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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To the Young Men and Women of America: From the GOP

This is a very powerful and well written post from one of my favorite blogs, JohnPavlovitz.com.

Warning:  it may be triggering to survivors of abuse.

To The Young Men and Women of America, From the GOP

3 questions to ask yourself if you raised kids in a dysfunctional home.

I’m giving this post another day in the sun. This is for anyone with children at home who thinks their own issues might be negatively affecting the way they raise their kids. I hope this helps.

Lucky Otters Haven

Nobody’s perfect, and that goes for parents too.  There’s no such thing as a perfect parent. There’s something called a “good enough” parent though, which means that you are going to make mistakes raising your kids, no matter how much talent you have for the task or how well adjusted you are.  Children don’t come with instruction manuals, and some of the mistakes you make might even be pretty bad ones.    But overall, you’re “good enough” if your kids know you love them no matter what mistakes you made, and they turn out to be functioning, reasonably happy adults.

But for survivors of narcissistic abuse, things are a little more dire.   Because many of us suffer from mental disorders caused by abuse–C-PTSD, BPD, OCD, anxiety, depression, and a host of other mental maladies–we probably entered parenthood with less of a sense of ourselves and our place in the…

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The little books.

Originally posted on August 30, 2015

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I remembered something today. Little by little my mind is pulling up ancient memories from dark and forgotten corners as I move further along in my recovery. This one almost knocked me over.

For years…decades, even…I couldn’t write. This past year and a half has been the first time in my life I haven’t in under the thrall of a high spectrum (malignant) narcissist, and it wasn’t until I freed myself from them that my words began to come back.

As a child I wrote all the time. I drew pictures too. I remember my father bringing home these little blank stapled booklets in different colors with lined paper in them. There were about 50 of them, tied up in rubber bands. I used to write little stories and illustrate them. I could spend hours doing this.

I always blame my mother for everything. I act as if my father (who was codependent, and probably either covert NPD or borderline) had nothing to do with my disorders. I always saw him as a victim too. But he colluded with my mother; both were abusers. I remember one day when I was 7 or 8, I came home from school, and as I did every day, I went to my desk and opened the drawer to start writing my little stories. I noticed some of my finished booklets were gone. Panicking, I looked everywhere for them, and couldn’t find them. They were very personal to me, like diaries. They were for my eyes only (my Avoidant traits had already set in) . I was very upset but couldn’t tell my parents because then they’d be looking for them and they’d KNOW.

I looked all over the house for them, and finally found them in my father’s filing cabinet in a folder with my name on it. I was horrified. He stole my private creations from me! I felt so violated. My boundaries had been viciously invaded. I remember stealing them back and destroying them. I couldn’t even bring myself to look at them anymore. There was too much shame.
It was as if I wanted to annihilate myself…my true self.

After that I seemed to lose interest in drawing, although I continued to write. But my passion for even that was gone. I didn’t say anything to my dad about him stealing those booklets because to do so would be to invite critique and shame. I knew instinctively he liked them (otherwise he wouldn’t have taken them from me), but I didn’t even want to hear anything good about them. The stuff in them was just too personal. I felt like I’d been raped.

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I wrote a novel in 2003. No one wanted to publish it. It sucked. I still have it but it’s embarrassing to read because of how bad it is. I know why though; at that time, still under the thrall of my ex, I was trying too hard to be “a writer,” to make an impression, instead of being authentic.

And now…I’ve done a 180 from when I’d hide my little illustrated books and was so horrified when they were discovered: deliberately posting the most personal stuff imaginable for total strangers all over the Internet to see (under an assumed name, of course). It’s like I’m trying to redeem my shame, somehow. It’s very hard to explain.

After being in my abusive marriage, I thought I’d lost all my ability to do anything at all. I’d sit down and try to write something, and….I couldn’t do it. I even thought I’d lost my intelligence. I was marking time until death. I felt stupid, dead. But I didn’t care either…or thought I didn’t care. I couldn’t feel anything at all. All my emotions were gone.

I was wrong, so wrong about all that.

Empathy burnout and the normalization of the unthinkable.

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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.

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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.

The insanity of being a news junkie in the age of Trump.

wellinformed

Every day when I wake up, I check the news headlines. Maybe it’s just hypervigilance and wanting to reassure myself that Trump hasn’t started nuclear war yet.   This presidency makes me feel like I’m back in an abusive relationship and as a result I feel on guard all the time.

But at the same time, there’s a certain thrill I get from reading stories that seem like they would have been headlines from The Onion just a year ago.   It’s not a good kind of thrill, but the kind of thrill you get from doing something you know might kill you but feeling compelled to try it anyway — like, oh, maybe sky diving or trying methamphetamine.    Only the sick thrill is always accompanied by that awful, sinking, helpless feeling you get when you realize you are totally fucked and there’s not a thing you can do about it.    Maybe it’s a familiar feeling to me and somehow comforting, but I know people who didn’t come from narcissistic families or abusive relationships and report they feel exactly the same way about this presidency and the endless stream of unthinkable news that it’s unleashed.

I want my news to be boring again.

On the plus side, more people than ever before are getting an education in basic civics (now that civility is a thing of the past) and how government works (now that it doesn’t).

I think we’re also learning to be more discerning about which news is fake and which is not.  Sometimes it’s hard to tell, especially when the president is waging war on truth.

If you can get angry and stay angry instead of allowing the news to make you depressed or emotionally numb, then there is  hope.    Every revolution in history began because a lot of people were mad as hell and weren’t gonna take it anymore.

I feel like I’m about to snap.

I’m not handing all the bad news well today, especially now that I have to worry about a major hurricane possibly hitting where my son lives next weekend.   All my C-PTSD and BPD symptom are triggered — dissociation, hypervigilance, obsessive monitoring of the weather/news in general, physical symptoms (fatigue, headache), snappishness, mood swings, isolation, feeling helpless, and intense anxiety are all symptoms that have returned and threaten to overwhelm me.

I recently quit therapy because I felt guilty about not wanting to talk about anything but the political situation, but dammit, it’s so triggering and I take it very personally, given my background of abuse.   So I might have to go back soon.

I’ve been busy on Twitter (I’m meeting a lot of fellow #resisters there and it’s how I get the most up to date news).  Today I just had to sound off.    It was just stream of conscienceness venting.   It feels good to get all this off my chest, even if no one was really paying attention.  (Read bottom to top).  

I chose my new Twitter user name because it makes me laugh and I need all the laughs I can get.   Gallows humor does help.

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Our Nation Suffers From C-PTSD

I found two articles that I think many of you will find helpful and informative.  I know I did!    I completely agree with the author that our nation’s most vulnerable — immigrants, the poor, women, the old, the disabled, people of color, gay and transgender people, etc. — are being gaslighted and smeared by this administration so that WE are the monsters, while the real monsters paint themselves as the victims.   This is a common manipulation tactic used by sociopaths called DARVO (Deny, Attack, Reverse the roles of Victim and Offender).

We have never had a president like Donald Trump before.   This is NOT politics as usual, nor is it normal.  You have every right to feel the way you do.  You are not crazy.

What other administration acted the way these people do?   What other president was hell-bent on destroying the truth? What other president waged a Twitter war against his predecessor and others who disagree with him?   What other president was so obsessed with the number of people who voted for him or who showed up at his inauguration?   What other president was so destructive,  hell-bent on tearing down any and all agencies and programs that benefit and protect the everyday people, our environment, and democracy itself?  What other president admired dictators and authoritarian regimes, and thumbed his nose at other western democracies as being “weak”? What other president used scare tactics and hatred to divide and conquer, the way Trump does at his rallies and on Twitter?  Most politicians have more than average levels of narcissism, or they wouldn’t survive long in their jobs (or even be attracted to politics as a profession).    But I think, in most cases, they had healthy narcissism, not the sort of malignant narcissism Donald Trump clearly suffers from.  Nor do they surround themselves with equally sociopathic, destructive personalities.

It hit me how truly monstrous these sociopaths were when I saw this picture of them laughing after their “healthcare bill” that would toss 23 million people off healthcare passed the House back in May.

<> on January 7, 2016 in Washington, DC.

Until, then, like anyone who’s being abused, I wanted to believe they somehow had our best interests at heart.

They don’t.   They have no conscience and no empathy.   They are entitled and think they are above the law.    They use toxic religion to manipulate and scare the religious into submission and to shame the vulnerable.  Their intention is to destroy us and all that we hold dear.   That is no exaggeration or crazy conspiracy theory (as they want us to think), and he is riling up his flying monkeys at his rallies.   Most Trump supporters have authoritarian personalities, and authoritarianism is highly correlated with narcissism and antisocial behavior.

Even Republicans are abandoning their own party because of what it’s become.  They aren’t a political party anymore.  They are a cult.  They show all the signs of being a cult, and Trump’s followers act like cult members.

Many people are being traumatized by Trump and his policies.  Even his own staff are being abused and manipulated.   Most of those who still have a conscience have already fled the White House or been fired (it’s my opinion that Sean Spicer was being traumatized and spiritually destroyed by his job).

I think those of us who endured narcissistic abuse have a special advantage because we recognize exactly what we are now faced with.  We can and should call them out on their BS.    I think we have a responsibility to fight against this darkness and our own abuse prepared us for this.  And I believe that in the end, justice and truth will win.   It always does.

It would be nice if we could go No Contact with our country, but for most of us, that isn’t a possibility.   It’s not all hopeless though.   We can fight back and resist, but we also need to take care of ourselves. The author of the C-PTSD article also wrote a post about how to survive what’s been dubbed Trump Trauma.  Even therapists regard it as a real malady and are seeing a spike in their patient rolls since January.

Our Nation Suffers From C-PTSD

A Practical Guide to Surviving Trump

PTSD & the Blindness of the Just Man

A friend wrote this thought provoking post (closely related to the one I posted earlier today). Comments are disabled; please leave comments on the original post.

Unraveled and the Birth of Joy

blog image YodaLove will find a way where wolves fear to thread.
– Lord Byron

Recently I took part in a research study regarding OIF and OEF veterans with post-traumatic stress disorder, that was designed to examine how a vet’s PTSD affects present and past relationship partners.  Psychiatrists are discovering that the failure by our government to provide effective deprogramming to combat vets, and their resulting emotional suppression, disregulation, and too often infantile personality syndrome, is now resulting in widespread PTSD in “dependents” (wives, husbands, and children) and their romantic partners as well.

Seems incorrectly treated (or untreated) PTSD in combat vets is contagious.

The shameful truth is, this country keeps its soldiers ready for deployment – by medical suppression of symptoms and emotions (utilizing anti-depressants, anti-anxieties, and stigma propaganda) but largely does not make us of trigger normalization and cognitive therapy, known world-wide to help heal PTSD, and necessary for a…

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Always waiting for the other shoe to drop…

An older post that I’d forgotten I wrote, but I think people will be able to relate to the traumatic experience I describe here.

Lucky Otters Haven

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I think I made a kind of breakthrough in my therapy session tonight. For years one of my problems has been this overwhelming fear that something bad will happen to one of my kids. (I don’t like to even say the D word because I irrationally believe if I say it, I’ll somehow make it happen, by putting it out into the universe or something).

Of course all parents worry about their adult kids, especially when they know they’re out there somewhere in cars, which we all know are dangerous hunks of metal capable of the most ghastly and gory deaths you can imagine and operated by countless idiots and drunks on the road who can’t drive. I think my apprehension about something bad happening to my adult children edges into OCD-type territory though, because of how overpowering and pervasive these thoughts are, intruding where and when they are not…

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