Being involved in, witnessing, or learning about an event that seriously transgresses moral beliefs is quite different from experiencing trauma that can lead to PTSD. A lot can happen in war or military service that doesn't clearly fit into the definition of a traumatic event because war brings with it moments of ambiguous situations, many of which need to be acted upon in a split second. Clinicians like Dr. Klassen want people to know that one moment does not define you as a person forever; healing can occur from moral injury.
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Moral injury, which is defined as being personally involved in witnessing or learning about an event that seriously transgresses moral beliefs, is an interest of mine. Because I think a lot happens in war and in military service that doesn’t cleanly fit the definition of a traumatic event as officially defined. Right? That the nature of the most recent conflicts kind of lends itself to these very morally ambiguous situations where you’re sort of damned if you do, damned if you don’t. And you have to make a very high stakes decision in less than a second. Things like, “Do I shoot at a vehicle that’s moving towards me? Do I continue on with the convoy even though there are children in the road that might get run over?” Things like, “Do I stop to help people who are obviously suffering and kind of give them my rations, even though it might be a ruse to sort of ambush us?” You know, there’s many such situations I think in modern conflicts, that are better understood by moral injury rather than by trauma and PTSD. What I routinely find about moral injury is that, again, it’s just one of those things that people just do not speak about and it might be years, it might be ten years, twenty, thirty years before people really open up about some of these things. They’re buried so deeply inside. And they’re not going to talk about it unless they know that you as a clinician or you as a family member are going to understand it. They think, a fear that many veterans have, is that they see themselves as a monster for being involved in what they were involved with. And they don’t want their family members, their clinicians, their pastors, you know, faith leaders, to see them in the same way. And so, I think until they feel that they can trust whoever it is they’re disclosing to, it won’t happen. One thing that I’ve found professionally helpful in working with moral injury is that I’m just very much in touch with this notion of like if I were in this person’s shoes, who’s to say I wouldn’t have done the same thing? And I think with moral injury what I really want, you know, my patients with moral injury to kind of come to realize is that that one moment doesn’t have to define you as a person forever. That there is more to you than the shot you took or didn’t take. There’s more to you than deciding to stop or not to stop.
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Brian Klassen, Ph.D., is the Clinical Director for The Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush University in Chicago, Illinois. Brian spent his formative years training at the Jesse Brown VA Medical Center, completing rotations in chronic pain management, residential substance use disorder treatment, and PTSD. Brian has special expertise in providing front-line treatments for PTSD, including Prolonged Exposure and Cognitive Processing Therapy.