Less widely well known than PTSD is a condition identified as “Moral Injury”. Through his work with veterans of the Vietnam War being treated in the Department of Veterans Affairs, clinical psychiatrist, Jonathan Shay introduced the concept of “Moral Injury” in his book, (Achilles in Vietnam: Combat Trauma and the Undoing of Character, 1994).
As defined by Shay moral injury has three parts. Shay asserts that moral injury is occurs when there has been a betrayal of what is morally correct by someone who holds legitimate authority in a high-stakes situation.
Note the three components in Shay’s definition of moral injury: (1) There has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; (3) in a high-stakes situation. Although Shay’s definition of moral injury is widely accepted, it is not the only definition of this condition. For instance,
The Syracuse University Moral Injury Project defines moral injury as “the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct”.
The symptoms of moral injury manifest themselves in high levels of anguish, anger, alienation, and a keen sense of shame none of which are well explained in terms of mental health diagnoses.
One of the toxic results of shaming another person is that it diminishes them and robs them of their self-respect. When we shame another person we silence them, we take away their voice.
According to research produced by the Veterans Administration, from the beginning of the Vietnam War in February 1965 until May of 1975 there were approximately 2.7 million American men and women who served in Vietnam. More than 58,000 of those servicemen and women lost their lives. As the war became increasingly unpopular, blame and accountability was placed increasingly upon the shoulders of individual soldiers rather than on the political and civilian leadership that committed the country to the war. Consequently, many returning Vietnam combat soldiers became the focus of the anti-war movement and its shaming behavior toward those veterans. While many Vietnam War veterans were affected by their combat experience, especially those who knew or suspected that they had actually killed enemy soldiers not all veterans were diagnosed with Post-Traumatic Stress. Some of the combat veteran manifested symptoms that were not readily diagnosable as PTS. Dr. Shira Maguen, a VA psychologist, in a study of the effects of killing among combat veterans found that many of the veterans displayed symptoms that were not related to PTS, including shame, guilt, grief, losing aspects of one’s self-identity due to the violation of their core values and personal moral compasses. This discovery led the term, “Moral Injury” being coined.
As moral injury has been researched and studied the role that shame and shaming behavior play in the emotional distress experienced by combat veterans and their families has been uncovered. A significant aspect of shame and shaming behavior is that of “toxic silence”. The experience of shame silences and robs the veterans of their self-respect. The lack of understanding of the nature of a combat experience by family, friends, and fellow citizens causes the veteran to feel isolated and makes it increasingly difficult for the veterans to talk about their experiences. This, in turn, silences them and they keep the experiences to themselves. One of the ways of dealing with the effects of moral injury is to open opportunities for the veterans to tell their stories, bring the shame to light in an empathetic fashion and thereby reduce the power of the shame. This is the genesis of the theme adopted by Moral Injury International in its podcast, “Lending Our Ears to Give Them Their Voice” ™
“Shame thrives when we feel most alone – cut off, separate, and different from those closest to us. Shame happens in the gaps between people; when separation is removed or lessened, the feeling loses its power over us.” (Brené Brown)
The shame that stems from Moral Injury is highly toxic. It forces us to embrace isolation; it takes away our voice and makes us silent; it diminishes our sense of self-worth. However, there are two things that overcome shame and take away its power over us. Shame cannot survive empathy and it withers when a person’s voice is returned. Speaking gives us the power of being recognized and thereby eliminates secrecy. Empathy defeats isolation and restores self-worth. This is the genesis of our slogan: “Lending Our Ears to Give Them Their Voice” ™