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
Katherine Williams is a student of Social Work and Pubic Policy at Arizona State University. This website does not depict views of the ASU School of Social Work.
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