Moral Injury
Post-traumatic stress disorder, often shorthanded as PTSD, refers to a mental condition that is typically sparked by some kind of terrifying or horrific experience.
Soldiers coming back from conflict zones sometimes suffer from PTSD, and it may in such cases manifest as a surge of adrenaline and fear when a car backfires or dog barks or stranger walks toward them on the street. Their brains and bodies push them into a highly alert, ultra-vigilant, panicked state because of those earlier, traumatic experiences, and that can feed a self-reinforcing cycle of misery, depression, and interpersonal issues.
Folks who have been victims of sexual violence, who have been involved in car accidents, and who were abused as children may also demonstrate PTSD-aligned symptoms, and though most people who go through such things do not suffer from these sorts of issues it's common enough that specialist doctors, treatments and treatment centers, and vernacular—the latter of which separates relatively moderate cases from more extreme, complex-PTSD cases—have emerged to help define and cope with these issues over the past several decades.
Similar in some ways to PTSD, "moral injury" refers to the intentional or unintentional violation of some kind of moral code which can, in turn, lead to psychological scars and trauma-related disordered behaviors.
Like with PTSD, this concept was initially developed to help explain and categorize psychological issues faced by veterans, including the psychic wounds that can result from even talking about war-time experiences and concepts.
Also like PTSD, moral injury has since expanded to encompass the experiences and psychological responses and thinking-patterns of folks who have gone through traumatic natural disasters, pandemics, and even stressful interpersonal situations.
One example oft-cited by the psychiatrist who originally described moral injury, Jonathan Shay, is that of a Vietnam War veteran who, while fighting in the war, was instructed by his commanding officer to fire on a bunch of people he was told were unloading weapons.
It turned out—and this only became clear the next morning, when the sun came up—that the targets they'd fired on and killed were actually fishermen and their children; people who were innocent, but who they had killed because their commander told them to.
That soldier had killed innocent people. His moral code about not killing innocent people had been violated, and someone in authority who he had been taught to trust and obey made him do it.
The consequent sense of betrayal by his commanding officer, and in some ways by the military hierarchy and system overall, resulted in a type of PTSD that seemed distinct from other sorts of explosion- and violence- and physical injury-related triggers.
A list of other moral violations was later developed by researchers in this space, all of which were based on cases psychiatrists had reported, but which they'd had trouble categorizing because they didn't seem to fit within the schema of traditional PTSD.
The resulting conception of this framing is that just as it's possible to develop maladaptive responses to strangers and sounds and sleeping after going through a period of abuse or warfare or something else that causes our bodies and brains to rewire our reflexes and thought-patterns, it's also possible to develop maladaptive responses to moral code violations, which can result in floods of shame, depression, a lack of trust in one's own moral validity or the validity of outside moral structures, and an overall sense of stress, anxiety, and nihilism.
This framing has since been applied to many categories of traumatic, morality-related experiences, ranging from people who accidentally—and through no fault of their own—kill someone in a car accident, to people who work at hospitals who are unable to save everyone who comes through their doors because of hospital policies or resource-shortages caused by a pandemic or other disaster.
It's been observed in people who work at schools who are unable to provide a full range of services to local children who come from impoverished families, and it's been associated with anger, a sense of hopelessness, substance-abuse, an ever-present feeling of guilt and shame, and sometimes anger and aggression—at times aimed at innocent people who unwittingly trigger these moral-injurious feelings.
This is a new concept, and we're still learning about it and how it differs from other, similar concepts, like PTSD.
Based on brain scans, it would seem that these two close-match maladaptive responses impact the brain differently, with physical trauma being more likely to light up the right amygdala, while moral injury seems focused on the left precuneus (a part of the brain that is associated with one's sense of self, and thus, potentially, one's sense of moral rightness).
It may be that, like many labels, this one is eventually incorporated into a different, existing category.
But for the moment it's worth being aware that you can experience something akin to PTSD following moral code violations, even if the violation isn't your fault, and that it may be worth getting professional help if persistent, maladaptive responses emerge in the aftermath.
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