What is moral injury?

moral-injury-in-the-context-of-war

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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Self-care in turbulent times.

dog-walking-in-snow

The trendy term “self care” irritates me the same way other trendy terms tend to irritate me, but it’s actually a good phrase and good advice.

I had two days off from work this week due to the snow, and I could have spent that time glued to the news, scanning Twitter for the latest Trumpian outrages (I can’t even keep up with them anymore), and making myself angry, depressed, and scared.

For a year I have struggled with retriggered C-PTSD because of this president and his abuse of vulnerable Americans, which includes myself because I am not rich or conservative.

I could have worked myself up into a righteous tizzy and returned to work feeling exhausted instead of refreshed.

But instead, I took a moratorium from the news and from the Internet.   Reading my Kindle copy of “Fire and Fury” (I’m almost done) was about the extent of my politics-related activities.   I cleaned my house (really well for a change) , organized a couple of closets, and actually cooked.   I spent time catching up with friends on Facebook and reading funny or inspiring websites, and watching funny animal videos.  I watched part of a “Bizarre Foods with Andrew Zimmern” marathon, and even walked in the snow.    I read one of the novels in the list of books I posted the other day, and was actually able to concentrate on the plot.   I’m almost finished with it now.

readingabook

I have to admit I felt a twinge of guilt for burying my head in the sand and choosing not to follow the news for a couple of days.    I’ve always believed if you’re not part of the solution, you’re part of the problem, but taking mental health breaks from all the chaos coming from the White House doesn’t mean you’re ignoring the dangers and becoming complacent and complicit.  It means you are a human being and need time to take care of yourself.  If you’re active in the resistance, whether as an actual activist, or just protesting online, you’re not going to be any good to anyone if you’re depressed, deflated,  apathetic, terrified, or unhealthily enraged.   All you’ll be able to do is spread negativity instead of inspiration and ideas.

So it’s absolutely imperative, especially if you suffer from PTSD, C-PTSD or a depressive disorder, to give yourself breaks from all the chaos and negative politics and take care of yourself.   It’s still possible to enjoy the simple things in life and even have fun, yes, even in the darkest times.   I can’t help but think of Anne Frank, a young girl confined in a German concentration camp, but she never let that reality break her spirit.  She was still a happy, positive person who spread joy and hope to others, even knowing she and her family were going to die.   Even today, her legacy still inspires others.

After my two days off spent staying away from politics and the news, I actually felt refreshed and ready to fight again.    So don’t feel guilty if you need to take breaks to concentrate on yourself, your friends or family.   Spend time doing things you like or that relax you — listening to music, watching a funny movie, meditating, praying, doing Yoga, reading a novel, cooking or baking, or spending time in nature (nothing is more healing than nature, if that’s your thing).   You are not abandoning your ideals or becoming complacent.   You are just refueling.

*****

Further reading:

12 Ways to Resist Without Losing Your Mind

Throwback Thursday (a day late): My Christmas present to myself.

This was originally posted on December 21, 2014, when I’d only been blogging for a little over three months.  So much has happened in three years!   But this is a pleasant little memory, so I may do this again this year.   What a crazy year 2017 has been.  I could sure use a little self care right now!

comfort

As ACONS or victims of narcissistic abuse, we can be nervous, hypervigilant, and constantly feel stressed out and overwhelmed. It’s so hard for us to relax and just feel happy and in the moment.

Sometimes it’s the simple things that work best and take us to a place where we feel more at peace and more sane. We need to seek out and savor these small things.

The other day I received a gift card for Cracker Barrel. I have to admit, I love their country stores that are always a treat after pigging out on their heavy country cooking.

This morning I had to go have two of my tires changed and get an oil change. I hate dealing with servicing my car, but it had to be done. I already felt better knowing at least my tires won’t skid off the road, even though my car is 13 years old and the transmission is starting to slip.

Blasting rock music and singing along to it on the way home, I remembered my Cracker Barrel gift card and decided to stop by and buy a few things with it.

I adore candles and always buy those big scented jar candles at the dollar store, K-Mart or Walmart because usually those are all I can afford. Those are fine, but today I decided I could afford to splurge and buy a $20 Yankee Candle. I had a tough time choosing an aroma, because they all smell so great, but I finally settled on a new scent called “Silver Birch,” which smells just like woodsmoke and reminded me of a crackling fire.

I also love bath products, so I bought myself a bottle of JR. Watkins apothecary bath salts in Menthol/Camphor with Eucalyptus oil. The bottle, charmingly printed in a late 19th/early 20th century style, says it’s great for soothing colds and flu, but I’ve tried it before and it’s great for everything. It makes your body feel energized but relaxes your mind at the same time.

So when I got home, I decided to take a long hot bath, and just let the scents and warmth of the water swirl around me and bring me into the moment, only the moment. I lit the candle and placed it on the sink, poured a handful of the scented bath salts into the water and mixed in a little vanilla/lavender scented bath gel (cheap from Dollar General) in there too to make the water softer for a little moisture. Then I slid into the tub and literally sighed as I settled in. I lay there with my eyes closed for about an hour, just letting my mind wander and focus on the moment. I also said a little prayer of thanks for small blessings like this.

I nearly drifted off to sleep, but finally, when the water began to get too cool, I dried myself off, put on some comfortable clothes and decided to write a blog post about the bath from heaven.

We need moments like this to validate ourselves. We need to give ourselves little gifts every day if we can. If we didn’t get the mothering and nurture we needed, or we’re still surrounded by narcissists who don’t give a shit about how we feel, we can still give ourselves comfort and nurture every day in small ways like this

It’s not even necessary to spend the kind of money I did today (and the only reason I had it was because of the gift card I received). You can get the same effect with cheaper products from lower end stores. I always find great stuff at the Dollar General a few blocks away Their candles are limited in variety but smell really good. You can also mix a little baby oil with a cheap scented bath gel. At some smoke shops and other stores, you can buy little bottles of scented oil, or even learn to make your own (I’m sure there’s plenty of how-to instructions online).

There’s nothing like a long, hot, leisurely, great smelling bath to soothe your nerves and make you feel normal again, at least for a little while. And make sure you light a candle while you soak.

I’m still feeling so relaxed I think I’m going to nap for about an hour.

 

Empathy burnout and the normalization of the unthinkable.

whatever

While I don’t hold Trump or his administration directly responsible for the increase in mass shootings and killings this year, there definitely seems to be a lot more of them than ever before.  I think the national mood where people have become so divided and where hatred and violence have become almost normalized have been a contributing factor to these killings. It seems that almost every week now, there is a news story about yet another mass shooting or terrorist attack (to me, this includes white nationalist domestic terrorism) here in America. I feel more and more like we are living in a third world country where these sort of things are commonplace.

When the news broke today about the shooting at a Texas church, where 25 worshipers were killed, my first thought was a detached, almost bored, “again?” This was followed by the cynical thought “I sure hope it was a white guy who did it, and preferably a Republican” (because a Muslim, black, Mexican, or liberal shooter would make my side “look bad” and contribute to even more Trumpian cracking down on people’s civil rights).

My reaction shocked me. I didn’t feel much grief or outrage for the people who lost their lives in the one place — a church — that’s supposed to be a sanctuary from the world and all its problems. I didn’t think about the families who would be grieving for their lost loved ones or about all the innocent injured people who would never be the same again even after they physically recovered. No, I automatically politicized the atrocious event. My only real concern was that the shooter had best be a white conservative or just someone who “snapped” under stress.

A month ago, a man opened fire on 500 innocent country music lovers in Las Vegas and 58 of them died. I reacted more strongly to that event, and I don’t think it was just because more people were killed that time. I think it was because I still saw these kinds of events as abnormal; tragedies like that that just didn’t happen here in America. But even then, I had already begun to normalize such events in my mind. In June of 2016, when 49 people were shot in an Orlando nightclub, I cried. I doubt I would have cried had that happened anytime this year. In fact, I worry that if 9/11 happened today, it wouldn’t have anywhere near the gravity it did seventeen years ago, and after a few days of outrage and grief, I’d just forget it happened, like I have with all the terrible events this year.

empathyburnout

I know I’m not alone. I’ve talked to others about my growing indifference and cynicism and they have told me they feel the same way. I’ve also have noticed the way it seems to take a lot less time for us as a nation to recover from such events. The Las Vegas shooting has been all but forgotten and is barely mentioned in the news anymore, as the daily bombardment of other terrible or frightening news overwhelms us and eclipses that terrible event. Would we be so quick to forget something like that a year ago? Ten years ago? If 9/11 happened today, would we have already moved on with our lives? I’m afraid we might have. In fact, rather than bring us together in solidarity as a nation the way it did then, I’m afraid 9/11 would have divided us even further into opposing political camps, with some demanding martial law or even tossing Muslims into concentration camps.

I think America is experiencing a psychological phenomenon called empathy burnout or compassion fatigue. It’s a common condition among people who work in the helping professions. When you’re continually exposed to the hurting, the dying, the sick, and the victimized, people begin to unconsciously put up an emotional shield to protect themselves.   In other words, they lose their capacity to empathize, at least for the group of people they’re helping.  I’ve read this sometimes goes so far that some people even begin to resent or feel contempt for their vulnerable charges.  Compassion fatigue is the reason why there’s such high turnover in professions like social work, firefighting, police work, teaching, emergency services, and nursing.

When compassion fatigue begins to infect an entire country, and we all begin to psychologically wall ourselves off from the world and stop caring, such events become “normal” to that society, and we become less able to recover our national sanity at the one time we need it the most.

We can’t afford to lose our capacity to feel pain and empathize with the victims of atrocities like these mass killings.    But since we also need to emotionally protect ourselves, I think the only way to avoid compassion burnout is to take frequent breaks from the news, as addictive as it has become in these times.   Spend time with your friends, your family, and immerse yourself in non-news related interests and hobbies.   Spend time with animals or in nature, or engage in volunteer work (but not so much you get burned out).    Remind yourself that these are not normal times we live in, and these events are not normal.   It’s also important to remember that the emotional numbness we may be feeling when we hear of such events don’t mean we’ve become bad people or that we don’t care, but is a normal reaction to trauma, and these are are all trauma-inducing events, even though they may not directly affect us.

We also should be working toward tightening our gun laws, but that’s another topic which I won’t elaborate on for now.

Sometimes the little things

…make a world of difference in how you perceive yourself. I haven’t had my hair styled professionally in years.  I finally grew tired of the same old boring look and decided to get my hair done today.  I chose a short (but not too short) layered hairstyle and had honey-blonde highlights put in too (although naturally blonde, I’d been dying my hair to cover gray roots, and the build-up of the dark blonde color I was using made it way too dark).

The hairstylist told me (correctly) that my hair was “fried.”   But she made it look terrific and I feel so much more attractive, and that gives me a boost of self confidence.  It’s amazing what changing your look can do for your self esteem.

If you’re feeling down about yourself, go have your hair done, or do something else nice for yourself, like having a massage or getting your nails done.   It might sound trivial and shallow but it really works!

Here’s my new do:

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Foot soak.

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I worked a long, grueling day today and am sore all over, especially my feet. Right now I’m sitting with my feet submerged in a big pot of hot water with lavender scented Epsom salt. They’re starting to feel tingly and that’s a good sign. I won’t take them out of the water until it starts to get lukewarm. Epsom salt is cheap and can be purchased at any drugstore or Walmart or other big box store. It’s amazing how much better and more relaxed I feel all over now that my feet are getting some much-needed TLC. Now all I need is for someone to give me a neck-and-back rub.

Why you should never jump into a new relationship after narcissistic abuse

The Wheel of Abuse

cycle_of_violence
Not all abusive relationships involve physical abuse. Emotional and mental abuse can be every bit as damaging, and sometimes more so. (Click image to make larger).

A new friend of mine (a survivor of several abusive relationships with narcs) and I were talking on Facebook. Rather than try to paraphrase, I’ll quote her directly–and then give my own opinions.

Friend:

“I realized he [her malignant narcissist ex-boyfriend who she’s still in minimal contact with but who is still trying to gaslight her and get her attention by stalking her on Facebook] did everything on that wheel except for the Economic abuse. He started to subtle test the boundaries…and realized I wasn’t game. Although I believe he probably still believes I’ll contact him again. It’s amazing, [Lauren.]

The more time your away, they stronger you feel. Your self-esteem comes back slowly. I get those frightened moments when I think my new boyfriend will just Abandoned me out of nowhere. I understand why the Psychopathic free support group did not recommend a relationship right away. They know you suffer from PTSD from the aftermath of this abuse. It’s difficult. I find myself having dark flashbacks. I also believe you have to be careful and choosy about your women friends and surround yourself with only kind people. We are fragile and vulnerable after this abuse.

My reply (My original reply was short–I embellished it when I wrote this post. I hope my friend sees it).

These are all great points. It makes sense to stay out of relationships if you’ve just escaped from an abusive one because of the PTSD you probably have or even worse problems such as major depression–you need time to find yourself and work on yourself. You need time to be selfish and not have to answer to anyone because you’ve been giving, giving and giving some more with nothing to show for it in return.

We’re mentally and emotionally exhausted and need time to recover, just as if we’re recovering from any illness. We need to not have to be responsible for someone else’s welfare or self esteem or happiness for a while before taking the plunge into a new relationship. We need to take care of ourselves and find out who we are–whether that means going to therapy, writing a journal, turning that journal into a public spectacle like a blog or video diary, taking up martial arts, yoga, or finding God. We need time to heal.

Jumping into any new relationship–even with a non-narc–when you’re this vulnerable is almost guaranteed to fail and retard you in your self growth, and if you’ve been attracted to another narcissistic abuser (which is common in codependent, PTSD and Borderline women), you may wind up much worse when all is said and done.

We’re like addicts. Narcs need their narcissistic supply; we codependents need our narcs. Let’s face it: Narcissistic suitors (male or female)–at first–make us feel alive, vital and fulfill our wildest romantic and sexual fantasies (when they are trying to trap you as their prey). In a weakened state like PTSD or depression, your judgment is not going to be great and you re going to be VERY suggestible. Most likely, you’ll also become unconsciously attracted to a romantic partner who reminds you of the narc you just left (or who left you). He made sure you can’t forget him easily, even if he was terribly cruel at the end.

anime
Anime drawing (artist unknown).

Also, we tend to be attracted to the same type of person anyway. So if you’re usually or always attracted to narcissists, then most likely your taste is not going to change.

Getting involved too early after the end of a relationship with a narcissist is dangerous. Even with a non-narcissist, old patterns will still come up and you will be hypervigilant and suspicious of your new partner, causing them confusion and eventual discord. If you’re falling for a non-narc, that’s a good sign, but if you just left an abusive relationship, please wait. Envision a giant red STOP sign. Be friends instead. Now’s not the time to get involved beyond that level. If you met someone who truly cares for you, they won’t mind waiting a while and being friends with you.

If you’re already falling hard for someone, I know it’s going to be really hard to resist the pull of a new romance. It’s a powerful force, built into normally-wired people’s genes.

But remember, even though it feels like the most exciting, heady, intoxicating rush you ever felt, that feeling won’t last: what you feel is infatuation, a crush–actually caused by changes in the brain that act like a euphoric drug. That’s really what it boils down to.

infatuation-vs-love1

Infatuation so soon after an abusive relationship is really just a form of transference onto a phantom “therapist” [the person you are infatuated with] when you are at your most vulnerable. You’re looking for someone to rescue you. There is no Prince Charming. A love relationship cannot rescue you from yourself, your memories, or your PTSD. By its nature, it can’t. You are the only one who can make you well, with the help of therapists, counselors or another other trusted person who is not involved sexually or romantically with you.

So be patient, wait until you heal yourself and feel more confident. Then if you fall in love, dive in and enjoy it–and with any luck it might turn into the real thing.

Thank you to Mary Pranzatelli for this idea.