INTRODUCTION TO MORAL INJURY

Running calls add up over time, and one may develop cumulative stress issues, which create difficulty in coping with everyday events, let alone running even more calls. With each incidence, each response, each one of us will be affected differently. So, if you’re not sure why you are feeling anxious or depressed or have less patience or energy than you used to, it may be the result of a bad call and/ or the cumulative effect of the stuff you have had to deal with as a first responder. But be assured. You’re not the only one to ever feel this way. ­

This is where the internal conflict called moral injury arises. Moral injury can contribute more to the pain, suffering, and disability of an incident than the actual trauma exposure itself. ­ This is also where an awareness of these issues is of great assistance to the first responder and the veteran.

Again, for perspective, common to both PTSD and moral injury are symptoms of anger, depression, intrusive thoughts, insomnia, nightmares, self-medication, anxiety, and avoidance. Although not sharing the startle response common of many suffering with PTSD, the moral injury component adds a few more of its own fun little symptoms to the mix.

Often associated with PTSD, the moral injury aspect may also include symptoms of numbness, loss of interest, shame, guilt, stomach problems, trust issues, loneliness, loss of meaning/faith, feelings of betrayal, grief, and feeling overwhelmed.

As a first responder, you have been running calls, and you have witnessed suffering and death. Your concept of right and wrong and good and evil have been challenged and maybe even undermined by what you’ve experienced. Now you are experiencing the symptoms and feelings listed here. You may think that these symptoms will pass, and there is a chance they might. Yet if they don’t pass in a couple of weeks and if you fail to acknowledge and address them, there is a distinct possibility they will fester and poison you, creating havoc in your life as well as in the lives of those around you. Recognizing the signs and symptoms of moral injury, opening up dialogue, and receiving assistance will greatly increase your level of functioning, both on and off the job, your quality of life, and your overall well-being.

In the 1990s, while at the VA Hospital in Boston, psychiatrist Dr. Jonathan Shay began working with the concept of moral injury/ internal conflict as the psychological, social, and physiological results of a betrayal of what’s right. While also serving at the VA Hospital in Boston a few years later in 2009, Dr. Brett Litz further defined moral injury as “Perpetrating, Failing to Prevent, Witnessing or Learning about Acts that: transgress deeply held moral beliefs and expectations.” Accordingly, any events, actions, or inactions transgressing our moral/ethical beliefs, expectations, and standards can set the stage for moral injury. ­