There is a current
train of thought within mental health care that the use of PTSD as a cover-all
diagnosis for the psychological difficulties faced by veterans should be re-evaluated.
Some mental health experts have proposed the existence of a separate condition
known as ‘moral injury’, which is marked by a slightly different set of
symptoms and different causal triggers. The term ‘moral
injury’
is a new
term but it's an old concept. It’s a term that few like to use in the
military because it implies wrongdoing. From the
philosopher's perspective, the concept is a way of talking about anguish caused
by wrongdoing (real and perceived).
But transgression isn't the only issue at the heart of moral injury. So is the
perception of falling short in combat, that you failed in some way and perhaps your
shortcomings cost lives. This in turn brings guilt, the guilt that you survived
when others didn’t. The result may be shame, and all too often suicidal shame.
Moral injury is said to be distinct from post-traumatic stress disorder, which is generally thought of narrowly as a fear-conditioned
syndrome marked by hyper-vigilance and flashbacks. The prevailing treatment for
PTSD is therapy to “decondition”
the fear response. But guilt, shame, raging resentment, and betrayal are different
from fear and, it is argued, require a different approach. By using moral
philosophy, it is suggested that we can understand the evaluative content of
emotions such as guilt and shame – common occurrences in the proposed diagnosis
of moral injury – and therefore provide more effective treatment.
It’s an interesting
argument and pertinent to the story in ‘A Life Before’ which touches on PTSD
and the concept of moral injury.