PTSD: Policy Issues - Psychoanalytic Psychology (original) (raw)
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Distinguishing PTSD from Moral Injury
The moral dimension of combat trauma is being increasingly recognised within psychological and philosophical literature. Indeed, there is a growing movement to distinguish between PTSD and “moral injury.” By moral injury, these theorists refer to something like what psychiatrist Jonathan Shay describes as “the soul wound inflicted by doing something that violates one’s own ethics, ideals, or attachments.” This type of injury does not appear to be captured by the increasing diagnosis of Posttraumatic Stress Disorder (PTSD). Each of these has important moral implications for philosophers of war, but the conditions need to be appropriately delineated before appropriate remedies can be identified. The growing interest in moral injury opens the door for philosophers to explore and explain how moral concepts can contribute to understanding, treatment and prevention of combat trauma-related psychological injuries. In this paper I will explore some of the significant differences between PTSD and moral injury, and how these differences hold moral significance. Using the clinical guidelines presented in the DSM-5, I will explore how the conditions of PTSD differ in terms of clinical presentation. I will then consider the experiential differences between moral injury and PTSD, which will reveal some possible avenues for therapeutic interventions for the morally injured.
Military Behavioral Health
The model of posttraumatic stress disorder (PTSD) that has been dominant for many years has focused on fear conditioning and anxiety-related symptoms as main drivers of the pathology. Yet, the fear based conceptualization fails to consider the rules of modern combat, the culture of combatants, operational stressors and the moral dimension. Recently there is renewed interest in moral distress and moral injury with a focus on guilt, shame, and anger. Accumulating evidence suggests a link between transgression of moral values and symptoms of guilt and shame, anger, suicidal ideation, and PTSD in military servicemen and veterans. Although proper assessment is still in its infancy, there is a need to better understand how moral decisions can affect the mental health of military personnel at any point during their careers, including postrelease. The authors illustrate this with three clinical case reports. They conclude with a call for attention to the relation between the incurrence of moral injurious distress, and the role of guilt and shame as drivers for chronicity of PTSD. Identifying and addressing these issues can contribute to therapy adherence, facilitate successful progression, and contribute to healing and moral repair and reduce overall symptoms of PTSD.
PTSD: diagnosis, evolution, and treatment of combat-related psychological/psychiatric injury
Missouri medicine
The long Iraq and Afghanistan conflicts have thrust Combat Related Post-Traumatic Stress Disorder (CR-PTSD) into the public consciousness and promoted national dialogue on the incidence and results of war related psychological trauma. In the first of a two part series we outline our contemporary understanding of CR-PTSD, the evolution of the diagnosis throughout the history of modern warfare, its impact on the mind and body, and its treatment. PTSD has become the mental health issue of our time.
PTSD vs. moral injury: a scoping review
Journal of Military, Veteran and Family Health
While Post Traumatic Stress Disorder (PTSD) has garnered much research attention, the concept of moral injury has recently been increasingly raised. This scoping review was undertaken to explored how the literature conceptualizes the relation between PTSD and moral injury. Moral injury Posttraumatic Stress Disorder "…the emotional and spiritual impact of participating "a history of exposures to a traumatic event that in, witnessing, and/or being victimized by actions and produces symptoms that can be found in the four behaviors which violate a service member's core moral symptom clusters that include intrusion, avoidance, values and behavioral expectations of self or others. negative alterations in cognitions and mood, and Moral injury almost always pivots with the dimension alterations in arousal and reactivity" of time: moral codes evolve alongside identities, and (American Psychological Association, 2013) transitions inform perspectives that form new conclusions about old events."
A Functional Approach to Understanding and Treating Military-related Moral Injury
The term moral injury has been coined to describe the suffering that may develop following a violation of deeply held moral beliefs and values and subsequent difficulties in functioning. Yet despite an increase in research and intervention approaches for this topic, the relationship between moral injury and mental health diagnoses such as Posttraumatic Stress Disorder (PTSD) remains unclear and concern exists that, in some cases, moral injury might be used to unnecessarily pathologize moral processes. With the goal of further refining the construct, we argue that moral injury is a condition distinct from PTSD and other disorders and, using a functional approach, propose enhanced definitions for the terms, morally injurious event, moral pain, moral injury, and moral healing. Consistent with these new definitions, we then argue for Acceptance and Commitment Therapy (ACT) as a feasible and promising treatment for moral injury and present initial qualitative data supporting the intervention.
A Theory of Moral Injury and PTSD
An Essay describing a theory of Moral Injury and PTSD which manifests in behavioral and cognitive effects after experiencing combat. Moreover, I describe the differences between these conditions, and argue that changing a philosophical position is a primary tool to begin understanding and recognizing the long last and negative effects of war, and thus reclaim the ability to heal and redirect such behavior and cognition.