever again.

I know that’s exactly what their intention is.  To wear us down, exhaust us, make us give up, make us buckle under and become sheep who never complain, and just do as we’re told because we know there is no better choice.

I know I have to fight this malaise and negativity, but on days like this it’s so hard. I just feel so depressed and tired.  I want to succumb to it, to let the darkness engulf me and take me down with it.

Maybe I should just ignore what’s going on, not read the news, but I can’t do that either. They want us to be ignorant.  To ignore what’s going on is to become ignorant.

We are being threatened from the outside, and also from our own government. There is no safe place to retreat to, nowhere to run.

Somehow I have to maintain my desire to resist and push back against this assault on the people — their assault on me and everything and everyone I know and love feels so personal.  But it’s getting so hard, and today I feel like nothing can be done and hope is gone.   My C-PTSD has been retriggered by this president.    It’s traumatizing to a lot of people, but especially those who have been through this kind of abuse on the personal  level.

It’s only been 7 months and I feel numb.   I feel like a prisoner on death row who is innocent of any crime but can’t get a fair trial, can’t get an appeal, so I just sit in my cell counting the days until they come to walk me down the green mile.

Please stop calling suicide victims ‘selfish’ or ‘weak.’ (reblog)

One of the best blogs I’ve recently discovered is John Pavlovitz’s blog “Stuff That Needs to Be Said.”  Pavlovitz is a Christian pastor, but he is different because he abhors what has become “conservatism” and is an active member of the resistance.  Like Jesus himself, he is compassionate and bravely defends all those who are vulnerable or “different,” including groups many fake Christians hate and fear, such as the LGBTQ population and Muslim immigrants.

Every day, Mr. Pavlovitz writes impassioned, brutally honest posts calling out the darkness and evil so many of us see in the new White House and in the greater society.   I love what he has to say and I love the way he writes.  But he doesn’t write exclusively about the political situation.   In this post, he calls out those who accuse Linkin Park’s frontman Chester Bennington as weak and selfish for killing himself on Friday — and in so doing, defends all people who have sunk into such despair and hopelessness that they think suicide is their only way out.

Please Stop Calling Suicide Victims “Weak” and “Selfish”

By John Pavlovitz

Chester

Soon after news broke about the death of Linkin Park singer Chester Bennington, amid the flood of condolences and the raw expressions of grief and shock—came the others; the ones who are never far, always hiding just out of view, ever ready to crawl from out from the cracks.

In moments like these, they surface to offer flippant, callous, armchair sermons about how selfish suicide is, about how cowardly the dead person was, about why he or she should have thought of their children, spouses, loved ones.
They add insult to fatal injury by heaping shame upon a suffering that had already proven to be too much to bear for someone.
These people somehow feel fine critiquing dead strangers, before they’ve even been buried.

I’ve come to realize that there is only one kind of person who says things like this about those who take their own lives: a person who has never been where Chester Bennington was in his final moments, or where Chris Cornell was, or where 121 people in the US are every single day—where many are in the seconds it takes for you to read these words. The people who say such things, are those who’ve never (because of mental illness or acute trauma or severe addiction), been pushed to the precipice of their very will to live. They are people who (fortunately for them) have the luxury of their ignorance, who’ve never walked through this unrivaled internal Hell and wanted nothing more than to get out.

Read the rest of John’s post here

And follow his amazing blog!

 

 

Eeyore wisdom.

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