-Recovery From Moral Injury

Key takeaway:

Moral injury happens when an event damages our view of the world’s moral landscape; our moral compass goes off course. Post-traumatic stress occurs when we have lasting difficulty trying to piece our world back together, and this effort involves every element of our health.

  Why do some people develop post-traumatic stress while others don’t, even if they’re exposed to the same event? The answer to that is complex because the mind-body injury described as “PTSD” in medical literature exists on a broad spectrum. The various criteria psychiatrists use to determine if someone has PTS is not a straightforward “if-then” decision. There are eight different criteria and sub-criteria within those; you don’t have to check every box to make a diagnosis, just enough of them. Now, a tool like this might be better than how we used to deal with the problem, but it has its limitations. Our previous life experience; everything from our diet, to the type of trauma our parents were exposed to, to how cruel our elementary school bully was, can affect our response to, and potential diagnoses from, trauma. The great number of known and unknown factors we bring into the clinician’s office can make things very complicated. The video below summarizes how children of parents who survived the holocaust had a much higher chance of experiencing effects of that trauma themselves, even if the child never even knew the parent.

The point is to illustrate that we are only scratching the surface of what exactly we mean by this condition the mainstream so confidently refers to as “PTSD.” A clear diagnosis can be a relief for many because it provides a direct answer or framework that you can start from. Unfortunately, with PTS in particular, we’ve seen far too often that this framework leaves out a deeply human factor, an element that a pill can’t provide. Do we really expect a series of medications and trips to an overworked and often ossified medical system to cure someone who is trying to process generational trauma, chronic inflammation, a loss of sense of purpose, childhood trauma, wartime turmoil, the effects of an aging body, and the inhuman amount of distractibility offered by screens and devices we flood our lives with? Oh, and the kid just pooped his diaper again and you’re up to bat. Where to begin?! Let’s take a moment to understand how someone can end up with post-traumatic stress. If a forest is experiencing a windstorm, inevitably some of the trees are going to shed a few branches. Other trees, however, are able to bend with the gusts and return closely back to the shape they were in before. Sure, some leaves or pine needles may have been lost, but those can grow back relatively quickly as long as the branches and roots are in place. So what allows some of the trees to recover, while others could get completely toppled? It depends on the integrity of the wood, the resiliency of the branches. And what makes a healthy branch is a history of proper sunlight, good soil, a robust underground mycelium network, and pure rainwater. That windstorm is a traumatic event, and whether we develop post-traumatic stress from it depends on both our history and how we react in the days and years after the event; our existing resiliency and our recovery strategies.

What, then, makes an event traumatic? We know things can be traumatic for some people and less so for others, so what’s going on there? Spiritually, trauma can be described this way: when one’s framework of right and wrong, the moral structure guiding one’s life and actions, collapses. This experience can also be categorized as “moral injury.” The degree of resulting trauma can be described as the differential between how we thought things were and how we’re really experiencing them now. And it can be a product of something we find ourselves doing, or of something we’ve witnessed in others. This can of course happen in its most gruesome forms in combat, but wartime violence is by no means the only stimulus that can lead to trauma. Moral injury isn’t the same thing as PTS, but it is a precursor. Our baseline level of resilience largely, if not entirely, determines if the trauma impacts our minds and bodies long-term, developing into PTS, or if we bounce back after having lost some leaves and needles. It’s not fair to say that it’s entirely up to us how much resilience we have to shield us from life’s horrors; we didn’t get to choose how our parents treated us growing up, for example. But we can choose our next decision, we can take responsibility for where we go from here. Our existing resiliency may have been based on many factors out of our control, but future recovery is in our hands. Post-traumatic stress develops after a moral injury when we haven’t been able to recover from the injury in our spirit, and it eventually makes its way into our body. The healing strategies we should choose following moral injury depend on the individual; some of us have more robust “root systems” than others. But the strategies share many common fundamentals, which you’ll learn about in future lessons. Let’s take an example. Imagine you’ve been married for, let’s say, five years, and just found out that your spouse has had an affair. Suddenly, everything you thought held that union together has dissolved; something you thought never possible, something that couldn’t fit into your personal moral framework, has just happened. Like a plot twist at the end of a movie, the very beginnings of the relationship are called into question. Not only do you have to overhaul your perspective of them, but yourself as well. Were you more naive than you thought? Did you make some horrible mistake? Or was it more to do with bad luck? Some of both? The questions flood in from the fissure that is moral injury. How do we recover from such a blow? We can numb the pain with substance abuse, physical indulgence, or any other “deadly sin” that feels terribly justified based on what’s happened. And it works temporarily to ease the pain because numbness is temporarily protective. But our conscience knows there’s a better—if far more initially difficult—way. The choices we make in the aftermath of this collapse can determine whether we grow from that anguish, or fall into the darkness. Many of us were never taught how to recover from trauma. Our military is great at teaching the mechanics of lethality but sadly falls short in explaining the psychology of killing. We can see this pattern in the rest of our culture as well; our ability to generate financial wealth can numb us to the true cost of affluence. A bank account packed with money is no remedy for a broken heart, and affluence has a nasty tendency to make a once heroic society fragile. So, we shouldn’t shame ourselves for turning to healing strategies that don’t work. It’s not surprising that people turn to substances and distractions to take away the pain. Who enjoys that pain, after all? There is a reason we drop the “Disorder” from “PTSD”—disorder implies that the individual is at fault or is intrinsically broken rather than having simply sustained an injury. The nature of this injury is that it never completely goes away. But, we can learn to grow around it, and because you’re still in the fight it’s never too late to grow.         Recovery from moral injury is made up of four pillars which I’ve mapped here roughly following the four agreements:

1. Precise speech: careful and complete expression of what has happened to you or others.
2. Forgiveness: forgiving the wrong and realizing that nothing that is done to you is because of you. This allows you to take nothing personally.
3. Openness to a new story: don’t assume that the way you live your life right now is the best and only way to live it. You can change your story, your past is not your destiny.
4. Faith in the process: understanding that doing your best is the best you can do. The best you can do today can look different than yesterday and tomorrow, and that is absolutely OK. Trust the healing process even when the progression goes up and down.

To summarize, post-traumatic stress as a diagnosis exists on a spectrum and starts with moral injury. The degree of PTS is related to our preexisting resiliency. To what degree we recover depends on how we rebuild our value structure around that pain. We can numb the pain and allow that trauma to fester in us. Or we can take responsibility for that pain and do the hard work of speaking truthfully, forgiving, rewriting our story, and trusting the process while knowing we’re doing the best we can.

For the rest of the module, we’ll continue to refer to the ideas of these four agreements and explore what acting that out looks like.

Take heart,

-Marcus

Podcast & Reflection

1. Listen to this 27-minute podcast on the four agreements.
2. Reflect on what you took away; practice a journal entry or talk it through with a friend or family member.