Overview
Less recognized than PTSD, "Moral Injury" is a condition introduced by clinical psychiatrist Jonathan Shay through his work with Vietnam War veterans treated in the Department of Veterans Affairs, as outlined in his book "Achilles in Vietnam: Combat Trauma and the Undoing of Character" (1994).
Shay delineates moral injury into three components: a betrayal of moral correctness by a legitimate authority figure in a high-stakes scenario. While Shay's definition is widely acknowledged, other interpretations exist. For instance, the Syracuse University Moral Injury Project defines it as "the damage inflicted on one's conscience or moral compass when they perpetrate, witness, or fail to prevent actions that violate their own moral beliefs, values, or ethical codes."
Symptoms of moral injury often present as heightened levels of anguish, anger, alienation, and profound shame, which are inadequately addressed by conventional mental health diagnoses.
Manifestations of Moral Injury
In addition to the symptoms previously mentioned, manifestations of moral injury encompass:
- Loss of meaning in life
- Intense guilt
- Deep shame
- Intense anger or rage
- Feelings of worthlessness, despair, and remorse
- Sensation of losing part of oneself
- Identity confusion ("I don't know who I am anymore.")
- Intense distrust
- Suicidal thoughts
- Marital and family problems
- Self-medicating behaviors
- Social distancing or alienation
- Anxiety
- Insomnia
The Toxic Silence
Shaming another person has a toxic effect, stripping them of their dignity and self-respect while stifling their ability to speak out. This act of shame not only diminishes individuals but also suppresses their voices.
During the Vietnam War, approximately 2.7 million American men and women served, with over 58,000 losing their lives. As the war lost favor, blame shifted from political and civilian leaders to individual soldiers, leading to a surge of shaming behavior directed at returning combat veterans by the anti-war movement. While many suffered from combat experiences, not all were diagnosed with Post-Traumatic Stress (PTS). Dr. Shira Maguen's research revealed that some veterans exhibited symptoms beyond PTS, such as shame, guilt, and loss of identity due to moral conflicts. This recognition birthed the concept of "Moral Injury."
Further studies on moral injury uncovered the detrimental role of shame and shaming behaviors in exacerbating emotional distress among combat veterans and their families. Central to this is the concept of "toxic silence," where shame isolates veterans, hindering their ability to discuss their experiences openly. Breaking this silence is crucial in addressing moral injury, allowing veterans to share their stories empathetically and diminish the power of shame. This philosophy underpins Moral Injury International's podcast theme, aiming to empower veterans to reclaim their narratives and heal from moral injury.
The Dark Side of Shame
"Shame flourishes in isolation, thriving in the voids between individuals, where feelings of separation and alienation abound." (Brené Brown)
The shame stemming from Moral Injury is profoundly corrosive, plunging us into isolation, muting our voices, and eroding our self-esteem. Yet, two powerful antidotes dismantle shame's grip. Empathy dismantles shame's stronghold, fostering connection and restoring self-worth. Returning one's voice disarms shame by dispelling secrecy and granting recognition. Our slogan, "Lending Our Ears to Give Them Their Voice"™, embodies this ethos, emphasizing the transformative power of empathy and the restoration of individual agency.