Month: June 2019

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Moral Trauma vs. PTSD: What’s the difference? Part 1

Posted on by Addy Vaughn

Moral Trauma vs. PTSD

What’s the difference?

            Post-Traumatic Stress Disorder (PTSD) is a relatively new diagnosis, appearing in 1980 as a new and controversial alternative to psychosis, but evidence of the disorder dates back to a bit earlier than that. [1]I’m sure that the first time a human being was ripped apart in front of their friends or family by a large animal, there was most likely some symptoms of PTSD. While the recognition of this diagnosis has brought relief to millions of individuals and family members, it is often quickly assigned without regard to another devastating emotional injury that can creep up on you years after a traumatic incident: moral trauma.

Moral trauma and moral injuries are essentially exactly what they sound like. These injuries are fatal hits to the values and held identity of an individual. While PTSD localizes in a specific area in the brain (we will talk more about this in a minute), moral injury attacks the moral identity of the person experiencing the trauma.

Think about it like this. An 18-year old male joins the local police force. He has always dreamed of having a career in law enforcement and saw police officers as heroes as a child. His vision of law enforcement consisted of apprehending serial killers, saving children from potential kidnappers, and capturing men in black masks that steal purses from elderly women. He has aligned his core values with his perspective of the job of a police officer; he saves good people; he puts bad people in jail.

He graduates from the local police academy and is placed on a detail that provides security for local politicians for the first three years of his career. His vision for being that ‘good cop’ has been flattened a bit, and he finds himself becoming less of that childhood police officer that he wanted to be. He then receives a promotion to work in probation for the county’s drug court participants. He has developed internal biases towards specific ethnicities and socioeconomic groups after five years of working in probation. Nothing that he sees as radical or outrageous, but simply the truth of the job. He arranges to meet with one of his probation clients and hears screams and yelling from the inside of the apartment. He bangs on the door and orders to be let in. The screaming turns to things being thrown around the apartment, and he orders the man to come out of the house. He hears a gunshot, and the door flies open. The officer has never used deadly force before, but with a cocktail of inexperience and adrenaline, he shoots twice.

A little girl that was being held in her mom’s arms falls to the floor. The man had killed himself, and the mother had grabbed the baby and ran so that she wouldn’t see what had happened. The daughter is pronounced dead on the scene, and the officer has experienced a trauma that will change his life forever.

The officer is immediately put on administrative leave and is mandated to receive post-traumatic incident counseling. He is treated for PTSD for three years and seems to be doing well. He has recently been assigned to a community liaison officer in a local district and spends time doing what he always wanted to do: help people.

But he is not doing well. He no longer thinks of that little girl every day, but he has a growing hatred for himself flowing under the surface. He is probably funny, smart, and empathic towards others. He probably speaks openly about the traumatic event and may even try to help others navigate through similar struggles. But he hates himself. He cannot explain it any other way. He doesn’t actually know why, but it gets worse every day. With every argument with his wife, every forgotten report that he failed to file at the end of the day, and every moment that he is unable to name his emotions or categorize his rage.

Let’s be honest. The event was very traumatic and he probably does have Post-Traumatic Stress from the event. He has  likely hurdled the traumatic response to the event itself in his psychology. But what he can’t reconcile, is how the little boy that wanted to save the good people could have possibly committed such a heinous act. It’s not that he doesn’t understand that it was an accident or that he wasn’t trying to kill the little girl. The incident directly violates his deeply held values. And the result of that internal conflict is often a deep, seething, sense of self-hatred.

One of the central catalysts of PTSD symptoms is fear. Fear is the basis of most behavioral struggles for those diagnosed with PTSD, usually stemming from the physical, psychological, and emotional feelings of fear that manifested during the occurrence of the trauma. But what is also critically important is to understand that often traumatic events can also leave us questioning who we are, morally. Moral injuries do not illicit fear in the same way, they manifest through the lens of shame. If a husband and wife are driving home from a party, and the husband had too much to drink and the wife is killed due to his drunk driving, it is very likely that he will have a moral injury to overcome. However, if he is not aware that moral injuries even exist, he will not be aware that he needs to reconcile that injury with his moral identity.

My “PTSD” stems from several different incidents over a span of time. Combat medics often experience re-occurring incidents of trauma that are similar in nature. They may care for hundreds of casualties and will experience survivor’s guilt at an incredibly high rate. That reoccurrence of experiencing people die in their presence (and let’s face it, sometimes working to save them) produces an environment ripe for moral injury.

PTSD affects very specific parts of the brain. The amygdala, which is basically a storage facility for all the scary and traumatizing stuff that you’ve experienced in your life, trains you how to react to things that remind you of all of those experiences. It kicks your brain into overdrive, puts you in that wonderful fight or flight mode that we all love so much, and often makes you feel ridiculous, usually envisioning an international war out of a fight over a T.V. show. Next, PTSD hits your prefrontal cortex, or as I like to refer to it, “that which makes me a basket case”.  Here is where your emotions are regulated. Or not regulated, or at least not well in some of us. So here is where the actions associated with PTSD manifest. The inability to control your fight or flight, ‘something horrible is happening’ mentality, explodes through a lack of regulation of emotions in your prefrontal cortex, and the cycle begins.

(Continue to Part 2)

[1]National Center for PTSD. (2007, January 31). PTSD History and Overview. Retrieved June 29, 2019, from https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp

 

Introduction: Moral Injury and Reconstructing your Moral Identity

 

I have always known that someday I would write a memoir. Well, maybe not always, but certainly in the last 15 years. What I didn’t know was that going to have to stumble through writing this story while trying to save myself. Learning the concepts of moral injury and trauma refocused my perspective of myself, my mental and emotional obstacles, and clarified the purpose behind some of my thoughts and behaviors. But before we get to those pieces of the book, let me give a quick recap of what has brought me to this point.

I am a veteran, and yes, that is important to my story. I deployed twice as a medic and absolutely saw absolutely horrible things. But that is a very small piece of the torment and emotional anguish that has gotten me to this point. The darkest and deepest fracture of this type of injury occurs far after the trauma itself. It grows with every painful moment, every situation that leaves you feeling defeated, and every morning that you wake up when you hoped that you wouldn’t. Unlike some other categories of psychological struggles, this one seems to be dismissed to make room for its sister diagnoses: Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders, etc. It is difficult to explain to everyone you meet that you are in the midst of a moral crisis that questions your very values, so it always falls back on the old PTSD. Easier to explain, no one questions it, they thank you for your service, and they might pitch a couple hundred bucks at a charity for veterans. Simple, easy, and no need to get into anything emotional or existential that make other people uncomfortable.

After I was diagnosed with (pretty obvious) PTSD, I left the military, and pursued another career choice: Social Work. I would spend the next few years taking the same meds every day, trying to find ways to cope with an incredibly dark and very present sense of shame. Not just guilt. Guilt visited on occasion, but this is very different. As we all are learning (Seriously thankful for Brene Brown), shame is a totally different animal.  I would sit through my social work classes, look around at other students, and think to myself, “Something must be wrong with me. Learning about all this social work-y stuff is making me feel like a hypocrite”.  It wasn’t until I had almost hit what I would say, the last few branches before a pretty devastating fall, that I learned about moral trauma. And just in time.

My vision for this book is to take you through a reconstruction of my moral identity. This doesn’t necessarily mean that all parts of my morality are going to be ripped apart, demolished, and built up brand new. Hopefully, some things can stay, because they are good, healthy, and just need to be noticed, shined up, and given a little attention. However, others may need to be set on fire with gasoline and burned to the ground. But my hope is that others out there, like me, that have been treated for PTSD exclusively and feel that there is a very substantial struggle that never is alleviated, that we can find a new sense of self after a trauma to our identity.

Please don’t stop reading because you were diagnosed with PTSD that is not due to combat. You will find that we all have similar struggles regardless of the source of our trauma, and I do not consider my personal experience of trauma to be the worst, the most relatable, or the most damaging. However, I do consider my trauma to be substantial enough to take you on this journey with me. I think that often, while we each experience various traumatic moments in our lives, I believe that there is power in sharing our story for the collective purpose of society. I want to empower others to reconstruct their own moral identity and realize that we are more powerful in our vulnerability and transparency. I hope that we can recognize that we can create and re-create ourselves, and that we are not confined to our historical idea of who we are.